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

Jeffrey R. Vittengl, Lee Anna Clark, Michael E. Thase, Robin B. Jarrett

Research output: Contribution to journalArticle

5 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)174-181
Number of pages8
JournalPsychiatry Research
Volume253
DOIs
StatePublished - Jul 1 2017

Keywords

  • Cognitive therapy
  • Fluoxetine
  • Major depressive disorder
  • Personalized advantage index
  • Personalized medicine
  • Recurrence
  • Relapse

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Biological Psychiatry

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