Effects of Patient Preferences on Outcomes in the Predictors of Remission in Depression to Individual and Combined Treatments (PReDICT) Study.
The Predictors of Remission in Depression to Individual and Combined Treatments [PReDICT] study aimed to identify clinical and biological factors predictive of treatment outcomes in major depressive disorder among treatment-naive adults. The authors evaluated the efficacy of cognitive-behavioral therapy (CBT) and two antidepressant medications (escitalopram and duloxetine) in patients with major depression and examined the moderating effect of patients' treatment preferences on outcomes.



Adults aged 18-65 with treatment-naive major depression were randomly assigned with equal likelihood to 12 weeks of treatment with escitalopram (10-20 mg/day), duloxetine (30-60 mg/day), or CBT (16 50-minute sessions). Prior to randomization, patients indicated whether they preferred medication or CBT or had no preference. The primary outcome was change in the 17-item Hamilton Depression Rating Scale (HAM-D), administered by raters blinded to treatment.



A total of 344 patients were randomly assigned, with a mean baseline HAM-D score of 19.8 (SD=3.8). The mean estimated overall decreases in HAM-D score did not significantly differ between treatments (CBT: 10.2, escitalopram: 11.1, duloxetine: 11.2). Last observation carried forward remission rates did not significantly differ between treatments (CBT: 41.9%, escitalopram: 46.7%, duloxetine: 54.7%). Patients matched to their preferred treatment were more likely to complete the trial but not more likely to achieve remission.



Treatment guidelines that recommend either an evidence-based psychotherapy or antidepressant medication for nonpsychotic major depression can be extended to treatment-naive patients. Treatment preferences among patients without prior treatment exposure do not significantly moderate symptomatic outcomes.
From the Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta; the Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta; the Department of Psychiatry and Behavioral Sciences, Tulane University School of Medicine, New Orleans; the Department of Clinical Pathology, Emory University School of Medicine, Atlanta; the Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami; the Department of Psychology, Emory University, Atlanta; and the Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta.
Boadie W
BW
Dunlop
From the Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta; the Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta; the Department of Psychiatry and Behavioral Sciences, Tulane University School of Medicine, New Orleans; the Department of Clinical Pathology, Emory University School of Medicine, Atlanta; the Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami; the Department of Psychology, Emory University, Atlanta; and the Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta.
Mary E
ME
Kelley
From the Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta; the Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta; the Department of Psychiatry and Behavioral Sciences, Tulane University School of Medicine, New Orleans; the Department of Clinical Pathology, Emory University School of Medicine, Atlanta; the Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami; the Department of Psychology, Emory University, Atlanta; and the Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta.
Vivianne
V
Aponte-Rivera
From the Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta; the Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta; the Department of Psychiatry and Behavioral Sciences, Tulane University School of Medicine, New Orleans; the Department of Clinical Pathology, Emory University School of Medicine, Atlanta; the Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami; the Department of Psychology, Emory University, Atlanta; and the Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta.
Tanja
T
Mletzko-Crowe
From the Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta; the Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta; the Department of Psychiatry and Behavioral Sciences, Tulane University School of Medicine, New Orleans; the Department of Clinical Pathology, Emory University School of Medicine, Atlanta; the Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami; the Department of Psychology, Emory University, Atlanta; and the Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta.
Becky
B
Kinkead
From the Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta; the Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta; the Department of Psychiatry and Behavioral Sciences, Tulane University School of Medicine, New Orleans; the Department of Clinical Pathology, Emory University School of Medicine, Atlanta; the Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami; the Department of Psychology, Emory University, Atlanta; and the Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta.
James C
JC
Ritchie
From the Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta; the Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta; the Department of Psychiatry and Behavioral Sciences, Tulane University School of Medicine, New Orleans; the Department of Clinical Pathology, Emory University School of Medicine, Atlanta; the Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami; the Department of Psychology, Emory University, Atlanta; and the Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta.
Charles B
CB
Nemeroff
From the Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta; the Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta; the Department of Psychiatry and Behavioral Sciences, Tulane University School of Medicine, New Orleans; the Department of Clinical Pathology, Emory University School of Medicine, Atlanta; the Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami; the Department of Psychology, Emory University, Atlanta; and the Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta.
W Edward
WE
Craighead
From the Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta; the Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta; the Department of Psychiatry and Behavioral Sciences, Tulane University School of Medicine, New Orleans; the Department of Clinical Pathology, Emory University School of Medicine, Atlanta; the Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami; the Department of Psychology, Emory University, Atlanta; and the Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta.
Helen S
HS
Mayberg
From the Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta; the Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta; the Department of Psychiatry and Behavioral Sciences, Tulane University School of Medicine, New Orleans; the Department of Clinical Pathology, Emory University School of Medicine, Atlanta; the Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami; the Department of Psychology, Emory University, Atlanta; and the Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta.
D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use*; D015283:Citalopram / Q000627:therapeutic use*; D015928:Cognitive Behavioral Therapy; D003131:Combined Modality Therapy; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D000068736:Duloxetine Hydrochloride / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D057240:Patient Preference; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D011594:Psychometrics; D016896:Treatment Outcome
D000928:Antidepressive Agents; D015283:Citalopram; D000068736:Duloxetine Hydrochloride
Antidepressants; Cognitive Therapy; Mood Disorders-Unipolar; Outcome Studies