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Honoring patient preferences improves treatment adherence

Treatment-naïve individuals with depression who received their preferred treatment method were more likely to complete a randomized trial but not more likely to reach remission.

“Current guidelines recommend that most patients should initially be treated with either an antidepressant medication or an evidence-based psychotherapy, based on the roughly equivalent efficacy, on average, of psychotherapy and medication treatments for major depression. This average equivalency, however, masks the substantial variability in outcomes that exists across patients,” Boadie W. Dunlop, MD, of Emory University School of Medicine, and colleagues wrote. “There is great need to develop methods for identifying the best treatment for a particular individual depressed patient.”

To assess moderating effects of patient treatment preferences on outcomes, researchers conducted a randomized study of CBT and two antidepressants, escitalopram and duloxetine, among 344 individuals with treatment-naïve major depression. Study participants were randomly assigned to receive 12 weeks of escitalopram (10 mg or 20 mg/day), duloxetine (30 mg to 60 mg/day) or CBT (16 50-minute sessions). Prior to randomization, participants indicated whether they preferred medication, CBT or had no preference.

Participants had a mean Hamilton Depression Rating Scale (HAM-D) score of 19.8 at baseline.

Mean estimated overall decreases in HAM-D scores and remission rates did not significantly differ between treatments.

Participants who received their preferred treatment were more likely to complete the trial but not more likely to achieve remission.

“There are two important implications of our results that can inform treatment guidelines. First, guideline recommendations that psychotherapy or antidepressant medications are equally appropriate for the initial treatment of major depression can be extended to treatment-naive patients,” the researchers wrote. “Second, because ethnic minorities comprised more than one-half of our study’s population, these treatment recommendations can be extended with confidence beyond the white non-Hispanic population, who comprised the majority of all prior randomized treatment studies comparing pharmacotherapy with psychotherapy.” – by Amanda Oldt

Disclosure: Dunlop reports receiving research support from Assurex, Bristol-Myers Squibb, Forest, Janssen, GlaxoSmithKline, NIMH, Otsuka, Pfizer, and Takeda; and serving as a consultant to Pfizer and Medavante. Please see the study for a full list of relevant financial disclosures.