Prediction of treatment outcomes to exercise in patients with nonremitted major depressive disorder

Abstract

Background Only one-third of patients with Major Depressive Disorder (MDD) achieve remission with initial treatment. Consequently, current clinical practice relies on a “trial-and-error” approach to identifying an effective treatment for each patient. The purpose of this report was to determine whether we could identify a set of clinical and biological parameters with potential clinical utility for prescription of exercise for treatment of MDD in a secondary analysis of the Treatment with Exercise Augmentation in Depression (TREAD) trial. Methods Participants with non-remitted MDD were randomized to one of two exercise doses for 12 weeks. Participants were categorized as “remitters” (≤ 12 on the IDS-C), non-responders (< 30% drop in IDS-C), or neither. The least absolute shrinkage and selection operator (LASSO) and random forests were used to evaluate thirty variables as predictors of both remission and non-response. Predictors were used to model treatment outcomes using logistic regression. Results Of the 122 participants, 36 were categorized as remitters (29.5%), 56 as non-responders (45.9%), and 30 as neither (24.6%). Predictors of remission were higher levels of brain derived neurotrophic factor (BDNF) and IL-1B, greater depressive symptom severity, and higher post-exercise positive affect. Predictors of treatment non-response were low cardiorespiratory fitness, lower levels of IL-6 and BDNF, and lower post-exercise positive affect. Models including these predictors resulted in predictive values greater than 70% (true predicted remitters/all predicted remitters) with specificities greater than 25% (true predicted remitters/all remitters). Conclusions Results indicate feasibility in identifying patients who will either remit or not respond to exercise as a treatment for MDD utilizing a clinical decision model that incorporates multiple patient characteristics.

Network changes associated with transdiagnostic depressive symptom improvement following cognitive behavioral therapy in MDD and PTSD

“…The multivariate results presented in this paper were obtained by performing elastic net penalized regression [45]. Elastic net regression has been increasingly used in neuroimaging and psychiatry [56], in particular, to determine what brain regions are impacted by depression [57] and to predict clinical outcomes [58,59]. The findings of the multivariate analysis are also important to understanding how CBT-related decrease of depression symptoms might work, since it allows potential simultaneous contributions from multiple systems.…”

Physical Activity Promotes Health and Reduces Cardiovascular Mortality in Depressed Populations: A Literature Overview

“…Despite anhedonic experiences which are commonly observed in depression, these patients may still perceive exercise as pleasant [ 141 , 142 , 143 ]. The positive affective response obtained with exercise is also associated with treatment response, predicting both the improvement of depressive symptoms as well as the adherence to the exercise program [ 144 , 145 ].…”

Physical Exercise in Major Depression: Reducing the Mortality Gap While Improving Clinical Outcomes

“…Among non-depressed adults, affective responses to a bout of exercise have been found in correlational studies to be associated with the amount of physical activity individuals choose to do (158), while experimental manipulations resulting in improved affective responses have been shown to increase the amount of physical activity performed over a subsequent period of 6 months (159). Early evidence among individuals with depression indicates that affective responses to a bout of exercise may predict treatment response (160, 161). While randomized controlled trials investigating the efficacy, effectiveness, and cost-effectiveness of affect-based exercise prescriptions for the treatment of depression are not yet available, this method seems to hold promise for clinical application due to its simplicity, making it appealing to physicians who lack specialized training in exercise and to healthcare organizations concerned about implementation costs.…”