To the Editor: The randomized trial by Dr Brent and colleagues1 addressed the clinically important question of how to treat depressed adolescents who are not responsive to initial treatment with a selective serotonin reuptake inhibitor (SSRI). We would like to raise 2 issues regarding this study.
First, the design included a slow tapering of the original SSRI. Because all patients received another medication with a serotonergic component, we do not believe that slow tapering was necessary, based on studies of adults with depression.2 An immediate switch would have shortened the overall study duration and thereby may have decreased the number of dropouts during the wash-out phase.
Anghelescu I, Regen F. SSRI Tapering and Suicidal Ideation in the TORDIA Study for Treatment of Depressed Adolescents. JAMA. 2008;299(23):2745-2746. doi:10.1001/jama.299.23.2745-c