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

for the PReDICT Team

Research output: Contribution to journalArticle

33 Citations (Scopus)

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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Patient Preference
Depression
Citalopram
Therapeutics
Antidepressive Agents
Major Depressive Disorder
Biological Factors

ASJC Scopus subject areas

  • Psychiatry and Mental health

Cite this

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

In: American Journal of Psychiatry, Vol. 174, No. 6, 01.06.2017, p. 546-556.

Research output: Contribution to journalArticle

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title = "Effects of patient preferences on outcomes in the predictors of remission in depression to individual and combined treatments (PReDICT) Study",
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.",
author = "{for the PReDICT Team} and Dunlop, {Boadie W.} and Kelley, {Mary E.} and Vivianne Aponte-Rivera and Tanja Mletzko-Crowe and Becky Kinkead and Ritchie, {James C.} and Charles Nemeroff and Craighead, {W. Edward} and Mayberg, {Helen S.} and Carla Alvarez and Julie Etzel and Rosario Falero and Maryrose Gerardi and Mary Heekin and Meredith Jones and Noriel Lim and Vivianna Mahoney and Cynthia Ramirez and Sheethal Reddy and Lorie Ritschel and Jill Rosenberg and Diana Simeonova and Patrick Sylvers and Alexandra Zagoloff and Craighead, {Linda Wilcoxon} and Nicole Almeida and Corey Beck and Steve Garlow and Ebrahim Haroon and Maryann Jacob and Jeffrey Rakofsky and Dylan Wint and Yara Betancourt and Beatriz Blastos and Ronald Chismar and Melanie Galanti and Rachelle Gibson and Lauren Marx and Melissa McKenzie and Crowe, {Tanja Mletzko}",
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T1 - Effects of patient preferences on outcomes in the predictors of remission in depression to individual and combined treatments (PReDICT) Study

AU - for the PReDICT Team

AU - Dunlop, Boadie W.

AU - Kelley, Mary E.

AU - Aponte-Rivera, Vivianne

AU - Mletzko-Crowe, Tanja

AU - Kinkead, Becky

AU - Ritchie, James C.

AU - Nemeroff, Charles

AU - Craighead, W. Edward

AU - Mayberg, Helen S.

AU - Alvarez, Carla

AU - Etzel, Julie

AU - Falero, Rosario

AU - Gerardi, Maryrose

AU - Heekin, Mary

AU - Jones, Meredith

AU - Lim, Noriel

AU - Mahoney, Vivianna

AU - Ramirez, Cynthia

AU - Reddy, Sheethal

AU - Ritschel, Lorie

AU - Rosenberg, Jill

AU - Simeonova, Diana

AU - Sylvers, Patrick

AU - Zagoloff, Alexandra

AU - Craighead, Linda Wilcoxon

AU - Almeida, Nicole

AU - Beck, Corey

AU - Garlow, Steve

AU - Haroon, Ebrahim

AU - Jacob, Maryann

AU - Rakofsky, Jeffrey

AU - Wint, Dylan

AU - Betancourt, Yara

AU - Blastos, Beatriz

AU - Chismar, Ronald

AU - Galanti, Melanie

AU - Gibson, Rachelle

AU - Marx, Lauren

AU - McKenzie, Melissa

AU - Crowe, Tanja Mletzko

PY - 2017/6/1

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N2 - 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.

AB - 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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