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Cited by 40Treatment of Major DepressionAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesPsychotherapy Techniques and Applications

Continued Effectiveness of Relapse Prevention Cognitive-Behavioral Therapy Following Fluoxetine Treatment in Youth With Major Depressive Disorder

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Emslie, Graham J., Kennard, Betsy D., Mayes, Taryn L., Nakonezny, Paul A., Moore, Jarrette, Jones, Jessica M., Foxwell, Aleksandra A., King, Jessica·2015·Journal of the American Academy of Child & Adolescent Psychiatry
DOI 10.1016/j.jaac.2015.09.014PMC PMC9597885
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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.Method 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).Conclusion 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.

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  • A previous relapse prevention study in youth MDD reported a relapse rate at an 18-month follow-up of 62% for TAU and 36% in the relapse prevention group (OR=2.9).

    “A previous relapse prevention study in youth MDD reported a relapse rate at an 18-month follow-up of 62% for TAU and 36% in the relapse prevention group (OR=2.9).48”

    From A mindfulness-based, cognitive, social, digital relapse-prevention intervention for youth with depression in Australia: study protocol for a randomised controlled trial of Rebound (2024) · cites this paper as [48]

    The Results (Hazard of Relapse Through 78-Week Follow-Up; page unavailable) report estimated relapse probabilities at 78 weeks of 62% with medication management alone and 36% with medication management plus relapse-prevention CBT. The paper calls the comparison group medication management, not TAU, and reports a hazard ratio of 0.467 rather than an odds ratio of 2.9. The quoted odds ratio can be calculated approximately from the reported percentages, but is not reported by the paper. (LLM, conf=0.88)

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Authors
Emslie, G. J., Kennard, B. D., Mayes, T. L., Nakonezny, P. A., Moore, J., Jones, J. M., Foxwell, A. A., & King, J.
Affiliations
  • Children's Medical Center (US)
  • The University of Texas Southwestern Medical Center (US)
Corresponding author
Emslie, Graham J.
ORCID
Venue
Journal of the American Academy of Child & Adolescent Psychiatry
Publisher
Elsevier BV
Published
2015-12
Volume
54
Issue
12
Pages
991-998
ISSN
0890-8567 (ISSN-L)
DOI
10.1016/j.jaac.2015.09.014
PMC
PMC9597885
OpenAlex
W2188495513
Cited by
40
References
36
Citations by year
2026: 3 · 2025: 3 · 2024: 8 · 2023: 7 · 2022: 6 · 2021: 3 · 2020: 1 · 2019: 4 · 2018: 3 · 2017: 1 · 2016: 1
FWCI
1.19
Type
journal article
Language
en
Open access
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Journal of the American Academy of Child & Adolescent Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Institute of Mental Health (R01MH039188)
Topics
  • Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
  • Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
Keywords
fluoxetine, major depressive disorder, youth, childhood depression, relapse prevention, sequential therapy, long-term follow-up, remission, time to relapse
MeSH terms
Adolescent, Child, Cognition, Combined Modality Therapy, Major Depressive Disorder, Female, Fluoxetine, Follow-Up Studies, Humans, Male, Psychiatric Status Rating Scales, Recurrence, Remission Induction, Risk Factors, Severity of Illness Index, Cognitive Behavioral Therapy, Proportional Hazards Models, Single-Blind Method, Treatment Outcome, Selective Serotonin Reuptake Inhibitors, Secondary Prevention

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