Predictors and moderators of time to remission of major depression with interpersonal psychotherapy and SSRI pharmacotherapy

Abstract

Background Although many studies suggest that, on average, depression-specific psychotherapy and antidepressant pharmacotherapy are efficacious, we know relatively little about which patients are more likely to respond to one versus the other. We sought to determine whether measures of spectrum psychopathology are useful in deciding which patients with unipolar depression should receive pharmacotherapy vs. depression-specific psychotherapy. Methods 318 adult outpatients with major depression were randomly assigned to escitalopram pharmacotherapy or interpersonal psychotherapy at academic medical centers at Pittsburgh, Pennsylvania and Pisa, Italy. The outcomes of primary interest were predictors and moderators time to remission on monotherapy at 12 weeks. Results Participants with higher scores on the need for medical reassurance factor of the PAS-SR had more rapid remission with IPT and those with lower scores on the psychomotor activation factor of the MOODS-SR experienced more rapid remission with SSRI. Nonspecific predictors of longer time to remission with monotherapy included several panic spectrum and mood spectrum factors and the social phobia spectrum total score. Higher baseline HRSD-17 and-25, and Work and Social Adjustment Scale scores also predicted longer time to remission, while being married predicted shorter time to remission. Conclusions This exploratory study identified several nonspecific predictors, but few moderators of psychotherapy vs. pharmacotherapy outcome. It offers useful indicators of the characteristics of patients that are generally difficult to treat, but only limited guidance as to who benefits from IPT versus SSRI pharmacotherapy.

Incidence and predictors of relapse during continuation treatment of major depression with SSRI, interpersonal psychotherapy, or their combination

“…Another possible contributor is the nature of our study protocol, including relatively frequent visits to the clinic (once a week during the acute phase, with the possibility of more frequent visits when necessary), the involvement of family members and friends through inclusion in patients' initial evaluation and in a psychoeducational workshop on depression and the goals of the study, and the availability of an emergency phone service that gave each patient the possibility of speaking with a study clinician (most often his/her own treating clinician) 24 hr a day. [26] Regarding the demographic and clinical predictors of relapse, we found that older age, higher severity of depression at baseline, and residual symptoms of depressive mood spectrum conferred higher risk during the continuation phase. Our results are consistent with evidence from the literature suggesting that residual symptoms together with symptom severity are significant predictors of relapse.…”

“…[26] The study was approved by the Institutional Review Board of the University of Pittsburgh and the Ethics Committee of the Azienda Ospedaliero-Universitaria of Pisa. All participants provided written informed consent.…”

Cognitive-Behavioral Analysis System of Psychotherapy, Drug, or Their Combination for Persistent Depressive Disorder: Personalizing the Treatment Choice Using Individual Participant Data Network Metaregression

“…Baseline depression severity has sometimes been noted as EM in the choice of treatments with psychotherapy, pharmacotherapy, or their combination [48, 49] but not always [50]. Anxiety or some related characteristics have also been suggested to moderate the treatment effects in several studies [51, 52] but there are far fewer studies on the impact of anxiety in the treatment of depression. Prior drug treatment was found to be an EM in another study [53].…”

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

“…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.…”