title: Initial Steps to inform selection of continuation cognitive therapy or fluoxetine for higher risk responders to cognitive therapy for recurrent major depressive disorder.
abstract: Responders to acute-phase cognitive therapy (A-CT) for major depressive disorder (MDD) often relapse or recur, but continuation-phase cognitive therapy (C-CT) or fluoxetine reduces risks for some patients. We tested composite moderators of C-CT versus fluoxetine's preventive effects to inform continuation treatment selection. Responders to A-CT for MDD judged to be at higher risk for relapse due to unstable or partial remission (N=172) were randomized to 8 months of C-CT or fluoxetine with clinical management and assessed, free from protocol treatment, for 24 additional months. Pre-continuation-treatment characteristics that in survival analyses moderated treatments' effects on relapse over 8 months of continuation-phase treatment (residual symptoms and negative temperament) and on relapse/recurrence over the full observation period's 32 months (residual symptoms and age) were combined to estimate the potential advantage of C-CT versus fluoxetine for individual patients. Assigning patients to optimal continuation treatment (i.e., to C-CT or fluoxetine, depending on patients' pre-continuation-treatment characteristics) resulted in absolute reduction of relapse or recurrence risk by 16-21% compared to the other non-optimal treatment. Although these novel results require replication before clinical application, selecting optimal continuation treatment (i.e., personalizing treatment) for higher risk A-CT responders may decrease risks of MDD relapse and recurrence substantively.
authors.affiliation: Department of Psychology, Truman State University, Kirksville, MO, USA. Electronic address: vittengl@truman.edu.
authors.forename: Jeffrey R
authors.initials: JR
authors.lastname: Vittengl
authors.affiliation: Department of Psychology, University of Notre Dame, Notre Dame, IN, USA.
authors.forename: Lee
authors.initials: L
authors.lastname: Anna Clark
authors.affiliation: Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Thase
authors.affiliation: Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX, USA. Electronic address: Robin.Jarrett@UTSouthwestern.edu.
authors.forename: Robin B
authors.initials: RB
authors.lastname: Jarrett
mesh_terms: D000328:Adult; D018687:Antidepressive Agents, Second-Generation / Q000008:administration & dosage*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003865:Major Depressive Disorder / Q000523:psychology / Q000628:therapy*; D005260:Female; D005473:Fluoxetine / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012008:Recurrence; D012307:Risk Factors
chemical_list: D018687:Antidepressive Agents, Second-Generation; D005473:Fluoxetine
keywords: Cognitive therapy; Fluoxetine; Major depressive disorder; Personalized advantage index; Personalized medicine; Recurrence; Relapse