November 1, 2010
For Youths, Depression Often Has a Sequel
By PAM BELLUCK

About half of adolescents who recovered from major depression became depressed again within five years, regardless of what treatment or therapy they received to get over their initial depression, a new study shows.

The study, published Monday in Archives of General Psychiatry, also found that girls were more likely to have another major depression, which surprised researchers because, as adults, women have not been considered more likely to have a recurrence than men.

In the study, nearly 200 adolescents, 12 to 17, received 12 weeks of fluoxetine (Prozac), cognitive behavioral therapy, both, or a placebo pill. (Those not receiving cognitive therapy met with a psychiatrist for basic support.) Placebo-takers who did not improve after 12 weeks could choose any of the other treatments.

Researchers had previously found that those receiving the Prozac-and-cognitive-therapy combination recovered faster from the first depression. So they expected those youths to be less prone to another depression.

But that did not happen. After 36 weeks, improvement for everyone was similar, researchers said, and by two years most completely recovered. But by five years, 47 percent suffered another major depression, no matter what treatment had helped them recover.

“It looks like we don’t have a treatment yet that really prevents recurrence,” said the study’s lead author, Dr. John Curry, a psychologist in the psychiatry department at the Duke University School of Medicine. “And we don’t have much of an indicator while the person is in treatment of how protected they’re going to be against recurrence.”

The researchers also expected that youths who improved almost fully during the 12 weeks would have less chance of recurrence. They did not, although those showing no improvement at all at 12 weeks were more prone to another depression after recovery than those who showed at least some progress during the 12 weeks. Teenagers who also suffered from anxiety were more likely to become depressed again.

“It’s a very important study,” said Dr. Aradhana Bela Sood, medical director of the Virginia Treatment Center for Children, who was not involved in the research. “As you counsel families, you can say there’s a 50 percent chance that this is going to recur,” and “now that we know that being female and having anxiety predisposes them, it’s certainly going to make me focus on the population who has this profile.”

Dr. Curry said that while girls are known to be more prone to initial depression, it was unclear why 57 percent of girls who recovered became depressed again, compared with 33 percent of boys. “Maybe it has to do with something in girls around the particular age that this is going on, stressful life events or the way people cope with stress,” he said.

Dr. Sood said that it might be related to hormonal changes or that “women tend to brood more, so the slightest stress is multiplied many times.”

Dr. David Brent, a psychiatry professor at University of Pittsburgh’s medical school, who was not involved in the research, wondered whether more girls experienced a “more pure type of depression than you see in boys,” he said. “Maybe more boys get into trouble and feel sad, but when trouble goes away they feel better."

Most who got depressed again had only one episode in five years, but a few had two or three. The adolescent’s age made no difference.

Dr. Curry said one limitation to the study was that researchers did not look at specific events in the youths’ lives to see if some encountered more stress than others. His team plans to examine whether those who received therapy or drug treatment over the five years were more or less prone to another depression.

“We don’t know if the disorder is recurrent because it’s recurrent or because something happens to you after the first episode that makes you more vulnerable to another one,” Dr. Brent said. The study “points up the need for some kind of aftercare to prevent recurrence,” he said, and “highlights that what we’re doing now is not good enough.”