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Treatment of Resistant Depression in Adolescents (TORDIA): Week 24 Outcomes
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OBJECTIVE: The purpose of this study was to report on the outcome of participants in the Treatment of Resistant Depression in Adolescents (TORDIA) trial after 24 weeks of treatment, including remission and relapse rates and predictors of treatment outcome. METHOD: Adolescents (ages 12-18 years) with selective serotonin reuptake inhibitor (SSRI)-resistant depression were randomly assigned to either a medication switch alone (alternate SSRI or venlafaxine) or a medication switch plus cognitive-behavioral therapy (CBT). At week 12, responders could continue in their assigned treatment arm and nonresponders received open treatment (medication and/or CBT) for 12 more weeks (24 weeks total). The primary outcomes were remission and relapse, defined by the Adolescent Longitudinal Interval Follow-Up Evaluation as rated by an independent evaluator. RESULTS: Of 334 adolescents enrolled in the study, 38.9% achieved remission by 24 weeks, and initial treatment assignment did not affect rates of remission. Likelihood of remission was much higher (61.6% versus 18.3%) and time to remission was much faster among those who had already demonstrated clinical response by week 12. Remission was also higher among those with lower baseline depression, hopelessness, and self-reported anxiety. At week 12, lower depression, hopelessness, anxiety, suicidal ideation, family conflict, and absence of comorbid dysthymia, anxiety, and drug/alcohol use and impairment also predicted remission. Of those who responded by week 12, 19.6% had a relapse of depression by week 24. CONCLUSIONS: Continued treatment for depression among treatment-resistant adolescents results in remission in approximately one-third of patients, similar to adults. Eventual remission is evident within the first 6 weeks in many, suggesting that earlier intervention among nonresponders could be important.
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“Blinding (performance bias and detection bias) Blinding of partici- pants/care providers | High risk | 'Participants were blind to medication type'. NB: unlikely that participants were blind if receiving adjunctive CBT treatment. pg. 785 (Emslie 2010)”
From Interventions for preventing relapse and recurrence of a depressive disorder in children and adolescents (2012) · cites this paper as Emslie 2010
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“Blinding (performance bias and detection bias) Blinding of outcome as- | Low risk | 'independent evaluators were blind to medication type. Independent evalua- tors were also blind to CBT treatment'”
From Interventions for preventing relapse and recurrence of a depressive disorder in children and adolescents (2012) · cites this paper as Emslie 2010
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“NB: 'In 64 cases, the blinding of the independent evaluator was compromised, most commonly because of participant disclosure of receiving CBT'. pg. 785 (Emslie 2010)”
From Interventions for preventing relapse and recurrence of a depressive disorder in children and adolescents (2012) · cites this paper as Emslie 2010
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Bernal, K. E. D., Lilibeth, B. P. A., Omar, D. A. C., Paulina, R. Z. A., Alondra, M. F. I., Joel, T. R. R., & Samantha, O. F. D. (2023) · Revista sanitaria de investigación. · doi:10.34896/rsi.2023.26.74.001
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Chapter 4. Principles of Treatment of Mood Disorders Across Development
Zalpuri, I., & Singh, M. K. (2019) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615379200.lg04
Chapter 11. Longer-Term Management of Mood Disorders in Youth
Diler, R. S., & Birmaher, B. B. (2019) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615379200.lg11
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Miljevic, A., Hoath, K., Leggett, K. S., Hennessy, L. A., Boax, C. A., Hryniewicki, J., & Rodger, J. (2025) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2025.1513339
Ayvaci, E. R., Nandy, K., Becker, R., Stone, L., Minhajuddin, A., Slater, H., Goodman, L. C., Wakefield, S. M., Storch, E. A., Blader, J. C., et al. (2025) · Psychiatric Research and Clinical Practice · doi:10.1176/appi.prcp.20240117
“Previous multi ‐ site randomized clinical trials for adolescent depression, such as TADS (4) and TORDIA (36), found increased efficacy when psychotherapy was added in combination with pharmacotherapy in the treatment of moderate to severe major depression.”
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Comorbid Cannabis Use and Mood Disorders Among Adolescents
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Treatment-resistant depression in children and adolescents
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Self-citationKorean Medication Algorithm Project for Depressive Disorder 2025 (III): Child and Adolescent
Yang, C.-M., Shim, S.-H., Bahk, W., Seo, J. S., Kim, N.-Y., Choi, W.-S., Woo, Y. S., Park, S., Kim, W., Lee, J. G., et al. (2025) · 신경정신의학 · doi:10.4306/jknpa.2025.64.3.200
Metadata
- Authors
- Emslie, G. J., Mayes, T., Porta, G., Vitiello, B., Clarke, G., Wagner, K. D., Asarnow, J. R., Spirito, A., Birmaher, B., Ryan, N., Kennard, B., DeBar, L., McCracken, J., Strober, M., Onorato, M., Zelazny, J., Keller, M., Iyengar, S., & Brent, D.
- Affiliations
- The University of Texas Southwestern Medical Center (US)
- Suburban Hospital (US)
- ORCID
- Venue
- American Journal of Psychiatry
- Published
- 2010-07-01
- Volume
- 167
- Issue
- 7
- Pages
- 782-791
- ISSN
- 0002-953X (ISSN-L)
- 1535-7228
- PMC
- PMC3257891
- OpenAlex
- W2140498388
- Cited by
- 217
- References
- 39
- Citations by year
- 2026: 13 · 2025: 15 · 2024: 15 · 2023: 12 · 2022: 9 · 2021: 13 · 2020: 14 · 2019: 8 · 2018: 10 · 2017: 8 · 2016: 23 · 2015: 8 · 2014: 13 · 2013: 8 · 2012: 24
- FWCI
- 12.74
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- American Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Institutional Research Information System University of Turin (University of Turin) (submittedVersion)
- Funders
- National Institute of Mental Health (MH61958, U01MH061856, MH-66371, U01MH061835, U01MH061869, MH-61869, U01MH062014, MH61856, MH-61835, MH61864, U01MH061958, P30MH066371, U01MH061864, MH62014)
- Topics
- Health Sciences › Medicine › Pharmacology (medical) › Treatment of Major Depression
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Keywords
- treatment-resistant depression, adolescent depression, selective serotonin reuptake inhibitors, venlafaxine, cognitive behavioral therapy, remission, relapse, predictors of treatment outcome, hopelessness, suicidal ideation, family conflict, anxiety comorbidity, early intervention
- MeSH terms
- Venlafaxine Hydrochloride, Adolescent, Combined Modality Therapy, Cyclohexanols, Depressive Disorder, Female, Fluoxetine, Humans, Male, Psychiatric Status Rating Scales, Remission Induction, Time Factors, Cognitive Behavioral Therapy, Treatment Failure, Selective Serotonin Reuptake Inhibitors, Antidepressive Agents, Second-Generation
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