Cited by 134Treatment of Major DepressionAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesPsychotherapy Techniques and Applications

Sequential Treatment With Fluoxetine and Relapse-Prevention CBT to Improve Outcomes in Pediatric Depression

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Kennard, Betsy D., Emslie, Graham J., Mayes, Taryn L., Nakonezny, Paul A., Jones, Jessica M., Foxwell, Aleksandra A., King, Jessica·2014·American Journal of Psychiatry

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. METHOD: 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.

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Crossref · 10.1176/appi.ajp.2014.13111460

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  • Three independent randomized controlled trials using the sequential combination of cognitive therapy and WBT were performed in Italy, Germany, and the US.

    “Three independent randomized controlled trials using the sequential combination of cognitive therapy and WBT were performed in Italy 73,74 , Germany 75 and the US 76 .”

    From The pursuit of euthymia (2020) · cites this paper as [76]

    The Methods describe a single-site randomized trial approved at the University of Texas Southwestern Medical Center, supporting its identification as a US trial. But the Discussion describes the sequence as fluoxetine followed by relapse-prevention CBT, not cognitive therapy combined with well-being therapy (WBT). This source also does not establish the stated total of three trials. (LLM, conf=0.85)

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Research works printed but not linked: 1

  1. [25]Emslie GJ Kennard BD Mayes TL Nightingale-Teresi J Carmody T Hughes CW Rush AJ Tao R Rintelmann JW Fluoxetine versus placebo in preventing relapse of major depression in children and adolescents Am J Psychiatry 2008 165 4 459 67 18281410 PMC2824429

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Authors
Kennard, B. D., Emslie, G. J., Mayes, T. L., Nakonezny, P. A., Jones, J. M., Foxwell, A. A., & King, J.
Affiliations
Children's Medical Center (US)
Venue
American Journal of Psychiatry
Published
2014-10
Volume
171
Issue
10
Pages
1083-1090
ISSN
  • 0002-953X (ISSN-L)
  • 1535-7228
OpenAlex
W2050645823
Cited by
134
References
30
Citations by year
2026: 2 · 2025: 4 · 2024: 7 · 2023: 8 · 2022: 8 · 2021: 3 · 2020: 62 · 2019: 5 · 2018: 11 · 2017: 7 · 2016: 11 · 2015: 5 · 2014: 1
FWCI
5.77
Type
journal article
Language
en
Open access
Locations
  • American Journal of Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • U.S. Department of State
  • Bristol-Myers Squibb
  • Eli Lilly and Company
  • Pfizer
  • GlaxoSmithKline
  • University of Miami
  • Valeant Pharmaceuticals International
  • Mylan
  • Texas Department of State Health Services
  • H. Lundbeck A/S
  • Forest Laboratories
  • Allergan
  • 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
childhood depression, major depressive disorder, fluoxetine, continuation treatment, relapse prevention, remission, children and adolescents, well-being therapy, residual depressive symptoms
MeSH terms
Adolescent, Child, Combined Modality Therapy, Major Depressive Disorder, Female, Fluoxetine, Humans, Male, Recurrence, Remission Induction, Time Factors, Cognitive Behavioral Therapy

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