Remission and residual symptoms after short-term treatment in the Treatment of Adolescents with Depression Study (TADS).
OBJECTIVE
To ascertain remission rates in depressed youth participating in the Treatment for Adolescents With Depression Study (TADS), a multisite clinical trial that randomized 439 adolescents with major depressive disorder (MDD) to a 12-week treatment of fluoxetine (FLX), cognitive-behavioral therapy (CBT), their combination (COMB), or clinical management with pill placebo (PBO).


METHODS
Using an end-of-treatment Children's Depression Rating Scale-Revised (CDRS-R) total score of 28 or below as the criterion for remission, rates of remission were examined with logistic regression, controlling for site. Loss of MDD diagnosis and residual symptoms in responders (defined as Clinical Global Impressions-Improvement (CGI-I) score of 1 (very much improved) or 2 (much improved) were also examined across treatment groups.


RESULTS
After 12 weeks of treatment, 102 (23%) of 439 youths had reached remission. The remission rate was significantly higher in the COMB group (37%) relative to the other treatment groups (FLX, 23%; CBT, 16%; PBO, 17%), with odds ratios of 2.1 for COMB versus FLX, 3.3 for COMB versus CBT, and 3.0 for COMB versus PBO. In addition, 71% of subjects across treatment groups no longer met criteria for MDD at the end of acute treatment. Fifty percent of the youths who responded by CGI-I criteria continued to have residual symptoms, such as sleep or mood disturbances, fatigue, and poor concentration.


CONCLUSIONS
The combination of FLX and CBT was superior to both monotherapy and PBO in terms of remission rates, but overall rates of remission remain low and residual symptoms are common at the end of 12 weeks of treatment.
Kennard
Betsy
B
UT Southwestern Medical Center, Dallas, TX 75390-8589, USA. beth.kennard@utsouthwestern.edu
Silva
Susan
S
Vitiello
Benedetto
B
Curry
John
J
Kratochvil
Christopher
C
Simons
Anne
A
Hughes
Jennifer
J
Feeny
Norah
N
Weller
Elizabeth
E
Sweeney
Michael
M
Reinecke
Mark
M
Pathak
Sanjeev
S
Ginsburg
Golda
G
Emslie
Graham
G
March
John
J
D000293:Adolescent; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003131:Combined Modality Therapy; D003710:Demography; D003865:Major Depressive Disorder / Q000175:diagnosis* / Q000188:drug therapy / Q000628:therapy*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D005473:Fluoxetine / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D012074:Remission Induction; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use*; D012720:Severity of Illness Index; D013997:Time Factors
D005473:Fluoxetine; D017367:Selective Serotonin Reuptake Inhibitors