Behavioral Therapy Added to Pediatric Antidepressant Treatment Reduces Likelihood of Relapse

Based on the results of a clinical trial conducted at UT Southwestern and Children’s Medical Center of Dallas, depression relapse rates were substantially lower in a group of youth who received both forms of treatment versus medication alone.

“Continuation-phase strategies designed to reduce the high rates of relapse in depressed youths have important public health implications, as recurrence of depression is more likely in youths with multiple episodes,” said Dr. Betsy Kennard, Professor of Psychiatry at UT Southwestern and senior author of the study published June 17 in The American Journal of Psychiatry.

Relapse rates in youth with major depressive disorders typically range from 40 percent to 70 percent, said Dr. Kennard, also Director of an outpatient program at Children’s Medical Center called Suicide Prevention and Resilience at Children’s (SPARC).

In this study, the relapse rate for the group of 75 youth who received behavioral therapy for six months following six weeks of initial treatment with the antidepressant fluoxetine, also known as Prozac, was 9 percent. Among the group of 69 youth who received only the drug during this period, 26.5 percent relapsed.

Youth who showed improvement after receiving fluoxetine for an initial six-week treatment period continued in the study, split between the medication-only and therapy plus medication groups. Study participants’ ages ranged from 8-17.

“Unfortunately, medication alone is not always enough to prevent relapse,” said Dr. Graham Emslie, Chief of the Division of Adolescent and Child Psychiatry, Professor of Psychiatry and Pediatrics at UT Southwestern, and a contributing author of the study. “Identifying novel strategies to prevent future relapses for young people should be a priority. This approach is unique in that treatment was added at a time when the intensity of care is frequently decreasing.”

The type of therapy used in this trial – called Relapse Prevention Cognitive Behavioral Therapy – is an individual psychotherapy treatment with a family component that focuses on reducing residual symptoms, increasing wellness behaviors, and preventing relapse. For six months, the youth in this arm of the trial participated in eight to 11 therapy sessions that were tailored to each child.

“It is also worth noting that youth who received the therapy had lower medication doses, yet had better outcomes than those on higher dosages in the medication management-only group,” said Dr. Kennard.

Dr. Emslie, holder of the Charles E. and Sarah M. Seay Chair in Child Psychiatry, and Dr. Kennard were co-principal investigators of this single-center clinical trial funded through a National Institute of Mental Health grant.

Other UT Southwestern researchers who contributed to this study were Taryn Mayes, a Faculty Associate in Psychiatry; Dr. Paul Nakonezny, Associate Professor of Clinical Science and Psychiatry; Jessica Jones, psychological associate in Psychiatry; Dr. Aleksandra Foxwell, Assistant Professor of Psychiatry; and Jessica King, a research assistant in Psychiatry.

Dr. Emslie receives research support from Eli Lilly, BioMarin, Somerset, Duke University, Forest Laboratories, Valeant, GlaxoSmithKline, and Mylan; is a consultant for Allergan, Biobehavioral Diagnostics Company, Bristol-Myers Squibb, Eli Lilly, GlaxoSmithKline, INC Research, Lundbeck, Merck, Pfizer, Seaside Therapeutics, Shire, Texas Department of State Health Services, University of Miami, and Valeant; and is on the speakers bureau for Forest Laboratories.

About UT Southwestern Medical Center

UT Southwestern, one of the premier academic medical centers in the nation, integrates pioneering biomedical research with exceptional clinical care and education. The institution’s faculty includes many distinguished members, including six who have been awarded Nobel Prizes since 1985. Numbering more than 2,700, the faculty is responsible for groundbreaking medical advances and is committed to translating science-driven research quickly to new clinical treatments. UT Southwestern physicians provide medical care in 40 specialties to nearly 91,000 hospitalized patients and oversee more than 2 million outpatient visits a year.