title: Do sub-syndromal manic symptoms influence outcome in treatment resistant depression in adolescents? A latent class analysis from the TORDIA study.
abstract: BACKGROUND
  To identify distinct depressive symptom trajectories in the TORDIA study and determine their correlates.
  
  
  METHODS
  Latent Class Growth Analysis (LCGA) using the Children's Depression Rating Scale-Revised (CDRS-R) through 72 weeks from intake.
  
  
  RESULTS
  3 classes were identified: (1) little change in symptomatic status ("NO"), comprising 24.9% of participants, with a 72-week remission rate of 25.3%; (2) slow, steady improvement ("SLOW"), comprising 47.9% of participants, with a remission rate of 60.0%, and (3) rapid symptom response ("GO"), comprising 27.2% of participants, with a remission rate of 85.7%. Higher baseline CDRS-R (p<0.001) and poorer functioning (p=0.03) were the strongest discriminators between NO and GO. Higher baseline CDRS (p<0.001) and scores on the Mania Rating Scale (MRS) (p=0.01) were the strongest discriminators between SLOW and GO. Other variables differentiating GO from both NO and from SLOW, were better baseline functioning, lower hopelessness, and lower family conflict. Both NO and SLOW showed increases on the MRS over time compared to GO (ps ≤ 0.04), and increasing MRS was strongly associated with lack of remission by 72 weeks (p=0.02).
  
  
  CONCLUSIONS
  High rate of open treatment by the end of the follow-up period creates difficulty in drawing clear inferences about the long-term impact of initial randomization.
  
  
  CONCLUSIONS
  Along with depressive severity, sub-syndromal manic symptoms, at baseline, and over time emerged as important predictors and correlates of poor outcome in this sample. Further research is needed on the treatment of severe depression, and on the assessment and management of sub-syndromal manic symptoms in treatment resistant depression.
authors.affiliation: American University of Beirut, Lebanon.
authors.forename: Fadi T
authors.initials: FT
authors.lastname: Maalouf
authors.forename: Giovanna
authors.initials: G
authors.lastname: Porta
authors.forename: Benedetto
authors.initials: B
authors.lastname: Vitiello
authors.forename: Graham
authors.initials: G
authors.lastname: Emslie
authors.forename: Taryn
authors.initials: T
authors.lastname: Mayes
authors.forename: Gregory
authors.initials: G
authors.lastname: Clarke
authors.forename: Karen D
authors.initials: KD
authors.lastname: Wagner
authors.forename: Joan Rosenbaum
authors.initials: JR
authors.lastname: Asarnow
authors.forename: Anthony
authors.initials: A
authors.lastname: Spirito
authors.forename: Martin
authors.initials: M
authors.lastname: Keller
authors.forename: Boris
authors.initials: B
authors.lastname: Birmaher
authors.forename: Neal
authors.initials: N
authors.lastname: Ryan
authors.forename: Wael
authors.initials: W
authors.lastname: Shamseddeen
authors.forename: Satish
authors.initials: S
authors.lastname: Iyengar
authors.forename: David
authors.initials: D
authors.lastname: Brent
mesh_terms: D000293:Adolescent; D001714:Bipolar Disorder / Q000175:diagnosis; D002648:Child; D015928:Cognitive Behavioral Therapy; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000188:drug therapy*; D061218:Depressive Disorder, Treatment-Resistant / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use; D013577:Syndrome
chemical_list: D017367:Selective Serotonin Reuptake Inhibitors