TY - JOUR
T1 - Remission, response without remission, and nonresponse in major depressive disorder
T2 - Impact on functioning
AU - Trivedi, Madhukar H.
AU - Corey-Lisle, Patricia K.
AU - Guo, Zhenchao
AU - Lennox, Richard D.
AU - Pikalov, Andrei
AU - Kim, Edward
PY - 2009/5
Y1 - 2009/5
N2 - Major depressive disorder (MDD) is associated with significant functional impairment. This post-hoc analysis of data from two randomized trials assessed the impact of response status on functioning in MDD. Patients with at least one historical treatment failure followed by an inadequate response after 8 weeks of prospective open-label treatment with escitalopram, fluoxetine, paroxetine-CR, sertraline, or venlafaxine-XR plus single-blind placebo were randomized to 6 weeks of double-blind treatment with adjunctive placebo or adjunctive aripiprazole. At the end of double-blind treatment, patients were defined as: in remission [≥ 50% reduction in Montgomery-Åsberg Depression Rating Scale (MADRS) score with MADRS ≤10]; with a response without remission (≥50% reduction in MADRS with MADRS >10); or with a nonresponse (all others). Functional status was assessed with the Sheehan Disability Scale. Of the 679 patients, 144 were in remission, 44 had a response without remission, and 491 had a nonresponse. Mean improvements in the Sheehan Disability Scale total and item scores were significantly greater in patients in remission versus those with a response without remission (P<0.02) as well as nonresponse (P<0.001). Structural Equation Modeling found that efficacy (Hamilton Rating Scale for Depression scores) did not significantly correlate with functioning in this study. In conclusion, MDD patients achieving symptomatic remission experience greater functional improvements than those respond without remission. Functioning may be a distinctly different outcome from symptom reduction. Treatments focused on producing high remission rates may improve patient functioning over and above that seen with patients who only achieve response.
AB - Major depressive disorder (MDD) is associated with significant functional impairment. This post-hoc analysis of data from two randomized trials assessed the impact of response status on functioning in MDD. Patients with at least one historical treatment failure followed by an inadequate response after 8 weeks of prospective open-label treatment with escitalopram, fluoxetine, paroxetine-CR, sertraline, or venlafaxine-XR plus single-blind placebo were randomized to 6 weeks of double-blind treatment with adjunctive placebo or adjunctive aripiprazole. At the end of double-blind treatment, patients were defined as: in remission [≥ 50% reduction in Montgomery-Åsberg Depression Rating Scale (MADRS) score with MADRS ≤10]; with a response without remission (≥50% reduction in MADRS with MADRS >10); or with a nonresponse (all others). Functional status was assessed with the Sheehan Disability Scale. Of the 679 patients, 144 were in remission, 44 had a response without remission, and 491 had a nonresponse. Mean improvements in the Sheehan Disability Scale total and item scores were significantly greater in patients in remission versus those with a response without remission (P<0.02) as well as nonresponse (P<0.001). Structural Equation Modeling found that efficacy (Hamilton Rating Scale for Depression scores) did not significantly correlate with functioning in this study. In conclusion, MDD patients achieving symptomatic remission experience greater functional improvements than those respond without remission. Functioning may be a distinctly different outcome from symptom reduction. Treatments focused on producing high remission rates may improve patient functioning over and above that seen with patients who only achieve response.
KW - Aripiprazole
KW - Functioning
KW - Major depressive disorder
KW - Remission
KW - Response
KW - Sheehan disability scale
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U2 - 10.1097/YIC.0b013e3283277614
DO - 10.1097/YIC.0b013e3283277614
M3 - Article
C2 - 19318972
AN - SCOPUS:67649227652
SN - 0268-1315
VL - 24
SP - 133
EP - 138
JO - International Clinical Psychopharmacology
JF - International Clinical Psychopharmacology
IS - 3
ER -