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Drug Switch Tied to Depression Remission at Six Months

Continued treatment linked to remission in over a third of teens with treatment-resistant depression

WEDNESDAY, May 26 (HealthDay News) -- More than one-third of adolescents with treatment-resistant depression may achieve remission within six months after simply switching their medication or undergoing cognitive behavioral therapy along with a medication switch, and those who show symptom benefits early after switching are more likely to have lasting benefits, according to a study published online May 17 in the American Journal of Psychiatry.

In the Treatment of Resistant Depression in Adolescents trial, Graham J. Emslie, M.D., of the University of Texas Southwestern Medical Center in Dallas, and colleagues randomized 334 adolescents, aged 12 to 18 years, with selective serotonin reuptake inhibitor (SSRI)-resistant depression to either a drug switch alone (alternative SSRI or venlafaxine) or drug switch and cognitive-behavioral therapy.

At 24 weeks, the researchers found that 38.9 percent of adolescents had achieved remission, with those already demonstrating a clinical response by week 12 experiencing a higher likelihood of remission (61.6 versus 18.3 percent) and a faster time to remission. Remission was higher among those who had lower baseline depression, hopelessness and self-reported anxiety. In addition, lower depression, hopelessness, suicidal ideation and family conflict, as well as absence of comorbid dysthymia, anxiety, and drug/alcohol use and impairment at week 12 were predictors of remission. Of those who responded by week 12, 19.6 percent relapsed by week 24.

"These findings suggest that current clinical guidelines, which recommend pursuing a given treatment strategy for at least eight to 12 weeks, may need to be revisited," the authors write. "Instead, our data support more vigorous intervention earlier in the course of treatment for nonresponding patients."

Multiple authors disclosed financial ties to various pharmaceutical companies.

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