Substantial progress has been made in the development of efficacious treatments for adolescent depression. However, even when depressed adolescents receive the best treatments delivered under optimal circumstances, there is a great deal of heterogeneity in treatment response. There is a significant need for specific evidence-based clinical guidelines to direct clinicians in personalizing their patients'treatments to optimize their chances of reaching remission and minimizing burden. These guidelines, often referred to as adaptive treatment strategies, provide decision rules that recommend when, how, and for whom treatment should change. The purpose of this Mentored Patient-Oriented Research Career Development Award (K23) is the acquire expertise necessary to become an independent clinical interventions researcher with a focus on personalized treatment for adolescent depression. To achieve this goal, formal coursework and consultation with established experts are proposed in the following areas: (1) the development, implementation, and evaluation of combined psychosocial and pharmacological treatments for adolescent depression, (2) the development, implementation, and evaluation of strategies for personalizing treatment based on individuals'characteristics and treatment responses, and (3) advanced statistical methods for clinical trials. To complement these training activities, the candidate proposes to conduct a pilot sequential multiple assignment randomized trial (SMART) to develop an adaptive treatment strategy for adolescent depression that will operationalize when to make the determination that a patient treated with Interpersonal Psychotherapy for Depressed Adolescents (IPT-A) is not likely to reach remission if the treatment is continued and what the next treatment strategy should be. The feasibility and acceptability of the adaptive treatment strategy will be assessed, and exploratory analyses of treatment outcomes will be used to inform further development of the adaptive treatment strategy that will be tested in a subsequent R01 application.

Public Health Relevance

Adaptive treatment strategies have the potential to have a significant public health impact as they can simultaneously improve treatment outcomes and conserve resources by delivering treatments when and for whom they will do the most good. They address some of the major questions faced by mental health clinicians on a daily basis and they have the potential to have high impact on clinical practice.

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Mentored Patient-Oriented Research Career Development Award (K23)
Project #
5K23MH090216-05
Application #
8581354
Study Section
Interventions Committee for Disorders Involving Children and Their Families (ITVC)
Program Officer
Hill, Lauren D
Project Start
2010-11-12
Project End
2015-10-31
Budget Start
2013-11-01
Budget End
2014-10-31
Support Year
5
Fiscal Year
2014
Total Cost
$160,457
Indirect Cost
$11,886
Name
University of Minnesota Twin Cities
Department
Psychiatry
Type
Schools of Medicine
DUNS #
555917996
City
Minneapolis
State
MN
Country
United States
Zip Code
55455
Almirall, Daniel; Compton, Scott N; Gunlicks-Stoessel, Meredith et al. (2012) Designing a pilot sequential multiple assignment randomized trial for developing an adaptive treatment strategy. Stat Med 31:1887-902
Gunlicks-Stoessel, Meredith; Mufson, Laura (2011) Early patterns of symptom change signal remission with interpersonal psychotherapy for depressed adolescents. Depress Anxiety 28:525-31