Prediction of Response to Medication and Cognitive Therapy in the Treatment of Moderate to Severe Depression.
Open accessAbstract
A recent randomized controlled trial found nearly equivalent response rates for antidepressant medications and cognitive therapy in a sample of moderate to severely depressed outpatients. In this article, the authors seek to identify the variables that were associated with response across both treatments as well as variables that predicted superior response in one treatment over the other. The sample consisted of 180 depressed outpatients: 60 of whom were randomly assigned to cognitive therapy; 120 were assigned to antidepressant medications. Treatment was provided for 16 weeks. Chronic depression, older age, and lower intelligence each predicted relatively poor response across both treatments. Three prescriptive variables-marriage, unemployment, and having experienced a greater number of recent life events-were identified, and each predicted superior response to cognitive therapy relative to antidepressant medications. Thus, 6 markers of treatment outcome were identified, each of which might be expected to carry considerable clinical utility. The 3 prognostic variables identify subgroups that might benefit from alternative treatment strategies; the 3 prescriptive variables identify groups who appear to respond particularly well to cognitive therapy.
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Adults with resistant depressive disorders may display traits of overcontrol, such as heightened self-criticism, diminished autonomy, rigid internalized expectations, heightened control over spontaneous emotions, and a fear of making mistakes.
“Adults with resistant depressive disorders may display traits of overcontrol, such as heightened self-criticism, diminished autonomy, rigid internalized expectations, heightened control over spontaneous emotions, and a fear of making mistakes [28–30].”
From Dialectical Behavior Therapy as an intervention for Treatment Resistant Depression in adults: A protocol for systematic review and meta-analysis (2024) · cites this paper as [29]
The Methods > Potential Predictors section (page unavailable) includes perfectionism, need for approval, and self-esteem among variables assessed in depressed outpatients, which overlaps with the claimed traits. It does not establish that adults with treatment-resistant depression display the listed pattern of overcontrol, including reduced autonomy, emotional restraint, or fear of mistakes. The Methods > Participants section (page unavailable) describes a moderate-to-severe depression sample, not a treatment-resistant sample. (LLM, conf=0.78)
Experimental — accuracy not yet measuredThese maladaptive responses can prolong depressive symptoms.
“These maladaptive responses can prolong depressive symptoms [29,30].”
From Dialectical Behavior Therapy as an intervention for Treatment Resistant Depression in adults: A protocol for systematic review and meta-analysis (2024) · cites this paper as [29]
The Methods section lists cognitive variables such as attributional style and perfectionism, but does not say that maladaptive responses prolong depression. The Discussion reports that patients with chronic depression had less symptom relief during treatment, without attributing that persistence to maladaptive responses. Searches for maladaptive coping, rumination, and symptom persistence found no passage making the claimed link. (LLM, conf=0.74)
Experimental — accuracy not yet measured
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“[27] was followed where predictor domains (socio-demographic variables, clinical variables, family history and treatment factors) were first examined separately.”
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“Such indices could be used for treatment selection if they predicted differential response to different interventions (moderation) (Fournier et al., 2009).”
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- Authors
- Fournier, J. C., DeRubeis, R. J., Shelton, R. C., Hollon, S. D., Amsterdam, J. D., & Gallop, R.
- Affiliations
- University of Pennsylvania (US)
- Vanderbilt University Medical Center (US)
- Vanderbilt University (US)
- West Chester University (US)
- Venue
- Journal of Consulting and Clinical Psychology
- Published
- 2009
- Volume
- 77
- Issue
- 4
- Pages
- 775-787
- ISSN
- 0022-006X (ISSN-L)
- 1939-2117
- PMC
- PMC2810269
- OpenAlex
- W2085575985
- Cited by
- 340
- References
- 68
- Citations by year
- 2026: 14 · 2025: 7 · 2024: 13 · 2023: 16 · 2022: 21 · 2021: 43 · 2020: 17 · 2019: 29 · 2018: 20 · 2017: 19 · 2016: 23 · 2015: 27 · 2014: 22 · 2013: 20 · 2012: 16
- FWCI
- 16.95
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Consulting and Clinical Psychology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health (MH55877 (R10); MH55875 (R10); MH01697 (K02); MH01741 (K24))
- Topics
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- depression, antidepressants, cognitive therapy, treatment response prediction, prognostic factors, chronic depression, old age, intelligence, marital status, unemployment, life events, outpatients, treatment selection
- MeSH terms
- Adult, Antidepressive Agents, Chronic Disease, Combined Modality Therapy, Major Depressive Disorder, Female, Humans, Male, Middle Aged, Personality Inventory, Prognosis, Recurrence, Cognitive Behavioral Therapy, Randomized Controlled Trials as Topic, Age of Onset, Dysthymic Disorder
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