Response rate profiles for major depressive disorder: Characterizing early response and longitudinal nonresponse

• Type of Material: Article
• Authors: Mary Kelley, Emory University; Boadie Dunlop, Emory University; Charles B. Nemeroff, University of Miami; Adriana Lori, Emory University; Tania Carrillo-Roa, Max-Planck Institute of Psychiatry, Germany; Elisabeth Binder, Emory University; Michael Kutner, Emory University; Vivianne Aponte Rivera, Tulane University; Wade Craighead, Emory University; Helen Mayberg, Emory University
• Language: English
• Date: 2018-10-01
• Publisher: Wiley
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2018 Wiley Periodicals, Inc.
• Final Published Version (URL): http://dx.doi.org/10.1002/da.22832
• Title of Journal or Parent Work: Depression and Anxiety
• ISSN: 1091-4269
• Volume: 35
• Issue: 10
• Start Page: 992
• End Page: 1000
• Grant/Funding Information: National Institute of Mental Health, Grant/Award Numbers: K23MH086690, P50 MH077083, R01 MH080880
• Keywords: CLINICAL-TRIALS; Psychology, Clinical; cognitive behavior therapy; OUTCOMES; TRAJECTORIES; METAANALYSIS; genetics; POLYMORPHISM 5-HTTLPR ASSOCIATION; CBT; Life Sciences & Biomedicine; Psychology; PSYCHOTHERAPY; COGNITIVE-BEHAVIORAL THERAPY; Science & Technology; ANTIDEPRESSANT MEDICATION; Psychiatry; treatment; SUDDEN GAINS; depression; Social Sciences; antidepressants; NONSPECIFIC FACTORS
• Research Categories: Psychology, Cognitive; Health Sciences, Public Health

Abstract

Background: Definition of response is critical when seeking to establish valid predictors of treatment success. However, response at the end of study or endpoint only provides one view of the overall clinical picture that is relevant in testing for predictors. The current study employed a classification technique designed to group subjects based on their rate of change over time, while simultaneously addressing the issue of controlling for baseline severity. Methods: A set of latent class trajectory analyses, incorporating baseline level of symptoms, were performed on a sample of 344 depressed patients from a clinical trial evaluating the efficacy of cognitive behavior therapy and two antidepressant medications (escitalopram and duloxetine) in patients with major depressive disorder. Results: Although very few demographic and illness-related features were associated with response rate profiles, the aggregated effect of candidate genetic variants previously identified in large pharmacogenetic studies and meta-analyses showed a significant association with early remission as well as nonresponse. These same genetic scores showed a less compelling relationship with endpoint response categories. In addition, consistent nonresponse throughout the study treatment period was shown to occur in different subjects than endpoint nonresponse, which was verified by follow-up augmentation treatment outcomes. Conclusions: When defining groups based on the rate of change, controlling for baseline depression severity may help to identify the clinically relevant distinctions of early response on one end and consistent nonresponse on the other.