Hostname: page-component-cd9895bd7-gbm5v Total loading time: 0 Render date: 2024-12-23T01:26:07.145Z Has data issue: false hasContentIssue false
  • English
  • Français

Suicidal ideation and other persisting symptoms after CBT or antidepressant medication treatment for major depressive disorder

Published online by Cambridge University Press:  12 September 2018

Boadie W. Dunlop ,
Philip E. Polychroniou ,
Jeffrey J. Rakofsky ,
Charles B. Nemeroff ,
W. Edward Craighead  and
Helen S. Mayberg
Boadie W. Dunlop*
Affiliation:
Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
Philip E. Polychroniou
Affiliation:
Emory University School of Medicine, Atlanta, GA, USA
Jeffrey J. Rakofsky
Affiliation:
Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
Charles B. Nemeroff
Affiliation:
Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
W. Edward Craighead
Affiliation:
Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA Department of Psychology, Emory University, Atlanta, GA, USA
Helen S. Mayberg
Affiliation:
Department of Psychiatry, Mount Sinai School of Medicine, New York, NY, USA
*
Author for correspondence: Boadie W. Dunlop, E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Persisting symptoms after treatment for major depressive disorder (MDD) contribute to ongoing impairment and relapse risk. Whether cognitive behavior therapy (CBT) or antidepressant medications result in different profiles of residual symptoms after treatment is largely unknown.

Methods

Three hundred fifteen adults with MDD randomized to treatment with either CBT or antidepressant medication in the Predictors of Remission in Depression to Individual and Combined Treatments (PReDICT) study were analyzed for the frequency of residual symptoms using the Montgomery Asberg Depression Rating Scale (MADRS) item scores at the end of the 12-week treatment period. Separate comparisons were made for treatment responders and non-responders.

Results

Among treatment completers (n = 250) who responded to CBT or antidepressant medication, there were no significant differences in the persistence of residual MADRS symptoms. However, non-responders treated with medication were significantly less likely to endorse suicidal ideation (SI) at week 12 compared with those treated with CBT (non-responders to medication: 0/54, 0%, non-responders to CBT: 8/30, 26.7%; p = .001). Among patients who terminated the trial early (n = 65), residual MADRS item scores did not significantly differ between the CBT- and medication-treated groups.

Conclusions

Depressed adults who respond to CBT or antidepressant medication have similar residual symptom profiles. Antidepressant medications reduce SI, even among patients for whom the medication provides little overall benefit.

Keywords

Cognitive therapyduloxetineescitaloprampredictionSSRI
Type
Original Articles
Information
Psychological Medicine , Volume 49 , Issue 11 , August 2019 , pp. 1869 - 1878
Copyright
Copyright © Cambridge University Press 2018 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

*

These authors contributed equally to the manuscript.

References

Beasley, CM Jr, Ball, SG, Nilsson, ME, Polzer, J, Tauscher-Wisniewski, S, Plewes, J and Acharya, N (2007) Fluoxetine and adult suicidality revisited: an updated meta-analysis using expanded data sources from placebo-controlled trials. Journal of Clinical Psychopharmacology 27, 682–686.Google Scholar
Carney, CE, Segal, ZV, Edinger, JD and Krystal, AD (2007) A comparison of rates of residual insomnia symptoms following pharmacotherapy or cognitive-behavioral therapy for major depressive disorder. Journal of Clinical Psychiatry 68, 254–260.Google Scholar
Claassen, CA, Trivedi, MH, Rush, AJ, Husain, MM, Zisook, S, Young, E, Leuchter, A, Wisniewski, SR, Balasubramani, GK and Alpert, J (2007) Clinical differences among depressed patients with and without a history of suicide attempts: findings from the STAR*D trial. Journal of Affective Disorders 97, 77–84.Google Scholar
Conradi, HJ, Ormel, J and de Jonge, P (2011) Presence of individual (residual) symptoms during depressive episodes and periods of remission: a 3-year prospective study. Psychological Medicine 41, 1165–1174.Google Scholar
Craighead, WE, Johnson, BJ, Carey, S and Dunlop, BW (2015) Psychosocial treatments for major depressive disorder. In Nathan, PE and Gorman, JM (Eds), Treatments That Work, 4th Edn. New York: Oxford University Press, pp. 381–408.Google Scholar
Dunlop, BW (2016) Evidence-based applications of combination psychotherapy and pharmacotherapy for depression. Focus 14, 156–173.Google Scholar
Dunlop, BW and Mayberg, HS (2014) Neuroimaging-based biomarkers for treatment selection in major depressive disorder. Dialogues in Clinical Neuroscience 16, 479–490.Google Scholar
Dunlop, BW, Binder, EB, Cubells, JF, Goodman, MM, Kelley, ME, Kinkead, B, Kutner, M, Nemeroff, CB, Dewport, DJ, Owens, MJ, Pace, TW, Ritchie, JC, Rivera, VA, Westen, D, Craighead, WE and Mayberg, HS (2012) Predictors of remission in depression to individual and combined treatments (PReDICT): study protocol for a randomized controlled trial. Trials 13, 106.Google Scholar
Dunlop, BW, Kelley, ME, Aponte-Rivera, V, Mletzko-Crowe, T, Kinkead, B, Ritchie, JC, Nemeroff, CB, Craighead, WE and Mayberg, HS (2017) Effects of patient preferences on outcomes in the Predictors of Remission in Depression to Individual and Combined Treatments (PReDICT) study. American Journal of Psychiatry 6, 546–556.Google Scholar
Dunlop, BW, Cole, SP, Nemeroff, CB, Mayberg, HS and Craighead, WE (2018) Differential change on depressive symptom factors with antidepressant medication and cognitive behavior therapy for major depressive disorder. Journal of Affective Disorders 229, 111–119.Google Scholar
Fournier, JC, DeRubeis, RJ, Hollon, SD, Gallop, R, Shelton, RC and Amsterdam, JD (2013) Differential change in specific depressive symptoms during antidepressant medication or cognitive therapy. Behaviour Research and Therapy 51, 392–398.Google Scholar
Frank, E, Prien, RF, Jarrett, RB, Keller, MB, Kupfer, DJ, Lavori, PW, Rush, AJ and Weissman, MM (1991) Conceptualization and rationale for consensus definitions of terms in major depressive disorder: remission, recovery, relapse, and recurrence. Archives of General Psychiatry 48, 851–855.Google Scholar
Fried, EI and Nesse, RM (2014) The impact of individual depressive symptoms on impairment of psychosocial functioning. PLoS ONE 9, e90311.Google Scholar
Gibbons, RD, Hur, K, Brown, CH, Davis, JM and Mann, JJ (2012) Benefits from antidepressants: synthesis of 6-week patient-level outcomes from double-blind placebo-controlled randomized trials of fluoxetine and venlafaxine. Archives of General Psychiatry 69, 572–579.Google Scholar
Greenberg, PE, Fournier, AA, Sisitsky, T, Pike, CT and Kessler, RC (2015) The economic burden of adults with major depressive disorder in the United States (2005 and 2010). Journal of Clinical Psychiatry 76, 155–162.Google Scholar
Hamilton, M (1967) Development of a rating scale for primary depressive illness. British Journal of Clinical Psychology 6, 78–96.Google Scholar
Iovieno, N, van Nieuwenhuizen, A, Clain, A, Baer, L and Nierenberg, AA (2011) Residual symptoms after remission of major depressive disorder with fluoxetine and risk of relapse. Depression and Anxiety 28, 137–144.Google Scholar
Judd, LL, Paulus, MP, Wells, KB and Rapaport, MH (1996) Socioeconomic burden of subsyndromal depressive symptoms and major depression in a sample of the general population. American Journal of Psychiatry 153, 1411–1417.Google Scholar
Kennedy, JC, Dunlop, BW, Craighead, LW, Nemeroff, CB, Mayberg, HS and Craighead, WE (2018) Follow-up of monotherapy remitters in the PReDICT study: maintenance treatment outcomes and clinical predictors of recurrence. Journal of Consulting and Clinical Psychology 86, 189–199.Google Scholar
Laughren, TP (2006) Overview for December 13 Meeting of Psychopharmacologic Drugs Advisory Committee. Available at https://www.fda.gov/ohrms/dockets/ac/06/briefing/2006-4272b1-01-FDA.pdf (Accessed 10 November 2017).Google Scholar
Madhoo, M and Levine, SZ (2015) Initial severity effects on residual symptoms in response and remission. Journal of Clinical Psychopharmacology 35, 450–453.Google Scholar
Manber, R, Rush, AJ, Thase, ME, Amow, B, Klein, D, Trivedi, MH, Korenstein, SG, Markowitz, JC, Dunner, DL, Munsaka, M, Borian, FE and Keller, MB (2003) The effects of psychotherapy, nefazodone, and their combination on subjective assessment of disturbed sleep in chronic depression. Sleep 26, 130–136.Google Scholar
McClintock, SM, Husain, MM, Wisniewski, SR, Nierenberg, AA, Stewart, JW, Trivedi, MH, Cook, I, Morris, D, Warden, D and Rush, AJ (2011) Residual symptoms in depressed outpatients who respond by 50% but do not remit to antidepressant medication. Journal of Clinical Psychopharmacology 31, 180–186.Google Scholar
Montgomery, SA and Åsberg, M (1979) A new depression scale designed to be sensitive to change. British Journal of Psychiatry 134, 382–389.Google Scholar
Müller-Oerlinghausen, B, Müser-Causemann, B and Volk, J (1992) Suicides and parasuicides in a high-risk patient group on and off lithium long-term medication. Journal of Affective Disorders 25, 261–269.Google Scholar
Nierenberg, AA, Keefe, BR, Leslie, VC, Alpert, JE, Pava, JA, Worthington, JJ, Rosenbaum, JF and Fava, M (1999) Residual symptoms in depressed patients who respond acutely to fluoxetine. Journal of Clinical Psychiatry 60, 221–225.Google Scholar
Nierenberg, AA, Husain, MM, Trivedi, MH, Fava, M, Warden, D, Wisniewski, SR, Miyahara, S and Rush, AJ (2010) Residual symptoms after remission of major depressive disorder with citalopram and risk of relapse: a STAR*D report. Psychological Medicine 40, 41–50.Google Scholar
Paykel, ES, Ramana, R, Cooper, Z, Hayhurst, H, Kerr, J and Barocka, A (1995) Residual symptoms after partial remission: an important outcome in depression. Psychological Medicine 25, 1171–1180.Google Scholar
Pratt, LA and Brody, DJ (2014) Depression in the U.S. household population, 2009–2012. NHCS Data Brief 172, 1–8.Google Scholar
Romera, I, Perez, V, Quail, D, Berggren, L, Lenox-Smith, A and Gilaberte, I (2014) Individual residual symptoms and functional impairment in patients with depression. Psychiatry Research 220, 258–262.Google Scholar
Sharma, T, Guski, LS, Freund, N and Gotzsche, PC (2016) Suicidality and aggression during antidepressant treatment: systematic review and meta-analyses based on clinical study reports. The British Medical Journal 352, i65.Google Scholar
Szanto, K, Mulsant, BH, Houck, P, Dew, MA and Reynolds, CF (2003) Occurrence and course of suicidality during short-term treatment of late-life depression. Archives of General Psychiatry 60, 610–617.Google Scholar
Taylor, DJ, Walters, HM, Vittengl, JR, Krebaum, S and Jarrett, RB (2010) Which depressive symptoms remain after response to cognitive therapy of depression and predict relapse and recurrence? Journal of Affective Disorders 123, 181–187.Google Scholar
Trivedi, MH, Rush, AJ, Wisniewski, SR, Nierenberg, AA, Warden, D, Ritz, L, Norquist, G, Howland, RH, Lebowitz, B, McGrath, PJ, Shores-Wilson, K, Biggs, MM, Balasubramani, GK, Fava, M and STAR*D Study Team (2006) Evaluation of outcomes with citalopram for depression using measurement-based care in STAR*D: implications for clinical practice. American Journal of Psychiatry 163, 28–40.Google Scholar
Trivedi, MH, Morris, DW, Wisniewski, SR, Nierenberg, AA, Gaynes, BN, Kurian, BT, Warden, D, Stegman, D, Shores-Wilson, K and Rush, AJ (2013) Clinical and sociodemographic characteristics associated with suicidal ideation in depressed outpatients. The Canadian Journal of Psychiatry 58, 113–122.Google Scholar
Weitz, ES, Hollon, SD, Twisk, J, van Straten, A, Huibers, MJ, David, D, DeRubeis, RJ, Dimidjian, S, Dunlop, BW, Cristea, IA, Faramarzi, M, Hegerl, U, Jarrett, RB, Kheirkhah, F, Kennedy, SH, Mergl, R, Miranda, J, Mohr, DC, Rush, AJ, Segal, ZV, Siddique, J, Simons, AD, Vittengl, JR and Cuijpers, P (2015) Baseline depression severity as moderator of depression outcomes between cognitive behavioral therapy vs pharmacotherapy: an individual patient data meta-analysis. JAMA Psychiatry 72, 1102–1109.Google Scholar
Wightman, DS, Foster, VJ, Krishen, A, Richard, NE and Modell, JG (2010) Meta-analysis of suicidality in placebo-controlled clinical trials of adults taking bupropion. Primary Care Companion to The Journal of Clinical Psychiatry 12, pii: PCC.09m00894.Google Scholar
Wilkinson, ST, Ballard, ED, Bloch, MH, Mathew, SJ, Murrough, JW, Feder, A, Sos, P, Wang, G, Zarate, CA and Sanacora, G (2018) The effect of a single dose of intravenous ketamine on suicidal ideation: a systematic review and individual participant data meta-analysis. American Journal of Psychiatry 175, 150–158.Google Scholar
Williams, JB and Kobak, KA (2008) Development and reliability of a structured interview guide for the Montgomery Asberg Depression Rating Scale (SIGMA). British Journal of Psychiatry 192, 52–58.Google Scholar
Yang, H, Chuzi, S, Sinicropi-Yao, L, Johnson, D, Chen, Y, Clain, A, Baer, L, McGrath, PJ, Stewart, JW, Fava, M and Papakostas, GI (2010) Type of residual symptom and risk of relapse during the continuation/maintenance phase treatment of major depressive disorder with the selective serotonin reuptake inhibitor fluoxetine. European Archives of Psychiatry and Clinical Neuroscience 260, 145–150.Google Scholar
Supplementary material: File

Dunlop et al. supplementary material

Dunlop et al. supplementary material 1

Download Dunlop et al. supplementary material(File)
File 14.3 KB