Predicting response to cognitive therapy and interpersonal therapy, with or without antidepressant medication, for major depression: a pragmatic trial in routine practice.
BACKGROUND
Identifying patient characteristics that predict response within treatments (prognostic) or between treatments (prescriptive) can inform clinical decision-making. In this study, we sought to identify predictors of response to evidence-based treatments in a sample of depressed patients seeking help in routine practice.


METHODS
Data come from a pragmatic trial of 174 patients with major depression who received an evidence-based treatment of their own choice: cognitive therapy (CT), interpersonal therapy (IPT), antidepressant medication (ADM) alone or in combination with either of the two psychotherapies. Patient characteristics measured at baseline were examined to see if they predicted subsequent response as measured with the Beck Depression Inventory (BDI) over the course of 26 weeks of treatment, using mixed regression modeling.


RESULTS
Higher agoraphobia scores at baseline predicted more change in depression scores across treatments, irrespective of the treatment received. Physical functioning moderated the response to treatment: patients with high physical functioning fared better in combined treatment than patients with low physical functioning, whereas physical functioning did not predict a differential response in the psychotherapy group. Moreover, the lowest levels of physical functioning predicted an increase of depressive symptoms in combined treatment.


CONCLUSIONS
A relatively small sample size, and selection of several predictors that were less theory-driven, which hampers the translation to clinical practice.


CONCLUSIONS
If replicated, the prognostic and prescriptive indices identified in this study could guide decision-making in routine practice. Development of more uniform requirements for the analysis and reporting of prediction studies is recommended.
Department of Clinical Psychological Science, Research Institute Experimental Psychology, Faculty of Psychology and Neuroscience, Maastricht University, The Netherlands; Department of Clinical Psychology, VU University Amsterdam, The Netherlands; Academic RIAGG Maastricht, Maastricht, The Netherlands. Electronic address: m.j.h.huibers@vu.nl.
Marcus J H
MJ
Huibers
Gerard
G
van Breukelen
Jeffrey
J
Roelofs
Steven D
SD
Hollon
John C
JC
Markowitz
Jim
J
van Os
Arnoud
A
Arntz
Frenk
F
Peeters
D000328:Adult; D018687:Antidepressive Agents, Second-Generation / Q000627:therapeutic use*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003131:Combined Modality Therapy; D003865:Major Depressive Disorder / Q000188:drug therapy / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D011613:Psychotherapy / Q000379:methods*; D011788:Quality of Life / Q000523:psychology; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use*; D016896:Treatment Outcome
D018687:Antidepressive Agents, Second-Generation; D017367:Selective Serotonin Reuptake Inhibitors
Antidepressant medication; Depression; Evidence-based treatments; Prediction of response; Psychotherapy