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Fluoxetine plus cognitive behavioural therapy was most effective for adolescents with major depressive disorder
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 Q In adolescents with major depressive disorder (MDD), how do fluoxetine, cognitive behavioural therapy (CBT), and their combination compare for effectiveness?

Clinical impact ratings GP/FP/Primary care ★★★★★★☆ Mental health ★★★★★★☆ Psychiatry ★★★★★★☆ Paediatrics ★★★★★★☆

METHODS

Embedded ImageDesign:

2 x 2 factorial randomised placebo controlled trial.

Embedded ImageAllocation:

{concealed*}.

Embedded ImageBlinding:

blinded (patients and healthcare providers [fluoxetine v placebo comparison] and outcome assessors).*

Embedded ImageFollow up period:

12 weeks.

Embedded ImageSetting:

outpatient clinic in the US.

Embedded ImagePatients:

439 adolescents (mean age 14.6 y, 54% girls) who had a DSM-IV diagnosis of major depressive disorder, could attend an outpatient clinic, scored ⩾45 on the Children’s Depression Rating Scale–Revised (CDRS–R), had a full scale IQ ⩾80, and were not taking antidepressants. Exclusion criteria included bipolar disorder, severe conduct disorder, substance abuse/dependence, 2 failed selective serotonin reuptake inhibitor trials (SSRI), and poor response to CBT.

Embedded ImageIntervention:

(1) fluoxetine, from 10 mg/day to a maximum of 40 mg/day …

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