Does early response predict outcome in psychotherapy and combined therapy for major depression?
BACKGROUND
To examine the predictive value of early response for final outcome of psychotherapy and combined therapy in major depression.


METHODS
Mild- to moderately depressed patients were treated with either Short-Term Psychodynamic Supportive Psychotherapy (SPSP) (N=63) only, or combined with an antidepressant (N=127). Early response was defined as a reduction of more than 25% on the HAM-D-17 after 2 months. Outcome was determined in terms of complete nonresponse and remission rates. Associations between early response and outcome were examined using logistic regression analysis.


RESULTS
In SPSP, early nonresponse was clearly related to final nonresponse (OR=3.57). Nevertheless, remission was not predicted by early response, and 26% of the early nonresponders ultimately achieved remission. In combined therapy, both final nonresponse (OR 7.13) and remission (OR 3.66) were associated with early nonresponse.


CONCLUSIONS
In this study, SPSP was the only psychotherapy examined. The design did not provide feedback to the therapist of the independently measured depression score after two months.


CONCLUSIONS
Although a number of early nonresponsive patients will achieve remission, this study points out that these patients are at risk factor for ultimate treatment failure. This could be an indication for clinicians to adapt their treatment strategy.
Van
Henricus L
HL
Depression Research Group of Mentrum Health Care Amsterdam, The Netherlands. rien.van@mentrum.nl
Schoevers
Robert A
RA
Kool
Simone
S
Hendriksen
Mariëlle
M
Peen
Jaap
J
Dekker
Jack
J
D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000188:drug therapy / Q000628:therapy*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D005473:Fluoxetine / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D011446:Prospective Studies; D011613:Psychotherapy / Q000379:methods*; D012074:Remission Induction; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use*; D012720:Severity of Illness Index; D013997:Time Factors
D000928:Antidepressive Agents; D005473:Fluoxetine; D017367:Selective Serotonin Reuptake Inhibitors