Hostname: page-component-7c8c6479df-xxrs7 Total loading time: 0 Render date: 2024-03-28T15:05:35.898Z Has data issue: false hasContentIssue false

Initial rate of improvement in major depression

Published online by Cambridge University Press:  02 January 2018

A. C. M. Vergouwen*
Affiliation:
Department of Psychiatry, St Lucas Andreas Hospital, Jan Tooropstraat 164, NL-1006 AE, Amsterdam, The Netherlands. Email: vergouwen@slaz.nl
Rights & Permissions [Opens in a new window]

Abstract

Type
Columns
Copyright
Copyright © 2006 The Royal College of Psychiatrists 

Dr Mitchell (Reference Mitchell2006) suggests that it may be pertinent to re-examine another commonly quoted recommendation - that an antidepressant trial must be at least 6 to 8 weeks before switching drugs. The evidence on which switch guidelines are based is weak but these guidelines are applied frequently in daily clinical practice. In previous studies symptom improvement at earlier time points in relation to response has been investigated (e.g. Reference Koran, Hamilton and HertzmarKoran et al, 1995) but the ultimate goal of depression treatment is complete remission. Remission takes longer than 4-6 weeks to achieve but substantial improvement is unlikely after 10-12 weeks (Reference Trivedi, Rush and WisniewskiTrivedi et al, 2006). Quitkin et al (Reference Quitkin, Petkova and McGrath2003) investigated the relationship between initial change in symptoms and remission by week 12 and demonstrated that even when there was no improvement after 6 weeks of treatment, an antidepressant trial should be continued because the proportion of patients attaining remission by week 12 was still considerable (i.e. greater than 30%). They argued that a switch of antidepressant medication would be unlikely to have resulted in higher remission rates. Furthermore, large studies are required in which change in symptoms is frequently measured at uniform time-points and dimensions other than those measured by conventional questionnaires for depression are assessed. These might be more sensitive to early change following the initiation of antidepressant treatment (Reference Harmer, Shelley and CowenHarmer et al, 2004), and therefore might better predict which patients will attain remission. Calculation of the sensitivity, specificity, area under the receiver operating characteristic curve, and positive and negative predictive power to assess the likelihood of remission for various levels of symptom change at different time-points would help clinicians to decide on clinical applicability. Results from such studies will improve the evidence on which switch guidelines are based.

References

Harmer, C. J., Shelley, N. C., Cowen, P. J., et al (2004) Increased positive versus negative perception and memory in heathy volunteers following selective serotonin and norepinephrine reuptake inhibition. American Journal of Psychiatry, 161, 12561263.CrossRefGoogle Scholar
Koran, L. M., Hamilton, S. H., Hertzmar, M., et al (1995) Predicting response to fluoxetine in geriatric patients with major depression. Journal of Clinical Psychopharmacology, 15, 421427.CrossRefGoogle ScholarPubMed
Mitchell, A. J. (2006) Two-week delay in onset of action of antidepressants: new evidence. British Journal of Psychiatry, 188, 105106.Google Scholar
Quitkin, F. M., Petkova, E., McGrath, P. J., et al (2003) When should a trial of fluoxetine for major depression be declared failed? American Journal of Psychiatry, 160, 734740.CrossRefGoogle ScholarPubMed
Trivedi, M. H., Rush, J., Wisniewski, S. R., et al (2006) Evaluation of outcomes with citalopram for depression using measurement-based care in STAR*D: implications for clinical practice. American Journal of Psychiatry, 163, 2840.Google Scholar
Submit a response

eLetters

No eLetters have been published for this article.