[Lack of early response to psychotherapy for depression predicts treatment non-response]

Many patients with depressive disorder do not recover after psychotherapy. It is unclear for how long treatment should be continued unchanged for patients showing limited progress.

Examine whether early non-response is a predictor of treatment outcome in patients with moderate to severe depression and when the predictive value is highest.

Per-protocol analyses were performed with 252 moderately to severely depressed patients. Participants were randomly assigned to 16 sessions of either short-term psychodynamic supportive psychotherapy (SPSP) or cognitive behavioural therapy (CBT). The predictive value of early non-response (< 20% reduction of symptoms of the Inventory of Depressive Symptomatology) at week 1, 2, and 4 for treatment non-response at week 8 (< 50% reduction of symptoms) was evaluated with logistic regression.

Early non-response was a moderate to strong predictor of final non-response in week 8. The predictive value was highest in week 4 (odds ratio: 12.1; p < 0,001; AUC: 0.78). Most early non-responders remained non-responder after treatment (84% of non-responders in week 1 to 93% of non-responders in week 4).

Early non-response indicates little chance of treatment response and may indicate that changes in depression management should be considered earlier than conventionally thought.