title: A Pilot SMART for Developing an Adaptive Treatment Strategy for Adolescent Depression.
abstract: This pilot study was conducted to assess the feasibility and acceptability of 4 adaptive treatment strategies (ATSs) for adolescent depression to plan for a subsequent full-scale clinical trial. The ATSs aim to address 2 questions that arise when personalizing treatment: (a) For adolescents treated with Interpersonal Psychotherapy for depressed adolescents (IPT-A; Mufson et al., 2004 ), at what time point should therapists make the determination that the adolescent is not likely to respond if the initial treatment plan is continued (week 4 or week 8)? (b) For adolescents who are judged to need their treatment augmented, should the therapist increase the number of IPT-A sessions or add pharmacotherapy (fluoxetine)? A 16-week pilot sequential multiple assignment randomized trial (SMART) was conducted with 32 adolescents (M age = 14.9) who had a diagnosis of major depressive disorder, dysthymic disorder, or depressive disorder not otherwise specified. Adolescents were primarily female (75%) and Caucasian (84.4%). Data regarding the feasibility and acceptability of the study and treatment procedures and treatment response rates were collected. Week 4 was the more feasible and acceptable decision point for assessing need for a change to treatment. Adolescents, parents, and therapists reported a range of attitudes about medication and more intensive therapy as treatment options. Results from the pilot study have yielded additional research questions for the full-scale SMART and will improve our ability to successfully conduct the trial.
authors.affiliation: a Department of Psychiatry , University of Minnesota.
authors.forename: Meredith
authors.initials: M
authors.lastname: Gunlicks-Stoessel
authors.affiliation: b Department of Psychiatry , Columbia University College of Physicians & Surgeons and New York State Psychiatric Institute.
authors.forename: Laura
authors.initials: L
authors.lastname: Mufson
authors.affiliation: a Department of Psychiatry , University of Minnesota.
authors.forename: Ana
authors.initials: A
authors.lastname: Westervelt
authors.affiliation: c Institute for Social Research , University of Michigan.
authors.forename: Daniel
authors.initials: D
authors.lastname: Almirall
authors.affiliation: c Institute for Social Research , University of Michigan.|d Department of Statistics, Department of Psychiatry.
authors.forename: Susan
authors.initials: S
authors.lastname: Murphy
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior / Q000523:psychology*; D018687:Antidepressive Agents, Second-Generation / Q000008:administration & dosage; D002648:Child; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy*; D005240:Feasibility Studies; D005260:Female; D005473:Fluoxetine / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D010865:Pilot Projects; D011613:Psychotherapy / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D018687:Antidepressive Agents, Second-Generation; D005473:Fluoxetine