1 / 25

Treatment for Adolescents With Depression Study (TADS)

Treatment for Adolescents With Depression Study (TADS). Fluoxetine, Cognitive Behavioral Therapy, and Their Combination for Adolescents With Depression Treatment for Adolescents With Depression Study (TADS) Team JAMA 2004: Vol 292, No. 7. TADS.

paniz
Download Presentation

Treatment for Adolescents With Depression Study (TADS)

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Treatment for Adolescents With Depression Study (TADS)

  2. Fluoxetine, Cognitive Behavioral Therapy, and Their Combination for Adolescents With Depression Treatment for Adolescents With Depression Study (TADS) Team JAMA 2004: Vol 292, No. 7

  3. TADS • A randomized controlled trial funded by the National Institute of Mental Health • Conducted at 13 academic and community centers in the United States • To evaluate the effectiveness of treatments for adolescents with MDD

  4. Participants • 429 patients • Age 12 -17 years (mean age 15 years) • Primary diagnosis of major depressive disorder (DSM-IV)

  5. Inclusion Criteria • Outpatient • CDRS ≥ 45 • IQ ≥ 80 • Not taking antidepressants • Depressive mood in at least 2 contexts for at least 6 weeks prior to consent

  6. Exclusion criteria • Bipolar disorder • Severe conduct disorder • Substance abuse • PDD • Thought disorder • Concurrent psychotropic medications • Failed 2 SSRIs or CBT

  7. Exclusion criteria Dangerousness to self or others • Had been hospitalized for dangerousness within 3 months • Suicidal attempt within 6 months • Active plan of suicide • Suicidal ideation with disorganized family

  8. Participants • Moderate to severe symptoms • Average depressive episode duration - 72 weeks • 27% had at least minimal suicidal ideation at baseline

  9. Randomization To 1 of 4 treatments for 12 weeks • Fluoxetine alone • CBT alone • Fluoxetine with CBT • Placebo

  10. Randomization • Blinding • Independent evaluators

  11. Fluoxetine • 6 medication visits x 20-30 minutes • Dosage adjusted • Starting dose 10 mg/d • Optimum 20 mg/d • Maximum 40 mg/d • Mean highest dose 30 mg/d

  12. CBT • 15 sessions over 12 weeks x 50-60 minutes • Psychoeducation • Mood monitoring • Increasing pleasant activities • Social problem solving • Cognitive restructuring • Parent and family sessions

  13. Outcome Assessment • Children’s Depression Rating Scale-Revised (CDRS-R) • CGI improvement score (much improved or very much improved) • Assessed at baseline, week 6, and week12

  14. Outcome Assessment • Reynolds Adolescent Depression Scale (RADS) • Suicidal Ideation Questionnaire-Junior High School Version (SIQ-Jr) • All measures reported acceptable psychometric properties

  15. Harm-Related Adverse Event • Harm to self; e.g. cutting • Worsening of suicidal ideation • Suicidal attempt • Harm to others

  16. Suicide-Related Adverse Event • Worsening suicidal ideation • Suicidal attempt

  17. Results • Combination of fluoxetine with CBT was significantly superior to • placebo • fluoxetine alone • CBT alone

  18. Results • Fluoxetine alone was superior to placebo • CBT alone was not superior to placebo • Fluoxetine alone was significantly better than CBT alone

  19. Response Rate Based On CGI • 71% in the fluoxetine with CBT • 61% in the fluoxetine alone • 43% in the CBT alone • 35% in the placebo

  20. Results

  21. Results “Combination of fluoxetine with CBT is better than fluoxetine alone, which is better than CBT alone, which is equal to placebo”

  22. Suicidal Behavior in Children Receiving SSRIs • Suicidal ideation decreased in all of the treatment groups • 6% of the patients experienced a suicide-related event with no statistically significant difference among the 4 treatment groups • Seven patients made a suicide attempt and there were no completed suicides

  23. Suicidal Behavior in Children Receiving SSRIs • Harm-related adverse events: increased risk (odds ratio = 2.19) for patients receiving fluoxetine compared with those who were not • The odds ratio was higher for fluoxetine alone compared with fluoxetine with CBT. • Protective effect for CBT for suicidal ideation

  24. Summary • Combination treatment with fluoxetine and CBT shows highest efficacy • CBT is a protective factor for suicide in adolescents receiving fluoxetine

More Related