Depression and Bipolar info explaining the latest research in everyday English

Predicting a response to medication and cognitive therapy for moderate to severe depression

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Predicting a response to medication and cognitive therapy for moderate to severe depression

The hefty research literature around cognitive therapy and pharmacotherapy therapy confirms that both are really good ways of treating depression.

But are there some symptoms and variables that would predict a superior response of one treatment over another?

This is the research question that Jay C. Fournier and colleagues decided to investigate. To do so they randomly assigned 60 depressed outpatients to cognitive therapy and 120 to antidepressant medications. Both groups were given a treatment regimen that lasted for 16 weeks.

They found that chronic depression, older age and lower intelligence didn't augur well for either type of treatment. Conversely, marriage, unemployment and having experienced a greater number of recent life events predicted a better response to cognitive therapy than pharmacological.

By the way, 'life event' is the total number of life events reported on the Psychiatric Epidemiology Research Interview Life Events scale, a 102-item self-report measure (Dohrenwend, Krasnoff, Askenasy, & Dohrenwend, 1978). This instrument is agnostic as to whether life events are positive, negative, or neutral.

Previous studies of depression and age had found (albeit not conclusively) that the older the sufferer was, the less likely they were to recover quickly from their depression.

Interestingly, dropout rates were lower for those who suffered from chronic depression; someone with nonchronic depression was approximately four times more likely to drop out of treatment. Although chronically depressed patients were likely to report less symptom relief, they at least 'stayed the course' -- although exactly why they stayed is open to discussion. There is the possibility that the chronically depressed were more motivated to complete their treatment course in the hope of achieving some degree of relief from their long-standing pain.

The researchers also found that those who were married/cohabiting, had a greater number of significant events in their lives and those who were unemployed were far more likely to benefit from cognitive therapy than medication. To me, that's interesting. I have tried CBT but had so little success with it that I dropped out after four weeks of a ten week program. Something to be discussed with my psychiatrist the next time I see them, methinks.

Sources:

Fournier, J.C.; DeRubeis, R.J.; Shelton, R.C.; Hollon, S.P.; Amsterdam, J.D.; & Gallop, R. (2009). Prediction of Response to Medication and Cognitive Therapy in the Treatment of Moderate to Severe Depression. Journal of Consulting & Clinical Psychology, Aug, Vol. 77 (4), 775-787

Dohrenwend, B. S., Krasnoff, L., Askenasy, A. R., & Dohrenwend, B. P. (1978). Exemplification of a method for scaling life events: The PERI Life Events Scale. Journal of Health and Social Behavior, 19, 205-229

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