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Major Depression and Treatment Response in Adolescents with ADHD and Substance Use Disorder.

Drug and Alcohol Dependence 2012;120(1-3):214-219. [doi: 10.1016/j.drugalcdep.2011.08.001]

Diane Warden, PhD, MBA (University of Texas Southwestern Medical Center, TX Node), Paula D. Riggs, MD (University of Colorado, FNA Node), Sung-Joon Min, PhD (University of Colorado, FNA Node), Susan K. Mikulich-Gilbertson, PhD (University of Colorado, FNA Node), Leanne Tamm, PhD (University of Texas Southwestern Medical Center, TX Node), Kathlene Trello-Rishel, PhD (Mental Health and Mental Retardation of Tarrant County, TX Node), Theresa M. Winhusen, PhD (University of Cincinnati/CinARC, OV Node).

Major depressive disorder (MDD) frequently co-occurs in adolescents with substance use disorders (SUDs) and attention deficit hyperactivity disorder (ADHD), but the impact of MDD on substance treatment and ADHD outcomes and implications for clinical practice are unclear. To examine this impact, adolescents aged 13-18 meeting DSM-IV criteria for ADHD and SUD were randomized to osmotic release methylphenidate (OROS-MPH) or placebo and 16 weeks of cognitive behavioral therapy, as part of protocol CTN-0028 ("Osmotic-Release Methylphenidate for ADHD in Adolescents with Substance Use Disorders"). Adolescents with (n=38) and without (n=265) MDD were compared on baseline demographic and clinical characteristics as well as non-nicotine substance use and ADHD treatment outcomes. Results found that adolescents with MDD reported more non-nicotine substance use days at baseline and continued using more throughout treatment compared to those without MDD. There was no difference between adolescents with and without MDD in retention or CBT sessions attended. ADHD symptom severity (based on DSM-IV ADHD rating scale) followed a slightly different course of improvement although with no difference between groups in baseline or 16-week symptom severity or 16-week symptom reduction. There was no difference in days of substance use or ADHD symptom outcomes over time in adolescents with MDD or those without MDD treated with OROS-MPH or placebo. Depressed adolescents were more often female, older, and not court ordered.

Conclusions: These preliminary findings suggest that compared to non-depressed adolescents with ADHD and SUD, those with co-occurring MDD have more severe substance use at baseline and throughout treatment. Such youth may require interventions targeting depression. Adequately powered trials evaluating treatments focused on MDD in the context of SUD and other frequently present, co-occurring psychiatric disorders are needed. In the interim, mechanisms for assessing and treating these disorders are essential in SUD treatment settings since their presence appears to interfere with maximizing SUD outcomes. (Article (Peer-Reviewed), PDF, English, 2012)

Keywords: ADHD Rating Scale (ADHD-RS) | Adolescents | Attention Deficit Hyperactivity Disorder (ADHD) | Community health services | Concerta | Co-occurring disorders | CTN platform/ancillary study | Depression | Osmotic-Release Methylphenidate (OROS-MPH) | Pharmacological therapy | Drug and Alcohol Dependence (journal)

Document No: 745, PMID: 21885210, PMCID: PMC3245790.

Submitted by the CTN Dissemination Librarians, 9/1/2011.

AUTHORS SEARCH LINK
Mikulich-Gilbertson, Susan K. search
Min, Sung-Joon search
Riggs, Paula D. search mail
Tamm, Leanne search mail
Trello-Rishel, Kathlene search mail
Warden, Diane search mail
Winhusen, Theresa M. search mail
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NIDA-CTN-0028 search www
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