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.
Antonuccio D. Tailoring Treatment to Parental Values: A Comment on TADS. Arch Gen Psychiatry. 2008;65(6):723. doi:10.1001/archpsyc.65.6.723-a
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