Predictors of response in the treatment of moderate depression

Abstract

Objective: To identify neurocognitive and sociodemographic variables that could be associated with clinical response to three modalities of treatment for depression, as well as variables that predicted superior response to one treatment over the others. Method: The present study derives from a research project in which depressed patients (n=272) received one of three treatments -long-term psychodynamic psychotherapy (n=90), fluoxetine therapy (n=91), or a combination thereof (n=91) -over a 24-month period. Results: Sociodemographic variables were not found to be predictive. Six predictive neurocognitive variables were identified: three prognostic variables related to working memory and abstract reasoning; one prescriptive variable related to working memory; and two variables found to be moderators. Conclusions:The results of this study indicate subgroups of patients who might benefit from specific therapeutic strategies and subgroups that seem to respond well to long-term psychodynamic psychotherapy and combined therapy. The moderators found suggest that abstract reasoning and processing speed may influence the magnitude and/or direction of clinical improvement.

A Systematic Review of Cognitive Predictors of Treatment Outcome in Major Depression

“…In a longer treatment trial, Bastos et al ( 25 ) examined the relationship between executive function performance and response to 24 months of treatment with Fluoxetine ( n = 91), psychodynamic psychotherapy ( n = 90) or a combination thereof ( n = 90). The largely negative results were complex.…”

“…The largely negative results were complex. Of 14 cognitive variables, higher scores on two (WAIS-III, Letter Number Sequencing and Matrix Reasoning) were associated with better response across all three treatments (Fluoxetine, psychodynamic psychotherapy and the combination) and higher scores on one (WAIS-III, Similarities) was associated with poorer response ( 25 ).…”

Patient predictors of response to cognitive behaviour therapy and schema therapy for depression

“…Beaudreau et al (2015) reported that impaired cognitive flexibility predicted poorer therapeutic response (problem-solving therapy and supportive therapy) in older depressed patients. Similarly, Bastos et al (2017) found that better performance on measures of cognitive flexibility/executive functioning predicted better response to psychotherapy (psychodynamic) and medication or a combination of the two. These findings are also consistent with Mason et al's (2016) recent review reporting that connections from the prefrontal cortex appear to be an important predictor of outcome in CBT.…”

Psychodynamic day treatment programme for patients with schizophrenia spectrum disorders: Dynamics and predictors of therapeutic change

“…It seems that psychodynamic treatment which focuses mainly on basic relational and emotional processes does not interact with these variables. Similar results of missing relationships between sociodemographic variables and the outcome of psychodynamic psychotherapy were found in the treatment of depression (Bastos, Guimaraes, & Trentini, 2017), social anxiety disorder (Wiltink et al, 2016), and deliberate self-poisoning (Guthrie et al, 2003). However, these findings are not entirely consistent.…”