Kratochvil Christopher J, May Diane E, Silva Susan G, Madaan Vishal, Puumala Susan E, Curry John F, Walkup John, Kepley Hayden, Vitiello Benedetto, March John S
Department of Psychiatry, University of Nebraska Medical Center , Omaha, Nebraska, USA.
J Child Adolesc Psychopharmacol. 2009 Oct;19(5):519-27. doi: 10.1089/cap.2008.0143.
In the Treatment for Adolescents with Depression Study (TADS), fluoxetine (FLX) and the combination of fluoxetine with cognitive-behavioral therapy (COMB) had superior improvement trajectories compared to pill placebo (PBO), whereas cognitive-behavioral therapy (CBT) was not significantly different from PBO. Because attention-deficit/hyperactivity disorder (ADHD) and major depressive disorder (MDD) frequently co-exist, we examined whether ADHD moderated these outcomes in TADS.
A total of 439 adolescents with MDD, 12-17 years old, were randomized to FLX, CBT, COMB, or PBO. Random coefficients regression models examined depression improvement in 377 depressed youths without ADHD and 62 with ADHD, including 20 who were treated with a psychostimulant.
Within the ADHD group, the improvement trajectories of the three active treatments were similar, all with rates of improvement greater than PBO. For those without ADHD, only COMB had a rate of improvement that was superior to PBO.
Co-morbid ADHD moderated treatment of MDD. CBT alone or FLX alone may offer benefits similar to COMB in the treatment of MDD in youths with co-morbid MDD and ADHD, whereas monotherapy may not match the benefits of COMB for those without ADHD. The ADHD subgroup analysis presented in this paper is exploratory in nature because of the small number of youths with ADHD in the sample.
www.clinicaltrials.gov Identifier: NCT00006286. The TADS protocol and all of the TADS manuals are available on the Internet at https://trialweb.dcri.duke.edu/tads/index.html .
在青少年抑郁症治疗研究（TADS）中，与安慰剂（PBO）相比，氟西汀（FLX）以及氟西汀与认知行为疗法联合治疗（COMB）具有更好的改善轨迹，而认知行为疗法（CBT）与PBO无显著差异。由于注意力缺陷多动障碍（ADHD）和重度抑郁症（MDD）经常共存，我们研究了ADHD是否会影响TADS中的这些结果。
共有439名12至17岁的患有MDD的青少年被随机分配至FLX、CBT、COMB或PBO组。随机系数回归模型研究了377名无ADHD的抑郁青少年和62名有ADHD的抑郁青少年的抑郁改善情况，其中62名有ADHD的青少年中有20名接受了精神兴奋剂治疗。
在ADHD组中，三种积极治疗的改善轨迹相似，改善率均高于PBO。对于无ADHD者，只有COMB的改善率优于PBO。
共病ADHD会影响MDD的治疗。对于患有MDD和ADHD共病的青少年，单独使用CBT或FLX可能提供与COMB相似的治疗效果，而对于无ADHD者，单一疗法可能无法达到COMB的治疗效果。由于样本中患有ADHD的青少年数量较少，本文中的ADHD亚组分析本质上是探索性的。
www.clinicaltrials.gov标识符：NCT000062... 6. TADS方案和所有TADS手册可在互联网上获取，网址为https://trialweb.dcri.duke.edu/tads/index.html 。
