Follow-up of Monotherapy Remitters in the PReDICT Study: Maintenance Treatment Outcomes and Clinical Predictors of Relapse and Recurrence Open Access

Abstract

This study followed remitted patients from a randomized controlled trial of adults with Major Depression. The aims were to describe rates of relapse and recurrence and to evaluate three clinical predictor domains. Ninety-four treatment naïve patients (50% female; Mage = 38.1; 48.9% Caucasian) with Major Depression who had remitted to 12-week monotherapy (escitalopram, duloxetine, or cognitive-behavior therapy (CBT)) participated in a 21-month maintenance phase (i.e., continued medication or up to 3 CBT booster sessions per year). Relapse and recurrence were operationalized as the single construct of relapse/recurrence and were assessed quarterly. The clinical predictors were: two measures of residual depressive symptoms, one measure of prior depressive episodes, and two measures of baseline anxiety. Standard survival analysis methods were used for the analyses. An estimated 15.5% of patients suffered a relapse/recurrence, and the survival distributions did not statistically differ across treatment conditions. Residual depressive symptoms on the Hamilton Rating Scale for Depression were associated with increased risk in relapse/recurrence (Hazard Ratio = 1.31, 95% CI [1.02., 1.67], Wald X² = 4.41, p = .036), as was a comorbid anxiety disorder diagnosis at study baseline (Hazard Ratio = .31, 95% CI [.10, .94], Wald X² = 4.28, p = .039). Both variables were marginally significant in a multivariate model, and none of the other clinical measures were statistically significant in any of the analyses. The current study supports the benefits of maintenance treatment for most treatment naïve patients who remit to initial monotherapy. However, patients with residual depressive symptoms after initial treatment or a comorbid anxiety disorder diagnosis at the beginning of treatment are at risk for poorer long-term outcomes despite achieving remission.

Table of Contents

Introduction………………………………………………………………………………………. 1

Method……………………………………………………………………………………………... 6

Results………………………………………………………………………………………….... 11

Discussion……………………………………………………………………………………….. 17

References………………………………………………………………………………………. 25

Tables……………………………………………………………………………………………... 37

Figures………………………………………………………………………………………….... 39

About this Master's Thesis

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School	Laney Graduate School
Department	Psychology
Degree	MA
Submission	Master's Thesis
Language	English
Research Field	Psychology, Clinical Psychology, General
Keyword	Recurrence Antidepressant Medication Cognitive Behavior Therapy Major Depression Relapse
Committee Chair / Thesis Advisor	Craighead, W Edward, Emory University
Committee Members	Rodman, Hillary R, Emory University Craighead, Linda, Emory University

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