RESPONSE TO DESIPRAMINE TREATMENT IN ADOLESCENT DEPRESSION - A FIXED-DOSE, PLACEBO-CONTROLLED TRIAL

Objective: To determine the efficacy and tolerability of the tricyclic antidepressant desipramine (DMI) in the treatment of DSM-III-R-diagno sed major depressive disorder in adolescents. Method: Sixty adolescent s (42 female, 18 male; aged 15 to 19 years) diagnosed with major depre ssive disorder using clinical interview and Schedule for Affective Dis orders and Schizophrenia for School-Age Children were randomized to re ceive either DMI (200 mg daily in divided doses) or placebo for six co nsecutive weeks following a 1-week placebo period. Treatment outcome w as determined using the Hamilton Depression Rating Scale and the Beck Depression Inventory. Tolerability was determined using a symptom side effects scale. In addition, a variety of laboratory and cardiovascula r monitoring was performed. Results: No significant differences in tre atment outcome between DMI- and placebo-treated groups were determined . Neither DMI, nor its metabolite 2-hydroxy-DMI, nor their ratio, was positively correlated to treatment outcome. The DMI group endorsed mor e side effects but there were no significant between-group differences in any laboratory, electrocardiographic, or other cardiovascular para meters apart from heart rate, which was increased in the DMI-treated g roup (p = .03). Conclusions: Given the findings of this study and our review of previously published reports of tricyclic antidepressant tre atment in this population, the routine use of short-term (6 weeks) DMI in the treatment of adolescent depression is not supported by the dat a on hand. Further investigations into what constitutes optimal psycho pharmacological treatment of adolescent depression are warranted.