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


METHODS
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 nonresponders could be important.
Emslie
Graham J
GJ
University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-8589, USA. graham.emslie@utsouthwestern.edu
Mayes
Taryn
T
Porta
Giovanna
G
Vitiello
Benedetto
B
Clarke
Greg
G
Wagner
Karen Dineen
KD
Asarnow
Joan Rosenbaum
JR
Spirito
Anthony
A
Birmaher
Boris
B
Ryan
Neal
N
Kennard
Betsy
B
DeBar
Lynn
L
McCracken
James
J
Strober
Michael
M
Onorato
Matthew
M
Zelazny
Jamie
J
Keller
Marty
M
Iyengar
Satish
S
Brent
David
D
D000293:Adolescent; D018687:Antidepressive Agents, Second-Generation / Q000627:therapeutic use; D015928:Cognitive Behavioral Therapy; D003131:Combined Modality Therapy; D003511:Cyclohexanols / Q000627:therapeutic use; D003866:Depressive Disorder / Q000188:drug therapy / Q000628:therapy*; D005260:Female; D005473:Fluoxetine / Q000627:therapeutic use; D006801:Humans; D008297:Male; D011569:Psychiatric Status Rating Scales; D012074:Remission Induction; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use; D013997:Time Factors; D017211:Treatment Failure; D000069470:Venlafaxine Hydrochloride
D018687:Antidepressive Agents, Second-Generation; D003511:Cyclohexanols; D005473:Fluoxetine; D017367:Selective Serotonin Reuptake Inhibitors; D000069470:Venlafaxine Hydrochloride