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Adolescents with major depression who received cognitive behavioral therapy (CBT) after responding to an antidepressant were less likely to experience a relapse or recurrence of symptoms compared to teens who did not receive CBT, according to a small, NIMH-funded pilot study published in the December 2008 issue of the Journal of the American Academy of Child and Adolescent Psychiatry.

Studies have found that adults with depression who have responded to medication treatment are less likely to have a relapse if they receive CBT during the follow-up treatment phase, according to researchers Betsy Kennard, Psy.D., of the University of Texas Southwestern Medical Center, and colleagues. Scientists theorize that initial antidepressant treatment may help improve symptoms enough so that a patient becomes more receptive to CBT or other psychosocial component. Kennard and colleagues aimed to determine if a similar sequential treatment strategy would be effective with depressed adolescents.

In this pilot study, 46 depressed youths ages 11 to 18 who had responded to 12 weeks of treatment with the antidepressant fluoxetine (Prozac) were randomly assigned to either six months of continued medication management (MM), or to medication management plus cognitive behavioral therapy (MM+CBT) designed to prevent relapse.

Results of the Study
Kennard and colleagues found that the youths who received only MM were significantly more likely to relapse than the youths who received MM+CBT. The researchers estimated that 37 percent of those in the MM group were likely to relapse, while 15 percent of those in the MM+CBT group were likely to relapse. Patients getting MM+CBT also reported higher rates of satisfaction compared to those getting MM only.


This pilot study demonstrates that, as in adult studies, introducing CBT in follow-up treatment after a patient responds to antidepressant treatment may be a promising strategy in preventing relapse among depressed adolescents.

What’s Next

The researchers currently are conducting a larger trial of MM+CBT to further evaluate the effectiveness of this treatment strategy in youths with depression.


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