Effects of patient preferences on outcomes in the predictors of remission in depression to individual and combined treatments (PReDICT) Study

Boadie W. Dunlop, Mary E. Kelley, Vivianne Aponte-Rivera, Tanja Mletzko-Crowe, Becky Kinkead, James C. Ritchie, Charles B. Nemeroff, W. Edward Craighead, Helen S. Mayberg, Carla Alvarez, Julie Etzel, Rosario Falero, Maryrose Gerardi, Mary Heekin, Meredith Jones, Noriel Lim, Vivianna Mahoney, Cynthia Ramirez, Sheethal Reddy, Lorie RitschelJill Rosenberg, Diana Simeonova, Patrick Sylvers, Alexandra Zagoloff, Linda Wilcoxon Craighead, Nicole Almeida, Corey Beck, Steve Garlow, Ebrahim Haroon, Maryann Jacob, Jeffrey Rakofsky, Dylan Wint, Yara Betancourt, Beatriz Blastos, Ronald Chismar, Melanie Galanti, Rachelle Gibson, Lauren Marx, Melissa McKenzie, Tanja Mletzko Crowe, for the PReDICT Team

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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.

Original languageEnglish (US)
Pages (from-to)546-556
Number of pages11
JournalAmerican Journal of Psychiatry
Volume174
Issue number6
DOIs
StatePublished - Jun 1 2017

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Dunlop, B. W., Kelley, M. E., Aponte-Rivera, V., Mletzko-Crowe, T., Kinkead, B., Ritchie, J. C., Nemeroff, C. B., Craighead, W. E., Mayberg, H. S., Alvarez, C., Etzel, J., Falero, R., Gerardi, M., Heekin, M., Jones, M., Lim, N., Mahoney, V., Ramirez, C., Reddy, S., ... for the PReDICT Team (2017). Effects of patient preferences on outcomes in the predictors of remission in depression to individual and combined treatments (PReDICT) Study. American Journal of Psychiatry, 174(6), 546-556. https://doi.org/10.1176/appi.ajp.2016.16050517