Selective serotonin reuptake inhibitors (SSRIs), psychotherapy,
or both are recommended for the acute management of adolescents with depression. However, at least 40% of patients do not respond to initial treatment with these therapies, and evidence-based guidance for subsequent treatment is lacking. Brent and colleagues report results of a clinical trial in which adolescents with depression who had not responded to an initial 2-month treatment with an SSRI and had not received cognitive behavioral therapy (CBT) were randomly assigned to switch for 12 weeks to 1 of the following treatment strategies: (1) a second, different SSRI, (2) a different SSRI and CBT, (3) venlafaxine (a selective serotonin and noradrenergic reuptake inhibitor), or (4) venlafaxine and CBT.
The authors found that the combination of switching to a different antidepressant agent and receiving CBT resulted in a higher rate of clinical response than switching only to a different medication. There was no difference in response to the medication switches, and patients who were switched to a different SSRI experienced fewer adverse effects than patients taking venlafaxine.