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.

中文翻译：

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增强抑郁症青少年人际心理治疗的关键决策点：先后顺序多重分配随机试验

客观的

实践参数建议在治疗过程中对抑郁症状进行系统评估，以告知治疗计划；但是，目前尚无有关如何使用症状监测来指导心理治疗决策的指南。当前的研究比较了两个时间点（第4周和第8周）来评估抑郁症青少年的人际心理治疗期间的症状（IPT-A），并探讨了使用症状评估选择后续治疗方法的四种算法。

方法

诊断为抑郁的四十名青少年（年龄在12-17岁之间）开始IPT-A，最初的治疗计划是在16周内分12疗程。将青少年随机分配到第4周或第8周的决定点，以考虑改变治疗方法。在任一时间点，应答者不足均再次随机分配至IPT-A频率增加（每周两次）或添加氟西汀。在基线和第4、8、12和16周进行测量。

结果

与第8周的决策点相比，第4周的评估响应和对反应不足的患者实施治疗增强的决策点更有效地减轻了抑郁症的症状。抑郁症和社会心理功能结局的算法之间存在显着差异。

结论

实施IPT-A的治疗师应例行监测抑郁症症状，并考虑在治疗的第4周就针对反应不足的患者加强治疗。

临床试验注册信息

青少年抑郁症的适应性治疗策略。https://clinicaltrials.gov; NCT02017535。