TY - JOUR
T1 - Defined symptom-change trajectories during acute-phase cognitive therapy for depression predict better longitudinal outcomes
AU - Vittengl, Jeffrey R.
AU - Clark, Lee Anna
AU - Thase, Michael E.
AU - Jarrett, Robin B.
N1 - Funding Information:
Dr. Vittengl is a paid reviewer for UpToDate. Dr. Clark has no financial interest or conflict of interest in the research. During the past 3 years Dr. Thase has consulted with and/or served on advisory boards for Advir, Alkermes, Allergan, AstraZeneca, Avenir, Bristol-Myers Squibb Company, Cerecor, Cerenex, Eli Lilly and Company, Forest Laboratories, Janssen Pharmaceutica, Johnson & Johnson, Lundbeck, MedAvante, Merck, Moksha8, Naurex, Neuronetics, Novartis, Otsuka, Nestlé (formerly Pamlab), Pfizer Pharmaceuticals, Roche, Shire, Sunovion, Takeda, and Teva. During this time, he has received grant support from Alkermes, Assurerx, AstraZeneca, Avenir, Eli Lilly and Company, Forest Laboratories, Janssen/Johnson & Johnson, Otsuka, and Roche, as well as funding from the Agency for Healthcare Research and Quality and the NIMH. He has equity holdings for MedAvante, Inc. and has received royalties from American Psychiatric Publishing, Inc. (APPI), Guilford Publications, Herald House, and W.W. Norton & Company, Inc. Two books currently promoted by the APPI specifically pertain to cognitive therapy. Dr. Thase also discloses that his spouse is an employee of Peloton Advantage, which does business with several pharmaceutical companies that market medications used to treat depression. Dr. Jarrett's medical center collects the payments from the cognitive therapy she provides to patients. Dr. Jarrett is a paid consultant to the NIH, NIMH, and UpToDate.
Publisher Copyright:
© 2016 Elsevier Ltd
PY - 2016/12/1
Y1 - 2016/12/1
N2 - Background Acute-phase cognitive therapy (CT) is an efficacious treatment for major depressive disorder (MDD), but responders experience varying post-acute outcomes (e.g., relapse vs. recovery). Responders’ symptom-change trajectories during response to acute-phase CT may predict longer term outcomes. Method We studied adult outpatients (N = 220) with recurrent MDD who responded to CT but had residual symptoms. Responders with linear (steady improvement), log-linear (quicker improvement earlier and slower later), one-step (a single, relatively large, stable improvement between adjacent assessments), or undefined (not linear, log-linear, or one-step) symptom trajectories were assessed every 4 months for 32 additional months. Results Defined (linear, log-linear, one-step) versus undefined acute-phase trajectories predicted lower depressive symptoms (d = 0.36), lower weekly probability of being in a major depressive episode (OR = 0.46), higher weekly probabilities of remission (OR = 1.93) and recovery (OR = 2.35), less hopelessness (d = 0.41), fewer dysfunctional attitudes (d = 0.31), and better social adjustment (d = 0.32) for 32 months after acute-phase CT. Differences among defined trajectory groups were nonsignificant. Conclusions Responding to acute-phase CT with a defined trajectory (orderly pattern) of symptom reduction predicts better longer term outcomes, but which defined trajectory (linear, log-linear, or one-step) appears unimportant. Frequent measurement of depressive symptoms to identify un/defined CT response trajectories may clarify need for continued clinical monitoring and treatment.
AB - Background Acute-phase cognitive therapy (CT) is an efficacious treatment for major depressive disorder (MDD), but responders experience varying post-acute outcomes (e.g., relapse vs. recovery). Responders’ symptom-change trajectories during response to acute-phase CT may predict longer term outcomes. Method We studied adult outpatients (N = 220) with recurrent MDD who responded to CT but had residual symptoms. Responders with linear (steady improvement), log-linear (quicker improvement earlier and slower later), one-step (a single, relatively large, stable improvement between adjacent assessments), or undefined (not linear, log-linear, or one-step) symptom trajectories were assessed every 4 months for 32 additional months. Results Defined (linear, log-linear, one-step) versus undefined acute-phase trajectories predicted lower depressive symptoms (d = 0.36), lower weekly probability of being in a major depressive episode (OR = 0.46), higher weekly probabilities of remission (OR = 1.93) and recovery (OR = 2.35), less hopelessness (d = 0.41), fewer dysfunctional attitudes (d = 0.31), and better social adjustment (d = 0.32) for 32 months after acute-phase CT. Differences among defined trajectory groups were nonsignificant. Conclusions Responding to acute-phase CT with a defined trajectory (orderly pattern) of symptom reduction predicts better longer term outcomes, but which defined trajectory (linear, log-linear, or one-step) appears unimportant. Frequent measurement of depressive symptoms to identify un/defined CT response trajectories may clarify need for continued clinical monitoring and treatment.
KW - Cognitive therapy
KW - Major depressive disorder
KW - Recovery
KW - Relapse
KW - Trajectory
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U2 - 10.1016/j.brat.2016.08.008
DO - 10.1016/j.brat.2016.08.008
M3 - Article
C2 - 27591917
AN - SCOPUS:84984837759
VL - 87
SP - 48
EP - 57
JO - Behavioral Assessment
JF - Behavioral Assessment
SN - 0005-7967
ER -