Characterizing the long-term course of individuals with major depressive disorder.
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Adult↗
Biomedical subjects
Ivan W Miller
Publications and source records attributed to Ivan W Miller.
Perfectionism, cognitive bias, and hopelessness as prospective predictors of suicidal ideation.
Perfectionism, negative cognitive bias, and hopelessness were assessed among people hospitalized for depression (N = 121). Hopelessness and suicidal ideation were assessed 6 months after discharge. Path analyses indicated that higher perfectionism as an inpatient was directly associated with higher suicidal ideation 6 months later. Cognitive bias, in contrast, led to greater hopelessness 6 months later, which in turn led to higher concurrent suicidal ideation. Alternative models examined whether hopelessness partially or fully mediated the effect of perfectionism, whether hopelessness partially mediated the effect of cognitive bias, and whether inpatient depression and suicidal ideation severity explained the observed relationships. These alternative models were not supported. Perfectionism and negative cognitive bias both uniquely contributed to the prospective prediction of suicidal ideation.
Adult↗
Family therapy and chronic depression.
Individuals with chronic depression report significant problems in multiple areas of their family functioning, suggesting the importance of combining family therapy with psychotherapy and pharmacotherapy in the treatment of their depression. We describe a model of family functioning (the McMaster model) and therapy (the Problem-Centered Systems Therapy of the Family) and its application in the treatment of a young woman with chronic depression. The key elements of the family treatment are a comprehensive assessment of the family, a systematic progression through defined treatment stages, an open, collaborative stance with the family, and a focus on the family's responsibility for change. Family therapy can aid the amelioration of depressive symptoms and improve the ability of family members to deal more effectively with the depression as well as a wider range of problems.
Adult↗
Cognitive predictors of symptom return following depression treatment.
This study tested whether poor cognitive change during depression treatment predicted time to return of depressive symptoms. Depressed participants (N = 121) completed assessments of dysfunctional attitudes and extreme thinking (i.e., number of totally agree and totally disagree responses) during hospitalization and again after 6 months of outpatient treatment. Participants then completed monthly depression assessments for 1 year. Survival analyses for time to symptom recurrence during follow-up were conducted among participants who reported 50% improvement in their depressive symptoms and were at least partially asymptomatic at the end of treatment (n = 53). Poor change in dysfunctional attitudes and poor change in extreme thinking both predicted shorter time to return of depressive symptoms.
Adult↗
Therapeutic alliance in depression treatment: controlling for prior change and patient characteristics.
Although many studies report that the therapeutic alliance predicts psychotherapy outcome, few exclude the possibility that this association is accounted for by 3rd variables, such as prior improvement and prognostically relevant patient characteristics. The authors treated 367 chronically depressed patients with the cognitive-behavioral analysis system of psychotherapy (CBASP), alone or with medication. Using mixed effects growth-curve analyses, they found the early alliance significantly predicted subsequent improvement in depressive symptoms after controlling for prior improvement and 8 prognostically relevant patient characteristics. In contrast, neither early level nor change in symptoms predicted the subsequent level or course of the alliance. Patients receiving combination treatment reported stronger alliances with their psychotherapists than patients receiving CBASP alone. However, the impact of the alliance on outcome was similar for both treatment conditions.
Adult↗
Negative mood, depressive symptoms, and major depression after smoking cessation treatment in smokers with a history of major depressive disorder.
Negative mood, depressive symptoms, and major depressive episodes (MDEs) were examined in 179 smokers with a history of major depression in a trial comparing standard smoking cessation treatment to treatment incorporating cognitive-behavioral therapy for depression (CBT-D). Early lapses were associated with relatively large increases in negative mood on quit date. Mood improved in the 2 weeks after quit date among those returning to regular smoking but not among those smoking moderately. Continuous abstinence was associated with short- and long-term reductions in depressive symptoms. MDE incidence during follow-up was 15.3% and was not associated with abstinence. Unexpected was that CBT-D was associated with greater negative mood and depressive symptoms and increased MDE risk. Results suggest complex bidirectional associations between affect and smoking outcomes.
Adolescent↗
Patterns of change in depressive symptoms during smoking cessation: who's at risk for relapse?
The authors examined patterns of change in depressive symptoms during smoking cessation treatment in 163 smokers with past major depressive disorder (MDD). Cluster analysis of Beck Depression Inventory (A. T. Beck, C. H. Ward, M. Mendelson, J. Mock, & J. Erbaugh, 1961) scores identified 5 patterns of change. Although 40% of participants belonged to clusters characterized by increasing depressive symptoms during quitting (rapid increasers, n = 31, and delayed increasers, n = 35), almost 47% were in clusters characterized by decreasing symptoms (delayed decreasers, n = 24, and rapid decreasers, n = 52). Both rapid and delayed increasers had especially poor smoking cessation outcomes. Results suggest that among smokers with an MDD history there is substantial heterogeneity in patterns of depressive symptoms during quitting and that patterns involving increased symptoms are associated with low abstinence rates.
Adult↗
Cognitive variables in alcohol dependent patients with elevated depressive symptoms: changes and predictive utility as a function of treatment modality.
The aim of the current study was to examine, through posthoc analyses, changes in and predictive utility of mood-related cognitive variables as a function of treatment modality in a group of alcohol dependent patients with elevated depressive symptoms. In addition to the background partial hospital treatment for alcoholism which lasted a mean of 21.2 days, study patients (n = 35) received cognitive-behavioral treatment for depression (CBT-D) or a control treatment consisting of relaxation training (RTC). While both groups showed improvement on dysfunctional attitudes during treatment, only the CBT-D group improved on measures of alcohol-related expectancies. Changes in cognitive variables during treatment predicted drinking outcomes, and the predictors of drinking outcomes varied across the two treatments. Among the RTC patients, changes in positive alcohol-related expectancies were negatively correlated with drinking frequency and quantity at follow-up. However, for the CBT-D patients, changes in self-efficacy concerning negative mood situations and negative alcohol-related expectancies were negatively correlated with drinking at longer-term follow-up. The results of this study provide evidence concerning the mechanisms by which the treatment modalities examined may affect patient outcome. Although these results are preliminary in nature, they do suggest that future research might examine efforts to capitalize on these mechanisms through the facilitation of changes found to predict better drinking outcomes in this study.
Adult↗
A reevaluation of the exclusion criteria used in antidepressant efficacy trials.
OBJECTIVE: Antidepressant efficacy trials use multiple exclusion criteria that are intended primarily to maximize differences between the drug and placebo. These exclusion criteria were implemented prior to having undergone rigorous testing, however, and it is unclear whether they accomplish their intended goal. The authors review the current state of knowledge about treatment response rates in individuals who are typically excluded from antidepressant efficacy trials. METHOD: After reviewing 31 antidepressant efficacy trials published between 1994 and 1998, the authors identified 10 commonly used exclusion criteria. A computerized MEDLINE search and a manual search were used to identify studies evaluating the efficacy of antidepressant medications in populations of subjects typically excluded from antidepressant efficacy trials. RESULTS: Three exclusion criteria-short episode duration, mild severity of illness, and positive response during the placebo lead-in phase-are used primarily to reduce placebo response rates. Preliminary evidence suggests that, of those three criteria, only a short episode duration has been associated with less robust differences between drug and placebo response rates. The seven other exclusion criteria, including various psychiatric comorbidities, long duration of illness, medical comorbidity, and prior nonresponse to treatment, are used because individuals who meet those criteria are believed to have lower response rates to somatic therapy. Although such individuals are often found to have lower response rates to somatic therapy, they also appear to have lower response rates to placebo, and there is little evidence to suggest that drug-placebo differences are any less robust in these individuals. CONCLUSIONS: Many of the standard exclusion criteria currently used in antidepressant efficacy trials may not be achieving their intended goal of maximizing drug-placebo differences. The practice of excluding subjects with particular clinical profiles, which greatly reduces the generalizability of antidepressant efficacy trials, appears to lack empirical support.
Adult↗
Longitudinal course of bipolar I disorder.
The course of bipolar I disorder is characterized by frequently fluctuating levels of manic and depressive symptoms. In the current study, we sought to characterize the month-by- month course of this disorder in 61 patients who were originally enrolled in a clinical trial and were followed for a mean of 23.7 months (SD = 6.1). All patients in the trial received medication management; some received family psychosocial interventions as well. On a monthly basis, we assessed symptom severity using the Modified Hamilton Rating Scale for Depression (MHRSD) and the Bech-Rafaelson Mania Scale (BRMS). Each month, we categorized each participant as fully symptomatic, partially symptomatic, or asymptomatic in terms of both depressed and manic symptoms. We found that the median percent time fully symptomatic was 8%, the median percent time partially symptomatic was 22%, and the median percent time asymptomatic was 59%. Using DSM-IV-TR criteria for defining an acute mood episode, we found that the median length of episode was 1 month, and participants experienced, on average, one episode every 8 months. Estimates concerning percent time fully symptomatic and asymptomatic converge with those reported in other datasets.
Adaptation, Psychological↗
Persistence of antidepressant treatment effects in a pharmacotherapy plus psychotherapy trial for active injection drug users.
The objective of this study was to determine if combined psychotherapy and pharmacotherapy reduces reported depressive symptoms compared to an assessment only condition for active drug injectors over nine months. Using a randomized controlled trial at an outpatient academic research office, the researchers applied psychotherapy (eight sessions of cognitive behavioral therapy) plus pharmacotherapy (citalopram) to active injection drug users with a DSM-IV diagnosis of major depression, dysthymia, substance-induced mood disorder with symptoms persisting for at least three months, or major depression plus dysthymia, and a Modified Hamilton Rating Scale for Depression (MHRSD) score greater than 13. The MHRSD scale scores were then assessed at the completion of three, six, and nine months. Participants (n = 109) were 64% male and 82% Caucasian, with a mean baseline MHRSD score of 20.7. Depression subtypes included major depression only (63%), substance-induced depression (17%), and double-depression (17%). Study retention at nine months was 89%. At the completion of three months of acute treatment, 26% of combined treatment patients (n = 53), compared to 12% of control patients (n = 56), were in remission (p = .047). At both six and nine months, the between-group differences in remission rates and mean MHRSD scores were insignificant, although the overall mean MHRSD score decreased from baseline (p < .01). At all follow-up assessments, depression remission was significantly associated with lower heroin use. Among active drug injectors diagnosed with depression, symptoms decline over time. Combined treatment is superior to an assessment-only condition in depression remission rates at the end-of-treatment, but this difference does not persist.
Adult↗