Summer Is the Best Time for Treatment of Resistant Depression in Adolescents (TORDIA): The Importance of School in Medication Trials

Abstract

m w s i d T he Treatment of Resistant Depression in Adolescents (TORDIA) multisite trial is providing much useful information, including illumination of variables that may significantly influence treatment response and that will, at some point, have to be configured into treatment planning. TORDIA included 334 adolescents who did not respond to a robust daily selective serotonin reuptake inhibitor dose for at least 8 weeks; the study occurred across six U.S. sites, and the secondary analyses of the TORDIA data provide an intriguing finding described in this issue of the Journal: subjects who completed their antidepressant treatment when school was “out” (for the summer) had a more positive response than those subjects who completed their antidepressant treatment amid the school year. Indeed, 59% of those on summer vacation responded to treatment (another antidepressant with/without cognitive-behavioral therapy) compared with 41% who completed treatment during the school year. The implication is that school stress may substantially affect treatment response and should be factored into treatment planning. That said, what does this finding really suggest, and what should clinicians do, given this finding, at this point to benefit their patients? First, all studies have limitations, and this one is no different. The TORDIA trial was not designed to quantify the effects of various school variables on treatment response; however, the data collected provide an important initial finding worthy of replication and elaboration. For example, these students were categorized as ending treatment (final assessment) during the school year or not during the school year. It is still unclear how long a student must be “out of school” before that stress abates. In addition, it is not clear whether any of these students were