The early improvement of depressive symptoms as a potential predictor of response to antidepressants in depressive patients who failed to respond to previous antidepressant treatments. Analysis of naturalistic data.
ABSTRACT Current studies suggest that improvement of depressive symptoms after 2 weeks of treatment could predict the subsequent response. The aim of our study was to compare the predictive effect of early improvement (EI) after 1 and 2 weeks of treatment in patients who had failed to respond to previous antidepressant treatments (≥1 unsuccessful antidepressant trial).
Seventy-one subjects were treated (≥4 weeks) with various antidepressants chosen according to the judgment of attending psychiatrists. We used three definitions of EI (MADRS reduction ≥20, 25, 30%) at both time points. Areas under curve (AUC) were calculated to compare predictive effect of EI.
We found lower MADRS scores in weeks 1 and 2 in responders (≥50% reduction of MADRS, n=35) compared to nonresponders. AUCs of MADRS reduction for response prediction at week 1 and 2 were not significantly different (0.73 vs 0.8; p=0.24).
The results indicate that improvement of depressive symptoms in the treatment of resistant patients may occur after the first week of treatment. The predictive potential might be comparable to that found after the second week of antidepressant intervention and be clinically meaningful.
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ABSTRACT: Major depressive disorder (MDD) is a chronic, recurrent mental disease that causes serious disability. Because currently available antidepressants have limited efficacy with respect to response and remission in patients with MDD, clinicians must choose the best available treatment interventions for patients who do not respond to initial antidepressant treatment. The existing literature demonstrates that augmentation with atypical antipsychotics (AAs) shows higher response and remission rates compared with antidepressant monotherapy, but is associated with more withdrawals due to adverse events. In this paper, specific clinical issues in the use of AA augmentation for patients with MDD are briefly discussed. Given the limited information and clinical knowledge on the proper and effective use of AAs for MDD, future research should focus on practical clinical issues that can be commonly seen in routine practice but have not been addressed yet. This is because the use of AAs is likely to expand as there is good evidence for their effectiveness and tolerability as augmentation therapy for patients with MDD.CNS Drugs 05/2013; · 4.83 Impact Factor