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Suicidal ideation and other persisting symptoms after CBT or antidepressant medication treatment for major depressive disorder

Published online by Cambridge University Press:  12 September 2018

Boadie W. Dunlop ,
Philip E. Polychroniou ,
Jeffrey J. Rakofsky ,
Charles B. Nemeroff ,
W. Edward Craighead  and
Helen S. Mayberg
Boadie W. Dunlop*
Affiliation:
Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
Philip E. Polychroniou
Affiliation:
Emory University School of Medicine, Atlanta, GA, USA
Jeffrey J. Rakofsky
Affiliation:
Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
Charles B. Nemeroff
Affiliation:
Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
W. Edward Craighead
Affiliation:
Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA Department of Psychology, Emory University, Atlanta, GA, USA
Helen S. Mayberg
Affiliation:
Department of Psychiatry, Mount Sinai School of Medicine, New York, NY, USA
*
Author for correspondence: Boadie W. Dunlop, E-mail: bdunlop@emory.edu
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Abstract

Background

Persisting symptoms after treatment for major depressive disorder (MDD) contribute to ongoing impairment and relapse risk. Whether cognitive behavior therapy (CBT) or antidepressant medications result in different profiles of residual symptoms after treatment is largely unknown.

Methods

Three hundred fifteen adults with MDD randomized to treatment with either CBT or antidepressant medication in the Predictors of Remission in Depression to Individual and Combined Treatments (PReDICT) study were analyzed for the frequency of residual symptoms using the Montgomery Asberg Depression Rating Scale (MADRS) item scores at the end of the 12-week treatment period. Separate comparisons were made for treatment responders and non-responders.

Results

Among treatment completers (n = 250) who responded to CBT or antidepressant medication, there were no significant differences in the persistence of residual MADRS symptoms. However, non-responders treated with medication were significantly less likely to endorse suicidal ideation (SI) at week 12 compared with those treated with CBT (non-responders to medication: 0/54, 0%, non-responders to CBT: 8/30, 26.7%; p = .001). Among patients who terminated the trial early (n = 65), residual MADRS item scores did not significantly differ between the CBT- and medication-treated groups.

Conclusions

Depressed adults who respond to CBT or antidepressant medication have similar residual symptom profiles. Antidepressant medications reduce SI, even among patients for whom the medication provides little overall benefit.

Keywords

Cognitive therapyduloxetineescitaloprampredictionSSRI
Type
Original Articles
Information
Psychological Medicine , Volume 49 , Issue 11 , August 2019 , pp. 1869 - 1878
Copyright
Copyright © Cambridge University Press 2018 

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Footnotes

*

These authors contributed equally to the manuscript.

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