An Adaptive Treatment Strategy for Adolescent Depression

描述（由申请人提供）：在开发有效治疗青少年抑郁症的方法方面取得了实质性进展。然而，即使抑郁的青少年在最理想的情况下接受了最好的治疗，治疗反应也存在很大的异质性。迫切需要有具体的循证临床指南来指导临床医生对患者进行个性化治疗，以优化患者达到缓解的机会，并将负担降至最低。这些指导方针，通常被称为适应性治疗策略，提供决策规则，建议何时、如何以及为谁改变治疗。本次指导患者导向研究职业发展奖（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，建议在以下领域开展正式的课程和咨询：(1)制定、实施和评估青少年抑郁症的心理社会和药物联合治疗方法；(2)制定、实施和评估基于个体特征和治疗反应的个性化治疗策略；(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先导顺序多任务随机试验（SMART），以制定一种青少年抑郁症的适应性治疗策略，该策略将确定何时确定接受青少年抑郁症人际心理治疗（IPT-A）治疗的患者如果继续治疗不太可能达到缓解，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，并对治疗结果进行探索性分析，以进一步开发适应性治疗策略，并在随后的R01应用中进行测试。

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.