Treating Depression and Oppositional Behavior in Adolescents

Abstract

Adolescents with depression and high levels of oppositionality often are particularly difficult to treat. Few studies, however, have examined treatment outcomes among youth with both externalizing and internalizing problems. This study examines the effect of fluoxetine, cognitive behavior therapy (CBT), the combination of fluoxetine and CBT, and placebo on co-occurring oppositionality within a sample of depressed adolescents. All treatments resulted in decreased oppositionality at 12 weeks. Adolescents receiving fluoxetine, either alone or in combination with CBT, experienced greater reductions in oppositionality than adolescents not receiving antidepressant medication. These results suggest that treatments designed to alleviate depression can reduce oppositionality among youth with a primary diagnosis of depression.

TADS is supported by contract N01 MH80008 from the National Institute of Mental Health (NIMH) to Duke University Medical Center (John S. March, Principal Investigator). Preparation of this manuscript was supported by NIMH fellowship F31 MH075308 to Rachel H. Jacobs. The Treatment for Adolescents with Depression Study is coordinated by the Department of Psychiatry and Behavioral Sciences and the Duke Clinical Research Institute at Duke University Medical Center in collaboration with the NIMH, Rockville, Maryland. The Coordinating Center principal collaborators are John March, Susan Silva, Stephen Petrycki, John Curry, Karen Wells, John Fairbank, Barbara Burns, Marisa Domino, and Steven McNulty. The NIMH principal collaborators are Benedetto Vitiello and Joanne Severe. Principal Investigators and Co-Investigators from the clinical sites are as follows: Carolinas Medical Center: Charles Casat, Jeanette Kolker, Karyn Riedal, Marguerita Goldman; Case Western Reserve University: Norah Feeny, Robert Findling, Sheridan Stull, Felipe Amunategui; Children's Hospital of Philadelphia: Elizabeth Weller, Michele Robins, Ronald Weller, Naushad Jessani; Columbia University: Bruce Waslick, Michael Sweeney, Rachel Kandel, Dena Schoenholz; Johns Hopkins University: John Walkup, Golda Ginsburg, Elizabeth Kastelic, Hyung Koo; University of Nebraska: Christopher Kratochvil, Diane May, Randy LaGrone, Martin Harrington; New York University: Anne Marie Albano, Glenn Hirsch, Tracey Knibbs, Emlyn Capili; University of Chicago/Northwestern University: Mark Reinecke, Bennett Leventhal, Catherine Nageotte, Gregory Rogers; Cincinnati Children's Hospital Medical Center: Sanjeev Pathak, Jennifer Wells, Sarah Arszman, Arman Danielyan; University of Oregon: Anne Simons, Paul Rohde, James Grimm, Lananh Nguyen; University of Texas Southwestern: Graham Emslie, Beth Kennard, Carroll Hughes, Maryse Ruberu; Wayne State University: David Rosenberg, Nili Benazon, Michael Butkus, Marla Bartoi. Greg Clarke (Kaiser Permanente) and David Brent (University of Pittsburgh) are consultants; James Rochon (Duke University Medical Center) is statistical consultant.

Disclosure: Susan Silva is a consultant with Pfizer. John March is a consultant or scientific advisor to Pfizer, Lilly, Wyeth, GSK, Jazz, and MedAvante and holds stock in MedAvante; he receives research support from Lilly and study drug for an NIMH-funded study from Lilly and Pfizer. The other authors have no financial relationships to disclose.

Notes

Note: All comparisons are made to pill placebo with clinical management. COMB = combination of fluoxetine (FLX) and cognitive behavioral therapy (CBT); AIC = Akaike's information criterion.

*p ≤ .05. **p ≤ .01.

Note: COMB = combination of fluoxetine (FLX) and cognitive behavioral therapy (CBT); PBO = pill placebo with clinical management.

**p ≤ .01.

Additional information

Notes on contributors

Rachel H. Jacobs

Rachel H. Jacobs is now at Columbia University College of Physicians and Surgeons, Department of Child Psychiatry.