title: Major depression and treatment response in adolescents with ADHD and substance use disorder.
abstract: BACKGROUND
  Major depressive disorder (MDD) frequently co-occurs in adolescents with substance use disorders (SUDs) and attention deficit hyperactivity disorder (ADHD), but the impact of MDD on substance treatment and ADHD outcomes and implications for clinical practice are unclear.
  
  
  METHODS
  Adolescents (n=303; ages 13-18) meeting DSM-IV criteria for ADHD and SUD were randomized to osmotic release methylphenidate (OROS-MPH) or placebo and 16 weeks of cognitive behavioral therapy (CBT). Adolescents with (n=38) and without (n=265) MDD were compared on baseline demographic and clinical characteristics as well as non-nicotine substance use and ADHD treatment outcomes.
  
  
  RESULTS
  Adolescents with MDD reported more non-nicotine substance use days at baseline and continued using more throughout treatment compared to those without MDD (p<0.0001 based on timeline followback; p<0.001 based on urine drug screens). There was no difference between adolescents with and without MDD in retention or CBT sessions attended. ADHD symptom severity (based on DSM-IV ADHD rating scale) followed a slightly different course of improvement although with no difference between groups in baseline or 16-week symptom severity or 16-week symptom reduction. There was no difference in days of substance use or ADHD symptom outcomes over time in adolescents with MDD or those without MDD treated with OROS-MPH or placebo. Depressed adolescents were more often female, older, and not court ordered.
  
  
  CONCLUSIONS
  These preliminary findings suggest that compared to non-depressed adolescents with ADHD and SUD, those with co-occurring MDD have more severe substance use at baseline and throughout treatment. Such youth may require interventions targeting depression.
authors: Department of Psychiatry, University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Blvd., Dallas, TX 75390-9119, United States. Diane.Warden@UTSouthwestern.edu
authors: Diane
authors: D
authors: Warden
authors: Paula D
authors: PD
authors: Riggs
authors: Sung-Joon
authors: SJ
authors: Min
authors: Susan K
authors: SK
authors: Mikulich-Gilbertson
authors: Leanne
authors: L
authors: Tamm
authors: Kathlene
authors: K
authors: Trello-Rishel
authors: Theresa
authors: T
authors: Winhusen
mesh_terms: D000293:Adolescent; D019973:Alcohol-Related Disorders / Q000150:complications; D001289:Attention Deficit Disorder with Hyperactivity / Q000150:complications* / Q000188:drug therapy / Q000628:therapy; D000697:Central Nervous System Stimulants / Q000008:administration & dosage / Q000627:therapeutic use*; D015928:Cognitive Behavioral Therapy; D003131:Combined Modality Therapy; D003865:Major Depressive Disorder / Q000150:complications*; D005260:Female; D006801:Humans; D008297:Male; D008774:Methylphenidate / Q000008:administration & dosage / Q000627:therapeutic use*; D019966:Substance-Related Disorders / Q000150:complications*; D014029:Tobacco Use Disorder / Q000150:complications; D016896:Treatment Outcome
chemical_list: D000697:Central Nervous System Stimulants; D008774:Methylphenidate