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Treatment response for acute depression is not associated with number of previous episodes: lack of evidence for a clinical staging model for major depressive disorder

journal contribution
posted on 2013-01-01, 00:00 authored by Seetal DoddSeetal Dodd, Michael BerkMichael Berk, K Kelin, M Mancini, A Schacht
Mental illness has been observed to follow a neuroprogressive course, commencing with prodrome, then onset, recurrence and finally chronic illness. In bipolar disorder and schizophrenia responsiveness to treatment mirrors these stages of illness progression, with greater response to treatment in the earlier stages of illness and greater treatment resistance in chronic late stage illness.

Using data from 5627 participants in 15 controlled trials of duloxetine, comparator arm (paroxetine, venlafaxine, escitalopram) or placebo for the treatment of an acute depressive episode, the relationship between treatment response and number of previous depressive episodes was determined. Data was dichotomised for comparisons between participants who had >3 previous episodes (n=1697) or ≤3 previous episodes (n=3930), and additionally for no previous episodes (n=1381) or at least one previous episode (n=4246). Analyses were conducted by study arm for each clinical trial, and results were then pooled.

There was no significant difference between treatment response and number of previous depressive episodes. This unexpected finding suggests that treatments to reduce symptoms of depression during acute illness do not lose efficacy for patients with a longer history of illness.

History

Journal

Journal of affective disorders

Volume

150

Pagination

344 - 349

Publisher

Elsevier BV

Location

Amsterdam, The Netherlands

ISSN

0165-0327

eISSN

1573-2517

Language

eng

Publication classification

C1 Refereed article in a scholarly journal; C Journal article