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DOI: 10.1055/s-0030-1267177
© Georg Thieme Verlag KG Stuttgart · New York
Relationship between Baseline Severity of Depression and Antidepressant Treatment Outcome
Publikationsverlauf
received 11.01.2010
revised 16.08.2010
accepted 16.08.2010
Publikationsdatum:
27. Oktober 2010 (online)
Abstract
Introduction: Assessment of depression severity is of key importance, since several clinical guidelines recommend choice of treatment dependent on the depression severity grade. Using different tools to assess baseline severity may result in different outcomes.
Methods: This paper describes the results of a multicentre, naturalistic study investigating the relationship between depression symptom severity (using 4 different measures of symptom severity) and clinical outcome among patients hospitalised for depression (N=1 014). Moreover, the impact of differences between methods of measuring depression severity has been investigated. Statistical analyses (univariate measurements, logistic regression models) were conducted to detect coherences and differences between the various methods of severity categorisation.
Results: Results revealed different associations between outcome and classification methods. Response or remission rates varied if baseline severity was assessed by different instruments. Moreover, the number of responders increased with higher baseline severity grades of depression, whereas the number of remitters decreased. Additional analyses dependent on outcome criteria using continuous instead of categorical data revealed similar results.
Discussion: Baseline severity may be only one of many other important clinical variables that mediate clinical outcome, but it is surely an important one deserving further research and consideration.
References
- 1 APA-American Psychiatric Association . Diagnostic and Statistical Manual of Mental Disorders – DSM-IV-TR (4th edition, Text Revision) Washington, DC. 2000;
- 2 Bagby RM, Ryder AG, Schuller DR. et al . The Hamilton Depression Rating Scale: has the gold standard become a lead weight?. Am J Psychiatry. 2004; 161 2163-2177
- 3 Bauer M, Bschor T, Pfennig A. et al . World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for biological treatment of unipolar depressive disorders in primary care. World J Biol Psychiatry. 2007; 8 67-104
- 4 Cording C, Gaebel W, Spengler A. Die neue psychiatrische Basisdokumentation. Eine Empfehlung der DGPPN zur Qualitätssicherung im (teil-) stationären Bereich. [The new psychiatric basic documentation. A recommendation by the DGPPN for quality assurance in inpatient treatment]. Spektrum Psychiatrie Nervenheilkunde. 1995; 3-41
- 5 Coyne JC, Fechner-Bates S, Schwenk TL. Prevalence, nature, and comorbidity of depressive disorders in primary care. Gen Hosp Psychiatry. 1994; 16 267-276
- 6 CPMP . Committee for Proprietary Medicinal Products (CPMP). Note for guidance on clinical investigation of medicinal products in the treatment of depression. CPMP/EWP/518/97 Rev.1.. 1997;
- 7 Elkin I, Shea MT, Watkins JT. et al . National Institute of Mental Health Treatment of Depression Collaborative Research Program General effectiveness of treatments. Arch Gen Psychiatry. 1989; 46 971-982
- 8 Guy W. Clinical Global Impressions. ECDEU Assessment Manual for Psychopharmacology. National Institute of Mental Health, Rockville, MD revised; 1976
- 9 Hamilton M. Development of a rating scale for primary depressive illness. Br J Soc Clin Psychol. 1967; 6 278-296
- 10 Hegerl U, Hautzinger M, Mergl R. et al . Effects of pharmacotherapy and psychotherapy in depressed primary-care patients: a randomized, controlled trial including a patients' choice arm. Int J Neuropsychopharmacol. 2010; 13 31-44
- 11 Judd LL, Akiskal HS, Maser JD. et al . A prospective 12-year study of subsyndromal and syndromal depressive symptoms in unipolar major depressive disorders. Arch Gen Psychiatry. 1998; 55 694-700
- 12 Judd LL, Rapaport MH, Yonkers KA. et al . Randomized, placebo-controlled trial of fluoxetine for acute treatment of minor depressive disorder. Am J Psychiatry. 2004; 161 1864-1871
- 13 Kessler RC, Zhao S, Blazer DG. et al . Prevalence, correlates, and course of minor depression and major depression in the National Comorbidity Survey. J Affect Disord. 1997; 45 19-30
- 14 Khan A, Schwartz K, Kolts RL. et al . Relationship between depression severity entry criteria and antidepressant clinical trial outcomes. Biol Psychiatry. 2007; 62 65-71
- 15 Kirsch I, Deacon BJ, Huedo-Medina TB. et al . Initial severity and antidepressant benefits: a meta-analysis of data submitted to the Food and Drug Administration. PLoS Med. 2008; 5 e45
- 16 Lyness JM, Heo M, Datto CJ. et al . Outcomes of minor and subsyndromal depression among elderly patients in primary care settings. Ann Intern Med. 2006; 144 496-504
- 17 Markowitz JC. Psychotherapy of dysthymia. Am J Psychiatry. 1994; 151 1114-1121
- 18 Melander H, Salmonson T, Abadie E. et al . A regulatory Apologia – a review of placebo-controlled studies in regulatory submissions of new-generation antidepressants. Eur Neuropsychopharmacol. 2008; 18 623-627
- 19 Moller HJ. Isn’t the efficacy of antidepressants clinically relevant? A critical comment on the results of the metaanalysis by Kirsch et al. 2008. Eur Arch Psychiatry Clin Neurosci. 2008; 258 451-455
- 20 Montgomery SA, Asberg M. A new depression scale designed to be sensitive to change. Br J Psychiatry. 1979; 134 382-389
- 21 Morris JB, Beck AT. The efficacy of antidepressant drugs. A review of research (1958–1972). Arch Gen Psychiatry. 1974; 30 667-674
- 22 Mulrow CD, Williams Jr JW, Chiquette E. et al . Efficacy of newer medications for treating depression in primary care patients. Am J Med. 2000; 108 54-64
- 23 Paykel ES, Freeling P, Hollyman JA. Are tricyclic antidepressants useful for mild depression? A placebo controlled trial. Pharmacopsychiatry. 1988; 21 15-18
- 24 Rapaport MH, Judd LL, Schettler PJ. et al . A descriptive analysis of minor depression. Am J Psychiatry. 2002; 159 637-643
- 25 Rush AJ, First MB, Blacker D. Handbook of Psychiatric Measures, Edition Number: 2 edn., 2007
- 26 Sartorius N, Ustun TB, Lecrubier Y. et al . Depression comorbid with anxiety: results from the WHO study on psychological disorders in primary health care. Br J Psychiatry Suppl. 1996; 38-43
- 27 Schulberg HC, Block MR, Madonia MJ. et al . Treating major depression in primary care practice Eight-month clinical outcomes. Arch Gen Psychiatry. 1996; 53 913-919
- 28 Seemuller F, Riedel M, Obermeier M. et al . Outcomes of 1014 naturalistically treated inpatients with major depressive episode. Eur Neuropsychopharmacol. 2010;
- 29 Turner EH, Matthews AM, Linardatos E. et al . Selective publication of antidepressant trials and its influence on apparent efficacy. N Engl J Med. 2008; 358 252-260
- 30 Wagner HR, Burns BJ, Broadhead WE. et al . Minor depression in family practice: functional morbidity, co-morbidity, service utilization and outcomes. Psychol Med. 2000; 30 1377-1390
- 31 Wilcox CS, Cohn JB, Linden RD. et al . Predictors of placebo response: a retrospective analysis. Psychopharmacol Bull. 1992; 28 157-162
- 32 Williams Jr JW, Barrett J, Oxman T. et al . Treatment of dysthymia and minor depression in primary care: A randomized controlled trial in older adults. JAMA. 2000; 284 1519-1526
- 33 Wittchen HU, Wunderlich U, Gruschwitz S. et al . Strukturiertes Klinisches Interview für DSM-IV Göttingen, Hogrefe. 1997;
- 34 World Health Organization .The ICD-10 Classification of Mental and behavioural Disorders. Clinical Descriptions and Diagnostic Guidelines. Geneva, WHO; 1992
Correspondence
F. SeemüllerMD
Department of Psychiatry and Psychotherapy
Ludwig-Maximilians University
Nussbaumstraße 7
80336 Munich
Germany
Telefon: +49/89/5160 5846
Fax: +49/89/5160 5857
eMail: florian.seemueller@med.uni-muenchen.de