The effectiveness of combined CBT and
fluoxetine for treating clinically depressed
youth has not been examined
previously in a randomized controlled
trial. As has generally been the case in
studies of depressed adults,18,19 CBT incrementally
enhanced clinical management
with fluoxetine leading to the
highest response rate among all treatments.
However, because the CBT plus
placebo condition was not included in
the design (it was deemed both too expensive
and too artificial to have clinical
relevance) it is not possible to determine
whether this combined effect
is additive (more is better) or synergistic
(the 2 treatments enhance each
other). Conversely, the divergent response
patterns for depression and suicidality
for participants who received
fluoxetine with CBT suggests that the
combination may exert a complimentary
effect (targeting different
domains) that enhances the overall
outcome.