TY - JOUR
T1 - Treatment-Resistant Depression in Adolescents
T2 - Clinical Features and Measurement of Treatment Resistance
AU - Strawn, Jeffrey R.
AU - Aaronson, Scott T.
AU - Elmaadawi, Ahmed Z.
AU - Schrodt, G. Randolph
AU - Holbert, Richard C.
AU - Verdoliva, Sarah
AU - Heart, Karen
AU - Demitrack, Mark A.
AU - Croarkin, Paul E.
N1 - Funding Information:
Dr. Strawn has received research support from Allergan, Neu-ronetics, Otsuka, the National Institute of Mental Health, Eunice Kennedy Shriver National Institute of Child Health and Development, and National Institute of Environmental Health Sciences as well as the Yung Family Foundation. He receives royalties from Springer Publishing and received honoraria from CMEology and Neuroscience Educational Institute. He receives royalties from UpToDate. Finally, he received material support from and provided consultation to Myriad Genetics. Dr. Aaronson has received research support from Compass Pathways and Neuronetics and serves as a consultant to LivaNova, Neuronetics, Janssen, Geno-mind, and Sage Therapeutics. He serves on speaker boards for Janssen and Sunovion. Dr. Holbert has received material support (equipment) from Neuronetics. Dr. Elmaadawi receives research support from Duke University and University of North Western. He receives research fund from Neurocrine, Inc and Neuronetics. He is also a speaker for Neuronetics. Dr. Croarkin has received research support from the National Institute of Mental Health, Neuronetics, and NeoSync. He has received material support from and provided consultation to Myraid. He has consulted for Procter & Gamble Company. Dr. Demitrack is a consultant to Neuronetics, Inc. and a full-time employee of Trevena, Inc. All other authors have no competing financial interests.
Publisher Copyright:
© Copyright 2020, Mary Ann Liebert, Inc.
PY - 2020/5
Y1 - 2020/5
N2 - Objective: To describe the clinical characteristics of adolescents with antidepressant treatment-resistant major depressive disorder (MDD) and to examine the utility of the Antidepressant Treatment Record (ATR) in categorizing treatment resistance in this population. Methods: Adolescents with treatment-resistant MDD enrolled in an interventional study underwent a baseline evaluation with the ATR, Children's Depression Rating Scale-Revised (CDRS-R), and Clinical Global Impressions-Severity (CGI-S) scales. Demographic and clinical characteristics were examined with regard to ATR-defined level of resistance (level 1 to ≥3) using analysis of variance and χ2 tests. Results: In adolescents with treatment-resistant MDD (N = 97), aged 12-21 years, most were female (65%), white (89%), and had recurrent illness (78%). Patients were severely ill (median CGI-S score of 5), had a mean CDRS-R score of 63 ± 10, and 17.5% had been hospitalized for depression-related symptoms. Fifty-two patients were classified as ATR 1, whereas 32 were classified as ATR level 2 and 13 patients as ≥3, respectively. For increasing ATR-defined levels, illness duration increased from 12.0 (range: 1.5-31.9) to 14.8 (range: 1.8-31.7) to 19.5 (range: 2.5-36.2) months and the likelihood of treatment with serotonin norepinephrine reuptake inhibitors (SNRIs) and dopamine norepinephrine reuptake inhibitors (DNRIs) similarly increased (p = 0.006 for both SNRIs and DNRIs) as did the likelihood of treatment with mixed dopamine serotonin receptor antagonists (χ2 = 17, p < 0.001). Conclusions: This study underscores the morbidity and chronicity of treatment-resistant MDD in adolescents. The present characterization of related clinical features describes the use of nonselective serotonin reuptake inhibitors in adolescents with treatment-resistant depression and raises the possibility that those with the greatest medication treatment resistance are less likely to have had recurrent episodes. The study also demonstrates the utility of the ATR in categorizing treatment resistance in adolescents with MDD.
AB - Objective: To describe the clinical characteristics of adolescents with antidepressant treatment-resistant major depressive disorder (MDD) and to examine the utility of the Antidepressant Treatment Record (ATR) in categorizing treatment resistance in this population. Methods: Adolescents with treatment-resistant MDD enrolled in an interventional study underwent a baseline evaluation with the ATR, Children's Depression Rating Scale-Revised (CDRS-R), and Clinical Global Impressions-Severity (CGI-S) scales. Demographic and clinical characteristics were examined with regard to ATR-defined level of resistance (level 1 to ≥3) using analysis of variance and χ2 tests. Results: In adolescents with treatment-resistant MDD (N = 97), aged 12-21 years, most were female (65%), white (89%), and had recurrent illness (78%). Patients were severely ill (median CGI-S score of 5), had a mean CDRS-R score of 63 ± 10, and 17.5% had been hospitalized for depression-related symptoms. Fifty-two patients were classified as ATR 1, whereas 32 were classified as ATR level 2 and 13 patients as ≥3, respectively. For increasing ATR-defined levels, illness duration increased from 12.0 (range: 1.5-31.9) to 14.8 (range: 1.8-31.7) to 19.5 (range: 2.5-36.2) months and the likelihood of treatment with serotonin norepinephrine reuptake inhibitors (SNRIs) and dopamine norepinephrine reuptake inhibitors (DNRIs) similarly increased (p = 0.006 for both SNRIs and DNRIs) as did the likelihood of treatment with mixed dopamine serotonin receptor antagonists (χ2 = 17, p < 0.001). Conclusions: This study underscores the morbidity and chronicity of treatment-resistant MDD in adolescents. The present characterization of related clinical features describes the use of nonselective serotonin reuptake inhibitors in adolescents with treatment-resistant depression and raises the possibility that those with the greatest medication treatment resistance are less likely to have had recurrent episodes. The study also demonstrates the utility of the ATR in categorizing treatment resistance in adolescents with MDD.
KW - antidepressant
KW - depression
KW - major depressive disorder
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U2 - 10.1089/cap.2020.0008
DO - 10.1089/cap.2020.0008
M3 - Article
C2 - 32315537
AN - SCOPUS:85084720735
SN - 1044-5463
VL - 30
SP - 261
EP - 266
JO - Journal of Child and Adolescent Psychopharmacology
JF - Journal of Child and Adolescent Psychopharmacology
IS - 4
ER -