A Randomized Controlled Trial of Fluoxetine and Cognitive Behavioral Therapy in Adolescents With Major Depression, Behavior Problems, and Substance Use Disorders

Riggs, Paula; Mikulich‐Gilbertson, Susan K.; Davies, Robert D. M.; Lohman, Michelle; Klein, Constance; Stover, Shannon

doi:10.1001/archpedi.161.11.1026

Cited by 124 publications

(111 citation statements)

References 27 publications

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“…A second kind is combined treatments, EVIDENCE BASE UPDATE ASU in which ASU behavioral treatment is coordinated with medication intervention for a co-occurring disorder. For example, Riggs and colleagues have investigated CBT-I for ASU combined with stimulant medication for attention disorders (Riggs et al, 2011) and antidepressants for mood disorders (Riggs et al, 2007). 2.…”

Section: Discussionmentioning

confidence: 99%

Evidence Base on Outpatient Behavioral Treatments for Adolescent Substance Use: Updates and Recommendations 2007–2013

Hogue

Henderson

Ozechowski

et al. 2014

Journal of Clinical Child & Adolescent Psychology

145

120

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This article updates the evidence base on outpatient behavioral treatments for adolescent substance use (ASU) since publication of the previous review completed for this journal by Waldron and Turner (2008). It first summarizes the Waldron and Turner findings as well as those from more recent literature reviews and meta-analytic studies of ASU treatment. It then presents study design and methods criteria used to select 19 comparative studies subjected to Journal of Clinical Child & Adolescent Psychology level of support evaluation. These 19 studies are grouped by study category (efficacy or effectiveness) and described for sample characteristics, methodological quality, and substance use outcomes. Cumulative level of support designations are then made for each identified treatment approach: ecological family-based treatment, group cognitive-behavioral therapy, and individual cognitive-behavioral therapy are deemed Well Established; behavioral family-based treatment and motivational interviewing are deemed Probably Efficacious; drug counseling is deemed Possibly Efficacious; and four integrated treatment models combining more than one approach are deemed Well Established or Probably Efficacious. The remainder of the article (a) articulates fidelity, mediator, and moderator effects reported for evidence-based approaches since 2008 and (b) recommends four enhancements to the prevailing business model of ASU outpatient services to accelerate penetration of evidence-based approaches into the underserved consumer base: pursue partnerships with influential governmental systems, utilize web-based technology to extend reach and control costs, adapt effective methods for linking services across sectors of care, and promote uptake and sustainability by emphasizing return on investment. INTRODUCTIONThis article reviews the evidence base on outpatient behavioral treatments for adolescent substance use (Turner, Muck, Muck, Stephens, & Sukumar, 2004). Because practice guidelines in behavioral healthcare now favor on-site treatment over referral for comorbid disorders (see Sacks et al., 2013), behavioral therapists should be fully prepared to manage common ASU problems that present as a secondary reason for referral or an emergent treatment issue. Thus for behavioral health providers who serve teenage populations in a variety of settings, identifying effective treatments for ASU remains a top priority.The following two sections specify the area of intervention science surveyed in this update and recap the Waldron and Turner (2008) findings that are the launching point for review. The remainder of the article summarizes findings from other literature reviews and meta-analytic studies of ASU treatment published since 2008 and introduces the main contributions of the current review; defines the search parameters and inclusion criteria for identifying the final pool of 19 comparative studies subjected to the JCCAP evidence-based treatment evaluation criteria (Southam-Gerow & Prinstein, 2014); describes the main findings of these ...

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Section: Discussionmentioning

confidence: 99%

Evidence Base on Outpatient Behavioral Treatments for Adolescent Substance Use: Updates and Recommendations 2007–2013

Hogue

Henderson

Ozechowski

et al. 2014

Journal of Clinical Child & Adolescent Psychology

145

120

View full text Add to dashboard Cite

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“…The manual that was used was chosen because of its feasibility and empirical support as a psychosocial treatment for SUD in adolescents with co-occurring psychiatric and substance use disorders. 13 Other studies also demonstrate the efficacy of MI/CBT as a treatment for adolescent SUD. 1,14 The MI/CBT consisted of hour-long, weekly individual sessions and could include up to three family sessions.…”

Section: Methodsmentioning

confidence: 97%

Randomized, Controlled Trial of Atomoxetine for Attention-Deficit/Hyperactivity Disorder in Adolescents With Substance Use Disorder

Thurstone

Riggs

Salomonsen‐Sautel

et al. 2010

Journal of the American Academy of Child & Adolescent Psych

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Objective-To evaluate the effect of atomoxetine hydrochloride versus placebo on attentiondeficit/hyperactivity disorder (ADHD) and substance use disorder (SUD) in adolescents receiving motivational interviewing / cognitive behavioral therapy (MI/CBT) for SUD.Method-This single-site, randomized, controlled trial was conducted between December 2005 and February 2008. Seventy adolescents (13-19 years) with Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) (DSM-IV) ADHD, a DSM-IV ADHD checklist score greater than or equal to 22, and at least one non-tobacco SUD were recruited from the community. All subjects received 12 weeks of atomoxetine hydrochloride + MI/CBT versus placebo + MI/CBT. The main outcome measure for ADHD was self-report DSM-IV ADHD checklist score. For SUD, the main outcome was self-report number of days used non-tobacco substances in the past 28 days using the Timeline Followback interview.Results-Change in ADHD scores did not differ between atomoxetine + MI/CBT and placebo + MI/CBT (F4,191 = 1.23, p = 0.2975). Change in days used non-nicotine substances in the last 28 days did not differ between groups (F3,100 = 2.06, p = 0.1103).Conclusions-There was no significant difference between the atomoxetine + MI/CBT and placebo + MI/CBT groups in ADHD or substance use change. The MI/CBT and/or a placebo effect may have contributed to a large treatment response in the placebo group.

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“…[18] One subsequent RCT (126 people aged 13-19 years with depression, comorbid substance abuse disorder and conduct disorder) found no significant difference between fluoxetine plus CBT and CBT plus placebo in remission rates for depression (CDRS score 28 or less) after 16 weeks of treatment (70% with combined treatment v 52% with CBT alone, P = 0.07). [36] It found that combined treatment significantly improved depressive symptoms (measured by CDRS) compared with CBT alone (effect size 0.78; P = 0.04).…”

Section: Fluoxetine Plus Cbt Versus Fluoxetine Alonementioning

confidence: 95%

Complementary, light, sleep deprivation and exercise therapies

2007

Treating Depression Effectively

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INTRODUCTION: Depression may affect 2-8% of children and adolescents, with a peak incidence around puberty. It may be self-limiting, but about 40% of affected children experience a recurrent attack, a third of affected children will make a suicide attempt, and 3-4% will die from suicide. METHODS AND OUTCOMES: We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of pharmacological, psychological, combination, and complementary treatments for depression in children and adolescents? What are the effects of treatments for refractory depression in children and adolescents? We searched: Medline, Embase, The Cochrane Library, and other important databases up to April 2008 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). RESULTS: We found 18 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. CONCLUSIONS: In this systematic review we present information relating to the effectiveness and safety of the following interventions: citalopram, cognitive behavioural therapy (CBT) (individual or group, to prevent relapse), escitalopram, electroconvulsive therapy, family therapy, fluoxetine (alone or with cognitive therapy or CBT), fluvoxamine, group therapeutic support (other than CBT), guided self-help, individual psychodynamic psychotherapy, interpersonal therapy, lithium, mirtazapine, monoamine oxidase inhibitors (MAOIs), omega-3 polyunsaturated fatty acids, paroxetine, sertraline (alone or with CBT), St John's Wort (Hypericum perforatum), tricyclic antidepressants, and venlafaxine.

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A Randomized Controlled Trial of Fluoxetine and Cognitive Behavioral Therapy in Adolescents With Major Depression, Behavior Problems, and Substance Use Disorders

Cited by 124 publications

References 27 publications

Evidence Base on Outpatient Behavioral Treatments for Adolescent Substance Use: Updates and Recommendations 2007–2013

Evidence Base on Outpatient Behavioral Treatments for Adolescent Substance Use: Updates and Recommendations 2007–2013

Randomized, Controlled Trial of Atomoxetine for Attention-Deficit/Hyperactivity Disorder in Adolescents With Substance Use Disorder

Complementary, light, sleep deprivation and exercise therapies

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