Recovery and recurrence following treatment for adolescent major depression.
BACKGROUND
Major depressive disorder in adolescents is common and impairing. Efficacious treatments have been developed, but little is known about longer-term outcomes, including recurrence.


OBJECTIVE
To determine whether adolescents who responded to short-term treatments or who received the most efficacious short-term treatment would have lower recurrence rates, and to identify predictors of recovery and recurrence.


METHODS
Naturalistic follow-up study.


METHODS
Twelve academic sites in the United States.


METHODS
One hundred ninety-six adolescents (86 males and 110 females) randomized to 1 of 4 short-term interventions (fluoxetine hydrochloride treatment, cognitive behavioral therapy, their combination, or placebo) in the Treatment for Adolescents With Depression Study were followed up for 5 years after study entry (44.6% of the original Treatment for Adolescents With Depression Study sample).


METHODS
Recovery was defined as absence of clinically significant major depressive disorder symptoms on the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version interview for at least 8 weeks, and recurrence was defined as a new episode of major depressive disorder following recovery.


RESULTS
Almost all participants (96.4%) recovered from their index episode of major depressive disorder during the follow-up period. Recovery by 2 years was significantly more likely for short-term treatment responders (96.2%) than for partial responders or nonresponders (79.1%) (P < .001) but was not associated with having received the most efficacious short-term treatment (the combination of fluoxetine and cognitive behavioral therapy). Of the 189 participants who recovered, 88 (46.6%) had a recurrence. Recurrence was not predicted by full short-term treatment response or by original treatment. However, full or partial responders were less likely to have a recurrence (42.9%) than were nonresponders (67.6%) (P = .03). Sex predicted recurrence (57.0% among females vs 32.9% among males; P = .02).


CONCLUSIONS
Almost all depressed adolescents recovered. However, recurrence occurs in almost half of recovered adolescents, with higher probability in females in this age range. Further research should identify and address the vulnerabilities to recurrence that are more common among young women.
Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27705, USA. curry005@mc.duke.edu
John
J
Curry
Susan
S
Silva
Paul
P
Rohde
Golda
G
Ginsburg
Christopher
C
Kratochvil
Anne
A
Simons
Jerry
J
Kirchner
Diane
D
May
Betsy
B
Kennard
Taryn
T
Mayes
Norah
N
Feeny
Anne Marie
AM
Albano
Sarah
S
Lavanier
Mark
M
Reinecke
Rachel
R
Jacobs
Emily
E
Becker-Weidman
Elizabeth
E
Weller
Graham
G
Emslie
John
J
Walkup
Elizabeth
E
Kastelic
Barbara
B
Burns
Karen
K
Wells
John
J
March
D000293:Adolescent; D018687:Antidepressive Agents, Second-Generation / Q000627:therapeutic use*; D015928:Cognitive Behavioral Therapy; D003131:Combined Modality Therapy; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D005473:Fluoxetine / Q000627:therapeutic use*; D006801:Humans; D012008:Recurrence; D012737:Sex Factors; D016896:Treatment Outcome; D055815:Young Adult
D018687:Antidepressive Agents, Second-Generation; D005473:Fluoxetine