New research from UT Southwestern Medical Center indicates that adding cognitive behavioral therapy to medication improves the long-term success of treatment for children and adolescents diagnosed with depression.
A clinical trial conducted at UT Southwestern and Children’s Medical Center of Dallas revealed that the rates of depression relapses were substantially lower in the group who received both treatments, as opposed to the medication-only group.
“Continuation-phase strategies designed to reduce the high rates of relapse in depressed youths have important public health implications, as recurrence of depression is more likely in youths with multiple episodes,” said Dr. Betsy Kennard, Professor of Psychiatry at UT Southwestern and senior author of the study, which was published on June 17 in The American Journal of Psychiatry.
40 percent to 70 percent of youths with major depressive disorders typically relapse, said Dr. Kennard, who also serves as Suicide Prevention and Resilience at Children’s (SPARC) outpatient program Director at Children’s Medical Center.
Those who showed improvement following treatment with fluoxetine for an initial six-week treatment period remained in the study. They were split between medication-only and therapy plus medication groups. Study participants were aged 8-17.
This study addressed 75 youth who received behavioral therapy for six months after six weeks of initial treatment with the antidepressant fluoxetine, also known as Prozac. In this group, the relapse rate was nine percent. In the control group of 69 youth treated only with the drug during during the same period, the relapse rate was 26.5 percent.
“Unfortunately, medication alone is not always enough to prevent relapse,” said Dr. Graham Emslie, Chief of the Division of Adolescent and Child Psychiatry, Professor of Psychiatry and Pediatrics at UT Southwestern, and a contributing author of the study. “Identifying novel strategies to prevent future relapses for young people should be a priority. This approach is unique in that treatment was added at a time when the intensity of care is frequently decreasing.”
The type of therapy used in this trial is called Relapse Prevention Cognitive Behavioral Therapy. It consists of individual psychotherapy treatment with a family component focusing on reducing residual symptoms, increasing wellness behaviors, and preventing relapse. For six months, the youths in this arm of the trial participated in eight to eleven individually-tailored therapy sessions.
“It is also worth noting that youth who received the therapy had lower medication doses, yet had better outcomes than those on higher dosages in the medication management-only group,” said Dr. Kennard.
Dr. Emslie, who holds the Charles E. and Sarah M. Seay Chair in Child Psychiatry, and Dr. Kennard were co-principal investigators of this single-center clinical trial. The study was funded through a National Institute of Mental Health grant.
Taryn Mayes, a Faculty Associate in Psychiatry; Dr. Paul Nakonezny, Associate Professor of Clinical Science and Psychiatry; Jessica Jones, psychological associate in Psychiatry; Dr. Aleksandra Foxwell, Assistant Professor of Psychiatry; and Jessica King, a research assistant in Psychiatry were among other UT Southwestern researchers who contributed to this study.
Dr. Emslie’s research is supported by Eli Lilly, BioMarin, Somerset, Duke University, Forest Laboratories, Valeant, GlaxoSmithKline, and Mylan. She is a consultant for Allergan, Biobehavioral Diagnostics Company, Bristol-Myers Squibb, Eli Lilly, GlaxoSmithKline, INC Research, Lundbeck, Merck, Pfizer, Seaside Therapeutics, Shire, Texas Department of State Health Services, University of Miami, and Valeant; and she is on the speakers bureau for Forest Laboratories.