Cognitive-Behavioral Analysis System of Psychotherapy, Drug, or Their Combination for Persistent Depressive Disorder: Personalizing the Treatment Choice Using Individual Participant Data Network Metaregression

Abstract

Background: Persistent depressive disorder is prevalent, disabling, and often difficult to treat. The cognitive-behavioral analysis system of psychotherapy (CBASP) is the only psychotherapy specifically developed for its treatment. However, we do not know which of CBASP, antidepressant pharmacotherapy, or their combination is the most efficacious and for which types of patients. This study aims to present personalized prediction models to facilitate shared decision-making in treatment choices to match patients’ characteristics and preferences based on individual participant data network metaregression. Methods: We conducted a comprehensive search for randomized controlled trials comparing any two of CBASP, pharmacotherapy, or their combination and sought individual participant data from identified trials. The primary outcomes were reduction in depressive symptom severity for efficacy and dropouts due to any reason for treatment acceptability. Results: All 3 identified studies (1,036 participants) were included in the present analyses. On average, the combination therapy showed significant superiority over both monotherapies in terms of efficacy and acceptability, while the latter 2 treatments showed essentially similar results. Baseline depression, anxiety, prior pharmacotherapy, age, and depression subtypes moderated their relative efficacy, which indicated that for certain subgroups of patients either drug therapy or CBASP alone was a recommendable treatment option that is less costly, may have fewer adverse effects and match an individual patient’s preferences. An interactive web app (https://kokoro.med.kyoto-u.ac.jp/CBASP/prediction/) shows the predicted disease course for all possible combinations of patient characteristics. Conclusions: Individual participant data network metaregression enables treatment recommendations based on individual patient characteristics.

Two-Year Follow-Up after Treatment with the Cognitive Behavioral Analysis System of Psychotherapy versus Supportive Psychotherapy for Early-Onset Chronic Depression

“…A substantial number of patients did not achieve remission 2 years after having received CBASP treatment, and the average participant still scored in the mildly depressed range. Additional research should clarify whether further treatment, including augmentation with pharmacotherapy or modular interventions based on individual patient characteristics [44] in the acute phase, might result in a higher rate of remission and consequently a lower rate of relapse. In addition, considering management options that proved helpful in treating other chronic diseases may be promising.…”

Providing the most appropriate care to our individual patients

“…Network meta-analysis has been developed to (1) synthesise evidence across a network of randomised trials, (2) allow the estimation of the relative effectiveness of several interventions and (3) produce ranked treatment options 14. A further advancement is individual patient data network meta-analysis (IPD-NMA) 15. IPD-NMA allows the comparative efficacy of different treatments to be assessed, as well as providing a prediction of the clinical outcome, looking for instance at time to response or temporal trajectory of side effects.…”

Group Cognitive Behavioral Analysis System of Psychotherapy (CBASP): A Pilot Study for Bipolar Depression

“…CBASP has been reported on in several meta-analyses on psychotherapy for persistent depression ( 18 – 20 ). In spite of wide heterogeneity between trials being compared, there is consistent evidence of the effectiveness of CBASP as monotherapy for acute depression but even more effectiveness when combined with medication for persistent depression ( 19 , 21 ).…”