R H Perlis1, C Cusin1, M Fava1. 1. Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
Abstract
BACKGROUND: Draft DSM-5 criteria for a mixed major depressive episode have been proposed, but their predictive validity has not yet been established. We hypothesized that such symptoms would be associated with poorer antidepressant treatment outcomes. METHOD: We examined outcomes among individuals with major depressive disorder participating in the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study, an effectiveness study conducted at primary and specialty care centers in the USA. Mixed features were derived from the six self-report items of the mania subscale of the Psychiatric Diagnosis Screening Questionnaire. Primary analyses examined the association between the presence of at least two of these in the 6 months before study entry, and remission across up to four sequential treatment trials, as well as adverse outcomes. RESULTS: Of the 2397 subjects with a major depressive episode of at least 6 months' duration, 449 (18.7%) reported at least two mixed symptoms. The presence of such symptoms was associated with a greater likelihood of remission across up to four sequential treatments, which persisted after adjustment for potential confounding clinical and demographic variables (adjusted hazard ratio 1.16, 95% confidence interval 1.03-1.28). Two individual items, expansive mood and cheerfulness, were strongly associated with a greater likelihood of remission. CONCLUSIONS: Proposed DSM-5 mixed state features were associated with a greater rather than a lesser likelihood of remission. While unexpected, this result suggests the potential utility of further investigation of depressive mixed states in major depression.
BACKGROUND: Draft DSM-5 criteria for a mixed major depressive episode have been proposed, but their predictive validity has not yet been established. We hypothesized that such symptoms would be associated with poorer antidepressant treatment outcomes. METHOD: We examined outcomes among individuals with major depressive disorder participating in the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study, an effectiveness study conducted at primary and specialty care centers in the USA. Mixed features were derived from the six self-report items of the mania subscale of the Psychiatric Diagnosis Screening Questionnaire. Primary analyses examined the association between the presence of at least two of these in the 6 months before study entry, and remission across up to four sequential treatment trials, as well as adverse outcomes. RESULTS: Of the 2397 subjects with a major depressive episode of at least 6 months' duration, 449 (18.7%) reported at least two mixed symptoms. The presence of such symptoms was associated with a greater likelihood of remission across up to four sequential treatments, which persisted after adjustment for potential confounding clinical and demographic variables (adjusted hazard ratio 1.16, 95% confidence interval 1.03-1.28). Two individual items, expansive mood and cheerfulness, were strongly associated with a greater likelihood of remission. CONCLUSIONS: Proposed DSM-5 mixed state features were associated with a greater rather than a lesser likelihood of remission. While unexpected, this result suggests the potential utility of further investigation of depressive mixed states in major depression.
Authors: Michael B First; Wolfgang Gaebel; Mario Maj; Dan J Stein; Cary S Kogan; John B Saunders; Vladimir B Poznyak; Oye Gureje; Roberto Lewis-Fernández; Andreas Maercker; Chris R Brewin; Marylene Cloitre; Angelica Claudino; Kathleen M Pike; Gillian Baird; David Skuse; Richard B Krueger; Peer Briken; Jeffrey D Burke; John E Lochman; Spencer C Evans; Douglas W Woods; Geoffrey M Reed Journal: World Psychiatry Date: 2021-02 Impact factor: 49.548
Authors: Dan J Stein; Peter Szatmari; Wolfgang Gaebel; Michael Berk; Eduard Vieta; Mario Maj; Ymkje Anna de Vries; Annelieke M Roest; Peter de Jonge; Andreas Maercker; Chris R Brewin; Kathleen M Pike; Carlos M Grilo; Naomi A Fineberg; Peer Briken; Peggy T Cohen-Kettenis; Geoffrey M Reed Journal: BMC Med Date: 2020-01-27 Impact factor: 8.775