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Half Of Depressed Youth Suffer Relapse: Study

November 2, 2010

New research from Duke University Medical Center finds that while most depressed adolescents who receive proper treatment appear to recover, the condition recurs in nearly half within five years.

Females were at much higher risk of relapse than males, the study found.

“We need to learn why females in this age range have higher chances of descending into another major depression after they have made a recovery,” said Dr. John Curry, lead author of the study and professor in the Duke Department of Psychiatry and Behavioral Sciences.

The study was a follow-up investigation of 86 male and 110 female teens that had participated in the Treatment for Adolescents with Depression Study (TADS), a short-term 12-week depression treatment study.

Symptoms of major depression include depressed mood, loss of interest, poor concentration, a sense of worthlessness, and disruptions in appetite, sleep, and energy levels.  Severe cases can cause suicidal thoughts or behavior.  Adolescents must have at least five of these symptoms for a length of time to be diagnosed with major depression. 

In the TADS study, the adolescents were all at least moderately to severely depressed for an average of 40 weeks before beginning treatment.  The depression had also affected with their studies, family life or relationships.

In the current study, known as SOFTAD (Survey of Outcomes Following Treatment for Adolescent Depression), the researchers followed the TADS participants for five years after their initial 12-week treatment.

They found that 96.4 percent of the participants had recovered for at least 8 weeks after the short-term treatment. Those who fully responded to the short-term treatment, rather than partially or not at all, were significantly more likely to be recovered by the two-year follow-up mark. 

The most effective treatment was the antidepressant Prozac (fluoxetine) combined with cognitive behavioral therapy. However, reaching recovery within two years was not significantly related to being in the group that received this combination therapy.  Instead, what mattered was whether the patients responded fully to treatment, as opposed to being partial responders or non-responders.

The three other short-term treatments were fluoxetine alone, cognitive therapy alone, or a placebo.

Out of a total of 196 study participants, 189 had initially recovered, with 88 of those, or nearly half, suffering a recurrence of major depression.

The relapse could not be predicted by the patient’s full short-term treatment response or by original treatment, the researchers found.  However, those who responded fully or partially were less likely to have a recurrence than were non- responders — 42.9 percent versus 67.6 percent, respectively.

Gender played a significant role in recurrence, with a majority of females (57.6 percent) having another major depression, compared with just 32.9% of males.

Dr. Curry hypothesized that there may be a number of reasons to explain the higher relapse rate among females. Young females, for instance, may be at risk for a second depression if they feel they cannot personally make any impact, which affects their desire to set or reach goals.  They may also have a tendency toward unproductive, repetitive thoughts that focus on their negative experiences, personal weaknesses, or bad feelings, he added.

Although females are more likely to become depressed than males during both adulthood and adolescence, adult women are not more likely than men to have a second major depression, Curry explained.

“Further research needs to be done to confirm our findings and to sort out the variables that may be associated with recurrent major depression in young women,” he said.

The study was published online in the Nov. 1 issue of the Archives of General Psychiatry, and will appear in the March 2011 print issue. 

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