Continued Effectiveness of Relapse Prevention Cognitive-Behavioral Therapy Following Fluoxetine Treatment in Youth With Major Depressive Disorder

• Published in: Journal of the American Academy of Child and Adolescent Psychiatry Vol. 54; no. 12; pp. 991 - 998
• Main Authors: Emslie, Graham J., MD, Kennard, Betsy D., PsyD, Mayes, Taryn L., MS, Nakonezny, Paul A., PhD, Moore, Jarrette, MA, Jones, Jessica M., MA, Foxwell, Aleksandra A., PhD, King, Jessica, BA
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.12.2015; Elsevier BV
• Subjects: Adolescent; Behavior; CBT; Child; Children; Cognition; Cognitive ability; Cognitive aspects; Cognitive behavioral therapy; Cognitive Therapy; Cognitive-behavioral factors; Combined Modality Therapy; continuation treatment; Depression; Depressive Disorder, Major - therapy; Depressive personality disorders; Drugs; Evaluation; Female; Fluoxetine; Fluoxetine - therapeutic use; Follow-Up Studies; Formulae; Humans; Male; Management; Medical treatment; Mental depression; Pediatrics; Prevention programs; Proportional Hazards Models; Psychiatric Status Rating Scales; Psychiatry; Rating Scales; Recurrence; Relapse; Remission; Remission (Medicine); Remission Induction; Risk assessment; Risk Factors; Secondary Prevention - methods; Serotonin Uptake Inhibitors - therapeutic use; Severity of Illness Index; Single-Blind Method; Treatment Outcome; Youth; depression; CBT; relapse; youth; continuation treatment
• ISSN: 0890-8567; 1527-5418
• DOI: 10.1016/j.jaac.2015.09.014

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. Clinical trial registration information —Sequential Treatment of Pediatric MDD to Increase Remission and Prevent Relapse; http://clinicaltrials.gov/ ; NCT00612313.