The Pharmacotherapy of Depressive Illness in Adolescence: III. Diagnostic and Conceptual Issues in Studies of Tricyclic Antidepressants

Abstract

ABSTRACT In current pharmacological treatment studies, diagnostic subgroups vary appreciably in phenomenological characteristics, biological dysfunctions, and illness severity. In adults, a variety of diagnostic conditions as well as concurrent psychological and social features, medical disorders, and personality disorders have been proposed to be predictors of weak responsivity to tricyclic antidepressants. Such clinical and diagnostic predictors of treatment response in adults may be applied heuristically in adolescents; however, whether or not these features have the same predictive significance in adolescents is not known. Further, the onset, course, and treatment responsivity of depressive disorders may be more intimately affected by naturally occurring maturational processes in adolescents than in adults. Until pharmacological studies in adolescents address these conceptual and diagnostic problems, we cannot reasonably infer any firm knowledge about the alleged inefficacy of tricyclic antidepressants in adolescents. Without adequate inclusionary and exclusionary criteria, developed in adolescent populations, samples may be studied (and patients may be treated) who have a high likelihood of placebo response or refractoriness to antidepressant treatment.