When considering efficacy, the Treatment for Adolescents With Depression Study (TADS),1 in my view the best comparative study ever done in children with depression, ranks the acute outcome of the treatments from best to worst this way: combination treatment, followed by fluoxetine hydrochloride therapy alone, followed by cognitive behavior therapy (CBT) alone, followed by placebo. Analysis of longer-term efficacy2 suggests that CBT caught up with fluoxetine therapy at the 18-week follow-up and CBT caught up with the combination treatment at the 36-week follow-up (81% response for CBT, 81% response for fluoxetine therapy, and 85% response for combination treatment). When considering safety, the acute treatment rankings from best to worst were entirely different1: CBT alone was best, followed by placebo, followed by combination treatment, followed by fluoxetine therapy alone. These safety rankings were maintained (suicidal events were 6.3% in CBT, 8.4% in combination treatment, and 14.7% in fluoxetine therapy [not reported for placebo]) at follow-up,2 though combination treatment crept closer to CBT. What's a clinician to do? One possibility is to empower parents to make informed choices about treatment consistent with their own values by giving them this information on risk and benefit and letting them decide.
Thank you for submitting a comment on this article. It will be reviewed by JAMA Psychiatry editors. You will be notified when your comment has been published. Comments should not exceed 500 words of text and 10 references.
Do not submit personal medical questions or information that could identify a specific patient, questions about a particular case, or general inquiries to an author. Only content that has not been published, posted, or submitted elsewhere should be submitted. By submitting this Comment, you and any coauthors transfer copyright to the journal if your Comment is posted.
* = Required Field
Disclosure of Any Conflicts of Interest*
Indicate all relevant conflicts of interest of each author below, including all relevant financial interests, activities, and relationships within the past 3 years including, but not limited to, employment, affiliation, grants or funding, consultancies, honoraria or payment, speakers’ bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued. If all authors have none, check "No potential conflicts or relevant financial interests" in the box below. Please also indicate any funding received in support of this work. The information will be posted with your response.
Some tools below are only available to our subscribers or users with an online account.
Download citation file:
Web of Science® Times Cited: 1
Customize your page view by dragging & repositioning the boxes below.
More Listings atJAMACareerCenter.com >
Enter your username and email address. We'll send you a link to reset your password.
Enter your username and email address. We'll send instructions on how to reset your password to the email address we have on record.
Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.