 |
|
Switching medications, adding psychotherapy may help teens with ineffective depression medication
February 27, 2008For adolescents with depression not responding to an initial treatment with a selective serotonin reuptake inhibitor (SSRI; a class of antidepressant drugs), switching medications and adding cognitive behavioral therapy resulted in an improvement in symptoms, compared to just changing medications, according to a study in the February 27 issue of JAMA.
Adolescent depression is a common, chronic, recurrent and impairing condition. "Untreated depression results in impairment in school, interpersonal relationships, occupational adjustment, and increases the risk for suicidal behavior and completed suicide. Therefore, the proper treatment of adolescent depression has profound public health implications for youth in this critical stage of development," the researchers write.
Clinical guidelines for the treatment of adolescent depression recommend the prescribing of SSRI medications, psychotherapy, or both. While these treatments alone or in combination have been shown to be effective, at least 40 percent of adolescents with depression do not show an adequate clinical response to these interventions.
David Brent, M.D., of the University of Pittsburgh, and colleagues examined the relative efficacy of medication type, cognitive behavioral therapy (CBT), and the combination of both for the treatment of resistant adolescent depression. The randomized controlled trial, conducted from 2000-2006, included 334 patients, age 12 to 18 years, with a primary diagnosis of major depressive disorder who had not responded to a two-month initial treatment with an SSRI. For 12 weeks, participants were randomized to one of four treatments: switch to a second, different SSRI (paroxetine, citalopram, or fluoxetine); switch to a different SSRI plus CBT; switch to venlafaxine (a selective serotonin and noradrenergic reuptake inhibitor [SNRI], an antidepressant shown in some studies to be superior to an SSRI in the management of treatment-resistant adult depression); switch to venlafaxine plus CBT.
"In this study of adolescents with moderately severe and chronic depression who had not responded to an adequate course of treatment with an SSRI antidepressant, switching to a combination of CBT and another antidepressant resulted in a higher rate of clinical response [54.8 percent] than switching to another medication without CBT [40.5 percent]. There was no differential effect between switching to another SSRI [47.0 percent] or to venlafaxine [48.2 percent]," the authors write.
There were also no differential treatment effects on change in self-rated depressive symptoms, suicidal ideation, or on the rate of harm-related or other adverse events. There was a greater increase in diastolic blood pressure and pulse and more frequent occurrence of skin problems during venlafaxine than SSRI treatment.
"- the clinician should convey hope to the adolescent with depression and his or her family that, despite a first unsuccessful treatment for depression, persistence with additional appropriate interventions can result in substantial clinical improvement," the researchers conclude.
JAMA and Archives Journals
David Brent, M.D., of the University of Pittsburgh, and colleagues examined the relative efficacy of medication type, cognitive behavioral therapy (CBT), and the combination of both for the treatment of resistant adolescent depression. The randomized controlled trial, conducted from 2000-2006, included 334 patients, age 12 to 18 years, with a primary diagnosis of major depressive disorder who had not responded to a two-month initial treatment with an SSRI. For 12 weeks, participants were randomized to one of four treatments: switch to a second, different SSRI (paroxetine, citalopram, or fluoxetine); switch to a different SSRI plus CBT; switch to venlafaxine (a selective serotonin and noradrenergic reuptake inhibitor [SNRI], an antidepressant shown in some studies to be superior to an SSRI in the management of treatment-resistant adult depression); switch to venlafaxine plus CBT.
"In this study of adolescents with moderately severe and chronic depression who had not responded to an adequate course of treatment with an SSRI antidepressant, switching to a combination of CBT and another antidepressant resulted in a higher rate of clinical response [54.8 percent] than switching to another medication without CBT [40.5 percent]. There was no differential effect between switching to another SSRI [47.0 percent] or to venlafaxine [48.2 percent]," the authors write.
There were also no differential treatment effects on change in self-rated depressive symptoms, suicidal ideation, or on the rate of harm-related or other adverse events. There was a greater increase in diastolic blood pressure and pulse and more frequent occurrence of skin problems during venlafaxine than SSRI treatment.
"- the clinician should convey hope to the adolescent with depression and his or her family that, despite a first unsuccessful treatment for depression, persistence with additional appropriate interventions can result in substantial clinical improvement," the researchers conclude.
JAMA and Archives Journals
Psychotherapy Current Events and Psychotherapy News RSSNew therapy gives hope for very severe depression
Thanks to a new method there is a reason for hope for patients with very severe depression. Physicians at the University Clinics of Bonn and Cologne have treated ten patients with deep brain stimulation.
Making connections the key to overcoming shame
Shame is a common reaction when someone feels that they have fallen below social norms or their own standards.
Mothers with postpartum depression with suicidal thoughts and their infant interactions
The joys of motherhood for many women can also lead other new moms to experience postpartum depression and even worse - ideas for committing suicide.
If bipolar disorder is over-diagnosed, what are the actual diagnoses?
A year ago, a study by Rhode Island Hospital and Brown University researchers reported that fewer than half the patients previously diagnosed with bipolar disorder received an actual diagnosis of bipolar disorder after using a comprehensive, psychiatric diagnostic interview tool --the Structured Clinical Interview for DSM-IV (SCID).
Map of your brain may reveal early mental illness
John Csernansky wants to take your measurements. Not the circumference of your chest, waist and hips. No, this doctor wants to stretch a tape measure around your hippocampus, thalamus and prefrontal cortex.
Care Management Reduces Depression and Suicidal Thoughts in Older Primary Care Patients
Depression in older adults too often goes unrecognized and untreated, resulting in untold misery, worsening of medical illness, and early death. A new study has identified one important remedy: Adding a trained depression care manager to primary care practices can increase the number of patients receiving treatment, lead to a higher remission rate of depression, and reduce suicidal thoughts.
Online cognitive behavioral therapy is effective in treating chronic insomnia
A study in the June 1 issue of the journal SLEEP demonstrates that online cognitive behavioral therapy (CBT) for chronic insomnia significantly improves insomnia severity, daytime fatigue, and sleep quality.
A genetic link to premature ejaculation
Premature ejaculation can be embarrassing, but a new study suggests that it might be a genetic disorder.
Understanding the therapeutic process of mother-infant psychotherapy
Psychotherapists who treat mothers suffering from postpartum depression and other mood disorders with their infants have developed a proven process that contributes to a greater positive experience with immediate insights for the mothers to develop healthy connections between their maternal experiences and their infants' behaviors.
Understanding mental illness through gene-environment interactions
Biological Psychiatry, published by Elsevier, is very pleased to present a special section of its February 1st issue devoted to fundamental new insights into epigenetics, a field of research devoted to understanding how the environment can produce long-lasting or even heritable changes in gene function without altering the DNA sequence.
More Psychotherapy Current Events and Psychotherapy News Articles
 |
Doing Psychotherapy by Michael Franz Basch (Author) Here is a practical guide to doing psychotherapy which, unlike most other manuals that present an idealized view of the therapist-patient relationship, shows what the therapeutic encounter is really like. Using detailed excerpts from clinical protocals, Basch draws the reader into the therapeutic dialogue as a way of experiencing what actually happens in the course of treatment with cases of varying complexity. Notes and Index. |
 |
Theory and Practice of Counseling and Psychotherapy by Gerald Corey (Author) Develop your own counseling style using Corey's bestselling THEORY AND PRACTICE OF COUNSELING AND PSYCHOTHERAPY. You will see the major theories of counseling (psychoanalytic, Adlerian, existential, person-centered, Gestalt, reality, behavior, cognitive-behavior, family systems, feminist and, and postmodern approaches) as they are used in practice through a case study focused on one client, "Stan." The case of "Stan" appears in each chapter so you can see how the theory presented in that chapter informs therapeutic decision-making. "At a Glance" charts pinpoint the major differences between theories in areas such as multicultural focus, basic philosophies, and limitations. |
 |
Attachment in Psychotherapy by David J. Wallin PhD (Author) This eloquent book translates attachment theory and research into an innovative framework that grounds adult psychotherapy in the facts of childhood development. Advancing a model of treatment as transformation through relationship, the author integrates attachment theory with neuroscience, trauma studies, relational psychotherapy, and the psychology of mindfulness. Vivid case material illustrates how therapists can tailor interventions to fit the attachment needs of their patients, thus helping them to generate the internalized secure base for which their early relationships provided no foundation. Demonstrating the clinical uses of a focus on nonverbal interaction, the book describes powerful techniques for working with the emotional responses and bodily experiences of patient and... |
 |
The Neuroscience of Psychotherapy: Building and Rebuilding the Human Brain by Louis Cozolino (Author) Proposing a reconciliation between neuroscience and psychotherapy. Many forms of psychotherapy, developed in the absence of any understanding of the brain, are now supported by neuroscientific findings. This book argues that the brain is an organ of adaptation, built by interpersonal experiences and capable of change during one's life. Written for anyone interested in the relationship between brain and behavior, it encourages us to consider the brain when attempting to understand others and ourselves. |
 |
Resolving Therapeutic Impasses This two DVD set demonstrates principles for resolving difficult therapeutic impasses that can lead to treatment failure. Jeremy Safran and Chris Muran provide a systematic framework to guide therapists in dealing with such impasses. The DVDs serve as a valuable companion to the authors' influential book: "Negotiating the Therapeutic Alliance: A Relational Training Guide", and also stand alone as an invaluable training tool. They demonstrate relevant techniques with hostile, withdrawn and compliant clients. Clinical vignettes are accompanied by illuminating commentaries to maximize the learning experience. The first DVD illustrates basic principles of therapeutic metacommunication as a tool for collaboratively exploring and working through vicious cycles that are being enacted in the... |
 |
The Complete Adult Psychotherapy Treatment Planner (PracticePlanners®) by Arthur E. Jongsma Jr. (Author), L. Mark Peterson (Author), Timothy J. Bruce (Editor) The Complete Adult Psychotherapy Treatment Planner, Fourth Edition provides all the elements necessary to quickly and easily develop formal treatment plans that satisfy the demands of HMOs, managed care companies, third-party payors, and state and federal agencies. New edition features: Empirically supported, evidence-based treatment interventions Organized around 43 main presenting problems, including anger management, chemical dependence, depression, financial stress, low self-esteem, and Obsessive-Compulsive Disorder Over 1,000 prewritten treatment goals, objectives, and interventions - plus space to record your own treatment plan options Easy-to-use reference format helps locate treatment plan components by behavioral problem Designed... |
 |
Current Psychotherapies by Raymond J. Corsini (Author), Danny Wedding (Author) Used in top counseling, psychology, and social work programs, CURRENT PSYCHOTHERAPIES is the ideal resource to not only help you excel in the course, but also to learn, compare, and apply the major systems of psychotherapy in a way that will be meaningful in your own practice. Each contributor is either an originator or a leading proponent of one of the systems, and each presents the basic principles of the system in a clear and straightforward manner, discussing it in the context of the other systems. Theory chapters include a case example that guides you through the problem, evaluation, treatment, and follow-up process. Accompanying CURRENT PSYCHOTHERAPIES is CASE STUDIES IN PSYCHOTHERAPY, each case demonstrates the basic techniques and methods of the theory being illustrated. This... |
 |
Becoming a Therapist: What Do I Say, and Why? by Suzanne Bender (Author), Edward Messner MD (Author) This book provides students and novice clinicians with nuts-and-bolts advice about the process of doing therapy, starting with the first contact with a new patient. Suzanne Bender, a junior clinician, and Edward Messner, a seasoned practitioner and supervisor, provide a unique, combined perspective on how therapy is conducted, what works and what doesn't work in treatment, and how to take care of oneself as a clinician. Organized around the treatment of one fictitious patient, with other case examples brought in as needed, the book speaks directly to the questions, concerns, and insecurities that beginning therapists typically face. Written with candor and empathy, it offers authoritative guidance for understanding and resolving common clinical dilemmas. |
 |
Psychoanalytic Psychotherapy: A Practitioner's Guide by Nancy McWilliams (Author) Building on the enormous popularity of her two previous texts on diagnosis and case formulation, this important work from Nancy McWilliams completes the trilogy by addressing in detail the art and science of psychodynamic treatment. McWilliams distills the essential principles of clinical practice, including effective listening and talking; transference and countertransference; emotional safety; and an empathic, attuned attitude toward the patient. The author describes the values, assumptions, and clinical and research findings that guide the psychoanalytic enterprise, and shows how to integrate elements of other theoretical perspectives when necessary. She also discusses the phases of treatment and covers such neglected topics as educating the client about the therapeutic process,... |
 |
Mindfulness and Psychotherapy by Christopher K. Germer PhD (Editor), Ronald D. Siegel PsyD (Editor), Paul R. Fulton EdD (Editor) Responding to growing interest among psychotherapists of all theoretical orientations, this practical book provides a comprehensive introduction to mindfulness and its clinical applications. The authors, who have been practicing both mindfulness and psychotherapy for decades, present a range of clear-cut procedures for implementing mindfulness techniques and teaching them to patients experiencing depression, anxiety, chronic pain, and other problems. Also addressed are ways that mindfulness practices can increase acceptance and empathy in the therapeutic relationship. The book reviews the philosophical underpinnings of mindfulness and presents compelling empirical findings. User-friendly features include illustrative case examples, practice exercises, and resource... |
| © 2009 BrightSurf.com |