Recovery and recurrence following treatment for adolescent major depression

John Curry, Susan Silva, Paul Rohde, Golda Ginsburg, Christopher Kratochvil, Anne Simons, Jerry Kirchner, Diane May, Betsy Kennard, Taryn Mayes, Norah Feeny, Anne Marie Albano, Sarah Lavanier, Mark Reinecke, Rachel Jacobs, Emily Becker-Weidman, Elizabeth Weller, Graham Emslie, John Walkup, Elizabeth KastelicBarbara Burns, Karen Wells, John March

Research output: Contribution to journalArticle

Abstract

Context: Major depressive disorder in adolescents is common and impairing. Efficacious treatments have been developed, but little is known about longer-term outcomes, including recurrence. Objectives: To determine whether adolescents who responded to short-term treatments or who received the most efficacious short-term treatment would have lower recurrence rates, and to identify predictors of recovery and recurrence. Design: Naturalistic follow-up study. Setting: Twelve academic sites in the United States. Participants: One hundred ninety-six adolescents (86 males and 110 females) randomized to 1 of 4 short-term interventions (fluoxetine hydrochloride treatment, cognitive behavioral therapy, their combination, or placebo) in the Treatment for Adolescents With Depression Study were followed up for 5 years after study entry (44.6% of the original Treatment for Adolescents With Depression Study sample). Main Outcome Measures: Recovery was defined as absence of clinically significant major depressive disorder symptoms on the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version interview for at least 8 weeks, and recurrence was defined as a new episode of major depressive disorder following recovery. Results: Almost all participants (96.4%) recovered from their index episode of major depressive disorder during the follow-up period. Recovery by 2 years was significantly more likely for short-term treatment responders (96.2%) than for partial responders or nonresponders (79.1%) (P<.001) but was not associated with having received the most efficacious short-term treatment (the combination of fluoxetine and cognitive behavioral therapy). Of the 189 participants who recovered, 88 (46.6%) had a recurrence. Recurrence was not predicted by full short-term treatment response or by original treatment. However, full or partial responders were less likely to have a recurrence (42.9%) than were non-responders (67.6%) (P=.03). Sex predicted recurrence (57.0% among females vs 32.9% among males; P=.02). Conclusions: Almost all depressed adolescents recovered. However, recurrence occurs in almost half of recovered adolescents, with higher probability in females in this age range. Further research should identify and address the vulnerabilities to recurrence that are more common among young women.

Original languageEnglish (US)
Pages (from-to)263-270
Number of pages8
JournalArchives of general psychiatry
Volume68
Issue number3
DOIs
StatePublished - Mar 1 2011

ASJC Scopus subject areas

  • Arts and Humanities (miscellaneous)
  • Psychiatry and Mental health

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    Curry, J., Silva, S., Rohde, P., Ginsburg, G., Kratochvil, C., Simons, A., Kirchner, J., May, D., Kennard, B., Mayes, T., Feeny, N., Albano, A. M., Lavanier, S., Reinecke, M., Jacobs, R., Becker-Weidman, E., Weller, E., Emslie, G., Walkup, J., ... March, J. (2011). Recovery and recurrence following treatment for adolescent major depression. Archives of general psychiatry, 68(3), 263-270. https://doi.org/10.1001/archgenpsychiatry.2010.150