Substance use and the treatment of resistant depression in adolescents.
OBJECTIVE
Despite the known association between substance use disorders and major depressive disorder (MDD) among adolescents, little is known regarding substance use among adolescents with MDD.


METHODS
Youths with MDD who had not improved after an adequate selective serotonin reuptake inhibitor trial (N = 334) were enrolled in the Treatment of SSRI-Resistant Depression in Adolescents trial. Analyses examined substance use (via the Drug Use Severity Index) and changes therein in relation to treatment and depressive symptoms. Adolescents meeting substance use disorder criteria via the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime version at baseline were excluded.


RESULTS
Substance use was common: 28.1% reported repeated experimentation at baseline. Substance-related impairment was associated with baseline depression severity, older age, physical/sexual abuse, family conflict, hopelessness, and comorbid oppositional defiant disorder/conduct disorder. There was significant improvement in substance-related impairment among adolescents who responded to MDD treatment. Baseline suicidal ideation was higher among the subjects who progressed to high substance-related impairment (≥ 75th percentile) versus those whose substance-related impairment remained low (< 75th percentile), and parental depressive symptoms predicted persistence of high substance-related impairment during the study. The MDD response was best among the adolescents with low 12 week substance-related impairment scores regardless of whether they had high or low baseline substance-related impairment. There were no significant differential effects of specific treatments, pharmacological or cognitive-behavioral therapy, on substance use.


CONCLUSIONS
Substance use is common among adolescents with treatment-resistant MDD. The subjects who had persistently low substance-related impairment or who demonstrated reduced substance-related impairment had better MDD treatment response, although the direction of this association is uncertain.
Goldstein
Benjamin I
BI
University of Pittsburgh, USA.
Shamseddeen
Wael
W
Spirito
Anthony
A
Emslie
Graham
G
Clarke
Greg
G
Wagner
Karen Dineen
KD
Asarnow
Joan Rosenbaum
JR
Vitiello
Benedetto
B
Ryan
Neal
N
Birmaher
Boris
B
Mayes
Taryn
T
Onorato
Matthew
M
Zelazny
Jamie
J
Brent
David A
DA
D000293:Adolescent; D000437:Alcoholism / Q000175:diagnosis / Q000453:epidemiology* / Q000534:rehabilitation*; D018687:Antidepressive Agents, Second-Generation / Q000627:therapeutic use*; D019958:Attention Deficit and Disruptive Behavior Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000534:rehabilitation; D002649:Child Abuse / Q000523:psychology / Q000706:statistics & numerical data; D002650:Child Abuse, Sexual / Q000523:psychology / Q000706:statistics & numerical data; D015928:Cognitive Behavioral Therapy; D003131:Combined Modality Therapy; D015897:Comorbidity; D019955:Conduct Disorder / Q000175:diagnosis / Q000453:epidemiology / Q000534:rehabilitation; D003511:Cyclohexanols / Q000627:therapeutic use*; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology* / Q000534:rehabilitation*; D017831:Diagnosis, Dual (Psychiatry); D004351:Drug Resistance; D004359:Drug Therapy, Combination; D054541:Family Conflict / Q000523:psychology; D005260:Female; D006801:Humans; D013287:Illicit Drugs; D008297:Male; D010555:Personality Inventory / Q000706:statistics & numerical data; D011594:Psychometrics; D011619:Psychotropic Drugs; D012307:Risk Factors; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use*; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000534:rehabilitation*; D059020:Suicidal Ideation; D016896:Treatment Outcome; D000069470:Venlafaxine Hydrochloride
D018687:Antidepressive Agents, Second-Generation; D003511:Cyclohexanols; D013287:Illicit Drugs; D011619:Psychotropic Drugs; D017367:Selective Serotonin Reuptake Inhibitors; D000069470:Venlafaxine Hydrochloride