PracticeUpdate Conference Series European Congress of Psychiatry 2019

6-week endpoint, experience a full response (defined as a ≥50% reduction in HDRS baseline score) or remission (defined as an HDRS score <8). All 2-week improvers showed significantly better outcomes at the 6-week evaluation, in comparison with the 2-week non- improvers, and this held true regardless of which of the three medications they took. According to Dr. Anmella, 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. Although the investigators concluded in their abstract that “2-week antidepressant responsiveness does not provide enough information to make therapeutic decisions in patients with moderate to severe unipolar major depressive episode,” they also suggested that “responsiveness after 2 weeks of anti- depressant treatment could be suggested as a prognostic factor.” The study has been accepted for publication in the Journal of Clinical Psychopharmacology .

moderate-to-severe unipolar major depression, defined as a Hamilton Depression Rating Scale (HDRS) score ≥19. They ranged in age from 18 to 70 years. Subjects were given one of three antidepressants according to their HDRS score: escitalopram (10–30 mg/day) if HDRS <21, venlafaxine-ER (75–300 mg/day) if HDRS = 21 to 23, and imipra- mine (50–150 mg/day) if HDRS >23. Raters blind to the treatment option monitored clinical severity, as defined by the HDRS, at 2, 4 and 6 weeks. By the end of the study, there were 260 improvers, defined as at least a 25% reduction in HDRS score compared with baseline. There were 358 non-improvers. There were no differences in response rates based on class of drug, sex, age, duration of depression, presence of psychotic episodes, or being an in-patient or outpatient. There were no data as to whether subjects had undergone psychotherapy or whether subjects were experiencing their first or a subsequent depressive episode. The study results gave weight to current guidelines in that response after 2 weeks of pharmacotherapy was not predictive of response at 6 weeks. More than 80% of subjects who had not improved after 2 weeks of pharmacotherapy did, at the

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EPA 2019 • PRACTICEUPDATE CONFERENCE SERIES 17