9th Annual Todd Ouida Clinical Scholars Award & Lecture Assistance for Treatment Resistance in Adolescent Depression: Lessons from the TORDIA study
David A. Brent, MD
Academic Chief, Child and Adolescent Psychiatry, Professor of
Psychiatry, Pediatrics, and Epidemiology, Endowed Chair, Suicide
Studies, Director Services for Teens at Risk (STAR-Center)
Western Psychiatric Institute and Clinic
Brent examines the results of the Treatment of SSRI-Resistant Depression in Adolescents (TORDIA) Study. Researchers aimed to effectively treat patients who showed resistance to SSRI treatment. Participants included mostly Caucasian female adolescents, 60% of whom were actively suicidal, suffering from moderate depression. This study randomized participants into one of four treatments: Two different medication conditions, a CBT condition, and a combined medication/CBT condition. Results demonstrated that CBT in addition to medication was more beneficial than medication alone. CBT proved particularly effective for those participants suffering from comorbid disorders; however, patients suffering from abuse were adversely affected by CBT. Additionally, CBT was not found to be protective against suicidal events. Further findings suggested that anhedonia and drug/alcohol use predicted negative outcomes for participants. Moreover, the commonly used sleep aid Trazodone for depressed adolescents was predictive of a poor response rate. Results of the study indicated early response as an important factor for reducing depression and suicidality. From the study, researchers gather that combined CBT and SSRI treatment is most effective, as long as nine sessions of CBT are implemented and patients receive an adequate dose. In addition, drug/alcohol use, sleep, family conflict, abuse, and manic symptoms are likely moderators for depression.