Moderators of fluoxetine treatment response for children and adolescents with comorbid depression and substance use disorders

• Published in: Journal of substance abuse treatment 2012-06, Vol.42 (4), p.366-372
• Main Authors: Hirschtritt, Matthew E., B.A, Pagano, Maria E., Ph.D, Christian, Kelly M., M.A, McNamara, Nora K., M.D, Stansbrey, Robert J., M.D, Lingler, Jacqui, B.S, Faber, Jon E., M.A, Demeter, Christine A., M.A, Bedoya, Denise, M.A, Findling, Robert L., M.D., M.B.A
• Format: Article
• Language: English
• Subjects: Addictive behaviors; Adolescent; Adolescents; Adult and adolescent clinical studies; Alcohol; Alcohol consumption; Alcohol use; Alcoholism - complications; Alcoholism - psychology; Antidepressants; Antidepressive Agents, Second-Generation - therapeutic use; Biological and medical sciences; Child; Children & youth; Chronic Disease; Depression; Depressive Disorder - complications; Depressive Disorder - drug therapy; Desintoxication. Drug withdrawal; Diagnostic and Statistical Manual of Mental Disorders; Drug abuse; Drug addiction; Dysthymia; Female; Fluoxetine; Fluoxetine - therapeutic use; Humans; Male; Marijuana; Marijuana Abuse - complications; Marijuana Abuse - psychology; Mediators; Medical sciences; Mental depression; Miscellaneous; Moderators; Motivation; Psychiatric Status Rating Scales; Psychiatry; Psychology. Psychoanalysis. Psychiatry; Psychometrics; Psychopathology. Psychiatry; Public health. Hygiene; Public health. Hygiene-occupational medicine; Substance abuse; Substance abuse disorders; Substance abuse treatment; Substance-Related Disorders - complications; Substance-Related Disorders - drug therapy; Treatments
• ISSN: 0740-5472; 1873-6483
• DOI: 10.1016/j.jsat.2011.09.010

Abstract Our recent 8-week, randomized, placebo-controlled trial of fluoxetine in adolescents (ages 12-17 years) with comorbid depression and substance use disorder (SUD) did not detect a significant antidepressant treatment effect. The purpose of this secondary analysis was to explore moderators of the effect of fluoxetine in this sample. Static moderators measured at baseline were depression chronicity and hopelessness severity; time-varying moderators measured at baseline and weekly during the 8-week trial period were alcohol and marijuana use severity. Treatment effects on depression outcomes were examined among moderating subgroups in random effects regression models. Subjects assigned to fluoxetine treatment with chronic depression at baseline ( p = .04) or no more than moderate alcohol use during the trial ( p = .04) showed significantly greater decline in depression symptoms in comparison to placebo-assigned subgroups. The current analysis suggests that youth with chronic depression and no more than moderate alcohol consumption are likely to respond better to treatment with fluoxetine compared with placebo than youth with transient depression and heavy alcohol use.