Treatment for Adolescents With Depression Study (TADS) Team. (2004).Journal of the American Medical Association,292,807-820

Major depressive disorder (MDD) in adolescence is associated with significant morbidity and family burden. Initial treatment of MDD in adolescents may include cognitive-behavioral therapy (CBT) or a selective serotonin reuptake inhibitor (SSRI). Because minimal information exists about their relative or combined effectiveness, this randomized controlled trial (RCT) was designed to address the question. The sample consisted of 439 patients between the ages of 12 and 17 years with a primary diagnosis of MDD as defined by the Diagnostic and Statistical Manual of Mental Disorders (4th Ed.). Conducted at 13 academic and community clinics, the RCT consisted of four treatment interventions over a 12-week period: fluoxethine alone (10 to 40 mg/day); CBT alone; CBT with fluoxethine (10 to 40 mg/day); or placebo. Treatment interventions were designed to meet best practice standards and were conducted using standardized protocols that enabled dissemination in clinical practice at the end of the trial. The primary outcome measures included the Children's Depression Rating Scale-Revised total score (based on a synthesis of interview-collected information from both the adolescent patient and the parent) and a dichotomized Clinical Global impressions improvement score (defined as much improved or very much improved). Both outcome measures were assessed by the independent evaluator at baseline, week 6 and week 12. After 12 weeks of treatment, results indicated that the combination of fluoxethine with CBT offered the most favorable tradeoff between benefit and risk for adolescents with MDD. Clinically significant suicidal thinking, present in 29% of the sample at baseline, improved significantly in all four treatment groups. The results of this RCT underscore the importance of identifying and treating MDD in adolescents. Nurses working with adolescents in healthcare and community-based settings are encouraged to read the TADS study and the editorial (Glass, 2004) that provides additional insight for evidence-based practice and future research.

Comment by Laura L. Hayman

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