Baseline alexithymia and recovery from major depressive disorder: a longitudinal study

Objective To investigate whether alexithymia is associated with baseline symptom severity or longitudinal treatment outcomes in patients with major depressive disorder (MDD).Methods The sample comprised 258 outpatients with MDD (mean age = 31.77, SD = 11.30) followed for six months. Alexithymia was assessed with the Toronto Alexithymia Scale (TAS-20), depressive symptoms with the Beck Depression Inventory (BDI), and psychopathology with the SCL-90-R.Results The prevalence of alexithymia was 27.9% (n = 72) at baseline, 18.4% (n = 29) at 3 months, and 16.1% (n = 23) at 6 months. Among patients with baseline alexithymia, 40.3% remained alexithymic at 3 months and 31.9% at 6 months. At baseline, alexithymic patients had significantly higher BDI scores and scores on all TAS-20 subscales and SCL-90-R domains. Depressive symptoms decreased significantly during follow-up, with the greatest improvement during the first 3 months. Although alexithymic patients had consistently higher depressive symptom levels, the time × group interaction was not significant, indicating similar improvement in both groups. However, participants with baseline alexithymia were significantly more likely to be lost to follow-up than those without alexithymia.Conclusion Alexithymia was associated with greater baseline psychopathology and persistently higher depressive symptom levels. However, alexithymic and non-alexithymic patients showed similar trajectories of symptom reduction, suggesting that alexithymia does not limit improvement in depressive symptoms.