Predictors of Response to Desipramine in Dysthymia

Abstract

Little is known about factors that may predict the response of dysthymia or other forms of chronic depression to treatment with antidepressant medication. We investigated several sociodemographic and clinical variables for their relationship to the acute treatment response to desipramine in subjects with DSM-III-R dysthymia. Subjects with DSM-III-R dysthymia were treated with desipramine in an open fashion for 10 weeks. Various clinical and sociodemographic variables were assessed at baseline. Ratings of depressive symptoms and severity and determination of categorical outcome were done during treatment. Baseline extended family adjustment as measured by the Social Adjustment Scale Self-Report was significantly better in the responders compared with the nonresponders (2.1 +/- 0.5 vs. 2.6 +/- 0.8; t = 2.84, df = 52.11, p = 0.006). There was a trend (p = 0.06) for overall baseline social impairment (SAS-SR) to be higher in nonresponders versus responders. Older age was a significant predictor of higher depressive severity (Cornell Dysthymia Rating Scale) and global impairment in the last week of the study. No other variable significantly distinguished responders from non-responders. Although few of the variables that were examined were found to affect acute treatment response, better extended family adjustment as reported on the SAS-SR was a significant predictor of good acute treatment response to desipramine in patients with dysthymia.

Evaluation of Outcomes With Citalopram for Depression Using Measurement-Based Care in STAR*D: Implications for Clinical Practice

“…With a rare exception (17), no adequately powered previous studies have searched for baseline features predicting which patients will achieve remission as opposed to those who will respond to treatment. Response moderator studies with small samples have yielded inconsistent correlates of response (18), except for pretreatment depressive symptom severity, which has been associated consistently with lower response rates (19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35). Therefore, STAR*D also aimed to evaluate moderators of symptom remission.…”

Dysthymia: a review of pharmacological and behavioral factors

“…22,159,[193][194][195] Studies that focused on social and interpersonal impairments likewise indicated marked deficits among dysthymic patients. 22,159,193,[196][197][198][199] These reports indicated that social impairment correlated positively with increasing severity and chronicity of the illness, and worsened with onset of double depression. In addition to alleviating the depressive symptoms, antidepressants attenuated the social impairment characteristic of dysthymic patients.…”

“…Thus, it was posited that the reduced capacity to enjoy leisure time may be a state marker of chronic depression. 131,159,201 It is interesting that while significant improvement in quality of life was observed among dysthymic patients treated with either imipramine or sertraline over 12 weeks, 202 self-reported social functioning showed greater improvement than did participation in leisure activity. It was suggested that the delayed alleviation of certain aspects of psychosocial functioning may have been due to the relatively short duration of pharmacotherapy relative to the patients' often life-long impairment.…”

A patient-centered model of the action of psychotropic drugs

“…On the other hand, social support may positively influence drug response [65], as can family support [66], and perceived criticism by spouses can trigger relapses even in patients receiving continued treatment [66]. Recent data from a large antidepressant trial has found that socioeconomic variables -low education, lower income and unemployment -are robust predictors of a poor response to the SSRI citalopram [67]; it is unknown if these effects are themselves mediated through exposure to stressful life events or lack of support systems.…”