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Letters
December 1, 2004

Adolescents With Depression—Reply

Author Affiliations
 

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2004;292(21):2577-2579. doi:10.1001/jama.292.21.2578-c

In Reply: We appreciate the opportunity to clarify the results of TADS. Drs Antonuccio and Burns interpret our results as showing that fluoxetine offers no significant benefit over placebo, arguing (we believe incorrectly) that exercise is a placebo treatment and is somehow preferable to any of the TADS treatments. Drs Rifkin and Rifkin conclude that for the study population as a whole CBT plus fluoxetine offers little or no advantage over fluoxetine alone. In response, we note that TADS used the rate of improvement and 12-week outcome on the Children’s Depression Rating Scale, the rate of improvement and 12-week outcome on the RADS, and percentage of patients much or very much improved on the CGI scale. Fluoxetine in combination with CBT was superior to placebo and to CBT alone on all 5 measures. Combined treatment was superior to fluoxetine on 2 measures. Fluoxetine alone was superior to placebo on 3 measures and to CBT alone on all 5 measures. Additionally, fluoxetine in combination with CBT showed a large effect size and fluoxetine alone showed a moderate effect size on the Children’s Depression Rating Scale-Revised and on the CGI, whereas CBT alone was not different from placebo. Thus, we believe that the data show that fluoxetine in combination with CBT is best, fluoxetine alone is effective but not as effective as combined treatment, and that either fluoxetine-containing treatment is superior to CBT alone.

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