A pilot study of depressed adolescents' cortisol patterns during parent-adolescent conflict and response to interpersonal psychotherapy (IPT-A)

Background: This study examined functioning of the Hypothalamic Pituitary Adrenal (I-IPA) axis, a neurobiological stress system centrally implicated in depression, as a predictor of treatment response to Interpersonal Psychotherapy for Depressed Adolescents (IPT-A; Mufson et al., 2004. Interpersonal psychotherapy for depressed adolescents. (second ed.). New York, Guilford Press), Methods: The sample consisted of fifteen depressed adolescents (age 12-17; mean age = 15.2; 86.7% female) experiencing high levels of conflict with their parents who were recruited to participate in a pilot study of individual IPT-A and IPT-A delivered with greater and more structured involvement of parents. Adolescents came primarily from low-income Latino (93.3%) families. Prior to treatment, adolescents participated in a 15 min conflict negotiation task with their parents in which salivary cortisol was collected prior to and 10, 20, and 30 min post conflict. Adolescents' depression symptoms were assessed pre-treatment and post treatment (week 16) using the Children's Depression Rating Scale (CDRS-R). Results: Higher levels of cortisol 30 min after the conflict task were associated with greater improvement in depression symptoms with IPT-A, controlling for baseline levels of depression. Limitations: The study has a small sample size. Conclusions: This is the first study to examine HPA functioning as a predictor of depressed adolescents' response to a psychotherapeutic intervention. IF replicated with larger samples, these results have important implications for advancing the use of neurobiological markers to personalize psychotherapeutic interventions for depressed adolescents. (C) 2013 Elsevier B.V. All rights reserved.