Trial reportArchives of general psychiatry2011
Incremental cost-effectiveness of combined therapy vs medication only for youth with selective serotonin reuptake inhibitor-resistant depression: treatment of SSRI-resistant depression in adolescents trial findings.
Trial report in Archives of general psychiatry, 2011. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 2 registered trials, which are not on this map. Cited by 26 papers, 3 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Treatment of SSRI-Resistant Depression in Adolescents (TORDIA)
Randomized Trial of KEEP-P, a Preventive Intervention for Foster Preschoolers
Who cites it
26 citing papers in PubMed, 3 syntheses or guidelines pooled it, 49 citations in OpenAlex.
- A systematic review of interventions for treatment resistant major depressive disorder in adolescents.European child & adolescent psychiatry · 2020Pooled it
- Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder: Section 6. Special Populations: Youth, Women, and the Elderly.Canadian journal of psychiatry. Revue canadienne de psychiatrie · 2016Pooled it
- The estimation of utility weights in cost-utility analysis for mental disorders: a systematic review.PharmacoEconomics · 2013Pooled it
- Cognitive behavioral program for the prevention of depression in at-risk adolescents: isolating the effects of dose.American journal of epidemiology · 2025Trial
- Cost-effectiveness of Brief Behavioral Therapy for Pediatric Anxiety and Depression in Primary Care.JAMA network open · 2021Trial
- Development and efficacy of a family-focused treatment for depression in childhood.Journal of affective disorders · 2020Trial
- Cost-Effectiveness of Preventing Depression Among At-Risk Youths: Postintervention and 2-Year Follow-Up.Psychiatric services (Washington, D.C.) · 2019Trial
- Cost-effectiveness of Cognitive Behavioral Therapy for Depressed Youth Declining Antidepressants.Pediatrics · 2018Trial
- Anhedonia predicts poorer recovery among youth with selective serotonin reuptake inhibitor treatment-resistant depression.Journal of the American Academy of Child and Adolescent Psychiatry · 2012Trial
- Out of the black box: treatment of resistant depression in adolescents and the antidepressant controversy.Journal of child and adolescent psychopharmacology · 2012Trial
- Article
- Existing Evidence from Economic Evaluations of Antimicrobial Resistance-A Systematic Literature Review.Antibiotics (Basel, Switzerland) · 2025Review
- Article
- Stepped care for suicide prevention in teens and young adults: Design and methods of a randomized controlled trial.Contemporary clinical trials · 2022Article
- Augmenting usual care SSRIs with cognitive behavioral therapy for insomnia to improve depression outcomes in youth: Design of a randomized controlled efficacy-effectiveness trial.Contemporary clinical trials · 2020Article
- The ReThink study: a 3-arm parallel randomized trial of cognitive bias modification, with and without adherence promotion, for adolescent anxiety disorder: trial design and protocol.BMC psychiatry · 2019Article
- The Child and Adolescent Services Assessment: Interrater Reliability and Predictors of Rater Disagreement.Administration and policy in mental health · 2018Article
- Prevention of Depression in At-Risk Adolescents: Moderators of Long-term Response.Prevention science : the official journal of the Society for Prevention Research · 2018Article
- Cost Effectiveness of a School Readiness Intervention for Foster Children.Children and youth services review · 2017Article
- Effects of Selective Serotonin Reuptake Inhibitors on Interregional Relation of Serotonin Transporter Availability in Major Depression.Frontiers in human neuroscience · 2017Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
22 authors at 7 institutions in 1 country.
Funding
Abstract
contextMany youth with depression do not respond to initial treatment with selective serotonin reuptake inhibitors (SSRIs), and this is associated with higher costs. More effective treatment for these youth may be cost-effective.
objectiveTo evaluate the incremental cost-effectiveness over 24 weeks of combined cognitive behavior therapy plus switch to a different antidepressant medication vs medication switch only in adolescents who continued to have depression despite adequate initial treatment with an SSRI.
designRandomized controlled trial.
settingSix US academic and community clinics. PATIENTS: Three hundred thirty-four patients aged 12 to 18 years with SSRI-resistant depression.
interventionParticipants were randomly assigned to (1) switch to a different medication only or (2) switch to a different medication plus cognitive behavior therapy.
main outcome measuresClinical outcomes were depression-free days (DFDs), depression-improvement days (DIDs), and quality-adjusted life-years based on DFDs (DFD-QALYs). Costs of intervention, nonprotocol services, and families were included.
resultsCombined treatment achieved 8.3 additional DFDs (P = .03), 0.020 more DFD-QALYs (P = .03), and 11.0 more DIDs (P = .04). Combined therapy cost $1633 more (P = .01). Cost per DFD was $188 (incremental cost-effectiveness ratio [ICER] = $188; 95% confidence interval [CI], -$22 to $1613), $142 per DID (ICER = $142; 95% CI, -$14 to $2529), and $78,948 per DFD-QALY (ICER = $78,948; 95% CI, -$9261 to $677,448). Cost-effectiveness acceptability curve analyses suggest a 61% probability that combined treatment is more cost-effective at a willingness to pay $100,000 per QALY. Combined treatment had a higher net benefit for subgroups of youth without a history of abuse, with lower levels of hopelessness, and with comorbid conditions.
conclusionsFor youth with SSRI-resistant depression, combined treatment decreases the number of days with depression and is more costly. Depending on a decision maker's willingness to pay, combined therapy may be cost-effective, particularly for some subgroups.
trial registrationclinicaltrials.gov Identifier: NCT00018902.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.