TY - JOUR
T1 - Do sub-syndromal manic symptoms influence outcome in treatment resistant depression in adolescents? A latent class analysis from the TORDIA study
AU - Maalouf, Fadi T.
AU - Porta, Giovanna
AU - Vitiello, Benedetto
AU - Emslie, Graham
AU - Mayes, Taryn
AU - Clarke, Gregory
AU - Wagner, Karen D.
AU - Asarnow, Joan Rosenbaum
AU - Spirito, Anthony
AU - Keller, Martin
AU - Birmaher, Boris
AU - Ryan, Neal
AU - Shamseddeen, Wael
AU - Iyengar, Satish
AU - Brent, David
N1 - Funding Information:
Dr. Keller is currently a professor of Psychiatry and Human Behavior at Brown University School of Medicine, has been a consultant and received honoraria from CENEREX, Medtronic, Sierra Neuropharmaceuticals, and has received grant funding from Pfizer.
Funding Information:
Dr. Brent is currently employed by the University of Pittsburgh, School of Medicine and the University of Pittsburgh Medical Center, Western Psychiatric Institute and Clinic; has received research support from the National Institute of Mental Health; receives royalties from Guilford Press; and serves as UpToDate Psychiatry Editor.
Funding Information:
Dr. Birmaher is currently employed by the University of Pittsburgh and the University of Pittsburgh Medical Center/Western Psychiatric Institute and Clinic; has received research funding from the National Institute of Mental Health; is a consultant for Schering Plough; and has received royalties from Random House, Inc. (New Hope for Children and Teens with Bipolar Disorder) and Lippincott Williams & Wilkins (Treating Child and Adolescent Depression).
PY - 2012/4
Y1 - 2012/4
N2 - Background: To identify distinct depressive symptom trajectories in the TORDIA study and determine their correlates. Methods: Latent Class Growth Analysis (LCGA) using the Children's Depression Rating Scale-Revised (CDRS-R) through 72 weeks from intake. Results: 3 classes were identified: (1) little change in symptomatic status ("NO"), comprising 24.9% of participants, with a 72-week remission rate of 25.3%; (2) slow, steady improvement ("SLOW"), comprising 47.9% of participants, with a remission rate of 60.0%, and (3) rapid symptom response ("GO"), comprising 27.2% of participants, with a remission rate of 85.7%. Higher baseline CDRS-R (p < 0.001) and poorer functioning (p = 0.03) were the strongest discriminators between NO and GO. Higher baseline CDRS (p < 0.001) and scores on the Mania Rating Scale (MRS) (p = 0.01) were the strongest discriminators between SLOW and GO. Other variables differentiating GO from both NO and from SLOW, were better baseline functioning, lower hopelessness, and lower family conflict. Both NO and SLOW showed increases on the MRS over time compared to GO (ps ≤ 0.04), and increasing MRS was strongly associated with lack of remission by 72 weeks (p = 0.02). Limitations: High rate of open treatment by the end of the follow-up period creates difficulty in drawing clear inferences about the long-term impact of initial randomization. Conclusion: Along with depressive severity, sub-syndromal manic symptoms, at baseline, and over time emerged as important predictors and correlates of poor outcome in this sample. Further research is needed on the treatment of severe depression, and on the assessment and management of sub-syndromal manic symptoms in treatment resistant depression.
AB - Background: To identify distinct depressive symptom trajectories in the TORDIA study and determine their correlates. Methods: Latent Class Growth Analysis (LCGA) using the Children's Depression Rating Scale-Revised (CDRS-R) through 72 weeks from intake. Results: 3 classes were identified: (1) little change in symptomatic status ("NO"), comprising 24.9% of participants, with a 72-week remission rate of 25.3%; (2) slow, steady improvement ("SLOW"), comprising 47.9% of participants, with a remission rate of 60.0%, and (3) rapid symptom response ("GO"), comprising 27.2% of participants, with a remission rate of 85.7%. Higher baseline CDRS-R (p < 0.001) and poorer functioning (p = 0.03) were the strongest discriminators between NO and GO. Higher baseline CDRS (p < 0.001) and scores on the Mania Rating Scale (MRS) (p = 0.01) were the strongest discriminators between SLOW and GO. Other variables differentiating GO from both NO and from SLOW, were better baseline functioning, lower hopelessness, and lower family conflict. Both NO and SLOW showed increases on the MRS over time compared to GO (ps ≤ 0.04), and increasing MRS was strongly associated with lack of remission by 72 weeks (p = 0.02). Limitations: High rate of open treatment by the end of the follow-up period creates difficulty in drawing clear inferences about the long-term impact of initial randomization. Conclusion: Along with depressive severity, sub-syndromal manic symptoms, at baseline, and over time emerged as important predictors and correlates of poor outcome in this sample. Further research is needed on the treatment of severe depression, and on the assessment and management of sub-syndromal manic symptoms in treatment resistant depression.
KW - Adolescent
KW - Depression
KW - Latent class analysis
KW - TORDIA
KW - Trajectories
UR - http://www.scopus.com/inward/record.url?scp=84858289082&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84858289082&partnerID=8YFLogxK
U2 - 10.1016/j.jad.2011.12.021
DO - 10.1016/j.jad.2011.12.021
M3 - Article
C2 - 22284022
AN - SCOPUS:84858289082
SN - 0165-0327
VL - 138
SP - 86
EP - 95
JO - Journal of Affective Disorders
JF - Journal of Affective Disorders
IS - 1-2
ER -