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Residual symptoms after remission of major depressive disorder with citalopram and risk of relapse: a STAR*D report

Published online by Cambridge University Press:  22 May 2009

A. A. Nierenberg ,
M. M. Husain ,
M. H. Trivedi ,
M. Fava ,
D. Warden ,
S. R. Wisniewski ,
S. Miyahara  and
A. J. Rush
A. A. Nierenberg*
Affiliation:
Depression Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA
M. M. Husain
Affiliation:
The University of Texas Southwestern Medical Center, Department of Psychiatry, Dallas, TX, USA
M. H. Trivedi
Affiliation:
The University of Texas Southwestern Medical Center, Department of Psychiatry, Dallas, TX, USA
M. Fava
Affiliation:
Depression Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA
D. Warden
Affiliation:
The University of Texas Southwestern Medical Center, Department of Psychiatry, Dallas, TX, USA
S. R. Wisniewski
Affiliation:
Epidemiology Data Center, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
S. Miyahara
Affiliation:
Epidemiology Data Center, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
A. J. Rush
Affiliation:
The University of Texas Southwestern Medical Center, Departments of Clinical Sciences and Psychiatry, Dallas, TX, USA
*
*Address for correspondence: A. A. Nierenberg, M.D., Massachusetts General Hospital, Suite 580, 50 Staniford Street, Boston, MA02114, USA. (Email: [email protected])
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Abstract

Background

Many patients with major depressive disorder (MDD) who experience full symptomatic remission after antidepressant treatment still have residual depressive symptoms. We describe the types and frequency of residual depressive symptoms and their relationship to subsequent depressive relapse after treatment with citalopram in the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial.

Method

Participants in primary (n=18) and psychiatric (n=23) practice settings were openly treated with citalopram using measurement-based care for up to 14 weeks and follow-up for up to 1 year. We assessed 943 (32.8% of 2876) participants who met criteria for remission to determine the proportions with individual residual symptoms and any of the nine DSM-IV criterion symptom domains to define a major depressive episode. At each visit, the 16-item Quick Inventory of Depressive Symptomatology, Self-Report (QIDS-SR16) and the self-report Frequency, Intensity, and Burden of Side Effects Rating (FIBSER) scale were used to assessed depressive symptoms and side-effects respectively.

Results

More than 90% of remitters had at least one residual depressive symptom (median=3). The most common were weight increase (71.3%) and mid-nocturnal insomnia (54.9%). The most common residual symptom domains were sleep disturbance (71.7%) and appetite/weight disturbance (35.9%). Those who remitted before 6 weeks had fewer residual symptoms at study exit than did later remitters. Residual sleep disturbance did not predict relapse during follow-up. Having a greater number of residual symptom domains was associated with a higher probability of relapse.

Conclusions

Patients with remission of MDD after treatment with citalopram continue to experience selected residual depressive symptoms, which increase the risk of relapse.

Keywords

Major depressionremissionresidual symptoms
Type
Original Articles
Information
Psychological Medicine , Volume 40 , Issue 1 , January 2010 , pp. 41 - 50
Copyright
Copyright © Cambridge University Press 2009

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References

Bockting, C, Spinhoven, P, Koeter, M, Wouters, L, Schene, A; Depression Evaluation Longitudinal Therapy Assessment (DELTA) Study Group (2006). Prediction of recurrence in recurrent depression and the influence of consecutive episodes on vulnerability for depression: a 2-year prospective study. Journal of Clinical Psychiatry 67, 747–755.CrossRefGoogle ScholarPubMed
Carney, CE, Segal, ZV, Edinger, JD, Krystal, AD (2007). A comparison of rates of residual insomnia symptoms following pharmacotherapy or cognitive-behavioral therapy for major depressive disorder. Journal of Clinical Psychiatry 68, 254–260.CrossRefGoogle ScholarPubMed
DeBattista, C, Doghramji, K, Menza, M, Rosenthal, M, Fieve, R (2003). Adjunct modafinil for the short-term treatment of fatigue and sleepiness in patients with major depressive disorder: a preliminary double-blind, placebo-controlled study. Journal of Clinical Psychiatry 64, 1057–1064.CrossRefGoogle ScholarPubMed
Fava, G, Ruini, C, Belaise, C (2007). The concept of recovery in major depression. Psychological Medicine 37, 307–317.CrossRefGoogle ScholarPubMed
Fava, GA, Fabbri, S, Sonino, N (2002). Residual symptoms in depression: an emerging therapeutic target. Progress in Neuro-Psychopharmacology and Biological Psychiatry 26, 1019–1027.CrossRefGoogle ScholarPubMed
Fava, M, Rush, AJ, Trivedi, MH, Nierenberg, AA, Thase, ME, Sackeim, HA, Quitkin, FM, Wisniewski, S, Lavori, PW, Rosenbaum, JF, Kupfer, DJ (2003). Background and rationale for the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study. Psychiatric Clinics of North America 26, 457–494.CrossRefGoogle ScholarPubMed
Fava, M, Thase, ME, DeBattista, C (2005). A multicenter, placebo-controlled study of modafinil augmentation in partial responders to selective serotonin reuptake inhibitors with persistent fatigue and sleepiness. Journal of Clinical Psychiatry 66, 85–93.CrossRefGoogle ScholarPubMed
Hamilton, M (1960). A rating scale for depression. Journal of Neurology, Neurosurgery and Psychiatry 23, 56–61.CrossRefGoogle ScholarPubMed
Hamilton, M (1967). Development of a rating scale for primary depressive illness. British Journal of Social and Clinical Psychology 6, 278–296.CrossRefGoogle ScholarPubMed
Judd, LL, Akiskal, HS, Maser, JD, Zeller, PJ, Endicott, J, Coryell, W, Paulus, MP, Kunovac, JL, Leon, AC, Mueller, TI, Rice, JA, Keller, MB (1998 a). Major depressive disorder: a prospective study of residual subthreshold depressive symptoms as predictor of rapid relapse. Journal of Affective Disorders 50, 97–108.CrossRefGoogle ScholarPubMed
Judd, LL, Akiskal, HS, Maser, JD, Zeller, PJ, Endicott, J, Coryell, W, Paulus, MP, Kunovac, JL, Leon, AC, Mueller, TI, Rice, JA, Keller, MB (1998 b). A prospective 12-year study of subsyndromal and syndromal depressive symptoms in unipolar major depressive disorders. Archives of General Psychiatry 55, 694–700.CrossRefGoogle ScholarPubMed
Kanai, T, Takeuchi, H, Furukawa, TA, Yoshimura, R, Imaizumi, T, Kitamura, T, Takahashi, K (2003). Time to recurrence after recovery from major depressive episodes and its predictors. Psychological Medicine 33, 839–845.CrossRefGoogle ScholarPubMed
Kennedy, N, Paykel, E (2004). Residual symptoms at remission from depression: impact on long-term outcome. Journal of Affective Disorders 80, 135–144.CrossRefGoogle ScholarPubMed
Leon, AC (2007). The revised warning for antidepressants and suicidality: unveiling the black box of statistical analyses. American Journal of Psychiatry 164, 1786–1789.CrossRefGoogle ScholarPubMed
Leon, AC, Marzuk, PM, Tardiff, K, Bucciarelli, A, Stajic, M, Piper, TM, Galea, S (2007). Antidepressants in adult suicides in New York City: 2001–2004. Journal of Clinical Psychiatry 68, 1399–1403.CrossRefGoogle ScholarPubMed
Mintz, J, Mintz, LI, Arruda, MJ, Hwang, SS (1992). Treatments of depression and the functional capacity to work. Archives of General Psychiatry 49, 761–768.CrossRefGoogle ScholarPubMed
Mojtabai, R (2001). Residual symptoms and impairment in major depression in the community. American Journal of Psychiatry 158, 1645–1651.CrossRefGoogle ScholarPubMed
Nierenberg, AA, Keefe, BR, Leslie, VC, Alpert, JE, Pava, JA, Worthington, JJ, Rosenbaum, JF, Fava, M (1999). Residual symptoms in depressed patients who respond acutely to fluoxetine. Journal of Clinical Psychiatry 60, 221–225.Google Scholar
Nierenberg, AA, Wright, EC (1999). Evolution of remission as the new standard in the treatment of depression. Journal of Clinical Psychiatry 60, 7–11.Google ScholarPubMed
Rush, AJ, Bernstein, IH, Trivedi, MH, Carmody, TJ, Wisniewski, S, Mundt, JC, Shores-Wilson, K, Biggs, MM, Woo, A, Nierenberg, AA, Fava, M (2006 a). An evaluation of the Quick Inventory of Depressive Symptomatology and the Hamilton Rating Scale for Depression: a Sequenced Treatment Alternatives to Relieve Depression trial report. Biological Psychiatry 59, 493–501.CrossRefGoogle ScholarPubMed
Rush, AJ, Fava, M, Wisniewski, SR, Lavori, PW, Trivedi, MH, Sackeim, HA, Thase, ME, Nierenberg, AA, Quitkin, FM, Kashner, TM, Kupfer, DJ, Rosenbaum, JF, Alpert, J, Stewart, JW, McGrath, PJ, Biggs, MM, Shores-Wilson, K, Lebowitz, BD, Ritz, L, Niederehe, G (2004). Sequenced Treatment Alternatives to Relieve Depression (STAR*D): rationale and design. Controlled Clinical Trials 25, 119–142.Google Scholar
Rush, AJ, Kraemer, HC, Sackeim, HA, Fava, M, Trivedi, MH, Frank, E, Ninan, PT, Thase, ME, Gelenberg, AJ, Kupfer, DJ, Regier, DA, Rosenbaum, JF, Ray, O, Schatzberg, AF (2006 b). Report by the ACNP Task Force on Response and Remission in Major Depressive Disorder. Neuropsychopharmacology 31, 1841–1853.CrossRefGoogle ScholarPubMed
Rush, AJ, Trivedi, MH, Ibrahim, HM, Carmody, TJ, Arnow, B, Klein, DN, Markowitz, JC, Ninan, PT, Kornstein, S, Manber, R, Thase, ME, Kocsis, JH, Keller, MB (2003). The 16-Item Quick Inventory of Depressive Symptomatology (QIDS), clinician rating (QIDS-C), and self-report (QIDS-SR): a psychometric evaluation in patients with chronic major depression. Biological Psychiatry 54, 573–583.Google Scholar
Simon, GE (2006). How can we know whether antidepressants increase suicide risk? American Journal of Psychiatry 163, 1861–1863.CrossRefGoogle ScholarPubMed
Stahl, SM, Zhang, LS, Damatarca, C, Grady, M (2003). Brain-circuits determine destiny in depression: a novel approach to the psychopharmacology of wakefulness, fatigue, and executive dysfunction in major depressive disorder. Journal of Clinical Psychiatry 64, 6–17.Google Scholar
Thase, ME, Fava, M, DeBattista, C, Arora, S, Hughes, RJ (2006). Modafinil augmentation of SSRI therapy in patients with major depressive disorder and excessive sleepiness and fatigue: a 12-week, open-label, extension study. CNS Spectrums 11, 93–102.CrossRefGoogle ScholarPubMed
Trivedi, MH, Rush, AJ, Ibrahim, HM, Carmody, TJ, Biggs, MM, Suppes, T, Crismon, ML, Shores-Wilson, K, Toprac, MG, Dennehy, EB, Witte, B, Kashner, TM (2004). The Inventory of Depressive Symptomatology, Clinician Rating (IDS-C) and Self-Report (IDS-SR), and the Quick Inventory of Depressive Symptomatology, Clinician Rating (QIDS-C) and Self-Report (QIDS-SR) in public sector patients with mood disorders: a psychometric evaluation. Psychological Medicine 34, 73–82.CrossRefGoogle ScholarPubMed
Trivedi, MH, Rush, AJ, Wisniewski, SR, Nierenberg, AA, Warden, D, Ritz, L, Norquist, G, Howland, RH, Lebowitz, B, McGrath, PJ, Shores-Wilson, K, Biggs, MM, Balasubramani, GK, Fava, M (2006). Evaluation of outcomes with citalopram for depression using measurement-based care in STAR*D: implications for clinical practice. American Journal of Psychiatry 163, 28–40.CrossRefGoogle ScholarPubMed
Wisniewski, SR, Rush, AJ, Balasubramani, GK, Trivedi, MH, Nierenberg, AA, for the STAR*D Investigators (2006). Self-rated global measure of the frequency, intensity, and burden of side effects. Journal of Psychiatric Practice 12, 71–79.CrossRefGoogle ScholarPubMed
Zimmerman, M, Posternak, MA, Chelminski, I (2007). Heterogeneity among depressed outpatients considered to be in remission. Comprehensive Psychiatry 48, 113–117.CrossRefGoogle ScholarPubMed