Benedetto Vitiello1, David A Brent2, Laurence L Greenhill2, Graham Emslie2, Karen Wells2, John T Walkup2, Barbara Stanley2, Oscar Bukstein2, Betsy D Kennard2, Scott Compton2, Barbara Coffey2, Mary F Cwik2, Kelly Posner2, Ann Wagner2, John S March2, Mark Riddle2, Tina Goldstein2, John Curry2, Lisa Capasso2, Taryn Mayes2, Sa Shen2, S Sonia Gugga2, J Blake Turner2, Shannon Barnett2, Jamie Zelazny2. 1. Drs. Vitiello and Wagner are with the National Institute of Mental Health; Drs. Brent, Bukstein, and Goldstein, and Ms. Zelazny are with the University of Pittsburgh Western Psychiatnc Institute and Clinic; Drs. Greenhill Stanley, Posner, Shen, and Turner, and Ms. Gugga and Ms. Capasso are with the Columbia University-New York State Psychiatric Institute; Drs. Emslie and Kennard, and Ms. Mayes are with the University of Texas Southwestern Medical Center in Dallas; Drs. Wells, Compton, Curry, and March are with the Duke University Medical Center; Dr. Coffey is with the New York University Child Study Center; Drs. Walkup, Cwik, Barnett, and Riddle are with Johns Hopkins University. Electronic address: bvitiell@mail.nih.gov. 2. Drs. Vitiello and Wagner are with the National Institute of Mental Health; Drs. Brent, Bukstein, and Goldstein, and Ms. Zelazny are with the University of Pittsburgh Western Psychiatnc Institute and Clinic; Drs. Greenhill Stanley, Posner, Shen, and Turner, and Ms. Gugga and Ms. Capasso are with the Columbia University-New York State Psychiatric Institute; Drs. Emslie and Kennard, and Ms. Mayes are with the University of Texas Southwestern Medical Center in Dallas; Drs. Wells, Compton, Curry, and March are with the Duke University Medical Center; Dr. Coffey is with the New York University Child Study Center; Drs. Walkup, Cwik, Barnett, and Riddle are with Johns Hopkins University.
Abstract
OBJECTIVE: To examine the course of depression during the treatment of adolescents with depression who had recently attempted suicide. METHOD: Adolescents (N = 124), ages 12 to 18 years, with a 90-day history of suicide attempt, a current diagnosis of depressive disorder (96.0% had major depressive disorder), and a Children's Depression Rating Scale-Revised (CDRS-R) score of 36 or higher, entered a 6-month treatment with antidepressant medication, cognitive-behavioral therapy focused on suicide prevention, or their combination (Comb), at five academic sites. Treatment assignment could be either random or chosen by study participants. Intent-to-treat, mixed effects regression models of depression and other relevant ratings were estimated. Improvement and remission rates were computed with the last observation carried forward. RESULTS: Most patients (n = 104 or 84%) chose treatment assignment, and overall, three fourths (n = 93) received Comb. In Comb, CDRS-R declined from a baseline adjusted mean of 49.6 (SD 12.3) to 38.3 (8.0) at week 12 and to 27.0 (10.1) at week 24 (p < .0001), with a Clinical Global Impression -defined improvement rate of 58.0% at week 12 and 72.2% at week 24 and a remission (CDRS-R ≤ 28) rate of 32.5% at week 12 and 50.0% at week 24. The CDRS-R and the Scale for Suicidal Ideation scores were correlated at baseline (r = 0.43, p < .0001) and declined in parallel. CONCLUSIONS: When vigorously treated with a combination of medication and psychotherapy, adolescents with depression who have recently attempted suicide show rates of improvement and remission of depression that seem comparable to those observed in nonsuicidal adolescents with depression.
RCT Entities:
OBJECTIVE: To examine the course of depression during the treatment of adolescents with depression who had recently attempted suicide. METHOD: Adolescents (N = 124), ages 12 to 18 years, with a 90-day history of suicide attempt, a current diagnosis of depressive disorder (96.0% had major depressive disorder), and a Children's Depression Rating Scale-Revised (CDRS-R) score of 36 or higher, entered a 6-month treatment with antidepressant medication, cognitive-behavioral therapy focused on suicide prevention, or their combination (Comb), at five academic sites. Treatment assignment could be either random or chosen by study participants. Intent-to-treat, mixed effects regression models of depression and other relevant ratings were estimated. Improvement and remission rates were computed with the last observation carried forward. RESULTS: Most patients (n = 104 or 84%) chose treatment assignment, and overall, three fourths (n = 93) received Comb. In Comb, CDRS-R declined from a baseline adjusted mean of 49.6 (SD 12.3) to 38.3 (8.0) at week 12 and to 27.0 (10.1) at week 24 (p < .0001), with a Clinical Global Impression -defined improvement rate of 58.0% at week 12 and 72.2% at week 24 and a remission (CDRS-R ≤ 28) rate of 32.5% at week 12 and 50.0% at week 24. The CDRS-R and the Scale for Suicidal Ideation scores were correlated at baseline (r = 0.43, p < .0001) and declined in parallel. CONCLUSIONS: When vigorously treated with a combination of medication and psychotherapy, adolescents with depression who have recently attempted suicide show rates of improvement and remission of depression that seem comparable to those observed in nonsuicidal adolescents with depression.
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