Substance use and the treatment of resistant depression in adolescents.
Substance use and the treatment of resistant depression in adolescents.
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DOI：
10.1097/chi.0b013e3181bef6e8
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发表时间：
2009-12
影响因子：
13.3
通讯作者：
Brent DA
中科院分区：
文献类型：
--
作者：
Goldstein BI;Shamseddeen W;Spirito A;Emslie G;Clarke G;Wagner KD;Asarnow JR;Vitiello B;Ryan N;Birmaher B;Mayes T;Onorato M;Zelazny J;Brent DA
尽管青少年中物质使用障碍（SUD）和重度抑郁症（MDD）之间存在已知的相关性，但对MDD青少年中物质使用的相关性知之甚少。在适当的SSRI试验后没有改善的MDD青年（N = 334）被纳入SSRI抵抗性抑郁症青少年（TORDIA）试验的治疗。分析检查物质使用（通过药物使用严重程度指数）及其与治疗和抑郁症状相关的变化。基线时通过学龄儿童情感障碍和精神分裂症量表和终生版本符合SUD标准的青少年被排除在外。物质使用很常见：28.1%的人报告在基线时重复实验。物质相关损害与基线抑郁严重程度、年龄较大、身体/性虐待、家庭冲突、绝望和共病对立违抗性障碍/行为障碍相关。对MDD治疗有反应的青少年中物质相关损害有显著改善。基线自杀意念在进展至高物质相关损害（≥第75百分位数）的受试者中高于那些物质相关损害仍然较低（<第75百分位数）的受试者，并且父母抑郁症状预测研究期间高物质相关损害的持续性。MDD反应在12周物质相关损害评分低的青少年中最好，无论他们是否有高或低的基线物质相关损害。具体的治疗，药物或CBT，对物质使用没有显着的差异影响。药物使用在患有难治性MDD的青少年中很常见。物质相关损害持续较低或物质相关损害降低的受试者具有更好的MDD治疗应答，尽管这种关联的方向尚不确定。
Despite the known association between substance use disorders (SUD) and major depressive disorder (MDD) among adolescents, little is known regarding substance use among adolescents with MDD. Youth with MDD who had not improved after an adequate SSRI trial (N = 334) were enrolled in the Treatment of SSRI-Resistant Depression in Adolescents (TORDIA) trial. Analyses examined substance use (via the Drug Use Severity Index) and changes therein in relation to treatment and depressive symptoms. Adolescents meeting SUD criteria via the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime version at baseline were excluded. Substance use was common: 28.1% reported repeated experimentation at baseline. Substance-related impairment was associated with baseline depression severity, older age, physical/sexual abuse, family conflict, hopelessness, and comorbid oppositional defiant disorder/conduct disorder. There was significant improvement in substance-related impairment among adolescents who responded to MDD treatment. Baseline suicidal ideation was higher among subjects who progressed to high substance-related impairment (≥75th percentile) versus those whose substance-related impairment remained low (<75th percentile), and parental depressive symptoms predicted persistence of high substance-related impairment during the study. MDD response was best among adolescents with low 12-week substance-related impairment scores regardless of whether they had high or low baseline substance-related impairment. There were no significant differential effects of specific treatments, pharmacological or CBT, on substance use. Substance use is common among adolescents with treatment-resistant MDD. Subjects who had persistently low substance-related impairment or who demonstrated reduced substance-related impairment had better MDD treatment response, although the direction of this association is uncertain.