TY - JOUR
T1 - Treatment of selective serotonin reuptake inhibitor-resistant depression in adolescents
T2 - Predictors and moderators of treatment response
AU - Asaknow, Joan Rosenbaum
AU - Emslie, Graham
AU - Clarke, Greg
AU - Wagner, Karen Dineen
AU - Spirito, Anthony
AU - Vitiello, Benedetto
AU - Iyengar, Satish
AU - Shamseddeen, Wael
AU - Ritz, Louise
AU - Birmaher, Boris
AU - Ryan, Neal
AU - Kennard, Betsy
AU - Mayes, Taryn
AU - DeBar, Lynn
AU - McCracken, James
AU - Strober, Michael
AU - Suddath, Robert
AU - Leonard, Henrietta
AU - Porta, Giovanna
AU - Keller, Martin
AU - Brent, David
N1 - Funding Information:
This study was supported by NIMH grants MH61835 (Pittsburgh), MH61856 (Galveston), MH61864 (UCLA), MH61869 (Portland), MH61958 (Dallas), and MH62014 (Brown) and the Advanced Center for Early-Onset Mood and Anxiety Disorders (MH66371, PI: D.B.).
PY - 2009/3
Y1 - 2009/3
N2 - Objective: To advance knowledge regarding strategies for treating selective serotonin reuptake inhibitor (SSRI)-resistant depression in adolescents, we conducted a randomized controlled trial evaluating alternative treatment strategies. In primary analyses, cognitive-behavioral therapy (CBT) combined with medication change was associated with higher rates of positive response to short-term (12-week) treatment than medication alone. This study examines predictors and moderators of treatment response, with the goal of informing efforts to match youths to optimal treatment strategies. Method: Youths who had not improved during an adequate SSRI trial (N= 334) were randomized to an alternative SSRI, an alternative SSRI plus CBT, venlafaxine, or venlafaxine plus CBT. Analyses examined predictors and moderators of treatment response. Results: Less severe depression, less family conflict, and absence of nonsuicidal self-injurious behavior predicted better treatment response status. Significant moderators of response to CBT + medication (combined) treatment were number of comorbid disorders and abuse history; hopelessness was marginally significant. The CBT/combined treatment superiority over medication alone was more evident among youths who had more cornorbid disorders (particularly attention-deficit/hyperactivity disorder and anxiety disorders), no abuse history, and lower hopelessness. Further analyses revealed a stronger effect of combined CBT + medication treatment among youths who were older and white and had no nonsuicidal self-injurious behavior and longer prestudy pharmacotherapy. Conclusions: Combined treatment with CBT and antidepressant medication may be more advantageous for adolescents whose depression is comorbid with other disorders. Given the additional costs of adding CBT to medication, consideration of moderators in clinical decision making can contribute to a more personalized and effective approach to treatment.
AB - Objective: To advance knowledge regarding strategies for treating selective serotonin reuptake inhibitor (SSRI)-resistant depression in adolescents, we conducted a randomized controlled trial evaluating alternative treatment strategies. In primary analyses, cognitive-behavioral therapy (CBT) combined with medication change was associated with higher rates of positive response to short-term (12-week) treatment than medication alone. This study examines predictors and moderators of treatment response, with the goal of informing efforts to match youths to optimal treatment strategies. Method: Youths who had not improved during an adequate SSRI trial (N= 334) were randomized to an alternative SSRI, an alternative SSRI plus CBT, venlafaxine, or venlafaxine plus CBT. Analyses examined predictors and moderators of treatment response. Results: Less severe depression, less family conflict, and absence of nonsuicidal self-injurious behavior predicted better treatment response status. Significant moderators of response to CBT + medication (combined) treatment were number of comorbid disorders and abuse history; hopelessness was marginally significant. The CBT/combined treatment superiority over medication alone was more evident among youths who had more cornorbid disorders (particularly attention-deficit/hyperactivity disorder and anxiety disorders), no abuse history, and lower hopelessness. Further analyses revealed a stronger effect of combined CBT + medication treatment among youths who were older and white and had no nonsuicidal self-injurious behavior and longer prestudy pharmacotherapy. Conclusions: Combined treatment with CBT and antidepressant medication may be more advantageous for adolescents whose depression is comorbid with other disorders. Given the additional costs of adding CBT to medication, consideration of moderators in clinical decision making can contribute to a more personalized and effective approach to treatment.
KW - Adolescents
KW - Cognitive-behavioral therapy
KW - Depression
KW - Treatment-resistant
UR - http://www.scopus.com/inward/record.url?scp=62849116679&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=62849116679&partnerID=8YFLogxK
U2 - 10.1097/CHI.0b013e3181977476
DO - 10.1097/CHI.0b013e3181977476
M3 - Article
C2 - 19182688
AN - SCOPUS:62849116679
SN - 0890-8567
VL - 48
SP - 330
EP - 339
JO - Journal of the American Academy of Child and Adolescent Psychiatry
JF - Journal of the American Academy of Child and Adolescent Psychiatry
IS - 3
ER -