Abstract
Objective To evaluate the continued effect of a sequential treatment strategy (fluoxetine followed by continued medication plus relapse prevention cognitive-behavioral therapy [RP-CBT]) on relapse prevention beyond the treatment phase. Method Youth (aged 8-17 years) with major depressive disorder (MDD) were treated with fluoxetine for 6 weeks. Responders (≥50% reduction on the Children's Depression Rating Scale-Revised [CDRS-R]) were randomized to continued medication management alone (MM) or continued medication management plus RP-CBT (MM+CBT) for an additional 6 months. Long-term follow-up assessments were conducted at weeks 52 and 78. Results Of 144 youth randomized to MM (n = 69) or MM+CBT (n = 75), 67% had at least 1 follow-up assessment, with equal rates in the 2 groups. Remission rates were high, although most had remitted during the 30-week treatment period. Only 6 additional participants remitted during long-term follow-up, and there were no differences on time to remission between MM+CBT and MM. The MM+CBT group had a significantly lower risk of relapse than the MM group throughout the 78-week follow-up period (hazard ratio = 0.467, 95% CI = 0.264 to 0.823; χ2 = 6.852, p =.009). The estimated probability of relapse during the 78-week period was lower with MM+CBT than MM only (36% versus 62%). Mean time to relapse was also significantly longer with MM+CBT compared to MM alone by approximately 3 months (p =.007). Conclusion The addition of RP-CBT after acute response to medication management had a continued effect on reducing risk of relapse even after the end of treatment.
Original language | English (US) |
---|---|
Pages (from-to) | 991-998 |
Number of pages | 8 |
Journal | Journal of the American Academy of Child and Adolescent Psychiatry |
Volume | 54 |
Issue number | 12 |
DOIs | |
State | Published - 2015 |
Keywords
- CBT
- continuation treatment
- depression
- relapse
- youth
ASJC Scopus subject areas
- Developmental and Educational Psychology
- Psychiatry and Mental health