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Combined fluoxetine plus cognitive behavioural therapy is more effective than monotherapy or placebo for adolescents with depression

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Q What are the effects of fluoxetine plus cognitive behavioural therapy on depression and suicide ideation compared with either component alone or placebo?


Embedded ImageDesign:

Randomised controlled trial.

Embedded ImageAllocation:


Embedded ImageBlinding:

Double blind (fluoxetine and placebo), single blind (cognitive behavioural therapy (CBT) and combination treatment).

Embedded ImageFollow-up period:

Twelve weeks (treatment period only).

Embedded ImageSetting:

US; enrolment 2000–3.

Embedded ImagePatients:

439 adolescents (12–17 years) with major depressive disorder (DSM-IV) and a Children’s Depression Rating Scale-Revised (CDRS-R) total score ⩾45, demonstrating impairment due to depression in at least two settings (home, school or with friends) for at least 6 weeks. Exclusions: comorbid conditions requiring medication, previously failed CBT or two trials of selective serotonin reuptake inhibitor, currently receiving psychotherapy or psychotropic medication.

Embedded ImageIntervention:

Fluoxetine, CBT (15 sessions), fluoxetine plus CBT, or placebo for 12 weeks. Fluoxetine and placebo started at 10 mg/day, …

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  • For correspondence: Dr John March, Department of Psychiatry, DUMC Box 3527, Durham, NC 27710, USA; jsmarch{at}

  • Source of funding: National Institute of Mental Health.


  • Competing interests: None.

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