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Impersistence of Depression in Youth: Implications for Drug Study Design

From the Department of Psychiatry at Drexel University College of Medicine and Philadelphia Health & Education Corporation, Philadelphia, Pennsylvania (Dr Malone, Dr Bennett, Dr Delaney); Columbia University, New York, New York (Dr Choudhury); Wordsworth Academy in Ft. Washington, Pennsylvania (Dr Luebbert); and Biomedical Statistical Consulting, Wynnewood, Pennsylvania (Dr Cater).

Food and Drug Administration data show that most anti-depressant studies in youth do not show drug effect. The few positive studies used rigorous diagnostic screening procedures, suggesting major depressive disorder (MDD) may not be a persistent condition in a subgroup of youth. To investigate persistence of MDD, we serially assessed a cohort of inpatients admitted to the hospital with a clinical diagnosis of MDD. Assessments included a structured diagnostic interview, the Diagnostic Interview for Children and Adolescents-Revised (DICA-R), and measures of depressive symptomatology. Of 66 subjects (40 girls; mean age, 14.4 ± 2.2 years), 34 (51.5%) met DICA-R criteria for MDD at the initial postadmission assessment. Of these, only 8 (23.5%) met DICA-R criteria for MDD at any subsequent assessment. Similar reductions were found on other ratings of depression. In conclusion, MDD did not persist in this sample. The findings suggest a multigated assessment procedure should be employed before randomization in antidepressant clinical trials.

Key Words: Depression • adolescents • study design

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