History Of Recurrent Depression Research Articles

Electroconvulsive therapy response and remission in moderate to severe depressive illness: a decade of national Scottish data.

Despite strong evidence of efficacy of electroconvulsive therapy (ECT) in the treatment of depression, no sensitive and specific predictors of ECT response have been identified. Previous meta-analyses have suggested some pre-treatment associations with response at a population level. Using 10 years (2009-2018) of routinely collected Scottish data of people with moderate to severe depression (n = 2074) receiving ECT we tested two hypotheses: (a) that there were significant group-level associations between post-ECT clinical outcomes and pre-ECT clinical variables and (b) that it was possible to develop a method for predicting illness remission for individual patients using machine learning. Data were analysed on a group level using descriptive statistics and association analyses as well as using individual patient prediction with machine learning methodologies, including cross-validation. ECT is highly effective for moderate to severe depression, with a response rate of 73% and remission rate of 51%. ECT response is associated with older age, psychotic symptoms, necessity for urgent intervention, severe distress, psychomotor retardation, previous good response, lack of medication resistance, and consent status. Remission has the same associations except for necessity for urgent intervention and, in addition, history of recurrent depression and low suicide risk. It is possible to predict remission with ECT with an accuracy of 61%. Pre-ECT clinical variables are associated with both response and remission and can help predict individual response to ECT. This predictive tool could inform shared decision-making, prevent the unnecessary use of ECT when it is unlikely to be beneficial and ensure prompt use of ECT when it is likely to be effective.

Inhibition moderates the effect of attentional bias modification for reducing residual depressive symptoms: A randomized sham-controlled clinical trial

ObjectivesResidual symptoms represent risk factor for relapse. Attention bias modification (ABM) may reduce clinical and sub-clinical depressive symptoms, indicating that is may be of relevance when preventing relapse. Current evidence suggests that executive functions may moderate the outcome of interventions targeting depressive symptoms. MethodsWe assessed inhibition and shifting as indicators of executive functioning by means of the Color-Word Interference Test (i.e., “Stroop task”). These baseline characteristics were investigated as moderator of the effect of ABM on depression symptoms in a double-blinded randomized sham-controlled trial of ABM including patients with a history of recurrent depression (N = 301). Inclusion and follow-ups took place from January 2015 to October 2016. The trial was retrospectively registered #NCT02658682 January 2016. ResultsThe moderation analysis was based on the interaction term ABM x Stroop. Scaled inhibition scores ≤10.8, but not shifting ability, moderated the effect of ABM compared to sham on clinician-rated depression (HDRS). The difference from the 15th to the 85th percentile of the inhibition score was about 1 HDRS-point, indicating a small effect size. No moderation was found when self-reported depression and AB were the outcome. Post-hoc power calculation indicates risk of Type-II error. ConclusionWhen targeting depressive symptoms, ABM seems to be somewhat more effective in patients with weak inhibitory control. This suggests that evaluating the level of inhibition in individual patients could provide some information when making decisions about prescribing ABM to reduce residual symptoms, but the clinical implications of this is uncertain due to an overall small effect size attributable to ABM. Future studies should examine whether inhibitory control still is a relevant moderator when comparing ABM to treatment options other than the sham control condition.

Depression in Working Professionals – A Systematic Review of the Literature

Introduction: Workplace depression is a debilitating public health issue with far-reaching impacts on employees, employers, and organizations. Depression among working professionals is on the rise, and is a direct and indirect threat to the overall health and well-being of the employees, the productivity of the organizations, and the economic progress of the nations as a whole. This systematic review synthesizes evidence from the existing literature regarding workplace depression and the factors implicated in the development of depression in this population. Methods: The author conducted a search on electronic research databases including PubMed/MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and Google Scholar, without language restrictions. The studies published within the last 20 years were screened based on the title and abstract. The data extraction of the eligible studies included measures of mental health symptoms, screening (If included), work-related adverse outcomes, work-related satisfaction outcomes, quality of life, help- seeking behavior, risk factors, protective factors, and non-work-related factors. The health risk factors or health- related behaviors associated with workplace depression include overweight or obesity, daily tobacco or cigarette smoking, sleep duration, alcohol consumption, low physical activity, diagnosis of diabetes mellitus, diagnosis of other chronic conditions, and overall poor health status. Results: The development of depression in working professionals is a complex and multifaceted interplay of personal, work-related, and health risk factors of varying degrees. The personal risk factors comprise age, gender, having a partner at home, being a family caregiver, diagnosis of a chronic illness, having children at home, history of recurrent depression, low education level, widowed or divorced status, and history of diabetes mellitus. The workplace factors include role conflict, procedural injustice, .....

Recurrent depression relates to worse outcomes than single episode depression among Hispanic adolescents with diabetes.

Adolescents with type 1 diabetes (T1D) are at increased risk for depression. A history of recurrent depression (HRD) may relate to worse health outcomes than single-episode depression. However, no study has explored this issue among T1D adolescents. We examined differences in psychosocial and diabetes-related outcomes between T1D adolescents with (G1; n = 33) and without (G2; n = 18) HRD. Participants were 51 youths (aged 12-17 years) enrolled in a depression treatment study. Youths and one caregiver each completed several measures. Using MANOVA, followed by individual ANOVAs, and chi-square tests, we compared groups in continuous and categorical variables, respectively. MANOVA results were significant, F(7, 43) = 3.97, p = .002. Adolescents from G1 obtained higher scores than youths in G2 in self-esteem/guilt problems, cognitive alterations, and sadness due to T1D. Their caregivers reported more burden and rated their offspring as having more internalizing problems, facing more barriers to complying with T1D treatment, and using a medical ID less frequently than their counterparts did. A higher percentage of G1 participants presented clinical anxiety and inadequate glycemic control, and reported a history of major depression. According to caregivers, a higher proportion of G1 members had experienced multiple diabetes-related hospitalizations, were non-compliant with insulin treatment, and lived in homes with a conflictive environment. Our study documents important differences in outcomes between T1D youths with vs. without any HRD. Clinicians may need an intensive and integrative approach to treat mental and physical aspects of health among these patients.

Randomised controlled trial of cognitive behaviour therapy versus mindfulness for people with rheumatoid arthritis with and without a history of recurrent depression: study protocol and design

IntroductionPsychosocial treatments have been shown to benefit people with rheumatoid arthritis (RA) on various outcomes. Two evidence-based interventions are cognitive behavioural therapy (CBT) and mindfulness-based stress reduction (MBSR). However, these...

A randomized controlled trial of a web-based mindfulness programme for people with MS with and without a history of recurrent depression

Background: Evidence shows small positive effects associated with psychological treatments for people with multiple sclerosis (PwMS). In a recent meta-analysis, the treatment with the largest effect size was a mindfulness-based intervention (MBI). Objectives: We aimed to determine whether an Internet-delivered MBI was beneficial for PwMS. Furthermore, we aimed to investigate history of recurrent depression as a moderator of treatment outcome. Methods: Participants (N = 132) were assessed based on whether they had a history of recurrent depression, then stratified and randomized to MBI or waitlist. Outcomes were assessed at baseline, post-intervention, and 3 and 6 months. Results: The MBI group reported significantly improved depressive symptoms (primary outcome) compared with the waitlist (p = 0.046, Cohen’s d = 0.39). Those with a history of recurrent depression benefitted significantly more than those without (p = 0.034, d = 0.66). There were benefits for health-related quality of life (HRQoL) in the MBI, irrespective of depression history (p = 0.009, d = 0.5). Pain interference was less overall in the MBI group (p < 0.001, d = 0.2), but change over time did not differ from waitlist. There were no treatment effects for anxiety, pain severity or fatigue. Conclusion: The Internet-delivered MBI significantly improved depressive symptoms and HRQoL in PwMS. For depression, the benefits were greater for those with a history of recurrent depression. Trial Registration: ACTRN12618001260213, available at: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375598

ADHD in adults with recurrent depression

BackgroundDepression is highly heterogeneous in its clinical presentation. Those with attention deficit/hyperactivity disorder (ADHD) may be at risk of a more chronic and impairing depression compared to those with depression alone according to studies of young people. However, no studies to date have examined ADHD in recurrently depressed adults in mid-life. MethodIn a sample of women in mid-life (n=148) taken from a UK based prospective cohort of adults with a history of recurrent depression, we investigated the prevalence of ADHD and the association of ADHD with clinical features of depression. Results12.8% of the recurrently depressed women had elevated ADHD symptoms and 3.4% met DSM-5 diagnostic criteria for ADHD. None of the women reported having a diagnosis of ADHD from a medical professional. ADHD symptoms were associated with earlier age of depression onset, higher depression associated impairment, a greater recurrence of depressive episodes and increased persistence of subthreshold depression symptoms over the study period, higher levels of irritability and increased risk of self-harm or suicide attempt. ADHD symptoms were associated with increased risk of hospitalisation and receiving non-first-line antidepressant medication. LimitationsADHD was measured using a questionnaire measure. We focussed on mothers in a longitudinal study of recurrent depression, so the findings may not apply to males or other groups. ConclusionsHigher ADHD symptoms appear to index a worse clinical presentation for depression. Clinical implications include that in women with early onset, impairing and recurrent depression, the possibility of underlying ADHD masked by depression needs to be considered.

The psychometric properties of the cognitive emotion regulation questionnaire (CERQ) in a clinical sample of adults with recurrent depression

BackgroundAffective dysregulation is central to depression. However, emotion regulation (ER) tendencies in depression remain poorly understood. It is critical, therefore, to validate measures of habitual ER in clinical populations. The current study aimed to validate the Cognitive Emotion Regulation Questionnaire (CERQ) in a sample of individuals with a history of recurrent depression who are currently in remission. MethodThe CERQ measures ER tendencies with 36 self-report items that are divided into nine subscales. Each subscale is purported to assess one of five adaptive and four maladaptive ER strategies. The CERQ was administered to 476 adults (mean age = 46.76 years; 75% female) that were currently in remission with a history of recurrent depression, who were recruited from primary care settings. We first investigated the CERQ's nine factor structure, internal consistency, convergent and criterion validity. ResultsThe nine-factor structure did not fit the CERQ structure in a sample of individuals with recurrent depression and convergent validity was poor. Instead, a five-factor structure fit the data best and showed acceptable convergent and criterion validity. LimitationsThe generalisability of the findings may be limited due to relative lack of diversity in terms of gender and ethnicity of the sample. ConclusionThese results suggest that the taxonomic structure of the CERQ does not fit emotion regulation patterns in adults with a history of depression. These findings highlight the importance of validating measures in clinical samples.

Recovery from recurrent depression with mindfulness-based cognitive therapy and antidepressants: a qualitative study with illustrative case studies

ObjectivesThis study aimed to describe the recovery journeys of people with a history of recurrent depression who took part in a psychosocial programme designed to teach skills to prevent depressive...

Emotion Regulation as a Mediator of Self-Compassion and Depressive Symptoms in Recurrent Depression

A key challenge for people who struggle with major depressive disorder (MDD) is the prevention of recurrence, given that the risk of recurrence increases significantly with each episode. Recently, it has been suggested that low levels of self-compassion may be an enduring risk factor for depression recurrence; however, surprisingly little research has examined the pathways through which self-compassion and recurrent depressive symptoms are linked. Thus, our study examined how self-compassion may be protective in the recurrence of depressive symptoms through four emotion regulation strategies associated with depression: brooding rumination, experiential avoidance, cognitive reappraisal, and acceptance. A sample of 100 participants with a history of recurrent depression were recruited using Amazon’s Mechanical Turk (MTurk). Simple and multiple mediation analyses were conducted. Results from the simple mediation models indicated that higher levels of self-compassion were associated with lower depressive symptoms through brooding rumination, experiential avoidance, and acceptance, while cognitive reappraisal did not mediate the relation. The multiple mediation model revealed that brooding rumination was the only significant mediator, when controlling for other emotion regulation strategy variables. Theoretical implications are discussed.

Economic Evaluation of an Internet-Based Preventive Cognitive Therapy With Minimal Therapist Support for Recurrent Depression: Randomized Controlled Trial

BackgroundMajor depressive disorder (MDD) is highly recurrent and has a significant disease burden. Although the effectiveness of internet-based interventions has been established for the treatment of acute MDD, little is known about their cost effectiveness, especially in recurrent MDD.ObjectivesOur aim was to evaluate the cost effectiveness and cost utility of an internet-based relapse prevention program (mobile cognitive therapy, M-CT).MethodsThe economic evaluation was performed alongside a single-blind parallel group randomized controlled trial. Participants were recruited via media, general practitioners, and mental health care institutions. In total, 288 remitted individuals with a history of recurrent depression were eligible, of whom 264 were randomly allocated to M-CT with minimal therapist support added to treatment as usual (TAU) or TAU alone. M-CT comprised 8 online lessons, and participants were advised to complete 1 lesson per week. The economic evaluation was performed from a societal perspective with a 24-month time horizon. The health outcomes were number of depression-free days according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, (DSM-IV) criteria assessed with the Structured Clinical Interview for DSM-IV axis I disorders by blinded interviewers after 3, 12, and 24 months. Quality-adjusted life years (QALYs) were self-assessed with the three level version of the EuroQol Five Dimensional Questionnaire (EQ-5D-3L). Costs were assessed with the Trimbos and Institute for Medical Technology Assessment Questionnaire on Costs Associated with Psychiatric Illness (TiC-P). Incremental cost-effectiveness ratios were calculated and cost-effectiveness planes and cost-effectiveness acceptability curves were displayed to assess the probability that M-CT is cost effective compared to TAU.ResultsMean total costs over 24 months were €8298 (US $9415) for M-CT and €7296 (US $8278) for TAU. No statistically significant differences were found between M-CT and TAU regarding depression-free days and QALYs (P=.37 and P=.92, respectively). The incremental costs were €179 (US $203) per depression-free day and €230,816 (US $261,875) per QALY. The cost-effectiveness acceptability curves suggested that for depression-free days, high investments have to be made to reach an acceptable probability that M-CT is cost effective compared to TAU. Regarding QALYs, considerable investments have to be made but the probability that M-CT is cost effective compared to TAU does not rise above 40%.ConclusionsThe results suggest that adding M-CT to TAU is not effective and cost effective compared to TAU alone. Adherence rates were similar to other studies and therefore do not explain this finding. The participants scarcely booked additional therapist support, resulting in 17.3 minutes of mean total therapist support. More studies are needed to examine the cost effectiveness of internet-based interventions with respect to long-term outcomes and the role and optimal dosage of therapist support. Overall, more research is needed on scalable and cost-effective interventions that can reduce the burden of recurrent MDD.Trial registrationNetherlands Trial Register NTR2503; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2503 (Archived by WebCite at http://www.webcitation.org/73aBn41r3)

Dispositional self-compassion and responses to mood challenge in people at risk for depressive relapse/recurrence.

This paper explores the relationship between dispositional self‐compassion and cognitive emotion regulation capacities in individuals with a history of depression. Study 1 (n = 403) established that self‐compassion was associated with increased use of positive and decreased use of negative strategies, with small to medium sized correlations. Study 2 (n = 68) was an experimental study examining the association between dispositional self‐compassion, use of cognitive emotion regulation strategies, and changes in mood and self‐devaluation in participants exposed to a negative mood induction followed by mood repair (mindfulness, rumination, silence). Individuals with higher levels of dispositional self‐compassion showed greater mood recovery after mood induction, and less self‐devaluation across the experimental procedure, independent of their mood‐repair condition or habitual forms of cognitive emotion regulation. These results suggest that self‐compassion is associated with more adaptive responses to mood challenges in individuals with a history of recurrent depression.

Thought\u2013Action Fusion in Individuals with a History of Recurrent Depression and Suicidal Depression: Findings from a Community Sample

Although suicidal ideation is one of the most consistent symptoms across recurrent episodes of depression, the mechanisms underpinning its maintenance are poorly understood. In order to develop effective treatments for suicidally depressed patients, understanding what maintains suicidal distress is critical. We hypothesised that Thought–Action Fusion (TAF), i.e., to assume that having a thought has real world consequences, originally described in Obsessive–Compulsive Disorder, might be a bias in recurrently suicidally depressed people. To assess this, we revised the original TAF scale, and assessed TAF in three samples: healthy controls, recurrently depressed individuals with no history of suicidality (D-NS) and individuals with a history of recurrent suicidal depression (D-S). Exploratory and confirmatory factor analyses indicated a three-factor solution of TAF: (1) TAF for uncontrollable events, (2) self-suicidal TAF for suicidal acts related to oneself, and (3) TAF for positive controllable events. Compared to healthy controls, the D-NS group reported significantly higher total TAF, TAF uncontrollable, and TAF self-suicidal subscales, whilst positive controllable TAF was lower compared to healthy controls. Both D-S and D-NS samples reported higher TAF for suicidal thought compared to healthy controls, i.e., believing that having suicidal thoughts means they will act on them, however in the context of low mood this became more pronounced for the D-S group. These findings suggest that targeting TAF both in suicidal and non-suicidal depression has merit.

Mindfulness – en gjennomgang av kunnskapsstatus og relevans for psykologisk behandling [Mindfulness – a review of knowledge status and relevance for psychological treatment

Mindfulness is a non-judgmental awareness of present-moment experience. Since the turn of the 21st century, there has been increasing interest in mindfulness-based approaches in psychological treatment. This narrative review describes what this mental attitude entails and how it may be relevant in the treatment of the common mental disorders depression and anxiety. Treatment research indicates that mindfulness-based interventions reduce the risk of relapse for people with a history of recurrent depression. Such interventions also alleviate ongoing depressive symptoms for those in more acute phases of the disorder. For anxiety disorders, research indicates that mindfulness-based interventions can be as effective as other approaches in the treatment of heterogeneous anxiety disorders and generalized anxiety disorder. For other anxiety diagnoses, however, the approach is not recommended as a first-line treatment. Despite promising results, the quality of research is highly variable, with a preponderance of pilot trials and a lack of 1) studies on basic processes, 2) well-designed randomized controlled trials, and 3) research on implementation in clinical practice. There are also several unanswered questions regarding the definition and measurement of mindfulness, mechanisms of action, and potential aversive effects. Clinical implications of our current knowledge about mindfulness in psychological treatment are discussed.

Like mother like daughter: putamen activation as a mechanism underlying intergenerational risk for depression.

Having a depressed mother is one of the strongest predictors for developing depression in adolescence. Given the role of aberrant reward processing in the onset and maintenance of depression, we examined the association between mothers’ and their daughters’ neural response to the anticipation of reward and loss. Fifteen non-depressed mothers with a history of recurrent depression and their never-disordered daughters, and 23 mothers without past or current depression and their never-disordered daughters, underwent functional magnetic resonance imaging while performing the monetary incentive delay task. To assess mother-daughter concordance, we first identified ROIs involved in the anticipation of reward and loss across all mother-daughter pairs. Within each of these ROIs, we examined the association between mothers’ and daughters’ neural response, and the interaction between group status and mothers’ neural response in predicting daughters’ neural response. We found a significant association between mothers’ and daughters’ putamen response to the anticipation of loss, regardless of mother’s depression history. Furthermore, pubertal stage moderated the association between mother-daughter putamen concordance. Our findings suggest a unique role of the putamen in the maternal transmission of reward learning and have important implications for understanding disorders characterized by disturbances in reward learning and processing, such as major depression.

Beneficial effects of training in self-distancing and perspective broadening for people with a history of recurrent depression

Cognitive training designed to recalibrate maladaptive aspects of cognitive-affective processing associated with the presence of emotional disorder can deliver clinical benefits. This study examined the ability of an integrated training in self-distancing and perspective broadening (SD-PB) with respect to distressing experiences to deliver such benefits in individuals with a history of recurrent depression (≥3 prior episodes), currently in remission. Relative to an overcoming avoidance (OA) control condition, SD-PB: a) reduced distress to upsetting memories and to newly encountered events, both during training when explicitly instructed to apply SD-PB techniques, and after-training in the absence of explicit instructions; b) enhanced capacity to self-distance from and broaden perspectives on participants' experiences; c) reduced residual symptoms of depression. These data provide initial support for SD-PB as a low-intensity cognitive training providing a spectrum of cognitive and affective benefits for those with recurrent depression who are at elevated risk of future episodes.

Examining the Factor Structure of the Self-Compassion Scale in Four Distinct Populations: Is the Use of a Total Scale Score Justified?

ABSTRACTThis study examined the factor structure of the Self-Compassion Scale (SCS) using a bifactor model, a higher order model, a 6-factor correlated model, a 2-factor correlated model, and a 1-factor model in 4 distinct populations: college undergraduates (N = 222), community adults (N = 1,394), individuals practicing Buddhist meditation (N = 215), and a clinical sample of individuals with a history of recurrent depression (N = 390). The 6-factor correlated model demonstrated the best fit across samples, whereas the 1- and 2-factor models had poor fit. The higher order model also showed relatively poor fit across samples, suggesting it is not representative of the relationship between subscale factors and a general self-compassion factor. The bifactor model, however, had acceptable fit in the student, community, and meditator samples. Although fit was suboptimal in the clinical sample, results suggested an overall self-compassion factor could still be interpreted with some confidence. Moreover, estimates suggested a general self-compassion factor accounted for at least 90% of the reliable variance in SCS scores across samples, and item factor loadings and intercepts were equivalent across samples. Results suggest that a total SCS score can be used as an overall mesure of self-compassion.

Examining whether offspring psychopathology influences illness course in mothers with recurrent depression using a high-risk longitudinal sample.

Depression is known to be influenced by psychosocial stressors. For mothers with recurrent depressive illness, the presence of psychopathology in their children may have important effects on their own mental health. Although the impact of maternal depression on child mental health is well-established, no study to date, as far as we are aware, has examined the extent to which offspring psychopathology influences the course of depression in mothers with a history of recurrent depressive illness, what types of child psychopathology impact maternal mental health, or whether risks vary by child gender. Aims were to (a) Use a longitudinal design to examine whether adolescent psychopathology (depression, disruptive behavior disorder; DBD) predicts recurrence of a depressive episode and depression symptom course in women with a history of recurrent depression; and (b) To test if observed effects vary by child gender. 299 mothers with recurrent major depressive disorder and their adolescent offspring were assessed on 2 occasions, 29 months apart. Maternal depression and offspring psychopathology were assessed using semistructured interview measures. Cross-generational links across time were assessed using structural equation modeling. Analyses were adjusted for past severity of maternal depression. Offspring depression symptoms but not DBD symptoms at baseline predicted future episode recurrence in mothers. Depression symptoms in daughters (β = .16, p = .039) but not sons (β = −.07, p = .461), predicted an increase in maternal depression symptoms across time. Psychopathology in daughters is associated with long-term depressive symptoms in women (mothers) with a history of recurrent depression. Findings highlight the importance of careful assessment and management of mental health problems in adolescents for more effective management of maternal depression. This study suggests that offspring symptoms of depression may be important for the recurrence of maternal depression episodes. Girls’ symptoms of depression may be a particularly important psychosocial stressor for the development of depressive symptoms in mothers with a history of recurrent depression.

Are SSRIs during pregnancy safe? More studies seek answers

Are SSRIs during pregnancy safe? More studies seek answers

Predicting placebo response in adolescents with major depressive disorder: The Adolescent Placebo Impact Composite Score (APICS)

ObjectiveThe aim of this study was to construct a composite scoring system to predict the probability of placebo response in adolescents with Major Depressive Disorder (MDD). MethodParticipants of the current study were 151 adolescents (aged 12–17 years) who were randomized to the placebo arm (placebo transdermal patches) of a randomized controlled trial (RCT) comparing the selegiline transdermal patch with placebo (DelBello et al., 2014). The primary outcome of response was defined as a CGI-I score of 1 or 2 (very much or much improved) at week 12 (study-end) or exit. As a first step, a multiple logistic mixed model was used to estimate the odds of placebo response from each predictor in the model, including age, CDRS-R total at baseline (depressive symptom severity), history of recurrent depression (yes vs. no), sex (female vs. male), and race (non-Caucasian vs. Caucasian). On the basis of the initial logistic mixed model analysis, we then constructed an Adolescent Placebo Impact Composite Score (APICS) that became the sole predictor in a re-specified Bayesian logistic regression model to estimate the probability of placebo response. Finally, the AUC for the APICS was tested against a nominal area of 0.50 to evaluate how well the APICS discriminated placebo response status. ResultsAmong the 151 adolescents, with a mean age of 14.6 years (SD = 1.6) and a mean baseline CDRS-R total of 60.6 (SD = 12.1), 68.2% were females, 50.3% was Caucasian, and 39.7% had a history of recurrent depression. Placebo response rate was 58.3%. Based on the logistic mixed model, the re-specified equation with the highest discriminatory ability to estimate the probability of placebo response was APICS = age + (0.32 × CDRS-R Total at baseline) + (−2.85 × if female) + (−5.50 × if history of recurrent depression) + (−5.85 × if non-Caucasian). The AUC for this model was 0.59 (p = .049). Within a Bayesian decision-theoretic framework, in 95.5% of the time, the 10,000 posterior Monte Carlo samples suggested that as APICS decreased the probability of placebo response increased. The observed APICS and related probability of responding to placebo in this adolescent sample ranged from 14.1 = 74.1% (in placebo responders) to 39.1 = 41.8% (in placebo non-responders). ConclusionThe APICS model estimates the probability of placebo response in adolescents with MDD with a modest degree of accuracy (AUC = 0.59) and with a reasonable degree of positive predictive value (74.5%), and is based on five previously identified patient characteristics of placebo response from prior meta-analytic studies (Bridge et al., 2009; Cohen et al., 2010) of randomized placebo-controlled trials of antidepressants in youth with MDD. Calculation of the APICS should be restricted to the range of the adolescent ages (12–17 years) and CDRS-R total scores (17–113); thus, the APICS can assume possible calculated values and related probability of responding to placebo ranging from about 3 (84%) to 53 (25%). The APICS Bayesian logistic model, based on a given aggregate patient profile, has a range of predicted probabilities of placebo response that is fairly wide, albeit truncated, but potentially meaningful for predicting the probability of placebo response among adolescent youth with MDD. The ability of the APICS to objectify the probability of placebo response in adolescents with MDD could be accounted for in the clinical research design of the trial itself and perhaps aid clinicians in treatment strategy for youth who are more likely to experience placebo response.