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Paul Rohde, PhD; Susan G. Silva, PhD; Simon T. Tonev, PhD; Betsy D. Kennard, PsyD; Benedetto Vitiello, MD; Christopher J. Kratochvil, MD; Mark A. Reinecke, PhD; John F. Curry, PhD; Anne D. Simons, PhD; John S. March, MD

Arch Gen Psychiatry. 2008;65(4):447-455.

Context  The Treatment for Adolescents With Depression Study evaluated fluoxetine (FLX), cognitive behavioral therapy (CBT), and FLX/CBT combination (COMB) vs pill placebo in 439 adolescents with major depressive disorder. Treatment consisted of 3 stages: (1) acute (12 weeks), (2) continuation (6 weeks), and (3) maintenance (18 weeks).

Objective  To examine rates of achieving and maintaining sustained response during continuation and maintenance treatments.

Design  Randomized controlled trial. Response was determined by blinded independent evaluators.

Setting  Thirteen US sites.

Patients  Two hundred forty-two FLX, CBT, and COMB patients in their assigned treatment at the end of stage 1.

Interventions  Stage 2 treatment varied based on stage 1 response. Stage 3 consisted of 3 CBT and/or pharmacotherapy sessions and, if applicable, continued medication.

Main Outcome Measures  Sustained response was defined as 2 consecutive Clinical Global Impression–Improvement ratings of 1 or 2 ("full response"). Patients achieving sustained response were classified on subsequent nonresponse status.

Results  Among 95 patients (39.3%) who had not achieved sustained response by week 12 (29.1% COMB, 32.5% FLX, and 57.9% CBT), sustained response rates during stages 2 and 3 were 80.0% COMB, 61.5% FLX, and 77.3% CBT (difference not significant). Among the remaining 147 patients (60.7%) who achieved sustained response by week 12, CBT patients were more likely than FLX patients to maintain sustained response through week 36 (96.9% vs 74.1%; P = .007; 88.5% of COMB patients maintained sustained response through week 36). Total rates of sustained response by week 36 were 88.4% COMB, 82.5% FLX, and 75.0% CBT.

Conclusions  Most adolescents with depression who had not achieved sustained response during acute treatment did achieve that level of improvement during continuation and maintenance therapies. The possibility that CBT may help the subset of adolescents with depression who achieve early sustained response maintain their response warrants further investigation.

Trial Registration  clinicaltrials.gov Identifier: NCT00006286.

Author Affiliations: Oregon Research Institute (Dr Rohde) and University of Oregon (Dr Simons), Eugene; Duke Clinical Research Institute (Drs Silva, Tonev, and March) and Department of Psychiatry and Behavioral Sciences (Dr Curry), Duke University Medical Center, Durham, North Carolina; University of Texas Southwestern Medical Center at Dallas (Dr Kennard); National Institute of Mental Health, Bethesda, Maryland (Dr Vitiello); University of Nebraska Medical Center, Omaha (Dr Kratochvil); and Northwestern University, Evanston, Illinois (Dr Reinecke).

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