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Depression has a significant impact on patient health, individual and family quality of life, everyday activities, and daily functioning, as well as healthcare providers, payers, and employers. People who suffer from depression frequently have many comorbidities, which compound bad consequences and raise costs. The disorder has a considerable economic impact, with direct medical expenditures estimated at $3.5 million per 1000 plan members suffering from depression.¹ Depression is vastly underdiagnosed and undertreated, particularly in primary care where many depressed people seek treatment. Effective remission techniques have been found and demonstrated in clinical trials. Early detection, management, and appropriate treatment can promote remission, prevent relapse, and lessen the disease's emotional and financial toll.¹

Early symptomatic response has been linked to better post-treatment outcomes in some studies. However, the degree of this connection varies significantly across research and clinical samples. According to one study, early response predicts some post-treatment outcomes (panic attacks), but not others (anticipatory avoidance).² Furthermore, in psychological therapy there is still no agreed-upon time range for when early response occurs. For example, some studies have found that early response can happen as soon as week two or three, while others have found that it can happen as late as week eight or nine.² Additionally, different psychological therapies require a variable number of appointments during the first month of treatment. Early response studies also vary because they use different symptom measures, and baseline levels of distress differ across research samples.²

As a result, whereas early symptomatic improvements appear to be associated with a better prognosis, the replicability, statistical significance, and magnitude of the link between early response and post-treatment outcomes remain unknown. One study sought to synthesize what is known regarding the relationship between early response and psychological treatment results in adult patients seeking treatment for depression and anxiety.²

Early symptomatic response has been linked in certain studies to greater post-treatment results. However, the strength of this relationship varies significantly between research and clinical samples. For instance, in studies predicting treatment response in patients seeking guided self-help for depression, one study showed an odds ratio (OR) of 1.33, whilst another study reported an OR of 12.60.² Others have discovered contradictory outcomes. For example, another study revealed no correlation between early response and treatment discontinuation. In addition, it was discovered that some post-treatment outcomes (panic episodes) were predicted by early response, but not others (anticipatory avoidance). Furthermore, there is currently no accepted timeline for what constitutes an early response in psychiatric therapy.²

Additionally, various psychological treatments have diverse sessions held during the first month of treatment. According to one study, cognitive behavioral therapy (CBT) does not necessarily involve four sessions in the first month; rather, in treatments spanning from 12- to 20-weeks, 40 to 60 percent of sessions take place in the first month. Studies evaluating early response are also diverse in terms of their inclusion criteria, design (for example, observational studies, randomized controlled trials), and outcome measures.²

There is strong evidence to support the idea that patients who exhibit consistent clinical improvement during the first few therapy sessions will likely have a substantially better prognosis after treatment.² Frequently evaluating early response is crucial because it has the potential to identify those who may have a prolonged, or restricted response, to therapy. For patients who have not yet seen reliable symptomatic improvements, a clinical assessment using validated outcome measures is advised—during the fourth therapy session—to evaluate progress and spot any potential roadblocks to recovery.

References:

1.    Halfin A. Depression: the benefits of early and appropriate treatment. Am J Manag Care. 2007;13(4 Suppl):S92-S97.
2.    Beard JIL, Delgadillo J. Early response to psychological therapy as a predictor of depression and anxiety treatment outcomes: A systematic review and meta-analysis. Depress Anxiety. 2019;36(9):866-878. doi:10.1002/da.22931