Trajectories of Change in Chronic Depression: Differences in Self-Criticism and Somatic Symptoms Between Users of Antidepressants and Nonmedicated Patients

Public Significance Statement Self-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. 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 self-criticism 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.