Depression beliefs, treatment preference, and outcomes in a randomized trial for major depressive disorder

Dunlop, Boadie W.; Kelley, Mary E.; Mletzko, Tanja; Velasquez, Cristina M.; Craighead, W. Edward; Mayberg, Helen S.

doi:10.1016/j.jpsychires.2011.11.003

Cited by 71 publications

(57 citation statements)

References 42 publications

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“…Some studies, however, suggest that treatment preferences in RCTs may not significantly affect outcomes [76]. In addition, Steidtman et al [77] indicates that patient preference may act as moderators, but in unexpected ways.…”

Section: Discussionmentioning

confidence: 99%

A Randomized Controlled Trial of Mindfulness-Based Cognitive Therapy for Treatment-Resistant Depression

Eisendrath

Gillung²,

Delucchi³

et al. 2016

Psychother Psychosom

141

102

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Background: Due to the clinical challenges of treatment-resistant depression (TRD), we evaluated the efficacy of mindfulness-based cognitive therapy (MBCT) relative to a structurally equivalent active comparison condition as adjuncts to treatment-as-usual (TAU) pharmacotherapy in TRD. Methods: This single-site, randomized controlled trial compared 8-week courses of MBCT and the Health Enhancement Program (HEP), comprising physical fitness, music therapy and nutritional education, as adjuncts to TAU pharmacotherapy for outpatient adults with TRD. The primary outcome was change in depression severity, measured by percent reduction in the total score on the 17-item Hamilton Depression Rating Scale (HAM-D₁₇), with secondary depression indicators of treatment response and remission. Results: We enrolled 173 adults; mean length of a current depressive episode was 6.8 years (SD = 8.9). At the end of 8 weeks of treatment, a multivariate analysis showed that relative to the HEP condition, the MBCT condition was associated with a significantly greater mean percent reduction in the HAM-D₁₇ (36.6 vs. 25.3%; p = 0.01) and a significantly higher rate of treatment responders (30.3 vs. 15.3%; p = 0.03). Although numerically superior for MBCT than for HEP, the rates of remission did not significantly differ between treatments (22.4 vs. 13.9%; p = 0.15). In these models, state anxiety, perceived stress and the presence of personality disorder had adverse effects on outcomes. Conclusions: MBCT significantly decreased depression severity and improved treatment response rates at 8 weeks but not remission rates. MBCT appears to be a viable adjunct in the management of TRD.

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Section: Discussionmentioning

confidence: 99%

A Randomized Controlled Trial of Mindfulness-Based Cognitive Therapy for Treatment-Resistant Depression

Eisendrath

Gillung²,

Delucchi³

et al. 2016

Psychother Psychosom

141

102

View full text Add to dashboard Cite

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“…Client preferences are often assessed without any accompanying psychoeducation or decision support. For example, Dunlop et al (2012) conducted a study in which clients diagnosed with major depressive disorder were asked to indicate their preferred treatment by a single question on a questionnaire. In these instances, clients’ choices may be influenced by several variables including perceived efficacy, convenience, or stigma.…”

Section: Informed Versus Uninformed Preferences and Choicesmentioning

confidence: 99%

Client preferences affect treatment satisfaction, completion, and clinical outcome: A meta-analysis

Lindhiem

Bennett

Trentacosta

et al. 2014

Clinical Psychology Review

244

187

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We conducted a meta-analysis on the effects of client preferences on treatment satisfaction, completion, and clinical outcome. Our search of the literature resulted in 34 empirical articles describing 32 unique clinical trials that either randomized some clients to an active choice condition (shared decision making condition or choice of treatment) or assessed client preferences. Clients who were involved in shared decision making, chose a treatment condition, or otherwise received their preferred treatment evidenced higher treatment satisfaction (ESd = .34; p < .001), increased completion rates (ESOR = 1.37; ESd = .17; p < .001), and superior clinical outcome (ESd = .15; p < .0001), compared to clients who were not involved in shared decision making, did not choose a treatment condition, or otherwise did not receive their preferred treatment. Although the effect sizes are modest in magnitude, they were generally consistent across several potential moderating variables including study design (preference versus active choice), psychoeducation (informed versus uninformed), setting (inpatient versus outpatient), client diagnosis (mental health versus other), and unit of randomization (client versus provider). Our findings highlight the clinical benefit of assessing client preferences, providing treatment choices when two or more efficacious options are available, and involving clients in treatment-related decisions when treatment options are not available.

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“…1. Thirty-five studies met inclusion criteria [2][3][4]5,6,8,[15][16][17][18]20,21,24,27,31,33,34,[40][41][42][43]45,46,[50][51][52][53][56][57][58][60][61][62]65,66]. Fig.…”

Section: Selection and Inclusion Of Studiesmentioning

confidence: 99%

The Effects of Blinding on the Outcomes of Psychotherapy and Pharmacotherapy for Adult Depression: a Meta-Analysis

et al. 2015

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BackgroundRandomized trials with antidepressants are often run under double blind placebo-controlled conditions, whereas those with psychotherapies are mostly unblinded. This can introduce bias in favor of psychotherapy when the treatments are directly compared. In this meta-analysis, we examine this potential source of bias.MethodsWe searched Pubmed, PsycInfo, Embase and the Cochrane database (1966 to January 2014) by combining terms indicative of psychological treatment and depression, and limited to randomized trials. We included 35 trials (with 3721 patients) in which psychotherapy and pharmacotherapy for adult depression were directly compared with each other. We calculated effect sizes for each study indicating the difference between psychotherapy and pharmacotherapy at post-test. Then, we examined the difference between studies with a placebo condition and those without in moderator analyses.ResultsWe did not find a significant difference between the studies with and those without a placebo condition. The studies in which a placebo condition was included indicated no significant difference between psychotherapy and pharmacotherapy (g = −0.07; NNT = 25). Studies in which no placebo condition was included (and patients and clinicians in both conditions were not blinded), resulted in a small, but significant difference between psychotherapy and pharmacotherapy in favor of pharmacotherapy (g = −0.13; NNT = 14).ConclusionsStudies comparing psychotherapy and pharmacotherapy in which both groups of patients (and therapists) are not blinded (no placebo condition is included) result in a very small, but significantly higher effect for pharmacotherapy.

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Depression beliefs, treatment preference, and outcomes in a randomized trial for major depressive disorder

Cited by 71 publications

References 42 publications

A Randomized Controlled Trial of Mindfulness-Based Cognitive Therapy for Treatment-Resistant Depression

A Randomized Controlled Trial of Mindfulness-Based Cognitive Therapy for Treatment-Resistant Depression

Client preferences affect treatment satisfaction, completion, and clinical outcome: A meta-analysis

The Effects of Blinding on the Outcomes of Psychotherapy and Pharmacotherapy for Adult Depression: a Meta-Analysis

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