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Depression symptom dimensions as predictors of antidepressant treatment outcome: replicable evidence for interest-activity symptoms

Published online by Cambridge University Press:  20 September 2011

R. Uher ,
R. H. Perlis ,
N. Henigsberg ,
A. Zobel ,
M. Rietschel ,
O. Mors ,
J. Hauser ,
M. Z. Dernovsek ,
D. Souery  and
M. Bajs
...Show all authors
R. Uher*
Affiliation:
MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, UK
R. H. Perlis
Affiliation:
Center for Experimental Drugs and Diagnostics, Department of Psychiatry and Center for Human Genetic Research, Massachusetts General Hospital, Boston, USA
N. Henigsberg
Affiliation:
Croatian Institute for Brain Research, Medical School, University of Zagreb, Croatia
A. Zobel
Affiliation:
Department of Psychiatry, University of Bonn, Germany
M. Rietschel
Affiliation:
Central Institute of Mental Health, Division of Genetic Epidemiology in Psychiatry, Mannheim, Germany
O. Mors
Affiliation:
Centre for Psychiatric Research, Aarhus University Hospital, Risskov, Denmark
J. Hauser
Affiliation:
Laboratory of Psychiatric Genetics, Department of Psychiatry, Poznan University of Medical Sciences, Poland
M. Z. Dernovsek
Affiliation:
University Psychiatric Clinic, Ljubljana, Slovenia
D. Souery
Affiliation:
Laboratoire de Psychologie Médicale, Université Libre de Bruxelles and Psy Pluriel – Centre Européen de Psychologie Médicale, Belgium
M. Bajs
Affiliation:
Croatian Institute for Brain Research, Medical School, University of Zagreb, Croatia
W. Maier
Affiliation:
Department of Psychiatry, University of Bonn, Germany
K. J. Aitchison
Affiliation:
MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, UK
A. Farmer
Affiliation:
MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, UK
P. McGuffin
Affiliation:
MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, UK
*
*Address for correspondence: Dr R. Uher, P080, SGDP, Institute of Psychiatry, 16 De Crespigny Park, London SE5 8AF, UK. (Email: [email protected])
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Abstract

Background

Symptom dimensions have not yet been comprehensively tested as predictors of the substantial heterogeneity in outcomes of antidepressant treatment in major depressive disorder.

Method

We tested nine symptom dimensions derived from a previously published factor analysis of depression rating scales as predictors of outcome in 811 adults with moderate to severe depression treated with flexibly dosed escitalopram or nortriptyline in Genome-based Therapeutic Drugs for Depression (GENDEP). The effects of symptom dimensions were tested in mixed-effect regression models that controlled for overall initial depression severity, age, sex and recruitment centre. Significant results were tested for replicability in 3637 adult out-patients with non-psychotic major depression treated with citalopram in level I of Sequenced Treatment Alternatives to Relieve Depression (STAR*D).

Results

The interest-activity symptom dimension (reflecting low interest, reduced activity, indecisiveness and lack of enjoyment) at baseline strongly predicted poor treatment outcome in GENDEP, irrespective of overall depression severity, antidepressant type and outcome measure used. The prediction of poor treatment outcome by the interest-activity dimension was robustly replicated in STAR*D, independent of a comprehensive list of baseline covariates.

Conclusions

Loss of interest, diminished activity and inability to make decisions predict poor outcome of antidepressant treatment even after adjustment for overall depression severity and other clinical covariates. The prominence of such symptoms may require additional treatment strategies and should be accounted for in future investigations of antidepressant response.

Keywords

Antidepressant medicationdepressive symptomsdimensional classificationmajor depressionoutcome prediction
Type
Original Articles
Information
Psychological Medicine , Volume 42 , Issue 5 , May 2012 , pp. 967 - 980
Copyright
Copyright © Cambridge University Press 2011

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