Impact of treatments for depression on comorbid anxiety, attentional, and behavioral symptoms in adolescents with selective serotonin reuptake inhibitor-resistant depression

Robert C. Hilton, Manivel Rengasamy, Brandon Mansoor, Jiayan He, Taryn Mayes, Graham J. Emslie, Giovanna Porta, Greg N. Clarke, Karen Dineen Wagner, Boris Birmaher, Martin B. Keller, Neal Ryan, Wael Shamseddeen, Joan Rosenbaum Asarnow, David A. Brent

Research output: Contribution to journalArticle

11 Scopus citations

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. Method: 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. Conclusion: 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.

Original languageEnglish (US)
Pages (from-to)482-492
Number of pages11
JournalJournal of the American Academy of Child and Adolescent Psychiatry
Volume52
Issue number5
DOIs
StatePublished - May 1 2013

Keywords

  • Treatment of Resistant Depression in Adolescents (TORDIA)
  • antidepressants
  • cognitive behavioral therapy (CBT)
  • comorbidity
  • secondary outcomes

ASJC Scopus subject areas

  • Developmental and Educational Psychology
  • Psychiatry and Mental health

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    Hilton, R. C., Rengasamy, M., Mansoor, B., He, J., Mayes, T., Emslie, G. J., Porta, G., Clarke, G. N., Wagner, K. D., Birmaher, B., Keller, M. B., Ryan, N., Shamseddeen, W., Asarnow, J. R., & Brent, D. A. (2013). Impact of treatments for depression on comorbid anxiety, attentional, and behavioral symptoms in adolescents with selective serotonin reuptake inhibitor-resistant depression. Journal of the American Academy of Child and Adolescent Psychiatry, 52(5), 482-492. https://doi.org/10.1016/j.jaac.2013.02.013