Predicting response to cognitive therapy and interpersonal therapy, with or without antidepressant medication, for major depression: A pragmatic trial in routine practice

• Published in: Journal of affective disorders 2014-01, Vol.152, p.146-154
• Main Authors: Huibers, Marcus J.H, van Breukelen, Gerard, Roelofs, Jeffrey, Hollon, Steven D, Markowitz, John C, van Os, Jim, Arntz, Arnoud, Peeters, Frenk
• Format: Article
• Language: English
• Subjects: Adult; Adult and adolescent clinical studies; Antidepressant drugs; Antidepressant medication; Antidepressive Agents, Second-Generation - therapeutic use; Behavior therapy. Cognitive therapy; Biological and medical sciences; Cognitive therapy; Cognitive Therapy - methods; Combined Modality Therapy; Decision making; Depression; Depressive Disorder, Major - drug therapy; Depressive Disorder, Major - therapy; Evidence-based treatments; Female; Humans; Individual psychotherapy; Male; Medical sciences; Middle Aged; Mood disorders; Neuropharmacology; Pharmacology. Drug treatments; Physical ability; Pragmatics; Prediction of response; Psychiatric Status Rating Scales; Psychiatry; Psychoanaleptics: cns stimulant, antidepressant agent, nootropic agent, mood stabilizer; Psychoanaleptics: cns stimulant, antidepressant agent, nootropic agent, mood stabilizer..., (alzheimer disease); Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Psychopharmacology; Psychotherapies. Psychological and clinical counseling; Psychotherapy; Psychotherapy - methods; Quality of Life - psychology; Serotonin Uptake Inhibitors - therapeutic use; Treatment Outcome; Treatments
• ISSN: 0165-0327; 1573-2517
• DOI: 10.1016/j.jad.2013.08.027

Abstract Background Identifying patient characteristics that predict response within treatments (prognostic) or between treatments (prescriptive) can inform clinical decision-making. In this study, we sought to identify predictors of response to evidence-based treatments in a sample of depressed patients seeking help in routine practice. Methods Data come from a pragmatic trial of 174 patients with major depression who received an evidence-based treatment of their own choice: cognitive therapy (CT), interpersonal therapy (IPT), antidepressant medication (ADM) alone or in combination with either of the two psychotherapies. Patient characteristics measured at baseline were examined to see if they predicted subsequent response as measured with the Beck Depression Inventory (BDI) over the course of 26 weeks of treatment, using mixed regression modeling. Results Higher agoraphobia scores at baseline predicted more change in depression scores across treatments, irrespective of the treatment received. Physical functioning moderated the response to treatment: patients with high physical functioning fared better in combined treatment than patients with low physical functioning, whereas physical functioning did not predict a differential response in the psychotherapy group. Moreover, the lowest levels of physical functioning predicted an increase of depressive symptoms in combined treatment. Limitations A relatively small sample size, and selection of several predictors that were less theory-driven, which hampers the translation to clinical practice. Conclusions If replicated, the prognostic and prescriptive indices identified in this study could guide decision-making in routine practice. Development of more uniform requirements for the analysis and reporting of prediction studies is recommended.