Medications

Emslie et al. (1997) were the first to demonstrate that an antidepressant medication (fluoxetine) was superior to placebo in the treatment of childhood and adolescent MDD. Later studies suggest that other selective serotonin reuptake inhibitors (SSRIs) might be efficacious in treating depression among youth (Whittington et al., 2004). A comprehensive discussion of antidepressant medications for adolescent MDD is beyond the scope of this chapter. However, it is important to note that the combination of fluoxetine and CBT was the most effective treatment for the moderately to severely depressed adolescents in the TADS study (TADS Team, 2004). Therefore, we generally recommend such a combination treatment for teens with this level of depressive severity. There remains the possibility that CBT alone may be efficacious for moderately to severely depressed adolescents, if conducted over more than a 12-week period, or in a manner that differs from the TADS acute treatment model.

Concerns have been raised during recent years about the safety of SSRIs for treating depressed youth. Although the absolute risk is low, there is evidence of treatment-emergent suicidal ideation and behavior among children and adolescents treated with these medications relative to youth receiving pill placebo (Hammad, Laughren, & Racoosin, 2006). Although results of TADS study confirmed that during acute treatment there is a statistically nonsignificant increase in the rate of suicidal ideation among youth receiving fluoxetine relative to those receiving placebo, it is important to note that the occurrence of suicidal ideations declined among youth receiving each of the active treatments. Moreover, findings from the TADS study suggest that the attendant risk of suicidal ideations that accompanies the use of SSRIs may be mitigated by the concomitant use of CBT (TADS Team, 2004). CBT, either alone or in combination with fluoxetine, appears to reduce suicidal ideations and behavior among adolescents. CBT may accomplish this by bolstering adolescents' ability to cope with stressful life events, providing them with adaptive skills for managing negative moods, and reducing behavioral impulsivity. However, the combination of CBT and fluoxetine did not negate the risk of serious suicidality in TADS. Therefore, it is necessary that clinicians working with young people who have been prescribed SSRIs monitor carefully for suicidality, even when the medication is combined with CBT.

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