Among children and teenagers with major depressive disorder, those with comorbid dysthymia and higher levels of residual symptoms after acute treatment are at greater risk for relapse, according to a study published in The Journal of Clinical Psychiatry. Identification of predictors and moderators of relapse in youth with major depressive disorder may inform follow-up care.

“It is important to note that early-onset depression is often chronic, leading to high rates of relapse. In fact, 20% to 60% of youth will experience a relapse of depression within 1 to 2 years of remission,” Beth D. Kennard, department of psychiatry, University of Texas Southwestern Medical Center and colleagues wrote. “There are limited extant findings on predicting who will relapse. To date, no placebo-controlled study has examined the predictors and moderators of relapse.”

Researchers conducted a randomized controlled trial to identify predictors and moderators of relapse among 102 youth aged 7 to 18 years with major depression who responded to 12 weeks of fluoxetine and then were randomly assigned to continue or switch to placebo for 6 more moths.

They examined predictors and moderators, including demographic characteristics (age, sex and race); illness characteristics (presence of recurrent depression, length of episode, depression severity at baseline and presence of insomnia); comorbid conditions (presence of dysthymia or anxiety disorder at baseline); family characteristics; and symptom change during treatment.

Overall, relapse occurred among 35.3% of participants, with fewer relapses among youth who remained on fluoxetine compared with placebo. The odds of relapse among children and adolescents with comorbid dysthymia at baseline was 2.88 times higher compared with the risk among those without dysthymia. In total, four of 17 youth with dysthymia relapsed while on fluoxetine while 13 of 17 relapsed on placebo.

Poor leadership in the family was linked to increased odds of relapse. At week 12, higher severity of depression also increased the odds of relapse by 21%; however, at week 6, it was not predictive.

Youth who relapsed were more likely to have residual symptoms as well. At week 12, those still experiencing sleep disturbances had a higher odds of relapse than those who were not; those with remaining irritability were also more likely to relapse.

Girls who took fluoxetine were 8.86 times more likely to experience relapse compared with boys taking fluoxetine. Boys had 93% decreased odds of relapsing on fluoxetine compared with placebo. Furthermore, higher levels of depressive symptoms at baseline in those who remained on fluoxetine for the duration of the study were more likely to relapse.

“In an era of improving individualized treatment strategies for patients with mental health concerns, it is important to identify characteristics that may predict treatment outcomes,” Kennard and colleagues wrote. “Knowing which youth are at greater risk may inform follow-up care, as well as identify possible risk factors to target for further treatment.”