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Randomized Controlled Trial
. 2019 Jan;58(1):80-91.
doi: 10.1016/j.jaac.2018.06.032. Epub 2018 Oct 27.

Critical Decision Points for Augmenting Interpersonal Psychotherapy for Depressed Adolescents: A Pilot Sequential Multiple Assignment Randomized Trial

Meredith Gunlicks-Stoessel  1 , Laura Mufson  2 , Gail Bernstein  3 , Ana Westervelt  3 , Kristina Reigstad  3 , Bonnie Klimes-Dougan  3 , Kathryn Cullen  3 , Aimee Murray  3 , David Vock  3
Affiliations
Randomized Controlled Trial

Critical Decision Points for Augmenting Interpersonal Psychotherapy for Depressed Adolescents: A Pilot Sequential Multiple Assignment Randomized Trial

Meredith Gunlicks-Stoessel et al. J Am Acad Child Adolesc Psychiatry. 2019 Jan.

Abstract

Objective: Practice parameters recommend systematic assessment of depression symptoms over the course of treatment to inform treatment planning; however, there are currently no guidelines regarding how to use symptom monitoring to guide treatment decisions for psychotherapy. The current study compared two time points (week 4 and week 8) for assessing symptoms during interpersonal psychotherapy for depressed adolescents (IPT-A) and explored four algorithms that use the symptom assessments to select the subsequent treatment.

Method: Forty adolescents (aged 12-17 years) with a depression diagnosis began IPT-A with an initial treatment plan of 12 sessions delivered over 16 weeks. Adolescents were randomized to a week 4 or week 8 decision point for considering a change in treatment. Insufficient responders at either time point were randomized a second time to increased frequency of IPT-A (twice per week) or addition of fluoxetine. Measures were administered at baseline and weeks 4, 8, 12, and 16.

Results: The week 4 decision point for assessing response and implementing treatment augmentation for insufficient responders was more efficacious for reducing depression symptoms than the week 8 decision point. There were significant differences between algorithms in depression and psychosocial functioning outcomes.

Conclusion: Therapists implementing IPT-A should routinely monitor depression symptoms and consider augmenting treatment for insufficient responders as early as week 4 of treatment.

Clinical trial registration information: An Adaptive Treatment Strategy for Adolescent Depression. https://clinicaltrials.gov; NCT02017535.

Keywords: algorithms; depression; fluoxetine; psychotherapy; symptom assessment.

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Conflict of interest statement

Disclosure: Dr. Mufson has received royalties from Guilford Press, Inc. for the book, Interpersonal Psychotherapy for Depressed Adolescents. Drs. Gunlicks-Stoessel, Bernstein, Reigstad, Klimes-Dougan, Cullen, Murray, Vock, and Ms. Westervelt report no biomedical financial interests or potential conflicts of interest.

Figures

FIGURE 1
FIGURE 1. Sequential Multiple Assignment Randomized Trial (SMART) Design
Note: HRSD = Hamilton Rating Scale for Depression; IPT-A = interpersonal psychotherapy for depressed adolescents; R = randomization.
FIGURE 2
FIGURE 2. CONSORT Diagram
Note: IPT-A = interpersonal psychotherapy for depressed adolescents.
FIGURE 3
FIGURE 3. Model-Estimated Children’s Depression Rating Scale–Revised (CDRS-R) Scores by Algorithm
Note: FLX = fluoxetine; IPT-A = interpersonal psychotherapy for depressed adolescents.
FIGURE 4
FIGURE 4. Model-Estimated Children’s Global Assessment Scale (C-GAS) Scores by Algorithm
Note: FLX = fluoxetine; IPT-A = interpersonal psychotherapy for depressed adolescents.
FIGURE 5
FIGURE 5. Model-Estimated Social Adjustment Scale–Self-Report (SAS-SR) Scores by Algorithm
Note: FLX = fluoxetine; IPT-A = interpersonal psychotherapy for depressed adolescents.
See this image and copyright information in PMC

Comment in

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