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Targeting remission by 8 weeks: when should supplementation be considered in patients with major depression treated with a specific serotonin reuptake inhibitor?

Abstract：

BACKGROUND:Timely administration/supplementation of a specific serotonin reuptake inhibitor with a second therapeutic agent could improve treatment outcome in patients with major depressive disorder (MDD). The purpose of this study was to identify the optimal time at which to implement supplementation so as to maximize the likelihood of remission by 8 weeks and minimize overtreatment. METHOD:Data from patients with MDD treated with sertraline (n = 108) or citalopram (n = 107) in a randomized controlled trial were analyzed by multivariate logistic regression. The 21-item Hamilton Depression Scale scores at weeks 1, 2, 3, 4, and 6; sex; age; and baseline Hamilton Anxiety Scale score were used as predictors of remission by 8 weeks sustained for a further 4 weeks. RESULTS:Regression models for weeks 2, 3, 4, and 6 were significant (area under the curve values, 0.73-0.91). The models for weeks 3 to 6 yielded κ coefficients greater than 0.40 with the outcome variable. A Hamilton Depression Scale reduction score of 50% at week 4 as a criterion for supplementation would have resulted in overtreatment of 4% and 0% of patients in the sertraline and citalopram groups, respectively, and none if applied at week 6. The rates at which patients who should have received supplementation (destined to be nonremitters at 8 weeks) would have been missed would be 49%/54% for sertraline/citalopram at week 4 and 43%/50% at week 6. LIMITATIONS:The study limitations are as follows: secondary analysis of data, relatively low sertraline dose, and relatively small sample sizes. CONCLUSIONS:It may be possible to identify patients treated with specific serotonin reuptake inhibitors who will not achieve sustained remission by 8 weeks. If supplementation were implemented accordingly, the number of overtreated patients would be small. However, a substantial number of patients who should be supplemented would be missed, indicating a need for greater sensitivity of the prediction model. Further studies are needed.

journal_name

Compr Psychiatry

journal_title

Comprehensive psychiatry

authors

Cooper-Kazaz R,Rigbi A,Lerer B

doi

10.1016/j.comppsych.2010.04.007

subject

Has Abstract

pub_date

2011-01-01 00:00:00

pages

9-16

issue

eissn

0010-440X

issn

1532-8384

pii

S0010-440X(10)00040-4

journal_volume

pub_type

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Targeting remission by 8 weeks: when should supplementation be considered in patients with major depression treated with a specific serotonin reuptake inhibitor?