After TADS, Can We Measure Up, Catch Up, and Ante Up?

Abstract

This special section, featuring the National Institute of Mental Health (NIMH) Treatment for Adolescents With Depression Study (TADS), is an extraordinary offering for careful readers, researchers, clinicians, and health care policymakers alike. An investigation of major international significance, this study will deservedly be cited for decades to come as one of the preeminent research investigations ever mounted in child and adolescent psychiatry. TADS' significance and impact derive not just from the study's findings, but from the many strengths characterizing TADS: its unique design, expert investigator team, careful study execution, rigorous quality controls and monitoring, and state-of-the-art data analysis. Yet surprisingly, from this commentator's perspective, TADS has generated some modest controversy, not because of the study's strengths, but because of the use of a psychotropic agent for a not well-understood condition (major depressive disorder [MDD]) and where medication use is easily depicted as malevolent. Although the various conspiracy theories do not hold much sway among the well-educated public and persons who know first-hand how MDD affects adolescents-whether depressed adolescents themselves, their parents and families, or those who care for them-these notions and the larger problem of stigma ( Hinshaw, 2005 Hinshaw SP The stigmatization of mental illness in children and parents: Developmental issues, family concerns, and research needs. J Child Psychol Psychiatry. 2005; 46: 714-734 Crossref PubMed Scopus (279) Google Scholar ) pose significant, continuing distractions from our purposefully mounting a coherent national agenda to address MDD and related mental health problems in children and adolescents.