Acute time to response in the Treatment for Adolescents with Depression Study (TADS).
OBJECTIVE
To examine the time to response for both pharmacotherapy and psychotherapy in the Treatment for Adolescents with Depression Study (TADS).


METHODS
Adolescents (N = 439, ages 12 to 17 years) with major depressive disorder were randomized to fluoxetine (FLX), cognitive-behavioral therapy (CBT), their combination (COMB), or pill placebo (PBO). Defining response as very much improved or much improved on the Clinical Global Impression-Improvement Scale (CGI-I), survival analyses using Cox proportional hazards models, and Kaplan-Meier curves were conducted to evaluate time to first response and time to stable response for subjects receiving pharmacotherapy (COMB, FLX, PBO) as well as for subjects receiving CBT (COMB, CBT). Direct comparisons between pharmacotherapy and CBT were not made because of differences in visit schedules.


RESULTS
Based on pharmacotherapist CGI-I scores, COMB and FLX showed faster onset of benefit than PBO on time to response and time to stable response (p < .001), and COMB was faster than FLX on time to stable response (p = .034). The probability of sustained early response was approximately threefold greater for COMB than PBO, twofold greater for FLX than PBO, and 1.5-fold greater for COMB than FLX. On the psychotherapist CGI-I scores, both first response and stable response occurred faster in COMB than CBT (p < .001), with a probability of sustained early response approximately threefold greater for COMB than CBT.


CONCLUSIONS
In the acute treatment of depressed adolescents, FLX and COMB accelerate response relative to PBO, and COMB accelerates response relative to CBT alone.
Kratochvil
Christopher
C
University of Nebraska Medical Center NE 68198-5581, USA. ckratoch@unmc.edu
Emslie
Graham
G
Silva
Susan
S
McNulty
Steve
S
Walkup
John
J
Curry
John
J
Reinecke
Mark
M
Vitiello
Benedetto
B
Rohde
Paul
P
Feeny
Nora
N
Casat
Charles
C
Pathak
Sanjeev
S
Weller
Elizabeth
E
May
Diane
D
Mayes
Taryn
T
Robins
Michele
M
March
John
J
D000293:Adolescent; D002648:Child; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003131:Combined Modality Therapy; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000188:drug therapy / Q000628:therapy*; D005260:Female; D005473:Fluoxetine / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use*; D011795:Surveys and Questionnaires; D013997:Time Factors
D005473:Fluoxetine; D017367:Selective Serotonin Reuptake Inhibitors