Boadie W Dunlop1, Mary E Kelley1, Vivianne Aponte-Rivera1, Tanja Mletzko-Crowe1, Becky Kinkead1, James C Ritchie1, Charles B Nemeroff1, W Edward Craighead1, Helen S Mayberg1. 1. From the Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta; the Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta; the Department of Psychiatry and Behavioral Sciences, Tulane University School of Medicine, New Orleans; the Department of Clinical Pathology, Emory University School of Medicine, Atlanta; the Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami; the Department of Psychology, Emory University, Atlanta; and the Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta.
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 treatment-naive adults. The authors evaluated the efficacy of cognitive-behavioral 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 to randomization, patients indicated whether they preferred 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 exposure do not significantly moderate symptomatic outcomes.
RCT Entities:
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 treatment-naive adults. The authors evaluated the efficacy of cognitive-behavioral 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 to randomization, patients indicated whether they preferred 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 exposure do not significantly moderate symptomatic outcomes.
Authors: Boadie W Dunlop; Steven P Cole; Charles B Nemeroff; Helen S Mayberg; W Edward Craighead Journal: J Affect Disord Date: 2017-12-27 Impact factor: 4.839
Authors: Boadie W Dunlop; Devon LoParo; Becky Kinkead; Tanja Mletzko-Crowe; Steven P Cole; Charles B Nemeroff; Helen S Mayberg; W Edward Craighead Journal: Am J Psychiatry Date: 2019-02-15 Impact factor: 18.112
Authors: Jamie C Kennedy; Boadie W Dunlop; Linda W Craighead; Charles B Nemeroff; Helen S Mayberg; W Edward Craighead Journal: J Consult Clin Psychol Date: 2018-02
Authors: Manish K Jha; Bruce D Grannemann; Joseph M Trombello; E Will Clark; Sara Levinson Eidelman; Tiffany Lawson; Tracy L Greer; A John Rush; Madhukar H Trivedi Journal: Ann Fam Med Date: 2019-07 Impact factor: 5.166
Authors: Boadie W Dunlop; Justin K Rajendra; W Edward Craighead; Mary E Kelley; Callie L McGrath; Ki Sueng Choi; Becky Kinkead; Charles B Nemeroff; Helen S Mayberg Journal: Am J Psychiatry Date: 2017-03-24 Impact factor: 18.112
Authors: Shariful A Syed; Eléonore Beurel; David A Loewenstein; Jeffrey A Lowell; W Edward Craighead; Boadie W Dunlop; Helen S Mayberg; Firdaus Dhabhar; W Dalton Dietrich; Robert W Keane; Juan Pablo de Rivero Vaccari; Charles B Nemeroff Journal: Neuron Date: 2018-08-23 Impact factor: 17.173