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Predictors and moderators of time to remission of major depression with interpersonal psychotherapy and SSRI pharmacotherapy

Published online by Cambridge University Press:  12 April 2010

E. Frank ,
G. B. Cassano ,
P. Rucci ,
W. K. Thompson ,
H. C. Kraemer ,
A. Fagiolini ,
L. Maggi ,
D. J. Kupfer ,
M. K. Shear  and
P. R. Houck
...Show all authors
E. Frank*
Affiliation:
Department of Psychiatry, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, Pittsburgh, PA, USA
G. B. Cassano
Affiliation:
Department of Psychiatry, Neurobiology, Pharmacology and Biotechnology, University of Pisa, Italy
P. Rucci
Affiliation:
Department of Psychiatry, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, Pittsburgh, PA, USA
W. K. Thompson
Affiliation:
Department of Psychiatry, University of California at San Diego, San Diego, CA, USA
H. C. Kraemer
Affiliation:
Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA
A. Fagiolini
Affiliation:
Department of Neuroscience, Psychiatry Division, University of Siena School of Medicine, Siena, Italy
L. Maggi
Affiliation:
Department of Psychiatry, Neurobiology, Pharmacology and Biotechnology, University of Pisa, Italy
D. J. Kupfer
Affiliation:
Department of Psychiatry, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, Pittsburgh, PA, USA
M. K. Shear
Affiliation:
School of Social Work, Columbia University, New York, NY, USA
P. R. Houck
Affiliation:
Department of Psychiatry, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, Pittsburgh, PA, USA
S. Calugi
Affiliation:
Department of Psychiatry, Neurobiology, Pharmacology and Biotechnology, University of Pisa, Italy
V. J. Grochocinski
Affiliation:
Department of Psychiatry, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, Pittsburgh, PA, USA
P. Scocco
Affiliation:
Mental Health Department, ULSS 16, Padua, Italy
J. Buttenfield
Affiliation:
Department of Psychiatry, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, Pittsburgh, PA, USA
R. N. Forgione
Affiliation:
Department of Psychiatry, Neurobiology, Pharmacology and Biotechnology, University of Pisa, Italy
*
*Address for correspondence: E. Frank, Ph.D., University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, 3811 O'Hara Street, Pittsburgh, PA 15213, USA. (Email: franke@upmc.edu)
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Abstract

Background

Although many studies suggest that, on average, depression-specific psychotherapy and antidepressant pharmacotherapy are efficacious, we know relatively little about which patients are more likely to respond to one versus the other. We sought to determine whether measures of spectrum psychopathology are useful in deciding which patients with unipolar depression should receive pharmacotherapy versus depression-specific psychotherapy.

Method

A total of 318 adult out-patients with major depression were randomly assigned to escitalopram pharmacotherapy or interpersonal psychotherapy (IPT) at academic medical centers at Pittsburgh, Pennsylvania and Pisa, Italy. Our main focus was on predictors and moderators of time to remission on monotherapy at 12 weeks.

Results

Participants with higher scores on the need for medical reassurance factor of the Panic–Agoraphobic Spectrum Self-Report (PAS-SR) had more rapid remission with IPT and those with lower scores on the psychomotor activation factor of the Mood Spectrum Self-Report (MOODS-SR) experienced more rapid remission with selective serotonin reuptake inhibitor (SSRI) pharmacotherapy. Non-specific predictors of longer time to remission with monotherapy included several panic spectrum and mood spectrum factors and the Social Phobia Spectrum (SHY) total score. Higher baseline scores on the 17- and 25-item Hamilton Depression Rating Scales (HAMD-17 and HAMD-25) and the Work and Social Adjustment Scale (WSAS) also predicted a longer time to remission, whereas being married predicted a shorter time to remission.

Conclusions

This exploratory study identified several non-specific predictors but few moderators of psychotherapy versus pharmacotherapy outcome. It offers useful indicators of the characteristics of patients that are generally difficult to treat, but only limited guidance as to who benefits from IPT versus SSRI pharmacotherapy.

Keywords

Depressioninterpersonal psychotherapymoderatorspredictorstreatment
Type
Original Articles
Information
Psychological Medicine , Volume 41 , Issue 1 , January 2011 , pp. 151 - 162
Copyright
Copyright © Cambridge University Press 2010

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