Genetics of response to cognitive behavior therapy in adults with major depression: a preliminary report.

Major depressive disorder is heritable and a leading cause of disability. Cognitive behavior therapy is an effective treatment for major depression. By quantifying genetic risk scores based on common genetic variants, the aim of this report was to explore the utility of psychiatric and cognitive trait genetic risk scores, for predicting the response of 894 adults with major depressive disorder to cognitive behavior therapy. The participants were recruited in a psychiatric setting, and the primary outcome score was measured using the Montgomery Åsberg Depression Rating Scale-Self Rated. Single-nucleotide polymorphism genotyping arrays were used to calculate the genomic risk scores based on large genetic studies of six phenotypes: major depressive disorder, bipolar disorder, attention-deficit/hyperactivity disorder, autism spectrum disorder, intelligence, and educational attainment. Linear mixed-effect models were used to test the relationships between the six genetic risk scores and cognitive behavior therapy outcome. Our analyses yielded one significant interaction effect (B = 0.09, p < 0.001): the autism spectrum disorder genetic risk score correlated with Montgomery Åsberg Depression Rating Scale-Self Rated changes during treatment, and the higher the autism spectrum disorder genetic load, the less the depressive symptoms decreased over time. The genetic risk scores for the other psychiatric and cognitive traits were not related to depressive symptom severity or change over time. Our preliminary results indicated, as expected, that the genomics of the response of patients with major depression to cognitive behavior therapy were complex and that future efforts should aim to maximize sample size and limit subject heterogeneity in order to gain a better understanding of the use of genetic risk factors to predict treatment outcome.

Cost-effectiveness of internet-based cognitive-behavioural therapy and physical exercise for depression.

BACKGROUND: Both internet-based cognitive-behavioural therapy (ICBT) and physical exercise are alternatives to treatment as usual (TAU) in managing mild to moderate depression in primary care. AIMS: To determine the cost-effectiveness of ICBT and physical exercise compared with TAU in primary care. METHOD: Economic evaluation of a randomised controlled trial (N = 945) in Sweden. Costs were estimated by a service use questionnaire and used together with the effects on quality-adjusted life-years (QALYs). The primary 3-month healthcare provider perspective in primary care was complemented by a 1-year societal perspective. RESULTS: The primary analysis showed that incremental cost per QALY gain was €8817 for ICBT and €14 571 for physical exercise compared with TAU. At the established willingness-to-pay threshold of €21 536 (£20 000) per QALY, the probability of ICBT being cost-effective is 90%, and for physical exercise is 76%, compared with TAU. CONCLUSIONS: From a primary care perspective, both ICBT and physical exercise for depression are likely to be cost-effective compared with TAU. DECLARATION OF INTEREST: None.

The effects of cognitive-behavioral therapy for depression are not falling: A re-analysis of Johnsen and Friborg (2015).

Cognitive-behavioral therapy (CBT) has a solid evidence base as an effective treatment for depression. However, a recent meta-analysis (Johnsen & Friborg, 2015) including 70 studies, showed that the effect sizes of CBT for depression have been falling between 1977 and 2014. A possible important limitation in the Johnsen and Friborg (2015) study was that they did not investigate a leveling off in the decline over time of the effectiveness of CBT for depression. We therefore reanalyzed the data reported by Johnsen and Friborg (2015) using meta-analytic regression models that allowed for a curvilinear effect of publication year and also modeled separate estimates of the decline of treatment effect before and after 1995. Our analyses showed that adding a quadratic effect of time to a linear effect of time significantly improved the meta-analytic regression models (p = .017-.027). Furthermore, significant declines were only observed between 1977 and 1995 (p = .001-.009) and not between 1995 to 2014 (p = .987-.785). We conclude that the declining effect of CBT for depression observed by Johnsen and Friborg (2015) was highly influenced by 22 studies published before 1995 and that the 48 studies published after 1995 did not demonstrate such a decline. Thus, there are no indications that CBT for depression is gradually losing its value. (PsycINFO Database Record