Greetings NAMI leaders, members, and friends,
Yesterday, the Journal of the American Medical Association (JAMA) published the results of the Treatment of SSRI-resistant Depresssion in Adolescents (TORDIA) trial -- a large, multi-site trial funded by NIMH.
The research found that teens with difficult-to-treat depression who do not respond to a first antidepressant medication are more likely to get well if they switch to another antidepressant medication and add psychotherapy rather than just switching to another antidepressant medication.
The teens in the study all had major depression and had not responded to a previous two-month course of medication with a selective serotonin reuptake inhibitor (SSRI), a type of antidepressant medication. In the study, the teens were randomly assigned to one of the following four intervention groups for 12 weeks:
Group switched to another SSRI medication —paroxetine (Paxil), citalopram (Celexa) or fluoxetine (Prozac)
Group switched to a different SSRI medication plus cognitive behavioral therapy (CBT) was added (CBT is a type of psychotherapy that emphasizes problem-solving and behavior change)
Group switched to venlafaxine (Effexor)—another type of antidepressant medication called a serotonin and norepinephrine reuptake inhibitor (SNRI)
Group switched to venlafaxine medication and CBT was added to the treatment
The results showed that about 55% of those who switched to either another SSRI or an SNRI and added CBT responded to the treatment, while 41% of those who switched to another medication alone responded to the treatment. There were no differences in response to treatment between those who switched to an SSRI medication and those who switched to an SNRI medication, nor were there differences in response among the three SSRIs tested.
Although none of the medications seemed to be superior over the others, venlafaxine (SNRI) was associated with more adverse effects, such as skin infections and cardiovascular side effects. The researchers concluded that because venlafaxine had a greater potential for side effects, switching to another SSRI medication should be considered first.
The findings, showing that the best results came with switching to another medication and adding CBT psychotherapy, echo those of the NIMH-funded Treatment for Adolescents with Depression Study (TADS), which concluded that teens with major depression benefited most from a combination of medication and psychotherapy over both the short and long terms. They are also consistent with results from the NIMH-funded Systematic Treatment Alternatives to Relieve Depression (STAR *D) study, which showed that adults with persistent depression can get well after trying several treatment strategies.
If you would like to learn more about the Treatment of SSRI-resistant Depression in Adolescents (TORDIA) trial, you can click on the link below to the NIMH announcement about the published study results.
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