252 Integrating Cognitive Behavioral Therapy and Pharmacotherapy in the Treatment of Adolescent Depression Golda S. Ginsburg, Johns Hopkins University School of Medicine Anne Marie Albano, Columbia University Robert L. Findling, University Hospitals of Cleveland and Case Western Reserve University Christopher Kratochvil, University of Nebraska John Walkup, Johns Hopkins University School of Medicine Recent evidence from the Treatment for Adolescents With Depression Study (TADS) suggests that combining cognitive behavioral and pharmacological treatments holds the most promise for ameliorating depression among adolescents. This article describes lessons learned during the TADS trial about how to integrate these two treatments in the care of adolescents with depression. Toward this end, both common and unique components of each perspective's approach to data gathering and treatment selection are presented. Proceduresfor changing "dosage" and adding adjunctive treatments to each of these interventions are also discussed. Finally, issues related to sequencing treatments and guidelines for sharing information across treatment providers are offered. A NOTED IN THIS SPECIAL ISSUE, major depressive dis- order (MDD) is a common, recurrent, and impair- ing disorder affecting some 3% to 5% of American ado- lescents (American Academy of Child and Adolescent Psychiatry [AACAP], 1998; Essau & Dobson, 1999; Kashani, Beck, et al., 1987; Kashani, Carlson, et al., 1987). Fortu- nately, during the past 30 years, the field has progressed from debating about the very existence of pediatric de- pression to the development and implementation of ef- fective psychotherapies and pharmacotherapies to treat the disorder in youth. With a growing empirical founda- tion coalescing in the Treatment for Adolescents With De- pression Study (TADS), we are approaching a consensus that cognitive behavioral therapy (CBT) and pharmaco- therapy (PT; specifically the selective serotonin reuptake inhibitors [SSRIs] ), are beneficial in the treatment of ad- olescent MDD (Emslie et al., 1997; Emslie, Heiligenstein, & Wagner, 2002; Harrington, Whittaker, Shoebridge, & Campbell, 1998; Keller et al., 2001; Lewinsohn & Clarke, 1999; Wagner et al., 2003). Clinicians employing these therapies, however, have had practical questions regard- ing the comparative effectiveness of CBT and pharmaco- therapy, order of implementation, potential effectiveness of combination therapy, and the feasibility and utility of establishing and maintaining collaborative relationships with their psychologist or psychiatrist colleagues. In the context of conducting TADS, psychiatrists and Cognitive and Behavioral Practice 12, 252-262, 2005 1077-7229/05/252-26251.00/0 Copyright © 2005 by Association for Advancement of Behavior Therapy. All rights of reproduction in any form reserved. psychologists were required to collaborate in the clinical care of adolescents with MDD in ways that were unique and perhaps unprecedented. Lessons learned from inte- grating CBT and PT during this trial are the focus of this article. Toward this aim, we discuss the common and dis- tinct components of CBT and PT with respect to data gathering and treatment. We describe how decisions for changing "dosage" and adding adjunctive treat- ments are made for each of these interventions, as well as issues related to sequencing treatments. Guidelines for sharing information across treatment providers are also discussed. Assessment: Data Gathering for CBT and PT The initial assessment and data gathering is a key com- ponent of both CBT and PT. Each approach attends to distinct information that can complement and enhance both treatment approaches. Data gathering for CBT fo- cuses on evaluating the individual's person-environment interactions, cognitive and behavioral excesses and defi- cits, and personal goals, to serve as a framework for under- standing the unique issues of the patient and how they can best be addressed in therapy (see Rogers, Reinecke, & Curry, 2005; this issue). The CBT therapist also gathers key data related to these and other factors to guide the se- lection and sequencing of CBT strategies. Also, these data are important for addressing obstacles that may arise in treatment (see Kennard, Ginsburg, Feeny, Sweeney, & Zagurski, 2005; this issue). One approach that facilitates the gathering of this information is based on the acro- nym PAINT. Each letter represents a component of data to be collected from parents and adolescents that lead to