How Does Positive Mental Health Affect Next-Step Treatment Outcomes in Treatment-Resistant Depression? A VAST-D Report.

Background: Many patients view the return of "positive mental health" (PMH) to be their most important goal of treatment for major depressive disorder (MDD). However, few studies have systematically measured PMH or prospectively examined the added value of considering PMH as a treatment predictor of outcome. This report aims to fill those gaps by determining features associated with PMH and their contributions to outcomes in outpatients with treatment-resistant depression.

Methods: The VA Augmentation and Switching Treatments for Depression trial randomized 1522 participants to 1 of 3 next-step treatments: switching to bupropion (S-BUP), combining with bupropion (C-BUP), or augmenting with aripiprazole (A-ARI). PMH was measured by a novel, 7-item, self-rated questionnaire. The features and outcomes associated with PMH at baseline and during 12 weeks of treatment were explored.

Results: Low PMH scores at baseline were associated with greater severity and chronicity of depression, suicidal ideation, increased anxiety, comorbid PTSD, grief, and lower quality of life. High PMH scores were associated with a greater likelihood of remission. PMH scores improved with treatment, especially if the next-step treatment was A-AUG as opposed to S-BUP. Improvement in PMH was associated with higher remission and response rates.

Conclusions: Targeting deficiencies in PMH could help optimize outcomes in patients with MDD.

Clinical trial registration: ClinicalTrials.gov identifier NCT01421342.