Impact of Treatments for Depression on Comorbid Anxiety, Attentional, and Behavioral Symptoms in Adolescents With Selective Serotonin Reuptake Inhibitor–Resistant Depression

Abstract

Objective To assess the relative efficacy of antidepressant medication, alone and in combination with cognitive behavioral therapy (CBT), on comorbid symptoms of anxiety, attention, and disruptive behavior disorders in participants in the Treatment of Resistant Depression in Adolescents (TORDIA) trial. Method Adolescents with selective serotonin reuptake inhibitor (SSRI)–resistant depression (N = 334) were randomly assigned to a medication switch alone (to another SSRI or to venlafaxine) or to a medication switch plus CBT. Anxiety, attention-deficit/hyperactivity disorder (ADHD), and disruptive behavior disorder (DBD) symptoms were assessed by psychiatric interview and self-report at regular intervals between baseline and 24 weeks. The differential effects of medication and of CBT, and the impact of remission on the course of comorbid symptoms and diagnoses, were assessed using generalized linear mixed models. Results Remission was associated with a greater reduction in scalar measures of anxiety, ADHD, and DBDs, and a greater decrease in the rate of diagnosed anxiety disorders. The correlations between the changes in symptoms of depression on the CDRS-R and anxiety, ADHD, and oppositional symptoms were modest, ranging from r = 0.12 to r = 0.28. There were no significant differential treatment effects on diagnoses, or corresponding symptoms. Conclusion The achievement of remission had a beneficial effect on anxiety, ADHD, and DBD symptoms, regardless of the type of treatment received. There were no differential effects of medication or CBT on outcome, except for a nonsignificant trend that those adolescents treated with SSRIs showed a greater decrease in rates of comorbid DBDs relative to those treated with venlafaxine.

Mood and suicidality outcomes 3–11 years following pediatric anxiety disorder treatment

“…However, individuals who were treated to remission (i.e., loss of study entry anxiety diagnoses) were 5.26 times less likely to subsequently report suicidal behavior (preparatory acts or behavior communicating ideation, or aborted, interrupted, or actual attempt(s)), and those who were treatment responders (or remitters) were 3.48 times more likely to show consistently low rates of self-reported mood symptoms over several years of follow-up. Consistent with most depression and anxiety treatment studies (Barrett et al, 2001;Curry et al, 2011;Hilton et al, 2013;Silverman et al, 1999), type of acute treatment had no effect on later secondary outcomes. One explanation for the lack of a treatment type effect is that treatment, independent of type of treatment, has beneficial effects.…”

Toward precision therapeutics: general and specific factors differentiate symptom change in depressed adolescents

“…In the main IMPACT trial analysis (Goodyer et al, 2017b), significant decreases in anxiety, depression, obsessions-compulsions, and antisocial behavior were noted. Previous randomized controlled trials of psychotherapy for depression have also demonstrated improvements in comorbid symptom domains, including anxiety, attentiondeficit/hyperactivity disorder, and conduct problems (Asarnow et al, 2009;Hilton et al, 2013). Our results suggest that decreases in these various symptom domains can be best understood as overall decreases in psychopathology, rather than improvements in discrete symptom areas.…”

“…Evidence for this general factor runs counter to most current clinical practices, which often focus on categorical diagnosis and associated narrow-band questionnaires, and presumes disorder-specific interventions (Caspi & Moffitt, 2018;Hopwood et al, 2019;Messer & Wampold, 2006;Rodriguez-Seijas, Eaton, & Krueger, 2015). However, treatments often reduce symptoms in comorbid domains not explicitly targeted (Hilton et al, 2013;Weisz, McCarty, & Valeri, 2006), suggesting that interventions may decrease psychiatric symptoms overall, rather than those within a single category of psychopathology (Constantinou et al, 2019;Hopwood et al, 2019). We examined change in general and specific psychopathology factors among adolescents participating in psychosocial treatments for major depression in the IMPACT trial (Goodyer et al, 2017b(Goodyer et al, , 2011.…”

Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder

“…37 In the TORDIA study, remission from depression, regardless of treatment, was associated with a greater reduction in measures of anxiety, attention-deficit/hyperactivity disorder (ADHD), and oppositional symptoms. 38 Although the evidence is limited, treating depression in children/adolescents may reduce comorbid disorder(s) symptoms.…”