Multiple secondary data analyses of TORDIA have identified important predictors of treatment response and relapse .
To up date a comparative effectiveness review ( 1980–2011 ) of treatments for adolescents whose depressive episode or disorder ( MDE/MDD ) did not respond to one or more trials of SSRI antidepressants .
Long-term outcome of adolescent depression initially resistant to selective serotonin reuptake inhibitor treatment: a follow-up study of the TORDIA sample.
BACKGROUND We examined the long-term outcome of participants in the Treatment of SSRI-Resistant Depression in Adolescents ( TORDIA ) study , a r and omized trial of 334 adolescents ( aged 12 - 18 years ) with DSM-IV-defined major depressive disorder initially resistant to selective serotonin reuptake inhibitor ( SSRI ) treatment who were subsequently treated for 12 weeks with another SSRI , venlafaxine , another SSRI + cognitive-behavioral therapy ( CBT ) , or venlafaxine + CBT . Responders then continued with the same treatment through week 24 , while nonresponders were given open treatment . METHOD For the current study , patients were reassessed 48 ( n = 116 ) and 72 ( n = 130 ) weeks from intake . Data were gathered from February 2001 to February 2007 . St and ardized diagnostic interviews and measures of depression , suicidal ideation , related psychopathology , and level of functioning were periodically administered . Remission was defined as ≥ 3 weeks with ≤ 1 clinical ly significant symptom and no associated functional impairment ( score of 1 on the adolescent version of the Longitudinal Interval Follow-Up Evaluation [ A-LIFE ] ) , and relapse , as ≥ 2 weeks with probable or definite depressive disorder ( score of 3 or 4 on the A-LIFE ) . Mixed-effects regression models were applied to estimate remission , relapse , and functional recovery . RESULTS By 72 weeks , an estimated 61.1 % of the r and omized youths had reached remission . R and omly assigned treatment ( first 12 weeks ) did not influence remission rate or time to remission , but the group assigned to SSRIs had a more rapid decline in self-reported depressive symptoms and suicidal ideation than those assigned to venlafaxine ( P < .03 ) . Participants with more severe depression  ,  greater  dysfunction , and alcohol or drug use at baseline were less likely to remit . The depressive symptom trajectory of the remitters diverged from that of nonremitters by the first 6 weeks of treatment ( P < .001 ) . Of the 130 participants in remission at week 24 , 25.4 % relapsed in the subsequent year . CONCLUSIONS While most adolescents achieved remission , more than one-third did not , and one-fourth of remitted patients experienced a relapse . More effective interventions are needed for patients who do not show robust improvement early in treatment . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00018902
Multiple secondary data analyses of TORDIA have identified important predictors of treatment response and relapse .
To up date a comparative effectiveness review ( 1980–2011 ) of treatments for adolescents whose depressive episode or disorder ( MDE/MDD ) did not respond to one or more trials of SSRI antidepressants .