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Sequential Treatment With Fluoxetine and Relapse-Prevention CBT to Improve Outcomes in Pediatric Depression
Open accessAbstract
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 73,74 , Germany 75 and the US 76 .”
From The pursuit of euthymia (2020) · cites this paper as [76]
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- [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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Metadata
- 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 (medical) › 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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