Acute and chronic stress predict anti-depressant treatment outcome and naturalistic course of major depression: A CAN-BIND report.

BACKGROUND: In treatment studies of major depressive disorder (MDD), exposure to major life events predicts less symptom improvement and greater likelihood of relapse. In contrast, the impact of minor life events has received less attention. We hypothesized that the impact of minor events on symptom improvement and risk of relapse would be heightened in the presence of concurrent chronic stress. We also hypothesized that major events would predict less symptom improvement and greater risk of relapse independently of chronic stress. METHODS: Adult patients experiencing an episode of MDD were enrolled into a 16-week trial with antidepressant treatments (n = 156). Forty-three fully remitted patients agreed to participate in a naturalistic 18-month follow-up, and 30 had full data for analyses. Life events and chronic stressors were assessed using a contextual life stress interview. RESULTS: Greater exposure to minor events predicted greater improvement in symptoms during acute treatment, but this relation was specific to those who reported greater severity of chronic stress. During follow-up, however, major life events predicted increased risk of relapse, and this effect was not moderated by chronic stress. LIMITATION: High attrition rates led to a small sample size for the follow-up analyses. CONCLUSIONS: Exposure to minor events may provide an opportunity to practice problem-solving skills, thereby facilitating symptom improvement. Nevertheless, acute treatment did not protect patients from relapse when they subsequently faced major events during follow-up. Therefore, adjunctive strategies may be needed to enhance outcomes during pharmacotherapy, consolidating benefits from acute treatment and providing skills to prevent relapse.

Understanding the association between reappraisal use and depressive symptoms during adolescence: the moderating influence of regulatory success.

Higher levels of reliance on cognitive reappraisal to manage daily emotional events are commonly associated with lower levels of depressive symptoms. However, reappraisal is a cognitively demanding regulation strategy, and its efficacy may depend on how successfully an individual is able to employ it. Individual differences in the association between reappraisal use and depressive symptoms may be particularly evident during adolescence, when the cognitive skills required to implement this complex strategy are still in development. The current study sought to determine whether the association between reappraisal use and subsequent depressive symptom development is contingent on perceived regulatory success when using reappraisal. At Wave 1, adolescents (n = 178, mean age = 13.92, 49.7% female) used an experience-sampling smartphone app to report on their reappraisal use and perceptions of regulatory success over the course of two weeks. Six, 12, and 18 months later, adolescents completed a self-report measure of their depressive symptoms. Results showed that a) reappraisal use was associated with both subsequent depressive symptoms and trajectories of depressive symptoms over time, b) these associations were moderated by perceptions of regulatory success. Higher levels of reappraisal use were associated with lower levels of depressive symptoms only for those who reported higher than average between-subject regulatory success when reappraisal was enacted.