A placebo prognostic index (PI) as a moderator of outcomes in the treatment of adolescent depression: Could it inform risk-stratification in treatment with cognitive-behavioral therapy, fluoxetine, or their combination?

Abstract Treating adolescent depression effectively requires providing interventions that are optimally suited to patients’ individual characteristics and needs. Therefore, we aim to develop an algorithm that matches patients with optimal treatment among cognitive-behavioral therapy (CBT), fluoxetine (FLX), and combination treatment (COMB). We leveraged data from a completed clinical trial, the Treatment for adolescents with depression study, where a wide range of demographic, clinical, and psychosocial measures were collected from adolescents diagnosed with major depressive disorder prior to treatment. Machine-learning techniques were employed to derive a model that predicts treatment response (week 12 children’s depression rating scale-revised [CDRS-R]) to CBT, FLX, and COMB. The resulting model successfully identified subgroups of patients that respond preferentially to specific types of treatment. Specifically, our model identified a subgroup of patients (25%) that achieved on average a 16.9 point benefit on the CDRS-R from FLX compared to CBT. The model also identified a subgroup of patients (50%) that achieved an average benefit up to 19.0 points from COMB compared to CBT. Physical illness and disability were identified as overall predictors of response to treatment, regardless of treatment type, whereas baseline CDRS-R, psychosomatic symptoms, school missed, view of self, treatment expectations, and attention problems determined the patients’ response to specific treatments. The model developed in this study provides a critical starting point for personalized treatment planning for adolescent depression.

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6.66 Digital Cognitive-Behavioral Therapy in the Treatment of Adolescent Depression: a Randomized Controlled Trial

Journal of the American Academy of Child & Adolescent Psychiatry ◽

10.1016/j.jaac.2017.09.411 ◽

2017 ◽

Vol 56 (10) ◽

pp. S299-S300

Author(s):

Naira W. Topooco ◽

Gerhard Andersson

Keyword(s):

Randomized Controlled Trial ◽

Cognitive Behavioral Therapy ◽

Adolescent Depression ◽

Behavioral Therapy ◽

Controlled Trial ◽

Cognitive Behavioral ◽

Randomized Controlled

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Cognitive Behavioral Therapy + Alternative Selective Serotonin Reuptake Inhibitor Better than Alternative SSRI Alone in Adolescent Depression

Journal of the National Medical Association ◽

10.1016/s0027-9684(15)31361-4 ◽

2008 ◽

Vol 100 (6) ◽

pp. 762-763

Keyword(s):

Cognitive Behavioral Therapy ◽

Selective Serotonin Reuptake Inhibitor ◽

Reuptake Inhibitor ◽

Serotonin Reuptake ◽

Adolescent Depression ◽

Behavioral Therapy ◽

Cognitive Behavioral ◽

Selective Serotonin ◽

Serotonin Reuptake Inhibitor ◽

Better Than

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Does Homework “Matter” in Cognitive Behavioral Therapy for Adolescent Depression?

Journal of Cognitive Psychotherapy ◽

10.1891/0889-8391.26.4.390 ◽

2012 ◽

Vol 26 (4) ◽

pp. 390-404 ◽

Cited By ~ 15

Author(s):

Anne D. Simons ◽

C. Nathan Marti ◽

Paul Rohde ◽

Cara C. Lewis ◽

John Curry ◽

...

Keyword(s):

Depressive Symptoms ◽

Cognitive Behavioral Therapy ◽

Clinical Improvement ◽

Adolescent Depression ◽

Behavioral Therapy ◽

Antidepressant Medication ◽

Self Report ◽

Cognitive Behavioral ◽

Homework Completion ◽

Over Time

Objective: Examine the degree to which homework completion is associated with various indices of clinical improvement in adolescents with depression treated with cognitive behavioral therapy (CBT) either as a monotherapy and in combination with antidepressant medication. Method: This study used data from the Treatment of Adolescents with Depression Study (TADS), which compared the efficacy of CBT, fluoxetine (FLX), the combination of CBT and FLX (COMB), and a pill placebo (PBO; TADS Team, 2003, 2004, 2005). Current analyses included only TADS participants in the CBT (n = 111) or COMB (n = 107) conditions. Analyses focused on the relations between partial and full homework completion and a dichotomized measure of clinical response, evaluator and self-report ratings of depressive symptoms, hopelessness, and suicidality. Results: Homework completion significantly predicted clinical improvement, decrease in self-reported hopelessness, suicidality, and depression—but not in evaluator-rated depressive symptoms—in adolescents treated with CBT only. These relationships were almost completely absent in the COMB condition. The only significant COMB finding was that partially completed homework was related to decrease in hopelessness over time. Conclusions: These findings suggest that the ability of therapists and clients to collaboratively develop and complete between-session assignments is associated with response to CBT, self-report of severity of depressive symptoms, hopelessness, and suicidality and may be integral to optimizing the effects of CBT when delivered as a monotherapy.

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