Effects of Patient Preferences on Outcomes in the Predictors of Remission in Depression to Individual and Combined Treatments (PReDICT) Study

• Published in: The American journal of psychiatry Vol. 174; no. 6; pp. 546 - 556
• Main Authors: Dunlop, Boadie W, Kelley, Mary E, Aponte-Rivera, Vivianne, Mletzko-Crowe, Tanja, Kinkead, Becky, Ritchie, James C, Nemeroff, Charles B, Craighead, W. Edward, Mayberg, Helen S
• Format: Journal Article
• Language: English
• Published: United States American Psychiatric Association 01-06-2017
• Subjects: Adult; Antidepressants; Antidepressive Agents - therapeutic use; Citalopram - therapeutic use; Cognitive Behavioral Therapy; Combined Modality Therapy; Depressive Disorder, Major - diagnosis; Depressive Disorder, Major - psychology; Depressive Disorder, Major - therapy; Duloxetine Hydrochloride - therapeutic use; Female; Humans; Male; Mental depression; Mental health care; Middle Aged; Outcome Assessment (Health Care); Patient Preference; Preferences; Psychiatric Status Rating Scales - statistics & numerical data; Psychometrics; Remission (Medicine); Treatment Outcome; Cognitive Therapy; Outcome Studies; Mood Disorders-Unipolar; Antidepressants
• ISSN: 0002-953X; 1535-7228
• DOI: 10.1176/appi.ajp.2016.16050517

Objective: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.Method: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.Results: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.Conclusions: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.