Patient Predictors of Response to Psychotherapy and Pharmacotherapy: Findings in the NIMH Treatment of Depression Collaborative Research Program

Abstract

Objective: The authors investigated patient characteristics predictive of treatment response in the National Institute of Mental Health (NIMH) Treatment of Depression Collaborative Research Program. Method: Two hundred thirty-nine outpatients with major depressive disorder according to the Research Diagnostic Criteria entered a 16-week multicenter clinical trial and were randomly assigned to interpersonal psychotherapy, cognitive-behavior therapy, imipramine with clinical management, or placebo with clinical management. Pretreatment sociodemographic features, diagnosis, course of illness, function, personality, and symptoms were studied to identify patient predictors of depression severity (measured with the Hamilton Rating Scale for Depression) and complete response (measured with the Hamilton scale and the Beck Depression Inventory). Results: One hundred sixty-two patients completed the entire 16-week trial. Six patient characteristics, in addition to depression severity previously reported, predicted outcome across all treatments:social dysfunction, cognitive dysfunction, expectation of improvement, endogenous depression, double depression, and duration of current episode. Significant patient predictors of differential treatment outcome were identified. 1) Low social dysfunction predicted superior response to interpersonal psychotherapy. 2) Low cognitive dysfunction predicted superior response to cognitive-behavior therapy and to imipramine. 3) High work dysfunction predicted superior response to imipramine. 4) High depression severity and impairment of function predicted superior response to imipramine and to interpersonal psychotherapy. Conclusions: The results demonstrate the relevance of patient characteristics, including social, cognitive, and work function, for prediction of the outcome of major depressive disorder.They provide indirect evidence of treatment specificity by identifying characteristics responsive to different modalities, which may be of value in the selection of patients for alternative treatments.

The implications of gene–environment interactions in depression: will cause inform cure?

“…However, the distinction between reactive and endogenous depression based on symptom counts has proven to be unstable across episodes 72 and a weak predictor of differential treatment outcome. 73 However, an improved classification is possible, especially if the melancholic syndrome is defined, 74,75 and the course of the illness is taken into account. 9 A synthesis of the genetic and social studies suggests that episodic depression may have stronger genetic component and chronic depression may have greater psychosocial contribution, especially early adversity, in its aetiology.…”

What we know, what we do not know, and where are we heading? Efficacy and acceptability of psychological interventions for depression

“…Given the evidence from RCTs and meta-analyses, we believe that there is a great likelihood that these treatments will be equally effective and appropriate for patients who have failed to improve in briefer and more symptom-focused treatments. There is, however, some evidence that specific subgroups of patients benefit more from specific treatments (Barber & Muenz, 1996;Sotsky et al 2006;Barber et al 2012;Beutler et al 2012;DeRubeis et al 2014). If replicated, these findings should be included in the model.…”

“…Note: BA, behavioural activation therapy; PST, problem-solving therapy; CBT, cognitive-behavioural therapy; IPT, interpersonal therapy; EFT, emotion focused therapy; STDP, short-term dynamic psychotherapy; LTDP, long-term dynamic psychotherapy. specific populations benefit from specific treatments (e.g., Barber & Muenz, 1996;Sotsky et al 2006;DeRubeis et al 2014). For example, Barber et al (2012) found that depressed minority men (mostly AfricanAmerican) benefited more from short-term supportiveexpressive therapy than placebo or medication.…”

CBT in Affective Disorders – New Frontiers

“…An early study of Sotsky et al [34] in which 239 patients with a depressive disorder have been included has highlighted that six patient characteristics as well as the severity of the depression patients reported before the beginning of the treatment predict treatment outcome (not only of CBT but also of IPT, ADM with clinical management, and placebo with clinical management). These characteristics comprised social dysfunction, cognitive dysfunction, expectation of improvement, endogenous depression, double depression and the duration of the current episode.…”

“…Some patient characteristics examined in the early Sotsky study [34] have been predictive for differential treatment outcome. For instance, a low social dysfunction predicted superior response to IPT while a low cognitive dysfunction predicted superior response to CBT and to ADM.…”