Wednesday, November 07, 2007

Landmark study on SUD and depression in teens

A breathless press release is hyping the findings in a new study:
The adolescents were randomly assigned to receive either 20 milligrams of fluoxetine daily or a placebo, along with cognitive behavioral therapy (CBT) focused on substance abuse rather than depression.

"The weekly, individual cognitive behavioral therapy helps adolescents improve their decision-making skills as well as their coping, communication, and drug-refusal skills," added Riggs. "It also helps adolescents learn ways to avoid high-risk situations and increase their motivation and involvement in pro-social activities that are incompatible with drug use."

The study found fluoxetine combined with CBT was well-tolerated and had greater efficacy than the placebo with CBT on the Childhood Depression Rating Scale-Revised but not on the Clinical Global Impression Improvement measure of treatment response. Drug use and conduct disorder symptoms decreased significantly in both the fluoxetine and placebo treatment groups but there was no difference between fluoxetine and placebo treatment on either variable. The rate of treatment retention/completion (84 percent) was higher and reduction in drug use similar to that reported for other evidence-based substance treatment modalities in adolescents with less psychopathology.
Then there's this pearl:
The higher than expected rate of treatment response (CGI-I) in the placebo + CBT (67 percent) as well as the fluoxetine + CBT (76 percent) treatment group may indicate that CBT contributed to depression treatment response, despite its focus on substance abuse. Adolescents whose depressions remitted (regardless of medication group assignment) significantly decreased their drug use whereas drug use did not decrease in those whose depressions did not remit.
Ton anyone who is familiar with the literature, it should be no shock that depression would respond to CBT, even if it's substance abuse focused CBT. Further, anyone familiar with the literature would know that depressive symptoms generally improve dramatically in the first 3 to 6 weeks of abstinence, without any treatment for mental illness.

A remarkable conclusion:
"An important clinical implication of these results may be that in the context of cognitive behavior therapy (substance abuse treatment), co-occurring depression may significantly improve or remit without antidepressant pharmacotherapy," said Riggs.
Given that conclusion, why isn't the headline, "CBT very effective for treating depression in youth with SUDs"? Or, "Fluoxetine provides modest benefit for depressed teens with SUDs"?

UPDATE: Other possible headlines: "Substance abuse treatment effective for depression in teens", "Psychiatric treatment unnecessary for most depressed teen substance abusers"

They're all accurate, right? They're all also very different. Does this demonstrate that scholarly journals are used professional advocacy tools? At minimum, it's evidence that they reflect the assumptions and biases of that discipline.

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