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Latent classes of nonresponders, rapid responders, and gradual responders in depressed outpatients receiving antidepressant medication and psychotherapy

(2015) DEPRESSION AND ANXIETY. 32(3). p.213-220
Author
Organization
Abstract
BackgroundWe used growth mixture modeling (GMM) to identify subsets of patients with qualitatively distinct symptom trajectories resulting from treatment. Existing studies have focused on 12-week antidepressant trials. We used data from a concurrent antidepressant and psychotherapy trial over a 6-month period. MethodEight hundred twenty-one patients were randomized to receive either fluoxetine or tianepine and received cognitive-behavioral therapy, supportive therapy, or psychodynamic therapy. Patients completed the Montgomery-angstrom sberg depression rating scale (MADRS) at the 0, 1, 3, and 6-month periods. Patients also completed measures of dysfunctional attitudes, functioning, and personality. GMM was conducted using MADRS scores and the number of growth classes to be retained was based on the Bayesian information criterion. ResultsCriteria supported the presence of four distinct latent growth classes representing gradual responders of high severity (42% of sample), gradual responders of moderate severity (31%), nonresponders (15%), and rapid responders (11%). Initial severity, greater use of emotional coping strategies, less use of avoidance coping strategies, introversion, and less emotional stability predicted nonresponder status. Growth classes were not associated with different treatments or with proportion of dropouts. ConclusionsThe longer time period used in this study highlights potential overestimates of nonresponders in previous research and the need for continued assessments. Our findings demonstrate distinct growth trajectories that are independent of treatment modality and generalizable to most psychotherapy patients. The correlates of class membership provide directions for future studies, which can refine methods to predict likely nonresponders as a means to facilitate personalized treatments.
Keywords
MONTGOMERY-ASBERG DEPRESSION, STAR-ASTERISK-D, RATING-SCALE, SEVERITY, PHARMACOTHERAPY, TRAJECTORIES, METAANALYSIS, DEFINITION, depression, psychotherapy, antidepressive agents, treatment outcomes, controlled clinical trial, CLINICAL-PRACTICE, COGNITIVE THERAPY

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MLA
Thibodeau, Michel et al. “Latent Classes of Nonresponders, Rapid Responders, and Gradual Responders in Depressed Outpatients Receiving Antidepressant Medication and Psychotherapy.” DEPRESSION AND ANXIETY 32.3 (2015): 213–220. Print.
APA
Thibodeau, M., Quilty, L., De Fruyt, F., De Bolle, M., Rouillon, F., & Bagby, M. (2015). Latent classes of nonresponders, rapid responders, and gradual responders in depressed outpatients receiving antidepressant medication and psychotherapy. DEPRESSION AND ANXIETY, 32(3), 213–220.
Chicago author-date
Thibodeau, Michel, Lena Quilty, Filip De Fruyt, Marleen De Bolle, Frederic Rouillon, and Michael Bagby. 2015. “Latent Classes of Nonresponders, Rapid Responders, and Gradual Responders in Depressed Outpatients Receiving Antidepressant Medication and Psychotherapy.” Depression and Anxiety 32 (3): 213–220.
Chicago author-date (all authors)
Thibodeau, Michel, Lena Quilty, Filip De Fruyt, Marleen De Bolle, Frederic Rouillon, and Michael Bagby. 2015. “Latent Classes of Nonresponders, Rapid Responders, and Gradual Responders in Depressed Outpatients Receiving Antidepressant Medication and Psychotherapy.” Depression and Anxiety 32 (3): 213–220.
Vancouver
1.
Thibodeau M, Quilty L, De Fruyt F, De Bolle M, Rouillon F, Bagby M. Latent classes of nonresponders, rapid responders, and gradual responders in depressed outpatients receiving antidepressant medication and psychotherapy. DEPRESSION AND ANXIETY. 2015;32(3):213–20.
IEEE
[1]
M. Thibodeau, L. Quilty, F. De Fruyt, M. De Bolle, F. Rouillon, and M. Bagby, “Latent classes of nonresponders, rapid responders, and gradual responders in depressed outpatients receiving antidepressant medication and psychotherapy,” DEPRESSION AND ANXIETY, vol. 32, no. 3, pp. 213–220, 2015.
@article{5817498,
  abstract     = {BackgroundWe used growth mixture modeling (GMM) to identify subsets of patients with qualitatively distinct symptom trajectories resulting from treatment. Existing studies have focused on 12-week antidepressant trials. We used data from a concurrent antidepressant and psychotherapy trial over a 6-month period.
 
MethodEight hundred twenty-one patients were randomized to receive either fluoxetine or tianepine and received cognitive-behavioral therapy, supportive therapy, or psychodynamic therapy. Patients completed the Montgomery-angstrom sberg depression rating scale (MADRS) at the 0, 1, 3, and 6-month periods. Patients also completed measures of dysfunctional attitudes, functioning, and personality. GMM was conducted using MADRS scores and the number of growth classes to be retained was based on the Bayesian information criterion.
 
ResultsCriteria supported the presence of four distinct latent growth classes representing gradual responders of high severity (42% of sample), gradual responders of moderate severity (31%), nonresponders (15%), and rapid responders (11%). Initial severity, greater use of emotional coping strategies, less use of avoidance coping strategies, introversion, and less emotional stability predicted nonresponder status. Growth classes were not associated with different treatments or with proportion of dropouts.
 
ConclusionsThe longer time period used in this study highlights potential overestimates of nonresponders in previous research and the need for continued assessments. Our findings demonstrate distinct growth trajectories that are independent of treatment modality and generalizable to most psychotherapy patients. The correlates of class membership provide directions for future studies, which can refine methods to predict likely nonresponders as a means to facilitate personalized treatments.},
  author       = {Thibodeau, Michel and Quilty, Lena and De Fruyt, Filip and De Bolle, Marleen and Rouillon, Frederic and Bagby, Michael},
  issn         = {1091-4269},
  journal      = {DEPRESSION AND ANXIETY},
  keywords     = {MONTGOMERY-ASBERG DEPRESSION,STAR-ASTERISK-D,RATING-SCALE,SEVERITY,PHARMACOTHERAPY,TRAJECTORIES,METAANALYSIS,DEFINITION,depression,psychotherapy,antidepressive agents,treatment outcomes,controlled clinical trial,CLINICAL-PRACTICE,COGNITIVE THERAPY},
  language     = {eng},
  number       = {3},
  pages        = {213--220},
  title        = {Latent classes of nonresponders, rapid responders, and gradual responders in depressed outpatients receiving antidepressant medication and psychotherapy},
  url          = {http://dx.doi.org/10.1002/da.22293},
  volume       = {32},
  year         = {2015},
}

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