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Is prior course of illness relevant to acute or longer-term outcomes in depressed out-patients? A STAR*D report

Published online by Cambridge University Press:  19 October 2011

A. J. Rush ,
S. R. Wisniewski ,
S. Zisook ,
M. Fava ,
S. C. Sung ,
C. L. Haley ,
H. N. Chan ,
W. S. Gilmer ,
D. Warden  and
A. A. Nierenberg
...Show all authors
A. J. Rush
Affiliation:
Office of Clinical Sciences, Duke-NUS Graduate Medical School Singapore, Singapore
S. R. Wisniewski
Affiliation:
Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
S. Zisook
Affiliation:
Department of Psychiatry, University of California, San Diego, San Diego VA Medical Center, San Diego, CA, USA
M. Fava
Affiliation:
Depression Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA
S. C. Sung
Affiliation:
Office of Clinical Sciences, Duke-NUS Graduate Medical School Singapore, Singapore
C. L. Haley
Affiliation:
Office of Clinical Sciences, Duke-NUS Graduate Medical School Singapore, Singapore
H. N. Chan
Affiliation:
Department of Psychiatry, Singapore General Hospital, Singapore
W. S. Gilmer
Affiliation:
Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
D. Warden
Affiliation:
Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX, USA
A. A. Nierenberg
Affiliation:
Depression Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA
G. K. Balasubramani
Affiliation:
Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
B. N. Gaynes
Affiliation:
Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, NC, USA
M. H. Trivedi*
Affiliation:
Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
S. D. Hollon
Affiliation:
Department of Psychology, Vanderbilt University, Nashville, TN, USA
*
*Address for correspondence: M. H. Trivedi, M.D., University of Texas Southwestern Medical Center at Dallas, Bass Center, 6363 Forest Park Road, 13.354, Dallas, TX 75235, USA. (Email: madhukar.trivedi@utsouthwestern.edu)
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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.

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-SR16) ⩽5] or response (⩾50% reduction from baseline in QIDS-SR16) and time to first relapse [first QIDS-SR16 by Interactive Voice Response (IVR) ⩾11].

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.

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.

Keywords

Chroniccourse of illnessdepressionoutcomesrecurrent
Type
Original Articles
Information
Psychological Medicine , Volume 42 , Issue 6 , June 2012 , pp. 1131 - 1149
Copyright
Copyright © Cambridge University Press 2011

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