Patient predictors of response to psychotherapy and pharmacotherapy: findings in the NIMH treatment of Depression Collaborative Research Program

Article Abstract:

Depression is usually treated with psychotherapy, drug therapy, or a combination of the two. The choice of treatment and its likelihood of success may be dependent on patient characteristics and the underlying cause of the depression. Few comprehensive studies have examined specific patient characteristics that are predictive of treatment outcome. Treatment outcomes for depression and 26 patient characteristics were measured for 162 patients. Treatment consisted of either cognitive-behavioral or interpersonal psychotherapy, or drug therapy with either imipramine or a placebo. Patient characteristics that were measured included sociodemographic variables, personality variables, and variables related to the depression. Cognitive-behavioral therapy was most successful in patients with less initial cognitive dysfunction, without a family history of affective disorder, later age of onset, a history of previous episodes of depression, and those who were married. Interpersonal psychotherapy was most successful in patients with lower pretreatment levels of social dysfunction and patients who were divorced or separated. Males with these characteristics responded better to this type of therapy than did females. Treatment with imipramine and clinical management (CM) produced the best results in patients with the most work dysfunction and the highest depression severity. It was least effective in patients who were single and who had high levels of cognitive dysfunction. Six variables were highly predictive of outcome across treatments. These included pretreatment levels of social and cognitive dysfunction, expectation of improvement, endogenous depression, double depression, and duration of the current episode. These results indicate that patient characteristics can be useful in predicting the likely outcome of treatment for depression. Such characteristics may be helpful in deciding the appropriate treatment for a patient. (Consumer Summary produced by Reliance Medical Information, Inc.)

Prognosis

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The biological basis of an antidepressant response to sleep deprivation and relapse: review and hypothesis

Article Abstract:

An extensive review of studies on more than 1,700 depressed patients reveals that more than half show a definite decrease in depressive symptoms following one night's complete sleep deprivation. This treatment was especially effective for people with endogenous depression, a persistent condition characterized by unhappiness, anxiety, guilt, and difficulty in concentrating. The improvement in mood began the day before sleep was going to be interrupted, and continued well into the next day for some people. The effect was more pronounced for patients who were not taking antidepressant medication. It is possible that sleep itself induces depression, since many of these patients suffered a recurrence of their symptoms if allowed to sleep during the night following sleep deprivation. Some became depressed after even a nap. It is hypothesized that a depression-causing substance released during sleep is used by the body when the person is awake, leading to depressive symptoms. According to this hypothesis, remaining awake all night could prevent the manufacture of the substance, while napping would allow it to accumulate again. The idea gains support from the observation that people with endogenous depression feel their worst in the morning, when the concentration of the depression-causing substance is at its highest. An alternative hypothesis is that a factor that works against depression is produced during wakefulness. It is not yet clear which of these ideas best explains the results of sleep experiments; however, some substances whose levels are known to change with sleep states are growth hormone, cortisol, and thyroid-stimulating hormones. Individual variations in body rhythms and in REM (rapid eye movement) sleep may also be important in explaining the response of depressed people to sleep deprivation. Further research should include attempts to isolate the possible depression-causing substance. (Consumer Summary produced by Reliance Medical Information, Inc.)

Psychological aspects, Health aspects, Causes of, Sleep deprivation, Wakefulness

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Computer-administered cognitive-behavioral therapy for depression

Article Abstract:

Although psychotherapy administered by a computer has proven effective for certain specific behavioral problems, it has not shown promise in wider clinical use. This may be due to the difficulty of translating therapeutic techniques and style into a form appropriate to the computer. Cognitive-behavioral therapy seems ideal for administration by a computer, and this approach was used on 12 depressed, non-psychotic people selected from a group who responded to a newspaper announcement. Another group of similar subjects received the same type of therapy administered by a therapist, while those in the control group were simply assigned to a waiting list. Treatment consisted of six sessions over a six-week period. Patients were evaluated at the end of treatment and again two months after the last session. The two treatment groups showed greater improvement at both times than did the control group, but there was no difference between the computer-treated subjects and the therapist-treated subjects on any measure. Improvement was defined as a reduction in depressive symptoms as well as in automatic thoughts, a type of obsessive cognitive behavior. These results imply that computer-administered cognitive-behavioral therapy can be as effective as therapy performed by a therapist for the treatment of mild to moderate depression. (Consumer Summary produced by Reliance Medical Information, Inc.)

Methods, Behavior therapy

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