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January 2011



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Long-term depression treatment provides sustained recovery for teens

Colleen Labbe – NIMH

Long-term treatment of adolescents with major depression is associated with continuous and persistent improvement of depression symptoms in most cases, according to the most recent analysis of follow-up data from The National Institute of Mental Health (NIMH)-funded Treatment of Adolescents with Depression Study (TADS). The report, along with a commentary compiling the take-home messages of the study, was published in the October 2009 issue of the American Journal of Psychiatry.

The TADS team randomly assigned 439 adolescents aged 12 to 17 to one of four treatment strategies for 36 weeks-the antidepressant fluoxetine (Prozac®) only, cognitive behavior therapy (CBT) only, the combination of the two, or placebo (inactive or “sugar” pill). After the first 12 weeks, the placebo group was discontinued, while the participants assigned to the active interventions continued treatment for another six months. Overall, the combination therapy was found to be the most effective in speeding up remission. Visit the NIMH website for more information about TADS results.

After the trial ended, the teens who had been assigned to the active treatments were assessed up to four times during the following year to determine if improvements were sustained over time. TADS treatments were no longer offered, but participants were encouraged to continue to seek treatment within their communities.

Participants who had been assigned to the placebo group received open treatment during the one-year follow-up period and were not included in this follow-up assessment. About 66 percent of TADS subjects (not including those who had been in the placebo group) participated in at least one assessment during the follow-up year.

By the end of the 36-week trial, 82 percent of participants had improved and 59 percent had reached full remission. During the follow-up year, most participants maintained their improvements, and the remission rate climbed to 68 percent. However, about 30 percent of the participants who were in remission at week 36 became depressed again during the following year.

In addition, while 91 percent of participants showed no evidence of suicidal thinking or behavior at the end of the trial, 6 percent developed suicidal thinking during the follow-up year, with no statistically significant differences among the treatment groups.

The longer-term treatment of TADS, regardless of treatment strategy, was associated with lasting benefits for the majority of participants. However, a significant number of those who had recovered worsened during the follow-up period, indicating a need for continuous clinical monitoring and further improvement in long-term treatment of youth with major depression.

The final results of TADS suggest that for most teens with depression, long-term, evidence-based treatments are effective and sustainable. But future research should concentrate on improving treatment strategies to reduce the rate of depression relapse or deterioration. The authors suggest that a randomized maintenance therapy trial would help determine how long active treatment should last to ensure the effects of treatment will endure over time.

TADS Team The Treatment for Adolescents With Depression Study (TADS): Outcomes Over 1 Year of Naturalistic Follow-Up. Am J Psychiatry 2009 Oct;166:1141-1149   [Abstract]

March JS, Vitiello B. Clinical messages from the Treatment for Adolescents With Depression Study (TADS). Am J Psychiatry 2009 Oct; 166:1118-1123  [Abstract]

At-risk college students reduce BP, anxiety, depression through Transcendental Meditation

Ken Chawkin
Maharishi University of Management

The Transcendental Meditation® technique may be an effective method to reduce blood pressure, anxiety, depression, and anger among at-risk college students, according to a new study to be published in the American Journal of Hypertension.

The Transcendental Meditation Program, a widely-used standardized program to reduce stress, showed significant decreases in blood pressure and improved mental health in young adults at risk for hypertension,” said David Haaga, PhD, co-author of the study and professor of psychology at American University in Washington, D.C.

The study was conducted at American University with 298 university students randomly allocated to either the Transcendental Meditation technique or wait-list control over a three-month intervention period. A subgroup of 159 subjects at risk for hypertension was analyzed separately. At baseline and after three months, blood pressure, psychological distress, and coping ability were assessed.

For the students at risk for developing hypertension, significant improvements were observed in blood pressure, psychological distress and coping. Compared to the control group, students practicing the Transcendental Meditation program showed reductions of 6.3 mm Hg in systolic blood pressure and 4.0 mm Hg in diastolic blood pressure. These reductions are associated with a 52% lower risk for development of hypertension in later years.

The findings are timely. Today, an estimated 18 million students are dealing with mental health issues on college campuses. Statistics from colleges nationwide indicate there has been a 50 percent increase in the diagnosis of depression, and more than twice as many students are on psychiatric medications as a decade ago. According to recent national surveys of campus therapists, more students than ever are seeking psychiatric help on college campuses all across the United States.

This is the first randomized controlled study to show in young adults at risk for hypertension reductions in blood pressure that were associated with changes in psychological distress and coping,” said Sanford Nidich, EdD, lead author and senior researcher at the Institute for Natural Medicine and Prevention at Maharishi University of Management. “Previous research has shown that psychological distress such as anxiety, depression, and anger contribute to the development of hypertension in young adults.

College students are particularly prone to psychological distress caused by interpersonal and social problems, pressures to succeed academically, financial strains, and uncertain futures. For the entire sample in this study, there was a significant improvement in students’ mental health.

Hypertension is a common risk factor for cardiovascular disease in adulthood. Yet, decades of research show that high blood pressure begins in youth. This well-controlled clinical trial found that blood pressure can be effectively lowered in students with a stress-reducing intervention. This has major implications for the prevention of hypertension, heart attacks and strokes in adulthood,” said Robert Schneider MD, FACC, specialist in clinical hypertension, Director of the Institute for Natural Medicine and Prevention and study co-author.

Nidich SI, Rainforth MV, Haaga DA, et al. A Randomized Controlled Trial on Effects of the Transcendental Meditation Program on Blood Pressure, Psychological Distress, and Coping in Young Adults. Am J Hypertens. 2009 Oct; 22(12):1326-1331   [Abstract]

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