Treatment of Resistant Depression in Adolescents (TORDIA): Week 24 outcomes

Graham J. Emslie, Taryn Mayes, Giovanna Porta, Benedetto Vitiello, Greg Clarke, Karen Wagner, Joan Rosenbaum Asarnow, Anthony Spirito, Boris Birmaher, Neal Ryan, Betsy Kennard, Lynn DeBar, James McCracken, Michael Strober, Matthew Onorato, Jamie Zelazny, Marty Keller, Satish Iyengar, David Brent

Research output: Contribution to journalArticle

101 Citations (Scopus)

Abstract

Objective: The purpose of this study was to report on the outcome of participants in the Treatment of Resistant Depression in Adolescents (TORDIA) trial after 24 weeks of treatment, including remission and relapse rates and predictors of treatment outcome. Method: Adolescents (ages 12-18 years) with selective serotonin reuptake inhibitor (SSRI)-resistant depression were randomly assigned to either a medication switch alone (alternate SSRI or venlafaxine) or a medication switch plus cognitive-behavioral therapy (CBT). At week 12, responders could continue in their assigned treatment arm and nonresponders received open treatment (medication and/or CBT) for 12 more weeks (24 weeks total). The primary outcomes were remission and relapse, defined by the Adolescent Longitudinal Interval Follow-Up Evaluation as rated by an independent evaluator. Results: Of 334 adolescents enrolled in the study, 38.9% achieved remission by 24 weeks, and initial treatment assignment did not affect rates of remission. Likelihood of remission was much higher (61.6% versus 18.3% ) and time to remission was much faster among those who had already demonstrated clinical response by week 12. Remission was also higher among those with lower baseline depression, hopelessness, and self-reported anxiety. At week 12, lower depression, hopelessness, anxiety, suicidal ideation, family conflict, and absence of comorbid dysthymia, anxiety, and drug/alcohol use and impairment also predicted remission. Of those who responded by week 12, 19.6% had a relapse of depression by week 24. Conclusions: Continued treatment for depression among treatment-resistant adolescents results in remission in approximately one-third of patients, similar to adults. Eventual remission is evident within the first 6 weeks in many, suggesting that earlier intervention among non-responders could be important.

Original languageEnglish (US)
Pages (from-to)782-791
Number of pages10
JournalAmerican Journal of Psychiatry
Volume167
Issue number7
DOIs
StatePublished - Jul 2010
Externally publishedYes

Fingerprint

Treatment-Resistant Depressive Disorder
Depression
Anxiety
Serotonin Uptake Inhibitors
Cognitive Therapy
Recurrence
Therapeutics
Family Conflict
Suicidal Ideation
Alcohols
Pharmaceutical Preparations

ASJC Scopus subject areas

  • Psychiatry and Mental health

Cite this

Treatment of Resistant Depression in Adolescents (TORDIA) : Week 24 outcomes. / Emslie, Graham J.; Mayes, Taryn; Porta, Giovanna; Vitiello, Benedetto; Clarke, Greg; Wagner, Karen; Asarnow, Joan Rosenbaum; Spirito, Anthony; Birmaher, Boris; Ryan, Neal; Kennard, Betsy; DeBar, Lynn; McCracken, James; Strober, Michael; Onorato, Matthew; Zelazny, Jamie; Keller, Marty; Iyengar, Satish; Brent, David.

In: American Journal of Psychiatry, Vol. 167, No. 7, 07.2010, p. 782-791.

Research output: Contribution to journalArticle

Emslie, GJ, Mayes, T, Porta, G, Vitiello, B, Clarke, G, Wagner, K, Asarnow, JR, Spirito, A, Birmaher, B, Ryan, N, Kennard, B, DeBar, L, McCracken, J, Strober, M, Onorato, M, Zelazny, J, Keller, M, Iyengar, S & Brent, D 2010, 'Treatment of Resistant Depression in Adolescents (TORDIA): Week 24 outcomes', American Journal of Psychiatry, vol. 167, no. 7, pp. 782-791. https://doi.org/10.1176/appi.ajp.2010.09040552
Emslie, Graham J. ; Mayes, Taryn ; Porta, Giovanna ; Vitiello, Benedetto ; Clarke, Greg ; Wagner, Karen ; Asarnow, Joan Rosenbaum ; Spirito, Anthony ; Birmaher, Boris ; Ryan, Neal ; Kennard, Betsy ; DeBar, Lynn ; McCracken, James ; Strober, Michael ; Onorato, Matthew ; Zelazny, Jamie ; Keller, Marty ; Iyengar, Satish ; Brent, David. / Treatment of Resistant Depression in Adolescents (TORDIA) : Week 24 outcomes. In: American Journal of Psychiatry. 2010 ; Vol. 167, No. 7. pp. 782-791.
@article{15266a8b72f24386977f4ddcd73cc2e5,
title = "Treatment of Resistant Depression in Adolescents (TORDIA): Week 24 outcomes",
abstract = "Objective: The purpose of this study was to report on the outcome of participants in the Treatment of Resistant Depression in Adolescents (TORDIA) trial after 24 weeks of treatment, including remission and relapse rates and predictors of treatment outcome. Method: Adolescents (ages 12-18 years) with selective serotonin reuptake inhibitor (SSRI)-resistant depression were randomly assigned to either a medication switch alone (alternate SSRI or venlafaxine) or a medication switch plus cognitive-behavioral therapy (CBT). At week 12, responders could continue in their assigned treatment arm and nonresponders received open treatment (medication and/or CBT) for 12 more weeks (24 weeks total). The primary outcomes were remission and relapse, defined by the Adolescent Longitudinal Interval Follow-Up Evaluation as rated by an independent evaluator. Results: Of 334 adolescents enrolled in the study, 38.9{\%} achieved remission by 24 weeks, and initial treatment assignment did not affect rates of remission. Likelihood of remission was much higher (61.6{\%} versus 18.3{\%} ) and time to remission was much faster among those who had already demonstrated clinical response by week 12. Remission was also higher among those with lower baseline depression, hopelessness, and self-reported anxiety. At week 12, lower depression, hopelessness, anxiety, suicidal ideation, family conflict, and absence of comorbid dysthymia, anxiety, and drug/alcohol use and impairment also predicted remission. Of those who responded by week 12, 19.6{\%} had a relapse of depression by week 24. Conclusions: Continued treatment for depression among treatment-resistant adolescents results in remission in approximately one-third of patients, similar to adults. Eventual remission is evident within the first 6 weeks in many, suggesting that earlier intervention among non-responders could be important.",
author = "Emslie, {Graham J.} and Taryn Mayes and Giovanna Porta and Benedetto Vitiello and Greg Clarke and Karen Wagner and Asarnow, {Joan Rosenbaum} and Anthony Spirito and Boris Birmaher and Neal Ryan and Betsy Kennard and Lynn DeBar and James McCracken and Michael Strober and Matthew Onorato and Jamie Zelazny and Marty Keller and Satish Iyengar and David Brent",
year = "2010",
month = "7",
doi = "10.1176/appi.ajp.2010.09040552",
language = "English (US)",
volume = "167",
pages = "782--791",
journal = "American Journal of Psychiatry",
issn = "0002-953X",
publisher = "American Psychiatric Association",
number = "7",

}

TY - JOUR

T1 - Treatment of Resistant Depression in Adolescents (TORDIA)

T2 - Week 24 outcomes

AU - Emslie, Graham J.

AU - Mayes, Taryn

AU - Porta, Giovanna

AU - Vitiello, Benedetto

AU - Clarke, Greg

AU - Wagner, Karen

AU - Asarnow, Joan Rosenbaum

AU - Spirito, Anthony

AU - Birmaher, Boris

AU - Ryan, Neal

AU - Kennard, Betsy

AU - DeBar, Lynn

AU - McCracken, James

AU - Strober, Michael

AU - Onorato, Matthew

AU - Zelazny, Jamie

AU - Keller, Marty

AU - Iyengar, Satish

AU - Brent, David

PY - 2010/7

Y1 - 2010/7

N2 - Objective: The purpose of this study was to report on the outcome of participants in the Treatment of Resistant Depression in Adolescents (TORDIA) trial after 24 weeks of treatment, including remission and relapse rates and predictors of treatment outcome. Method: Adolescents (ages 12-18 years) with selective serotonin reuptake inhibitor (SSRI)-resistant depression were randomly assigned to either a medication switch alone (alternate SSRI or venlafaxine) or a medication switch plus cognitive-behavioral therapy (CBT). At week 12, responders could continue in their assigned treatment arm and nonresponders received open treatment (medication and/or CBT) for 12 more weeks (24 weeks total). The primary outcomes were remission and relapse, defined by the Adolescent Longitudinal Interval Follow-Up Evaluation as rated by an independent evaluator. Results: Of 334 adolescents enrolled in the study, 38.9% achieved remission by 24 weeks, and initial treatment assignment did not affect rates of remission. Likelihood of remission was much higher (61.6% versus 18.3% ) and time to remission was much faster among those who had already demonstrated clinical response by week 12. Remission was also higher among those with lower baseline depression, hopelessness, and self-reported anxiety. At week 12, lower depression, hopelessness, anxiety, suicidal ideation, family conflict, and absence of comorbid dysthymia, anxiety, and drug/alcohol use and impairment also predicted remission. Of those who responded by week 12, 19.6% had a relapse of depression by week 24. Conclusions: Continued treatment for depression among treatment-resistant adolescents results in remission in approximately one-third of patients, similar to adults. Eventual remission is evident within the first 6 weeks in many, suggesting that earlier intervention among non-responders could be important.

AB - Objective: The purpose of this study was to report on the outcome of participants in the Treatment of Resistant Depression in Adolescents (TORDIA) trial after 24 weeks of treatment, including remission and relapse rates and predictors of treatment outcome. Method: Adolescents (ages 12-18 years) with selective serotonin reuptake inhibitor (SSRI)-resistant depression were randomly assigned to either a medication switch alone (alternate SSRI or venlafaxine) or a medication switch plus cognitive-behavioral therapy (CBT). At week 12, responders could continue in their assigned treatment arm and nonresponders received open treatment (medication and/or CBT) for 12 more weeks (24 weeks total). The primary outcomes were remission and relapse, defined by the Adolescent Longitudinal Interval Follow-Up Evaluation as rated by an independent evaluator. Results: Of 334 adolescents enrolled in the study, 38.9% achieved remission by 24 weeks, and initial treatment assignment did not affect rates of remission. Likelihood of remission was much higher (61.6% versus 18.3% ) and time to remission was much faster among those who had already demonstrated clinical response by week 12. Remission was also higher among those with lower baseline depression, hopelessness, and self-reported anxiety. At week 12, lower depression, hopelessness, anxiety, suicidal ideation, family conflict, and absence of comorbid dysthymia, anxiety, and drug/alcohol use and impairment also predicted remission. Of those who responded by week 12, 19.6% had a relapse of depression by week 24. Conclusions: Continued treatment for depression among treatment-resistant adolescents results in remission in approximately one-third of patients, similar to adults. Eventual remission is evident within the first 6 weeks in many, suggesting that earlier intervention among non-responders could be important.

UR - http://www.scopus.com/inward/record.url?scp=77954240902&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=77954240902&partnerID=8YFLogxK

U2 - 10.1176/appi.ajp.2010.09040552

DO - 10.1176/appi.ajp.2010.09040552

M3 - Article

C2 - 20478877

AN - SCOPUS:77954240902

VL - 167

SP - 782

EP - 791

JO - American Journal of Psychiatry

JF - American Journal of Psychiatry

SN - 0002-953X

IS - 7

ER -