Fluoxetine in Adolescents with Comorbid Major Depression and an Alcohol Use Disorder: A Five-Year Follow-Up Study

Abstract

ABSTRACT The goal of this five-year follow-up evaluation was to characterize the long-term (five-year) clinical course following the completion of an acute phase study with fluoxetine in comorbid adolescents. At the five-year follow-up evaluation, the group continued to demonstrate significantly fewer DSM criteria for an Alcohol Use Disorder (AUD) and fewer BDI depressive symptoms, and also consumed fewer standard drinks than they had demonstrated at the baseline of the acute phase study. Also, between the three- and five-year follow-up assessments, the level of self-reported depressive symptoms showed a significant decrease. Three of the 10 participants demonstrated Major Depressive Disorder (MDD) at the five-year follow-up assessment, but only one demonstrated Alcohol Dependence (AD), and none demonstrated Cannabis Dependence (CD). Eight of the 10 participants (80%) had demonstrated MDD at some time during the five-year follow-up study. The presence of a current AUD was significantly associated with the presence of a current MDD episode at both the one-year and the three-year follow-up evaluations. Six of the participants (60%) restarted SSRI medications at some point during the five-year follow-up period, but none were still taking SSRI antidepressants at the time of the 5-year assessment. Despite their substantial residual depression and alcohol use, a strong majority (8/10, 80%) of the subjects graduated from college during the five-year follow-up period. We conclude that the long-term (5-year) prognosis for the AUD, CD, and academic functioning of comorbid adolescents following acute phase treatment with SSRIs is surprisingly good. However, the long-term prognosis for their depression was surprisingly poor, and was worse than is typically seen among non-comorbid adolescents or adults.