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Preventing Relapse in Pediatric Depression

Fluoxetine was better than placebo in this study of continuation treatment, but relapse rates were still notable.

Researchers in several studies have found that fluoxetine is significantly better than placebo for the acute treatment of major depressive disorder (MDD) in children and adolescents. Whether maintenance fluoxetine protects against relapse is an unanswered question. In this two-phase study, researchers gave fluoxetine to 169 children with MDD (age range, 7–18 years; mean age, 11.2) for 12 weeks. The 102 responders were randomized at week 12 to fluoxetine (mean dosage, 26.2 mg/day) or placebo for 6 months.

During either phase, participants who had not taken at least 70% of the pills at two consecutive visits, or at three visits overall, were discontinued from the study. Adverse events were assessed through general questions, rather than through questions about specific symptoms.

Relapse was significantly more frequent with placebo than with fluoxetine under both broad and conservative definitions of relapse (percentage relapsed under the broad definition: fluoxetine, 42%; placebo, 69%; under the conservative definition: fluoxetine, 22%; placebo, 48%). Participants with residual symptoms at 12 weeks were significantly more likely to relapse (46%) than participants with no residual symptoms (23%).

Comment: These findings show an advantage for fluoxetine compared with placebo during continuation treatment. However, the relatively high relapse rates, especially for participants with residual pathology, attest to the need for therapies that prevent relapse beyond currently available pharmacotherapy. Clinicians need to closely follow their depressed pediatric patients, even after acute response to fluoxetine.

— Barbara Geller, MD

Published in Journal Watch Psychiatry April 7, 2008

Citation(s):

Emslie GJ et al. Fluoxetine versus placebo in preventing relapse of major depression in children and adolescents. Am J Psychiatry 2008 Apr; 165:459.

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