Differential effects of treatments for chronic depression: a latent growth model
reanalysis.
Author(s): Stulz N, Thase ME, Klein DN, Manber R, Crits-Christoph P.
Affiliation(s): Department of Psychiatry, University of Pennsylvania Philadelphia, PA 19104, USA.
niklaus.stulz@gmail.com
Publication date & source: 2010, J Consult Clin Psychol. , 78(3):409-19
OBJECTIVE: Psychotherapy-pharmacotherapy combinations are frequently recommended
for the treatment of chronic depressive disorders. Our aim in this novel
reanalysis of archival data was to identify patient subgroups on the basis of
symptom trajectories and examine the clinical significance of the resultant
classification on basis of differential treatment effects to psychotherapy
(cognitive behavioral analysis system of psychotherapy), pharmacotherapy
(nefazodone), and their combination.
METHOD: We selected data for 504 patients diagnosed with chronic depression from
archival data of a clinical trial (N = 681) and analyzed treatment courses (as
assessed by the Hamilton Rating Scale for Depression) using growth mixture
models, a contemporary exploratory analysis technique.
RESULTS: Three patient subgroups were identified from the typical patterns of
change of depression severity during 12-week acute-phase treatment. Within these
patient subgroups, differential treatment effects were evident: combination
treatment clearly outperformed the 2 monotherapies in the largest patient
subgroup, characterized by moderate depression severity, but not in the remaining
2 subgroups, characterized by low and severe depression at baseline. Patient
characteristics prior to initiation of treatment enabled allocation of 61% of
patients to these subgroups.
CONCLUSIONS: Research on patient subgroups with different change patterns may
support classifications of patients that indicate which treatment is most
effective for which type of patient.
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