Psychiatry & Psychology

Therapy and Medication – Where’s the Breaking News?

Psychiatry and Psychology CategoryThe National Institute of Mental Health recently cited a study published in the December 2008 issue of the Journal of the American Academy of Child and Adolescent Psychiatry. The study was cited as providing evidence that supports the idea that adolescents with major depressive disorder (i.e., depression) are less likely to relapse after treatment if they receive cognitive behavioral therapy in conjunction with psychotropic medication.

I have to admit that this was not entirely shocking news to me, but I was slightly surprised to find the topic highlighted by NIMH as a “Science Update.” Granted, I don’t regularly read any psychiatric journals. I am a counselor by training, and typically receive only the professional publications that come with my professional association memberships. I suppose that I had just assumed that this was a well-researched topic. Obviously, the publications that I read are written from a different perspective. If the subject is featured, it is most likely written with the idea that therapy is inherently beneficial.

PillI teach in a counselor training program, and I would estimate that the majority of interventions that we discuss are primarily cognitive-behavioral in nature. Our counselors-in-training receive education is many different theoretical models, but cognitive-behavioral theory is the primary focus with respect to development of specific counseling skills.

So what is the “discovery” here? The connection with the treatment of adolescents?

The majority of my time spent in the field has been spent counseling adolescents. I’ve worked in conjunction with multiple psychiatrists over the years, and for the most part we have usually followed a similar protocol. All adolescents in treatment received counseling services. If warranted, the adolescent was seen by the psychiatrist for a medication evaluation (and management follow-up, if any medications were prescribed). One psychiatrist who I worked with, in particular, would cancel an appointment with the adolescent/family if they failed to keep their appointments with me (as their therapist).

My assumption here is that most practitioners and clients have had similar experiences. Therapy plus medication is more successful than medication alone. If that is true, why is this considered breaking news?

References

Kennard BD, Emslie GJ, Mayes TL, Nightingale-Teresi J, Nakonezny PA, Hughes JL, Jones JM, Tao R, Stewart SM, Jarrett RB (2008). Cognitive-behavioral therapy to prevent relapse in pediatric responders to pharmacotherapy for major depressive disorder J Am Acad Child Adolesc Psychiatry, 47 (12), 1395-1404 PMID: 18978634


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Anonymous
January 22, 2009 | Permalink

Ditto, Dr. Royal. The article in question looks like an infomercial. Here’s another one:
http://www.utsouthwestern.edu/utsw/cda/dept353744/files/513040.html

Anonymous
January 24, 2009 | Permalink

Here is a recently published study by the same author:
http://journals.lww.com/jaacap/Abstract/2009/02000/Remission_and_Recovery_in_the_Treatment_for.12.aspx

“At week 36, the estimated remission rates for intention-to-treat cases were as follows: combination, 60%; fluoxetine, 55%; cognitive-behavioral therapy, 64%; and overall, 60%.”

According to ClinicalTrials.gov, up to 432 subjects were to be enrolled. Where did the extra 7 subjects come from? As well, the data could be 4 – 10 years old:
http://www.clinicaltrials.gov/ct2/show/NCT00006286?term=emslie+tads&rank=1

Compare these results with a prior study:
http://www.nimh.nih.gov/science-news/2007/depressed-adolescents-respond-best-to-combination-treatment.shtml

NIMH has not posted a news release about this study on its Web site.

Anonymous
January 25, 2009 | Permalink

And yet another recent publication by the same author—the “no harm done” study:
http://ajp.psychiatryonline.org/cgi/content/abstract/appi.ajp.2008.08040487v1

“At week 36, the response rate was 82% in the placebo/open group and 83% in the active treatment groups. The remission rate was 48% in the placebo/open group and 59% in the active treatment groups, a difference that approached statistical significance.

Remission rates at 9 months were lower in patients treated initially with placebo, but 3 months of placebo treatment was not associated with any harm or diminished response to subsequent treatment.”

Key words: “approached” statistical significance

Again, according to ClinicalTrials.gov, up to 432 subjects were to be enrolled. Where did the extra 7 subjects come from? And the data could be 4 – 10 years old:
http://www.clinicaltrials.gov/ct2/show/NCT00006286?term=emslie+tads&rank=1

Here are two news releases on the study:
http://www.utsouthwestern.edu/utsw/cda/dept353744/files/513040.html

http://www.nimh.nih.gov/science-news/2009/adolescents-with-depression-not-harmed-in-studies-using-placebo.shtml

Anonymous
January 25, 2009 | Permalink

The protocol and sample consent forms for the Treatment for Adolescents With Depression Study (TADS) may be found on the study Web site:
https://trialweb.dcri.duke.edu/tads/templates.html

Anonymous
January 25, 2009 | Permalink

NIMH NEWS RELEASES ON THE TREATMENT FOR ADOLESCENTS WITH DEPRESSION STUDY (TADS)
August 17, 2004 Combination Treatment Most Effective in Adolescents with Depression
October 1, 2007 Depressed Adolescents Respond Best to Combination Treatment
April 8, 2008 Maintenance Treatment Crucial for Teens’ Recovery from Depression
May 12, 2008 Medication-only Therapy and Combination Therapy Both Cost Effective for Treating Teens with Depression
January 15, 2009 Adolescents with Depression Not Harmed in Studies Using Placebo

FEBRUARY 2009 TADS PUBLICATION
“Most depressed adolescents in all three treatment modalities achieved remission at the end of 9 months of treatment.” Remission and Recovery in the Treatment for Adolescents With Depression Study (TADS): Acute and Long-Term Outcomes [J Am Acad Child Adolesc Psychiatry 2009]

A MUST-SEE VIDEO
September 15, 2006 Treatment for Adolescents With Depression Study (TADS)
Link: rtsp://real.nih.gov/advisory/namh091506.rm?start=01:53:16.0&end=02:15:17.0

jamzo
January 31, 2009 | Permalink

insurance companies do not pay psychiatrists at the rate they want to do psychotherapy

this makes talk therapy the domain of psychologists and counselors who do not have the clout of
medical doctors

the reimbursement structures mental health treatment and determines research as well as who gets medicine or talk therapy

there is no value for psychiatry in talk therapy except when done in conjuction with medication

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