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New study challenges NICE guidelines on adolescent depression
July 20, 2007Selective serotonin reuptake inhibitors and routine specialist care with and without cognitive behaviour therapy in adolescents with major depression: randomised controlled trial
Should adolescents with depression be prescribed antidepressants, and if so, should they be given only with a psychological therapy, as advocated by the National Institute for Health and Clinical Excellence (NICE)"
A study published on bmj.com last month found that adding cognitive behaviour therapy (CBT) to selective serotonin reuptake inhibitor (SSRI) treatment is unlikely to improve outcomes for adolescents with moderate to severe depression.
These findings challenge current NICE guidelines that recommend SSRIs be prescribed only in conjunction with psychological therapies.
In an editorial in this week's BMJ, a child psychiatry expert reviews the evidence and explains what this means for clinicians managing adolescents with depression.
This is the fourth study to assess the combination of SSRI and cognitive behaviour therapy over monotherapy for depression in adolescents, writes Professor Philip Hazell from the University of Sydney.
A US study published in 2004 found that the combination of fluoxetine and cognitive behaviour therapy was better than fluoxetine or behaviour therapy alone in reducing depressive symptoms.
However, a more recent trial in 2006 found no advantage of sertraline plus cognitive behaviour therapy over monotherapy. A third trial published in 2005 also found that the addition of cognitive behaviour therapy to SSRIs had no significant effect on symptoms of depression.
The results of the BMJ trial suggest a further trend away from the positive findings of the US trial, says Professor Hazell. Differences in the dose and duration of treatment may have contributed to some variation, but the data suggest that combining cognitive behaviour therapy with an SSRI has only a modest advantage over an SSRI alone.
Combining cognitive behaviour therapy with and SSRI may have other advantages, such as reducing suicidal thoughts and prolonging the benefit of treatment, he says, but evidence for this across the four trials is equivocal.
So what does this mean for clinicians managing adolescents with depression, he asks"
Contrary to NICE guidelines, evidence suggests that monotherapy with an SSRI is a reasonable treatment option for moderate to severe depression in adolescents, particularly if access to cognitive behaviour therapy may be delayed, he writes.
He adds that trial participants received a high level of clinical care, with frequent clinical reviews and rigorous monitoring of the benefit of treatment and adverse events. The implication for clinical practice is that good quality drug treatment involves more than simply writing the prescription, he concludes.
BMJ-British Medical Journal
These findings challenge current NICE guidelines that recommend SSRIs be prescribed only in conjunction with psychological therapies.
In an editorial in this week's BMJ, a child psychiatry expert reviews the evidence and explains what this means for clinicians managing adolescents with depression.
This is the fourth study to assess the combination of SSRI and cognitive behaviour therapy over monotherapy for depression in adolescents, writes Professor Philip Hazell from the University of Sydney.
A US study published in 2004 found that the combination of fluoxetine and cognitive behaviour therapy was better than fluoxetine or behaviour therapy alone in reducing depressive symptoms.
However, a more recent trial in 2006 found no advantage of sertraline plus cognitive behaviour therapy over monotherapy. A third trial published in 2005 also found that the addition of cognitive behaviour therapy to SSRIs had no significant effect on symptoms of depression.
The results of the BMJ trial suggest a further trend away from the positive findings of the US trial, says Professor Hazell. Differences in the dose and duration of treatment may have contributed to some variation, but the data suggest that combining cognitive behaviour therapy with an SSRI has only a modest advantage over an SSRI alone.
Combining cognitive behaviour therapy with and SSRI may have other advantages, such as reducing suicidal thoughts and prolonging the benefit of treatment, he says, but evidence for this across the four trials is equivocal.
So what does this mean for clinicians managing adolescents with depression, he asks"
Contrary to NICE guidelines, evidence suggests that monotherapy with an SSRI is a reasonable treatment option for moderate to severe depression in adolescents, particularly if access to cognitive behaviour therapy may be delayed, he writes.
He adds that trial participants received a high level of clinical care, with frequent clinical reviews and rigorous monitoring of the benefit of treatment and adverse events. The implication for clinical practice is that good quality drug treatment involves more than simply writing the prescription, he concludes.
BMJ-British Medical Journal
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Cognitive therapy is an effective treatment for post-traumatic stress disorder related to acts of terrorism and other civil conflict, finds a study published on bmj.com today.
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Costs of antidepressants could have funded effective alternatives
Some of the costs of prescribing antidepressant drugs over the last decade could have been used to deliver psychological treatments of proven effectiveness, finds a study published online by the BMJ today.
Cognitive Behaviour Therapy Is At Least As Good As Antidepressant Drugs In Generalized Anxiety Disorder
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Patients who suffer from chronic fatigue have poor social support
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Stop being scared of school
A novel technique, being applied in education for the first time, is helping children with complex needs to become less scared of school. Dr Anne Greig and Dr Tommy Mackay of the Argyll & Bute Psychological Service and the University of Strathclyde have developed a psychological intervention to help young people with Asperger Syndrome (a type of social communication disorder) to cope better with school and avoid anxiety and depression. They explained the approach today, Thursday 8 January 2004, at the British Psychological Society's Division of Educational and Child Psychology Annual Conference in Paris. The technique is based on cognitive behaviour therapy and works by helping students to
Anti-epileptic Drug Could Be Future Treatment Option For Alcoholism (pp 1666, 1677)
Authors of a US study in this week's issue of THE LANCET provide evidence that the anti-epileptic drug topiramate could be an effective future treatment for alcohol dependence. Bankole A Johnson from the University of Texas Health Science Center at San Antonio, USA, and colleagues randomly allocated 150 heavy drinkers (defined as 5 alcoholic drinks per day for men, four for women) to receive either topiramate or placebo for three months in addition to standard behaviour therapy. People in the group receiving topiramate were drinking around three fewer drinks per day than those in the placebo group after three months follow-up. Topiramate therapy resulted in around a quarter fewer heavy drin
Concern Over Misclassification And Inappropriate Treatment Of People With Eating Disorders (p 407)
Authors of a seminar in this week's issue of THE LANCET provide an insight into our knowledge and treatment of eating disorders. They note how the current way of classifying eating disorders neglects the majority of people with eating disorders with the result that these cases have barely been studied and almost nothing is known about their treatment. Eating disorders are an important cause of physical and psychosocial illness in adolescent girls and young adult women and are much less frequent in men.They are divided into three diagnostic categories: anorexia nervosa (characterised by severe self-induced weight loss), bulimia nervosa (characterised by alternating dieting and binge eating),
GPs need more training to help patients with depression
General practitioners may require more extensive training and support to acquire skills to help patients with depression, finds a study in this week’s BMJ.
Family therapy helps get young ME sufferers back to school
Family therapy seems to help get young sufferers of chronic fatigue syndrome (ME) back to school, suggests research in the Archives of Disease in Childhood. ME is characterised by physical and mental fatigue. In children, symptoms include muscle pain, headache, sore throat and sleepiness. And specialist treatment often requires long periods away from school and leisure activities, and jeopardises friendships. Twenty three people with chronic fatigue syndrome, only three of whom were boys, were enrolled in a programme of cognitive behaviour therapy (CBT) with their families. Their average age was 15. Most of the sufferers had had symptoms for around two years, and most attributed the start o
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