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Original ArticleOpen Access
Cognitive-Behavioral Therapy Added to Fluoxetine in Major Depressive Disorder after 4 Weeks of Fluoxetine-Treatment: 16-Week Open Label Study
Maneeton N 
,
Thongkam A ,
Maneeton B
,
Thongkam A ,
Maneeton B Background: Major depressive disorder (MDD) not responding to antidepressant treatment poses challenges
in planning therapy and prognostic uncertainties. Adjunctive treatment to antidepressants with cognitivebehavioral
therapy (CBT) may be useful for these patients.
Objective: Determine the efficacy of CBT augmentation in patients with MDD not responding to fluoxetine.
Material and Method: Ten patients diagnosed with MDD, by Diagnostic and Statistical Manual of Mental
Disorders Fourth edition (DSM-IV) criteria between December 2007 and July 2008 were enrolled to the
present study. All patients had taken fluoxetine at least 20 mg a day and for at least 4 weeks prior to consent.
Baseline Montgomery Asberg Depression Rating Scale (MADRS) ratings were all moderate to severe (22-44
point). The maximum number of sessions of CBT was 16. Patients treated with CBT for at least 8 weeks were
defined as the completed treatment group. Response was defined as a reduction in MADRS score by at least 50
percent from baseline and remission was defined as a reduction in score of 10 or less.
Results: Fluoxetine augmentation with CBT was a significantly effective treatment in patients with MDD not
responding to 4 week-fluoxetine treatment alone according to MADRS, Clinical Global Impression-Severity
of illness and the 9-item Patient Health Questionnaire, Thai Version (p < 0.001, p = 0.002 and 0.004
respectively). The overall response and remission rates were 100% and 70% respectively. The VAS satisfaction
scores increased from baseline significantly (p < 0.001). Overall quality of life of all patients by WHOQOLBREF
was improved significantly (p < 0.001).
Conclusion: Adding CBT to fluoxetine in patients with MDD who did not respond to 4 weeks treatment of
fluoxetine had significantly more efficacy than previous fluoxetine treatment alone. With no control group, a
randomized and controlled method might substantiate these promising preliminary findings.
Keywords: Cognitive-behavioral therapy, Major depressive disorder, Fluoxetine
in planning therapy and prognostic uncertainties. Adjunctive treatment to antidepressants with cognitivebehavioral
therapy (CBT) may be useful for these patients.
Objective: Determine the efficacy of CBT augmentation in patients with MDD not responding to fluoxetine.
Material and Method: Ten patients diagnosed with MDD, by Diagnostic and Statistical Manual of Mental
Disorders Fourth edition (DSM-IV) criteria between December 2007 and July 2008 were enrolled to the
present study. All patients had taken fluoxetine at least 20 mg a day and for at least 4 weeks prior to consent.
Baseline Montgomery Asberg Depression Rating Scale (MADRS) ratings were all moderate to severe (22-44
point). The maximum number of sessions of CBT was 16. Patients treated with CBT for at least 8 weeks were
defined as the completed treatment group. Response was defined as a reduction in MADRS score by at least 50
percent from baseline and remission was defined as a reduction in score of 10 or less.
Results: Fluoxetine augmentation with CBT was a significantly effective treatment in patients with MDD not
responding to 4 week-fluoxetine treatment alone according to MADRS, Clinical Global Impression-Severity
of illness and the 9-item Patient Health Questionnaire, Thai Version (p < 0.001, p = 0.002 and 0.004
respectively). The overall response and remission rates were 100% and 70% respectively. The VAS satisfaction
scores increased from baseline significantly (p < 0.001). Overall quality of life of all patients by WHOQOLBREF
was improved significantly (p < 0.001).
Conclusion: Adding CBT to fluoxetine in patients with MDD who did not respond to 4 weeks treatment of
fluoxetine had significantly more efficacy than previous fluoxetine treatment alone. With no control group, a
randomized and controlled method might substantiate these promising preliminary findings.
Keywords: Cognitive-behavioral therapy, Major depressive disorder, Fluoxetine
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