An Adaptive Treatment Strategy for Adolescent Depression

描述(由申请人提供)：在开发有效的青少年抑郁症治疗方法方面取得了实质性进展。然而，即使抑郁症青少年在最佳条件下接受了最好的治疗，治疗反应也存在很大的异质性。很有必要制定具体的循证临床指南，以指导临床医生对患者进行个性化治疗，以优化他们达到缓解和最小化负担的机会。这些指南通常被称为适应性治疗策略，它们提供了建议何时、如何以及为谁改变治疗的决策规则。这个以患者为导向的导师研究职业发展奖(K23)的目的是获得必要的专业知识，成为一名独立的临床干预研究人员，专注于青少年抑郁症的个性化治疗。为了实现这一目标，建议在以下领域进行正式的课程学习和咨询：(1)青少年抑郁症心理社会和药物联合治疗的开发、实施和评估；(2)基于个体特征和治疗反应的个性化治疗策略的开发、实施和评估；以及(3)临床试验的高级统计方法。为了补充这些培训活动，候选人提议进行一项试点序贯多任务随机试验(SMART)，以开发青少年抑郁症的适应性治疗策略，该策略将在何时操作，以确定如果继续治疗，接受青少年抑郁人际心理疗法(IPT-A)治疗的患者不太可能达到缓解，以及下一步治疗策略应该是什么。将评估适应性治疗战略的可行性和可接受性，并将利用对治疗结果的探索性分析，为进一步制定适应性治疗战略提供信息，该战略将在随后的R01应用中进行测试。 与公共卫生相关：适应性治疗战略有可能对公共健康产生重大影响，因为它们可以同时改善治疗结果，并通过在最好的时间和为谁提供治疗来节省资源。它们解决了精神健康临床医生每天面临的一些主要问题，并有可能对临床实践产生很大影响。

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.