Abstract
Background: Treatment studies of children and adolescents with internalizing disorders suggest that the combination of a selective serotonin reuptake inhibitor (SSRI) and cognitive behavioral therapy (CBT) consistently produces greater improvement than either treatment alone. We sought to determine how response to combined treatment varies across disorders (anxiety versus depression), and by specific patient characteristics. Methods: Three large National Institutes of Health-funded trials of children and adolescents with major depression (n = 2) and anxiety disorders (n = 1) were evaluated, each comparing CBT + SSRI to SSRI only, Bayesian Hierarchical Models (BHMs) were used, for endpoint response, time course of response and predictors of response in participants who received SSRI or SSRI+CBT. Results: SSRI+CBT significantly decreased symptoms by week 4 (p<0.001) across disorders. This improvement continued at week 8 and 12 (p<0.001); however, the additive benefit of CBT over SSRI monotherapy was not statistically significant until week 12 (p<0.001). The fastest response to SSRI+CBT was for patients who were younger, with milder baseline anxiety/depression symptoms and depressive disorders. The slowest response for SSRI+CBT was for boys, adolescents, minoritized children, those with severe symptoms and externalizing disorders. Limitations: Limitations included inconsistent moderators, variation in the number of observations over time and a lack of genetic or pharmacokinetic variables related to SSRI exposure across studies. Conclusions: The superiority of SSRI+CBT for youth with depression and anxiety is further supported. For purposes of rapid and greater relief, combination treatment is the superior approach across anxiety and depression and is robust to a range of participant characteristics. However, the added value of CBT (with an SSRI) occurs late in treatment. These findings represent a step towards understanding heterogeneity of treatment response and raise the possibility that interventions could be better tailored or adapted based on patient characteristics.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 292-300 |
| Number of pages | 9 |
| Journal | Journal of Affective Disorders |
| Volume | 298 |
| DOIs | |
| State | Published - Feb 1 2022 |
Funding
These original studies (CAMS, TADS and TORDIA) were supported by the National Institutes of Mental Health. The current analyses were supported by the Yung Family Foundation and The Eunice Kennedy Shriver National Institute of Child Health and Development (NICHD; Grant R01HD098757). None of the study funders had any role in the analysis, writing or content of this piece and had no role in the decision to submit the manuscript for publication. These original studies (CAMS, TADS and TORDIA) were supported by the National Institutes of Mental Health. The current analyses were supported by the Yung Family Foundation and The Eunice Kennedy Shriver National Institute of Child Health and Development (NICHD; Grant R01HD098757). None of the study funders had any role in the analysis, writing or content of this piece and had no role in the decision to submit the manuscript for publication. This work was supported by the Eunice Kennedy Shriver National Institute of Child Health and Development (NICHD) through Grants R01HD098757 (JRS) and R01HD099775 (JRS) and by the Yung Family Foundation. The authors thank the original study investigators and the patients and their families who participated in CAMS, TADS and TORDIA. This work was supported by the Eunice Kennedy Shriver National Institute of Child Health and Development (NICHD) through Grants R01HD098757 (JRS) and R01HD099775 (JRS) and by the Yung Family Foundation. The authors thank the original study investigators and the patients and their families who participated in CAMS, TADS and TORDIA.
Keywords
- Anxiety
- Clinical trial
- Depression
- Fluoxetine
- Major depressive disorder
- Paroxetine
- SSRI
- Sertraline
ASJC Scopus subject areas
- Psychiatry and Mental health
- Clinical Psychology
