Author's reply

doi:10.1136/bmj.39289.579375.BE

BMJ 2007;335:221 (4 August), doi:10.1136/bmj.39289.579375.BE

Letters

Depression in adolescents

Author's reply

The first 150 words of the full text of this article appear below.

Jureidini (previous letter) is correct in reminding readersthat our trial is not a test of the efficacy of fluoxetine overpsychological treatments. I do not agree with his assertionthat it is acceptable to use a placebo arm in a pragmatic effectivenesstrial of treatment for adolescent depression.

There is evidence that active treatment involving interventionsof a psychological or a pharmacological nature is effectivecompared with a neutral passive placebo. Active psychologicaltreatment is more successful than placebo in reducing symptomsin the community,¹ and fluoxetine is effective in acceleratingthe response rate in more moderate to severe depression.² Undercurrent UK ethical guidelines and given the available evidencethe use of a neutral placebo could be considered to be exposingdepressed adolescents to greater risk than benefit.

I also disagree with Jureidini's negative perspective of theuse of fluoxetine and would guard against the implications ofnot . . . [Full text of this article]

Ian M Goodyer, professor of child and adolescent psychiatry

Developmental Psychiatry, Douglas House, Cambridge CB2 8AH

ig104@cam.ac.uk