- The addition of fluoxetine to cognitive behavioral therapy (CBT) does not enhance outcomes for youth with moderate-severe depression.
- There is some hint of benefit for older youth (more than age 18 years) and for amelioration of anxiety symptoms.
Why this matters
- The addition of pharmacotherapy to CBT for depression treatment in young people has been controversial.
- Adding fluoxetine to CBT did not improve scores on the Montgomery-Åsberg Depression Rating Scale (MADRS) vs placebo+CBT after 12 weeks of therapy.
- Both groups showed reduced MADRS scores, however:
- CBT+fluoxetine: −15.1 (95% CI, −17.4 to −12.9).
- CBT+placebo: −13.7 (95% CI, −16.0 to −11.4).
- Attempts at suicide did not differ between the groups (P=.21), nor did remission rates (P=.54).
- However, anxiety symptoms decreased significantly with fluoxetine added (P=.02).
- MADRS decreased a little more steeply with fluoxetine among participants older than age 18 years.
- Randomized, double-blind, placebo-controlled, multicenter Youth Depression Alleviation–Combined Treatment trial, included 153 care-seeking youth ages 15-25 years with moderate-severe depression, Australia.
- Participants were randomly allocated to 12 weeks of CBT+fluoxetine vs CBT+placebo.
- Outcome: change in MADRS.
- Funding: Australian National Health and Medical Research Council.
- Small numbers in study.