Predictors of Early Recovery From Major Depression Among Persons Admitted to Community-Based Clinics

Meyers, Barnett S.; Sirey, Jo Anne; Bruce, M.P.H. Martha L.; Hamilton, Mimi; Raue, Patrick J.; Friedman, Steven; Rickey, Cynthia; Kakuma, Tatsu; Carroll, Melissa K.; Kiosses, Dimitris N.; Alexopoulos, George S.

doi:10.1001/archpsyc.59.8.729

Cited by 88 publications

(64 citation statements)

References 31 publications

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“…Our data were collected in patients receiving structured treatment, including weekly clinical monitoring. Thus, the course of symptom resolution we observed might represent what happens under optimal conditions rather than what typically happens under "usual care" conditions (36). By design, this analysis focuses on the outcome of first-line pharmacotherapy.…”

Section: Discussionmentioning

confidence: 98%

Empirically Derived Decision Trees for the Treatment of Late-Life Depression

Andreescu

Mulsant²,

Houck³

et al. 2008

AJP

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Objective-Several predictors of treatment response in late-life depression have been reported in the literature. The aim of this analysis was to develop a clinically useful algorithm that would allow clinicians to predict which patients will likely respond to treatment and thereby guide clinical decision making.Method-A total of 461 patients with late-life depression were treated under structured conditions for up to 12 weeks and assessed weekly with the 17-item Hamilton Rating Scale for Depression . The authors developed a hierarchy of predictors of treatment response using signaldetection theory. The authors developed two models, one minimizing false predictions of future response and one minimizing false predictions of future nonresponse, to offer clinicians two clinically useful treatment algorithms.Results-In the first model, early symptom improvement (defined by the relative change in HAM-D-17 total score from baseline to week 4), lower baseline anxiety, and an older age of onset predict response at 12 weeks. In the second model, early symptom improvement represents the principal guide in tailoring treatment, followed by baseline anxiety level, baseline sleep disturbance, and-for a minority of patients-the adequacy of previous antidepressant treatment.Conclusions-Our two models, developed to help clinicians in different clinical circumstances, illustrate the possibility of tailoring the treatment of late-life depression based on clinical characteristics and confirm the importance of early observed changes in clinical status.Late-life major depression is associated with emotional suffering, disability, caregiver strain, suicide, and poor compliance with other medical treatments (1). Successful antidepressant treatment is one of the most effective ways to reduce disability, prevent morbidity, and improve quality of life in an older depressed patient (2,3). In many cases, patients appear to be resistant to treatment because their antidepressants are switched prematurely (4,5). If treating clinicians knew the probability of treatment response earlier in the course of treatment, they would be in a better position to advise patients about various treatment options. These options could include continuing the current medication, augmenting current pharmacotherapy, or switching to another approach (6,7). Previously, our group has shown that a patient's clinical status after 4 weeks of treatment predicts reliably their response status at week 12 (6). Furthermore, we have identified several biological, clinical, and psychosocial characteristics as predictors of treatment response in latelife major depression: allelic variation in the serotonin transporter promoter, REM sleep latency, cerebral glucose metabolism, age at onset of first episode, sleep disturbances at baseline, baseline Hamilton Depression Rating Scale (HAM-D) scores, baseline anxiety levels, suicidal ideation, response and adherence to previous antidepressant treatment, family support, and social inequalities (7-17). To our knowledge, there is n...

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Section: Discussionmentioning

confidence: 98%

Empirically Derived Decision Trees for the Treatment of Late-Life Depression

Andreescu

Mulsant²,

Houck³

et al. 2008

AJP

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“…[13][14][15] Also the mean duration of index episode should be considered, because a proportion of patients might already be on the road to recovery at the beginning of the study, following the natural course of an untreated depression. At the opposite side, chronic depression (with episode length 42 years) is thought to respond poorly to treatments.…”

Section: Clinical Features Of Depressionmentioning

confidence: 99%

“…63 The low antidepressant dosages could be some variables that have been associated to a worse probability of treatment response. 13 The use of concomitant antipsychotics, sometimes needed in the clinical practice for depression, could strongly modulate the genetic influence to antidepressant response and should be avoided or at least separate subjects treated with concomitant antipsychotics from one treated with only antidepressant to evaluate genetic efficacy of antidepressant or antidepressant plus antipsychotics. Use of benzoziazepines also could influence outcome in particular ones or in case of change of dose during the study.…”

Section: Treatment Issuesmentioning

confidence: 99%

Pharmacogenetic studies in depression: a proposal for methodologic guidelines

2007

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Pharmacogenetic studies in mood disorders are rapidly proliferating after the initial reports linking gene variants to treatment outcomes. However, a considerable range of methodologies has been used, making it difficult to compare results across studies and limiting the representativeness of findings. Specification of sampling source (inpatients vs outpatients, primary vs tertiary settings), standardization of diagnostic systems and treatments, adequate monitoring of compliance through plasma levels, sufficient length of observation (at least 6 weeks for acute antidepressant treatments, though 3-6 months are preferable), the use of a range of response criteria and the inclusion of possible environmental confounding variables (life events, social support, temperament) are all potentially important issues when planning pharmacogenetic studies. We reviewed the state-of-the-art methodology and suggested possible guideline for future studies.

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“…In an earlier study, we identified predictors of early (three-month) “recovery”, which was defined as two weeks with no or only minimal symptoms of depression (5). Early recovery was independently associated with less severe depression, adequate antidepressant treatment, being female, and married.…”

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confidence: 99%

Predictors of Major Depression Six Months After Admission for Outpatient Treatment

Weinberger

Sirey²,

Bruce³

et al. 2008

Psychiatric Services

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Objective This study examined the rate and predictors of major depression six months after outpatient mental health admission. Methods Assessments were conducted at admission and three and six months later among 166 participants. Antidepressant treatment adequacy and depression outcomes were assessed at follow-ups. Results Predictors of major depression at six months included nonremission status at three months (odds ratio [OR]=3.56, p=.003), inadequacy of early pharmacotherapy (OR=2.73, p=.009), worse physical functioning measured by the 36-Item Short-Form Health Survey (OR=.975, p<.001), and being unmarried (OR=2.54, p=.031). Conclusions The findings support the effects of baseline physical disability, marital status, early treatment adequacy, and early remission on the course of major depression. The identification of individuals who do not receive intensive pharmacotherapy or who have not recovered by three months may provide opportunities for interventions to optimize six-month outcomes and to prevent the development of a persistent depression.

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Predictors of Early Recovery From Major Depression Among Persons Admitted to Community-Based Clinics

Cited by 88 publications

References 31 publications

Empirically Derived Decision Trees for the Treatment of Late-Life Depression

Empirically Derived Decision Trees for the Treatment of Late-Life Depression

Pharmacogenetic studies in depression: a proposal for methodologic guidelines

Predictors of Major Depression Six Months After Admission for Outpatient Treatment

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