Personalized assessment and treatment of depression

Fisher, Aaron J.; Bosley, Hannah G.

doi:10.1016/j.copsyc.2015.03.031

Cited by 22 publications

(16 citation statements)

References 47 publications

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“…Hence, intervention may not only be matched or tailored at the outset based on patient characteristics, but also adaptive —that is, adjusted according to the patient's treatment response over time (Lei, Nahum‐Shani, Lynch, Oslin, & Murphy, ). We focus on personalizing approaches involving youth psychotherapy partly because of their documented efficacy for treating many mental health problems (for another review with greater focus on medication, see Fisher & Bosley, ). Furthermore, psychotherapy lacks side effects and can reduce serious side effects (Treatment for Adolescents with Depression Study Team, ) and required dosage (Pelham et al., ) of concurrent medications, which are important considerations for youths undergoing physical, cognitive, emotional, and social development.…”

Section: What Is Personalized Intervention For Mental Health Problems?mentioning

confidence: 99%

Annual Research Review: Building a science of personalized intervention for youth mental health

Weisz

2015

Child Psychology Psychiatry

229

147

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Background Within the past decade, healthcare service and research priorities have shifted from evidence-based medicine to personalized medicine. In mental healthcare, a similar shift to personalized intervention may boost the effectiveness and clinical utility of empirically supported therapies (ESTs). Aims and Scope The emerging science of personalized intervention will need to encompass evidence-based methods for determining which problems to target and in which order, selecting treatments and deciding whether and how to combine them, and informing ongoing clinical decision-making through monitoring of treatment response throughout episodes of care. We review efforts to develop these methods, drawing primarily from psychotherapy research with youths. Then we propose strategies for building a science of personalized intervention in youth mental health. Findings The growing evidence base for personalizing interventions includes research on therapies adapted for specific subgroups; treatments targeting youths’ environments; modular therapies; sequential, multiple assignment, randomized trials; measurement feedback systems; meta-analyses comparing treatments for specific patient characteristics; data-mining decision trees; and individualized metrics. Conclusion The science of personalized intervention presents questions that can be addressed in several ways. First, to evaluate and organize personalized interventions, we propose modifying the system used to evaluate and organize ESTs. Second, to help personalizing research keep pace with practice needs, we propose exploiting existing randomized trial data to inform personalizing approaches, prioritizing the personalizing approaches likely to have the greatest impact, conducting more idiographic research, and studying tailoring strategies in usual care. Third, to encourage clinicians’ use of personalized intervention research to inform their practice, we propose expanding outlets for research summaries and case studies, developing heuristic frameworks that incorporate personalizing approaches into practice, and integrating personalizing approaches into service delivery systems. Finally, to build a richer understanding of how and why treatments work for particular individuals, we propose accelerating research to identify mediators within and across RCTs, to isolate mechanisms of change, and to inform the shift from diagnoses to psychopathological processes. This ambitious agenda for personalized intervention science, though challenging, could markedly alter the nature of mental health care and the benefit provided to youths and families.

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Section: What Is Personalized Intervention For Mental Health Problems?mentioning

confidence: 99%

Annual Research Review: Building a science of personalized intervention for youth mental health

Weisz

2015

Child Psychology Psychiatry

229

147

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“…Fisher and Bosley (2015) describe the growing field of precision medicine—the idea that treatment selection for depression can and should be informed by patient attributes. They review attempts to use biological factors, including genetics and biomarkers, for pharmacological and psychological treatments.…”

Section: Predictors Of Treatment Responsementioning

confidence: 99%

Editorial overview: The assessment, etiology, and treatment of unipolar depression

Beevers

2015

Current Opinion in Psychology

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“…Whilst research on differential response to ADM focuses on biomarkers, research on differential response to psychotherapies has largely focused on quantitatively measured clinical characteristics such as depression severity, history and subtypes; comorbid conditions and sociodemographic factors [17][18][19]21]. However, such research has produced only limited knowledge about who benefits most from which treatment [17,18], leaving only a "trial and error approach" towards depression treatment [22] (p.40).…”

Section: Introductionmentioning

confidence: 99%

“…However, such research has produced only limited knowledge about who benefits most from which treatment [17,18], leaving only a "trial and error approach" towards depression treatment [22] (p.40). Efforts based on post hoc moderator analysis have been largely unsuccessful [21], and a recent review of randomised trials comparing two psychotherapies in patients with 27 specific characteristics indicates that completing sufficient trials to show an effect size of g = 0.50 would require another 326 years of research [23]. Understanding how combinations of such characteristics predict outcomes would require a longer timeframe still [19].…”

Section: Introductionmentioning

confidence: 99%

Personalising psychotherapies for depression using a novel mixed methods approach: an example from Morita therapy

Sugg

Frost

Richards

2020

Trials

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Background: Current quantitative methods for personalising psychotherapies for depression are unlikely to be able to inform clinical decision-making for hundreds of years. Novel alternative methods to generate hypotheses for prospective testing are therefore required, and we showcase mixed methods as one such approach. By exploring patients' perspectives in depth, and integrating qualitative and quantitative data at the level of the individual, we may identify new potential psychosocial predictors of psychotherapy outcomes, potentially informing the personalisation of depression treatment in a shorter timeframe. Using Morita therapy (a Japanese psychotherapy) as an exemplar, we thus explored how Morita therapy recipients' views on treatment acceptability explain their adherence and response to treatment. Methods: The Morita trial incorporated a pilot randomised controlled trial of Morita therapy versus treatment as usual for depression, and post-treatment qualitative interviews. We recruited trial participants from general practice record searches in Devon, UK, and purposively sampled data from 16 participants for our mixed methods analysis. We developed typologies of participants' views from our qualitative themes, and integrated these with quantitative data on number of sessions attended and whether participants responded to treatment in a joint typologies and statistics display. We enriched our analysis using participant vignettes to demonstrate each typology. Results: We demonstrated that (1) participants who could identify with the principles of Morita therapy typically responded to treatment, regardless of how many sessions they attended, whilst those whose orientation towards treatment was incompatible with Morita therapy did not respond to treatment, again regardless of treatment adherence and (2) participants whose personal circumstances impeded their opportunity to engage in Morita therapy attended the fewest sessions, though still benefitted from treatment if the principles resonated with them. Conclusions: We identified new potential relationships between "orientation" and outcomes, and "opportunity" and adherence, which could not have been identified using existing non-integrative methods. This mixed methods approach warrants replication in future trials and with other psychotherapies to generate hypotheses, based on typologies (or profiles) of patients for whom a treatment is more or less likely to be suitable, to be tested in prospective trials.

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Personalized assessment and treatment of depression

Cited by 22 publications

References 47 publications

Annual Research Review: Building a science of personalized intervention for youth mental health

Annual Research Review: Building a science of personalized intervention for youth mental health

Editorial overview: The assessment, etiology, and treatment of unipolar depression

Personalising psychotherapies for depression using a novel mixed methods approach: an example from Morita therapy

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