Hostname: page-component-5cf477f64f-n7lw4 Total loading time: 0 Render date: 2025-04-03T10:54:00.499Z Has data issue: false hasContentIssue false
  • English
  • Français

Dimensions of temperament and character as predictors of antidepressant discontinuation, response and adverse reactions during treatment with nortriptyline and escitalopram

Published online by Cambridge University Press:  12 November 2021

Ole Köhler-Forsberg Open the ORCID record for Ole Köhler-Forsberg [Opens in a new window] ,
Robert Keers ,
Rudolf Uher ,
Joanna Hauser ,
Wolfgang Maier ,
Marcella Rietschel ,
Peter McGuffin ,
Anne E. Farmer ,
Katherine J. Aitchison  and
Ole Mors
Ole Köhler-Forsberg*
Affiliation:
Psychosis Research Unit, Aarhus University Hospital – Psychiatry, Aarhus, Denmark Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
Robert Keers
Affiliation:
Department of Biological and Experimental Psychology, Queen Mary University of London, Mile End, London, UK Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
Rudolf Uher
Affiliation:
Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
Joanna Hauser
Affiliation:
Department of Psychiatry, Laboratory of Psychiatric Genetics, Poznan University of Medical Sciences, Poznan, Poland
Wolfgang Maier
Affiliation:
Department of Psychiatry, University of Bonn, Bonn, Germany
Marcella Rietschel
Affiliation:
Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
Peter McGuffin
Affiliation:
Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
Anne E. Farmer
Affiliation:
Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
Katherine J. Aitchison
Affiliation:
Department of Psychiatry, Department of Medical Genetics, University of Alberta, Edmonton, Canada Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Canada
Ole Mors
Affiliation:
Psychosis Research Unit, Aarhus University Hospital – Psychiatry, Aarhus, Denmark Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
*
Author for correspondence: Ole Köhler-Forsberg, E-mail: karkoe@rm.dk
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Personality traits may predict antidepressant discontinuation and response. However, previous studies were rather small, only explored a few personality traits and did not include adverse drug effects nor the interdependency between antidepressant discontinuation patterns and response.

Methods

GENDEP included 589 patients with unipolar moderate-severe depression treated with escitalopram or nortriptyline for 12 weeks. Seven personality dimensions were measured using the self-reported 240-item Temperament and Character Inventory-Revised (TCI-R). We applied Cox proportional models to study discontinuation patterns, logistic and linear regression to investigate response and remission after 8 and 12 weeks, and mixed-effects linear models regarding time-varying treatment response and adverse drug reactions.

Results

Low harm avoidance, low cooperativeness, high self-transcendence and high novelty seeking were associated with higher risks for antidepressant discontinuation, independent of depressed mood, adverse drug reactions, drug, sex and age. Regression analyses showed that higher novelty seeking and cooperativeness scores were associated with a greater likelihood of response and remission after 8 and 12 weeks, respectively, but we found no correlations with response in the mixed-effects models. Only high harm avoidance was associated with more self-reported adverse effects.

Conclusions

This study, representing the largest investigation between several personality traits and response to two different antidepressants, suggests that correlations between personality traits and antidepressant treatment response may be confounded by differential rates of discontinuation. Future trials on personality in the treatment of depression need to consider this interdependency and study whether interventions aiming at improving compliance for some personality types may improve response to antidepressants.

Keywords

Antidepressantdepressiondiscontinuationmajor depressive disorder (MDD)personalityresponse
Type
Original Article
Information
Psychological Medicine , Volume 53 , Issue 6 , April 2023 , pp. 2522 - 2530
Check for updates
Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

*

These authors share the first authorship.

†

These authors share the last authorship.

References

Akerblad, A. C., Bengtsson, F., Holgersson, M., von Knorring, L., & Ekselius, L. (2008). Identification of primary care patients at risk of nonadherence to antidepressant treatment. Patient Preference and Adherence, 2, 379–386. doi: 10.2147/ppa.s3511Google ScholarPubMed
Aluoja, A., Tõru, I., Raag, M., Eller, T., Võhma, Ü, & Maron, E. (2018). Personality traits and escitalopram treatment outcome in major depression. Nordic Journal of Psychiatry, 72(5), 354–360. doi: 10.1080/08039488.2018.1465590CrossRefGoogle ScholarPubMed
Ashton, A. K., Jamerson, B. D., W, L. W., & Wagoner, C. (2005). Antidepressant-related adverse effects impacting treatment compliance: Results of a patient survey. Current Therapeutic Research, Clinical and Experimentals, 66(2), 96–106. doi: 10.1016/j.curtheres.2005.04.006CrossRefGoogle ScholarPubMed
Beck, A. T., Ward, C. H., Mendelson, M., Mock, J., & Erbaugh, J. (1961). An inventory for measuring depression. Archives of General Psychiatry, 4, 561–571.CrossRefGoogle ScholarPubMed
Cloninger, C. R. (1999). The temperament and character inventory-revised. St.Louis, MO: Center for Psychobiology of Personality, Washington University.Google Scholar
Cloninger, C. R., Svrakic, D. M., & Przybeck, T. R. (1993). A psychobiological model of temperament and character. Archives of General Psychiatry, 50(12), 975–990.CrossRefGoogle ScholarPubMed
Cloninger, C. R., Svrakic, D. M., & Przybeck, T. R. (2006). Can personality assessment predict future depression? A twelve-month follow-up of 631 subjects. Journal of Affective Disorders, 92(1), 35–44. doi: 10.1016/j.jad.2005.12.034CrossRefGoogle ScholarPubMed
Dermody, S. S., Quilty, L. C., & Bagby, R. M. (2016). Interpersonal impacts mediate the association between personality and treatment response in major depression. Journal of Counseling Psychology, 63(4), 396–404. doi: 10.1037/cou0000144CrossRefGoogle ScholarPubMed
Ekselius, L., Bengtsson, F., & von Knorring, L. (2000). Non-compliance with pharmacotherapy of depression is associated with a sensation seeking personality. International Clinical Psychopharmacology, 15(5), 273–278. doi: 10.1097/00004850-200015050-00004CrossRefGoogle ScholarPubMed
Farmer, A., Mahmood, A., Redman, K., Harris, T., Sadler, S., & McGuffin, P. (2003). A sib-pair study of the temperament and character inventory scales in major depression. Archives of General Psychiatry, 60(5), 490–496. doi: 10.1001/archpsyc.60.5.490CrossRefGoogle ScholarPubMed
Gutiérrez, F., Torrens, M., Boget, T., Martín-Santos, R., Sangorrín, J., Pérez, G., & Salamero, M. (2001). Psychometric properties of the temperament and character inventory (TCI) questionnaire in a Spanish psychiatric population. Acta Psychiatrica Scandinavica, 103(2), 143–147. doi: 10.1034/j.1600-0447.2001.00183.xCrossRefGoogle Scholar
Hamilton, M. (1960). A rating scale for depression. Journal of Neurology, Neurosurgery, and Psychiatry, 23, 56–62.CrossRefGoogle ScholarPubMed
Hengartner, M. P., Ajdacic-Gross, V., Wyss, C., Angst, J., & Rössler, W. (2016). Relationship between personality and psychopathology in a longitudinal community study: A test of the predisposition model. Psychological Medicine, 46(8), 1693–1705. doi: 10.1017/s0033291716000210CrossRefGoogle Scholar
Joyce, P. R., Mulder, R. T., & Cloninger, C. R. (1994). Temperament predicts clomipramine and desipramine response in major depression. Journal of Affective Disorders, 30(1), 35–46. doi: 10.1016/0165-0327(94)90149-xCrossRefGoogle ScholarPubMed
Kohler-Forsberg, O., Larsen, E. R., Buttenschon, H. N., Rietschel, M., Hauser, J., Souery, D., … Mors, O. (2019). Effect of antidepressant switching between nortriptyline and escitalopram after a failed first antidepressant treatment among patients with major depressive disorder. The British Journal of Psychiatry, 215(2), 494–501. doi: 10.1192/bjp.2018.302. 10.1192/bjp.2018.302 [doi]CrossRefGoogle ScholarPubMed
Kravitz, H. M., Fawcett, J., McGuire, M., Kravitz, G. S., & Whitney, M. (1999). Treatment attrition among alcohol-dependent men: Is it related to novelty seeking personality traits? Journal of Clinical Psychopharmacology, 19(1), 51–56. doi: 10.1097/00004714-199902000-00010CrossRefGoogle ScholarPubMed
Kusunoki, K., Sato, T., Taga, C., Yoshida, T., Komori, K., Narita, T., … Ozaki, N. (2000). Low novelty-seeking differentiates obsessive-compulsive disorder from major depression. Acta Psychiatrica Scandinavica, 101(5), 403–405. doi: 10.1034/j.1600-0447.2000.101005403.xCrossRefGoogle ScholarPubMed
Liraud, F., & Verdoux, H. (2001). Association between temperamental characteristics and medication adherence in subjects presenting with psychotic or mood disorders. Psychiatry Research, 102(1), 91–95. doi: 10.1016/s0165-1781(01)00240-2CrossRefGoogle ScholarPubMed
Melke, J., Westberg, L., Nilsson, S., Landen, M., Soderstrom, H., Baghaei, F., … Eriksson, E. (2003). A polymorphism in the serotonin receptor 3A (HTR3A) gene and its association with harm avoidance in women. Archives of General Psychiatry, 60(10), 1017–1023. doi: 10.1001/archpsyc.60.10.1017CrossRefGoogle ScholarPubMed
Montgomery, S. A., & Asberg, M. (1979). A new depression scale designed to be sensitive to change. The British Journal of Psychiatry, 134, 382–389.CrossRefGoogle ScholarPubMed
Mulder, R. T. (2002). Personality pathology and treatment outcome in major depression: A review. American Journal of Psychiatry, 159(3), 359–371. doi: 10.1176/appi.ajp.159.3.359CrossRefGoogle ScholarPubMed
Naito, M., Kijima, N., & Kitamura, T. (2000). Temperament and character inventory (TCI) as predictors of depression among Japanese college students. Journal of Clinical Psychology, 56(12), 1579–1585. doi: 10.1002/1097-4679(200012)56:12<1579::Aid-8>3.0.Co;2-k3.0.CO;2-K>CrossRefGoogle ScholarPubMed
Otte, C., Gold, S. M., Penninx, B. W., Pariante, C. M., Etkin, A., Fava, M., … Schatzberg, A. F. (2016). Major depressive disorder. Nature Reviews Disease Primers, 2, 16065. doi: 10.1038/nrdp.2016.65 [doi]CrossRefGoogle ScholarPubMed
Prieto-Vila, M., Estupiñá, F. J., & Cano-Vindel, A. (2021). Risk factors associated with relapse in major depressive disorder in primary care patients: A systematic review. Psicothema, 33(1), 44–52. doi: 10.7334/psicothema2020.186Google ScholarPubMed
Quilty, L. C., De Fruyt, F., Rolland, J. P., Kennedy, S. H., Rouillon, P. F., & Bagby, R. M. (2008a). Dimensional personality traits and treatment outcome in patients with major depressive disorder. Journal of Affective Disorders, 108(3), 241–250. doi: 10.1016/j.jad.2007.10.022CrossRefGoogle ScholarPubMed
Quilty, L. C., Meusel, L. A., & Bagby, R. M. (2008b). Neuroticism as a mediator of treatment response to SSRIs in major depressive disorder. Journal of Affective Disorders, 111(1), 67–73. doi: 10.1016/j.jad.2008.02.006CrossRefGoogle ScholarPubMed
Richter, J., Polak, T., & Eisemann, M. (2003). Depressive mood and personality in terms of temperament and character among the normal population and depressive inpatients. Personality and Individual Differences, 35(4), 917–927.CrossRefGoogle Scholar
Schmidt, F. M., Sander, C., Minkwitz, J., Mergl, R., Dalton, B., Holdt, L. M., … Himmerich, H. (2018). Serum markers of inflammation mediate the positive association between neuroticism and depression. Frontiers in Psychiatry, 9, 609. doi: 10.3389/fpsyt.2018.00609CrossRefGoogle Scholar
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), 1322–1330. doi: 10.1001/archgenpsychiatry.2009.166CrossRefGoogle ScholarPubMed
Uher, R., Farmer, A., Henigsberg, N., Rietschel, M., Mors, O., Maier, W., … Aitchison, K. J. (2009a). Adverse reactions to antidepressants. British Journal of Psychiatry, 195(3), 202–210. doi: 10.1192/bjp.bp.108.061960CrossRefGoogle ScholarPubMed
Uher, R., Farmer, A., Maier, W., Rietschel, M., Hauser, J., Marusic, A., … Aitchison, K. J. (2008). Measuring depression: Comparison and integration of three scales in the GENDEP study. Psychological Medicine, 38(2), 289–300. doi: 10.1017/s0033291707001730CrossRefGoogle ScholarPubMed
Uher, R., Maier, W., Hauser, J., Marusic, A., Schmael, C., Mors, O., … McGuffin, P. (2009b). Differential efficacy of escitalopram and nortriptyline on dimensional measures of depression. British Journal of Psychiatry, 194(3), 252–259. doi: 10.1192/bjp.bp.108.057554CrossRefGoogle ScholarPubMed
Verhoeven, F. E. A., Wardenaar, K. J., Ruhé, H. G. E., Conradi, H. J., & de Jonge, P. (2018). Seeing the signs: Using the course of residual depressive symptomatology to predict patterns of relapse and recurrence of major depressive disorder. Depression and Anxiety, 35(2), 148–159. doi: 10.1002/da.22695CrossRefGoogle ScholarPubMed
Webb, C. A., Trivedi, M. H., Cohen, Z. D., Dillon, D. G., Fournier, J. C., Goer, F., … Pizzagalli, D. A. (2019). Personalized prediction of antidepressant v. placebo response: Evidence from the EMBARC study. Psychological Medicine, 49(7), 1118–1127. doi: 10.1017/s0033291718001708CrossRefGoogle ScholarPubMed
Wing, J. S. N., & Üstun, T. (1998). WHO diagnosis and clinical measurement in psychiatry. A reference manual for SCAN. Cambridge: Cambridge University Press.CrossRefGoogle Scholar
Wingerson, D., Sullivan, M., Dager, S., Flick, S., Dunner, D., & Roy-Byrne, P. (1993). Personality traits and early discontinuation from clinical trials in anxious patients. Journal of Clinical Psychopharmacology, 13(3), 194–197.CrossRefGoogle ScholarPubMed
Supplementary material: File

Köhler-Forsberg et al. supplementary material

Tables S1 and S2

Download Köhler-Forsberg et al. supplementary material(File)
File 20.9 KB