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Fluoxetine plus CBT Effective for Major Depressive Disorder in Adolescents

Major depressive disorder (MDD) is a significant threat to adolescents and a therapeutic challenge. This national, randomized study evaluated four treatments (medication management with fluoxetine [10 to 40 mg/day], fluoxetine plus cognitive-behavioral therapy [CBT], CBT alone, and placebo) in a volunteer sample of 439 adolescents with moderate-to-severe MDD (average depressive episode, 72 weeks). CBT consisted of 15 treatment sessions, including family sessions. Adolescents at high risk for suicide were excluded from the study.

Fluoxetine plus CBT significantly improved depression ratings compared with other therapies: 71% of the fluoxetine-plus-CBT group had a measurable improvement by the 12-week endpoint, compared with 61% of the fluoxetine-alone group, 43% of the CBT-alone group, and 35% of the placebo group. Suicidal ideation declined in all treatment groups; fluoxetine plus CBT was superior to the other therapies in reducing such ideation. Seven patients attempted suicide; the number of attempts did not differ by treatment group.

Comment: In this study, MDD was treated successfully within 12 weeks with fluoxetine (the only SSRI approved for children and adolescents), with the best outcome occurring when drug treatment was coupled with CBT. Children treated for MDD must be carefully monitored. It is sobering to note that 29% of these adolescents did not respond to the "best" therapy. Treating MDD in adolescents is serious business, and the availability of experienced mental health professionals for this important group is woefully deficient.

— F. Bruder Stapleton, MD

Published in Journal Watch Pediatrics and Adolescent Medicine September 13, 2004

Citation(s):

March J et al. Fluoxetine, cognitive-behavioral therapy, and their combination for adolescents with depression: Treatment for Adolescents With Depression Study (TADS) randomized controlled trial. JAMA 2004 Aug 18; 292:807-20.

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• Medline abstract (Free)

Glass RM. Treatment of adolescents with major depression: Contributions of a major trial. JAMA 2004 Aug 18; 292:861-3.

• Original article (Subscription may be required)
• Medline abstract (Free)