Anhedonia predicts poorer recovery among youth with selective serotonin reuptake inhibitor treatment-resistant depression.

Dana L McMakin, Thomas M Olino, Giovanna Porta, Laura J Dietz, Graham Emslie, Gregory Clarke, Karen Dineen Wagner, Joan R Asarnow, Neal D Ryan, Boris Birmaher, Wael Shamseddeen, Taryn Mayes, Betsy Kennard, Anthony Spirito, Martin Keller, Frances L Lynch, John F Dickerson, David A Brent

Journal: Journal of the American Academy of Child and Adolescent Psychiatry 2012;51(4):404-11

PMID: 22449646

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Abstract

OBJECTIVE

To identify symptom dimensions of depression that predict recovery among selective serotonin reuptake inhibitor (SSRI) treatment-resistant adolescents undergoing second-step treatment.

METHOD

The Treatment of Resistant Depression in Adolescents (TORDIA) trial included 334 SSRI treatment-resistant youth randomized to a medication switch, or a medication switch plus CBT. This study examined five established symptom dimensions (Child Depression Rating Scale-Revised) at baseline as they predicted recovery over 24 weeks of acute and continuation treatment. The two indices of recovery that were evaluated were time to remission and number of depression-free days.

RESULTS

Multivariate analyses examining all five depression symptom dimensions simultaneously indicated that anhedonia was the only dimension to predict a longer time to remission, and also the only dimension to predict fewer depression-free days. In addition, when anhedonia and CDRS-total score were evaluated simultaneously, anhedonia continued to uniquely predict longer time to remission and fewer depression-free days.

CONCLUSIONS

Anhedonia may represent an important negative prognostic indicator among treatment-resistant depressed adolescents. Further research is needed to elucidate neurobehavioral underpinnings of anhedonia, and to test treatments that target anhedonia in the context of overall treatment of depression.

Address: University of Pittsburgh, Western PsychiatricInstitute and Clinic, 3811 O’Hara Street, Pittsburgh, PA 15213, USA. [email protected]

DOI: 10.1016/j.jaac.2012.01.011

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MeSH Terms: Adolescent, Affect, Anhedonia, Antidepressive Agents, Second-Generation, Cognitive Behavioral Therapy, Combined Modality Therapy, Cyclohexanols, Depressive Disorder, Major, Depressive Disorder, Treatment-Resistant, Double-Blind Method, Drug Resistance, Drug Substitution, Female, Humans, Longitudinal Studies, Male, Personality Assessment, Psychometrics, Psychotherapy, Selective Serotonin Reuptake Inhibitors, Venlafaxine Hydrochloride