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In adolescents with SSRI resistant depression, CBT/combined treatment is most effective in those with comorbid disorders

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What are the predictors and moderators of treatment response among adolescents with selective serotonin reuptake inhibitor (SSRI) resistant depression?


334 adolescents (aged 12–18 years) with a primary diagnosis of major depressive disorder in active treatment but who had not responded to a 2 month trial with an SSRI. See online notes for main exclusions.


US academic and community clinics; 2000–2006.


One of four 12 week regimens: switch to a second, different SSRI (paroxetine, fluoxetine or citalopram at 20–40 mg daily); switch to venlafaxine (150–225 mg daily); switch to second SSRI plus CBT; switch to venlafaxine plus CBT. Before the switch, participants’ existing medication was tapered to discontinuation over up to 2 weeks. CBT was delivered by experienced therapists with at least master’s level qualifications; up to 12 sessions of CBT (60–90 min each) were provided during the first 12 weeks (3–6 of them were family sessions). Predictor and moderator variables were assessed at baseline and included measures of depression severity, comorbidity, suicidality/self-injurious behaviour, functioning/impairment, demographic and other variables.


Predictor …

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  • Sources of funding NIMH grants and Advanced Center for Early-Onset Mood and Anxiety Disorders, USA.


  • Competing interests: None.

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