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Adding cognitive behavioural therapy to SSRIs does not improve outcomes in adolescents with major depression

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Professor Ian Goodyer

Developmental Psychiatry Section, Department of Psychiatry, Cambridge University, Cambridge CB2 2AH, UK; ig104@cam.ac.uk

QUESTION

Question:

Is cognitive behavioural therapy (CBT) an effective addition to selective serotonin reuptake inhibitors (SSRIs) for adolescents with major depression?

Patients:

208 adolescents (aged 11–17 years) diagnosed with moderate to severe major or probable major depression who had not responded to a brief initial intervention, or with active suicidal intent, self-harm, conduct disorder or depressive psychosis. Exclusions: adolescents who were immediately due to take, or were already taking, antidepressants.

Setting:

Six specialist child and adolescent mental health services in Manchester and Cambridge, UK; recruitment 2000–4.

Intervention:

An SSRI (fluoxetine) with or without CBT, received as part of ongoing clinical care. Fluoxetine was started at 10 mg daily for one week, increasing to 20 mg for 5 weeks, and increased to a maximum of 60 mg daily if there was no response by 6 weeks. CBT …

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