Critical Decision Points for Augmenting Interpersonal Psychotherapy for Depressed Adolescents: A Pilot Sequential Multiple Assignment Randomized Trial

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1 Citation (Scopus)

Abstract

Objective: Practice parameters recommend systematic assessment of depression symptoms over the course of treatment to inform treatment planning; however, there are currently no guidelines regarding how to use symptom monitoring to guide treatment decisions for psychotherapy. The current study compared two time points (week 4 and week 8) for assessing symptoms during interpersonal psychotherapy for depressed adolescents (IPT-A) and explored four algorithms that use the symptom assessments to select the subsequent treatment. Method: Forty adolescents (aged 12−17 years) with a depression diagnosis began IPT-A with an initial treatment plan of 12 sessions delivered over 16 weeks. Adolescents were randomized to a week 4 or week 8 decision point for considering a change in treatment. Insufficient responders at either time point were randomized a second time to increased frequency of IPT-A (twice per week) or addition of fluoxetine. Measures were administered at baseline and weeks 4, 8, 12, and 16. Results: The week 4 decision point for assessing response and implementing treatment augmentation for insufficient responders was more efficacious for reducing depression symptoms than the week 8 decision point. There were significant differences between algorithms in depression and psychosocial functioning outcomes. Conclusion: Therapists implementing IPT-A should routinely monitor depression symptoms and consider augmenting treatment for insufficient responders as early as week 4 of treatment. Clinical Trial Registration Information: An Adaptive Treatment Strategy for Adolescent Depression. https://clinicaltrials.gov; NCT02017535.

Original languageEnglish (US)
Pages (from-to)80-91
Number of pages12
JournalJournal of the American Academy of Child and Adolescent Psychiatry
Volume58
Issue number1
DOIs
StatePublished - Jan 1 2019

Fingerprint

Psychotherapy
Depression
Therapeutics
Symptom Assessment
Fluoxetine
Clinical Trials
Guidelines

Keywords

  • algorithms
  • depression
  • fluoxetine
  • psychotherapy
  • symptom assessment

PubMed: MeSH publication types

  • Journal Article
  • Research Support, N.I.H., Extramural

Cite this

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title = "Critical Decision Points for Augmenting Interpersonal Psychotherapy for Depressed Adolescents: A Pilot Sequential Multiple Assignment Randomized Trial",
abstract = "Objective: Practice parameters recommend systematic assessment of depression symptoms over the course of treatment to inform treatment planning; however, there are currently no guidelines regarding how to use symptom monitoring to guide treatment decisions for psychotherapy. The current study compared two time points (week 4 and week 8) for assessing symptoms during interpersonal psychotherapy for depressed adolescents (IPT-A) and explored four algorithms that use the symptom assessments to select the subsequent treatment. Method: Forty adolescents (aged 12−17 years) with a depression diagnosis began IPT-A with an initial treatment plan of 12 sessions delivered over 16 weeks. Adolescents were randomized to a week 4 or week 8 decision point for considering a change in treatment. Insufficient responders at either time point were randomized a second time to increased frequency of IPT-A (twice per week) or addition of fluoxetine. Measures were administered at baseline and weeks 4, 8, 12, and 16. Results: The week 4 decision point for assessing response and implementing treatment augmentation for insufficient responders was more efficacious for reducing depression symptoms than the week 8 decision point. There were significant differences between algorithms in depression and psychosocial functioning outcomes. Conclusion: Therapists implementing IPT-A should routinely monitor depression symptoms and consider augmenting treatment for insufficient responders as early as week 4 of treatment. Clinical Trial Registration Information: An Adaptive Treatment Strategy for Adolescent Depression. https://clinicaltrials.gov; NCT02017535.",
keywords = "algorithms, depression, fluoxetine, psychotherapy, symptom assessment",
author = "Gunlicks-Stoessel, {Meredith L} and Laura Mufson and Bernstein, {Gail A} and Ana Westervelt and Reigstad, {Kristina M} and Bonnie Klimes-Dougan and Cullen, {Kathryn R} and Aimee Murray and Vock, {David M}",
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AU - Bernstein, Gail A

AU - Westervelt, Ana

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AB - Objective: Practice parameters recommend systematic assessment of depression symptoms over the course of treatment to inform treatment planning; however, there are currently no guidelines regarding how to use symptom monitoring to guide treatment decisions for psychotherapy. The current study compared two time points (week 4 and week 8) for assessing symptoms during interpersonal psychotherapy for depressed adolescents (IPT-A) and explored four algorithms that use the symptom assessments to select the subsequent treatment. Method: Forty adolescents (aged 12−17 years) with a depression diagnosis began IPT-A with an initial treatment plan of 12 sessions delivered over 16 weeks. Adolescents were randomized to a week 4 or week 8 decision point for considering a change in treatment. Insufficient responders at either time point were randomized a second time to increased frequency of IPT-A (twice per week) or addition of fluoxetine. Measures were administered at baseline and weeks 4, 8, 12, and 16. Results: The week 4 decision point for assessing response and implementing treatment augmentation for insufficient responders was more efficacious for reducing depression symptoms than the week 8 decision point. There were significant differences between algorithms in depression and psychosocial functioning outcomes. Conclusion: Therapists implementing IPT-A should routinely monitor depression symptoms and consider augmenting treatment for insufficient responders as early as week 4 of treatment. Clinical Trial Registration Information: An Adaptive Treatment Strategy for Adolescent Depression. https://clinicaltrials.gov; NCT02017535.

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