Charting the Depths

Reflections on the science of depression.

We are Losing the Fight Against Depression

One study. Ominous findings.

Decades of psychiatric epidemiology tells us that depression is recurrent. A person who battles serious depression once will likely need to do so again. But just how recurrent? And presumably with effective treatments, we can shrink the rate of recurrence, so recurrences become rare.

Findings published in the Archives of General Psychiatry earlier this month and widely reported in the media, demonstrate that depression in young people is (a) highly recurrent and (b) highly recurrent even in the face of treatment.

In the Treatment for Adolescents with Depression Study (TADS) study conducted at 13 academic centers across the United States, nearly 200 currently depressed adolescents were enrolled and randomly assigned to a treatment: (1) fluoxetine (Prozac) alone, (2) cognitive behavior therapy alone, (3) a fluoxetine-cognitive behavior therapy combination (4) or a placebo.

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The good news (sort of) is that EVENTUALLY just about all the teens recovered. Specifically 96% of study participants recovered from their initial depressive episode by three and a half years. In the short-term, most adolescents experienced some real relief of symptoms within three months of starting a treatment, with the combination treatment doing particularly well.

The alarming news is that nearly half, or 46% of those who recovered experienced at least one additional round of depression within the five years covered by the study. As alarming, exposure to treatment offered no protection against recurrence.

These treatments were pretty extensive: In terms of sessions with a professional, adolescents received 12 weeks of weekly treatments, then six weeks of weekly or every-other-week treatments, and finally sessions once every six weeks, for a total of 36 weeks. These treatments were carefully monitored and administered in university hospital settings. There is no reason to think that the TADS adolescents got anything less than state-of-the-art depression treatments for the better part of a year. And yet before their 22nd birthday half were depressed again.

Depression at any age is bad news, but depressions that arise in this tender period interfere with schooling, peer and romantic relationships, formation of careers, adult identity, in short, everything.  It is hard enough to be a young adult in today's world of diminished opportunity. To have to carry the baggage of multiple rounds of depression into young adulthood is an extra momumental task.

In the understatement of the year, Dr. John Curry, the lead author of the study was quoted in the NY Times as saying, “It looks like we don’t have a treatment yet that really prevents recurrence.”

These findings from a well-done long-term clinical trial add to warning signs about the perils of continuing business-as-usual in depression research and treatment: We are losing the fight against depression. We need new ideas about how to improve its long-term course. We need ideas that can be implemented in the real world, where it is difficult to get people in for treatment sessions at all, let alone for 36 weeks. And we need more money to develop the ideas. Is anyone listening?

 

References

TADS Team. The Treatment for Adolescents with Depression Study (TADS): Outcomes over one year of naturalistic follow-up. American Journal of Psychiatry. 2009 Oct. 166(10): 1141-1149.

John Curry; Susan Silva; Paul Rohde; Golda Ginsburg; Christopher Kratochvil; Anne Simons; Jerry Kirchner; Diane May; Betsy Kennard; Taryn Mayes; Norah Feeny; Anne Marie Albano; Sarah Lavanier; Mark Reinecke; Rachel Jacobs; Emily Becker-Weidman; Elizabeth Weller; Graham Emslie; John Walkup; Elizabeth Kastelic; Barbara Burns; Karen Wells; John March. Recovery and Recurrence Following Treatment for Adolescent Major Depression. Archives of General Psychiatry, 2010; link.

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I'm still seeking stories of misunderstood depression; send me your story at chartingthedepths@gmail.com

Jonathan Rottenberg is an Associate Professor of Psychology at the University of South Florida, where he directs the Mood and Emotion Laboratory.

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