Interactions between neuroticism and stressful life events predict response to pharmacotherapy for major depression: A CAN-BIND 1 report

Timothy A Allen, Kate L Harkness, Raymond W Lam, Roumen Milev, Benicio N Frey, Daniel J Mueller, Rudolf Uher, Sidney H Kennedy, Lena C Quilty, Timothy A Allen, Kate L Harkness, Raymond W Lam, Roumen Milev, Benicio N Frey, Daniel J Mueller, Rudolf Uher, Sidney H Kennedy, Lena C Quilty

Abstract

Exposure to stressful life events and individual differences in the personality trait neuroticism are important risk factors that interact to predict major depressive disorder (MDD). Less is known about their effect on treatment response in depression. Here, we examine whether stressful life events experienced prior to and during treatment interact with neuroticism to predict response to 16-week pharmacotherapy for MDD. Participants included 159 outpatients with MDD who were initially treated with 8 weeks of escitalopram. Those who responded to the initial treatment continued on escitalopram monotherapy, whereas non-responders received 8 weeks of adjunctive aripiprazole. Personality was assessed using the NEO-Five Factor Inventory, and stressful life events were assessed using the Life Events and Difficulties Schedule, a rigorous contextual interview that includes independent ratings of threatening life events. High baseline neuroticism was associated with a lower likelihood of response when patients experienced one or more negative life events before treatment. Secondary analyses indicated that this effect was specific to neuroticism, and not better accounted for by its self-criticism or negative affect facets. Our results suggest that assessing personality and stressful life events at baseline can help clinicians assess which patients will respond to antidepressant therapy and which may need treatment augmentation.

Trial registration: ClinicalTrials.gov NCT01655706.

© 2021 John Wiley & Sons, Ltd.

Figures

Figure 1.
Figure 1.
Interaction between neuroticism and pretreatment total negative life events (NE) predicting the probability of response on the MADRS at Week 16. A) Effect of neuroticism on treatment response moderated by pretreatment total negative events. B) Effect of pretreatment total negative events on treatment response moderated by neuroticism.
Figure 2.
Figure 2.
Interaction between neuroticism and pretreatment independent negative life (INE) events predicting the probability of response on the MADRS at Week 16. Note, this effect was reduced to non-significance after controlling for conscientiousness and its interaction with pretreatment independent negative events (see Table S5 and Figure S2). A) Pretreatment negative independent events as moderator. B) Neuroticism as moderator.

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Source: PubMed

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