title: Moderators of response to cognitive behavioural therapy as an adjunct to pharmacotherapy for treatment-resistant depression in primary care.
abstract: BACKGROUND
  Stratified medicine aims to improve clinical and cost-effectiveness by identifying moderators of treatment that indicate differential response to treatment. Cognitive behavioural therapy (CBT) is often offered as a 'next-step' for patients who have not responded to antidepressants, but no research has examined moderators of response to CBT in this population. We aimed, therefore, to identify moderators of response to CBT in treatment resistant depression.
  
  
  METHODS
  We used linear regression to test for interactions between treatment effect and 14 putative moderator variables using data from the CoBalT randomised controlled trial. This trial examined the effectiveness of CBT given in addition to usual care (n=234) compared with usual care alone (n=235) for primary care patients with treatment resistant depression.
  
  
  RESULTS
  Age was the only variable with evidence for effect modification (p Value for interaction term=0.012), with older patients benefiting the most from CBT. We found no evidence of effect modification by any other demographic, life, illness, personality trait, or cognitive variable (p≥0.2).
  
  
  CONCLUSIONS
  Given the largely null findings, a stratified approach that might limit offering CBT is premature; CBT should be offered to all individuals where antidepressant medication has failed.
authors.affiliation: Centre for Academic Mental Health, School of Social and Community Medicine, University of Bristol, Bristol, UK; Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK. Electronic address: kate.button@bristol.ac.uk.
authors.forename: Katherine S
authors.initials: KS
authors.lastname: Button
authors.affiliation: Centre for Academic Mental Health, School of Social and Community Medicine, University of Bristol, Bristol, UK.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Turner
authors.affiliation: Primary Care Research Group, University of Exeter Medical School, Exeter, UK.
authors.forename: John
authors.initials: J
authors.lastname: Campbell
authors.affiliation: Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK.
authors.forename: David
authors.initials: D
authors.lastname: Kessler
authors.affiliation: University Department of Psychiatry, University of Oxford, Oxford, UK.
authors.forename: Willem
authors.initials: W
authors.lastname: Kuyken
authors.affiliation: Division of Psychiatry, University College London, London, UK.
authors.forename: Glyn
authors.initials: G
authors.lastname: Lewis
authors.affiliation: School of Clinical Sciences, University of Bristol, Bristol, UK.
authors.forename: Tim J
authors.initials: TJ
authors.lastname: Peters
authors.affiliation: Centre for Academic Mental Health, School of Social and Community Medicine, University of Bristol, Bristol, UK.
authors.forename: Laura
authors.initials: L
authors.lastname: Thomas
authors.affiliation: Centre for Academic Mental Health, School of Social and Community Medicine, University of Bristol, Bristol, UK.
authors.forename: Nicola
authors.initials: N
authors.lastname: Wiles
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use; D003071:Cognition; D015928:Cognitive Behavioral Therapy; D003131:Combined Modality Therapy; D003362:Cost-Benefit Analysis; D061218:Depressive Disorder, Treatment-Resistant / Q000188:drug therapy / Q000523:psychology* / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010551:Personality; D011320:Primary Health Care; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000928:Antidepressive Agents
keywords: Cognitive behavioural therapy; Depression; Moderators; Primary care; Stratified medicine; Treatment resistance