A randomised controlled trial of cognitive behaviour therapy in adolescents with major depression treated by selective serotonin reuptake inhibitors. The ADAPT trial. The treatment of SSRI-resistant depression in adolescents (TORDIA): in search of the best next step. A randomized effectiveness trial of brief cognitive-behavioral therapy for depressed adolescents receiving antidepressant medication. Comparative effectiveness of biomarkers and clinical indicators for predicting outcomes of SSRI treatment in Major Depressive Disorder: Results of the BRITE-MD study Prophylactic efficacy of fluoxetine, escitalopram, sertraline, paroxetine, and concomitant psychotherapy in major depressive disorder: Outcome after long-term follow-up A comparison of cognitive-behavioral therapy, sertraline, and their combination for adolescent depression. Adolescent depression: Controlled desipramine treatment and atypical features A Double-Blind Placebo-Controlled Trial of Omega-3 Fatty Acids as a Monotherapy for Adolescent Depression. A randomised controlled out-patient trial of cognitive-behavioural treatment for children and adolescents with depression: 9-month follow-up. Does comorbid substance use disorder impair recovery from major depression with SSRI treatment? An analysis of the STAR*D level one treatment outcomes. Antidepressants Reduce the Risk of Suicide among Elderly Depressed Patients Treatment of selective serotonin reuptake inhibitor-resistant depression in adolescents: predictors and moderators of treatment response. Depression Treatment in Patients With General Medical Conditions: Results From the CO-MED Trial The Treatment for Adolescents With Depression Study (TADS): outcomes over 1 year of naturalistic follow-up. Cognitive-behavioural therapy and short-term psychoanalytic psychotherapy versus brief psychosocial intervention in adolescents with unipolar major depression (IMPACT): a multicentre, pragmatic, observer-blind, randomised controlled trial. Concurrent treatment for adolescent and parent depressed mood and suicidality: feasibility, acceptability, and preliminary findings. A randomized, controlled trial of amitriptyline in the acute treatment of adolescent major depression.
OBJECTIVES To determine if , in the short term , depressed adolescents attending routine NHS Child and Adolescent Mental Health Services ( CAMHS ) , and receiving ongoing active clinical care , treatment with selective serotonin reuptake inhibitors ( SSRIs ) plus cognitive behaviour therapy ( CBT ) compared with SSRI alone , results in better healthcare outcomes . DESIGN A pragmatic r and omised controlled trial ( RCT ) was conducted on depressed adolescents attending CAMHS who had not responded to a psychosocial brief initial intervention ( BII ) prior to r and omisation . SETTING Six English CAMHS participated in the study . PARTICIPANTS A total of 208 patients aged between 11 and 17 years were recruited and r and omised . INTERVENTIONS All participants received active routine clinical care in a CAMHS outpatient setting and an SSRI and half were offered CBT . MAIN OUTCOME MEASURES The duration of the trial was a 12-week treatment phase , followed by a 16-week maintenance phase . Follow-up assessment s were at 6 , 12 and 28 weeks . The primary outcome measure was the Health of the Nation Outcome Scales for Children and Adolescents ( HoNOSCA ) . Secondary outcome measures were self-report depressive symptoms , interviewer-rated depressive signs and symptoms , interviewer-rated psychosocial impairment and clinical global impression of response to treatment . Information on re source use was collected in interview at baseline and at the 12- and 28-week follow-up assessment s using the Child and Adolescent Service Use Schedule ( CA-SUS ) . RESULTS Of the 208 patients r and omised , 200 ( 96 % ) completed the trial to the primary end-point at 12 weeks . By the 28-week follow-up , 174 ( 84 % ) participants were re-evaluated . Overall , 193 ( 93 % ) participants had been assessed at one or more time points . Clinical characteristics indicated that the trial was conducted on a severely depressed group . There was significant recovery at all time points in both arms . The findings demonstrated no difference in treatment effectiveness for SSRI + CBT over SSRI only for the primary or secondary outcome measures at any time point . This lack of difference held when baseline and treatment characteristics where taken into account ( age , sex , severity , co-morbid characteristics , quality and quantity of CBT treatment , number of clinic attendances ) . The SSRI + CBT group was somewhat more expensive over the 28 weeks than the SSRI-only group ( p=0.057 ) and no more cost-effective . Over the trial period there was on average a decrease in suicidal thoughts and self-harm compared with levels recorded at baseline . There was no significant increase in disinhibition , irritability and violence compared with levels at baseline . Around 20 % ( n=40 ) of patients in the trial were non-responders . Of these , 17 ( 43 % ) showed no improvement by 28 weeks and 23 ( 57 % ) were considered minimally ( n=10 ) or moderately to severely worse ( n=13 ) . CONCLUSIONS For moderately to severely depressed adolescents who are non-responsive to a BII , the addition of CBT to fluoxetine plus routine clinical care does not improve outcome or confer protective effects against adverse events and is not cost-effective . SSRIs ( mostly fluoxetine ) are not likely to result in harmful adverse effects . The findings are broadly consistent with existing guidelines on the treatment of moderate to severe depression . Modification is advised for those presenting with moderate ( 6 - 8 symptoms ) to severe depressions ( > 8 symptoms ) and in those with either overt suicidal risk and /or high levels of personal impairment . In such cases , the time allowed for response to psychosocial interventions should be no more than 2 - 4 weeks , after which fluoxetine should be prescribed . Further research should focus on evaluating the efficacy of specific psychological treatments against brief psychological intervention , determining the characteristics of patients with severe depression who are non-responsive to fluoxetine , relapse prevention in severe depression and improving tools for determining treatment responders and non-responders The Treatment of SSRI-Resistant Depression in Adolescents study ( TORDIA ) was design ed to inform clinicians as to the best next step in the treatment after a depressed adolescent has not responded to an adequate trial with a selective  serotonin re-uptake inhibitor (SSRI).[1 ] In this six-site study , conducted from 2000 to 2006 , 334 treatment-resistant adolescents with major depressive disorder ( MDD ) were r and omized to one of the four treatment strategies in a two-by-two balanced factorial design : ( a ) switch to another SSRI ; ( b ) switch to venlafaxine ; ( c ) switch to another SSRI and add cognitive behavioral therapy ( CBT ) ; or ( d ) switch to venlafaxine and add CBT . The SSRI switch options were fluoxetine , and for the first half of the trial ( n = 181 ) , paroxetine . Because of the concerns about the safety and efficacy of paroxetine , citalopram was used instead during the second half of the trial ( n = 153 ) . All enrolled youth had not responded to an “ adequate trial ” with an SSRI , defined as treatment for at least 8 weeks , with the last 4 weeks at a dosage that was the equivalent of 40 mg of fluoxetine . This communication focuses on acute treatment , which was 12 weeks in duration OBJECTIVE To test a collaborative-care , cognitive-behavioral therapy ( CBT ) program adjunctive to selective serotonin reuptake inhibitor ( SSRI ) treatment in HMO pediatric primary care . METHOD A r and omized effectiveness trial comparing a treatment-as-usual ( TAU ) control condition consisting primarily of SSRI medication delivered outside the experimental protocol ( n = 75 ) versus TAU SSRI plus brief CBT ( n = 77 ) . Participants were identified by a recent dispense of SSRI medication followed by telephone screening . Adolescents with a diagnosis of major depressive disorder ( n = 152 ) were enrolled . The CBT program employed cognitive restructuring and /or behavioral activation training . Therapists consulted with prescribing pediatricians to improve medication adherence . RESULTS Through 1-year follow-up , the authors found CBT advantages on the Short Form-12 Mental Component Scale ( p = .04 ) , reductions in  TAU outpatient visits ( p = .02 ) , and days ' supply of all medications ( p = .01 ) . No effects were detected for major depressive disorder episodes ; a nonsignificant trend favoring CBT was detected on the Center for Epidemiology Depression Scale ( p = .07 ) . CONCLUSIONS The authors detected a weak CBT effect , possibly rendered less significant by the small sample and likely attenuated by the unexpected reduction in SSRI pharmacotherapy in the CBT condition . Small , incremental improvements over monotherapy , such as observed in this study , most likely represent the new norm in adolescent depression treatment research Patients with Major Depressive Disorder ( MDD ) may not respond to antidepressants for 8 weeks or longer . A biomarker that predicted treatment effectiveness after only 1 week could be clinical ly useful . We examined a frontal quantitative electroencephalographic ( QEEG ) biomarker , the Antidepressant Treatment Response ( ATR ) index , as a predictor of response to escitalopram , and compared ATR with other putative predictors . Three hundred seventy-five subjects meeting DSM-IV criteria for MDD had a baseline QEEG study . After 1 week of treatment with escitalopram , 10 mg , a second QEEG was performed , and the ATR was calculated . Subjects then were r and omly assigned to continue with escitalopram , 10 mg , or change to alternative treatments . Seventy-three evaluable subjects received escitalopram for a total of 49days . Response and remission rates were 52.1 % and 38.4 % , respectively . The ATR predicted both response and remission with 74 % accuracy . Neither serum drug levels nor 5HTTLPR and 5HT2a genetic polymorphisms were significant predictors . Responders had larger decreases in Hamilton Depression Rating Scale ( Ham-D(17 ) ) scores at day 7 ( P=0.005 ) , but remitters did not . Clinician prediction based upon global impression of improvement at day 7 did not predict outcome . Logistic regression showed that the ATR and early Ham-D(17 ) changes were additive predictors of response , but the ATR was the only significant predictor of remission . Future studies should replicate these results prior to clinical use The acute efficacy of selective serotonin reuptake inhibitors ( SSRIs ) in the treatment of major depressive disorder ( MDD ) is well established ; however their role in longer-term prevention of recurrence remains unconfirmed . This study aims at examining : the prophylactic efficacy of four commonly used SSRIs in MDD in a naturalistic setting with long-term follow-up , the effect of concomitant cognitive behavioral therapy ( CBT ) , and the predictors of outcome . In a prospect i ve cohort study , 387 patients who either remitted or responded following treatment with four different SSRIs-fluoxetine , escitalopram , sertraline and paroxetine-were  followed up over several years . During an average follow-up period of 34.5 months , 76.5 % of patients experienced MDD recurrence . Escitalopram and fluoxetine showed a numerically higher prophylactic efficacy than paroxetine and sertraline but the difference was statistically insignificant . The prophylactic efficacy for SSRI-only treatment was limited , with a recurrence rate of 82.0 % , compared to 59.0 % of patient recurrence rate in concomitant Cognitive Behavioral Therapy ( CBT ) . The relatively small size of the CBT group and the lack of r and omization may undermine the extrapolation of its findings to clinical practice . Nevertheless , the study preliminary data may help in defining the clinical utility of antidepressants and CBT in the prophylaxis from MDD recurrence OBJECTIVE To evaluate cognitive-behavioral therapy , antidepressant medication alone , and combined CBT and antidepressant medication in the treatment of depressive disorders in adolescents . METHOD Seventy-three adolescents ( ages 12 - 18 years ) with a primary diagnosis of DSM-IV major depressive disorder , dysthymic disorder , or depressive disorder not otherwise specified were r and omly allocated to one of three treatments . Treatment outcome measures were administered before and after acute treatment , and at a 6-month follow-up . Depression diagnosis was the primary outcome measure ; secondary measures were self- and other report and clinician rating of global functioning . The trial was conducted at three community-based clinics between July 2000 and December 2002 . Data analyses used an intent-to-treat strategy . RESULTS Following acute treatment , all treatment groups demonstrated statistically significant improvement on outcome measures ( depressive diagnosis , Reynolds Adolescent Depression Scale , Revised Children 's Manifest Anxiety Scale , Suicidal Ideation Question naire ) , and improvement was maintained at follow-up . Combined cognitive-behavioral therapy and antidepressant medication was not found to be superior to either treatment alone . Compared with antidepressant medication alone , participants receiving cognitive-behavioral therapy alone demonstrated a superior acute treatment response ( odds ratio = 6.86 ; 95 % confidence interval 1.12 - 41.82 ) . Although cognitive-behavioral therapy was found to be superior to antidepressant medication alone for the acute treatment of mild to moderate depression among youth , this may have stemmed from the relatively low dose of sertraline used . CONCLUSIONS All treatments led to a reduction in depression , but the advantages of a combined approach were not evident The study was design ed to test the efficacy of desipramine in adolescents with major depression ( MDD ) . In addition , we assessed the presence of atypical features of MDD , consisting of mood reactivity and two of four associated features ( rejection sensitivity , hyperphagia , hypersomnia , and leaden paralysis ) . Patients were r and omized to desipramine ( DMI ) or placebo for 6 weeks , provided they failed to improve ( e.g. , meeting MDD criteria and a Hamilton Depression Scale score ≥18 ) after 2 weeks on single blind placebo . Of 94 adolescents ( ages 13–18 ) who were diagnosed as having MDD , 64 entered the study and 62 received placebo for 2 weeks . Of these , 45 were r and omized  to DMI or  placebo . Completer analyses did not reveal significant improvement for the active treatment compared to the placebo . A large proportion of adolescents responded to placebo ( 50 % ) , suggesting the need for very large sample s to detect differential treatment efficacy , should it exist . A relatively high rate of atypical depression was observed ( 47 % in the 64 patients entered ) . In view of the demonstrated specificity of monoamine oxidase inhibitor efficacy in adults with atypical features of MDD , this clinical subtype may have relevance to future investigation of therapeutic interventions in adolescent MDD . Depression and Anxiety 7:15–31 , 1998 . © 1998 Wiley‐Liss , OBJECTIVE Reports are mixed on the efficacy of omega-3 fatty acids ( O3FA ) for the treatment of major depressive disorder ( MDD ) , with only limited data in adolescents . The present trial aim ed to investigate systematic ally the efficacy of O3FA as a monotherapy , compared to a placebo , in adolescents with MDD . Secondarily , we explored O3FA effects on anhedonia , irritability , and suicidality-all key features of adolescent MDD . METHODS Fifty-one psychotropic medication-free adolescents with DSM-IV-TR diagnoses of MDD ( aged 12 - 19 years ; 57 % female ) were r and omized to receive O3FA or a placebo for 10 weeks . Data were collected between January 2006 and June 2013 .  O3FA and a placebo were administered on a fixed-flexible dose titration schedule based on clinical response and side effects . The initial dose of 1.2 g/d was increased 0.6 g/d every 2 weeks , up to a maximum of 3.6 g/d . Clinician-rated and self-rated depression severity , along with treatment response , served as primary outcome measures . Additionally , we examined O3FA effects on depression-related symptoms , including anhedonia , irritability , and suicidality . Treatment differences were analyzed via intent-to-treat analyses . RESULTS O3FA were not superior to a placebo on any clinical feature , including depression severity and levels of anhedonia , irritability , or suicidality . Additionally , response rates were comparable between treatment groups . Within-treatment analyses indicated that both treatments were associated with significant improvement in depression severity on self- ( O3FA : t = -4.38 , P < .001 ; placebo : t = -3.52 , P = .002 ) and clinician ( O3FA : t = -6.47 , P < .001 ; placebo : t = -8.10 , P < .001 ) ratings . CONCLUSIONS In adolescents with MDD , O3FA do not appear to be superior to placebo . TRIAL REGISTRATION Clinical Trials.gov identifier : NCT00962598 Nine-month outcome data of a r and omized controlled out-patient trial of cognitive-behavioural treatment ( CBT ) for children and adolescents with depression are presented . CBT was compared with a non-focussed intervention ( NFI ) in 56 subjects . At 9 months after thr termination of the trial , 21 children ( 37.5 % ) fulfilled criteria for a psychiatric disorder ( DSM-III-R ) , out of whom 15 ( 26.8 % ) had a depressive illness . However , 25 subjects ( 45 % ) reported depressive symptoms of significant severity to suggest a depressive episode during the previous 9-month period . Both treatment groups maintained a significant improvement on all psychosocial measures since the post-treatment assessment . No significant treatment effect was established . Low self-esteem at the time of referral , predicted presence of psychiatric disorder , and child-reported scores of depressive symptoms and low self-esteem at follow-up . The research and clinical implication s for the treatment of depressive disorders in young life are discussed Many patients with major depressive disorder ( MDD ) present with concurrent substance use disorders ( SUDs ) , which has been thought to impair their response to antidepressants . Clinicians often delay antidepressant treatment until sustained sobriety has been established . Unfortunately , these comorbid subjects are typically excluded from depression treatment trials , leaving a gap in underst and ing the treatment outcomes . In the Sequenced Treatment Alternatives to Relieve Depression ( STAR*D ) study , 2876 adult out patients diagnosed with nonpsychotic MDD were prospect ively treated with the selective serotonin-reuptake inhibitor ( SSRI ) , citalopram , and returned for at least one post-baseline visit .  Participants with SUD ( 29 % ) and without SUD ( 71 % ) were compared in regard to baseline clinical and sociodemographic features and treatment response . The group with MDD and SUD was further subdivided into those with alcohol only , drug only , and both alcohol and drug use . Despite clear sociodemographic and clinical differences , there were no significant differences between groups in the time to achieve response or rates of response to citalopram ;  however , those who endorsed both alcohol and drug use had significantly reduced rates of remission and significantly increased times to reach remission compared to the MDD group without SUD . In addition , subjects with MDD and SUD had higher risk of psychiatric serious adverse events ( 3.3 % vs. 1.5 % ) and hospitalization ( 2.8 % vs. 1.2 % ) . The results indicate that first-line treatment with citalopram in depressed patients with alcohol or drug use respond as well as those without SUD . More intensive treatment is most likely needed for MDD patients with both drug and alcohol use disorders Treatment with selective serotonin reuptake inhibitors ( SSRIs ) may increase the risk of impulsive acts including suicide , while data from epidemiological studies suggest that the effect of SSRIs in the elderly may be beneficial . We aim ed to evaluate the association between exposure to antidepressants and suicidality in a cohort of elderly patients suffering from major depressive disorder ( MDD ) . This was a retrospective matched case-controlled evaluation over a 10-year period . All records of admissions of patients with MDD ( ICD-10 ) were assessed . The index group comprised all patients who had attempted suicide in the month prior to admission . The case-controlled group was the next admission of a patient suffering from MDD , matched for sex and age who had not attempted suicide  in the month prior to admission . The index group during the 10-year period ( 1995–2004 ) consisted of 101 patients suffering from MDD who were hospitalized following a suicide attempt . Mean age for the group was 76.5±6.6 years ; there were 42 men and 59 women . The control group patients ( N=101 ) were matched for age ( mean 76.6±6.9 years ) and sex . The proportion of patients exposed to an antidepressant  was significantly greater in the control group , than in the group of patients who had attempted suicide ( 58 vs 42 % , odds ratio 1.94 ( 95 % CI : 1.1–3.4 ) , p=0.019 ) . SSRIs were prescribed in 29 % of patients in the control group vs 21 % of patients in the index group ( p=0.03 ) . It is of interest to note that concomitant prescription of benzodiazepines also conferred a protective effect . In conclusion , elderly depressed patients treated with antidepressants may be at reduced risk of attempting suicide . These findings need support from prospect i ve r and omized trials OBJECTIVE To advance knowledge regarding strategies for treating selective serotonin reuptake inhibitor (SSRI)-resistant depression in adolescents , we conducted a r and omized controlled trial evaluating alternative treatment strategies . In primary analyses , cognitive-behavioral therapy ( CBT ) combined with medication change was associated with higher rates of positive response to short-term ( 12-week ) treatment than medication alone . This study examines predictors and moderators of treatment response , with the goal of informing efforts to match youths to optimal treatment strategies . METHOD Youths who had not improved during an adequate SSRI trial ( N = 334 ) were r and omized to an alternative SSRI , an alternative SSRI plus CBT , venlafaxine , or venlafaxine plus CBT . Analyses examined predictors and moderators of treatment response . RESULTS Less severe depression , less family conflict , and absence of nonsuicidal self-injurious behavior predicted better treatment response status . Significant moderators of response to CBT + medication ( combined ) treatment were number of comorbid disorders and abuse history ; hopelessness was marginally significant . The CBT/combined treatment superiority over medication alone was more evident among youths who had more comorbid disorders ( particularly attention-deficit/hyperactivity disorder and anxiety disorders ) , no abuse history , and lower hopelessness . Further analyses revealed a stronger effect of combined CBT + medication treatment among youths who were older and white and had no nonsuicidal self-injurious behavior and longer pre study pharmacotherapy . CONCLUSIONS Combined treatment with CBT and antidepressant medication may be more advantageous for adolescents whose depression is comorbid with other disorders . Given the additional costs of adding CBT to medication , consideration of moderators in clinical decision making can contribute to a more personalized and effective approach to treatment PURPOSE We studied the effect of 3 antidepressant treatments on outcomes ( depressive severity , medication tolerability , and psychosocial functioning ) in depressed patients having comorbid general medical conditions in the Combining Medications to Enhance Depression Outcomes ( CO-MED ) trial . METHODS Adult out patients who had chronic and /or recurrent major depressive disorder ( MDD ) with and without general medical conditions were r and omly assigned in 1:1:1 ratio to 28 weeks of single-blind , placebo-controlled antidepressant treatment with ( 1 ) escitalopram plus placebo , ( 2 ) bupropion-SR plus escitalopram , or ( 3 ) venlafaxine-XR plus mirtazapine . At weeks 12 and 28 , we compared response and tolerability between participants with 0 , 1 , 2 , and 3 or more general medical conditions . RESULTS Of the 665 evaluable patients , 49.5 % reported having no treated general medical conditions , 23.8 % reported having 1 , 14.8 % reported having 2 , and 11.9 % reported having at least 3 . We found only minimal differences in antidepressant treatment response between these groups having different numbers of conditions ; patients with 3 or more conditions reported higher rates of impairment in social and occupational functioning at week 12 but not at week 28 . Additionally , we found no significant differences between the 3 antidepressant treatments across these groups . CONCLUSIONS Patients with general medical conditions can be safely and effectively treated for MDD with antidepressants with no additional adverse effect or tolerability burden relative to their counterparts without such conditions . Combination therapy is not associated with an increased treatment response beyond that found with traditional monotherapy in patients with MDD , regardless of the presence and number of general medical conditions OBJECTIVE The Treatment for Adolescents With Depression Study ( TADS ) evaluates the effectiveness of fluoxetine , cognitive-behavioral therapy ( CBT ) , and their combination in adolescents with major depressive disorder . The authors report effectiveness outcomes across a 1-year naturalistic follow-up period . METHOD The r and omized , controlled trial was conducted in 13 academic and community sites in the United States . Stages I , II , and III consisted of 12 , 6 , and 18 weeks of acute , consolidation , and continuation treatment , respectively . Following discontinuation of TADS treatments at the end of stage III , stage IV consisted of 1 year of naturalistic follow-up . The participants were 327 subjects between the ages of 12 and 17 with a primary DSM-IV diagnosis of major depressive disorder .  No TADS treatment was provided during the follow-up period ; treatment was available in the community . The primary dependent measures , rated by an independent evaluator blind to treatment status , were the total score on the Children 's Depression Rating Scale-Revised and the rate of response , defined as a rating of much or very much improved on the Clinical Global Impressions improvement measure . RESULTS Sixty-six percent of the eligible subjects participated in at least one stage IV assessment . The benefits seen at the end of active treatment ( week 36 ) persisted during follow-up on all measures of depression and suicidality . CONCLUSIONS In contrast to earlier reports on short-term treatments , in which worsening after treatment is the rule , the longer treatment in the TADS was associated with persistent benefits over 1 year of naturalistic follow-up BACKGROUND Although there are effective psychological treatments for unipolar major depression in adolescents , whether or not one or more of the available therapies maintain reduced depressive symptoms 1 year after the end of treatment is not known . This is a non-trivial issue because maintaining lowered depressive symptoms below a clinical threshold level reduces the risk for diagnostic relapse into the adult years . OBJECTIVE To determine whether or not either of two specialist psychological treatments , cognitive-behavioural therapy ( CBT ) or short-term psychoanalytic psychotherapy ( STPP ) , is more effective than a reference brief psychosocial intervention ( BPI ) in maintaining reduction of depression symptoms in the year after treatment . DESIGN Observer-blind , parallel-group , pragmatic superiority r and omised controlled trial . SETTING A total of 15 outpatient NHS clinics in the UK from East Anglia , north-west Engl and and North London . PARTICIPANTS Adolescents aged 11 - 17 years with Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition major depression including those with suicidality , depressive psychosis and conduct disorder . Patients were r and omised using stochastic minimisation controlling for age , sex and self-reported depression sum score ; 470 patients were r and omised and 465 were included in the analyses . INTERVENTIONS In total , 154 adolescents received CBT , 156 received STPP and 155 received BPI . The trial lasted 86 weeks and study treatments were delivered in the first 36 weeks , with 52 weeks of follow-up . MAIN OUTCOME MEASURES Mean sum score on self-reported depressive symptoms ( primary outcome ) at final study assessment ( nominally 86 weeks , at least 52 weeks after end of treatment ) . Secondary measures were change in mean sum scores on self-reported anxiety symptoms and research er-rated Health of the Nation scales for children and adolescents measuring psychosocial function . Following baseline assessment , there were a further five planned follow-up re assessment s at nominal time points of 6 , 12 , 52 and 86 weeks post r and omisation . RESULTS There were non-inferiority effects of CBT compared with STPP [ treatment effect by final follow-up = -0.578 , 95 % confidence interval ( CI ) -2.948 to 4.104 ; p = 0.748 ] . There were no superiority effects for the two specialist treatments ( CBT + STPP ) compared with BPI ( treatment effect by final follow-up = -1.898 , 95 % CI -4.922 to 1.126 ; p = 0.219 ) . At final assessment there was no significant difference in the mean depressive symptom score between treatment groups . There was an average 49 - 52 % reduction in depression symptoms by the end of the study . There were no differences in total costs or quality -of-life scores between treatment groups and prescribing a selective serotonin reuptake inhibitor ( SSRI ) during treatment or follow-up did not differ between the therapy arms and , therefore , did not mediate the outcome . CONCLUSIONS The three psychological treatments differed markedly in theoretical and clinical approach and are associated with a similar degree of clinical improvement , cost-effectiveness and subsequent maintenance of lowered depressive symptoms . Both STPP and BPI offer an additional patient treatment choice , alongside CBT , for depressed adolescents attending specialist Child and Adolescent Mental Health Services . Further research should focus on psychological mechanisms that are associated with treatment response , the maintenance of positive effects , determinants of non-response and whether or not brief psychotherapies are of use in primary care and community setting s. LIMITATIONS Neither reason for SSRI prescribing or monitoring of medication compliance was controlled for over the course of the study , and the economic results were limited by missing data . TRIAL REGISTRATION Current Controlled Trials IS RCT N83033550 . FUNDING This project was funded by the National Institute for Heath Research Health Technology Assessment programme and will be published in full in Health Technology Assessment ; Vol . 21 , No. 12 . See the National Institute for Heath Research Journals Library website for further project information . Funding was also provided by the Department of Health . The funders had no role in the study design , patient recruitment , data collection , analysis or writing of the study , any aspect pertinent to the study or the decision to su bmi t to The Lancet OBJECTIVE The purpose of this study was to conduct a treatment development study to examine the feasibility , acceptability , and preliminary efficacy of treating depressed , suicidal adolescents and their depressed parent concurrently in a cognitive behavioral therapy ( CBT ) protocol ( Parent-Adolescent-CBT [ PA-CBT ] ) . METHODS A r and omized , controlled , repeated measures design was used to test the hypothesis that PA-CBT would lead to greater reductions in suicidality and depression compared with Adolescent Only CBT ( AO-CBT ) .  Participants included 24 adolescent and parent dyads in which the adolescent met American Psychiatric Association , Diagnostic and Statistical Manual of Mental Disorders , 4th ed . ( DSM-IV ) criteria for current major depressive episode ( MDE ) and the parent met DSM-IV criteria for current or past MDE . RESULTS The concurrent protocol was found to be feasible to implement with most depressed adolescents and parents .  Adolescent ratings of program satisfaction were somewhat lower in PA-CBT , suggesting that some teens view treatment negatively when they are required to participate with a parent . The concurrent treatment protocol was more effective in reducing depressed mood in the parent-adolescent dyad at the end of maintenance treatment ( 24 weeks ) than treating an adolescent alone for depression ; the largest effect was on parental depressed mood . This difference between dyads was no longer significant , however , at the 48 week follow-up . Adolescent and parent suicidal ideation improved equally in both groups during active and maintenance treatment , and remained low at follow-up in both groups . CONCLUSIONS The PA-CBT protocol is feasible to conduct and acceptable to most but not all adolescents . The strongest effect was on parental depressed mood . A larger study that has sufficient power to test efficacy and moderators of treatment outcome is necessary to better underst and which adolescents would benefit most from concurrent treatment with a parent OBJECTIVE To determine amitriptyline 's ( AMI )  efficacy in the acute treatment of adolescent major depressive disorder ( MDD ) . METHOD Subjects aged 12 through 17 years meeting Research Diagnostic Criteria for MDD , diagnosed with the Schedule for Affective Disorders and Schizophrenia for School-Age Children ( K-SADS ) , participated in a 2-week placebo-washout followed by an 8-week , r and omized , double-blind , parallel- design , placebo-controlled trial of AMI , 5 mg/kg per day . The K-SADS nine-item scale , the Hamilton Depression Rating Scale , and the Clinical Global Impressions rating scale were used as outcome measures . RESULTS Thirty-one subjects were r and omized ( 18 AMI , 13 placebo ) . Twenty-two subjects were study completers ( 12 AMI , 10 placebo ) . AMI 's efficacy was suggested by the Clinical Global Impressions but not the K-SADS-derived data . Perhaps the primary limitation of the current study is its small sample size . CONCLUSION No definitive recommendation can be made regarding the efficacy of tricyclic antidepressants in the treatment of adolescent MDD
Multiple secondary data analyses of TORDIA have identified important predictors of treatment response and relapse .
To up date a comparative effectiveness review ( 1980–2011 ) of treatments for adolescents whose depressive episode or disorder ( MDE/MDD ) did not respond to one or more trials of SSRI antidepressants .