Early patterns of symptom change signal remission with interpersonal psychotherapy for depressed adolescents

Abstract

Background This study examined whether reductions in depression symptoms at different time points over the course of therapy predict remission for depressed adolescents treated with interpersonal psychotherapy (IPT-A) or treatment as usual (TAU) delivered in school-based health clinics. Methods Participants were 63 adolescents (ages 12–18) drawn from a randomized controlled clinical trial examining the effectiveness of IPT-A. [1] Adolescents were randomized to receive IPT-A or TAU delivered by school-based mental health clinicians. Assessments were completed at baseline and weeks 4, 8, 12, and 16 (or at early termination) and included the Hamilton Rating Scale for Depression (HRSD [2]). Results Receiver operating characteristic analysis was used to identify the time point and degree of reduction in HRSD that best predicted remission (HRSD < 7) at the end of the trial (week 16). Week 4 was the best time point for classifying adolescents as likely to remit or not likely to remit for both IPT-A and TAU. A 16.2% reduction in HRSD from baseline represented the best combined sensitivity and specificity in predicting week 16 remission status for adolescents treated with IPT-A. A 24.4% reduction in depressive symptoms represented the best combined sensitivity and specificity in predicting remission status for TAU. Conclusions These findings provide preliminary evidence of one early marker of remission with IPT-A. Replication with larger samples would suggest that depressed adolescents who have not demonstrated at least a 16.2% reduction in their depressive symptoms after 4 weeks of IPT-A may benefit from a change in the treatment plan.

Adaptive Interventions in Child and Adolescent Mental Health

“…These two papers nicely complement other, recent work, which uses different methodology for identifying critical treatment decision points during the course of intervention (Fitzpatrick et al, 2014; Gunlicks-Stoessel & Mufson, 2011; Steidtmann et al, 2013). …”

Patterns of early change and their relationship to outcome and early treatment termination in patients with panic disorder.

“…Furthermore, Haas et al (2002) found that early responders needed fewer sessions to achieve stable improvement and were, therefore, more likely to terminate treatment earlier. Early response has been shown to be a powerful predictor of outcome in different samples (e.g., adolescents, adults, and elderly patients; e.g., Gunlicks-Stoessel & Mufson, 2011), modalities (psychological and pharmacological treatments; e.g., Hofmann, Schulz, Meuret, Moscovitch, & Suvak, 2006; Uher et al, 2010; van Calker et al, 2009), and diagnostic groups (depression, anxiety, and eating disorders; e.g., Aderka, Nickerson, Bøe, & Hofmann, 2012; Gunlicks-Stoessel & Mufson, 2011; Lutz, Stulz, & Köck, 2009). This literature has been primarily concerned with identifying patients who show rapid early improvement.…”

Future Directions in Research on Psychotherapy for Adolescent Depression

“…Obviously, improving the rate of response is a goal in itself. Moreover, from a longitudinal perspective, acute treatment response is associated with better longer term outcome (Curry et al, 2011;Emslie et al, 2010;Vitiello et al, 2011), and in turn, is more likely to occur when the adolescent responds early within the acute period treatment (Gunlicks-Stoessel & Mufson, 2011). Conversely, residual symptoms after short-term treatment are a predictor of failure to attain remission during follow-up (Kennard, Silva, et al, 2009).…”