Changing to a new drug and adding psychotherapy may help teenagers with depression that does not respond to initial treatment with a selective serotonin reuptake inhibitor (SSRI), according to an article in the February 27 issue of the Journal of the American Medical Association.

Clinical guidelines for the treatment of adolescent depression recommend the prescribing of a selective serotonin reuptake inhibitor, 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 the interventions.

David Brent, MD, of the University of Pittsburgh, and colleagues examined the relative efficacy of medication type, cognitive behavioral therapy, and the combination of both for treatment of resistant depression in adolescents.

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 a selective serotonin reuptake inhibitor.

For 12 weeks, participants were randomized to one of four treatments: switch to paroxetine, citalopram, or fluoxetine; switch to one of the three drugs plus cognitive behavioral therapy; switch to venlafaxine; or switch to venlafaxine plus cognitive behavioral therapy.

"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 cognitive behavioral therapy and another antidepressant resulted in a higher rate of clinical response [54.8 percent] than switching to another medication without cognitive behavioral therapy [40.5 percent]. There was no differential effect between switching to another SSRI [47.0 percent] or to venlafaxine [48.2 percent]," the authors wrote.

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 with venlafaxine than with the SSRIs.

"... 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 concluded.