Six Months of Treatment for Depression: Outcome and Predictors of the Course of Illness

Department of Psychological Medicine, Christchurch School of Medicine and Health Science, P.O. Box 4345, Christchurch, New Zealand.
American Journal of Psychiatry (Impact Factor: 12.3). 02/2006; 163(1):95-100. DOI: 10.1176/appi.ajp.163.1.95
Source: PubMed


The goals of this study were to determine the course of illness in a cohort of depressed patients undergoing treatment for 6 months and whether there are clinically useful predictors of their course of illness.
A cohort of 175 depressed outpatients undergoing drug treatment were followed prospectively for 6 months. Patients were initially randomly assigned to fluoxetine or nortriptyline. Those who responded were encouraged to continue taking their drugs for the 6 months. Those who did not were switched to other drugs or drug combinations.
Of the 175 patients, 101 (58%) had a good outcome (achieved recovery and remained well), 54 (31%) had a fluctuating outcome (achieved recovery or remission but suffered a relapse or recurrence), and 20 (11%) had a poor outcome (remained depressed for the 6 months). Factors predicting good outcome included early response and a low level of schizoid personality disorder symptoms, and variables predicting poor outcome included a high score for harm avoidance and the absence of an early response.
Depression is a recurring and chronic disorder. Personality factors such as a high harm avoidance score and schizoid traits were associated with a worse outcome, but demographic features, depression characteristics, depression subtypes, and comorbidity were not. Early response was strongly associated with the course of illness, but none of these features added significantly to the clinicians' ability to predict outcome.

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    • "We found baseline demographic and alcohol consumption variables, and depression variables other than depression type, did not predict the course of depression over 24 weeks. This is consistent with results from a study of depressed subjects without an alcohol disorder (Mulder et al., 2006). In that study, Mulder et al. reported baseline demographic variables and depression characteristics did not generally predict depression outcome, while early depression response and personality variables did. "
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    ABSTRACT: Depression commonly co-occurs with alcohol use disorders but predictors of depression treatment outcome in patients with both conditions are not well established. Outpatients with alcohol dependence and major depression (n=138) were prescribed naltrexone and randomized to citalopram or placebo for 12 weeks, followed by a 12-week naturalistic outcome phase. General linear mixed models examined predictors of Montgomery Asberg Depression Rating Scale (MADRS) score over 24 weeks. Predictors included whether depression was independent or substance-induced, and demographic, alcohol use, and personality variables (Temperament and Character Inventory subscales). Most improvement in drinking and depression occurred between baseline and week 3. During follow-up, patients with substance-induced depression reduced their drinking more and they had better depression outcomes than those with independent depression. However, greater reduction in drinking was associated with better depression outcomes for both independent and substance-induced groups, while antidepressant therapy had no effect for either group. Baseline demographic and alcohol use variables did not predict depression outcomes. Among personality variables, high self-directedness was a strong predictor of better depression outcomes. Subjects were not abstinent at baseline. The influence of naltrexone on depression outcomes could not be tested. Alcohol dependent patients with substance-induced depression have better short term depression outcomes than those with independent depression, but this is largely because they reduce their drinking more during treatment. Copyright © 2014 Elsevier B.V. All rights reserved.
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    • "Therefore, it often is under-treated [11] [12] [13] and tends to have the lowest proportion of met need for treatment compared to other psychiatric disorders [14]. Under-treated SAD may affect the treatment outcome of other conditions such as depression, in both pharmacologic and cognitive–behavioral treatments [15] [16] [17] [18]. Therefore, routine monitoring of SAD symptoms "
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    Full-text · Article · May 2013 · Comprehensive psychiatry
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    • "Our results are consistent with previous research that found that sex (Esposito and Goodnick, 2003; Quilty et al., 2008), education (Serretti et al., 2007), and basal HDRS (Petersen et al., 2002; Mulder et al., 2006; Quilty et al., 2008) were not useful for the prediction of SSRI responses in MDD. "
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