An Adaptive Treatment Strategy for Adolescent Depression

描述（由申请人提供）：在开发青少年抑郁症的有效治疗方法方面取得了实质性进展。然而，即使抑郁青少年在最佳环境下接受最好的治疗，治疗反应也存在很大的异质性。非常需要具体的循证临床指南来指导临床医生个性化患者治疗，以优化患者达到缓解的机会并最大限度地减少负担。这些指南，通常被称为适应性治疗策略，提供了决策规则，建议何时，如何以及为谁治疗应该改变。这个指导以患者为导向的研究职业发展奖（K23）的目的是获得必要的专业知识，成为一个独立的临床干预研究人员，专注于个性化治疗青少年抑郁症。为实现这一目标，建议在以下领域开展正式课程并与知名专家协商：（1）青少年抑郁症的心理社会和药物联合治疗的开发、实施和评估，（2）基于个人特征和治疗反应的个性化治疗策略的开发、实施和评估，（3）先进的临床试验统计方法。为了补充这些培训活动，候选人建议进行一项试点序贯多重分配随机试验（SMART），以制定一种适应性治疗策略，用于青少年抑郁症，该策略将可操作性地确定，如果继续治疗，接受抑郁青少年人际心理治疗（IPT-A）的患者不太可能达到缓解，以及下一步的治疗策略应该是什么。将评估适应性治疗策略的可行性和可接受性，并将使用治疗结局的探索性分析为适应性治疗策略的进一步开发提供信息，该策略将在后续R 01申请中进行测试。 公共卫生相关性：适应性治疗战略有可能产生重大的公共卫生影响，因为它们可以同时改善治疗结果，并通过在最有利的时间和对最有利的人提供治疗来节省资源。他们解决了精神卫生临床医生每天面临的一些主要问题，他们有可能对临床实践产生很大的影响。

DESCRIPTION (provided by applicant): Substantial progress has been made in the development of efficacious treatments for adolescent depression. However, even when depressed adolescents receive the best treatments delivered under optimal circumstances, there is a great deal of heterogeneity in treatment response. There is a significant need for specific evidence-based clinical guidelines to direct clinicians in personalizing their patients' treatments to optimize their chances of reaching remission and minimizing burden. These guidelines, often referred to as adaptive treatment strategies, provide decision rules that recommend when, how, and for whom treatment should change. The purpose of this Mentored Patient-Oriented Research Career Development Award (K23) is the acquire expertise necessary to become an independent clinical interventions researcher with a focus on personalized treatment for adolescent depression. To achieve this goal, formal coursework and consultation with established experts are proposed in the following areas: (1) the development, implementation, and evaluation of combined psychosocial and pharmacological treatments for adolescent depression, (2) the development, implementation, and evaluation of strategies for personalizing treatment based on individuals' characteristics and treatment responses, and (3) advanced statistical methods for clinical trials. To complement these training activities, the candidate proposes to conduct a pilot sequential multiple assignment randomized trial (SMART) to develop an adaptive treatment strategy for adolescent depression that will operationalize when to make the determination that a patient treated with Interpersonal Psychotherapy for Depressed Adolescents (IPT-A) is not likely to reach remission if the treatment is continued and what the next treatment strategy should be. The feasibility and acceptability of the adaptive treatment strategy will be assessed, and exploratory analyses of treatment outcomes will be used to inform further development of the adaptive treatment strategy that will be tested in a subsequent R01 application. PUBLIC HEALTH RELEVANCE: Adaptive treatment strategies have the potential to have a significant public health impact as they can simultaneously improve treatment outcomes and conserve resources by delivering treatments when and for whom they will do the most good. They address some of the major questions faced by mental health clinicians on a daily basis and they have the potential to have high impact on clinical practice.