BACKGROUND: There is substantial evidence that early improvement (EI) under antidepressant treatment is a clinically useful predictor of later treatment outcome in patients with major depressive disorders. The aim of this study was to test whether EI can also be used as a predictor for treatment outcome in patients with mild major, minor or subsyndromal depression, i.e. patients, who are typically treated by general practitioners. METHODS: Analyses were carried out using data from 223 patients of a 10-weeks randomized, placebo-controlled trial comparing the effectiveness of sertraline and cognitive-behavioural therapy (CBT) in patients with mild major, minor or subsyndromal depression. EI was defined as a reduction of > or =20% on the 17-item Hamilton Rating Scale for Depression (HAMD-17) compared with baseline within the first 2 weeks of treatment. The predictive value of EI for stable response at week 8 and 10 (> or =50% HAMD-17 sum score reduction at weeks 8 and 10) and stable remission (HAMD-17 sum score < or =7 at weeks 8 and 10) was evaluated. RESULTS: In both the sertraline- and CBT-treatment group, EI was a highly sensitive predictor for later stable response (76% and 82%, respectively) and stable remission (70% and 75%, respectively). In patients without EI, only a small proportion of sertraline or CBT-treated patients achieved stable response (20.9% and 5.9%, respectively) or stable remission (18.6% and 8.8%, respectively). Patients with EI were by far more likely to achieve stable response or stable remission than patients without as indicated by high odds ratios (95% confidence interval) of 8.1 (3.0-21.8) and 3.8 (1.4-10.1) for sertraline, and 11.1 (2.1-58.4) and 7.2 (1.7-30.8) for CBT-treated patients, respectively. LIMITATIONS: Sample sizes were relatively low in different treatment groups. CONCLUSION: The identification of early improvement might be useful in clinical decision making in the early course of treatment of patients with mild major, minor and subthreshold depression.
RCT Entities:
BACKGROUND: There is substantial evidence that early improvement (EI) under antidepressant treatment is a clinically useful predictor of later treatment outcome in patients with major depressive disorders. The aim of this study was to test whether EI can also be used as a predictor for treatment outcome in patients with mild major, minor or subsyndromal depression, i.e. patients, who are typically treated by general practitioners. METHODS: Analyses were carried out using data from 223 patients of a 10-weeks randomized, placebo-controlled trial comparing the effectiveness of sertraline and cognitive-behavioural therapy (CBT) in patients with mild major, minor or subsyndromal depression. EI was defined as a reduction of > or =20% on the 17-item Hamilton Rating Scale for Depression (HAMD-17) compared with baseline within the first 2 weeks of treatment. The predictive value of EI for stable response at week 8 and 10 (> or =50% HAMD-17 sum score reduction at weeks 8 and 10) and stable remission (HAMD-17 sum score < or =7 at weeks 8 and 10) was evaluated. RESULTS: In both the sertraline- and CBT-treatment group, EI was a highly sensitive predictor for later stable response (76% and 82%, respectively) and stable remission (70% and 75%, respectively). In patients without EI, only a small proportion of sertraline or CBT-treated patients achieved stable response (20.9% and 5.9%, respectively) or stable remission (18.6% and 8.8%, respectively). Patients with EI were by far more likely to achieve stable response or stable remission than patients without as indicated by high odds ratios (95% confidence interval) of 8.1 (3.0-21.8) and 3.8 (1.4-10.1) for sertraline, and 11.1 (2.1-58.4) and 7.2 (1.7-30.8) for CBT-treated patients, respectively. LIMITATIONS: Sample sizes were relatively low in different treatment groups. CONCLUSION: The identification of early improvement might be useful in clinical decision making in the early course of treatment of patients with mild major, minor and subthreshold depression.
Authors: Stella Bitran; Amy H Farabaugh; Victoria E Ameral; Rachel A LaRocca; Alisabet J Clain; Maurizio Fava; David Mischoulon Journal: Int Clin Psychopharmacol Date: 2011-07 Impact factor: 1.659
Authors: David E Kemp; Stephen J Ganocy; Martin Brecher; Berit X Carlson; Suzanne Edwards; James M Eudicone; Gary Evoniuk; Wim Jansen; Andrew C Leon; Margaret Minkwitz; Andrei Pikalov; Hans H Stassen; Armin Szegedi; Mauricio Tohen; Arjen P P Van Willigenburg; Joseph R Calabrese Journal: J Affect Disord Date: 2010-11-10 Impact factor: 4.839
Authors: André Tadić; Stanislav Gorbulev; Norbert Dahmen; Christoph Hiemke; Dieter F Braus; Joachim Röschke; Dietrich van Calker; Daniel Wachtlin; Kai Kronfeld; Thorsten Gorbauch; Monika Seibert-Grafe; Klaus Lieb Journal: Trials Date: 2010-02-26 Impact factor: 2.279
Authors: Thomas C Baghai; Pierre Blier; David S Baldwin; Michael Bauer; Guy M Goodwin; Kostas N Fountoulakis; Siegfried Kasper; Brian E Leonard; Ulrik F Malt; Dan Stein; Marcio Versiani; Hans-Jürgen Möller Journal: Eur Arch Psychiatry Clin Neurosci Date: 2011-11 Impact factor: 5.270
Authors: Belinda Graham; Natalia M Garcia; Mark S Burton; Andrew A Cooper; Peter P Roy-Byrne; Matig R Mavissakalian; Norah C Feeny; Lori A Zoellner Journal: Br J Psychiatry Date: 2018-10-25 Impact factor: 9.319
Authors: Fredric Schiffer; Andrea L Johnston; Caitlin Ravichandran; Ann Polcari; Martin H Teicher; Robert H Webb; Michael R Hamblin Journal: Behav Brain Funct Date: 2009-12-08 Impact factor: 3.759