Functioning and quality of life in the Treatment for Adolescents with Depression Study (TADS)

Objective: To test whether 12-week treatment of major depression improved the level of functioning, global health, and quality of life of adolescents. Method: The Treatment for Adolescents With Depression Study was a multisite, randomized clinical trial of fluoxetine, cognitive-behavioral therapy (CBT), their combination (COMB), or clinical management with placebo in 439 adolescents with major depression. Functioning was measured with the Children's Global Assessment Scale (CGAS), global health with the Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA), and quality of life with the Pediatric Quality of Life Enjoyment and Satisfaction Questionnaire (PQ-LES-Q). Random-effects regression models were applied to the data. Results: Compared with placebo, COMB was effective on the CGAS (p <.0001), HoNOSCA (p < 05), and PQ-LES-Q (p <.001), whereas fluoxetine was superior to placebo on the CGAS only (p <.05). COMB was superior to fluoxetine on the CGAS (p <.05) and PQ-LES-Q (p =.001). Fluoxetine was superior to CBT on the CGAS (p <.01). CBT monotherapy was not statistically different from the placebo group on any of the measures assessed. Treatment effects were mediated by improvement in depressive symptoms measured on the Child Depression Rating Scale-Revised. Conclusions: The combination of fluoxetine and CBT was effective in improving functioning, global health, and quality of life in depressed adolescents. Fluoxetine monotherapy improved functioning.