Residual Symptoms in Pediatric Depression after Acute Pharmacological Treatment

Abstract

Children and adolescents with major depressive disorder (MDD) are at an increased risk for school failure, school drop out, and suicidality. Childhood onset of MDD has been linked to an increased likelihood of relapse of MDD in child and adolescent research. Adult studies have found that residual symptoms increase the risk of relapse, and shorten the time to onset of relapse. This study sought to confirm the presence of residual symptoms in children and adolescents after successful treatment with antidepressant medication. An additional objective was to identify predictors of remission in those who have an adequate response to treatment. The participants (N=315) are from a combined data set of two separate studies conducted by Graham J. Emslie investigating the efficacy of fluoxetine 20 mg/day for 8 weeks in children and adolescents with non-psychotic depression. Evaluating the patients using the more stringent criteria of remission in responders, showed that 64% of fluoxetine treated patients, and 56% of placebo treated patients successfully achieved remission. In this subgroup of responders, dysthymic disorder and CDRS-R total baseline score were found to be predictive of responders who remit. Residual symptoms were found to be present in both the fluoxetine and placebo treatment group responders in high frequency. Finally, using the CDRS-R individual item scores of ≥3, fourteen different types of residual symptoms where found for the 86 fluoxetine responders, and eleven different types of residual symptoms were found for the 57 placebo responders.