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Early improvement as a predictor of eventual antidepressant treatment response in severely depressed inpatients

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Abstract

Rationale

Traditionally, the therapeutic effect of antidepressants is thought to take several weeks. However, several studies found evidence of early drug response occurring within the first 2 weeks of antidepressant treatment and that this early onset response may predict eventual treatment outcome.

Objective

This study aims to investigate the predictive value of early improvement in the course of treatment with imipramine or venlafaxine in an inpatient population with severe major depression.

Method

A post hoc analysis was conducted after pooling data from two almost identical trials. The study included 149 patients with DSM-IV diagnosis major depression and a baseline score ≥17 on the 17-item Hamilton Rating Scale for Depression (HAM-D). Patients were randomized for double-blind treatment with either antidepressant. Early improvement (≥25 % reduction on HAM-D score) was evaluated after 2 weeks and response (≥50 % reduction on HAM-D score) after 6 weeks of acute treatment.

Results

Of 64 patients achieving early improvement, 38 (59 %) became responders, whereas of 85 patients not achieving early improvement, only 23 (27 %) became responders. There was a significant difference in time to response between patients achieving early improvement and patients not achieving early improvement. Early improvement is a modest sensitive predictor for eventual response.

Conclusion

In the present study, although the sensitivity of early improvement was modest, based on the severity of clinical symptoms, a clinician treating a patient with severe major depression may seriously consider changing the treatment at an earlier stage than is presently customary.

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Acknowledgments

The authors thank the following for their support: Mrs. S. Verploegh for valuable assistance in data collection, A.I. Wierdsma for helping with the statistical analysis, and Laraine Visser-Isles for English language editing.

The data have not been previously presented. The Department of Psychiatry, Erasmus Medical Center Rotterdam, owns the preexisting datasets. All authors have access to all datasets. M. Vermeiden (corresponding author) can provide access to the dataset. This study protocol is registered at http://www.controlled-trials.com (identifier: ISRCTN73221288).

Conflict of interest

Funding for this study was provided by the Department of Psychiatry of the Erasmus Medical Center Rotterdam, The Netherlands. Venlafaxine was provided by Wyeth Pharmaceuticals. T.K.B. and W.W.B. have received grants from Lundbeck BV. T.K.B. has received speakers’ fees from Lundbeck BV and AstraZeneca. M.V., A.M.K., and M.E.V. have no conflict of interest.

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Authors and Affiliations

  1. Department of Psychiatry, Erasmus Medical Center Rotterdam, ’s-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands

    Marlijn Vermeiden, Walter W. van den Broek & Tom K. Birkenhäger

  2. Epidemiological and Social Psychiatric Research Institute, Department of Psychiatry, Erasmus Medical Center Rotterdam, ’s-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands

    Astrid M. Kamperman

  3. Forensic Care Specialists, De Waag, Marconistraat 2, 3029 AK, Rotterdam, The Netherlands

    Monique E. Vulink

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  1. Marlijn Vermeiden
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  2. Astrid M. Kamperman
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  3. Monique E. Vulink
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  4. Walter W. van den Broek
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  5. Tom K. Birkenhäger
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Correspondence to Marlijn Vermeiden.

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Vermeiden, M., Kamperman, A.M., Vulink, M.E. et al. Early improvement as a predictor of eventual antidepressant treatment response in severely depressed inpatients. Psychopharmacology 232, 1347–1356 (2015). https://doi.org/10.1007/s00213-014-3765-1

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  • DOI: https://doi.org/10.1007/s00213-014-3765-1

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