OBJECTIVE: The authors investigated patient characteristics predictive
of treatment response in the National Institute of Mental Health (NIMH)
Treatment of Depression Collaborative Research Program. METHOD: Two hundred
thirty-nine outpatients with major depressive disorder according to the
Research Diagnostic Criteria entered a 16-week multicenter clinical trial
and were randomly assigned to interpersonal psychotherapy,
cognitive-behavior therapy, imipramine with clinical management, or placebo
with clinical management. Pretreatment sociodemographic features,
diagnosis, course of illness, function, personality, and symptoms were
studied to identify patient predictors of depression severity (measured
with the Hamilton Rating Scale for Depression) and complete response
(measured with the Hamilton scale and the Beck Depression Inventory).
RESULTS: One hundred sixty-two patients completed the entire 16-week trial.
Six patient characteristics, in addition to depression severity previously
reported, predicted outcome across all treatments: social dysfunction,
cognitive dysfunction, expectation of improvement, endogenous depression,
double depression, and duration of current episode. Significant patient
predictors of differential treatment outcome were identified. 1) Low social
dysfunction predicted superior response to interpersonal psychotherapy. 2)
Low cognitive dysfunction predicted superior response to cognitive-
behavior therapy and to imipramine. 3) High work dysfunction predicted
superior response to imipramine. 4) High depression severity and impairment
of function predicted superior response to imipramine and to interpersonal
psychotherapy. CONCLUSIONS: The results demonstrate the relevance of
patient characteristics, including social, cognitive, and work function,
for prediction of the outcome of major depressive disorder. They provide
indirect evidence of treatment specificity by identifying characteristics
responsive to different modalities, which may be of value in the selection
of patients for alternative treatments.Abstract Teaser