title: Executive Functioning at Baseline Prospectively Predicts Depression Treatment Response.
abstract: OBJECTIVE
  Existing cognitive and clinical predictors of treatment response to date are not of sufficient strength to meaningfully impact treatment decision making and are not readily employed in clinical settings. This study investigated whether clinical and cognitive markers used in a tertiary care clinic could predict response to usual treatment over a period of 4 to 6 months in a sample of 75 depressed adults.
  
  
  METHODS
  Patients (N = 384) were sequentially tested in 2 half-day clinics as part of a quality improvement project at an outpatient tertiary care center between August 2003 and September 2007; additional subjects evaluated in the clinic between 2007 and 2009 were also included. Diagnosis was according to DSM-IV-TR criteria and completed by residents and attending faculty. Test scores obtained at intake visits on a computerized neuropsychological screening battery were the Parametric Go/No-Go task and Facial Emotion Perception Task. Treatment outcome was assessed using 9-item Patient Health Questionnaire (PHQ-9) self-ratings at follow-up (n = 75). Usual treatment included psychotropic medication and psychotherapy. Decline in PHQ-9 scores was predicted on the basis of baseline PHQ-9 score and education, with neuropsychological variables entered in the second step.
  
  
  RESULTS
  PHQ-9 scores declined by 46% at follow-up (56% responders). Using 2-step multiple regression, baseline PHQ-9 score (P ≤ .05) and education (P ≤ .01) were significant step 1 predictors of percent change in PHQ-9 follow-up scores. In step 2 of the model, faster processing speed with interference resolution (go reaction time) independently explained a significant amount of variance over and above variables in step 1 (12% of variance, P < .01), while other cognitive and affective skills did not. This 2-step model accounted for 28% of the variance in treatment change in PHQ-9 scores. Processing speed with interference resolution also accounted for 12% variance in treatment and follow-up attrition.
  
  
  CONCLUSIONS
  Use of executive functioning assessments in clinics may help identify individuals with cognitive weaknesses at risk for not responding to standard treatments.
authors.affiliation: Department of Psychiatry, University of Michigan Medical Center, Ann Arbor, Michigan, USA.
authors.forename: Erica L
authors.initials: EL
authors.lastname: Dawson
authors.affiliation: Department of Psychiatry, University of Michigan Medical Center, Ann Arbor, Michigan, USA.
authors.forename: Angela F
authors.initials: AF
authors.lastname: Caveney
authors.affiliation: Department of Psychiatry, University of Michigan Medical Center, Ann Arbor, Michigan, USA.
authors.forename: Kortni K
authors.initials: KK
authors.lastname: Meyers
authors.affiliation: Department of Psychiatry, University of Michigan Medical Center, Ann Arbor, Michigan, USA.
authors.forename: Sara L
authors.initials: SL
authors.lastname: Weisenbach
authors.affiliation: Department of Psychiatry, University of Michigan Medical Center, Ann Arbor, Michigan, USA.
authors.forename: Bruno
authors.initials: B
authors.lastname: Giordani
authors.affiliation: Department of Psychiatry, University of Michigan Medical Center, Ann Arbor, Michigan, USA.
authors.forename: Erich T
authors.initials: ET
authors.lastname: Avery
authors.affiliation: Department of Psychiatry, University of Michigan Medical Center, Ann Arbor, Michigan, USA.
authors.forename: Michael-Paul
authors.initials: MP
authors.lastname: Schallmo
authors.affiliation: Department of Psychiatry, University of Michigan Medical Center, Ann Arbor, Michigan, USA.
authors.forename: Armita
authors.initials: A
authors.lastname: Bahadori
authors.affiliation: Department of Psychiatry, University of Michigan Medical Center, Ann Arbor, Michigan, USA.
authors.forename: Linas A
authors.initials: LA
authors.lastname: Bieliauskas
authors.affiliation: Department of Psychiatry, University of Michigan Medical Center, Ann Arbor, Michigan, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Mordhorst
authors.affiliation: Department of Psychiatry, University of Michigan Medical Center, Ann Arbor, Michigan, USA.
authors.forename: Sheila M
authors.initials: SM
authors.lastname: Marcus
authors.affiliation: Department of Psychiatry, University of Michigan Medical Center, Ann Arbor, Michigan, USA.
authors.forename: Kevin
authors.initials: K
authors.lastname: Kerber
authors.affiliation: Department of Psychiatry, University of Michigan Medical Center, Ann Arbor, Michigan, USA.
authors.forename: Jon-Kar
authors.initials: JK
authors.lastname: Zubieta
authors.affiliation: Department of Psychiatry, The University of Illinois at Chicago, 1601 W Taylor Ave, Chicago, 60612. slangenecker@psych.uic.edu.|Department of Psychiatry, University of Michigan Medical Center, Ann Arbor, Michigan, USA.
authors.forename: Scott A
authors.initials: SA
authors.lastname: Langenecker
mesh_terms: D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use; D003201:Computers; D003865:Major Depressive Disorder / Q000175:diagnosis* / Q000523:psychology / Q000628:therapy*; D061218:Depressive Disorder, Treatment-Resistant / Q000175:diagnosis / Q000523:psychology / Q000628:therapy; D056344:Executive Function; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests; D011379:Prognosis; D011446:Prospective Studies; D011613:Psychotherapy; D012044:Regression Analysis; D062606:Tertiary Care Centers; D016896:Treatment Outcome
chemical_list: D000928:Antidepressive Agents