Depression beliefs, treatment preference, and outcomes in a randomized trial for major depressive disorder

Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, 1256 Briarcliff Road NE, Building A, 3rd Floor, Atlanta, GA 30306, USA.
Journal of Psychiatric Research (Impact Factor: 3.96). 11/2011; 46(3):375-81. DOI: 10.1016/j.jpsychires.2011.11.003
Source: PubMed


Previous studies suggest that individual preferences for medication- or psychotherapy-based treatments for depression may affect outcomes in clinical trials that compare these two forms of treatment. We assessed patients' beliefs about the causes of their depression, their preferred treatment, and strength of that preference in 80 patients participating in a 12-week clinical trial evaluating neuroimaging predictors of response to cognitive behavior therapy (CBT) or escitalopram. Forty-five patients expressed a preference for one of the 2 treatments, but being matched to preference did not influence remission or completion rates. Medication-preferring patients were more likely to terminate the trial early, regardless of treatment received. CBT-preferring patients rarely endorsed unknown causes for their depression, and medication-preferring patients were highly unlikely to identify pessimistic attitudes as a source of their depression. Among patients willing to be randomized to treatment, preference does not appear to strongly influence outcome. Specific preferences for CBT or medication may reflect differing conceptualizations about depressive illness, knowledge of which may enhance treatment retention and efficacy.

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Available from: Boadie Dunlop
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    • "In sum, treatment preferences likely reflect underlying beliefs and conceptualizations about illnesses that may be important for optimizing treatment response (e.g., Dunlop et al. 2012). Such findings linking preferences with beliefs about the origins of mental illness have direct implications for implicit theories, because entity theorists also tend to attribute abilities and personality to their genetic make-up (Dweck 2006; Dweck et al. 1995; Keller 2005), and may therefore have similar thoughts about treatment choices (i.e., medication). "
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    • "These variable findings indicate the crucial contribution of how the informed consent process is performed, particularly the discussion around randomization and the patient's willingness to start the treatment regardless of preference. More generally, patients preferring ADM over psychotherapy or combination treatment have higher rates of attrition (Dunlop et al. 2012c, Steidtmann et al. 2012), which may stem from beliefs about causes of their depression (Dunlop et al. 2012c, Steidtmann et al. 2012) or from practical factors related to treatment (e.g., preference for ADM may derive from time or travel constraints, which may contribute to attrition). Two large combination trials of treatments for chronic MDD have evaluated patient preference as a predictor (Kocsis et al. 2009, Steidtmann et al. 2012). "
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    • "However, neither preference match nor preference strength could predict symptom remission, although an unexpected negative association was found between preference strength and symptom severity at 12 weeks [13]. Dunlop et al. [14] also investigated the effect of preference strength in addition to preference matching in a study comparing CBT and escitalopram among patients with depression. In contrast to Raue et al. [13], Dunlop et al. [14] did not find any predictive value in strength of preference. "
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