Does early improvement in depressive symptoms predict subsequent remission in patients with depression who are treated with duloxetine?

Abstract

PurposeIn this prospective study, we examined whether early reduction in depressive symptoms predicts later remission to duloxetine in the treatment of depression, as monitored using the Montgomery–Asberg Depression Rating Scale (MADRS).Patients and methodsAmong the 106 patients who were enrolled in this study, 67 were included in the statistical analysis. A clinical evaluation using the MADRS was performed at weeks 0, 4, 8, 12, and 16 after commencing treatment. For each time point, the MADRS total score was separated into three components: dysphoria, retardation, and vegetative scores.ResultsRemission was defined as an MADRS total score of ≤10 at end point. From our univariate logistic regression analysis, we found that improvements in both the MADRS total score and the dysphoria score at week 4 had a significant interaction with subsequent remission. Furthermore, age and sex were significant predictors of remission. There was an increase of approximately 4% in the odds of remission for each unit increase in age, and female sex had an odds of remission of 0.318 times that of male sex (remission rate for men was 73.1% [19/26] and for women 46.3% [19/41]). However, in the multivariate model using the change from baseline in the total MADRS, dysphoria, retardation, and vegetative scores at week 4, in which age and sex were included as covariates, only sex retained significance, except for an improvement in the dysphoria score.ConclusionNo significant interaction was found between early response to duloxetine and eventual remission in this study. Sex difference was found to be a predictor of subsequent remission in patients with depression who were treated with duloxetine, with the male sex having greater odds of remission.

Personality features, dissociation, self-stigma, hope, and the complex treatment of depressive disorder

“…Approximately 40%–70% of the patients who are suffering from depression react positively to the treatment with the antidepressant for at least 2 months. 1 – 5 Approximately 80% of them respond to the first or second choice of a recommended antidepressant. Despite the relatively high antidepressant efficacy, the level of treatment resistance is relatively high.…”

Trajectories of Depressive Individual Symptoms over Time during Transcranial Photobiomodulation

“…A re-analysis of the STAR*D trial reported that an early improvement in core depressive symptoms within two weeks predicted a higher probability of eventual remission [14]. Another study involving 67 patients treated with duloxetine found that early improvement in specific individual symptoms, including dysphoria and retardation, after four weeks of intervention significantly correlated with subsequent remission [33]. Assessing individual symptoms in conjunction with the overall depression assessment score could enhance our ability to predict treatment outcomes and allow for more personalized therapeutic strategies [34][35][36].…”

Korean Medication Algorithm for Depressive Disorder: Comparisons with Other Treatment Guidelines

“… 6 , 7) To overcome this challenge in the treatment of depression, there have been many clinical trials to investigate better treatment strategies for treatment-resistant individuals. In addition, there have been many studies investigating predictors of treatment outcomes, such as early treatment improvement, 8) characteristics of the depressive episode, 9) patient characteristics, 10 , 11) and more. Clinicians should consider accumulated research findings when choosing a relevant treatment strategy in various clinical practice scenarios, which increases the need for the development of treatment guidelines.…”