A new trial hopes to clarify next steps for teen depression
STUDY: He Y et al, BMC Psychiatry 2023;23:789
STUDY TYPE: Randomized controlled trial protocol
FUNDING: Scientific and Technological Innovation 2030 — Brain Science Major Project
Background
Fluoxetine is the only antidepressant with robust positive trials in adolescent depression, but whether to use therapy (CBT) from the start remains genuinely unsettled. UK guidelines say yes; American ones say either approach is reasonable. And when the first treatment doesn’t work — which happens in 20–30% of teens — research doesn’t guide the way.
The Study
The trial has just begun and this paper describes the steps they will test. This “STAR-AD” is based on the STAR-D for adults.
They plan to enroll 520 adolescents with moderate-to-severe major depression across six centers in China:
- STEP 1: Patients choose fluoxetine alone or fluoxetine plus CBT for 8 weeks
- STEP 2: Nonresponders are randomized to one of three switches (sertraline, duloxetine, or vortioxetine) or three augmentation strategies (aripiprazole, olanzapine, or lithium added to fluoxetine) for another 8 weeks.
Practice Implications
- Looking forward to these results, as adolescents tend to respond different to medications than adults.
— Chris Aiken, MD
Director, Psych Partners
Editor in Chief, Carlat Psychiatry Report
What’s Your Take? Share in Comments
- What have they left out? What do you use for treatment resistant depression in teens?
