PracticeUpdate Conference Series European Congress of Psychiatry 2019

Early Antidepressant Response Not Sufficiently Predictive of Later Response In Major Depression Many 2-week non-improvers were responders or remitters at 6 weeks.

F or patients with moderate-to-severe unipolar major depressive disorder, response to antidepressant medication at 2 weeks is not sufficient to make therapeutic decisions. In an interview with Elsevier’s PracticeUpdate , presenter Gerard Anmella, MD, a psychiatry trainee at the University of Barcelona in Catalonia, Spain, said that several clinical practice guidelines, including those of the American Psychiatric Association, the National Institute for Health and Care Excellence (NICE), the Canadian Network for Mood and Anxiety Treatments (CANMAT), and the World Federation of Societies of Biological Psychiatry, recommend not assessing the efficacy of antidepressant medication until a minimum of 4 to 6 weeks of therapeutic doses have occurred. On the other hand, Dr. Anmella continued, upon post-hoc analysis, at least three clinical trial reports have proposed that improvement at 2 weeks is sufficient for gauging later degree of response. The situation is not clear, however, as only a few studies have provided evidence for this through prospective assessment. Furthermore, in these studies, the final outcomes of early non-improvers have not been ascertained. Dr. Anmella and colleagues conducted a 6-week longitudinal, prospective, single-blinded study to determine the predictive value of symptom respon- siveness after 2 weeks of antidepressant treatment for major depression. The 618 subjects were in- and outpatients who met DSM-IV criteria for

" …one strength of the

study is that it included severely depressed patients, unlike other trials, such as Sequenced Treatment Alternatives to Relieve Depression (STAR*D), which included patients with less severe depression and depressive episodes of longer duration. "

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