Category: Treatment - CBT

PS4- #A7 - Follow-Up of Monotherapy Remitters in the PReDICT Study: Treatment Outcomes and Clinical Predictors of Relapse and Recurrence

Friday, Nov 17
12:15 PM – 1:15 PM
Location: Indigo Ballroom CDGH, Level 2, Indigo Level

Keywords: Cognitive Therapy | Adult Depression | Relapse

This study followed remitted patients from a randomized controlled trial of adults with Major Depression. The aims were to describe rates of relapse and recurrence and to evaluate three clinical predictor domains. Ninety-four treatment naïve patients (50% female; Mage= 38.1; 48.9% Caucasian) with Major Depression who had remitted to 12-week monotherapy (escitalopram, duloxetine, or cognitive-behavior therapy (CBT)) participated in a 21-month maintenance phase (i.e., continued medication or up to 3 CBT booster sessions per year). Relapse and recurrence were operationalized as the single construct of relapse/recurrence and were assessed quarterly. The clinical predictors were: two measures of residual depressive symptoms, one measure of prior depressive episodes, and two measures of baseline anxiety. Standard survival analysis methods were used for the analyses. An estimated 15.5% of patients suffered a relapse/recurrence, and the survival distributions did not statistically differ across treatment conditions. Residual depressive symptoms on the Hamilton Rating Scale for Depression were associated with increased risk in relapse/recurrence (Hazard Ratio = 1.31, 95% CI [1.02., 1.67], Wald X2 = 4.41, p = .036), as was a comorbid anxiety disorder diagnosis at study baseline (Hazard Ratio = .31, 95% CI [.10, .94], Wald X2 = 4.28, p = .039). Both variables were marginally significant in a multivariate model, and none of the other clinical measures were statistically significant in any of the analyses. The current study supports the benefits of maintenance treatment for most treatment naïve patients who remit to initial monotherapy. However, despite achieving remission, patients with residual depressive symptoms after initial treatment or a comorbid anxiety disorder diagnosis at study baseline are at risk for poorer long-term outcomes.

Jamie Kennedy

Graduate Student
Department of Psychology, Emory University

Boadie Dunlop

Associate Professor
Department of Psychiatry and Behavioral Sciences, Emory University

Linda W. Craighead

Professor of Psychology & Director of Clinical Training
Department of Psychology, Emory University

Charles Nemeroff

Leonard M. Miller Professor & Chairman
Department of Psychiatry and Behavioral Sciences, University of Miami

Helen Mayberg

Professor
Departments of Psychiatry and Behavioral Sciences, Neurology, and Radiology, Emory University

Ed Craighead

J. Rex Fuqua Professor, Department of Psychiatry and Behavioral Sciences and Department of Psychology
Emory University