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Randomized Controlled Trial
. 2010 Jul;167(7):782-91.
doi: 10.1176/appi.ajp.2010.09040552. Epub 2010 May 17.

Treatment of Resistant Depression in Adolescents (TORDIA): week 24 outcomes

Graham J Emslie  1 , Taryn Mayes, Giovanna Porta, Benedetto Vitiello, Greg Clarke, Karen Dineen Wagner, Joan Rosenbaum Asarnow, Anthony Spirito, Boris Birmaher, Neal Ryan, Betsy Kennard, Lynn DeBar, James McCracken, Michael Strober, Matthew Onorato, Jamie Zelazny, Marty Keller, Satish Iyengar, David Brent
Affiliations
Randomized Controlled Trial

Treatment of Resistant Depression in Adolescents (TORDIA): week 24 outcomes

Graham J Emslie et al. Am J Psychiatry. 2010 Jul.

Abstract

Objective: The purpose of this study was to report on the outcome of participants in the Treatment of Resistant Depression in Adolescents (TORDIA) trial after 24 weeks of treatment, including remission and relapse rates and predictors of treatment outcome.

Method: Adolescents (ages 12-18 years) with selective serotonin reuptake inhibitor (SSRI)-resistant depression were randomly assigned to either a medication switch alone (alternate SSRI or venlafaxine) or a medication switch plus cognitive-behavioral therapy (CBT). At week 12, responders could continue in their assigned treatment arm and nonresponders received open treatment (medication and/or CBT) for 12 more weeks (24 weeks total). The primary outcomes were remission and relapse, defined by the Adolescent Longitudinal Interval Follow-Up Evaluation as rated by an independent evaluator.

Results: Of 334 adolescents enrolled in the study, 38.9% achieved remission by 24 weeks, and initial treatment assignment did not affect rates of remission. Likelihood of remission was much higher (61.6% versus 18.3%) and time to remission was much faster among those who had already demonstrated clinical response by week 12. Remission was also higher among those with lower baseline depression, hopelessness, and self-reported anxiety. At week 12, lower depression, hopelessness, anxiety, suicidal ideation, family conflict, and absence of comorbid dysthymia, anxiety, and drug/alcohol use and impairment also predicted remission. Of those who responded by week 12, 19.6% had a relapse of depression by week 24.

Conclusions: Continued treatment for depression among treatment-resistant adolescents results in remission in approximately one-third of patients, similar to adults. Eventual remission is evident within the first 6 weeks in many, suggesting that earlier intervention among nonresponders could be important.

Trial registration: ClinicalTrials.gov NCT00018902.

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Figures

FIGURE 1
FIGURE 1
CONSORT Diagram From Pre-Screening Through Analyses for Subjects in the Treatment of Resistant Depression in Adolescents (TORDIA) Study
FIGURE 2
FIGURE 2
Treatment Course by Week-12 Response Status Among Subjects in the Treatment of Resistant Depression in Adolescents (TORDIA) Study
FIGURE 3
FIGURE 3
Reduction in Children’s Depression Rating Scale–Revised Scores Among Subjects in the Treatment of Resistant Depression in Adolescents (TORDIA) Studya a Log time: p<0.001; remission: p=0.07; remission-by-log time: p<0.001.
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Comment in

  • Treatment of depressed adolescents.
    Walkup JT. Walkup JT. Am J Psychiatry. 2010 Jul;167(7):734-7. doi: 10.1176/appi.ajp.2010.10040566. Am J Psychiatry. 2010. PMID: 20595423 No abstract available.

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