Cited by 175Treatment of Major DepressionPsychotherapy Techniques and ApplicationsAnxiety, Depression, Psychometrics, Treatment, Cognitive Processes

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The Treatment for Adolescents With Depression Study (TADS)

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MARCH, JOHN, SILVA, SUSAN, VITIELLO, BENEDETTO·2006·Journal of the American Academy of Child & Adolescent Psychiatry

DOI 10.1097/01.chi.0000237709.35637.c0

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Abstract

Funded by the National Institute of Mental Health, the Treatment for Adolescents With Depression Study (TADS) is intended to evaluate the short-term (12 weeks) and longer-term (36 weeks) effectiveness of four treatments for adolescents with DSM-IV major depressive disorder: clinical management with fluoxetine (FLX), cognitive-behavioral therapy (CBT), FLX and CBT combined (COMB), and clinical management with placebo (PBO). We previously reported that COMB and FLX were more effective in reducing depression than CBT or PBO after 12 weeks of acute treatment. In this special section of the Journal, separate articles extend these findings to the impact of TADS treatments on remission, speed of response, function and quality of life, predictors of outcome, and safety during the first 12 weeks of treatment. To set the stage for the special section, we briefly review the rationale, design, and methods of the TADS; describe the TADS sample to which the TADS findings generalize; using all of the currently available data, summarize the intent-to-treat outcomes across multiple endpoints at 12 weeks; and consider the public health value of the TADS findings in the context of design decisions and methodological limitations of the TADS, including some that may have advantaged the combined treatment condition. Reflecting the ordering of effect sizes at week 12--COMB (0.98) > FLX (0.68) > CBT (-0.03)--combined treatment proved superior to PBO on 15 of 16 endpoints, to CBT on 14 of 16 endpoints, and to FLX on 8 of 16 endpoints, whereas FLX was superior to CBT on 8 of 14 and to PBO on 7 of 16 measures. CBT did not differ from PBO on any measure. Despite the fact that suicidality improved markedly across all of the treatment conditions, suicidal events were twice as common in patients treated with FLX alone than with COMB or CBT alone, perhaps indicating that CBT protects against suicidal events. Thus, combined treatment appears to accelerate recovery relative to CBT and, for some outcomes, FLX alone, while minimizing the risk of suicidality relative to FLX alone. Taking benefit and risk into account, we conclude that the combination of FLX and CBT appears superior to either monotherapy as a treatment for moderate to severe major depressive disorder in adolescents.

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Authors: MARCH, J., SILVA, S., & VITIELLO, B.
Affiliations: Duke University (US)
Pfizer (United States) (US)
Suburban Hospital (US)
Corresponding author: MARCH, JOHN
ORCID: SILVA, SUSAN
VITIELLO, BENEDETTO
Venue: Journal of the American Academy of Child & Adolescent Psychiatry
Publisher: Elsevier BV
Published: 2006-12
Volume: 45
Issue: 12
Pages: 1393-1403
ISSN: 0890-8567 (ISSN-L)
DOI: 10.1097/01.chi.0000237709.35637.c0
OpenAlex: W171724531
Cited by: 174
References: 81
Citations by year: 2026: 1 · 2025: 1 · 2024: 2 · 2023: 3 · 2021: 3 · 2020: 6 · 2019: 6 · 2018: 8 · 2017: 8 · 2016: 10 · 2015: 5 · 2014: 9 · 2013: 8 · 2012: 17
FWCI: 13.57
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: Journal of the American Academy of Child & Adolescent Psychiatry (publishedVersion)
PubMed (publishedVersion)
Institutional Research Information System University of Turin (University of Turin) (submittedVersion)
Funders: U.S. Department of Health and Human Services
Eli Lilly and Company
Pfizer
GlaxoSmithKline
Kaiser Permanente
Northwestern University
Johns Hopkins University
University of Pittsburgh
University of Cincinnati
Case Western Reserve University
University of Oregon
York University
National Institutes of Health (n01mh080008-004, 98DS-0008)
National Institute of Mental Health (N01 MH 80008, 98-DS-0008, RFP-NIH-NIMH 98-DS-0008)
Duke Clinical Research Institute
Topics: Health Sciences › Medicine › Pharmacology (medical) › Treatment of Major Depression
Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Keywords: adolescent depression, major depressive disorder, fluoxetine, cognitive behavioral therapy, combined psychotherapy and pharmacotherapy, treatment efficacy, remission, response speed, quality of life, suicidality, treatment safety, prognostic factors, placebo response
MeSH terms: Adolescent, Combined Modality Therapy, Major Depressive Disorder, Fluoxetine, Humans, Quality of Life, Remission Induction, Severity of Illness Index, Cognitive Behavioral Therapy, Selective Serotonin Reuptake Inhibitors, Diagnostic and Statistical Manual of Mental Disorders

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