Differential change on depressive symptom factors with antidepressant medication and cognitive behavior therapy for major depressive disorder

• Type of Material: Article
• Authors: Boadie Dunlop, Emory University; Steven Cole, Emory University; Charles B. Nemeroff, University of Miami; Helen Mayberg, Emory University; Wade Craighead, Emory University
• Language: English
• Date: 2018-03-15
• Publisher: Elsevier: 12 months
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2017
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.jad.2017.12.035
• Title of Journal or Parent Work: Journal of Affective Disorders
• ISSN: 0165-0327
• Volume: 229
• Start Page: 111
• End Page: 119
• Grant/Funding Information: Forest Labs and Elli Lilly Inc. donated the study medications, escitalopram and duloxetine, respectively, but were otherwise uninvolved in study design, data collection, data analysis, or interpretation of findings.; This work was supported by the National Institutes of Health (H.S.M., P50 MH077083; W.E.C, RO1MH080880; B.W.D., K23 MH086690; and David S. Stephens, UL1 RR025008, M01 RR0039).
• Keywords: PATIENT; OUTCOMES; Clinical Neurology; Psychiatry; Precision medicine; PHARMACOTHERAPY; Item response theory; CLINICIAN; COLLABORATIVE RESEARCH-PROGRAM; STRUCTURED INTERVIEW GUIDE; SEVERITY; Rating scales; FIT INDEXES; Science & Technology; Psychotherapy; Life Sciences & Biomedicine; Neurosciences & Neurology; RATING-SCALE; Biomarker; Escitalopram; Duloxetine; PSYCHOTHERAPY
• Research Categories: Psychology, Behavioral; Biology, Neuroscience; Psychology, Cognitive

Abstract

Background Major depressive disorder (MDD) is a heterogeneous condition and individual patients are likely to be differentially responsive to specific treatments. In an exploratory factor analysis of three rating scales, the Genome-based Therapeutic Drugs for Depression (GENDEP) trial identified three factors that were differentially associated with outcome to nortriptyline and escitalopram. However, this factor analysis has neither been replicated or applied to a psychotherapy treatment. Methods We replicated the GENDEP analytic method in the Emory Predictors of Remission to Individual and Combined Treatments (PReDICT) study. The 17-item Hamilton Depression Rating Scale, Montgomery Asberg Depression Rating Scale, and Beck Depression Inventory were administered to 306 MDD patients in the PReDICT study, which randomized previously untreated adults to 12 weeks of treatment with cognitive behavior therapy (CBT), escitalopram, or duloxetine. Utilizing Item Response Theory methodologies, factor scores were derived from the three scales and the efficacy of the three treatments was compared for the identified factor scores. Results Four factors were identified: “Despair,” “Mood and Interest,” “Sleep,” and “Appetite.” These factors closely aligned with the factors identified in GENDEP. Compared to CBT, escitalopram and duloxetine produced more rapid but ultimately similar improvement on the Despair and Mood and Interest factors; no significant differences between treatments emerged on the other factors. Limitations The scales contained differing numbers of items pertaining to specific depressive symptoms. Conclusion The heterogeneity of MDD can be parsed into a consistent factor structure, with the factors showing differential rapidity, but ultimately similar, improvement across treatments.