Autor:innen:
Andreas Menke, Würzburg (Germany)
Andreas Reif, Frankfurt am Main (Germany)
Boliang Guo, Nottingham (United Kingdom)
Jürgen Deckert, Würzburg (Germany)
Rebecca Dias, Wallingford (United Kingdom)
Gerry Dawson, Wallingford (United Kingdom)
Jonathan Kingslake, Wallingford (United Kingdom)
Richard Morriss, Nottingham (United Kingdom)
Mike Browning, Oxford (United Kingdom)
Background: We developed the PReDicT (Predicting Response to Depression Treatment) Test combining a measure of facial emotion processing with the Quick Inventory of Depressive Symptoms (QIDS-SR-16), to predict, after one week of antidepressant treatment, whether a patient will go on to respond to that treatment or not. We assessed the clinical effects of using PReDicT to inform antidepressant treatment in primary care in a large randomised controlled trial across 5 countries.
Method: Depressed patients (N=913), judged by their physician to require treatment with an antidepressant, were randomly assigned to have their treatment informed by PReDicT or to receive Treatment as Usual (TaU). In the PReDicT arm, one week after starting treatment, physicians were informed by PReDicT whether their patient was likely to respond to treatment or not. Participants in the TaU arm received standard care and no indication of their response.
Results: Physicians showed increased levels of antidepressant prescription change following predictions of non-response in the PReDicT arm (OR 1.99, p < 0.001). Although clinical response rates (defined as ≥ 50% reduction in QIDS) were numerically higher in the PReDicT arm (55.9% (95%C.I. 48.52, 63.05)) than the TaU arm (51.80% (44.44, 59.08)) this difference was not statistically significant (p=0.25). Participants in the PReDicT arm demonstrated a significantly greater decrease in GAD-7 anxiety (PReDicT: -5.44 (-6.14,-4.74)), Tau: 6.12 (-6.83, -5.41), p=0.04). Function (SAS-SR) was improved in the PReDicT arm compared to the TaU arm but significantly so (PReDicT: -7.58 (-8.81, -6.35), Tau: -6.59 (-7.79, -5.38), p=0.12).
Conclusion: Use of PReDicT induced behavioural changes among physicians. Participants using PReDicT to inform early treatment, compared to TaU, did not show significantly reduced rates of clinical response in depression at 8 weeks, although use of PReDicT to inform treatment was associated with greater reductions in anxiety.