Predictive Patterns of Early Symptom Change in the Treatment of Depression Open Access

Yoo, Daniel Jaesup (2015)

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Major Depressive Disorder is a costly and recurrent illness affecting about 17% of adults in the United States throughout their lifetimes. In order to achieve the ambition of treatment tailored to an individual's needs, a better characterization of the process of symptom change is needed. Extant studies treat changes to a multi-dimensional construct in a unidimensional manner. The present study, therefore, uses two-level exploratory factor analysis to characterize four symptom change factors (SCF) in 338 treatment naïve patients with Major Depressive Disorder randomized to 12 weeks of treatment with either cognitive behavior therapy (CBT) or an antidepressant medication, escitalopram and duloxetine. A primary SCF capturing change in emotional and cognitive depressive symptoms and a secondary SCF capturing change in insomnia symptoms were differentially predictive of end-of-treatment outcomes at different times. In both the CBT and escitalopram groups, early improvements in insomnia symptoms predicted better end-of-treatment outcomes, however early improvements in insomnia were not a predictor of outcomes in the duloxetine group. In the CBT group, the predictive relationship was fully mediated by middle improvements in emotional and cognitive depressive symptoms. Specific early patterns of symptom change are differentially predictive of outcomes during treatment with CBT, escitalopram, and duloxetine. Further examinations of the temporal dynamics and structure of symptom change during the treatment of MDD are warranted.

Table of Contents

Introduction 1
Method 8
Study Overview 8
Participants 8
Randomization and Treatments 11
Symptom Measures 13
Outcome Measures 14
Data Analysis Overview 15
STEP 1: Modeling Structure of Symptom Change 15
STEP 2: Treatment Outcome Prediction 19
Results 20
Two-Level Exploratory Analysis 20
Treatment Outcome Prediction 23
Discussion 26
References 35
Appendix A 59

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