What next? A Bayesian hierarchical modeling re-examination of treatments for adolescents with selective serotonin reuptake inhibitor-resistant depression

Vikram Suresh, Jeffrey A. Mills, Paul E. Croarkin, Jeffrey R. Strawn

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Background: Psychiatrists frequently struggle with how to sequence treatment for depressed adolescents who do not respond to an adequate trial of a selective serotonin reuptake inhibitor (SSRI). This study leveraged recent statistical and computational advances to create Bayesian hierarchal models (BHMs) of response in the treatment of SSRI-resistant depression in adolescents study to inform treatment planning. Methods: BHMs of individual treatment trajectories were developed and estimated using Hamiltonian Monte Carlo no u-turn sampling. From the Monte Carlo pseudorandom sample, 95% credible intervals, means, posterior tail probabilities, and so forth, were determined. Then, for the random effects model, posterior tail probabilities were used to create Bayesian two-tailed p values to evaluate the null hypotheses: no difference in efficacy between SSRIs and venlafaxine. The robustness of the results was examined using the fixed effects model of treatment comparisons. Results: In patients not receiving cognitive behavioral therapy (CBT; n = 168), SSRIs produced greater and faster improvement in depressive symptoms compared to venlafaxine (p =.015). No differences in response or trajectory of response for symptoms of anxiety were detected between SSRIs and venlafaxine (p =.168). For patients receiving CBT (n = 162), SSRIs and venlafaxine produced similar improvements in symptoms of anxiety and depression. Conclusions: Findings from this novel computational approach suggest that a second trial of an SSRI is warranted for depressed adolescents who fail to respond to initial SSRI treatment.

Original languageEnglish (US)
Pages (from-to)926-934
Number of pages9
JournalDepression and Anxiety
Volume37
Issue number9
DOIs
StatePublished - Sep 1 2020

Keywords

  • TORDIA
  • clinical trial
  • depression
  • fluoxetine
  • major depressive disorder
  • paroxetine
  • sertraline

ASJC Scopus subject areas

  • Clinical Psychology
  • Psychiatry and Mental health

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