Back to Search
Start Over
Is prior course of illness relevant to acute or longer-term outcomes in depressed out-patients? A STAR*D report.
- Source :
-
Psychological medicine [Psychol Med] 2012 Jun; Vol. 42 (6), pp. 1131-49. Date of Electronic Publication: 2011 Oct 19. - Publication Year :
- 2012
-
Abstract
- Background: Major depressive disorder (MDD) is commonly chronic and/or recurrent. We aimed to determine whether a chronic and/or recurrent course of MDD is associated with acute and longer-term MDD treatment outcomes.<br />Method: This cohort study recruited out-patients aged 18-75 years with non-psychotic MDD from 18 primary and 23 psychiatric care clinics across the USA. Participants were grouped as: chronic (index episode >2 years) and recurrent (n = 398); chronic non-recurrent (n=257); non-chronic recurrent (n=1614); and non-chronic non-recurrent (n = 387). Acute treatment was up to 14 weeks of citalopram (≤ 60 mg/day) with up to 12 months of follow-up treatment. The primary outcomes for this report were remission [16-item Quick Inventory of Depressive Symptomatology - Self-Rated (QIDS-SR(16)) ≤ 5] or response (≥ 50% reduction from baseline in QIDS-SR(16)) and time to first relapse [first QIDS-SR16 by Interactive Voice Response (IVR) ≥ 11].<br />Results: Most participants (85%) had a chronic and/or recurrent course; 15% had both. Chronic index episode was associated with greater sociodemographic disadvantage. Recurrent course was associated with earlier age of onset and greater family histories of depression and substance abuse. Remission rates were lowest and slowest for those with chronic index episodes. For participants in remission entering follow-up, relapse was most likely for the chronic and recurrent group, and least likely for the non-chronic, non-recurrent group. For participants not in remission when entering follow-up, prior course was unrelated to relapse.<br />Conclusions: Recurrent MDD is the norm for out-patients, of whom 15% also have a chronic index episode. Chronic and recurrent course of MDD may be useful in predicting acute and long-term MDD treatment outcomes.
- Subjects :
- Adolescent
Adult
Aged
Analysis of Variance
Antidepressive Agents, Second-Generation administration & dosage
Chronic Disease
Citalopram administration & dosage
Cohort Studies
Depressive Disorder, Major drug therapy
Disease Progression
Female
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Outpatients
Psychiatric Status Rating Scales
Recurrence
Severity of Illness Index
Treatment Outcome
United States
Young Adult
Antidepressive Agents, Second-Generation therapeutic use
Citalopram therapeutic use
Depressive Disorder, Major psychology
Subjects
Details
- Language :
- English
- ISSN :
- 1469-8978
- Volume :
- 42
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- Psychological medicine
- Publication Type :
- Academic Journal
- Accession number :
- 22008447
- Full Text :
- https://doi.org/10.1017/S0033291711002170