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Depression: HELP
Articles by Jay C. Fournier
Based on 12 articles published since 2008

Between 2008 and 2019, J. C. Fournier wrote the following 12 articles about Depression.
+ Citations + Abstracts
1 Review Antidepressant drug effects and depression severity: a patient-level meta-analysis. 2010

Fournier, Jay C / DeRubeis, Robert J / Hollon, Steven D / Dimidjian, Sona / Amsterdam, Jay D / Shelton, Richard C / Fawcett, Jan. ·Department of Psychology, University of Pennsylvania, 3720 Walnut St, Philadelphia, PA 19104, USA. jcf@sas.upenn.edu ·JAMA · Pubmed #20051569.

ABSTRACT: CONTEXT: Antidepressant medications represent the best established treatment for major depressive disorder, but there is little evidence that they have a specific pharmacological effect relative to pill placebo for patients with less severe depression. OBJECTIVE: To estimate the relative benefit of medication vs placebo across a wide range of initial symptom severity in patients diagnosed with depression. DATA SOURCES: PubMed, PsycINFO, and the Cochrane Library databases were searched from January 1980 through March 2009, along with references from meta-analyses and reviews. STUDY SELECTION: Randomized placebo-controlled trials of antidepressants approved by the Food and Drug Administration in the treatment of major or minor depressive disorder were selected. Studies were included if their authors provided the requisite original data, they comprised adult outpatients, they included a medication vs placebo comparison for at least 6 weeks, they did not exclude patients on the basis of a placebo washout period, and they used the Hamilton Depression Rating Scale (HDRS). Data from 6 studies (718 patients) were included. DATA EXTRACTION: Individual patient-level data were obtained from study authors. RESULTS: Medication vs placebo differences varied substantially as a function of baseline severity. Among patients with HDRS scores below 23, Cohen d effect sizes for the difference between medication and placebo were estimated to be less than 0.20 (a standard definition of a small effect). Estimates of the magnitude of the superiority of medication over placebo increased with increases in baseline depression severity and crossed the threshold defined by the National Institute for Clinical Excellence for a clinically significant difference at a baseline HDRS score of 25. CONCLUSIONS: The magnitude of benefit of antidepressant medication compared with placebo increases with severity of depression symptoms and may be minimal or nonexistent, on average, in patients with mild or moderate symptoms. For patients with very severe depression, the benefit of medications over placebo is substantial.

2 Article Neural correlates of autobiographical problem-solving deficits associated with rumination in depression. 2017

Jones, Neil P / Fournier, Jay C / Stone, Lindsey B. ·Department of Psychiatry, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, 3811 O'Hara St., Pittsburgh, PA 15216, USA. Electronic address: jonesnp@upmc.edu. · Department of Psychiatry, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, 3811 O'Hara St., Pittsburgh, PA 15216, USA. ·J Affect Disord · Pubmed #28477499.

ABSTRACT: BACKGROUND: Analytical rumination can be characterized as negative thoughts focused on searching for answers to personal problems. Failure to think concretely during autobiographical problem-solving (APS) is hypothesized to drive the inability of ruminators to generate effective solutions. Clarifying the brain correlates underlying APS deficits in depressed ruminators may identify novel biological targets for treatment. METHOD: Forty participants (22 unmedicated depressed and 18 never-depressed adults) ranging in rumination engaged in APS and negative self-referential processing (NSP) of negative trait adjectives during fMRI. We contrasted activation during APS with activation during NSP to isolate regions contributing to APS. RESULTS: Rumination was associated with having generated fewer solutions during APS and with a failure to recruit the angular gyrus (AG) and the medial frontal gyrus (MFG) during APS. Rumination was associated with greater MFG activation during NSP and stronger connectivity between the AG and the rostrolateral prefrontal cortex (RLPFC) during APS relative to NSP. Findings were not driven by clinical status. LIMITATIONS: The use of an extreme groups approach can result in overestimation of effects sizes. CONCLUSIONS: Ruminators fail to recruit regions with the default network (DN) that support APS. In particular, a failure to recruit the AG during APS may drive the abstract thinking style previously shown to explain depressed ruminator's difficulty generating concrete solutions. Targeting this mechanism directly may reduce rumination.

3 Article Brain mechanisms of anxiety's effects on cognitive control in major depressive disorder. 2016

Jones, N P / Chase, H W / Fournier, J C. ·Department of Psychiatry,University of Pittsburgh School of Medicine,Pittsburgh, PA,USA. ·Psychol Med · Pubmed #27291341.

ABSTRACT: BACKGROUND: Adults with major depressive disorder (MDD) demonstrate increased susceptibility to interfering effects of anxiety on cognitive control; although under certain conditions adults with MDD are able to compensate for these effects. The brain mechanisms that may facilitate the ability to compensate for anxiety either via the recruitment of additional cognitive resources or via the regulation of interference from anxiety remain largely unknown. To clarify these mechanisms, we examined the effects of anxiety on brain activity and amygdala-prefrontal functional connectivity in adults diagnosed with MDD. METHOD: A total of 22 unmedicated adults with MDD and 18 healthy controls (HCs) performed the Tower of London task under conditions designed to induce anxiety, while undergoing a functional magnetic resonance imaging assessment. RESULTS: During the easy condition, the MDD group demonstrated equivalent planning accuracy, longer planning times, elevated amygdala activity and left rostrolateral prefrontal cortex (RLPFC) hyperactivity relative to HCs. Anxiety mediated observed group differences in planning times, as well as differences in amygdala activation, which subsequently mediated observed differences in RLPFC activation. During the easy condition, the MDD group also demonstrated increased negative amygdala-dorsolateral prefrontal cortex (DLPFC) connectivity which correlated with improved planning accuracy. During the hard condition, HCs demonstrated greater DLPFC activation and stronger negative amygdala-DLPFC connectivity, which was unrelated to planning accuracy. CONCLUSIONS: Our results suggest that persons with MDD compensate for anxiety-related limbic activation during low-load cognitive tasks by recruiting additional RLPFC activation and through increased inhibitory amygdala-DLPFC communication. Targeting these neural mechanisms directly may improve cognitive functioning in MDD.

4 Article Gains in employment status following antidepressant medication or cognitive therapy for depression. 2015

Fournier, Jay C / DeRubeis, Robert J / Amsterdam, Jay / Shelton, Richard C / Hollon, Steven D. ·Jay C. Fournier, PhD, Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Robert J. DeRubeis, PhD, Department of Psychology, University of Pennsylvania, Philadelphia, Pennsylvania; Jay Amsterdam, MD, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Richard C. Shelton, MD, Department of Psychiatry and Behavioral Neurobiology, The University of Alabama at Birmingham, Birmingham, Alabama; Steven D. Hollon, PhD, Department of Psychology, Vanderbilt University, Nashville, Tennessee, USA. ·Br J Psychiatry · Pubmed #24925985.

ABSTRACT: BACKGROUND: Depression can adversely affect employment status. AIMS: To examine whether there is a relative advantage of cognitive therapy or antidepressant medication in improving employment status following treatment, using data from a previously reported trial. METHOD: Random assignment to cognitive therapy (n = 48) or the selective serotonin reuptake inhibitor paroxetine (n = 93) for 4 months; treatment responders were followed for up to 24 months. Differential effects of treatment on employment status were examined. RESULTS: At the end of 28 months, cognitive therapy led to higher rates of full-time employment (88.9%) than did antidepressant medication among treatment responders (70.8%), χ(2) 1 = 5.78, P = 0.02, odds ratio (OR) = 5.66, 95% CI 1.16-27.69. In the shorter-term, the main effect of treatment on employment status was not significant following acute treatment (χ(2) 1 = 1.74, P = 0.19, OR = 1.77, 95% CI 0.75-4.17); however, we observed a site×treatment interaction (χ(2) 1 = 6.87, P = 0.009) whereby cognitive therapy led to a higher rate of full-time employment at one site but not at the other. CONCLUSIONS: Cognitive therapy may produce greater improvements in employment v. medication, particularly over the longer term.

5 Article The Personalized Advantage Index: translating research on prediction into individualized treatment recommendations. A demonstration. 2014

DeRubeis, Robert J / Cohen, Zachary D / Forand, Nicholas R / Fournier, Jay C / Gelfand, Lois A / Lorenzo-Luaces, Lorenzo. ·Department of Psychology, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America. · Department of Psychiatry, The Ohio State University, Columbus, Ohio, United States of America. · Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America. ·PLoS One · Pubmed #24416178.

ABSTRACT: BACKGROUND: Advances in personalized medicine require the identification of variables that predict differential response to treatments as well as the development and refinement of methods to transform predictive information into actionable recommendations. OBJECTIVE: To illustrate and test a new method for integrating predictive information to aid in treatment selection, using data from a randomized treatment comparison. METHOD: Data from a trial of antidepressant medications (N = 104) versus cognitive behavioral therapy (N = 50) for Major Depressive Disorder were used to produce predictions of post-treatment scores on the Hamilton Rating Scale for Depression (HRSD) in each of the two treatments for each of the 154 patients. The patient's own data were not used in the models that yielded these predictions. Five pre-randomization variables that predicted differential response (marital status, employment status, life events, comorbid personality disorder, and prior medication trials) were included in regression models, permitting the calculation of each patient's Personalized Advantage Index (PAI), in HRSD units. RESULTS: For 60% of the sample a clinically meaningful advantage (PAI≥3) was predicted for one of the treatments, relative to the other. When these patients were divided into those randomly assigned to their "Optimal" treatment versus those assigned to their "Non-optimal" treatment, outcomes in the former group were superior (d = 0.58, 95% CI .17-1.01). CONCLUSIONS: This approach to treatment selection, implemented in the context of two equally effective treatments, yielded effects that, if obtained prospectively, would rival those routinely observed in comparisons of active versus control treatments.

6 Article Amygdala and whole-brain activity to emotional faces distinguishes major depressive disorder and bipolar disorder. 2013

Fournier, Jay C / Keener, Matthew T / Almeida, Jorge / Kronhaus, Dina M / Phillips, Mary L. ·Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. ·Bipolar Disord · Pubmed #23911154.

ABSTRACT: OBJECTIVES: It can be clinically difficult to distinguish depressed individuals with bipolar disorder (BD) and major depressive disorder (MDD). To examine potential biomarkers of difference between the two disorders, the current study examined differences in the functioning of emotion-processing neural regions during a dynamic emotional faces task. METHODS: During functional magnetic resonance imaging, healthy control adults (HC) (n = 29) and depressed adults with MDD (n = 30) and BD (n = 22) performed an implicit emotional-faces task in which they identified a color label superimposed on neutral faces that dynamically morphed into one of four emotional faces (angry, fearful, sad, happy). We compared neural activation between the groups in an amygdala region-of-interest and at the whole-brain level. RESULTS: Adults with MDD showed significantly greater activity than adults with BD in the left amygdala to the anger condition (p = 0.01). Results of whole-brain analyses (at p < 0.005, k ≥ 20) revealed that adults with BD showed greater activity to sad faces in temporoparietal regions, primarily in the left hemisphere, whereas individuals with MDD demonstrated greater activity than those with BD to displays of anger, fear, and happiness. Many of the observed BD-MDD differences represented abnormalities in functioning compared to HC. CONCLUSIONS: We observed a dissociation between depressed adults with BD and MDD in the processing of emerging emotional faces. Those with BD showed greater activity during mood-congruent (i.e., sad) faces, whereas those with MDD showed greater activity for mood-incongruent (i.e., fear, anger, and happy) faces. Such findings may reflect markers of differences between BD and MDD depression in underlying pathophysiological processes.

7 Article Differential change in specific depressive symptoms during antidepressant medication or cognitive therapy. 2013

Fournier, Jay C / DeRubeis, Robert J / Hollon, Steven D / Gallop, Robert / Shelton, Richard C / Amsterdam, Jay D. ·Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O'Hara Street, Pittsburgh, PA 15213, USA. fournierjc@upmc.edu ·Behav Res Ther · Pubmed #23644038.

ABSTRACT: Cognitive therapy and antidepressant medications are effective treatments for depression, but little is known about their relative efficacy in reducing individual depressive symptoms. Using data from a recent clinical trial comparing cognitive therapy, antidepressant medication, and placebo in the treatment of moderate-to-severe depression, we examined whether there was a relative advantage of any treatment in reducing the severity of specific depressive symptom clusters. The sample consisted of 231 depressed outpatients randomly assigned to: cognitive therapy for 16 weeks (n = 58); paroxetine treatment for 16 weeks (n = 116); or pill placebo for 8 weeks (n = 57). Differential change in five subsets of depressive symptoms was examined: mood, cognitive/suicide, anxiety, typical-vegetative, and atypical-vegetative symptoms. Medication led to a greater reduction in cognitive/suicide symptoms relative to placebo by 4 weeks, and both active treatments reduced these symptoms more than did placebo by 8 weeks. Cognitive therapy reduced the atypical-vegetative symptoms more than placebo by 8 weeks and more than medications throughout the trial. These findings suggest that medications and cognitive therapy led to different patterns of response to specific symptoms of depression and that the general efficacy of these two well-validated treatments may be driven in large part by changes in cognitive or atypical-vegetative symptoms.

8 Article Heterogeneity of amygdala response in major depressive disorder: the impact of lifetime subthreshold mania. 2013

Fournier, J C / Keener, M T / Mullin, B C / Hafeman, D M / Labarbara, E J / Stiffler, R S / Almeida, J / Kronhaus, D M / Frank, E / Phillips, M L. ·Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, USA. fournierjc@upmc.edu ·Psychol Med · Pubmed #22571805.

ABSTRACT: BACKGROUND: Patients with major depressive disorder (MDD) present with highly heterogeneous symptom profiles. We aimed to examine whether individual differences in amygdala activity to emotionally salient stimuli were related to heterogeneity in lifetime levels of depressive and subthreshold manic symptoms among adults with MDD. METHOD: We compared age- and gender-matched adults with MDD (n = 26) with healthy controls (HC, n = 28). While undergoing functional magnetic resonance imaging, participants performed an implicit emotional faces task: they labeled a color flash superimposed upon initially neutral faces that dynamically morphed into one of four emotions (angry, fearful, sad, happy). Region of interest analyses examined group differences in amygdala activity. For conditions in which adults with MDD displayed abnormal amygdala activity versus HC, within-group analyses examined amygdala activity as a function of scores on a continuous measure of lifetime depression-related and mania-related pathology. RESULTS: Adults with MDD showed significantly greater right-sided amygdala activity to angry and happy conditions than HC (p < 0.05, corrected). Multiple regression analyses revealed that greater right-amygdala activity to the happy condition in adults with MDD was associated with higher levels of subthreshold manic symptoms experienced across the lifespan (p = 0.002). CONCLUSIONS: Among depressed adults with MDD, lifetime features of subthreshold mania were associated with abnormally elevated amygdala activity to emerging happy faces. These findings are a first step toward identifying biomarkers that reflect individual differences in neural mechanisms in MDD, and challenge conventional mood disorder diagnostic boundaries by suggesting that some adults with MDD are characterized by pathophysiological processes that overlap with bipolar disorder.

9 Article The role of personality pathology in depression treatment outcome with psychotherapy and pharmacotherapy. 2012

Levenson, Jessica C / Wallace, Meredith L / Fournier, Jay C / Rucci, Paola / Frank, Ellen. ·Department of Psychology, University of Pittsburgh, PA 15213, USA. ·J Consult Clin Psychol · Pubmed #22823857.

ABSTRACT: BACKGROUND: Depressed patients with comorbid personality pathology may fare worse in treatment for depression than those without this additional pathology, and comorbid personality pathology may be associated with superior response in one form of treatment relative to another, though recent findings have been mixed. We aimed to evaluate the effect of personality pathology on time to remission of patients randomly assigned to 1 of 2 treatment strategies for depression and to determine whether personality pathology moderated the effect of treatment assignment on outcome. METHOD: Individuals undergoing an episode of unipolar major depression (n = 275) received interpersonal psychotherapy (Klerman, Weissman, Rounsaville, & Chevron, 1984) or selective serotonin reuptake inhibitor (SSRI) pharmacotherapy for depression. Depressive symptoms were measured with the HRSD-17. Remission was a mean HRSD-17 score of 7 or below over a period of 3 weeks. Personality disorders were measured according to SCID-II diagnoses, and personality pathology was measured dimensionally by summing the positive probes on the SCID-II. RESULTS: The presence of at least 1 personality disorder was not a significant predictor of time to remission, but a higher level of dimensionally measured personality pathology and the presence of borderline personality disorder were associated with a longer time to remission. Personality pathology did not moderate the effect of treatment assignment on time to remission. CONCLUSIONS: The findings suggest that depressed individuals with comorbid personality pathology generally fare worse in treatment for depression, although in this report, the effect of personality pathology did not differ by the type of treatment received.

10 Article The clinical effectiveness of cognitive therapy for depression in an outpatient clinic. 2010

Gibbons, Carly J / Fournier, Jay C / Stirman, Shannon Wiltsey / DeRubeis, Robert J / Crits-Christoph, Paul / Beck, Aaron T. ·Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06510, United States. carly.gibbons@yale.edu ·J Affect Disord · Pubmed #20080305.

ABSTRACT: BACKGROUND: Cognitive therapy (CT) has been shown to be efficacious in the treatment of depression in numerous randomized controlled trials (RCTs). However, little evidence is available that speaks to the effectiveness of this treatment under routine clinical conditions. METHOD: This paper examines outcomes of depressed individuals seeking cognitive therapy at an outpatient clinic (N=217, Center for Cognitive Therapy; CCT). Outcomes were then compared to those of participants in a large NIMH-funded RCT of cognitive therapy and medications as treatments for depression. RESULTS: The CCT is shown to be a clinically representative setting, and 61% of participants experienced reliable change in symptoms over the course of treatment; of those, 45% (36% of the total sample) met criteria for recovery by the end of treatment. Participants at CCT had similar outcomes to participants treated in the RCT, but there was some evidence that those with more severe symptoms at intake demonstrated greater improvement in the RCT than their counterparts at CCT. LIMITATIONS: The CCT may not be representative of all outpatient settings, and the structure of treatment there was considerably different from that in the RCT. Treatment fidelity was not assessed at CCT. CONCLUSIONS: Depressed individuals treated with cognitive therapy in a routine clinical care setting showed a significant improvement in symptoms. When compared with outcomes evidenced in RCTs, there was little evidence of superior outcomes in either setting. However, for more severe participants, outcomes were found to be superior when treatment was delivered within an RCT than in an outpatient setting. Clinicians treating such patients in non-research settings may thus benefit from making modifications to treatment protocols to more closely resemble research settings.

11 Article Prediction of response to medication and cognitive therapy in the treatment of moderate to severe depression. 2009

Fournier, Jay C / DeRubeis, Robert J / Shelton, Richard C / Hollon, Steven D / Amsterdam, Jay D / Gallop, Robert. ·Department of Psychology, University of Pennsylvania, Philadelphia, PA 19104, USA. jcf@sas.upenn.edu ·J Consult Clin Psychol · Pubmed #19634969.

ABSTRACT: A recent randomized controlled trial found nearly equivalent response rates for antidepressant medications and cognitive therapy in a sample of moderate to severely depressed outpatients. In this article, the authors seek to identify the variables that were associated with response across both treatments as well as variables that predicted superior response in one treatment over the other. The sample consisted of 180 depressed outpatients: 60 of whom were randomly assigned to cognitive therapy; 120 were assigned to antidepressant medications. Treatment was provided for 16 weeks. Chronic depression, older age, and lower intelligence each predicted relatively poor response across both treatments. Three prescriptive variables-marriage, unemployment, and having experienced a greater number of recent life events-were identified, and each predicted superior response to cognitive therapy relative to antidepressant medications. Thus, 6 markers of treatment outcome were identified, each of which might be expected to carry considerable clinical utility. The 3 prognostic variables identify subgroups that might benefit from alternative treatment strategies; the 3 prescriptive variables identify groups who appear to respond particularly well to cognitive therapy.

12 Article Antidepressant medications v. cognitive therapy in people with depression with or without personality disorder. 2008

Fournier, Jay C / DeRubeis, Robert J / Shelton, Richard C / Gallop, Robert / Amsterdam, Jay D / Hollon, Steven D. ·Department of Psychology, University of Pennsylvania, Philadelphia, PA 19104-6196, USA. ·Br J Psychiatry · Pubmed #18245030.

ABSTRACT: BACKGROUND: There is conflicting evidence about comorbid personality pathology in depression treatments. AIMS: To test the effects of antidepressant drugs and cognitive therapy in people with depression distinguished by the presence or absence of personality disorder. METHOD: Random assignment of 180 out-patients with depression to 16 weeks of antidepressant medication or cognitive therapy. Random assignment of medication responders to continued medication or placebo, and comparison with cognitive therapy responders over a 12-month period. RESULTS: Personality disorder status led to differential response at 16 weeks; 66% v. 44% (antidepressants v. cognitive therapy respectively) for people with personality disorder, and 49% v. 70% (antidepressants v. cognitive therapy respectively) for people without personality disorder. For people with personality disorder, sustained response rates over the 12-month follow-up were nearly identical (38%) in the prior cognitive therapy and continuation-medication treatment arms. People with personality disorder withdrawn from medication evidenced the lowest sustained response rate (6%). Despite the poor response of people with personality disorder to cognitive therapy, nearly all those who did respond sustained their response. CONCLUSIONS: Comorbid personality disorder was associated with differential initial response rates and sustained response rates for two well-validated treatments for depression.