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To the Editor: The randomized trial by Dr Brent and colleagues¹ addressed the clinically important question of how to treat depressed adolescents who are not responsive to initial treatment with a selective serotonin reuptake inhibitor (SSRI). We would like to raise 2 issues regarding this study.

First, the design included a slow tapering of the original SSRI. Because all patients received another medication with a serotonergic component, we do not believe that slow tapering was necessary, based on studies of adults with depression.² An immediate switch would have shortened the overall study duration and thereby may have decreased the number of dropouts during the wash-out phase.

Second, suicidal ideation decreased in all treatment groups, paralleling the antidepressant effect. Because post hoc analyses of the approval studies for antidepressants in this age group revealed a higher rate of suicidal ideation in depressed adolescents who received antidepressants compared with those receiving placebo,³ . . . [Full Text of this Article]

Ion Anghelescu, MD
ion.anghelescu@charite.de

Francesca Regen, MD
Department of Psychiatry and Psychotherapy
Charité–University Medicine Berlin
Berlin, Germany

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RELATED ARTICLE

Switching to Another SSRI or to Venlafaxine With or Without Cognitive Behavioral Therapy for Adolescents With SSRI-Resistant Depression: The TORDIA Randomized Controlled Trial
David Brent, Graham Emslie, Greg Clarke, Karen Dineen Wagner, Joan Rosenbaum Asarnow, Marty Keller, Benedetto Vitiello, Louise Ritz, Satish Iyengar, Kaleab Abebe, Boris Birmaher, Neal Ryan, Betsy Kennard, Carroll Hughes, Lynn DeBar, James McCracken, Michael Strober, Robert Suddath, Anthony Spirito, Henrietta Leonard, Nadine Melhem, Giovanna Porta, Matthew Onorato, and Jamie Zelazny
JAMA. 2008;299(8):901-913.
ABSTRACT | FULL TEXT  

RELATED LETTER

SSRI Tapering and Suicidal Ideation in the TORDIA Study for Treatment of Depressed Adolescents—Reply
David Brent and Karen Dineen Wagner
JAMA. 2008;299(23):2746.
EXTRACT | FULL TEXT