Initial Steps to inform selection of continuation cognitive therapy or fluoxetine for higher risk responders to cognitive therapy for recurrent major depressive disorder

PSYCHIATRY RESEARCH

卷:253

Article

Vittengl, Jeffrey R.¹  Clark, Lee Anna²  Thase, Michael E.³  Jarrett, Robin B.⁴ 

[1] Truman State Univ, Dept Psychol, 100 East Normal St, Kirksville, MO 63501 USA

[2] Univ Notre Dame, Dept Psychol, Notre Dame, IN 46556 USA

[3] Univ Penn, Dept Psychiat, Perelman Sch Med, Philadelphia, PA 19104 USA

[4] Univ Texas Southwestern Med Ctr Dallas, Dept Psychiat, 5323 Harry Hines Blvd, Dallas, TX USA

关键词: Major depressive disorder;    Cognitive therapy;    Fluoxetine;    Relapse;    Recurrence;    Personalized advantage index;    Personalized medicine;   

DOI  :  10.1016/j.psychres.2017.03.032

来源: Elsevier

【 摘 要 】

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.

【 授权许可】

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