Combining the antidepressant fluoxetine with cognitive behavioral therapy may be more effective than cognitive behavioral therapy alone in treating depression in teens with substance abuse disorders, according to a report published in the November issue of Archives of Pediatrics & Adolescent Medicine.
Paula D. Riggs, M.D., and colleagues at the University of Colorado Denver conducted a randomized controlled trial of the antidepressant fluoxetine in 126 teens diagnosed with major depressive disorder, lifetime conduct disorder and at least one substance abuse disorder other than tobacco use. The study participants were randomly assigned to receive either a daily dose of 20 mg of fluoxetine or a placebo. All participants received cognitive behavioral therapy.
At the end of the 16-week treatment period, fluoxetine combined with cognitive behavioral therapy had greater efficacy than placebo and cognitive behavioral therapy on one of the depression scales used. There was no significant difference on the other depression scale or in substance use or conduct disorder symptoms between the fluoxetine and placebo groups.
The results, the authors write, “indicate that, in the context of cognitive behavior therapy (substance abuse treatment), co-occurring depression may improve or remit without antidepressant pharmacotherapy. However, if depression does not appear to be improving early in the course of substance treatment, fluoxetine treatment should be considered, even if adolescents are not yet abstinent, with weekly monitoring of treatment adherence, substance use, adverse effects and target symptom response.”