AbstractObjectiveTo examine the course of depression during the treatment of depressed adolescents who had recently attempted suicide.MethodAdolescents (N=124), age 12–18 years, with a 90-day history of suicide attempt, a current diagnosis of depressive disorder (96.0% had major depressive disorder), and a Children's Depression Rating Scale-Revised (CDRS-R) score of 36 or greater, entered a 6-month treatment with antidepressant medication, cognitive-behavioral therapy focused on suicide prevention, or their combination (Comb), at five academic sites. Treatment assignment could be either random or chosen by study participants. Intent-to-treat, mixed effects regression models of depression and other relevant ratings were estimated. Improvement and remission rates were computed with the last observation carried forward.ResultsMost patients (N=104 or 84%) chose treatment assignment and, overall, three-fourths (N=93) received Comb. In Comb, CDRS-R declined from a baseline adjusted mean of 49.6 (SD 12.3) to 38.3 (8.0) at week 12, and to 27.0 (10.1) at week 24 (p<0.0001), with a Clinical Global Impression-defined improvement rate of 58.0% at week 12, and 72.2% at week 24; and a remission (CDRS-R ≤28) rate of 32.5% at week 12 and 50.0% at week 24. CDRS-R and the Scale for Suicidal Ideation (SSI) scores were correlated at baseline (r=0.43, p<0.0001), and declined in parallel.ConclusionsWhen vigorously treated with a combination of medication and psychotherapy, depressed adolescents who have recently attempted suicide show rates of improvement and remission of depression that appear comparable to those observed in non-suicidal depressed adolescents.Keywords: adolescents, suicide, depression, treatment
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