Trajectories of change in chronic depression: Differences in self-criticism and somatic symptoms between users of antidepressants and nonmedicated patients.

Abstract

Objective: Depression is typically seen as composed of several factors (i.e., cognitive, affective, somatic) which may be targeted by different interventions (i.e., pharmacotherapy, psychotherapy, or combination treatment). Successfully targeting these factors may contribute to improved treatment response in depression. A previous study identified two subfactors on Beck Depression Inventory-II (BDI-II) in a sample of chronically depressed patients: (a) self-criticism and (b) somatic symptoms (sleep disturbance, fatigue, changes in appetite). Prior research indicates that these symptoms may respond differently to psychotherapy and pharmacotherapy. In this study, we examined whether patients who were on antidepressant medication (ADM) had different outcomes on these factors than patients not using medication while undergoing intensive inpatient psychotherapeutic treatment. Method: After adjusting for baseline difference with propensity score matching, a total of 238 patients with chronic depression were included in the analysis of which 119 patients were using ADM during treatment while 119 were not. We analyzed whether the two groups had different trajectories of change on the factors "self-criticism" and "somatic symptoms" using multilevel growth curve modeling. Results: Patients not using medication during treatment had significantly larger symptom reduction than ADM users on the self-criticism factor, while there was no difference between groups on the somatic factor. Conclusion: There seems to be a difference in outcomes on selfcriticism depending on the use of ADM for this patient group. This may suggest that the simultaneous use of ADM while in psychotherapy could make patients less accessible to the effects of psychotherapeutic interventions on this factor. Public Significance StatementSelf-criticism may play a key role in maintaining chronic depression. This study suggests that chronically depressed patients not using antidepressant medication (ADM) while in psychotherapy reduce self-critical thought content more than patients using ADM. It is possible that patients using ADM experience emotional blunting which make them less accessible to psychotherapeutic interventions addressing dysfunctional rumination or emotional processing.

Analysis of the mental health status of hospital staff during the COVID-19 pandemic

“…Foreign studies have found that female medical staff generally suffer from subjective physical discomfort and lower moods [21]. In addition, other studies have found that depressive symptoms occur more often in women than in men [22], the prevalence of depression among female physicians is about 1.5 times higher than that of men and the prevalence of severe depression is about eight times higher [23]. The results of domestic studies indicate that the mental health quality of female medical personnel is lower than that of men [24][25][26].…”

Symptom Change during Waitlist for Medicated and Nonmedicated Patients with Chronic Depression

“…Many depressed patients use antidepressant medication (ADM) and chronically depressed patients often present for psychotherapy on a course of ADM [7, 8]. It is unclear how treatment with ADMs impacts long-term outcomes in depression, and it is difficult to predict how patients using ADM will respond during WL compared to nonmedicated patients.…”

Validity and Reliability of the Self-administered Psycho-TherApy-SystemS (SELFPASS) Item Pool for the Daily Mood Tracking of Depressive Symptoms: Cross-sectional Web-Based Survey

“…Few vegetative symptoms are considered part of the diagnostic routine; for example, fatigue, loss of appetite, and sleep [ 33 ]. Understanding the individual burden profile has been found to be crucial for targeted treatment, as patients with higher values in self-criticism respond better to psychotherapy than those with a somatic symptom profile [ 34 ]. As a result, in developing an item pool for daily mood tracking in e-mental health apps, somatic symptoms should be considered to a certain extent.…”