Monday, August 5, 2019

Adding Fluoxetine to CBT May Not Further Reduce Depressive Symptoms in Youth With MDD

A combination therapy of fluoxetine and cognitive-behavioral therapy (CBT) is not superior to CBT alone for treating teens and young adults with major depression, according to a study published in Lancet Psychiatry.

“[W]e did not find evidence that adding fluoxetine to CBT was beneficial for reducing depressive symptoms,” wrote Christopher Davey, M.B.B.S., Ph.D., of Orygen, the National Centre of Excellence in Youth Mental Health in Australia, and colleagues. “Our results show that adding fluoxetine to CBT might be more effective for treating anxiety symptoms than for depressive symptoms.”

Davey and colleagues conducted a 12-week randomized trial involving 153 participants aged 15 to 25 with moderate-to-severe major depression (score of 20 or higher on the Montgomery-├ůsberg Depression Rating Scale, or MADRS). All participants received weekly 50-minute CBT sessions as well as daily fluoxetine (up to 40 mg/day) or placebo pills. The researchers evaluated the participants’ depressive and anxiety symptoms, social functioning, quality of life, and suicidal thoughts every four weeks.

After 12 weeks, there was no statistical difference between the two study groups in terms of depression symptoms; MADRS scores decreased by 15.1 points among patients receiving CBT plus fluoxetine and 13.7 points among patients receiving CBT plus placebo. However, participants in the fluoxetine group showed statistically significant improvements in anxiety symptoms, as measured by the Generalized Anxiety Disorder 7-item scale (GAD-7); GAD-7 scores decreased by 5.3 points in the fluoxetine group compared with 3.2 points in the placebo group.

During the study, there were five suicide attempts in the CBT plus placebo group and one in the CBT plus fluoxetine group; all but one of these attempts were by participants 18 and older. In contrast, there were almost twice as many instances of nonsuicidal injury among participants taking fluoxetine compared with placebo, with most incidents occurring in participants under 18.

“The results of this study will probably discourage the combined use of CBT and medication as a first-line approach to treating youths with moderate-to-severe depression,” wrote Benedetto Vitiello, M.D., of the University of Turin, Italy, in an accompanying editorial. “Instead, a stepped-treatment approach, with initial monotherapy followed by the addition of another modality in case of insufficient response or to prevent relapse, seems to be a more reasonable use of resources.”

For more information on a related topic, see the Psychiatric News article “Adding Paroxetine May Not Improve CBT for Social Anxiety.”

(Image: iStock/izusek)


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