Behavior therapy plus medication may help teens with depression and substance use disorders

November 05, 2007

The antidepressant fluoxetine combined with cognitive behavioral therapy appears as effective for treating depression among teens who also have substance use disorders as among those without substance abuse problems, according to a report in the November issue of Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals.

"Adolescents with substance use disorders (SUDs) have higher rates of depression (15 percent to 24 percent) than adolescents in the general population," the authors write as background information in the article. "Comorbid [co-occuring] depression is also associated with more severe substance abuse, poorer drug treatment outcomes and higher relapse rates."

Paula D. Riggs, M.D., and colleagues at the University of Colorado Denver conducted a randomized controlled trial of the antidepressant fluoxetine in 126 teens (average age 17) who met diagnostic criteria for major depressive disorder, lifetime conduct disorder and at least one substance abuse disorder other than tobacco. The adolescents were randomly assigned to receive either 20 milligrams of fluoxetine daily or placebo, along with cognitive behavioral therapy, a type of psychotherapy addressing the way individuals currently think and act rather than past events. The cognitive behavior therapy was focused on substance abuse rather than depression.

At the end of the 16-week treatment period, fluoxetine combined with cognitive behavioral therapy improved the teens' scores on one of the two depression scales used. There were no significant differences on the other depression scale or in substance use or conduct disorder symptoms between the fluoxetine and placebo groups.

The results, the authors write, "indicate that, in the context of cognitive behavior therapy (substance abuse treatment), co-occurring depression may improve or remit without antidepressant pharmacotherapy. However, if depression does not appear to be improving early in the course of substance treatment, fluoxetine treatment should be considered, even if adolescents are not yet abstinent, with weekly monitoring of treatment adherence, substance use, adverse effects and target symptom response."
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(Arch Pediatr Adolesc Med. 2007;161(11):1026-1034. Available pre-embargo to the media at www.jamamedia.org.)

Editor's Note: This study was supported by a grant from the National Institute on Drug Abuse, National Institutes of Health. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

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