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Major depression is a common and often recurrent mood disorder, why pharmacotherapy should be maintained beyond the acute phase to prevent future depressive episodes (Otte et al., 2016). However, many patients do not complete the recommended course of medication, with a lack of efficacy and adverse effects representing the two most commonly reported reasons for discontinuation of antidepressants (Otte et al., 2016; Uher et al., 2008, 2009a). Several socio-demographic factors including age, occupation and marital status have been proposed as predictors for treatment response and discontinuation, but with contradictory findings (Otte et al., 2016).
Personality traits have been suggested to represent more valid predictors for antidepressant response. Particularly lower neuroticism scores correlated with a better response to SSRIs compared to non-SSRI antidepressants (Quilty, Meusel, & Bagby, 2008b) and compared to placebo or cognitive therapy (Dermody, Quilty, & Bagby, 2016; Hengartner, Ajdacic-Gross, Wyss, Angst, & Rössler, 2016; Schmidt et al., 2018; Tang et al., 2009), whereas a more recent trial found that those with higher neuroticism scores showed better response to sertraline compared to placebo (Webb et al., 2019). Furthermore, individuals with higher social desirability and extraversion and lower self-esteem showed a better response and lower relapse rates (Aluoja et al., 2018; Verhoeven, Wardenaar, Ruhé, Conradi, & de Jonge, 2018). Systematic reviews found a large variation between different trials but indicated that particularly higher neuroticism scores correlated with an increased risk for depression relapse (Prieto-Vila, Estupiñá, & Cano-Vindel, 2021) and worse response to antidepressants (Mulder, 2002), with lower scores on extraversion and self-esteem also correlating with an increased risk for depression relapse (Prieto-Vila et al., 2021).
Treatment response is largely affected and potentially confounded by antidepressant discontinuation, and several trials have studied associations between personality traits and patterns of treatment discontinuation. Already three decades ago, Wingerson et al. reported that patients with high scores on novelty seeking, measured using Cloninger's Tridimensional Personality Questionnaire (TPQ), were significantly more likely to discontinue pharmacotherapy for anxiety (Wingerson et al., 1993). Subsequent studies measuring the highly correlated construct of ‘sensation seeking’ (Gutiérrez et al., 2001) reported similar results for antidepressant (Akerblad, Bengtsson, Holgersson, von Knorring, & Ekselius, 2008; Ekselius, Bengtsson, & von Knorring, 2000; Liraud & Verdoux, 2001) and antipsychotic (Liraud & Verdoux, 2001) pharmacotherapy. Both neuroticism and aggressiveness...