Treatment of Selective Serotonin Reuptake Inhibitor-Resistant Depression in Adolescents: Predictors and Moderators of Treatment Response
Treatment of Selective Serotonin Reuptake Inhibitor-Resistant Depression in Adolescents: Predictors and Moderators of Treatment Response
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DOI：
10.1097/chi.0b013e3181977476
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发表时间：
2009-03-01
影响因子：
13.3
通讯作者：
Brent, David
中科院分区：
文献类型：
--
作者：
Asarnow, Joan Rosenbaum;Emslie, Graham;Brent, David
目的：为了进一步了解治疗选择性5-羟色胺再摄取抑制剂（SSRI）耐药的青少年抑郁症的策略，我们进行了一项随机对照试验，评估替代治疗策略。在初步分析中，认知行为疗法（CBT）联合药物改变与短期（12周）治疗的阳性反应率高于单独药物治疗。本研究探讨了治疗反应的预测因子和调节因子，目的是为年轻人提供最佳治疗策略。方法：在适当的SSRI试验期间没有改善的年轻人（N = 334）被随机分配到替代SSRI，替代SSRI + CBT，文拉法辛或文拉法辛+CBT。分析检查了治疗反应的预测因子和调节因子。结果：较轻的抑郁症、较少的家庭冲突以及不存在非自杀性自伤行为预示着更好的治疗反应状态。对CBT +药物（联合）治疗反应的重要调节因素是共病疾病和滥用史的数量;绝望是轻微的。CBT/联合治疗优于单独药物治疗在患有更多共病障碍（特别是注意力缺陷/多动障碍和焦虑障碍）、无滥用史和较低绝望感的青少年中更为明显。进一步的分析显示，在年龄较大、白色、没有非自杀性自伤行为和研究前药物治疗时间较长的青少年中，CBT +药物联合治疗的效果更强。结论：CBT和抗抑郁药物联合治疗可能对抑郁症与其他疾病共病的青少年更有利。考虑到将CBT添加到药物中的额外成本，在临床决策中考虑调节剂可以有助于更个性化和有效的治疗方法。J. Am. Acad.儿童青少年精神病学，2009;48（3）：330-339.
Objective: To advance knowledge regarding strategies for treating selective serotonin reuptake inhibitor (SSRI)-resistant depression in adolescents, we conducted a randomized controlled trial evaluating alternative treatment strategies. In primary analyses, cognitive-behavioral therapy (CBT) combined with medication change was associated with higher rates of positive response to short-term (12-week) treatment than medication alone. This study examines predictors and moderators of treatment response, with the goal of informing efforts to match youths to optimal treatment strategies. Method: Youths who had not improved during an adequate SSRI trial (N = 334) were randomized to an alternative SSRI, an alternative SSRI plus CBT, venlafaxine, or venlafaxine plus CBT. Analyses examined predictors and moderators of treatment response. Results: Less severe depression, less family conflict, and absence of nonsuicidal self-injurious behavior predicted better treatment response status. Significant moderators of response to CBT + medication (combined) treatment were number of comorbid disorders and abuse history; hopelessness was marginally significant. The CBT/combined treatment superiority over medication alone was more evident among youths who had more comorbid disorders (particularly attention-deficit/hyperactivity disorder and anxiety disorders), no abuse history, and lower hopelessness. Further analyses revealed a stronger effect of combined CBT + medication treatment among youths who were older and white and had no nonsuicidal self-injurious behavior and longer prestudy pharmacotherapy. Conclusions: Combined treatment with CBT and antidepressant medication may be more advantageous for adolescents whose depression is comorbid with other disorders. Given the additional costs of adding CBT to medication, consideration of moderators in clinical decision making can contribute to a more personalized and effective approach to treatment. J. Am. Acad. Child Adolesc. Psychiatry, 2009;48(3):330-339.