PSYCHOBIOLOGICAL CORRELATES OF POOR RESPONSE TO COGNITIVE-BEHAVIOR THERAPY - POTENTIAL INDICATIONS FOR ANTIDEPRESSANT PHARMACOTHERAPY

Correlates of outcome were studied in a sample of 142 unmedicated pati ents with major depressive disorder treated with cognitive behavior th erapy (CBT) in outpatient (n = 110) or inpatient (n = 32) protocols. O utpatients received up to 20 sessions of therapy over 16 weeks; inpati ents received up to 20 sessions over 4 weeks. Across all three protoco ls, nonresponse was associated with unemployment, higher levels of pre treatment severity, and an abnormal electroencephalographic (EEG) slee p profile. Chronicity was associated with poor outcomes in male outpat ients, whereas high scores on a measure of dysfunctional attitudes wer e associated with a trend for poor outcome only in female patients. Am ong inpatients, male gender, diagnostic comorbidity, and elevated urin ary free cortisol levels also were associated with poor outcome. Altho ugh a majority of the unmedicated patients experienced full or partial remissions, our findings suggest that assessments of both clinical (e .g., severity, chronicity, and comorbidity) and psychobiological (EG s leep and adrenocortical function) factors may identify those depressed patients who are less likely to benefit from CBT alone. Such patients may be preferentially responsive to treatment with pharmacotherapy, e ither alone or, in more complicated cases, in combination with psychot herapy.