Improving outcome of paediatric depression with cognitive–behavioural therapy (CBT) after initial improvement on antidepressant medication

摘要

Major depression is a common cause ot disability in youth due to its high prevalence, frequently incomplete resolution, and tendency to recur.1 Psychosocial and pharmacological interventions are effective as acute treatments, but little information had been available to clinicians on how to best consolidate initial improvement and prevent relapse. METHODS OF THE STUDY This randomised trial tested whether adding cognitive-behavioural therapy (CBT) to antidepressant medication after initial symptomatic improvement helps with reaching remission and decreasing relapse. Two hundred youths, aged 8-17, with major depression were first treated with fluoxet-ine. After 6 weeks, 144 had improved and were randomised to either adding CBT or continuing only on medication for 6 months. CBT consisted of a total of 8-11 visits, included a family component, and was delivered by non-physician psychotherapists according to a manual. There were two primary outcomes: (1) time to remission (ie, absence of clinically significant depression as shown by a score below 29 on the Children's Depression Rating Scale-Revised) and (2) rate of relapse (defined as re-emergence of significant depression with a score of 40 or greater). Outcome data were obtained through patient interviews conducted by independent evaluators who were blinded to treatment assignment.