Monday, October 29, 2018

Augmenting Interpersonal Therapy Early May Speed Improvement in Youth With Depression

Psychiatrists who treat adolescents with depression with interpersonal psychotherapy (IPT-A) should consider augmenting the treatment if there is no significant response to therapy within four weeks, suggests a small study published in the Journal of American Academy of Child & Adolescent Psychiatry.

“Waiting too long to decide whether to change treatment for an insufficient responder could mean prolonged experience of depressive symptoms and associated functional impairments,” wrote Meredith Gunlicks-Stoessel, Ph.D., of the University of Minnesota and colleagues. “On the other hand, augmenting treatment too soon might mean adding treatments that could increase risk of side effects or other burdens before giving the initial treatment sufficient time to work.”

For the study, Gunlicks-Stoessel and colleagues tracked 40 adolescents aged 12 to 17 with depression receiving 12 IPT-A sessions over a 16-week period. The participants were randomly assigned to receive a clinical evaluation after either four weeks or eight weeks, at which point treatment could be augmented if needed. Adolescents who showed an insufficient response to IPT-A (defined as less than a 20% reduction in depression symptom scores after four weeks or less than 40% reduction in depression symptom scores after eight weeks) were randomly assigned to four additional IPT-A sessions or daily fluoxetine (10 mg to 40 mg).

The authors found that the adolescents who received a clinical evaluation after four weeks had lower average depressive symptoms, as measured by the Children’s Depression Rating Scale-Revised, or CDRS-R, after 16 weeks compared with those who received the evaluation at eight weeks.

Additional analysis revealed that adolescents who received additional IPT-A sessions or adjunct fluoxetine beginning at week 4 saw statistically similar symptom improvements at week 16, the authors noted. Adolescents who received additional IPT-A sessions after four weeks saw greater symptom improvements compared with those who received the additional sessions after eight weeks. Adolescents who received fluoxetine experienced similar improvements regardless of when they began the augmentation.

“It may be that the timing of adding fluoxetine is not critical in the way that it appears to be for increasing the dose of IPT-A,” the authors wrote. “At week 4, the adolescent is about to initiate working on the interpersonal problem area and learning new communication and interpersonal problem-solving skills. It may be that meeting twice per week at this time is particularly good timing, as it provides more concentrated skill building and opportunities for engaging in interpersonal experiments in between sessions.”

For related information, see the Psychiatric News article “SSRIs/SNRIs Effective in Children, but Risks, Benefits Vary.”

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