Intended for healthcare professionals

Rapid response to:


Selective serotonin reuptake inhibitors (SSRIs) and routine specialist care with and without cognitive behaviour therapy in adolescents with major depression: randomised controlled trial

BMJ 2007; 335 doi: (Published 19 July 2007) Cite this as: BMJ 2007;335:142

Rapid Response:

Both groups had "combined treatment"

In the Goodyer et al. study(1), patients in the SSRI alone group
received a “routine clinical care” intervention consisting of nine or more
treatment sessions that included problem-solving, family support,
psychoeducation and addressing co-morbidities. While this may be routine
care in the UK, this is not the case in the US where patients may receive
a prescription for an SSRI from a family practice provider with no
additional care other than (hopefully) monitoring of side effects and
suicide ideation. In the Treatment for Adolescents wtih Depression Study
(TADS), patients in the fluoxetine only group were offered six 20-30
minute medication monitoring visits that had no psychotherapy component,
only “general encouragement about the effectiveness of pharmacotherapy for
MDD (major depressive disorder)(2).

To me, the findings of the Goodyer et al. study complement the
findings of TADS, rather than contradict them. One cannot conclude from
the Goodyer et al. study that adding a behavioral health intervention to
SSRI treatment is ineffective since the control group received a type of
combined treatment. I might conclude, instead, that adding this particular
cognitive-behavioral therapy intervention to a routine behavioral health
intervention does not appear to be beneficial.

(1) Goodyer I et al. Selective serotonin reuptake inhibitors (SSRIs)
and routine specialist care wtih and without cognitive behavior therapy in
adolescents with major depression: randomized controlled trial. BMJ 2007:
335: 142.

(2) Treatment for Adolescents with Depression Study (TADS) team.
Fluoxetine, cognitive-behavioral therapy, and their combination for
adolescents with depression. JAMA 2004; 292: 807-820.

Competing interests:
None declared

Competing interests: No competing interests

24 July 2007
Diane Civic
Clinical Epidemiologist
Group Health, Seattle, WA 98112