Redefining Therapeutic Outcomes of Depression Treatment

Abstract

Responses to evidence-based interventions for depression are divergent: Some patients benefit more than others during treatment and some do not benefit at all or even deteriorate. Tailoring interventions to the individual may improve outcomes. However, such personalization of evidence-based treatment in depression requires investigation of individual outcomes and the individual trajectories towards these outcomes. This theoretical paper provides a critical reflection on individual outcomes of depression treatment. First, it is argued that outcomes should be broadened, from a focus on mainly depressive symptomatology to recovery in different domains. It is acknowledged that recovery from depression reflects a personal journey that differs from person to person. Second, outcome measures should be lengthened beyond the acute treatment phase, taking a lifetime perspective on depression. The challenge then is to discover which trajectories of what measures during what interventions result in personalized sustainable recovery and for whom. Routine outcome monitoring systems may be used to inform this quest towards assessment of personalized sustainable therapeutic outcomes. Adaptations to broaden and lengthen measurements in routine outcome monitoring systems are proposed to identify predictors of personalized sustainable recovery. Routine outcome monitoring systems may eventually be used to implement personalized treatments for depression that result in personalized sustainable recovery.

Back to Basics: The Importance of Conceptual Clarification in Psychological Science

“…What it means for treatment of depression to be successful has been hotly debated, and successful treatment has been conceptualized in many alternative ways (Fava et al, 2007). If treatment success in a predictive study is defined in a way that does not match at all with the experiences of patients or practitioners (see Slofstra et al, 2019), all the predictions will be rendered meaningless and unhelpful for actual practice, no matter how good the predictions are.…”

Humanistic and economic burden associated with depression in the United States: a cross-sectional survey analysis

“…Considering the impact that depression has on various aspects of patients' lives, there is an additional need to treat patients focusing on core symptom resolution as well as overall and broader well-being, including functional improvement and minimizing residual symptoms [29,[39][40][41][42]. Additionally, it is important to broaden the routine outcome monitoring systems [43] to effectively capture patients' experiences, perspectives, needs, and priorities and incorporating them into the treatment approach for better outcomes [42]. The combination of psychotherapy and pharmacotherapy has already shown to improve QoL and work productivity in patients diagnosed with depression [35,44,45].…”

Mindful yoga intervention as add-on to treatment as usual for young women with major depressive disorder: Results from a randomized controlled trial.

“…As positive affect has been found to be important in the recovery from depression (Geschwind et al, 2011), it is also important to study the effects of MDD interventions on well-being. Additionally, previous studies have found that even when symptoms of depression decrease, patients oftentimes continue to experience impairments in various domains of functioning and quality of life (Slofstra et al, 2019). It is therefore important to also take these types of variables into consideration when evaluating the effectiveness of interventions.…”