Predicting Remission From Depression in Youth Receiving Outpatient Medication Management

Kennedy M. Balzen, BS; Jane K. Hensley, MRC; Paul A. Nakonezny, PhD; Jessica Jones, MA; Betsy D. Kennard, PsyD; Graham J. Emslie, MD

J Clin Psychiatry 2023;84(4):22m14581

ABSTRACT

Objective: To examine 6-month remission rates of adolescents treated for depression in a university-based clinic and examine predictors of eventual remission.

Methods: All patients aged 11–18 years treated in the clinic completed self-report measures assessing depression, suicidal ideation, anxiety, and associated symptoms. Remission was operationalized as a total score of ≤ 4 on the Patient Health Questionnaire-9 (PHQ-9) within 6 months of entering treatment.

Results: Of the 430 patients, (76.74% female, 65.34% Caucasian, mean ± SD age 14.65 ± 1.69 years), 26.74% achieved remission within 6 months. Mean ± SD scores on the PHQ-9 at visit 1 (clinic entry) were 11.97 ± 4.76 for remitters (n = 115) and 15.03 ± 5.21 for non-remitters (n = 315). Predicted odds of remitting decreased as depressive symptom severity at visit 1 increased (OR = 0.941; 95% CI, 0.886 to 1.000; P = .051) and as scores on the Concise Associated Symptoms Tracking scale at treatment entry increased (OR = 0.971; 95% CI, 0.948 to 0.995; P = .017). As depression severity increased between visits, odds of remitting decreased (OR = 0.873; 95% CI, 0.827 to 0.921; P < .0001). Finally, adolescent males were more likely to achieve remission than females within 6 months (OR = 2.257; 95% CI, 1.351 to 3.771; P = .002).

Conclusions: This study reports remission rates for depressed youth receiving medication management in a naturalistic outpatient setting. Results confirm that depression severity at treatment initiation and over time is a strong predictor of remission status. Additionally, monitoring associated symptoms via measurement-based care can provide important clinical information to inform treatment decisions.

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References (44)

World Health Organization. Depression and Other Common Mental Disorders: Global Health Estimates. WHO website. https://apps.who.int/iris/handle/10665/254610. 2017.
Bitsko RH, Claussen AH, Lichstein J, et al. Mental health surveillance among children - United States, 2013–2019. MMWR suppl. 2022;71(2):1–42. PubMed CrossRef
Mojtabai R, Olfson M. National trends in mental health care for US adolescents. JAMA Psychiatry. 2020;77(7):703–714. PubMed CrossRef
Maalouf FT, Brent DA. Pharmacotherapy and psychotherapy of pediatric depression. Expert Opin Pharmacother. 2010;11(13):2129–2140. PubMed CrossRef
Yu ZJ, Kratochvil CJ, Weller RA, et al. From TADS and SOFTADS to TORDIA and beyond: what’s new in the treatment of adolescent depression? Curr Psychiatry Rep. 2010;12(2):88–95. PubMed CrossRef
Weersing VR, Jeffreys M, Do MT, et al. Evidence base update of psychosocial treatments for child and adolescent depression. J Clin Child Adolesc Psychol. 2017;46(1):11–43. PubMed CrossRef
Bear HA, Edbrooke-Childs J, Norton S, et al. Systematic review and meta-analysis: outcomes of routine specialist mental health care for young people with depression and/or anxiety. J Am Acad Child Adolesc Psychiatry. 2020;59(7):810–841. PubMed CrossRef
Weisz JR, Kuppens S, Ng MY, et al. What five decades of research tells us about the effects of youth psychological therapy: A multilevel meta-analysis and implications for science and practice. Am Psychol. 2017;72(2):79–117. PubMed CrossRef
Emslie GJ, Mayes T, Porta G, et al. Treatment of Resistant Depression in Adolescents (TORDIA): week 24 outcomes. Am J Psychiatry. 2010;167(7):782–791. PubMed CrossRef
Kennard B, Silva S, Vitiello B, et al; TADS Team. Remission and residual symptoms after short-term treatment in the Treatment of Adolescents with Depression Study (TADS). J Am Acad Child Adolesc Psychiatry. 2006;45(12):1404–1411. PubMed CrossRef
Curry J, Silva S, Rohde P, et al. Recovery and recurrence following treatment for adolescent major depression. Arch Gen Psychiatry. 2011;68(3):263–269. PubMed CrossRef
Breslau J, Gilman SE, Stein BD, et al. Sex differences in recent first-onset depression in an epidemiological sample of adolescents. Transl Psychiatry. 2017;7(5):e1139. PubMed CrossRef
Hankin BL. Development of sex differences in depressive and co-occurring anxious symptoms during adolescence: descriptive trajectories and potential explanations in a multiwave prospective study. J Clin Child Adolesc Psychol. 2009;38(4):460–472. PubMed CrossRef
Gaynes BN, Warden D, Trivedi MH, et al. What did STAR*D teach us? results from a large-scale, practical, clinical trial for patients with depression. Psychiatr Serv. 2009;60(11):1439–1445. PubMed CrossRef
Serretti A, Gibiino S, Drago A. Specificity profile of paroxetine in major depressive disorder: meta-regression of double-blind, randomized clinical trials. J Affect Disord. 2011;132(1-2):14–25. PubMed CrossRef
Cuijpers P, Weitz E, Twisk J, et al. Gender as predictor and moderator of outcome in cognitive behavior therapy and pharmacotherapy for adult depression: an “individual patient data” meta-analysis. Depress Anxiety. 2014;31(11):941–951. PubMed CrossRef
Kornstein SG, Pedersen RD, Holland PJ, et al. Influence of sex and menopausal status on response, remission, and recurrence in patients with recurrent major depressive disorder treated with venlafaxine extended release or fluoxetine: analysis of data from the PREVENT study. J Clin Psychiatry. 2014;75(1):62–68. PubMed CrossRef
Fava M, Rush AJ, Alpert JE, et al. Difference in treatment outcome in outpatients with anxious versus nonanxious depression: a STAR*D report. Am J Psychiatry. 2008;165(3):342–351. PubMed CrossRef
Melton TH, Croarkin PE, Strawn JR, et al. Comorbid anxiety and depressive symptoms in children and adolescents: a systematic review and analysis. J Psychiatr Pract. 2016;22(2):84–98. PubMed CrossRef
Ghandour RM, Sherman LJ, Vladutiu CJ, et al. Prevalence and treatment of depression, anxiety, and conduct problems in US children. J Pediatr. 2019;206:256–267.e3. PubMed CrossRef
Trombello JM, Pizzagalli DA, Weissman MM, et al. Characterizing anxiety subtypes and the relationship to behavioral phenotyping in major depression: Results from the EMBARC study. J Psychiatr Res. 2018;102:207–215. PubMed CrossRef
Braund TA, Tillman G, Palmer DM, et al. Antidepressant side effects and their impact on treatment outcome in people with major depressive disorder: an iSPOT-D report. Transl Psychiatry. 2021;11(1):417. PubMed CrossRef
Fabbri C, Marsano A, Balestri M, et al. Clinical features and drug induced side effects in early versus late antidepressant responders. J Psychiatr Res. 2013;47(10):1309–1318. PubMed CrossRef
Trivedi MH, Wisniewski SR, Morris DW, et al. Concise Associated Symptoms Tracking scale: a brief self-report and clinician rating of symptoms associated with suicidality. J Clin Psychiatry. 2011;72(6):765–774. PubMed CrossRef
Jha MK, Minhajuddin A, South C, et al. Worsening anxiety, irritability, insomnia, or panic predicts poorer antidepressant treatment outcomes: clinical utility and validation of the Concise Associated Symptom Tracking (CAST) Scale. Int J Neuropsychopharmacol. 2018;21(4):325–332. PubMed CrossRef
McAllister-Williams RH, Arango C, Blier P, et al. The identification, assessment and management of difficult-to-treat depression: An international consensus statement. J Affect Disord. 2020;267:264–282. PubMed CrossRef
Zimmerman M, Walsh E, Friedman M, et al. Identifying remission from depression on 3 self-report scales. J Clin Psychiatry. 2017;78(2):177–183. PubMed CrossRef
Trivedi MH. Tools and strategies for ongoing assessment of depression: a measurement-based approach to remission. J Clin Psychiatry. 2009;70(suppl 6):26–31. PubMed CrossRef
Hughes CW, Emslie GJ, Crismon ML, et al; Texas Consensus Conference Panel on Medication Treatment of Childhood Major Depressive Disorder. Texas Children’s Medication Algorithm Project: update from Texas Consensus Conference Panel on medication treatment of childhood major depressive disorder. J Am Acad Child Adolesc Psychiatry. 2007;46(6):667–686. PubMed CrossRef
Spitzer RL, Kroenke K, Williams JB. Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. Primary Care Evaluation of Mental Disorders. Patient Health Questionnaire. JAMA. 1999;282(18):1737–1744. PubMed CrossRef
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Fifth Edition, Text Revision. American Psychiatric Association.
Spitzer RL, Kroenke K, Williams JB, et al. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006;166(10):1092–1097. PubMed CrossRef
Trivedi MH, Wisniewski SR, Morris DW, et al. Concise Health Risk Tracking scale: a brief self-report and clinician rating of suicidal risk. J Clin Psychiatry. 2011;72(6):757–764. PubMed CrossRef
Mayes TL, Killian M, Rush AJ, et al. Predicting future suicidal events in adolescents using the Concise Health Risk Tracking Self-Report (CHRT-SR). J Psychiatr Res. 2020;126:19–25. PubMed CrossRef
Jeffrey J, Klomhaus A, Aralis H, et al. Factors associated with response and remission from depression at 6-months of treatment in a retrospective cohort treated within an integrated care program. BMC Health Serv Res. 2021;21(1):703. PubMed CrossRef
Trombello JM, Killian MO, Liao A, et al. Psychometrics of the Self-Report Concise Associated Symptoms Tracking Scale (CAST-SR): results from the STRIDE (CTN-0037) study. J Clin Psychiatry. 2018;79(2):41–47. PubMed CrossRef
Emslie GJ, Wagner KD, Kutcher S, et al. Paroxetine treatment in children and adolescents with major depressive disorder: a randomized, multicenter, double-blind, placebo-controlled trial. J Am Acad Child Adolesc Psychiatry. 2006;45(6):709–719. PubMed CrossRef
Atkinson SD, Prakash A, Zhang Q, et al. A double-blind efficacy and safety study of duloxetine flexible dosing in children and adolescents with major depressive disorder. J Child Adolesc Psychopharmacol. 2014;24(4):180–189. PubMed CrossRef
Gaspersz R, Lamers F, Kent JM, et al. Anxious distress predicts subsequent treatment outcome and side effects in depressed patients starting antidepressant treatment. J Psychiatr Res. 2017;84:41–48. PubMed CrossRef
Wilkinson P, Dubicka B, Kelvin R, et al. Treated depression in adolescents: predictors of outcome at 28 weeks. Br J Psychiatry. 2009;194(4):334–341. PubMed CrossRef
Derdikman-Eiron R, Indredavik MS, Bratberg GH, et al. Gender differences in subjective well-being, self-esteem and psychosocial functioning in adolescents with symptoms of anxiety and depression: findings from the Nord-Trøndelag Health Study. Scand J Psychol. 2011;52(3):261–267. PubMed CrossRef
Ma D, Zhang Z, Zhang X, et al. Comparative efficacy, acceptability, and safety of medicinal, cognitive-behavioral therapy, and placebo treatments for acute major depressive disorder in children and adolescents: a multiple-treatments meta-analysis. Curr Med Res Opin. 2014;30(6):971–995. PubMed CrossRef
Forbes EE, Stepp SD, Dahl RE, et al. Real-world affect and social context as predictors of treatment response in child and adolescent depression and anxiety: an ecological momentary assessment study. J Child Adolesc Psychopharmacol. 2012;22(1):37–47. PubMed CrossRef
Scardera S, Perret LC, Ouellet-Morin I, et al. Association of social support during adolescence with depression, anxiety, and suicidal ideation in young adults. JAMA Netw Open. 2020;3(12):e2027491. PubMed CrossRef