The ability of early changes in motivation to predict later antidepressant treatment response

Abstract

Philip Gorwood,1,2 Guillaume Vaiva,3 Emmanuelle Corruble,4 Pierre-Michel Llorca,5 Franck J Baylé,1,2 Philippe Courtet61Centre Hospitalier Sainte-Anne (CMME), Paris, France; 2Centre of Psychiatry and Neuroscience, INSERM U894, University Paris-Descartes, Paris, France; 3Pôle de Psychiatrie, CHRU de Lille, Hôpital Michel-Fontan, Université Lille-Nord de France, Lille, France; 4Psychiatry Department of Bicêtre, University Hospital, INSERM U669, Paris XI University, Le Kremlin Bicêtre, France; 5CHU Clermont-Ferrand, Clermont Université, Université d’Auvergne, Clermont-Ferrand, France; 6Department of Emergency Psychiatry, CHU Montpellier, Montpellier, FranceIntroduction: Baseline values and early changes of emotional reactivity, cognitive speed, psychomotor function, motivation, and sensory perception have not been studied to any extent in unipolar depression, although they could help to characterize different dimensions of illness that are harder to capture by clinicians, give new insights on how patients improve, and offer new early clinical markers for later treatment response.Methods: About 1,565 adult outpatients with major depressive disorder receiving agomelatine completed the clinician-rated 16-item quick inventory of depressive symptoms, Clinical Global Impression, and Multidimensional Assessment of Thymic States (MAThyS) rating scales at inclusion, Week 2 and Week 6. The MAThyS includes a 20-item self-rated visual analog scale (from inhibition [0] to activation [10], with [5] representing the usual state) leading to five a priori dimensions (emotional reactivity, cognitive speed, psychomotor function, motivation, and sensory perception).Results: All MAThyS dimension scores increased from inclusion to Week 2 and from inclusion to Week 6 (P<0.001). Improvement was around 2 points (out of 10) for motivation, 1.5 points for psychomotor function, and 0.5 points for other dimensions. Motivation showed a trend to being more severely impaired at inclusion in future nonresponders (t=1.25, df=1,563, P=0.10). Its improvement at Week 2 was the most discriminating MAThyS dimension between future responders and nonresponders, and represents the best predictor of future response, with the highest area under the receptor operating characteristic curve (area under curve =0.616, 95% confidence interval [0.588–0.643], P<0.001). Finally, improvements in motivation correlated the most strongly with clinician-rated 16-item quick inventory of depressive symptoms improvement (r=-0.491, df=1,563, P<0.001).Conclusion: Motivation had the most capacity for early improvement, the best predictive value for response, and the largest global margin of progress in depressed outpatients. Assessing the evolution of self-reported motivation over time in major depressive disorder could offer an interesting complementary approach to predict response.Keywords: depression, agomelatine, dimension, motivation, treatment response