Psychotherapy or medication for depression? Using individual symptom meta-analyses to derive a Symptom-Oriented Therapy (SOrT) metric for a personalised psychiatry.

BACKGROUND: Antidepressant medication (ADM) and psychotherapy are effective treatments for major depressive disorder (MDD). It is unclear, however, if treatments differ in their effectiveness at the symptom level and whether symptom information can be utilised to inform treatment allocation. The present study synthesises comparative effectiveness information from randomised controlled trials (RCTs) of ADM versus psychotherapy for MDD at the symptom level and develops and tests the Symptom-Oriented Therapy (SOrT) metric for precision treatment allocation. METHODS: First, we conducted systematic review and meta-analyses of RCTs comparing ADM and psychotherapy at the individual symptom level. We searched PubMed Medline, PsycINFO, and the Cochrane Central Register of Controlled Trials databases, a database specific for psychotherapy RCTs, and looked for unpublished RCTs. Random-effects meta-analyses were applied on sum-scores and for individual symptoms for the Hamilton Rating Scale for Depression (HAM-D) and Beck Depression Inventory (BDI) measures. Second, we computed the SOrT metric, which combines meta-analytic effect sizes with patients' symptom profiles. The SOrT metric was evaluated using data from the Munich Antidepressant Response Signature (MARS) study (n = 407) and the Emory Predictors of Remission in Depression to Individual and Combined Treatments (PReDICT) study (n = 234). RESULTS: The systematic review identified 38 RCTs for qualitative inclusion, 27 and 19 for quantitative inclusion at the sum-score level, and 9 and 4 for quantitative inclusion on individual symptom level for the HAM-D and BDI, respectively. Neither meta-analytic strategy revealed significant differences in the effectiveness of ADM and psychotherapy across the two depression measures. The SOrT metric did not show meaningful associations with other clinical variables in the MARS sample, and there was no indication of utility of the metric for better treatment allocation from PReDICT data. CONCLUSIONS: This registered report showed no differences of ADM and psychotherapy for the treatment of MDD at sum-score and symptom levels. Symptom-based metrics such as the proposed SOrT metric do not inform allocation to these treatments, but predictive value of symptom information requires further testing for other treatment comparisons.

Predictors of response in the treatment of moderate depression

Objective: To identify neurocognitive and sociodemographic variables that could be associated with clinical response to three modalities of treatment for depression, as well as variables that predicted superior response to one treatment over the others. Method: The present study derives from a research project in which depressed patients (n=272) received one of three treatments – long-term psychodynamic psychotherapy (n=90), fluoxetine therapy (n=91), or a combination thereof (n=91) – over a 24-month period. Results: Sociodemographic variables were not found to be predictive. Six predictive neurocognitive variables were identified: three prognostic variables related to working memory and abstract reasoning; one prescriptive variable related to working memory; and two variables found to be moderators. Conclusions: The results of this study indicate subgroups of patients who might benefit from specific therapeutic strategies and subgroups that seem to respond well to long-term psychodynamic psychotherapy and combined therapy. The moderators found suggest that abstract reasoning and processing speed may influence the magnitude and/or direction of clinical improvement.

Predictors of response in the treatment of moderate depression.

OBJECTIVE:: To identify neurocognitive and sociodemographic variables that could be associated with clinical response to three modalities of treatment for depression, as well as variables that predicted superior response to one treatment over the others. METHOD:: The present study derives from a research project in which depressed patients (n=272) received one of three treatments - long-term psychodynamic psychotherapy (n=90), fluoxetine therapy (n=91), or a combination thereof (n=91) - over a 24-month period. RESULTS:: Sociodemographic variables were not found to be predictive. Six predictive neurocognitive variables were identified: three prognostic variables related to working memory and abstract reasoning; one prescriptive variable related to working memory; and two variables found to be moderators. CONCLUSIONS:: The results of this study indicate subgroups of patients who might benefit from specific therapeutic strategies and subgroups that seem to respond well to long-term psychodynamic psychotherapy and combined therapy. The moderators found suggest that abstract reasoning and processing speed may influence the magnitude and/or direction of clinical improvement.

Vulnerabilidade social:: o psicodiagnóstico como m étodo de mapeamento de doenças mentais / Social vulnerability:: psychological assesment as a mapping method of mental diseases / Vulnerabilidad social:: el psico-diagnóstico como método de mapeo de dolencias mentales

O presente estudo demonstra a experiência de trabalho em um Centro de Referência de Assistência Social do interior do Rio Grande do Sul. Foi realizado um mapeamento de doenças mentais na população em vulnerabilidade social, através do processo de psicodiagnóstico, em caráter de estudo-piloto. Foram escolhidos três sujeitos como amostragem: uma mulher, uma adolescente e um menino. Foram analisados os fatores psicossociais, e os resultados revelaram que essa população está mais sujeita ao desenvolvimento de psicopatologias. O estudo demonstrou que a inserção do psicodiagnóstico pode contribuir como instrumento de diagnóstico da população. É necessário que haja interesse por parte das políticas públicas em ofertar os serviços de saúde à população para trabalhar com os fatores de risco socioemocionais de maneira satisfatória....(AU)

This study demonstrates the experience of working in a Reference Center of Social Welfare of the state of Rio Grande do Sul. A mapping of the mental illnesses of the population in social vulnerability was carried out, through the process of psychological diagnosis, as a pilot study. Three subjects were chosen as sample: a woman, a female teenager and a boy. The social and psychological factors were analyzed. The pilot study showed that the inclusion of psychological diagnosis can contribute as an important diagnostic tool of the population. However, it is necessary that public policy offers the proper health services to the population as a strategy to the work with risk factors....(AU)

El presente estudio demuestra la experiencia de trabajo en un Centro de Referencia de Asistencia Social del interior de Rio Grande do Sul. Fue realizado un mapeo de dolencias mentales en la población en vulnerabilidad social, a través del proceso de psico-diagnóstico, en carácter de estudio-piloto. Fueron escogidos tres sujetos como muestreo: una mujer, una adolescente y un niño. Fueron analizados los factores psicosociales, y los resultados revelaron que esa población está más sujeta al desarrollo de psicopatologías. El estudio demostró que la inserción del psico-diagnóstico pode contribuir como instrumento de diagnóstico de la población. Es necesario que haya interés por parte de las políticas públicas en ofertar los servicios de salud a la población para trabajar con los factores de riesgo socioemocionales de manera satisfactoria....(AU)

Vulnerabilidade social: o psicodiagnóstico como método de mapeamento de doenças mentais / Social vulnerability: psychological assesment as a mapping method of mental diseases / Vulnerabilidad social: el psico-diagnóstico como método de mapeo de dolencias mentales

O presente estudo demonstra a experiência de trabalho em um Centro de Referência de Assistência Social do interior do Rio Grande do Sul. Foi realizado um mapeamento de doenças mentais na população em vulnerabilidade social, através do processo de psicodiagnóstico, em caráter de estudo-piloto. Foram escolhidos três sujeitos como amostragem: uma mulher, uma adolescente e um menino. Foram analisados os fatores psicossociais, e os resultados revelaram que essa população está mais sujeita ao desenvolvimento de psicopatologias. O estudo demonstrou que a inserção do psicodiagnóstico pode contribuir como instrumento de diagnóstico da população. É necessário que haja interesse por parte das políticas públicas em ofertar os serviços de saúde à população para trabalhar com os fatores de risco socioemocionais de maneira satisfatória.(AU)

This study demonstrates the experience of working in a Reference Center of Social Welfare of the state of Rio Grande do Sul. A mapping of the mental illnesses of the population in social vulnerability was carried out, through the process of psychological diagnosis, as a pilot study. Three subjects were chosen as sample: a woman, a female teenager and a boy. The social and psychological factors were analyzed. The pilot study showed that the inclusion of psychological diagnosis can contribute as an important diagnostic tool of the population. However, it is necessary that public policy offers the proper health services to the population as a strategy to the work with risk factors.(AU)

El presente estudio demuestra la experiencia de trabajo en un Centro de Referencia de Asistencia Social del interior de Rio Grande do Sul. Fue realizado un mapeo de dolencias mentales en la población en vulnerabilidad social, a través del proceso de psico-diagnóstico, en carácter de estudio-piloto. Fueron escogidos tres sujetos como muestreo: una mujer, una adolescente y un niño. Fueron analizados los factores psicosociales, y los resultados revelaron que esa población está más sujeta al desarrollo de psicopatologías. El estudio demostró que la inserción del psico-diagnóstico pode contribuir como instrumento de diagnóstico de la población. Es necesario que haya interés por parte de las políticas públicas en ofertar los servicios de salud a la población para trabajar con los factores de riesgo socioemocionales de manera satisfactoria.(AU)

Vulnerabilidade social:: o psicodiagnóstico como m étodo de mapeamento de doenças mentais / Social vulnerability:: psychological assesment as a mapping method of mental diseases / Vulnerabilidad social:: el psico-diagnóstico como método de mapeo de dolencias mentales

O presente estudo demonstra a experiência de trabalho em um Centro de Referência de Assistência Social do interior do Rio Grande do Sul. Foi realizado um mapeamento de doenças mentais na população em vulnerabilidade social, através do processo de psicodiagnóstico, em caráter de estudo-piloto. Foram escolhidos três sujeitos como amostragem: uma mulher, uma adolescente e um menino. Foram analisados os fatores psicossociais, e os resultados revelaram que essa população está mais sujeita ao desenvolvimento de psicopatologias. O estudo demonstrou que a inserção do psicodiagnóstico pode contribuir como instrumento de diagnóstico da população. É necessário que haja interesse por parte das políticas públicas em ofertar os serviços de saúde à população para trabalhar com os fatores de risco socioemocionais de maneira satisfatória.(AU)

This study demonstrates the experience of working in a Reference Center of Social Welfare of the state of Rio Grande do Sul. A mapping of the mental illnesses of the population in social vulnerability was carried out, through the process of psychological diagnosis, as a pilot study. Three subjects were chosen as sample: a woman, a female teenager and a boy. The social and psychological factors were analyzed. The pilot study showed that the inclusion of psychological diagnosis can contribute as an important diagnostic tool of the population. However, it is necessary that public policy offers the proper health services to the population as a strategy to the work with risk factors.(AU)

El presente estudio demuestra la experiencia de trabajo en un Centro de Referencia de Asistencia Social del interior de Rio Grande do Sul. Fue realizado un mapeo de dolencias mentales en la población en vulnerabilidad social, a través del proceso de psico-diagnóstico, en carácter de estudio-piloto. Fueron escogidos tres sujetos como muestreo: una mujer, una adolescente y un niño. Fueron analizados los factores psicosociales, y los resultados revelaron que esa población está más sujeta al desarrollo de psicopatologías. El estudio demostró que la inserción del psico-diagnóstico pode contribuir como instrumento de diagnóstico de la población. Es necesario que haya interés por parte de las políticas públicas en ofertar los servicios de salud a la población para trabajar con los factores de riesgo socioemocionales de manera satisfactoria.(AU)