Researchers at the University of Texas Southwestern Medical Center and Children’s Medical Center of Dallas randomly assigned youth aged 8 to 17 with major depression who responded well to an initial six weeks of fluoxetine treatment to either continued monotherapy with fluoxetine or continued medication management combined with CBT for six months. Primary outcome measures were time to remission (with remission defined as a score of 28 or less on the Children’s Depression Rating Scale–Revised [CDRS-R]) and rate of relapse (with relapse defined as either a CDRS-R score of 40 or more with a history of two weeks of symptom worsening, or clinical deterioration).
During the 30-week continuation treatment period, time to remission did not differ significantly between treatment groups, but the medication management plus CBT group had a significantly lower risk of relapse than the medication management only group. The estimated probability of relapse by week 30 was 9% with medication management plus CBT and 26.5% with medication management only.
“To our knowledge, this is the ﬁrst randomized controlled trial of a sequential treatment strategy to prevent relapse in youths with major depressive disorder,” the researchers said. “The results demonstrate that, as in adults, sequencing treatments can reduce risk of relapse and lengthen time to relapse in depressed youths.”
For more information on the use of CBT in youth with depression, see the Psychiatric News article, “CBT Program Helps Some Teens Lower Their Depression Risk.”