The latest news about children and depression (in the last month or so) is below. Older articles are on a different page, and older still articles are in the Archives. Click on the title of any article that interests you in the headlines below, which will take you to that article on a page of all the older articles summarized for you. Or just jump to the Articles page from the menu under News, then just scroll through the web page to review all of the articles. Same for the Archives page, which has old news articles that still might interest you and some of our older letters seeking help.
If you know of any interesting news about child depression or there are interesting political, legal or legislative developments in your local, state or the federal government, please e-mail the information to the Website Administrator for posting. webmaster@depressedchild.org. Older news can be found at our Archives page.
An NIMH-sponsored study of seriously depressed teens ages 12-18 -- over half of whom said they had considered suicide -- seems to confirm that a combination of drugs and therapy is better than drug treatment alone. Over half of those who did not respond to drug treatment improved when cognitive behavioral therapy (CBT) was added.
Previous trials have shown that SSRI antidepressants, the most common category prescribed for youth and adults, or CBT, or the combination, produces a favorable clinical response in up to 60 percent of treated adolescents. But this was reportedly the first study testing the impact of adding CBT to treatment of adolescents who were not properly responding to antidepressant drug treatment alone.
Unlike other trials of drug/therapy treatment, this trial included high-risk patients. Nearly 60 percent had expressed thoughts of suicide and had been diagnosed as depressed for an average of two years.
The test, which was reported in the February 27, 2008 Journal of the American Medical Association, initially involved 334 patients ages 12 to 18. About 86 percent of them completed 12 weeks of the treatment protocol. Eighty-two percent were white, 70 percent were femal and the median family income was $60,000.
About 55 percent (91 of 166) patients treated with both CBT and an antidepressant showed an “adequate” clinical response, compared with those treated with just antidepressants (47 percent, or 79 of 169), according to a summary of the report published in Psychiatric News. There were 18 suicide attempts but no successful suicides among the test group during the term of the study.
An unexpected additional finding from the study was that patients who used sleep medications had a poor response to treatment. “We don’t know if this was due to the hypnotic drugs themselves, or to drug-drug interactions, or to the underlying sleep problems,” the lead author of the study told Psychiatric News. “But it is important to pay attention to sleep difficulties when treating . . . depression.”
An abstract of the study can be found at The AMA Journal. A good summary can be found in The Psychiatric News. March 2008
Separate studies conclude that since the FDA pub “black box” warnings on SSRI antidepressants that they may increase suicidal thinking, doctors are prescribing the drugs for fewer kids but are not following another FDA recommendation that those receiving the drugs be monitored more frequently.
The fairly sharp decline in prescribing drugs for depressed children following the FDA warnings in 2004 has been documented on several occasions, most recently in a study reported in the January 2008 Archives of General Psychiatry. There was a substantial and continuing increase in prescriptions for children from the late 1980s until the FDA warnings, leading to concern that children were being “over drugged” for mental illnesses, including ADHD and depression. The latest study, based on sampling from a large pharmacy benefit management company’s database, showed that prescriptions for antidepressants for youth were growing at a 36 percent annualized rate early in this decade, but had fallen to a negative 9 percent after the FDA warnings. Other studies have shown greater declines.
Many physicians, including leaders in the mental health field, note that adolescent suicide rates declined while prescriptions grew and are worried the pendulum has swung too far against drugs. Others are more sanguine, although more recent reports suggest a renewed growth in the suicide rate among adolescents.
But it must be a good thing that fewer children are being put on antidepressants if it is important to increase monitoring them for suicidal thinking, because another recent study indicates that the medical profession has not increased monitoring at all. In fact, the frequency of repeat visits has declined. (See thumbnail chart. Double-click on it to make it bigger.) Trends in follow-up care for both children and adults was flat or declined, according to a study reported in AJP in Advance in November 2007. The study reviewed the files of more than 27,000 pediatric patients and 193,000 adult patients in a managed care claims database who received antidepressant medications.
Psychiatrists monitored their patients with visits more frequently than did pediatricians and primary care physicians. About 80 percent of psychiatric patients were deemed to have been seen sufficiently often for followup, but only 60 percent of the patients prescribed antidepressants by pediatricians and 54 percent of those seen by primary care physicians. But none of these rates, including for the psychiatrists, was significantly greater than before the FDA recommendation.
The bottom line: Once again, the evidence shows that you, the parent, have to be an advocate for your mentally ill child to be sure he or she gets the treatment they need.
An abstract of the study on declining prescriptions can be found at The Archives of General Psychiatry and a summary story at Psychiatric News. An abstract of the study of follow-up visits is here. You can find the Psychiatric News summary story here.