Depressed teens recover but half relapse

Almost all severely depressed adolescents recover with treatment, but about half suffer another crisis within five years.

That’s the good news-bad news from a federally-funded study that included researchers from Children’s Hospital of Philadelphia and nine other medical centers.

Previous studies have also found high recovery and relapse rates. In many ways, the new research, published Monday online in Archives of General Psychiatry, confirms the perplexing nature of teenage depression, and the limited effectiveness of current treatments.

The researchers started with 439 teens who had been diagnosed with a “major depressive disorder” marked by thoughts of suicide, hopelessness, irrational thinking, and other symptoms.

The teens were randomly assigned to one of four treatments: the anti-depressant Prozac; a type of talk therapy called cognitive behavioral therapy; a combination of Prozac and cognitive therapy; or a placebo. At 12 weeks, teens on placebo switched to the treatment of their choice, then the therapies continued for 24 more weeks.

 The researchers hypothesized that teens whose symptoms improved at week 12 — especially on the Prozac-cognitive therapy, which was presumed to be most effective — would be most likely to recover completely within 2 yrs, and not relapse over 3.5 years of follow-up.

But it didn’t turn out that way. First, only 196 — fewer than half of the original group — continued after the first year because many were going off to college or jobs. 

Second, while 189 (96 percent) of them recovered from their initial depression, 88 (46 percent) had at least one more depressive episode during the longterm follow-up.

And third, the outcomes defied prediction. Recovery was not more likely with any particular treatment (even placebo worked) or characteristics such as ethnicity or family income.

Females were more likely to relapse than males, but contrary to the hypothesis, the recurrence rate was not lower for teens with good responses to short-term treatment.

“Recurrence prevention effors, such as symptoms or medication monitoring or \[cognitive therapy\] booster sessions, may be of value,” the researchers concluded.

— Marie McCullough

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