title: Achievement and maintenance of sustained response during the Treatment for Adolescents With Depression Study continuation and maintenance therapy.
abstract: BACKGROUND
  The Treatment for Adolescents With Depression Study evaluated fluoxetine (FLX), cognitive behavioral therapy (CBT), and FLX/CBT combination (COMB) vs pill placebo in 439 adolescents with major depressive disorder. Treatment consisted of 3 stages: (1) acute (12 weeks), (2) continuation (6 weeks), and (3) maintenance (18 weeks).
  
  
  OBJECTIVE
  To examine rates of achieving and maintaining sustained response during continuation and maintenance treatments.
  
  
  METHODS
  Randomized controlled trial. Response was determined by blinded independent evaluators.
  
  
  METHODS
  Thirteen US sites.
  
  
  METHODS
  Two hundred forty-two FLX, CBT, and COMB patients in their assigned treatment at the end of stage 1.
  
  
  METHODS
  Stage 2 treatment varied based on stage 1 response. Stage 3 consisted of 3 CBT and/or pharmacotherapy sessions and, if applicable, continued medication.
  
  
  METHODS
  Sustained response was defined as 2 consecutive Clinical Global Impression-Improvement ratings of 1 or 2 ("full response"). Patients achieving sustained response were classified on subsequent nonresponse status.
  
  
  RESULTS
  Among 95 patients (39.3%) who had not achieved sustained response by week 12 (29.1% COMB, 32.5% FLX, and 57.9% CBT), sustained response rates during stages 2 and 3 were 80.0% COMB, 61.5% FLX, and 77.3% CBT (difference not significant). Among the remaining 147 patients (60.7%) who achieved sustained response by week 12, CBT patients were more likely than FLX patients to maintain sustained response through week 36 (96.9% vs 74.1%; P = .007; 88.5% of COMB patients maintained sustained response through week 36). Total rates of sustained response by week 36 were 88.4% COMB, 82.5% FLX, and 75.0% CBT.
  
  
  CONCLUSIONS
  Most adolescents with depression who had not achieved sustained response during acute treatment did achieve that level of improvement during continuation and maintenance therapies. The possibility that CBT may help the subset of adolescents with depression who achieve early sustained response maintain their response warrants further investigation.
  
  
  BACKGROUND
  clinicaltrials.gov Identifier: NCT00006286.
authors.affiliation: Oregon Research Institute, 1715 Franklin Blvd, Eugene, OR 97403-1983, USA. paulr@ori.org
authors.forename: Paul
authors.initials: P
authors.lastname: Rohde
authors.forename: Susan G
authors.initials: SG
authors.lastname: Silva
authors.forename: Simon T
authors.initials: ST
authors.lastname: Tonev
authors.forename: Betsy D
authors.initials: BD
authors.lastname: Kennard
authors.forename: Benedetto
authors.initials: B
authors.lastname: Vitiello
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Kratochvil
authors.forename: Mark A
authors.initials: MA
authors.lastname: Reinecke
authors.forename: John F
authors.initials: JF
authors.lastname: Curry
authors.forename: Anne D
authors.initials: AD
authors.lastname: Simons
authors.forename: John S
authors.initials: JS
authors.lastname: March
mesh_terms: D000124:Achievement; D000293:Adolescent; D018687:Antidepressive Agents, Second-Generation / Q000627:therapeutic use*; D002648:Child; D015928:Cognitive Behavioral Therapy; D003131:Combined Modality Therapy; D003865:Major Depressive Disorder / Q000453:epidemiology / Q000523:psychology / Q000628:therapy*; D005260:Female; D005473:Fluoxetine / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D010349:Patient Compliance; D015995:Prevalence; D016037:Single-Blind Method; D016896:Treatment Outcome
chemical_list: D018687:Antidepressive Agents, Second-Generation; D005473:Fluoxetine