A systematic review and individual patient data network analysis of the residual symptom structure following cognitive-behavioral therapy and escitalopram, mirtazapine and venlafaxine for depression
posted on 2022-04-01, 11:21authored byAoife Whiston, Amy Lennon, Catherine Brown, Chloe Looney, Eve Larkin, Laurie O'Sullivan, Nurcan Sik, Maria Semkovska
Objective: Consistent evidence suggests residual depressive symptomology are the
strongest predictors of depression relapse following cognitive-behavioral therapy (CBT)
and antidepressant medications (ADM’s). Psychometric network models help detecting
and understanding central symptoms that remain post-treatment, along with their
complex co-occurrences. However, individual psychometric network studies show
inconsistent findings. This systematic review and IPD network analysis aimed to
estimate and compare the symptom network structures of residual depressive symptoms
following CBT, ADM’s, and their combination.
Methods: PsycINFO, PsycArticles, and PubMed were systematically searched through
October 2020 for studies that have assessed individuals with major depression
at post-treatment receiving either CBT and/or ADM’s (venlafaxine, escitalopram,
mirtazapine). IPD was requested from eligible samples to estimate and compare residual
symptom psychometric network models post-CBT and post-ADM’s.
Results: In total, 25 from 663 eligible samples, including 1,389 patients qualified
for the IPD. Depressed mood and anhedonia were consistently central residual
symptoms post-CBT and post-ADM’s. For CBT, fatigue-related and anxiety symptoms
were also central post-treatment. A significant difference in network structure
across treatments (CBT vs. ADM) was observed for samples measuring depression
severity using the MADRS. Specifically, stronger symptom occurrences were present
amongst lassitude-suicide post-CBT (vs. ADM’s) and amongst lassitude-inability to
feel post-ADM’s (vs. CBT). No significant difference in global strength was observed
across treatments.
Conclusions: Core major depression symptoms remain central across treatments,
strategies to target these symptoms should be considered. Anxiety and fatigue related
complaints also remain central post-CBT. Efforts must be made amongst researchers,
institutions, and journals to permit sharing of IPD.
Funding
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