title: Continued Effectiveness of Relapse Prevention Cognitive-Behavioral Therapy Following Fluoxetine Treatment in Youth With Major Depressive Disorder.
abstract: OBJECTIVE
  To evaluate the continued effect of a sequential treatment strategy (fluoxetine followed by continued medication plus relapse prevention cognitive-behavioral therapy [RP-CBT]) on relapse prevention beyond the treatment phase.
  
  
  METHODS
  Youth (aged 8-17 years) with major depressive disorder (MDD) were treated with fluoxetine for 6 weeks. Responders (≥50% reduction on the Children's Depression Rating Scale-Revised [CDRS-R]) were randomized to continued medication management alone (MM) or continued medication management plus RP-CBT (MM+CBT) for an additional 6 months. Long-term follow-up assessments were conducted at weeks 52 and 78.
  
  
  RESULTS
  Of 144 youth randomized to MM (n = 69) or MM+CBT (n = 75), 67% had at least 1 follow-up assessment, with equal rates in the 2 groups. Remission rates were high, although most had remitted during the 30-week treatment period. Only 6 additional participants remitted during long-term follow-up, and there were no differences on time to remission between MM+CBT and MM. The MM+CBT group had a significantly lower risk of relapse than the MM group throughout the 78-week follow-up period (hazard ratio = 0.467, 95% CI = 0.264 to 0.823; χ(2) = 6.852, p = .009). The estimated probability of relapse during the 78-week period was lower with MM+CBT than MM only (36% versus 62%). Mean time to relapse was also significantly longer with MM+CBT compared to MM alone by approximately 3 months (p = .007).
  
  
  CONCLUSIONS
  The addition of RP-CBT after acute response to medication management had a continued effect on reducing risk of relapse even after the end of treatment. Clinical trial registration information-Sequential Treatment of Pediatric MDD to Increase Remission and Prevent Relapse; http://clinicaltrials.gov/; NCT00612313.
authors.affiliation: University of Texas Southwestern Medical Center and Children's Health Children's Medical Center, Dallas. Electronic address: graham.emslie@utsouthwestern.edu.
authors.forename: Graham J
authors.initials: GJ
authors.lastname: Emslie
authors.affiliation: University of Texas Southwestern Medical Center and Children's Health Children's Medical Center, Dallas.
authors.forename: Betsy D
authors.initials: BD
authors.lastname: Kennard
authors.affiliation: University of Texas Southwestern Medical Center and Children's Health Children's Medical Center, Dallas.
authors.forename: Taryn L
authors.initials: TL
authors.lastname: Mayes
authors.affiliation: Division of Biostatistics, University of Texas Southwestern Medical Center, Dallas.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Nakonezny
authors.affiliation: University of Texas Southwestern Medical Center and Children's Health Children's Medical Center, Dallas.
authors.forename: Jarrette
authors.initials: J
authors.lastname: Moore
authors.affiliation: University of Texas Southwestern Medical Center and Children's Health Children's Medical Center, Dallas.
authors.forename: Jessica M
authors.initials: JM
authors.lastname: Jones
authors.affiliation: University of Texas Southwestern Medical Center and Children's Health Children's Medical Center, Dallas.
authors.forename: Aleksandra A
authors.initials: AA
authors.lastname: Foxwell
authors.affiliation: University of Texas Southwestern Medical Center and Children's Health Children's Medical Center, Dallas.
authors.forename: Jessica
authors.initials: J
authors.lastname: King
mesh_terms: D000293:Adolescent; D002648:Child; D003071:Cognition; D015928:Cognitive Behavioral Therapy; D003131:Combined Modality Therapy; D003865:Major Depressive Disorder / Q000628:therapy*; D005260:Female; D005473:Fluoxetine / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D016016:Proportional Hazards Models; D011569:Psychiatric Status Rating Scales; D012008:Recurrence; D012074:Remission Induction; D012307:Risk Factors; D055502:Secondary Prevention / Q000379:methods*; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use*; D012720:Severity of Illness Index; D016037:Single-Blind Method; D016896:Treatment Outcome
chemical_list: D005473:Fluoxetine; D017367:Selective Serotonin Reuptake Inhibitors
keywords: CBT; continuation treatment; depression; relapse; youth