Early Improvement Under Mirtazapine and Paroxetine Predicts Later Stable Response and Remission With High Sensitivity in Patients With Major Depression

Szegedi, Armin; Müller, Matthias J.; Anghelescu, Ion; Klawe, Christoph; Kohnen, Ralf; Benkert, Otto

doi:10.4088/jcp.v64n0410

Cited by 162 publications

(119 citation statements)

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“…It is clear from the current study, however, that drug-specific types of behavioral responses in the first 1 or 2 weeks of treatment with DMI or paroxetine are highly predictive of later outcome. Consistent with these results, Szegedi et al (2003) found that improvement in the first 2 weeks in depressed patients treated with either mirtazapine or paroxetine was highly predictive of a positive response after 6 weeks of treatment. Lack of early improvement was also highly predictive of lack of improvement after 6 weeks.…”

Section: Prediction Of Drug Responsesupporting

confidence: 64%

Onset and Early Behavioral Effects of Pharmacologically Different Antidepressants and Placebo in Depression

Katz

Tekell

Bowden

et al. 2003

Neuropsychopharmacol

234

153

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This study was aimed at resolving the time course of clinical action of antidepressants (ADs) and the type of early behavioral changes that precede recovery in treatment-responsive depressed patients. The first goal was to identify, during the first 2 weeks of treatment, the onset of clinical actions of the selective serotonin reuptake inhibitor (SSRI), paroxetine, and the selective noradrenergic reuptake inhibitor, desipramine (DMI). The second aim was to test the hypothesis that the two pharmacologic subtypes would induce different early behavioral changes in treatment-responsive patients. The design was a randomized, parallel group, placebo-controlled, double-blind study for 6 weeks of treatment following a 1-week washout period. The study utilized measures of the major behavioral components of the depressive disorder as well as overall severity. The results indicated that the onset of clinical actions of DMI ranged from 3 to 13 days, averaged 13 days for paroxetine, and was 16-42 days for placebo. Furthermore, as hypothesized, the different types of ADs initially impacted different behavioral aspects of the disorder. After 1 week of treatment, DMI produced greater reductions in motor retardation and depressed mood than did paroxetine and placebo, and this difference persisted at the second week of treatment. Early improvement in depressed mood-motor retardation differentiated patients who responded to DMI after 6 weeks of treatment from those that did not. Paroxetine initially reduced anxiety more in responders than in nonresponders, and by the second week, significantly improved depressed mood and distressed expression in responders to a greater extent. Depressed patients who responded to placebo showed no consistent early pattern of behavior improvement. Early drug-specific behavioral changes were highly predictive of ultimate clinical response to the different ADs, results that could eventually be applied directly to clinical practice.

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Section: Prediction Of Drug Responsesupporting

confidence: 64%

Onset and Early Behavioral Effects of Pharmacologically Different Antidepressants and Placebo in Depression

Katz

Tekell

Bowden

et al. 2003

Neuropsychopharmacol

234

153

View full text Add to dashboard Cite

show abstract

“…Another recent meta-analysis study by Szegedi et al 28 also used improvement (defined as reduction in HAMD-17 score of Q20% compared with the baseline) within the first 2 weeks of treatment to predict the end point (4-8 weeks) stable response. The results were similar to their previous study, 30 indicating that early improvement with antidepressants can predict subsequent outcome with a high degree of sensitivity (eg, 88% for SSRI), but a low degree of corresponding specificity (eg, 50% for SSRI). One reason the 2 aforementioned studies 28,30 with lower specificities may be that the criteria of improvement (ie, at least 20%, 25%, or 30% symptom reduction) reflect only relatively minor symptom changes.…”

Section: Y18supporting

confidence: 88%

“…23 On the other hand, several studies with virtually all groups of antidepressants also suggest that a treatment response can be observed within the first 2 weeks of treatment. 12,24Y30 For example, Szegedi et al 30 found that improvement (defined as reduction in the 17-item Hamilton Depression Rating Scale score of Q20% from the baseline) in the first 2 weeks in depressed patients treated with either mirtazapine or paroxetine was highly predictive of a positive response after 6 weeks of treatment. They also concluded that lack of early improvement was predictive of lack of improvement after 6 weeks.…”

Section: Y18mentioning

confidence: 99%

Early Prediction of Fluoxetine Response for Han Chinese Inpatients With Major Depressive Disorder

Lin

Lane²,

Chen³

et al. 2011

Journal of Clinical Psychopharmacology

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The onset of antidepressant action is vital clinically. This study aimed to testify whether early symptom improvement can predict eventual treatment response at week 6 among depressive hospitalized patients taking fluoxetine. One hundred thirty-one hospitalized patients with major depressive disorder received 20 mg/d of fluoxetine for 6 weeks. Symptom severity was assessed by the 17-item Hamilton Depression Rating Scale (HAMD-17) at weeks 0, 1, 2, 3, 4, and 6. Stable response was defined as a reduction of 50% or more in the HAMD-17 total score at weeks 4 and 6 of treatment. Receiver operating characteristic curve was used to determine the cutoff point of the percentage of HAMD-17 score reduction between stable responders and nonresponders at weeks 1, 2, 3, and 4. At weeks 1, 2, 3, and 4, HAMD-17 score reductions of 25%, 39%, 43%, and 50% seemed to be the optimal cutoff points for predicting eventual response. They provided a sensitivity of 78%, 86%, 91%, and 93% and a specificity of 61%, 74%, 76%, and 92%. The percentage of HAMD-17 reduction at week 4 excellently predicted final response at week 6. Patients with less than a 50% symptom reduction during the first 4 weeks of treatment are unlikely to reach a final stable response. Whether this model can be applied to establish a prediction system for other antidepressants or for outpatients warrants further research.

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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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Early Improvement Under Mirtazapine and Paroxetine Predicts Later Stable Response and Remission With High Sensitivity in Patients With Major Depression

Cited by 162 publications

References 0 publications

Onset and Early Behavioral Effects of Pharmacologically Different Antidepressants and Placebo in Depression

Onset and Early Behavioral Effects of Pharmacologically Different Antidepressants and Placebo in Depression

Early Prediction of Fluoxetine Response for Han Chinese Inpatients With Major Depressive Disorder

Clinical Issues in Use of Atypical Antipsychotics for Depressed Patients

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