| NIMH is currently conducting a clinical research study to compare
the short- and long-term effectiveness of medication and psychotherapy
for major depression in teens. Called the Treatment for Adolescents
with Depression Study (TADS), this randomized controlled study looks
at the effectiveness of the medication fluoxetine (Prozacâ),
cognitive behavioral therapy (CBT), and their combination for adolescents
ages 12 to 17.
According to Dr. Elizabeth Weller, child and adolescent psychiatrist
and mood disorder expert from the Children's Hospital of Philadelphia,
we are just beginning to understand the extent of the problem. "Unfortunately,
parents and health professionals often do not recognize the signs
of depression in young people," says Dr. Weller. "Physicians
and families alike have a hard time differentiating between a depressive
disorder and normal mood swing typical of a particular development
stage. Also, as health care professionals, we are reluctant to prematurely
'label' a young person with a diagnosis of mental illness,"
Dr. Weller notes.
As a recognized expert in the field, Dr. Weller points out that
while the symptoms of depression in adolescents are the same as
in adults, teens may have trouble talking about how they feel. Instead,
they may withdraw, act out, or be irritable with others. Early depression
often persists, recurs, and continues into adulthood, and without
intervention, it often persists or reoccurs more severely in adulthood.
The current research tells the story behind Dr. Weller's statements.
About 4 percent of all teens suffer from major depression at any
one time (the recent Surgeon General's report on mental health puts
it as high as 8.3 percent), and girls are more likely than boys
to be affected. This illness is being recognized today earlier in
life than in past decades and has been associated with a number
of self-destructive behaviors. In 1999, the most recent year for
which statistics are available, suicide was the third leading cause
of death in 15- to 24-year-olds.
NIMH conducts study on adolescent depression
TADS is recruiting approximately 430 adolescents to participate
in treatments that have proven effective in many adults and adolescents.
The treatments are:
NAMI-TADS, pg. 2
· Fluoxetine (Prozacâ)-medication alone
· Placebo (sugar pill)-medication alone
· Cognitive behavior therapy (CBT)-talking with a therapist
but no medication
· Combination of both fluoxetine and CBT
The entire study will run about 21 months. During this time, the
adolescent will receive up to 9 months of treatment, depending on
results. After treatment, the adolescent will be followed for an
additional year to evaluate the long-term benefits. A parent or
family member will be asked to attend some
of the visits.
Participants who are on placebo or who don't respond during the
first 12 weeks will have a choice among the three other treatment
options.
Why study CBT and SSRIs?
According to NIMH, there is a pressing need for additional research
on psychological and pharmacological treatments for depression in
youth, as the value of such treatments have not yet been determined.
Recent studies, however, have shown that CBT can help relieve depression
in children and adolescents-one NIMH-funded study found that CBT
resulted in a more rapid treatment response and led to remission
in nearly 65 percent of cases, a higher rate than either supportive
therapy or family therapy.
Physicians have also been reluctant to prescribe psychotropic medications
for young people because of the lack of information about the safety
and efficacy of these drugs in youth. Research on selective serotonin
reuptake inhibitors (SSRIs) such as fluoxetine has shown them to
be effective in treating depression in young people.
Where and by whom is this study being conducted?
The study is being conducted in Baltimore, Charlotte (NC), Chicago,
Cleveland, Cincinnati, Dallas, Eugene (OR), New York City, Omaha
(NE), Philadelphia, and Warren (MI). The principal investigator
for the TADS study, John March, M.D., M.P.H., is a professor of
psychiatry and director of the Programs in Child and Adolescent
Anxiety Disorders and Developmental Psychopharmacology at Duke University
Medical Center in Charlotte.
Dr. Weller, quoted above, is the principal investigator at CHOP
in Philadelphia. "This study will give us vital information
about the best ways to treat depression in young people," said
the Children's Hospital expert. "It has enormous potential
to provide essential information for all of us," Dr. Weller
said.
As an NIMH outreach partner, we are helping to promote participation
in TADS. As mentioned above, the study is for adolescents ages 12
to 17, inclusive, in grades 6 to 12. In general, study candidates
are adolescents who have:
· Primary DSM-IV diagnosis of major depressive disorder,
pervasive and stable
· Parent (or family member) participation
· A Children's Depression Rating Scale-R total score of at
least 45
· A full-scale IQ of at least 80
· No medication prescriptions before start of the study
Adolescents who cannot join the study include those who suffer
from bipolar disorder or severe conduct disorder, have a substance
abuse problem, have pervasive developmental disorders, are suicidal
or homicidal, or are concurrently being treated with psychotherapy
with a psychotropic drug outside of the study (though a stable stimulant
for ADHD is permitted).
Adolescents from the NAMI PA area who are eligible for the study
will most likely be treated at the Children's Hospital of Philadelphia.
If you would like the complete inclusion/exclusion criteria for
the study, or need more information and materials on TADS, you can
go to their Web site at http://www.nimh.nih.gov/studies/tads.cfm
or call toll free, 1-866-458-7425 (1-866-45-TRIAL).
For assistance or more information please contact the NAMI PA office
at 800-223-0500 or 717-238-1514 or email us at nami-pa@nami.org
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