Feature Story

November 5, 2007

Landmark Study Finds Behavior Therapy Plus Medication May Help Teens With Depression and Substance Use Disorders

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New research from the University of Colorado Denver School of Medicine has found that a common antidepressant is showing promising success when combined with cognitive behavior therapy to treat adolescents with depression and substance use disorders.

The landmark study titled "A Randomized Control Trial of Fluoxetine and Cognitive Behavioral Therapy in Adolescents with Major Depression, Behavior Problems and Substance Use Disorders" is the first randomized controlled trial of combined pharmacotherapy for depression and behavioral intervention for substance use disorders in adolescents.

Research has shown that depression among adolescents with substance use disorders is three to four times greater than in adolescents without substance abuse and is associated with more severe substance abuse, poorer treatment outcomes and higher relapse rates.

To bridge this clinical and research gap, Paula Riggs, MD, and colleagues at the UC Denver School of Medicine conducted a 16-week randomized controlled trial of the antidepressant fluoxetine in 126 teens (average age 17) who met diagnostic criteria for major depressive disorder, lifetime conduct disorder and at least one substance abuse disorder other than tobacco.

The adolescents were randomly assigned to receive either 20 milligrams of fluoxetine daily or a placebo, along with cognitive behavioral therapy (CBT) focused on substance abuse rather than depression.

Drug use and conduct disorder symptoms decreased significantly in both the fluoxetine and placebo treatment groups but there was no difference between fluoxetine and placebo treatment on either variable.

Adolescents whose depressions remitted (regardless of medication group assignment) significantly decreased their drug use whereas drug use did not decrease in those whose depressions did not remit.

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