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Personality change during depression treatment: a placebo-controlled trial.
Arch Gen Psychiatry. 2009 Dec; 66(12):1322-30.AG

Abstract

CONTEXT

High neuroticism is a personality risk factor that reflects much of the genetic vulnerability to major depressive disorder (MDD), and low extraversion may increase risk as well. Both have been linked to the serotonin system.

OBJECTIVES

To test whether patients with MDD taking selective serotonin reuptake inhibitors (SSRIs) report greater changes in neuroticism and extraversion than patients receiving inert placebo, and to examine the state effect hypothesis that self-reported personality change during SSRI treatment is merely a change of depression-related measurement bias.

DESIGN

A placebo-controlled trial.

SETTING

Research clinics. Patients Adult patients with moderate to severe MDD randomized to receive paroxetine (n = 120), placebo (n = 60), or cognitive therapy (n = 60).

OUTCOME MEASURES

NEO Five-Factor Inventory and Hamilton Rating Scale for Depression.

RESULTS

Patients who took paroxetine reported greater personality change than placebo patients, even after controlling for depression improvement (neuroticism, P < .001; extraversion, P = .002). The advantage of paroxetine over placebo in antidepressant efficacy was no longer significant after controlling for change in neuroticism (P = .46) or extraversion (P = .14). Patients taking paroxetine reported 6.8 times as much change on neuroticism and 3.5 times as much change on extraversion as placebo patients matched for depression improvement. Although placebo patients exhibited substantial depression improvement (Hamilton Rating Scale for Depression score, -1.2 SD, P < .001), they reported little change on neuroticism (-0.18 SD, P = .08) or extraversion (0.08 SD, P = .50). Cognitive therapy produced greater personality change than placebo (P </= .01); but its advantage on neuroticism was no longer significant after controlling for depression (P = .14). Neuroticism reduction during treatment predicted lower relapse rates among paroxetine responders (P = .003) but not among cognitive therapy responders (P = .86).

CONCLUSIONS

Paroxetine appears to have a specific pharmacological effect on personality that is distinct from its effect on depression. If replicated, this pattern would disconfirm the state effect hypothesis and instead support the notion that SSRIs' effects on personality go beyond and perhaps contribute to their antidepressant effects.

Authors+Show Affiliations

Northwestern University, Evanston, IL 60208, USA. ttang@northwestern.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Randomized Controlled Trial
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

19996037

Citation

Tang, Tony Z., et al. "Personality Change During Depression Treatment: a Placebo-controlled Trial." Archives of General Psychiatry, vol. 66, no. 12, 2009, pp. 1322-30.
Tang TZ, DeRubeis RJ, Hollon SD, et al. Personality change during depression treatment: a placebo-controlled trial. Arch Gen Psychiatry. 2009;66(12):1322-30.
Tang, T. Z., DeRubeis, R. J., Hollon, S. D., Amsterdam, J., Shelton, R., & Schalet, B. (2009). Personality change during depression treatment: a placebo-controlled trial. Archives of General Psychiatry, 66(12), 1322-30. https://doi.org/10.1001/archgenpsychiatry.2009.166
Tang TZ, et al. Personality Change During Depression Treatment: a Placebo-controlled Trial. Arch Gen Psychiatry. 2009;66(12):1322-30. PubMed PMID: 19996037.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Personality change during depression treatment: a placebo-controlled trial. AU - Tang,Tony Z, AU - DeRubeis,Robert J, AU - Hollon,Steven D, AU - Amsterdam,Jay, AU - Shelton,Richard, AU - Schalet,Benjamin, PY - 2009/12/10/entrez PY - 2009/12/10/pubmed PY - 2009/12/16/medline SP - 1322 EP - 30 JF - Archives of general psychiatry JO - Arch Gen Psychiatry VL - 66 IS - 12 N2 - CONTEXT: High neuroticism is a personality risk factor that reflects much of the genetic vulnerability to major depressive disorder (MDD), and low extraversion may increase risk as well. Both have been linked to the serotonin system. OBJECTIVES: To test whether patients with MDD taking selective serotonin reuptake inhibitors (SSRIs) report greater changes in neuroticism and extraversion than patients receiving inert placebo, and to examine the state effect hypothesis that self-reported personality change during SSRI treatment is merely a change of depression-related measurement bias. DESIGN: A placebo-controlled trial. SETTING: Research clinics. Patients Adult patients with moderate to severe MDD randomized to receive paroxetine (n = 120), placebo (n = 60), or cognitive therapy (n = 60). OUTCOME MEASURES: NEO Five-Factor Inventory and Hamilton Rating Scale for Depression. RESULTS: Patients who took paroxetine reported greater personality change than placebo patients, even after controlling for depression improvement (neuroticism, P < .001; extraversion, P = .002). The advantage of paroxetine over placebo in antidepressant efficacy was no longer significant after controlling for change in neuroticism (P = .46) or extraversion (P = .14). Patients taking paroxetine reported 6.8 times as much change on neuroticism and 3.5 times as much change on extraversion as placebo patients matched for depression improvement. Although placebo patients exhibited substantial depression improvement (Hamilton Rating Scale for Depression score, -1.2 SD, P < .001), they reported little change on neuroticism (-0.18 SD, P = .08) or extraversion (0.08 SD, P = .50). Cognitive therapy produced greater personality change than placebo (P </= .01); but its advantage on neuroticism was no longer significant after controlling for depression (P = .14). Neuroticism reduction during treatment predicted lower relapse rates among paroxetine responders (P = .003) but not among cognitive therapy responders (P = .86). CONCLUSIONS: Paroxetine appears to have a specific pharmacological effect on personality that is distinct from its effect on depression. If replicated, this pattern would disconfirm the state effect hypothesis and instead support the notion that SSRIs' effects on personality go beyond and perhaps contribute to their antidepressant effects. SN - 1538-3636 UR - https://www.unboundmedicine.com/medline/citation/19996037/Personality_change_during_depression_treatment:_a_placebo_controlled_trial_ L2 - https://jamanetwork.com/journals/jamapsychiatry/fullarticle/10.1001/archgenpsychiatry.2009.166 DB - PRIME DP - Unbound Medicine ER -