Predicting response to cognitive therapy and interpersonal therapy, with or without antidepressant medication, for major depression: a pragmatic trial in routine practice.
BACKGROUND
Identifying patient characteristics that predict response within treatments (prognostic) or between treatments (prescriptive) can inform clinical decision-making. In this study, we sought to identify predictors of response to evidence-based treatments in a sample of depressed patients seeking help in routine practice.


METHODS
Data come from a pragmatic trial of 174 patients with major depression who received an evidence-based treatment of their own choice: cognitive therapy (CT), interpersonal therapy (IPT), antidepressant medication (ADM) alone or in combination with either of the two psychotherapies. Patient characteristics measured at baseline were examined to see if they predicted subsequent response as measured with the Beck Depression Inventory (BDI) over the course of 26 weeks of treatment, using mixed regression modeling.


RESULTS
Higher agoraphobia scores at baseline predicted more change in depression scores across treatments, irrespective of the treatment received. Physical functioning moderated the response to treatment: patients with high physical functioning fared better in combined treatment than patients with low physical functioning, whereas physical functioning did not predict a differential response in the psychotherapy group. Moreover, the lowest levels of physical functioning predicted an increase of depressive symptoms in combined treatment.


LIMITATIONS
A relatively small sample size, and selection of several predictors that were less theory-driven, which hampers the translation to clinical practice.


CONCLUSIONS
If replicated, the prognostic and prescriptive indices identified in this study could guide decision-making in routine practice. Development of more uniform requirements for the analysis and reporting of prediction studies is recommended.
['Huibers|Marcus J H|MJ|', 'van Breukelen|Gerard|G|', 'Roelofs|Jeffrey|J|', 'Hollon|Steven D|SD|', 'Markowitz|John C|JC|', 'van Os|Jim|J|', 'Arntz|Arnoud|A|', 'Peeters|Frenk|F|']
D000328:Adult D018687:Antidepressive Agents, Second-Generation D015928:Cognitive Behavioral Therapy D003131:Combined Modality Therapy D003865:Depressive Disorder, Major D005260:Female D006801:Humans D008297:Male D008875:Middle Aged D011569:Psychiatric Status Rating Scales D011613:Psychotherapy D011788:Quality of Life D017367:Serotonin Uptake Inhibitors D016896:Treatment Outcome
Antidepressant medication Depression Evidence-based treatments Psychotherapy Prediction of response