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David J Kupfer - One of the best experts on this subject based on the ideXlab platform.
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spousally bereaved elders with Subsyndromal Depression a descriptive analysis and comparison with major Depression
American Journal of Geriatric Psychiatry, 1996Co-Authors: Rona E Pasternak, Charles F Reynolds, Mark D Miller, Ellen Frank, Amy L Fasiczka, Holly G Prigerson, David J KupferAbstract:The authors compared the frequency and severity of symptoms in Subsyndromal and major Depression after spousal bereavement in later life, as well as measures of social support, functional status, and grief intensity. Subsyndromal subjects (n = 25, mean age = 68.1) experienced fewer and less severe depressive symptoms and less functional impairment and anxiety than subjects with major Depression (n = 25, mean age = 68.5). In a multivariate discriminant-function analysis (taking into account both symptom frequency and severity), mood, anxiety, early morning awakening, and weight loss correctly identified 92% of Subsyndromal subjects and 92% of those with major Depression. Further longitudinal study is under way to document the relationship of the current differences in symptomatology and clinical status to clinical outcome.
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the symptom profile and two year course of Subsyndromal Depression in spousally bereaved elders
American Journal of Geriatric Psychiatry, 1994Co-Authors: Rona E Pasternak, Charles F Reynolds, Mark D Miller, Ellen Frank, Amy L Fasiczka, Holly G Prigerson, Sati Mazumdar, David J KupferAbstract:The authors describe the symptom presentation and clinical course of Subsyndromal Depression in 20 bereaved elderly persons (mean age = 68.0 years) over a period of 2 years from spousal loss. Clinical ratings on measures of general functioning, depressive symptoms, sleep disturbance, medical burden, social support, and social rhythm stability were contrasted for bereaved subjects with Subsyndromal Depression, nondepressed bereaved subjects, and control subjects who were neither bereaved nor depressed. Subsyndromally depressed subjects had greater impairment in work and pleasure and more pronounced anxiety. Over follow-up, they showed persistently higher bereavement intensity and were more impaired than nondepressed, bereaved subjects on measures of general functioning, sleep quality, and social support, suggesting that Subsyndromally depressed, bereaved persons experience greater functional impairment, worse sleep quality, less perceived interpersonal support, and more intense grieving than non-depressed, bereaved subjects up to 2 years after spousal loss.
Charles F Reynolds - One of the best experts on this subject based on the ideXlab platform.
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using problem solving therapy to treat veterans with Subsyndromal Depression a pilot study
International Journal of Geriatric Psychiatry, 2014Co-Authors: John Kasckow, Charles F Reynolds, J Klaus, Jennifer Q Morse, David W Oslin, J Luther, Lauren Fox, Gretchen L HaasAbstract:Objective We conducted a pilot study comparing problem solving therapy for primary care (PST-PC) to a dietary education control condition in middle-aged and older veterans with symptoms of emotional distress and Subsyndromal Depression. Methods This was a two-site study at the VA Pittsburgh Healthcare System and Philadelphia VA Medical Center. Participants included veterans >50 years of age referred from primary care clinics who were eligible if they obtained a pre-screen score >11 on the Centers for Epidemiologic Studies Depression (CES-D) scale. Exclusions were a DSM-IV Major Depressive Episode within the past year, active substance abuse/dependence within 1 month, current antidepressant therapy, and a Mini mental status exam score <24. Participants were randomized to receive one of two interventions—either PST-PC or an attention control condition consisting of dietary education (DIET)—each consisting of six to eight sessions within a 4-month period. Results Of 45 individuals randomized, 23 (11 PST-PC and 12 DIET) completed treatment. Using regression models in completers that examined outcomes at end of treatment while controlling for baseline scores, there were significant differences between treatment groups in SF-36 mental health component scores but not in depressive symptoms (as assessed with either the 17-item Hamilton Rating Scale for Depression or the Beck Depression Inventory), social problem solving skills, or physical health status (SF-36 physical health component score). Conclusions These pilot study findings suggest that a six-to-eight session version of PST-PC may lead to improvements in mental health functioning in primary care veterans with Subsyndromal depressive symptoms. Copyright © 2014 John Wiley & Sons, Ltd.
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Subsyndromal Depression and anxiety in older adults health related functional cognitive and diagnostic implications
Journal of Psychiatric Research, 2013Co-Authors: John Kasckow, Jordan F Karp, Ellen M Whyte, Meryl A Butters, Charlotte Brown, Amy Begley, Salem Bensasi, Charles F ReynoldsAbstract:Subsyndromal Depression in later life is common in primary care. Comorbid anxiety disorders could exacerbate the negative effect of Subsyndromal Depression on functioning, health-related quality of life, comorbidity and/or cognition. We examined anxiety disorders co-existing with Subsyndromal Depression in participants ≥ age 50 in an NIH trial of Problem Solving Therapy for Primary Care for indicated prevention of major Depression. There were 247 participants, with Centers for Epidemiologic Studies - Depression scores ≥ 11. Participants could have multiple psychiatric diagnoses: 22% of the sample had no DSM IV diagnosis; 39% of the sample had only 1 DSM IV diagnosis; 28% had 2 diagnoses; 6% had 3 DSM IV diagnoses; 4% had 4 DSM IV diagnoses; and 1% had 5 diagnoses. Furthermore, 34% of participants had a current comorbid DSM IV diagnosis of a syndromal anxiety disorder. We hypothesized that those with Subsyndromal Depression, alone relative to those with co-existing anxiety disorders, would report better health-related quality of life, less disability, less medical comorbidity and less cognitive impairment. However, there were no differences in quality of life based on the SF 12 nor in disability based on Late Life Function and Disability Instrument scores. There were no differences in medical comorbidity based on the Cumulative Illness Scale-Geriatrics scale scores nor in cognitive function based on the Executive Interview (EXIT), Hopkins Verbal Learning Test-Revised and Mini-Mental Status Exam. Our findings suggest that about one third of participants 50 years and older with Subsyndromal Depression have comorbid anxiety disorders; however, this does not appear to be associated with worse quality of life, functioning, disability, cognitive function or medical comorbidity.
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outcomes of minor and Subsyndromal Depression among elderly patients in primary care settings
Annals of Internal Medicine, 2006Co-Authors: Jeffrey M Lyness, Rebecca A Drayer, Catherine J Datto, Thomas Ten R Have, Ira R Katz, Charles F Reynolds, George S Alexopoulos, Martha L BruceAbstract:BACKGROUND: Although depressive conditions in later life are a major public health problem, the outcomes of minor and Subsyndromal Depression are largely unknown. OBJECTIVE: To compare outcomes among patients with minor and Subsyndromal Depression, major Depression, and no Depression, and to examine putative outcome predictors. DESIGN: Cohort study. SETTING: Patients from primary care practices in greater New York City, and Philadelphia and Pittsburgh, Pennsylvania. PATIENTS: 622 patients who were at least 60 years of age and presented for treatment in primary care practices that provided usual care in a randomized, controlled trial of suicide prevention. Of the 441 (70.9%) patients who completed 1 year of follow-up, 122 had major Depression, 205 had minor or Subsyndromal Depression, and 114 did not have Depression at baseline. MEASUREMENTS: One year after a baseline evaluation, data were collected by using the following tools: Hamilton Depression Rating Scale, the depressive disorders section of the Structured Clinical Interview for DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, fourth edition), Charlson Comorbidity Index, Multilevel Assessment Instrument for measuring instrumental activities of daily living, Physical Component Summary of the Medical Outcomes Study Short Form-36, and Duke Social Support Index. RESULTS: Patients with minor or Subsyndromal Depression had intermediate depressive and functional outcomes. Mean adjusted 1-year Hamilton Depression score was 10.9 (95% CI, 9.6 to 12.2) for those with initial major Depression, 7.0 (CI, 5.9 to 8.1) for those with minor or Subsyndromal Depression, and 2.9 (CI, 1.6 to 4.2) for those without Depression (P < 0.001 for each paired comparison). Compared with patients who were not depressed, those who had minor or Subsyndromal Depression had a 5.5-fold risk (CI, 3.1-fold to 10.0-fold) for major Depression at 1 year after controlling for demographic characteristics (P < 0.001). Cerebrovascular risk factors were not associated with a diagnosis of Depression at 1 year after controlling for overall medical burden. Initial medical burden, self-rated health, and subjective social support were significant independent predictors of Depression outcome. LIMITATIONS: Participants received care at practices that had personnel who had been given enhanced education about Depression treatment; 29.1% of participants withdrew from the study before completing 1 year of follow-up. CONCLUSIONS: The intermediate outcomes of minor and Subsyndromal Depression demonstrate the clinical significance of these conditions and suggest that they are part of a spectrum of depressive illness. Greater medical burden, poor subjective health status, and poorer subjective social support confer a higher risk for poor outcome.
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spousally bereaved elders with Subsyndromal Depression a descriptive analysis and comparison with major Depression
American Journal of Geriatric Psychiatry, 1996Co-Authors: Rona E Pasternak, Charles F Reynolds, Mark D Miller, Ellen Frank, Amy L Fasiczka, Holly G Prigerson, David J KupferAbstract:The authors compared the frequency and severity of symptoms in Subsyndromal and major Depression after spousal bereavement in later life, as well as measures of social support, functional status, and grief intensity. Subsyndromal subjects (n = 25, mean age = 68.1) experienced fewer and less severe depressive symptoms and less functional impairment and anxiety than subjects with major Depression (n = 25, mean age = 68.5). In a multivariate discriminant-function analysis (taking into account both symptom frequency and severity), mood, anxiety, early morning awakening, and weight loss correctly identified 92% of Subsyndromal subjects and 92% of those with major Depression. Further longitudinal study is under way to document the relationship of the current differences in symptomatology and clinical status to clinical outcome.
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the symptom profile and two year course of Subsyndromal Depression in spousally bereaved elders
American Journal of Geriatric Psychiatry, 1994Co-Authors: Rona E Pasternak, Charles F Reynolds, Mark D Miller, Ellen Frank, Amy L Fasiczka, Holly G Prigerson, Sati Mazumdar, David J KupferAbstract:The authors describe the symptom presentation and clinical course of Subsyndromal Depression in 20 bereaved elderly persons (mean age = 68.0 years) over a period of 2 years from spousal loss. Clinical ratings on measures of general functioning, depressive symptoms, sleep disturbance, medical burden, social support, and social rhythm stability were contrasted for bereaved subjects with Subsyndromal Depression, nondepressed bereaved subjects, and control subjects who were neither bereaved nor depressed. Subsyndromally depressed subjects had greater impairment in work and pleasure and more pronounced anxiety. Over follow-up, they showed persistently higher bereavement intensity and were more impaired than nondepressed, bereaved subjects on measures of general functioning, sleep quality, and social support, suggesting that Subsyndromally depressed, bereaved persons experience greater functional impairment, worse sleep quality, less perceived interpersonal support, and more intense grieving than non-depressed, bereaved subjects up to 2 years after spousal loss.
Rona E Pasternak - One of the best experts on this subject based on the ideXlab platform.
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spousally bereaved elders with Subsyndromal Depression a descriptive analysis and comparison with major Depression
American Journal of Geriatric Psychiatry, 1996Co-Authors: Rona E Pasternak, Charles F Reynolds, Mark D Miller, Ellen Frank, Amy L Fasiczka, Holly G Prigerson, David J KupferAbstract:The authors compared the frequency and severity of symptoms in Subsyndromal and major Depression after spousal bereavement in later life, as well as measures of social support, functional status, and grief intensity. Subsyndromal subjects (n = 25, mean age = 68.1) experienced fewer and less severe depressive symptoms and less functional impairment and anxiety than subjects with major Depression (n = 25, mean age = 68.5). In a multivariate discriminant-function analysis (taking into account both symptom frequency and severity), mood, anxiety, early morning awakening, and weight loss correctly identified 92% of Subsyndromal subjects and 92% of those with major Depression. Further longitudinal study is under way to document the relationship of the current differences in symptomatology and clinical status to clinical outcome.
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the symptom profile and two year course of Subsyndromal Depression in spousally bereaved elders
American Journal of Geriatric Psychiatry, 1994Co-Authors: Rona E Pasternak, Charles F Reynolds, Mark D Miller, Ellen Frank, Amy L Fasiczka, Holly G Prigerson, Sati Mazumdar, David J KupferAbstract:The authors describe the symptom presentation and clinical course of Subsyndromal Depression in 20 bereaved elderly persons (mean age = 68.0 years) over a period of 2 years from spousal loss. Clinical ratings on measures of general functioning, depressive symptoms, sleep disturbance, medical burden, social support, and social rhythm stability were contrasted for bereaved subjects with Subsyndromal Depression, nondepressed bereaved subjects, and control subjects who were neither bereaved nor depressed. Subsyndromally depressed subjects had greater impairment in work and pleasure and more pronounced anxiety. Over follow-up, they showed persistently higher bereavement intensity and were more impaired than nondepressed, bereaved subjects on measures of general functioning, sleep quality, and social support, suggesting that Subsyndromally depressed, bereaved persons experience greater functional impairment, worse sleep quality, less perceived interpersonal support, and more intense grieving than non-depressed, bereaved subjects up to 2 years after spousal loss.
Isabella Helmreich - One of the best experts on this subject based on the ideXlab platform.
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Sensitivity to changes during antidepressant treatment: a comparison of unidimensional subscales of the Inventory of Depressive Symptomatology (IDS-C) and the Hamilton Depression Rating Scale (HAMD) in patients with mild major, minor or Subsyndromal
European Archives of Psychiatry and Clinical Neuroscience, 2012Co-Authors: Isabella Helmreich, Roland Mergl, Martin Hautzinger, Verena Henkel, Ulrich Hegerl, Stefanie Wagner, Antjekathrin Allgaier, André TadićAbstract:In the efficacy evaluation of antidepressant treatments, the total score of the Hamilton Depression Rating Scale (HAMD) is still regarded as the ‘gold standard’. We previously had shown that the Inventory of Depressive Symptomatology (IDS) was more sensitive to detect depressive symptom changes than the HAMD17 (Helmreich et al. 2011 ). Furthermore, studies suggest that the unidimensional subscales of the HAMD, which capture the core depressive symptoms, outperform the full HAMD regarding the detection of antidepressant treatment effects. The aim of the present study was to compare several unidimensional subscales of the HAMD and the IDS regarding their sensitivity to changes in Depression symptoms in a sample of patients with mild major, minor or Subsyndromal Depression (MIND). Biweekly IDS-C28 and HAMD17 data from 287 patients of a 10-week randomised, placebo-controlled trial comparing the effectiveness of sertraline and cognitive–behavioural group therapy in patients with MIND were converted to subscale scores and analysed during the antidepressant treatment course. We investigated sensitivity to depressive change for all scales from assessment-to-assessment, in relation to Depression severity level and placebo–verum differences. The subscales performed similarly during the treatment course, with slight advantages for some subscales in detecting treatment effects depending on the treatment modality and on the items included. Most changes in depressive symptomatology were detected by the IDS short scale, but regarding the effect sizes, it performed worse than most subscales. Unidimensional subscales are a time- and cost-saving option in judging drug therapy outcomes, especially in antidepressant treatment efficacy studies. However, subscales do not cover all facets of Depression (e.g. atypical symptoms, sleep disturbances), which might be important for comprehensively understanding the nature of the disease Depression. Therefore, the cost-to-benefit ratio must be carefully assessed in the decision for using unidimensional subscales.
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the inventory of depressive symptomatology ids c 28 is more sensitive to changes in depressive symptomatology than the hamilton Depression rating scale hamd 17 in patients with mild major minor or Subsyndromal Depression
European Archives of Psychiatry and Clinical Neuroscience, 2011Co-Authors: Isabella Helmreich, Roland Mergl, Martin Hautzinger, Verena Henkel, Ulrich Hegerl, Stefanie Wagner, Antjekathrin Allgaier, Andre TadicAbstract:Depression rating scales play a decisive role in the assessment of the severity of Depression and the evaluation of the efficacy of antidepressant treatments. The Hamilton Depression Rating Scale (HAMD) is regarded as the ‘gold standard’; nevertheless, studies suggest that the Inventory of Depressive Symptomatology (IDS) is more sensitive to detect symptom changes. The aim of the present study was to investigate whether the IDS is more sensitive in detecting changes in Depression symptoms in patients with mild major, minor or Subsyndromal Depression (MIND). Biweekly IDS-C28 and HAMD17 data from 340 patients of a 10-week randomized, placebo-controlled trial comparing the effectiveness of sertraline and cognitive-behavioural therapy in patients with MIND were analysed. We investigated sensitivity to change for both scales (1) from assessment-to-assessment, (2) in relation to Depression severity level, and (3) in relation to DSM-IV Depression criterion symptoms. The IDS-C28 was more sensitive in detecting changes in Depression symptomatology over the treatment course as well as for different severity levels, especially in patients with a low Depression severity. It assesses the DSM-IV criteria more thoroughly, is better able to track the change of cognitive symptoms and to identify residual symptoms. Both scales are well able to assess depressive symptomatology. However, the IDS-C28 surpasses the HAMD17 in detecting small changes especially in the core symptoms of Depression. This is important for an optimal treatment by capturing early improvements, enabling prompt reactions and detecting residual symptoms.
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the inventory of depressive symptomatology ids c28 is more sensitive to changes in depressive symptomatology than the hamilton Depression rating scale hamd17 in patients with mild major minor or Subsyndromal Depression
European Archives of Psychiatry and Clinical Neuroscience, 2011Co-Authors: Isabella Helmreich, Roland Mergl, Martin Hautzinger, Verena Henkel, Ulrich Hegerl, Stefanie Wagner, Antjekathrin Allgaier, Andre TadicAbstract:Depression rating scales play a decisive role in the assessment of the severity of Depression and the evaluation of the efficacy of antidepressant treatments. The Hamilton Depression Rating Scale (HAMD) is regarded as the ‘gold standard’; nevertheless, studies suggest that the Inventory of Depressive Symptomatology (IDS) is more sensitive to detect symptom changes. The aim of the present study was to investigate whether the IDS is more sensitive in detecting changes in Depression symptoms in patients with mild major, minor or Subsyndromal Depression (MIND). Biweekly IDS-C28 and HAMD17 data from 340 patients of a 10-week randomized, placebo-controlled trial comparing the effectiveness of sertraline and cognitive-behavioural therapy in patients with MIND were analysed. We investigated sensitivity to change for both scales (1) from assessment-to-assessment, (2) in relation to Depression severity level, and (3) in relation to DSM-IV Depression criterion symptoms. The IDS-C28 was more sensitive in detecting changes in Depression symptomatology over the treatment course as well as for different severity levels, especially in patients with a low Depression severity. It assesses the DSM-IV criteria more thoroughly, is better able to track the change of cognitive symptoms and to identify residual symptoms. Both scales are well able to assess depressive symptomatology. However, the IDS-C28 surpasses the HAMD17 in detecting small changes especially in the core symptoms of Depression. This is important for an optimal treatment by capturing early improvements, enabling prompt reactions and detecting residual symptoms.
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early improvement is a predictor of treatment outcome in patients with mild major minor or Subsyndromal Depression
Journal of Affective Disorders, 2010Co-Authors: Andre Tadic, Isabella Helmreich, Roland Mergl, Martin Hautzinger, Ralf Kohnen, Verena Henkel, Ulrich HegerlAbstract:Abstract 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 ≥ 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 (≥ 50% HAMD-17 sum score reduction at weeks 8 and 10) and stable remission (HAMD-17 sum score ≤ 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.
Andre Tadic - One of the best experts on this subject based on the ideXlab platform.
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the inventory of depressive symptomatology ids c 28 is more sensitive to changes in depressive symptomatology than the hamilton Depression rating scale hamd 17 in patients with mild major minor or Subsyndromal Depression
European Archives of Psychiatry and Clinical Neuroscience, 2011Co-Authors: Isabella Helmreich, Roland Mergl, Martin Hautzinger, Verena Henkel, Ulrich Hegerl, Stefanie Wagner, Antjekathrin Allgaier, Andre TadicAbstract:Depression rating scales play a decisive role in the assessment of the severity of Depression and the evaluation of the efficacy of antidepressant treatments. The Hamilton Depression Rating Scale (HAMD) is regarded as the ‘gold standard’; nevertheless, studies suggest that the Inventory of Depressive Symptomatology (IDS) is more sensitive to detect symptom changes. The aim of the present study was to investigate whether the IDS is more sensitive in detecting changes in Depression symptoms in patients with mild major, minor or Subsyndromal Depression (MIND). Biweekly IDS-C28 and HAMD17 data from 340 patients of a 10-week randomized, placebo-controlled trial comparing the effectiveness of sertraline and cognitive-behavioural therapy in patients with MIND were analysed. We investigated sensitivity to change for both scales (1) from assessment-to-assessment, (2) in relation to Depression severity level, and (3) in relation to DSM-IV Depression criterion symptoms. The IDS-C28 was more sensitive in detecting changes in Depression symptomatology over the treatment course as well as for different severity levels, especially in patients with a low Depression severity. It assesses the DSM-IV criteria more thoroughly, is better able to track the change of cognitive symptoms and to identify residual symptoms. Both scales are well able to assess depressive symptomatology. However, the IDS-C28 surpasses the HAMD17 in detecting small changes especially in the core symptoms of Depression. This is important for an optimal treatment by capturing early improvements, enabling prompt reactions and detecting residual symptoms.
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the inventory of depressive symptomatology ids c28 is more sensitive to changes in depressive symptomatology than the hamilton Depression rating scale hamd17 in patients with mild major minor or Subsyndromal Depression
European Archives of Psychiatry and Clinical Neuroscience, 2011Co-Authors: Isabella Helmreich, Roland Mergl, Martin Hautzinger, Verena Henkel, Ulrich Hegerl, Stefanie Wagner, Antjekathrin Allgaier, Andre TadicAbstract:Depression rating scales play a decisive role in the assessment of the severity of Depression and the evaluation of the efficacy of antidepressant treatments. The Hamilton Depression Rating Scale (HAMD) is regarded as the ‘gold standard’; nevertheless, studies suggest that the Inventory of Depressive Symptomatology (IDS) is more sensitive to detect symptom changes. The aim of the present study was to investigate whether the IDS is more sensitive in detecting changes in Depression symptoms in patients with mild major, minor or Subsyndromal Depression (MIND). Biweekly IDS-C28 and HAMD17 data from 340 patients of a 10-week randomized, placebo-controlled trial comparing the effectiveness of sertraline and cognitive-behavioural therapy in patients with MIND were analysed. We investigated sensitivity to change for both scales (1) from assessment-to-assessment, (2) in relation to Depression severity level, and (3) in relation to DSM-IV Depression criterion symptoms. The IDS-C28 was more sensitive in detecting changes in Depression symptomatology over the treatment course as well as for different severity levels, especially in patients with a low Depression severity. It assesses the DSM-IV criteria more thoroughly, is better able to track the change of cognitive symptoms and to identify residual symptoms. Both scales are well able to assess depressive symptomatology. However, the IDS-C28 surpasses the HAMD17 in detecting small changes especially in the core symptoms of Depression. This is important for an optimal treatment by capturing early improvements, enabling prompt reactions and detecting residual symptoms.
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early improvement is a predictor of treatment outcome in patients with mild major minor or Subsyndromal Depression
Journal of Affective Disorders, 2010Co-Authors: Andre Tadic, Isabella Helmreich, Roland Mergl, Martin Hautzinger, Ralf Kohnen, Verena Henkel, Ulrich HegerlAbstract:Abstract 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 ≥ 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 (≥ 50% HAMD-17 sum score reduction at weeks 8 and 10) and stable remission (HAMD-17 sum score ≤ 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.
