TY - JOUR
T1 - Cognitive therapy for anxious depression in STARD
T2 - What have we learned?
AU - Farabaugh, Amy
AU - Alpert, Jonathan
AU - Wisniewski, Stephen R.
AU - Otto, Michael W.
AU - Fava, Maurizio
AU - Baer, Lee
AU - Perlis, Roy
AU - Friedman, Ed
AU - Nyer, Maren
AU - Bitran, Stella
AU - Balasubramani, G. K.
AU - Inamori, Aya
AU - Trivedi, Madhukar
AU - Thase, Michael E.
N1 - Funding Information:
The Sequenced Treatment Alternatives to Relieve Depression (STAR ⁎ D) study was supported by the NIMH through the N01 MH-90003 contract.
PY - 2012/12/15
Y1 - 2012/12/15
N2 - Background: Anxious depression, defined as MDD with high levels of anxiety symptoms, has been associated with lower rates of antidepressant response and remission as well as greater chronicity, suicidality and antidepressant side-effect burden. The primary aim of this study was to assess the effectiveness of cognitive therapy (CT) alone or in combination with medications for anxious versus non-anxious depression. Methods: We assessed the STARD study participants who were partial or non-responders to citalopram. Subjects were then either switched (n=696) to a new antidepressant or to CT alone, or they were kept on citalopram and augmented (n=577) with another antidepressant or CT. We compared response and remission rates, across treatment conditions, between those who met criteria for anxious depression and those who did not. Results: Those with anxious depression had significantly lower remission rates based on the QIDS, whether assigned to switch or augmentation, compared to those with non-anxious depression. Those with anxious depression, compared to those without, had significantly lower response rates based on the QIDS only in the switch group. There was no significant interaction between anxious depression and treatment assignment. Limitations: Limitations include the use of citalopram as the only Level 1 pharmacotherapy and medication augmentation option, the relatively small size of the CT arms, use of depression-focused CT rather than anxiety-focused CT, and focus on acute treatment outcomes. Conclusions: Individuals with anxious depression appear to experience higher risk of poorer outcome following pharmacotherapy and/or CT after an initial course of citalopram and continued efforts to target this challenging form of depression are needed.
AB - Background: Anxious depression, defined as MDD with high levels of anxiety symptoms, has been associated with lower rates of antidepressant response and remission as well as greater chronicity, suicidality and antidepressant side-effect burden. The primary aim of this study was to assess the effectiveness of cognitive therapy (CT) alone or in combination with medications for anxious versus non-anxious depression. Methods: We assessed the STARD study participants who were partial or non-responders to citalopram. Subjects were then either switched (n=696) to a new antidepressant or to CT alone, or they were kept on citalopram and augmented (n=577) with another antidepressant or CT. We compared response and remission rates, across treatment conditions, between those who met criteria for anxious depression and those who did not. Results: Those with anxious depression had significantly lower remission rates based on the QIDS, whether assigned to switch or augmentation, compared to those with non-anxious depression. Those with anxious depression, compared to those without, had significantly lower response rates based on the QIDS only in the switch group. There was no significant interaction between anxious depression and treatment assignment. Limitations: Limitations include the use of citalopram as the only Level 1 pharmacotherapy and medication augmentation option, the relatively small size of the CT arms, use of depression-focused CT rather than anxiety-focused CT, and focus on acute treatment outcomes. Conclusions: Individuals with anxious depression appear to experience higher risk of poorer outcome following pharmacotherapy and/or CT after an initial course of citalopram and continued efforts to target this challenging form of depression are needed.
KW - Anxious depression
KW - CT
KW - MDD
KW - Psychosocial interventions
KW - STARD
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U2 - 10.1016/j.jad.2012.04.029
DO - 10.1016/j.jad.2012.04.029
M3 - Article
C2 - 22877961
AN - SCOPUS:84868130475
SN - 0165-0327
VL - 142
SP - 213
EP - 218
JO - Journal of Affective Disorders
JF - Journal of Affective Disorders
IS - 1-3
ER -