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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;



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


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.


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


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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  • Source of funding: NHS Health Technology Assessment Programme, Central Manchester and Manchester Children’s University Hospitals NHS Trust, and the Cambridge and Peterborough Mental Health Trust.


  • Competing interests: None.