Patient and course of care factors impacting time to response and remission in psychotherapy for depression.

INTRODUCTION: Psychotherapy effectively treats depression, but variation exists in response timing and treatment trajectories. METHODS: Using data from 7,161 adults receiving psychotherapy for depression (baseline PHQ-9 ≥10), we examined how baseline patient characteristics predict time to first response (≥50% symptom reduction) and first remission (PHQ-9 < 5), and whether patient features predict later outcomes for non-responders after 24 psychotherapy sessions. Baseline predictors were identified using elastic net; time to outcomes used Poisson regression. RESULTS: Overall, 67.9% achieved first response and 45.6% achieved first remission at median times of 6 and 8 sessions, (respectively); most responses occurred by session 12 (81.9%). Features predicting faster response included adjustment disorder diagnosis and good health; slower response related to comorbid anxiety, chronic pain, and diagnostic complexity. Among non-responders by session 24 (n = 778: first response, n = 1,477 first remission), only early symptom trajectories-not baseline characteristics-predicted later response. DISCUSSION: Findings support using complexity assessments for initial treatment planning and ongoing symptom monitoring for mid-treatment adjustments.