TY - JOUR
T1 - Differential impact of preventive cognitive therapy while tapering antidepressants versus maintenance antidepressant treatment on affect fluctuations and individual affect networks and impact on relapse
T2 - a secondary analysis of a randomised controlled trial
AU - van der Wal, Junus M.
AU - van Borkulo, Claudia D.
AU - Haslbeck, Jonas M.B.
AU - Slofstra, Christien
AU - Klein, Nicola S.
AU - Blanken, Tessa F.
AU - Deserno, Marie K.
AU - Lok, Anja
AU - Nauta, Maaike H.
AU - Bockting, Claudi L.
N1 - Funding Information: The Centre for Urban Mental Health is funded by the University of Amsterdam . CLB worked on the DRD manuscript during a fellowship at the Netherlands Institute for Advanced Study in the Humanities and Social Sciences (NIAS), supported by the Royal Netherlands Academy of Arts and Sciences . The DRD trial was funded by ZonMW: The Netherlands association for Health research and Development (1710002401) awarded to CLB and by an OOG Grant (100002035) awarded to Hermien Elgersma. The ESM study was further funded by an NWO grant (022.003.038), awarded to the Dutch-Flemish Research School Experimental Psychopathology (CS and CLB). We thank all study participants and involved clinicians and research assistants. We thank Laura Bringmann for her valuable advice on the analyses and Nikolaos Batalas for developing the app and the software used to collect the ESM data. We thank Karien Stronks and Mary Nicolaou for thoughtful comments on earlier drafts of the manuscript. Funding Information: The Netherlands Organisation for Health Research and Development, Dutch Research Council, University of Amsterdam.The Centre for Urban Mental Health is funded by the University of Amsterdam. CLB worked on the DRD manuscript during a fellowship at the Netherlands Institute for Advanced Study in the Humanities and Social Sciences (NIAS), supported by the Royal Netherlands Academy of Arts and Sciences. The DRD trial was funded by ZonMW: The Netherlands association for Health research and Development (1710002401) awarded to CLB and by an OOG Grant (100002035) awarded to Hermien Elgersma. The ESM study was further funded by an NWO grant (022.003.038), awarded to the Dutch-Flemish Research School Experimental Psychopathology (CS and CLB). We thank all study participants and involved clinicians and research assistants. We thank Laura Bringmann for her valuable advice on the analyses and Nikolaos Batalas for developing the app and the software used to collect the ESM data. We thank Karien Stronks and Mary Nicolaou for thoughtful comments on earlier drafts of the manuscript. Publisher Copyright: © 2023 The Author(s)
PY - 2023/12
Y1 - 2023/12
N2 - Background: There is an urgent need to better understand and prevent relapse in major depressive disorder (MDD). We explored the differential impact of various MDD relapse prevention strategies (pharmacological and/or psychological) on affect fluctuations and individual affect networks in a randomised setting, and their predictive value for relapse. Methods: We did a secondary analysis using experience sampling methodology (ESM) data from individuals with remitted recurrent depression that was collected alongside a randomised controlled trial that ran in the Netherlands, comparing: (I) tapering antidepressants while receiving preventive cognitive therapy (PCT), (II) combining antidepressants with PCT, or (III) continuing antidepressants without PCT, for the prevention of depressive relapse, as well as ESM data from 11 healthy controls. Participants had multiple past depressive episodes, but were remitted for at least 8 weeks and on antidepressants for at least six months. Exclusion criteria were: current (hypo)mania, current alcohol or drug abuse, anxiety disorder that required treatment, psychological treatment more than twice per month, a diagnosis of organic brain damage, or a history of bipolar disorder or psychosis. Fluctuations (within-person variance, root mean square of successive differences, autocorrelation) in negative and positive affect were calculated. Changes in individual affect networks during treatment were modelled using time-varying vector autoregression, both with and without applying regularisation. We explored whether affect fluctuations or changes in affect networks over time differed between treatment conditions or relapse outcomes, and predicted relapse during 2-year follow-up. This ESM study was registered at ISRCTN registry, ISRCTN15472145. Findings: Between Jan 1, 2014, and Jan 31, 2015, 72 study participants were recruited, 42 of whom were included in the analyses. We found no indication that affect fluctuations differed between treatment groups, nor that they predicted relapse. We observed large individual differences in affect network structure across participants (irrespective of treatment or relapse status) and in healthy controls. We found no indication of group-level differences in how much networks changed over time, nor that changes in networks over time predicted time to relapse (regularised models: hazard ratios [HR] 1063, 95% CI <0.0001–>10 000, p = 0.65; non-regularised models: HR 2.54, 95% CI 0.23–28.7, p = 0.45) or occurrence of relapse (regularised models: odds ratios [OR] 22.84, 95% CI <0.0001–>10 000, p = 0.90; non-regularised models: OR 7.57, 95% CI 0.07–3709.54, p = 0.44) during complete follow-up. Interpretation: Our findings should be interpreted with caution, given the exploratory nature of this study and wide confidence intervals. While group-level differences in affect dynamics cannot be ruled out due to low statistical power, visual inspection of individual affect networks also revealed no meaningful patterns in relation to MDD relapse. More studies are needed to assess whether affect dynamics as informed by ESM may predict relapse or guide personalisation of MDD relapse prevention in daily practice. Funding: The Netherlands Organisation for Health Research and Development, Dutch Research Council, University of Amsterdam.
AB - Background: There is an urgent need to better understand and prevent relapse in major depressive disorder (MDD). We explored the differential impact of various MDD relapse prevention strategies (pharmacological and/or psychological) on affect fluctuations and individual affect networks in a randomised setting, and their predictive value for relapse. Methods: We did a secondary analysis using experience sampling methodology (ESM) data from individuals with remitted recurrent depression that was collected alongside a randomised controlled trial that ran in the Netherlands, comparing: (I) tapering antidepressants while receiving preventive cognitive therapy (PCT), (II) combining antidepressants with PCT, or (III) continuing antidepressants without PCT, for the prevention of depressive relapse, as well as ESM data from 11 healthy controls. Participants had multiple past depressive episodes, but were remitted for at least 8 weeks and on antidepressants for at least six months. Exclusion criteria were: current (hypo)mania, current alcohol or drug abuse, anxiety disorder that required treatment, psychological treatment more than twice per month, a diagnosis of organic brain damage, or a history of bipolar disorder or psychosis. Fluctuations (within-person variance, root mean square of successive differences, autocorrelation) in negative and positive affect were calculated. Changes in individual affect networks during treatment were modelled using time-varying vector autoregression, both with and without applying regularisation. We explored whether affect fluctuations or changes in affect networks over time differed between treatment conditions or relapse outcomes, and predicted relapse during 2-year follow-up. This ESM study was registered at ISRCTN registry, ISRCTN15472145. Findings: Between Jan 1, 2014, and Jan 31, 2015, 72 study participants were recruited, 42 of whom were included in the analyses. We found no indication that affect fluctuations differed between treatment groups, nor that they predicted relapse. We observed large individual differences in affect network structure across participants (irrespective of treatment or relapse status) and in healthy controls. We found no indication of group-level differences in how much networks changed over time, nor that changes in networks over time predicted time to relapse (regularised models: hazard ratios [HR] 1063, 95% CI <0.0001–>10 000, p = 0.65; non-regularised models: HR 2.54, 95% CI 0.23–28.7, p = 0.45) or occurrence of relapse (regularised models: odds ratios [OR] 22.84, 95% CI <0.0001–>10 000, p = 0.90; non-regularised models: OR 7.57, 95% CI 0.07–3709.54, p = 0.44) during complete follow-up. Interpretation: Our findings should be interpreted with caution, given the exploratory nature of this study and wide confidence intervals. While group-level differences in affect dynamics cannot be ruled out due to low statistical power, visual inspection of individual affect networks also revealed no meaningful patterns in relation to MDD relapse. More studies are needed to assess whether affect dynamics as informed by ESM may predict relapse or guide personalisation of MDD relapse prevention in daily practice. Funding: The Netherlands Organisation for Health Research and Development, Dutch Research Council, University of Amsterdam.
KW - Affect fluctuations
KW - Ecological momentary assessment
KW - Network theory
KW - Personalisation
KW - Recurrent depression
KW - Relapse prevention
UR - http://www.scopus.com/inward/record.url?scp=85177765774&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.eclinm.2023.102329
DO - https://doi.org/10.1016/j.eclinm.2023.102329
M3 - Article
C2 - 38078193
SN - 2589-5370
VL - 66
JO - EClinicalMedicine
JF - EClinicalMedicine
M1 - 102329
ER -