Predictors of poor 6-week outcome in a cohort of major depressive disorder patients treated with antidepressant medication: the role of entrapment

Abstract

Background

Only a small number of consistent processes predict which depressed patients will achieve remission with antidepressant medication. One set of processes is that of social ranking strategies/variables that are related to life events and severe difficulties. Particularly, defeat and entrapment predict poorer response to antidepressants. However, results are inconsistent.

Aim

The current study aimed to evaluate evolutionary strategies, childhood maltreatment, neglect and life events and difficulties (LEDs) as predictors of remission in depressed patients undergoing pharmacological treatment in a psychiatric outpatient sample.

Methods

A cohort of 139 depressed outpatients undergoing pharmacological treatment was followed prospectively in a naturalistic study for 6 weeks. Two major evaluations were considered at baseline and 6 weeks. We allocated patients to a pharmacological treatment algorithm for depression – the Texas Medication Algorithm Project. Variables evaluated at baseline and tested as predictors of remission included demographic and clinical data, severity of depression, social ranking, evolution informed variables, LEDs and childhood maltreatment.

Results

Of the 139 patients, only 24.5% were remitted at week 6. In univariate analyses, non-remitted patients scored significantly higher in all psychopathology and vulnerability scales except for submissive behaviour and internal entrapment. For the logistic regression, a higher load of LEDs of the entrapment and humiliation dimension in the year before the index episode (OR = 6.62), and higher levels external entrapment in the Entrapment Scale (OR = 1.10) predicted non-remission. These variables accounted for 28.7% of the variance.

Conclusions

Multivariate analysis revealed that external entrapment was the only predictor of non-remission.

Keywords:

• Major depressive disorder
• pharmacological treatment
• childhood maltreatment
• life events
• entrapment
• social ranking

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Notes on contributors

Serafim Carvalho

Serafim Carvalho, MD, PhD, Psychiatrist at Hospital de Magalhães Lemos and Professor of Clinical Psychology at Instituto Universitário de Ciências da Saúde (IUCS), Porto, Portugal.

Filipa Caetano

Filipa Caetano, MD, Psychiatric Trainee at Hospital de Magalhães Lemos, Porto, Portugal.

José Pinto-Gouveia

José Pinto-Gouveia, MD, PhD, Psychiatrist, Head of the R&D Center for Research in Neuropsychology and Cognitive and Behavioural Intervention (CINEICC), Faculty of Psychology and Educational Sciences University of Coimbra, Portugal.

Jorge Mota-Pereira

Jorge Mota-Pereira, MD, PhD, Psychiatrist, at Clínica Médico-Psiquiátrica da Ordem, Porto, Portugal.

Dulce Maia

Dulce Maia, MD, Psychiatrist at Psychiatry and Mental Health Department - Centro Hospitalar de Trás-os-Montes e Alto Douro, Vila Real, Portugal.

Paulo Pimentel

Paulo Pimentel, Clinical Psychologist at Psychiatry and Mental Health Department - Centro Hospitalar de Trás-os-Montes e Alto Douro, Vila Real, Portugal.

Cátia Priscila

Cátia Priscila, MD, Psychiatrist at Hospital de Magalhães Lemos, Porto, Portugal.

Paul Gilbert

Paul Gilbert, FBPsS, PhD, OBE, Professor of Clinical Psychology at the University of Derby and Consultant Clinical Psychologist at the Derbyshire Health Care Foundation Trust, UK.