Assessing the efficacy of antidepressants: The transactional paradigm

Wolfaardt, Ulrich; Reddon, John R.; Joyce, Anthony S.

doi:10.1016/j.mehy.2004.12.024

Cited by 7 publications

(3 citation statements)

References 23 publications

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“…Persistent and negative life stressors coupled with limited supportive structures are believed to result in reduction of mental function in patients with chronic illnesses. The NFS fostered relationship may have replaced ineffective or insufficient social networks, and established an alliance that contributed to functional improvement22–24. Specific evidence to support the therapeutic impact of the NFS includes the maintenance of remission in these participants after 4–6 weeks when placebo effects tend to diminish25.…”

Section: Discussionmentioning

confidence: 99%

Characteristics of Depression Remission and Its Relation With Cardiovascular Outcome Among Patients With Chronic Heart Failure (from the SADHART-CHF Study)

Jiang¹,

Krishnan²,

Kuchibhatla³

et al. 2011

The American Journal of Cardiology

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Depression is prevalent among heart failure (HF) patients, and is associated with a significant increase in hospitalizations and death. Primary results of the SADHART-CHF (Sertraline Against Depression and Heart Disease in Chronic HF) trial revealed that sertraline and placebo had comparable effects on depression and cardiovascular outcomes. In this study, we explore whether remission from depression is associated with better survival and to characterize participants who remitted during the trial. Based on the depression response during the 12-week treatment phase, SADHART-CHF participants were divided into 2 groups: 1) remission, defined as participants whose last measured Hamilton Depression Rating Scale (HDRS) score was <8; 2) non-remission, defined as participants whose last measured HDRS score was ≥8. Patients who dropped out prior to having any repeat HDRS were not included. Baseline characteristics and survival differences up to 5 years were evaluated between the remission and the non-remission groups Of the 469 SADHART-CHF participants, 208 (44.3%) achieved remission, 194 (41.4%) remained depressed, and 67 (14.3%) dropped out or died without any repeat HDRS assessment. Patients in the remission group had significantly lower cardiovascular events than those in the non-remission group (1.34±1.86 vs. 1.93±2.71; P adjusted =.01). Male patients were more likely to remit than female patients (56.5 vs. 44.8%, p=0.02). The remission group had milder depressive symptoms at baseline compared to the non-remission group (HDRS: 17.0±5.4 vs. 19.6±5.5; Beck Depression Inventory scale: 17.9±6.5 vs. 20.3±7.2; ps<0.001). In conclusion, this study indicates that remission from depression may improve the cardiovascular outcome of HF patients.

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Section: Discussionmentioning

confidence: 99%

Characteristics of Depression Remission and Its Relation With Cardiovascular Outcome Among Patients With Chronic Heart Failure (from the SADHART-CHF Study)

Jiang¹,

Krishnan²,

Kuchibhatla³

et al. 2011

The American Journal of Cardiology

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“…[13] Based on this association it has been suggested that the alliance between patients and their therapists in case management is an important therapeutic component contributing to the success of psychopharmacology treatment. [14] Specifically, it has been suggested that a good alliance may have a positive effect on the patient’s compliance, retention and engagement in treatment,[15, 16] and on medication adherence [17], thus further exposing patients to the active ingredients of treatment. However, two main questions with regard to the alliance-outcome association in pharmacotherapy—one relating to causality and the other to alliance effect in placebo versus medication—require further exploration.…”

Section: Introductionmentioning

confidence: 99%

Therapeutic Alliance in Antidepressant Treatment: Cause or Effect of Symptomatic Levels?

Zilcha‐Mano

Roose

Barber

et al. 2015

Psychother Psychosom

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Background: Previous studies have shown that in psychotherapy alliance is a predictor of symptomatic change, even while accounting for the temporal precedence between alliance and symptoms. However, the extent to which alliance predicts outcomes in psychopharmacology is yet to be fully investigated considering the fact that alliance can be the result, rather than the cause, of symptomatic change. The current prospective study examined whether the alliance predicts outcomes in psychopharmacology, while controlling for previous symptomatic change throughout the course of treatment. Methods: Data from a psychopharmacological randomized controlled trial for the treatment of adult major depression (n = 42), including the patients' rating of the alliance with the physicians, were analyzed. Multilevel models controlling for autoregressive lag of the dependent variable were used in all analyses to examine the effect of alliance on outcome. Results: The effect of alliance on outcome, while controlling for prior symptomatic levels, was significant and restricted to the middle phase of treatment (week 4, p = 0.005), when most of the reductions in symptoms were observed. Exploratory analyses of the differences between placebo and medication conditions suggest that the differences between the patients in their average alliance levels predicted a greater reduction in symptoms in the placebo compared to the medication conditions (p = 0.008). The main limitation is the small cohort size. Conclusions: The findings suggest an effect of alliance on outcome in psychopharmacology, which is not merely the result of previous symptomatic levels. This effect may be more robust in conditions that do not include active treatment (placebo), possibly serving as a compensatory effect.

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“…Many have also pointed out that factors, such as the patient-doctor relationship and contextual factors, appear to play as great or a greater part than antidepressants per se in the patient recovery (Blatt, Sanislow, Zuroff, & Pilkonis, 1996; Krupnick et al, 1996; McKay, Imel, & Wampold, 2006; Moncrieff & Cohen, 2006). Some have also criticized the way the placebo concept is used in most current antidepressant research on the grounds that it discounts psychological mechanisms as a potential treatment pathway in its own right (Wolfaardt, Reddon, & Joyce, 2005).…”

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confidence: 99%

Treatment of depression with antidepressants is primarily a psychological treatment.

Ankarberg

Falkenström²

2008

Psychotherapy: Theory, Research, Practice, Training

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Depression treatment with antidepressants is generally described as evidence-based. However, generalizations to practice recommendations seem to us to rest on the tacit assumption that treatment outcome in research trials is the sum of three factors: specific effects of the drug, expectancy effects (placebo), and spontaneous recovery. Because randomization isolates the specific effects of the drug, trials showing significant drug effects are used as evidence for prescribing the drug regardless of context. Drawing on Wampold's (2001) description of two metamodels of psychotherapy, the authors argue that available empirical evidence indicates that depression treatment with antidepressants is primarily a psychological treatment. This conclusion has far-reaching consequences for the scientific status of contemporary treatments for depression. It also affects what the doctor should focus on in a treatment with antidepressants and how to act when the patient is treatment resistant. In order to achieve the results obtained in clinical trials, the quantity and quality of support from the doctor is more important than pharmacological concerns, such as adequate doses of medicine. When faced with a treatment resistant patient, relationship factors rather than pharmacological factors should be in focus. (PsycINFO Database Record (c) 2010 APA, all rights reserved).

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Assessing the efficacy of antidepressants: The transactional paradigm

Cited by 7 publications

References 23 publications

Characteristics of Depression Remission and Its Relation With Cardiovascular Outcome Among Patients With Chronic Heart Failure (from the SADHART-CHF Study)

Characteristics of Depression Remission and Its Relation With Cardiovascular Outcome Among Patients With Chronic Heart Failure (from the SADHART-CHF Study)

Therapeutic Alliance in Antidepressant Treatment: Cause or Effect of Symptomatic Levels?

Treatment of depression with antidepressants is primarily a psychological treatment.

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