Tuesday, April 22, 2014

Getting Closer to Personalized Treatment for Teens with Treatment-Resistant Depression

National Institute of Mental HealthSome teens with treatment-resistant depression are more likely than others to get well during a second treatment attempt of combination therapy, but various factors can hamper their recovery, according to an NIMH-funded study published online ahead of print February 4, 2009, in the Journal of the American Academy of Child and Adolescent Psychiatry.

About 40 percent of teens with major depression do not get well after a first treatment attempt with an antidepressant medication. The NIMH-funded Treatment of Resistant Depression in Adolescents (TORDIA) study was designed to test second-step treatment strategies for these teens.
In TORDIA, 334 teens who did not get well after taking a type of antidepressant called a selective serotonin reuptake inhibitor (SSRI) before the trial were randomly assigned to one of four treatments for 12 weeks:
  • Switch to another SSRI
  • Switch to venlafaxine, a different type of antidepressant
  • Switch to another SSRI and add cognitive behavioral therapy (CBT), a type of psychotherapy
  • Switch to venlafaxine and add CBT
Results of the trial, which were reported in February 2008, showed that the teens who received medication plus CBT were more likely to get well than those who switched medications only. In this most recent data analysis, Joan Rosenbaum Asarnow, Ph.D., of the University of California Los Angeles, and colleagues aimed to identify how to better predict a teen's response to treatment, and any factors that might affect response.
Results of the Study 
Many predictors were similar to those found in studies of first-step treatments, such as the NIMH-funded Treatment for Adolescents with Depression Study (TADS), underscoring the importance of early treatment before the depression becomes chronic. For instance, like in TADS, teens in the TORDIA study were less likely to respond to treatment if they had very severe depression or higher levels of suicidal thinking. In addition, teens prone to self-harming behavior and family conflict were less likely to respond to treatment.

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