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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
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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
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Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

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Footnotes

*

These authors share the first authorship.

†

These authors share the last authorship.

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