Changes in well-being and quality of life in a randomized trial comparing dynamic psychotherapy and pharmacotherapy for major depressive disorder

The Derner Institute of Advanced Psychological Studies, Adelphi University, United States. Electronic address: .
Journal of Affective Disorders (Impact Factor: 3.38). 10/2013; 152-154(1). DOI: 10.1016/j.jad.2013.10.015
Source: PubMed

ABSTRACT Major depressive disorder (MDD) is associated with a decrease in quality of life (QOL) and well-being. Therefore, researchers are increasingly complementing traditional symptom measurements with QOL and well-being assessments in order to broaden the evaluation of treatment outcomes. The current prospective study investigated the effectiveness of supportive-expressive therapy (SET), antidepressant medication (MED) and placebo (PBO) in improving QOL and well-being in patients with MDD.
Data from a randomized controlled trial (trial registration: NCT00043550) comparing SET, MED and PBO for the treatment of depression (N=156) were analyzed. Outcome measures addressed patients' QOL and physical and mental well-being. Changes in outcomes were assessed across and between treatments using linear mixed models.
Across treatments, patients showed significant improvement in QOL and mental and physical health measures, as well as a reduction in interpersonal distress and depressive and anxiety symptoms (p≤.002 for all measures). Those changes were not only the products of a decrease in depressive symptoms, but also predicted subsequent reduction in symptoms. No significant differences were found between the three treatment conditions.
The limitation is the study's moderate sample size.
Current treatments for depression significantly improve patients' QOL and well-being. No significant differences were found between the three conditions examined in this study. The current study highlights the role of well-being in predicting subsequent symptomatic change.

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Available from: Sigal Zilcha-Mano, Sep 28, 2015
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    • "The reason may be that certain common factors such as therapist empathy or positive regard are the remedial elements behind similar patient changes in different forms of therapy (Norcross and Wampold, 2011). It may also be that there are " many roads to Rome " : that is, the same improvement in psychosocial functioning may be achieved through differing techniques and psychological mechanisms in different therapies (Safran and Messer, 1997; Zilcha-Mano et al., 2014). It must furthermore be noted that although SFT and SPP appeared to produce equal effects, there remains the possibility of a masked difference which would be revealed if more stringent selection criteria had been used, since patients with certain characteristics may be more suitable to one form of treatment than another (Laaksonen et al., 2012). "
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    ABSTRACT: Knowledge is incomplete on whether long-term psychotherapy is more effective than short-term therapy in treating mood and anxiety disorder, when measured by improvements in psychosocial functioning and life quality. In the Helsinki Psychotherapy Study, 326 outpatients with mood or anxiety disorder were randomized to solution-focused therapy (SFT), short-term psychodynamic psychotherapy (SPP), or long-term psychodynamic psychotherapy (LPP), and followed up for 5 years from the start of treatment. The outcome measures comprised 4 questionnaires on psychosocial functioning, assessing global social functioning (Social Adjustment Scale (SAS-SR), sense of coherence (Sense of Coherence Scale (SOC)), perceived competence (Self-Performance Survey), dispositional optimism (Life Orientation Test (LOT)), and 1 questionnaire assessing quality of life (Life Situation Survey (LSS)). Short-term therapies improved psychosocial functioning and quality of life more than LPP during the first year. The only exceptions were LOT and perceived competence, which did not differ between SPP and LPP. Later in the follow-up, SOC and perceived competence showed significantly more improvement in LPP than in the short-term therapy groups. No direct differences between SFT and SPP were noted. Short-term therapy has consistently more short-term effects on psychosocial functioning and quality of life than LPP, whereas LPP has some additional long-term benefits on psychosocial functioning. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    06/2015; 229(1-2). DOI:10.1016/j.psychres.2015.05.113
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    • "As concerns evaluating effects of treatments, designs range from longitudinal studies and prospective assessments of QoL, before and after treatment to randomized clinical trials, with QoL indicators serving as a secondary or ancillary rather than primary outcome criteria.52-56 Relatively rare are studies comparing psychopharmacological vs psychological interventions with regard to QoL end points.57 Inclusion of QoL assessment in routine care or quality assurance is a relatively new field in need of increased research efforts. "
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    ABSTRACT: Assessing quality of life (QoL) as a patient-reported outcome in adult psychiatry poses challenges in terms of concepts, methods, and applications in research and practice. This review will outline conceptually the construct of QoL, its dimensionality, and its representation across patient groups. Methodological challenges are examined, along with principles of QoL instrument development and testing, as well as across cultures. Application of instruments in epidemiological, clinical health economics, and health services research is reviewed based on pertinent literature. Validated measures for depression, psychosis, and anxiety disorders are available in adult psychiatry, and are increasingly used in research. Still, targeted measures are lacking for many mental health conditions and only rarely are tools applied in the practice context. Progress has been made in the development of instruments that are now ready for implementation. The information to be gained is valuable for identifying patient-reported needs for and benefits of treatment.
    Dialogues in clinical neuroscience 06/2014; 16(2):137-45.
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    ABSTRACT: Objective: Scholars increasingly recognize that therapeutic alliance and symptomatic change are associated with one another. A common assumption is that alliance predicts symptomatic change. However, the issue is far from settled. One challenge in determining the causality is the establishment of temporal precedence showing that alliance, as opposed to previous symptomatic change, drives subsequent symptomatic reduction. Method: To make further advances in untangling this chicken-and-egg question, we employed autoregressive cross-lagged modeling over 4 time points in a sample of 149 depressive patients receiving supportive-expressive psychotherapy or clinical management combined with pharmacotherapy or clinical management combined with placebo. Results: Using this methodology, we found that both alliance and symptoms across treatment made significant and unique contributions in predicting subsequent symptomatic levels throughout treatment. Additionally, alliance, but not symptoms, predicted subsequent alliance levels. No differences were found between treatments. Conclusions: Our findings imply that alliance temporally precedes symptomatic levels throughout treatment.
    Journal of Consulting and Clinical Psychology 11/2013; 82(6). DOI:10.1037/a0035141 · 4.85 Impact Factor
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