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CBT plus an SSRI was as effective as an SSRI alone for adolescents with moderate to severe depression.

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I Goodyer

Dr I Goodyer, Cambridge University, Cambridge, UK;



randomised controlled trial (Adolescent Depression Antidepressant and Psychotherapy Trial [ADAPT]).




blinded (outcome assessors).*



6 specialist outpatient clinics in Manchester and Cambridge, UK.


208 adolescents (median age 14 y, range 11–17 y, 74% girls) who met criteria for major or probable major depression (4 symptoms with psychosocial impairment and a score ⩾7 on the Health of the Nation outcome scales, indicating moderate to severe difficulties). Exclusion criteria included schizophrenia or bipolar disorder, pregnancy, global learning disability, medical or pharmacological contraindications, or previous unsuccessful treatment with SSRIs and cognitive–behavioural therapy (CBT).


fluoxetine and CBT (n = 105) or fluoxetine alone (n = 103). Fluoxetine dose was 10 mg/day for 1 week, increased to 20 mg/day for 5 weeks. If no response by week 6, dose was increased to 40 mg/day; if no response by week 12, dose …

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