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Author Notes:

E-mail Address: bdunlop@emory.edu

The authors thank Flavia Mercado, M.D., for her assistance in operationalizing the study at the Grady Hospital location.

The authors also thank Leslie Sokol, Ph.D., and Jesus Salas, Ph.D., for performing the Cognitive Therapy Scale competency ratings.

Dr. Dunlop has received research support from Assurex, Bristol-Myers Squibb, Forest, Janssen, GlaxoSmithKline, NIMH, Otsuka, Pfizer, and Takeda; and he has served as a consultant to Pfizer and Medavante.

See article for full list of disclosures

Dr. Mayberg has received consulting fees from Eli Lilly and St. Jude Medical Neuromodulation; and she has received intellectual property licensing fees from St. Jude Medical Neuromodulation.

All other authors report no financial relationships with commercial interests.

Subjects:

Research Funding:

Supported by NIH grants P50 MH077083; RO1 MH080880; UL1 RR025008; M01 RR0039; and K23 MH086690.

Forest Laboratories and Elli Lilly donated the study medications, escitalopram and duloxetine, respectively, and were otherwise uninvolved in the study design, data collection, data analysis, or interpretation of findings.

Keywords:

  • Science & Technology
  • Life Sciences & Biomedicine
  • Psychiatry
  • COGNITIVE-BEHAVIORAL THERAPY
  • MENTAL-HEALTH TREATMENT
  • PRIMARY-CARE
  • MAJOR DEPRESSION
  • ANTIDEPRESSANT MEDICATION
  • NATIONAL-INSTITUTE
  • RANDOMIZED-TRIAL
  • ANALYSIS SYSTEM
  • CHRONIC FORMS
  • PSYCHOTHERAPY

Effects of Patient Preferences on Outcomes in the Predictors of Remission in Depression to Individual and Combined Treatments (PReDICT) Study

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Journal Title:

American Journal of Psychiatry

Volume:

Volume 174, Number 6

Publisher:

, Pages 546-556

Type of Work:

Article | Post-print: After Peer Review

Abstract:

Objective: The Predictors of Remission in Depression to Individual and Combined Treatments [PReDICT] study aimed to identify clinical and biological factors predictive of treatment outcomes in major depressive disorder among treatmentnaive adults. The authors evaluated the efficacy of cognitivebehavioral therapy (CBT) and two antidepressant medications (escitalopram and duloxetine) in patients with major depression and examined the moderating effect of patients' treatment preferences on outcomes. Method: Adults aged 18-65 with treatment-naive major depression were randomly assigned with equal likelihood to 12 weeks of treatment with escitalopram (10-20 mg/day), duloxetine (30-60 mg/day), or CBT (16 50-minute sessions). Prior torandomization,patients indicatedwhethertheypreferred medication or CBT or had no preference. The primary outcome was change in the 17-item Hamilton Depression Rating Scale (HAM-D), administered by raters blinded to treatment. Results: A total of 344 patients were randomly assigned, with a mean baseline HAM-D score of 19.8 (SD=3.8). The mean estimated overall decreases in HAM-D score did not significantly differ between treatments (CBT: 10.2, escitalopram: 11.1, duloxetine: 11.2). Last observation carried forward remission rates did not significantly differ between treatments (CBT: 41.9%, escitalopram: 46.7%, duloxetine: 54.7%). Patients matched to their preferred treatment were more likely to complete the trial but not more likely to achieve remission. Conclusions: Treatment guidelines that recommend either an evidence-based psychotherapy or antidepressant medication for nonpsychotic major depression can be extended to treatment-naive patients. Treatment preferences among patients without prior treatment exposuredonot significantly moderate symptomatic outcomes.
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