Thursday, March 30, 2017

Antidepressants, CBT Found to Be Equally Effective as Initial Therapy for MDD Patients

Current guidelines for treating major depressive disorder (MDD) recommend that clinicians consider both the clinical features of the disorder and patient preference when choosing the initial form of treatment. A study published in the AJP in Advance suggests that while antidepressants and psychotherapy appear to be equally effective in treatment-naïve MDD patients, those matched with their preferred treatment may be more likely to complete therapy.

“These results suggest that patients who receive their preferred treatment may invest more fully in their treatment, which makes the finding that preference does not affect improvement all the more striking,” Boadie Dunlop, M.D. (pictured left), director of the Mood and Anxiety Disorders Program at Emory University School of Medicine, and colleagues wrote. “This discrepancy implies that biological or psychosocial factors are stronger determinants of treatment efficacy than patient preference.”

The study was a part of the Predictors of Remission in Depression to Individual and Combined Treatments (PReDICT) trial that aimed to identify biological and psychological factors predictive of treatment outcomes in major depressive disorder in adults who had never previously received treatment for a mood disorder. 

The researchers randomly assigned 344 adults aged 18 to 65 with moderate MDD (mean baseline Hamilton Depression Rating Scale [HAM-D] score of 19.8) to 12 weeks of escitalopram (10-20 mg/day), duloxetine (30-60 mg/day), or cognitive-behavioral therapy (CBT, 16 50-minute sessions). Prior to randomization, patients indicated whether they preferred pharmacotherapy, CBT, or had no preference. Patients were evaluated at weeks 1 through 6, and again at weeks 8, 10, and 12. 

The authors found that the mean estimated overall decreases in HAM-D score from baseline to week 12 did not significantly differ between treatments (CBT: 10.2, escitalopram: 11.1, duloxetine: 11.2). Additionally, remission rates did not significantly differ between treatment arms (CBT: 41.9%; escitalopram: 46.7%; duloxetine: 54.7%). 

Of the 225 patients who expressed a treatment preference, 107 were matched to their preferred treatment and 118 were mismatched. Patients who were matched with their preferred treatment were significantly more likely to complete the trial than those who were not matched with preferred treatment (82.2% vs. 67.8%, respectively). However, patients matched to their preferred treatment were not found to be more likely to achieve remission.  

“There are two important implications of our results that can inform treatment guidelines,” Dunlop and colleagues wrote. “First, guideline recommendations that psychotherapy or antidepressant medications are equally appropriate for the initial treatment of major depression can be extended to treatment-naive patients. Second, because ethnic minorities comprised more than one-half of our study’s population, these treatment recommendations can be extended with confidence beyond the white non-Hispanic population, who comprised the majority of all prior randomized treatment studies comparing pharmacotherapy with psychotherapy.”

The authors concluded, “Until better predictors of remission probability are identified, there may be value in using patient preferences to select initial treatments, particularly for those with moderate or strong preferences.” 

For related information, see the Psychiatric News article “Patient-Centered Research Puts Focus on Patient’s Questions, Needs.”

Photo Courtesy of Emory University School of Medicine


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