25.4 AN ADAPTIVE TREATMENT STRATEGY FOR ADOLESCENT DEPRESSION: BEGINNING WITH NBSP; INTERPERSONAL PSYCHOTHERAPY FOR DEPRESSED ADOLESCENTS

Objectives: This presentation will describe a model and rationale for the development of an adaptive treatment strategy (ATS) for depression in adolescents. ATSs provide empirical guidelines for sequential clinical decisionmaking by providing decision rules that recommend when, how, and for whom treatments should be applied. These decision rules lead to personalized treatment sequences. We will describe the development and preliminary evaluation of four ATSs that aim to address the following two questions that arise when personalizing treatment for adolescents who begin treatment with interpersonal psychotherapy (IPT)-A: 1) at what time point should therapists make the determination that the adolescent is not likely to respond if the initial treatment plan is continued; and 2) should the therapist increase the number of IPT-A sessions or add pharmacotherapy (fluoxetine) for adolescents who may need their treatment augmented. Methods: A 16-week pilot sequential multiple assignment randomized trial (SMART) was conducted with 40 adolescents who had a diagnosis of MDD, dysthymic disorder, or depressive disorder NOS. Data on the feasibility and acceptability of the study and treatment procedures and treatment response rates were collected. Results: Week 4 was the more feasible and acceptable decision point for assessing the need for a change in treatment. Adolescents, parents, and therapists reported a range of attitudes about medication and more intensive therapy as treatment options. Conclusions: The results of pilot study support the continued clinical importance of examining the efficacy of adaptive treatments for adolescent depression. The ATSs, including the week 4 decision point, showed promise in terms of their feasibility and acceptability. Experiences from the pilot study have led to improvements in how the ATSs are discussed with families and how they are implemented. These will be discussed in the presentation.