A Meta-Analysis of Early Sustained Response Rates Between Antidepressants and Placebo for the Treatment of Major Depressive Disorder

Papakostas, George I.; Perlis, Roy H.; Scalia, Margaret; Petersen, Timothy; Fava, Maurizio

doi:10.1097/01.jcp.0000195042.62724.76

Cited by 109 publications

(42 citation statements)

References 34 publications

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“…While the guidelines of APA are consistent with the meta-analyses performed by Geddes et al [57] and Papakostas et al [58] reporting large effect sizes for antidepressants in preventing relapse, these analyses do not control for publication bias [59,60] nor selective outcome reporting [22,23], both of which may significantly inflate the findings from meta-analyses that fail to control for these common forms of researcher bias. For now, prospective naturalistic studies are likely a better guide to estimate real-world outcomes.…”

Section: Discussionsupporting

confidence: 48%

Efficacy and Effectiveness of Antidepressants: Current Status of Research

Pigott¹,

Leventhal

Alter³

et al. 2010

Psychother Psychosom

297

214

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Background: This paper examines the current status of research on the efficacy and effectiveness of antidepressants. Methods: This paper reviews four meta-analyses of efficacy trials submitted to America’s Food and Drug Administration (FDA) and analyzes STAR*D (Sequenced Treatment Alternatives to Relieve Depression), the largest antidepressant effectiveness trial ever conducted. Results: Meta-analyses of FDA trials suggest that antidepressants are only marginally efficacious compared to placebos and document profound publication bias that inflates their apparent efficacy. These meta-analyses also document a second form of bias in which researchers fail to report the negative results for the pre-specified primary outcome measure submitted to the FDA, while highlighting in published studies positive results from a secondary or even a new measure as though it was their primary measure of interest. The STAR*D analysis found that the effectiveness of antidepressant therapies was probably even lower than the modest one reported by the study authors with an apparent progressively increasing dropout rate across each study phase. Conclusions: The reviewed findings argue for a reappraisal of the current recommended standard of care of depression.

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Section: Discussionsupporting

confidence: 48%

Efficacy and Effectiveness of Antidepressants: Current Status of Research

Pigott¹,

Leventhal

Alter³

et al. 2010

Psychother Psychosom

297

214

View full text Add to dashboard Cite

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“…To avoid possible confounders, we used multivariable regression analysis adjusted for the baseline characteristics possibly influencing the response to antidepressant treatment. Notably, all these latelife MDD patients were classified as having a Btrue^drug response at six month, i.e., a response characterized by a clinical improvement not subsequently followed by a worsening of response (sustained clinical response) [77]. This may be a limitation of this study, since a time-course of symptoms during treatment was missing as well as the possibility to investigate the effects of KL polymorphisms on early/later response to SSRI treatment.…”

Section: Discussionmentioning

confidence: 99%

Klotho Gene and Selective Serotonin Reuptake Inhibitors: Response to Treatment in Late-Life Major Depressive Disorder

et al. 2016

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Klotho protein, encoded by the Klotho gene (KL) at locus 13q12, is an antiaging hormone-like protein playing a pivotal role in cell metabolism homeostasis and associated to longevity and age-related diseases. In particular, altered cell metabolism in central nervous system may influence the behavior of serotoninergic neurons. The role of KL in the response to treatment with selective serotonin reuptake inhibitors (SSRIs) in late-life depressive syndromes and late-life major depressive disorder (MDD) is unclear. We genotyped three single-nucleotide polymorphisms (SNPs) of KL in 329 older patients with diagnosis of late-life MDD, treated with SSRIs and evaluated with the Hamilton Rating Scale for Depression 21-items (HRSD-21) at baseline and after 6 months. A reduction ≥50 and <10 % in HDRS-21 score was considered as response or nonresponse to therapy, respectively, and the values of reduction between 10 and 49 % as poor responders. After 6 months of SSRI treatment, 176 patients responded, 54 patients did not respond and 99 patients showed a poor response. Ordinal logistic models showed a significant association between mutation of SNP rs1207568 and responders and, similarly, for each unitary risk allele increase overlapping results were found. Conversely, a significantly higher frequency of the minor genotype of SNP rs9536314 was found in nonresponders. Considering the pre-post differences of HRSD-21 scores as a continue variable, we confirmed a significant improvement of depressive symptoms after treatment in patients carrying at least one minor allele at rs1207568 and a worse response in patients homozygous for the minor allele at rs9536314. Our results were the first that suggested a possible role of KL in the complex pathway of SSRI response in late-life MDD.

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“…Early improvement in depressive symptoms with antidepressant treatment may predict a favourable treatment outcome [34][35][36][37][38][39]. Studies on the association between the onset time of antidepressant response and the probability of response have yielded some intriguing findings, although debates still continue.…”

Section: Clinical Issues In the Use Of Atypical Antipsychotics In CLImentioning

confidence: 99%

Clinical Issues in Use of Atypical Antipsychotics for Depressed Patients

Pae

Patkar

2013

CNS Drugs

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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.

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A Meta-Analysis of Early Sustained Response Rates Between Antidepressants and Placebo for the Treatment of Major Depressive Disorder

Abstract: The results of the present analysis suggest that "true" drug response can occur the first 2 week as well as the first week of treatment of major depressive disorder with conventional antidepressants.

Cited by 109 publications

References 34 publications

Efficacy and Effectiveness of Antidepressants: Current Status of Research

Efficacy and Effectiveness of Antidepressants: Current Status of Research

Klotho Gene and Selective Serotonin Reuptake Inhibitors: Response to Treatment in Late-Life Major Depressive Disorder

Clinical Issues in Use of Atypical Antipsychotics for Depressed Patients

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