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

Abstract

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.

Early Improvement in Depressive Symptoms With Desvenlafaxine 50 mg/d as a Predictor of Treatment Success in Patients With Major Depressive Disorder

“…In that previous study, optimal cut points were 39% and 43% for weeks 2 and 3, respectively, compared with 21% to 25% (week 2) and 30% to 33% (week 3) thresholds for predicting response in the current analysis. 26 Key differences between the current and previous studies likely account for the discrepancy in the optimal thresholds. The previous analysis was based on a single small (N = 131) trial of hospitalized patients; trial end point was at week 6, and patients received open-label fluoxetine treatment, with no placebo control.…”

“…The ROC method used in the current study has been used previously to determine the optimal thresholds of early symptom improvement for predicting stable treatment response (Q50% reduction in HAM-D 17 ) in Han Chinese patients with MDD. 26 In that study, the ROC analysis was used to define early improvement in HAM-D 17 scores at weeks 1, 2, 3, and 4. The sensitivity (86%Y91%) and specificity (74%Y76%) of the week 2 and 3 thresholds were comparable to the current results; however, the cutoff values determined for that population were substantially higher than those in the current analysis.…”

Pain Affects Clinical Patterns and Treatment Outcomes for Patients With Major Depressive Disorder Taking Fluoxetine

“…11 The trial was approved by Kai-Syuan Psychiatric Hospital's institutional review board and conducted in accordance with both Good Clinical Practice procedures and the most recent revision of the Declaration of Helsinki. Written, informed consent was obtained from the participants after a full explanation of the study's aims and procedures.…”

Early Switching Strategies in Antidepressant Non-Responders: Current Evidence and Future Research Directions

“…Early improvement was usually defined as at least 20 % reduction in HAM-D or MADRS (n = 11 studies). Two studies also examined optimum definitions of early improvement using receiver operating characteristic analysis [16,17]. For early improvement at 2 weeks, PPVs were 26-84 %, while NPVs were 35-92 %.…”