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Boris Birmaher - One of the best experts on this subject based on the ideXlab platform.
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anhedonia predicts poorer recovery among youth with selective Serotonin Reuptake Inhibitor treatment resistant depression
Journal of the American Academy of Child and Adolescent Psychiatry, 2012Co-Authors: Dana L Mcmakin, Karen Dineen Wagner, Graham J Emslie, Gregory N Clarke, Joan Rosenbaum Asarnow, Neal D Ryan, Thomas M Olino, Giovanna Porta, Laura J Dietz, Boris BirmaherAbstract:Objective To identify symptom dimensions of depression that predict recovery among selective Serotonin Reuptake Inhibitor (SSRI) treatment–resistant adolescents undergoing second-step treatment. Method The Treatment of Resistant Depression in Adolescents (TORDIA) trial included 334 SSRI treatment–resistant youth randomized to a medication switch, or a medication switch plus CBT. This study examined five established symptom dimensions (Child Depression Rating Scale—Revised) at baseline as they predicted recovery over 24 weeks of acute and continuation treatment. The two indices of recovery that were evaluated were time to remission and number of depression-free days. Results Multivariate analyses examining all five depression symptom dimensions simultaneously indicated that anhedonia was the only dimension to predict a longer time to remission, and also the only dimension to predict fewer depression-free days. In addition, when anhedonia and CDRS-total score were evaluated simultaneously, anhedonia continued to uniquely predict longer time to remission and fewer depression-free days. Conclusions Anhedonia may represent an important negative prognostic indicator among treatment-resistant depressed adolescents. Further research is needed to elucidate neurobehavioral underpinnings of anhedonia, and to test treatments that target anhedonia in the context of overall treatment of depression. Clinical trial registration information—Treatment of SSRI-Resistant Depression in Adolescents (TORDIA); http://www.clinicaltrials.gov; NCT00018902
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long term outcome of adolescent depression initially resistant to selective Serotonin Reuptake Inhibitor treatment a follow up study of the tordia sample
The Journal of Clinical Psychiatry, 2011Co-Authors: Benedetto Vitiello, Karen Dineen Wagner, Boris Birmaher, Graham J Emslie, Gregory N Clarke, Joan Rosenbaum Asarnow, Martin B Keller, Neal D Ryan, Betsy D Kennard, Taryn MayesAbstract:Objective We examined the long-term outcome of participants in the Treatment of SSRI-Resistant Depression in Adolescents (TORDIA) study, a randomized trial of 334 adolescents (aged 12-18 years) with DSM-IV-defined major depression disorder initially resistant to selective Serotonin Reuptake Inhibitor (SSRI) treatment who were and subsequently treated for 12 weeks with another SSRI, venlafaxine, another SSRI + cognitive behavioral therapy (CBT), or venlafaxine + CBT. Responders then continued with the same treatment through week 24, while non-responders were given open treatment.
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treatment of selective Serotonin Reuptake Inhibitor resistant depression in adolescents predictors and moderators of treatment response
Journal of the American Academy of Child and Adolescent Psychiatry, 2009Co-Authors: Joan Rosenbaum Asarnow, Satish Iyengar, Greg Clarke, Louise Ritz, Wael Shamseddeen, Karen Dineen Wagner, Benedetto Vitiello, Graham J Emslie, Anthony Spirito, Boris BirmaherAbstract:Abstract 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.
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Treatment of selective Serotonin Reuptake Inhibitor-resistant depression in adolescents: Predictors and moderators of treatment response
Journal of the American Academy of Child and Adolescent Psychiatry, 2009Co-Authors: Joan Rosenbaum Asaknow, Satish Iyengar, Greg Clarke, Louise Ritz, Wael Shamseddeen, Karen Dineen Wagner, Benedetto Vitiello, Graham J Emslie, Anthony Spirito, Boris BirmaherAbstract: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.\n\nMETHOD: 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.\n\nRESULTS: 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.\n\nCONCLUSIONS: 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.
Tim F Oberlander - One of the best experts on this subject based on the ideXlab platform.
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prenatal effects of selective Serotonin Reuptake Inhibitor antidepressants Serotonin transporter promoter genotype slc6a4 and maternal mood on child behavior at 3 years of age
JAMA Pediatrics, 2010Co-Authors: Tim F Oberlander, Shaila Misri, Michael Papsdorf, Colin J D Ross, Ursula Brain, Ruth E GrunauAbstract:Objectives To investigate whether prenatal selective Serotonin Reuptake Inhibitor (SSRI) antidepressant exposure affects behavior in 3-year-olds of antenatally anxious or depressed mothers and whether risk was moderated by the Serotonin transporter promoter ( SLC6A4 ) genotype. Design Prospective longitudinal cohort design. Setting Vancouver. Participants Mothers and their 3-year-old children (n = 33 SSRI exposed and n = 42 nonexposed). Main Exposures Prenatal exposure to SSRI antidepressants and prenatal and postnatal maternal mood disturbances. Main Outcome Measures Parent report of child behavior (Child Behavior Checklist, ages 1.5-5 years) and the child SLC6A4 genotype. The covariates used were maternal mood during the third trimester, 3 months post partum, and at the 3-year follow-up study and the child's 5-minute Apgar score. Results Prenatal exposure to both maternal depressed mood and SSRI antidepressants were associated with increased internalizing behaviors during early childhood, whereas current maternal mood increased risk for externalizing behaviors. Increased child anxiety and depression symptoms were predicted by higher third-trimester maternal anxiety only in children with 2 short S alleles. In contrast, increased aggression and externalizing behaviors were predicted by third-trimester maternal anxiety only in children with 2 copies of the L allele. Conclusions Exposure to prenatal SSRIs and maternal mood had distinct effects on child behavior at 3 years of age, reflected in an increased level of internalizing behaviors. The impact of antenatal maternal anxiety on child mood was moderated by the child SLC6A4 genotype. Despite SSRI treatment for prenatal maternal mood disturbances, childhood behavior at 3 years of age remained at risk.
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a register study of the impact of stopping third trimester selective Serotonin Reuptake Inhibitor exposure on neonatal health
Acta Psychiatrica Scandinavica, 2009Co-Authors: William P Warburton, Clyde Hertzman, Tim F OberlanderAbstract:Warburton W, Hertzman C, Oberlander TF. A register study of the impact of stopping third trimester selective Serotonin Reuptake Inhibitor exposure on neonatal health. Objective: To determine whether risk for adverse neonatal outcomes are reduced by stopping SSRI use before the end of pregnancy. Method: Using population health data, maternal health and prenatal SSRI prescriptions were linked to neonatal birth records (N = 119 547) (1998–2001). Neonates SSRI-exposed in the last 14 days (L14) of gestation were compared with infants who had gestational exposure, but not during the last 14 days (NL14). Propensity score matching was used to control for potential confounders (total exposure, maternal health characteristics). Results: Increased risk for neonatal respiratory distress was present where L14 exposure occurred compared with risk where exposure stopped before L14. However, controlling for potential maternal and neonatal confounders, differences disappeared. Conclusion: Controlling for maternal illness severity, reducing exposure to SSRI’s at the end of pregnancy had no significant clinical effect on improving neonatal health. These findings raise the possibility that some adverse neonatal outcomes may not be an acute pharmacological condition such as toxicity or withdrawal.
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effects of timing and duration of gestational exposure to Serotonin Reuptake Inhibitor antidepressants population based study
British Journal of Psychiatry, 2008Co-Authors: Tim F Oberlander, William P Warburton, Shaila Misri, Jaafar Aghajanian, Clyde HertzmanAbstract:Background Late-gestational Serotonin Reuptake Inhibitor (SRI) exposure has been linked to adverse neonatal outcomes; however, the impact of timing and duration of exposure is unknown. Aims To determine whether late-gestational exposure to an SRI is associated with increased risk of adverse neonatal outcome relative to early exposure. Method Population-based maternal and neonatal health records were linked to prenatal maternal prescription records for an SRI medication ( n =3500). Results After controlling for maternal illness and duration of exposure, using propensity score matching, neonatal outcomes did not differ between late and early exposure ( P >0.05). After controlling for maternal illness, longer prenatal exposure increased the risks of lower birth weight, respiratory distress and reduced gestational age ( P <0.05). Conclusions Using population health data, length of gestational SRI exposure, rather than timing, increased the risk for neonatal respiratory distress, lower birth weight and reduced gestational age, even when controlling for maternal illness and medication dose. These findings highlight the importance of distinguishing the specific impact of medication exposure from exposure to maternal illness itself.
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infant Serotonin transporter slc6a4 promoter genotype is associated with adverse neonatal outcomes after prenatal exposure to Serotonin Reuptake Inhibitor medications
Molecular Psychiatry, 2008Co-Authors: Tim F Oberlander, Shaila Misri, Russell J Bonaguro, Michael Papsdorf, Colin J D Ross, Elizabeth M SimpsonAbstract:Reduced Apgar scores and birth weight, increased risk of respiratory distress, jitteriness and increased tone have been reported in up to 30% of neonates with prenatal exposure to Serotonin Reuptake Inhibitor (SRI) antidepressant medications. In adults, effects of these medications may be related to the genotype for the Serotonin transporter (SLC6A4) promoter. In this study we investigated whether SLC6A4 genotype influences the risk for adverse outcomes in neonates with prenatal SRI exposure. Neonatal outcomes including Apgar scores, birth weight, gestational age at birth, symptoms of poor neonatal adaptation and genotype for SLC6A4 were determined in 37 prenatally SRI exposed neonates and compared with 47 non-exposed neonates. Reduced 5 min Apgar scores were observed in exposed neonates and this was moderated by the ss genotype (P<0.001). Birth weight was lower in exposed ls neonates (P=0.008). Risk for respiratory symptoms (respiratory distress and rapid breathing) was higher in exposed neonates with the ll genotype compared to non-exposed neonates (P<0.05) and risk for neuromotor symptoms increased in exposed ss neonates (P<0.026). These relationships remained when controlling for maternal mood during pregnancy, length of gestational medication exposure and gestational age at birth and cesarean section rate. Prenatal SRI exposure was associated with adverse neonatal outcomes and these effects were moderated by infant SLC6A4 genotype. Relationships between polymorphisms and specific outcomes varied during the neonatal period, suggesting that beyond apparent gene-medication interactions, multiple mechanisms contribute to adverse neonatal outcomes following prenatal SRI exposure.
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externalizing and attentional behaviors in children of depressed mothers treated with a selective Serotonin Reuptake Inhibitor antidepressant during pregnancy
JAMA Pediatrics, 2007Co-Authors: Tim F Oberlander, Shaila Misri, Michael Papsdorf, Pratibha Reebye, Ruth E GrunauAbstract:Objective To evaluate attentional and activity behaviors in 4-year-olds following prenatal selective Serotonin Reuptake Inhibitor (SSRI) exposure. Design Prospective cohort design. Setting Tertiary care center. Participants Twenty-two 4-year-olds with prolonged prenatal SSRI medication exposure and 14 children without prenatal exposure. Main Exposure Prenatal SSRI exposure. Main Outcome Measures Group differences in externalizing behaviors (according to the Child Behavior Checklist) and direct observations of child attention, activity, and impulsiveness in a laboratory setting using the procedure by Crowell and colleagues were compared, including measures of the duration of prenatal SSRI exposure, umbilical cord drug levels, a history of poor neonatal adaptation, and maternal mood. Results Externalizing behaviors did not differ between groups. Maternal depression and anxiety at the 4-year follow-up were associated with increased reports of externalizing behaviors. Increased externalizing behaviors were associated with increased umbilical cord drug levels (F 1,34 = 6.3; P = .02), but when controlling for maternal depressed mood at the 4-year follow-up, such levels only accounted for 11.2% of the behavioral outcomes ( P >.05). On direct observation, the persistence score for child behavior was significantly lower in the exposed group. Increased aggressiveness scores were associated with a history of poor neonatal adaptation, even when parental report of stress was added to the model (F 1,34 = 4.0; P = .03); however, neither parental report of stress nor poor neonatal adaptation were significant (both P = .09), suggesting that both are important, if not unique, predictors of child behavior. Conclusions These findings suggest that the best predictors of externalizing behaviors at age 4 years are current maternal mood and parental stress, regardless of prenatal depressed mood and SSRI treatment during pregnancy. It remains uncertain whether poor neonatal adaptation can be excluded as a possible predictor of externalizing behaviors.
Karen Dineen Wagner - One of the best experts on this subject based on the ideXlab platform.
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anhedonia predicts poorer recovery among youth with selective Serotonin Reuptake Inhibitor treatment resistant depression
Journal of the American Academy of Child and Adolescent Psychiatry, 2012Co-Authors: Dana L Mcmakin, Karen Dineen Wagner, Graham J Emslie, Gregory N Clarke, Joan Rosenbaum Asarnow, Neal D Ryan, Thomas M Olino, Giovanna Porta, Laura J Dietz, Boris BirmaherAbstract:Objective To identify symptom dimensions of depression that predict recovery among selective Serotonin Reuptake Inhibitor (SSRI) treatment–resistant adolescents undergoing second-step treatment. Method The Treatment of Resistant Depression in Adolescents (TORDIA) trial included 334 SSRI treatment–resistant youth randomized to a medication switch, or a medication switch plus CBT. This study examined five established symptom dimensions (Child Depression Rating Scale—Revised) at baseline as they predicted recovery over 24 weeks of acute and continuation treatment. The two indices of recovery that were evaluated were time to remission and number of depression-free days. Results Multivariate analyses examining all five depression symptom dimensions simultaneously indicated that anhedonia was the only dimension to predict a longer time to remission, and also the only dimension to predict fewer depression-free days. In addition, when anhedonia and CDRS-total score were evaluated simultaneously, anhedonia continued to uniquely predict longer time to remission and fewer depression-free days. Conclusions Anhedonia may represent an important negative prognostic indicator among treatment-resistant depressed adolescents. Further research is needed to elucidate neurobehavioral underpinnings of anhedonia, and to test treatments that target anhedonia in the context of overall treatment of depression. Clinical trial registration information—Treatment of SSRI-Resistant Depression in Adolescents (TORDIA); http://www.clinicaltrials.gov; NCT00018902
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long term outcome of adolescent depression initially resistant to selective Serotonin Reuptake Inhibitor treatment a follow up study of the tordia sample
The Journal of Clinical Psychiatry, 2011Co-Authors: Benedetto Vitiello, Karen Dineen Wagner, Boris Birmaher, Graham J Emslie, Gregory N Clarke, Joan Rosenbaum Asarnow, Martin B Keller, Neal D Ryan, Betsy D Kennard, Taryn MayesAbstract:Objective We examined the long-term outcome of participants in the Treatment of SSRI-Resistant Depression in Adolescents (TORDIA) study, a randomized trial of 334 adolescents (aged 12-18 years) with DSM-IV-defined major depression disorder initially resistant to selective Serotonin Reuptake Inhibitor (SSRI) treatment who were and subsequently treated for 12 weeks with another SSRI, venlafaxine, another SSRI + cognitive behavioral therapy (CBT), or venlafaxine + CBT. Responders then continued with the same treatment through week 24, while non-responders were given open treatment.
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treatment of selective Serotonin Reuptake Inhibitor resistant depression in adolescents predictors and moderators of treatment response
Journal of the American Academy of Child and Adolescent Psychiatry, 2009Co-Authors: Joan Rosenbaum Asarnow, Satish Iyengar, Greg Clarke, Louise Ritz, Wael Shamseddeen, Karen Dineen Wagner, Benedetto Vitiello, Graham J Emslie, Anthony Spirito, Boris BirmaherAbstract:Abstract 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.
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Treatment of selective Serotonin Reuptake Inhibitor-resistant depression in adolescents: Predictors and moderators of treatment response
Journal of the American Academy of Child and Adolescent Psychiatry, 2009Co-Authors: Joan Rosenbaum Asaknow, Satish Iyengar, Greg Clarke, Louise Ritz, Wael Shamseddeen, Karen Dineen Wagner, Benedetto Vitiello, Graham J Emslie, Anthony Spirito, Boris BirmaherAbstract: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.\n\nMETHOD: 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.\n\nRESULTS: 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.\n\nCONCLUSIONS: 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.
Graham J Emslie - One of the best experts on this subject based on the ideXlab platform.
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anhedonia predicts poorer recovery among youth with selective Serotonin Reuptake Inhibitor treatment resistant depression
Journal of the American Academy of Child and Adolescent Psychiatry, 2012Co-Authors: Dana L Mcmakin, Karen Dineen Wagner, Graham J Emslie, Gregory N Clarke, Joan Rosenbaum Asarnow, Neal D Ryan, Thomas M Olino, Giovanna Porta, Laura J Dietz, Boris BirmaherAbstract:Objective To identify symptom dimensions of depression that predict recovery among selective Serotonin Reuptake Inhibitor (SSRI) treatment–resistant adolescents undergoing second-step treatment. Method The Treatment of Resistant Depression in Adolescents (TORDIA) trial included 334 SSRI treatment–resistant youth randomized to a medication switch, or a medication switch plus CBT. This study examined five established symptom dimensions (Child Depression Rating Scale—Revised) at baseline as they predicted recovery over 24 weeks of acute and continuation treatment. The two indices of recovery that were evaluated were time to remission and number of depression-free days. Results Multivariate analyses examining all five depression symptom dimensions simultaneously indicated that anhedonia was the only dimension to predict a longer time to remission, and also the only dimension to predict fewer depression-free days. In addition, when anhedonia and CDRS-total score were evaluated simultaneously, anhedonia continued to uniquely predict longer time to remission and fewer depression-free days. Conclusions Anhedonia may represent an important negative prognostic indicator among treatment-resistant depressed adolescents. Further research is needed to elucidate neurobehavioral underpinnings of anhedonia, and to test treatments that target anhedonia in the context of overall treatment of depression. Clinical trial registration information—Treatment of SSRI-Resistant Depression in Adolescents (TORDIA); http://www.clinicaltrials.gov; NCT00018902
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long term outcome of adolescent depression initially resistant to selective Serotonin Reuptake Inhibitor treatment a follow up study of the tordia sample
The Journal of Clinical Psychiatry, 2011Co-Authors: Benedetto Vitiello, Karen Dineen Wagner, Boris Birmaher, Graham J Emslie, Gregory N Clarke, Joan Rosenbaum Asarnow, Martin B Keller, Neal D Ryan, Betsy D Kennard, Taryn MayesAbstract:Objective We examined the long-term outcome of participants in the Treatment of SSRI-Resistant Depression in Adolescents (TORDIA) study, a randomized trial of 334 adolescents (aged 12-18 years) with DSM-IV-defined major depression disorder initially resistant to selective Serotonin Reuptake Inhibitor (SSRI) treatment who were and subsequently treated for 12 weeks with another SSRI, venlafaxine, another SSRI + cognitive behavioral therapy (CBT), or venlafaxine + CBT. Responders then continued with the same treatment through week 24, while non-responders were given open treatment.
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treatment of selective Serotonin Reuptake Inhibitor resistant depression in adolescents predictors and moderators of treatment response
Journal of the American Academy of Child and Adolescent Psychiatry, 2009Co-Authors: Joan Rosenbaum Asarnow, Satish Iyengar, Greg Clarke, Louise Ritz, Wael Shamseddeen, Karen Dineen Wagner, Benedetto Vitiello, Graham J Emslie, Anthony Spirito, Boris BirmaherAbstract:Abstract 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.
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Treatment of selective Serotonin Reuptake Inhibitor-resistant depression in adolescents: Predictors and moderators of treatment response
Journal of the American Academy of Child and Adolescent Psychiatry, 2009Co-Authors: Joan Rosenbaum Asaknow, Satish Iyengar, Greg Clarke, Louise Ritz, Wael Shamseddeen, Karen Dineen Wagner, Benedetto Vitiello, Graham J Emslie, Anthony Spirito, Boris BirmaherAbstract: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.\n\nMETHOD: 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.\n\nRESULTS: 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.\n\nCONCLUSIONS: 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.
Joan Rosenbaum Asarnow - One of the best experts on this subject based on the ideXlab platform.
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anhedonia predicts poorer recovery among youth with selective Serotonin Reuptake Inhibitor treatment resistant depression
Journal of the American Academy of Child and Adolescent Psychiatry, 2012Co-Authors: Dana L Mcmakin, Karen Dineen Wagner, Graham J Emslie, Gregory N Clarke, Joan Rosenbaum Asarnow, Neal D Ryan, Thomas M Olino, Giovanna Porta, Laura J Dietz, Boris BirmaherAbstract:Objective To identify symptom dimensions of depression that predict recovery among selective Serotonin Reuptake Inhibitor (SSRI) treatment–resistant adolescents undergoing second-step treatment. Method The Treatment of Resistant Depression in Adolescents (TORDIA) trial included 334 SSRI treatment–resistant youth randomized to a medication switch, or a medication switch plus CBT. This study examined five established symptom dimensions (Child Depression Rating Scale—Revised) at baseline as they predicted recovery over 24 weeks of acute and continuation treatment. The two indices of recovery that were evaluated were time to remission and number of depression-free days. Results Multivariate analyses examining all five depression symptom dimensions simultaneously indicated that anhedonia was the only dimension to predict a longer time to remission, and also the only dimension to predict fewer depression-free days. In addition, when anhedonia and CDRS-total score were evaluated simultaneously, anhedonia continued to uniquely predict longer time to remission and fewer depression-free days. Conclusions Anhedonia may represent an important negative prognostic indicator among treatment-resistant depressed adolescents. Further research is needed to elucidate neurobehavioral underpinnings of anhedonia, and to test treatments that target anhedonia in the context of overall treatment of depression. Clinical trial registration information—Treatment of SSRI-Resistant Depression in Adolescents (TORDIA); http://www.clinicaltrials.gov; NCT00018902
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long term outcome of adolescent depression initially resistant to selective Serotonin Reuptake Inhibitor treatment a follow up study of the tordia sample
The Journal of Clinical Psychiatry, 2011Co-Authors: Benedetto Vitiello, Karen Dineen Wagner, Boris Birmaher, Graham J Emslie, Gregory N Clarke, Joan Rosenbaum Asarnow, Martin B Keller, Neal D Ryan, Betsy D Kennard, Taryn MayesAbstract:Objective We examined the long-term outcome of participants in the Treatment of SSRI-Resistant Depression in Adolescents (TORDIA) study, a randomized trial of 334 adolescents (aged 12-18 years) with DSM-IV-defined major depression disorder initially resistant to selective Serotonin Reuptake Inhibitor (SSRI) treatment who were and subsequently treated for 12 weeks with another SSRI, venlafaxine, another SSRI + cognitive behavioral therapy (CBT), or venlafaxine + CBT. Responders then continued with the same treatment through week 24, while non-responders were given open treatment.
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treatment of selective Serotonin Reuptake Inhibitor resistant depression in adolescents predictors and moderators of treatment response
Journal of the American Academy of Child and Adolescent Psychiatry, 2009Co-Authors: Joan Rosenbaum Asarnow, Satish Iyengar, Greg Clarke, Louise Ritz, Wael Shamseddeen, Karen Dineen Wagner, Benedetto Vitiello, Graham J Emslie, Anthony Spirito, Boris BirmaherAbstract:Abstract 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.
