title: Sequential treatment with fluoxetine and relapse--prevention CBT to improve outcomes in pediatric depression.
abstract: OBJECTIVE
  The authors evaluated a sequential treatment strategy of fluoxetine and relapse-prevention cognitive-behavioral therapy (CBT) to determine effects on remission and relapse in youths with major depressive disorder.
  
  
  METHODS
  Youths 8-17 years of age with major depression were treated openly with fluoxetine for 6 weeks. Those with an adequate response (defined as a reduction of 50% or more on the Children's Depression Rating Scale-Revised [CDRS-R]) were randomly assigned to receive continued medication management alone or continued medication management plus CBT for an additional 6 months. The CBT was modified to address residual symptoms and was supplemented by well-being therapy. Primary outcome measures were time to remission (with remission defined as a CDRS-R score of 28 or less) and rate of relapse (with relapse defined as either a CDRS-R score of 40 or more with a history of 2 weeks of symptom worsening, or clinical deterioration).
  
  
  RESULTS
  Of the 200 participants enrolled in acute-phase treatment, 144 were assigned to continuation treatment with medication management alone (N=69) or medication management plus CBT (N=75). During the 30-week continuation treatment period, time to remission did not differ significantly between treatment groups (hazard ratio=1.26, 95% CI=0.87, 1.82). However, the medication management plus CBT group had a significantly lower risk of relapse than the medication management only group (hazard ratio=0.31, 95% CI=0.13, 0.75). The estimated probability of relapse by week 30 was lower with medication management plus CBT than with medication management only (9% compared with 26.5%).
  
  
  CONCLUSIONS
  Continuation-phase relapse-prevention CBT was effective in reducing the risk of relapse but not in accelerating time to remission in children and adolescents with major depressive disorder.
authors.forename: Betsy D
authors.initials: BD
authors.lastname: Kennard
authors.forename: Graham J
authors.initials: GJ
authors.lastname: Emslie
authors.forename: Taryn L
authors.initials: TL
authors.lastname: Mayes
authors.forename: Paul A
authors.initials: PA
authors.lastname: Nakonezny
authors.forename: Jessica M
authors.initials: JM
authors.lastname: Jones
authors.forename: Aleksandra A
authors.initials: AA
authors.lastname: Foxwell
authors.forename: Jessica
authors.initials: J
authors.lastname: King
mesh_terms: D000293:Adolescent; D002648:Child; D015928:Cognitive Behavioral Therapy; D003131:Combined Modality Therapy; D003865:Major Depressive Disorder / Q000188:drug therapy* / Q000628:therapy*; D005260:Female; D005473:Fluoxetine / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D012008:Recurrence; D012074:Remission Induction / Q000379:methods; D013997:Time Factors
chemical_list: D005473:Fluoxetine