Remission and residual symptoms after short-term treatment in the Treatment of Adolescents with Depression Study (TADS).

Abstract

OBJECTIVE:

To ascertain remission rates in depressed youth participating in the Treatment for Adolescents With Depression Study (TADS), a multisite clinical trial that randomized 439 adolescents with major depressive disorder (MDD) to a 12-week treatment of fluoxetine (FLX), cognitive-behavioral therapy (CBT), their combination (COMB), or clinical management with pill placebo (PBO).

METHOD:

Using an end-of-treatment Children's Depression Rating Scale-Revised (CDRS-R) total score of 28 or below as the criterion for remission, rates of remission were examined with logistic regression, controlling for site. Loss of MDD diagnosis and residual symptoms in responders (defined as Clinical Global Impressions-Improvement (CGI-I) score of 1 (very much improved) or 2 (much improved) were also examined across treatment groups.

RESULTS:

After 12 weeks of treatment, 102 (23%) of 439 youths had reached remission. The remission rate was significantly higher in the COMB group (37%) relative to the other treatment groups (FLX, 23%; CBT, 16%; PBO, 17%), with odds ratios of 2.1 for COMB versus FLX, 3.3 for COMB versus CBT, and 3.0 for COMB versus PBO. In addition, 71% of subjects across treatment groups no longer met criteria for MDD at the end of acute treatment. Fifty percent of the youths who responded by CGI-I criteria continued to have residual symptoms, such as sleep or mood disturbances, fatigue, and poor concentration.

CONCLUSIONS:

The combination of FLX and CBT was superior to both monotherapy and PBO in terms of remission rates, but overall rates of remission remain low and residual symptoms are common at the end of 12 weeks of treatment.

• Authors: Betsy Kennard, Susan Silva, Benedetto Vitiello, John Curry, Christopher Kratochvil, Anne Simons, Jennifer Hughes, Norah Feeny, Elizabeth Weller, Michael Sweeney, Mark Reinecke, Sanjeev Pathak, Golda Ginsburg, Graham Emslie, John March, TADS Team
• Journal: Journal of the American Academy of Child and Adolescent Psychiatry (J Am Acad Child Adolesc Psychiatry) Vol. 45 Issue 12 Pg. 1404-11 (Dec 2006) ISSN: 0890-8567 [Print] United States
• PMID: 17135985 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)

Chemical References

• Serotonin Uptake Inhibitors
• Fluoxetine

Topics

• Adolescent
• Cognitive Behavioral Therapy (methods)
• Combined Modality Therapy
• Demography
• Depressive Disorder, Major (diagnosis, drug therapy, therapy)
• Diagnostic and Statistical Manual of Mental Disorders
• Female
• Fluoxetine (therapeutic use)
• Humans
• Male
• Remission Induction
• Selective Serotonin Reuptake Inhibitors (therapeutic use)
• Severity of Illness Index
• Time Factors