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Evid Based Nurs 8:45 doi:10.1136/ebn.8.2.45
  • Treatment

Fluoxetine plus cognitive behavioural therapy was most effective for adolescents with major depressive disorder


 
 Q In adolescents with major depressive disorder (MDD), how do fluoxetine, cognitive behavioural therapy (CBT), and their combination compare for effectiveness?

METHODS

GraphicDesign:

randomised controlled trial (RCT).

GraphicAllocation:

{concealed}.*

GraphicBlinding:

blinded (patients and healthcare providers [fluoxetine v placebo comparison], and outcome assessors).

GraphicFollow up period:

12 weeks.

GraphicSetting:

outpatient clinic in the US.

GraphicPatients:

439 adolescents (mean age 15 y, 54% girls) who had a DSM-IV diagnosis of MDD, could attend an outpatient clinic, scored ⩾45 on the Children’s Depression Rating Scale–Revised (CDRS–R), had a full scale IQ ⩾80, and were not taking antidepressants. Exclusion criteria included bipolar disorder, severe conduct disorder, substance abuse/dependence, 2 failed selective serotonin reuptake inhibitor (SSRI) trials, and poor response to CBT.

GraphicIntervention:

fluoxetine, from 10 mg/day to a maximum of 40 mg/day by week 8 (n = 109); CBT (n = 111); CBT plus fluoxetine (n = 107); or placebo (n = 112). CBT consisted of 15 sessions (50–60 min each) for …

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