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December 1, 2004

Adolescents With Depression

Author Affiliations

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

JAMA. 2004;292(21):2577-2579. doi:10.1001/jama.292.21.2577-a

To the Editor: The authors of the Treatment for Adolescents With Depression Study (TADS) conclude that “ . . . despite calls to restrict access to medications, medical management of MDD [major depressive disorder] with fluoxetine, including careful monitoring for adverse events, should be made widely available, not discouraged.”1 We disagree with this conclusion. Looking at the primary outcome measure (change in the Children’s Depression Rating Scale-Revised total score), fluoxetine alone resulted in minimal benefit over placebo: the placebo effects were 86% of the fluoxetine effects (change of 19.4 compared with 22.6 points). At the same time, fluoxetine caused a significantly higher rate of harm-related adverse events, such as suicidal ideation, and physiological effects (diarrhea, insomnia, and sedation) compared with placebo or cognitive-behavioral therapy (CBT) alone, as well as a higher rate of psychiatric adverse events (irritability, mania, and fatigue) compared with placebo.

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