title: Impact of treatments for depression on comorbid anxiety, attentional, and behavioral symptoms in adolescents with selective serotonin reuptake inhibitor-resistant depression.
abstract: OBJECTIVE
  To assess the relative efficacy of antidepressant medication, alone and in combination with cognitive behavioral therapy (CBT), on comorbid symptoms of anxiety, attention, and disruptive behavior disorders in participants in the Treatment of Resistant Depression in Adolescents (TORDIA) trial.
  
  
  METHODS
  Adolescents with selective serotonin reuptake inhibitor (SSRI)-resistant depression (N = 334) were randomly assigned to a medication switch alone (to another SSRI or to venlafaxine) or to a medication switch plus CBT. Anxiety, attention-deficit/hyperactivity disorder (ADHD), and disruptive behavior disorder (DBD) symptoms were assessed by psychiatric interview and self-report at regular intervals between baseline and 24 weeks. The differential effects of medication and of CBT, and the impact of remission on the course of comorbid symptoms and diagnoses, were assessed using generalized linear mixed models.
  
  
  RESULTS
  Remission was associated with a greater reduction in scalar measures of anxiety, ADHD, and DBDs, and a greater decrease in the rate of diagnosed anxiety disorders. The correlations between the changes in symptoms of depression on the CDRS-R and anxiety, ADHD, and oppositional symptoms were modest, ranging from r = 0.12 to r = 0.28. There were no significant differential treatment effects on diagnoses, or corresponding symptoms.
  
  
  CONCLUSIONS
  The achievement of remission had a beneficial effect on anxiety, ADHD, and DBD symptoms, regardless of the type of treatment received. There were no differential effects of medication or CBT on outcome, except for a nonsignificant trend that those adolescents treated with SSRIs showed a greater decrease in rates of comorbid DBDs relative to those treated with venlafaxine. Clinical trial registration information-Treatment of SSRI-Resistant Depression In Adolescents (TORDIA); http://clinicaltrials.gov/; NCT00018902.
authors.affiliation: Saint Louis University School of Medicine, MO, USA.
authors.forename: Robert C
authors.initials: RC
authors.lastname: Hilton
authors.forename: Manivel
authors.initials: M
authors.lastname: Rengasamy
authors.forename: Brandon
authors.initials: B
authors.lastname: Mansoor
authors.forename: Jiayan
authors.initials: J
authors.lastname: He
authors.forename: Taryn
authors.initials: T
authors.lastname: Mayes
authors.forename: Graham J
authors.initials: GJ
authors.lastname: Emslie
authors.forename: Giovanna
authors.initials: G
authors.lastname: Porta
authors.forename: Greg N
authors.initials: GN
authors.lastname: Clarke
authors.forename: Karen Dineen
authors.initials: KD
authors.lastname: Wagner
authors.forename: Boris
authors.initials: B
authors.lastname: Birmaher
authors.forename: Martin B
authors.initials: MB
authors.lastname: Keller
authors.forename: Neal
authors.initials: N
authors.lastname: Ryan
authors.forename: Wael
authors.initials: W
authors.lastname: Shamseddeen
authors.forename: Joan Rosenbaum
authors.initials: JR
authors.lastname: Asarnow
authors.forename: David A
authors.initials: DA
authors.lastname: Brent
mesh_terms: D000293:Adolescent; D001007:Anxiety / Q000188:drug therapy* / Q000453:epidemiology; D019958:Attention Deficit and Disruptive Behavior Disorders; D001526:Behavioral Symptoms / Q000188:drug therapy / Q000453:epidemiology; D015283:Citalopram / Q000008:administration & dosage / Q000494:pharmacology; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003131:Combined Modality Therapy / Q000379:methods; D015897:Comorbidity; D003511:Cyclohexanols / Q000008:administration & dosage / Q000494:pharmacology*; D061218:Depressive Disorder, Treatment-Resistant / Q000188:drug therapy* / Q000453:epidemiology; D005473:Fluoxetine / Q000008:administration & dosage; D006801:Humans; D017374:Paroxetine / Q000008:administration & dosage / Q000494:pharmacology; D012074:Remission Induction; D017367:Selective Serotonin Reuptake Inhibitors / Q000008:administration & dosage / Q000494:pharmacology*; D012720:Severity of Illness Index; D016896:Treatment Outcome; D000069470:Venlafaxine Hydrochloride
chemical_list: D015283:Citalopram; D003511:Cyclohexanols; D005473:Fluoxetine; D017374:Paroxetine; D017367:Selective Serotonin Reuptake Inhibitors; D000069470:Venlafaxine Hydrochloride