TY - JOUR
T1 - Divergent outcomes in cognitive-behavioral therapy and pharmacotherapy for adult depression
AU - Vittengl, Jeffrey R.
AU - Jarrett, Robin B.
AU - Weitz, Erica
AU - Hollon, Steven D.
AU - Twisk, Jos
AU - Cristea, Ioana
AU - David, Daniel
AU - DeRubeis, Robert J.
AU - Dimidjian, Sona
AU - Dunlop, Boadie W.
AU - Faramarzi, Mahbobeh
AU - Hegerl, Ulrich
AU - Kennedy, Sidney H.
AU - Kheirkhah, Farzan
AU - Mergl, Roland
AU - Miranda, Jeanne
AU - Mohr, David C.
AU - Rush, A. John
AU - Segal, Zindel V.
AU - Siddique, Juned
AU - Simons, Anne D.
AU - Cuijpers, Pim
N1 - Funding Information:
Dr. Vittengl is a reviewer for UpToDate. Dr. Jarrett receives grants from NIMH, nonfinancial support from Parke Davis (during the conduct of the study), consulting fees from NIMH and NIH, and consulting fees from UpToDate, and her medical center receives fees for cognitive therapy she provides to patients. Dr. Hollon is supported by NIMH grants MH60713 and MH01697. Dr. DeRubeis is supported by NIMH grant MH60998.
PY - 2016/5/1
Y1 - 2016/5/1
N2 - Objective: Although the average depressed patient benefits moderately from cognitive-behavioral therapy (CBT) or pharmacotherapy, some experience divergent outcomes. The authors tested frequencies, predictors, and moderators of negative and unusually positive outcomes. Method: Sixteen randomized clinical trials comparing CBT and pharmacotherapy for unipolar depression in 1,700 patients provided individual pre- and posttreatment scores on the Hamilton Depression Rating Scale (HAM-D) and/or Beck Depression Inventory (BDI). The authors examined demographic and clinical predictors and treatmentmoderators of any deterioration (increase≥1HAM-Dor BDI point), reliable deterioration (increase ≥8 HAM-D or ≥9 BDI points), extreme nonresponse (posttreatment HAM-D score ≥21 or BDI score ≥31), superior improvement (HAM-D or BDI decrease≥ 95%), and superior response (posttreatmentHAM-D or BDI score of 0) using multilevel models. Results: About5%27%of patients showedany deterioration, 1% reliable deterioration, 4%25% extreme nonresponse, 6%210% superior improvement, and 4%25% superior response. Superior improvement on the HAM-D only (odds ratio=1.67) and attrition (odds ratio=1.67) were more frequent in pharmacotherapy than in CBT. Patients with deterioration or superior response had lower pretreatment symptom levels, whereas patients with extreme nonresponse or superior improvement had higher levels. Conclusions: Deterioration and extreme nonresponse and, similarly, superior improvement and superior response, both occur infrequently in randomized clinical trials comparing CBT and pharmacotherapy for depression. Pretreatment symptom levels help forecast negative and unusually positive outcomes but do not guide selection of CBT versus pharmacotherapy. Pharmacotherapy may produce clinician-rated superior improvement and attrition more frequently than does CBT.
AB - Objective: Although the average depressed patient benefits moderately from cognitive-behavioral therapy (CBT) or pharmacotherapy, some experience divergent outcomes. The authors tested frequencies, predictors, and moderators of negative and unusually positive outcomes. Method: Sixteen randomized clinical trials comparing CBT and pharmacotherapy for unipolar depression in 1,700 patients provided individual pre- and posttreatment scores on the Hamilton Depression Rating Scale (HAM-D) and/or Beck Depression Inventory (BDI). The authors examined demographic and clinical predictors and treatmentmoderators of any deterioration (increase≥1HAM-Dor BDI point), reliable deterioration (increase ≥8 HAM-D or ≥9 BDI points), extreme nonresponse (posttreatment HAM-D score ≥21 or BDI score ≥31), superior improvement (HAM-D or BDI decrease≥ 95%), and superior response (posttreatmentHAM-D or BDI score of 0) using multilevel models. Results: About5%27%of patients showedany deterioration, 1% reliable deterioration, 4%25% extreme nonresponse, 6%210% superior improvement, and 4%25% superior response. Superior improvement on the HAM-D only (odds ratio=1.67) and attrition (odds ratio=1.67) were more frequent in pharmacotherapy than in CBT. Patients with deterioration or superior response had lower pretreatment symptom levels, whereas patients with extreme nonresponse or superior improvement had higher levels. Conclusions: Deterioration and extreme nonresponse and, similarly, superior improvement and superior response, both occur infrequently in randomized clinical trials comparing CBT and pharmacotherapy for depression. Pretreatment symptom levels help forecast negative and unusually positive outcomes but do not guide selection of CBT versus pharmacotherapy. Pharmacotherapy may produce clinician-rated superior improvement and attrition more frequently than does CBT.
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U2 - 10.1176/appi.ajp.2015.15040492
DO - 10.1176/appi.ajp.2015.15040492
M3 - Article
C2 - 26869246
AN - SCOPUS:84965150449
SN - 0002-953X
VL - 173
SP - 481
EP - 490
JO - American Journal of Psychiatry
JF - American Journal of Psychiatry
IS - 5
ER -