Sequential Treatment With Fluoxetine and Relapse-Prevention CBT to Improve Outcomes in Pediatric Depression
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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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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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Croarkin, P. E., Nakonezny, P. A., Morris, D. W., Rush, A. J., Kennard, B. D., & Emslie, G. J. (2024) · JAACAP Open · doi:10.1016/j.jaacop.2024.05.002 · Cited by 1 · see citing works
Self-citationIs atomoxetine effective in some comorbid mental disorders in ADHD?
Cesnekova, D., Šnircová, E., Nosalova, G., & Ondrejka, I. (2016) · European Pharmaceutical Journal · doi:10.1515/afpuc-2016-0003 · Cited by 1 · see citing works
New Applications of Well-Being Therapy
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The Role of Aesthetics in Wellness
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Ogunyemi, D. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108650182.011 · Cited by 1 · see citing works
Volle, D. C., & DeBonis, K. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108650182.023 · Cited by 1 · see citing works
Allergic, Infectious, and Immunological Processes
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Penalty for Delay of Game? Sobering Results in Treating Adolescent Depression
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Practical pharmacotherapy in child psychiatry: an update
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Psychopharmacological Treatment for Depression in Children and Adolescents
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Pediatric Psychopharmacology: Commonly Used Medications in Children
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Le processus de validation de la Well-Being Therapy
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Mindfulness, Meditation, and Yoga
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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
- PMC
- PMC4182111
- 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
- green
- www.ncbi.nlm.nih.gov
- 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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