Harvard Mental Health Letter

Second-step treatments for adolescent depression

The TORDIA study suggests options when initial drug treatment fails.

After six months of treatment with either an antidepressant or psychotherapy, about 60% of adolescents newly diagnosed with major depression attain remission. The Treatment of Resistant Depression in Adolescents (TORDIA) study was designed to determine how best to treat those youths who have not obtained adequate relief after one medication.

This government-funded randomized controlled trial enrolled 334 youths ages 12 to 18, newly diagnosed with major depression or dysthymia, who had not responded sufficiently to at least eight weeks of initial treatment with a selective serotonin reuptake inhibitor (SSRI). Participants were randomly assigned to one of four arms:

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