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Clinical practice guidelines recommend psychotherapy (usually cognitive behavioral therapy [CBT]), antidepressants, or both) but offer less guidance on what to do if initial treatment fails. At least 40% of depressed adolescents do not have adequate clinical responses to these treatments.
In a multisite, randomized, U.S. government–funded trial, 334 adolescents (age range, 12–18) who did not respond to at least 8 weeks of selective serotonin reuptake inhibitor (SSRI) therapy at recommended dosages received either a different SSRI or venlafaxine (a serotonin-norepinephrine reuptake inhibitor; Effexor and generics), with or without CBT. A total of 231 adolescents completed the full 12-week trial; adverse effects (more common with venlafaxine) …