Does the Duration of Index Episode Affect the Treatment Outcome of Major Depressive Disorder? A STAR*D Report
J Clin Psychiatry 2008;69(8):1246-1256
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Objective: This article aims to identify
baseline sociodemographic and clinical characteristics
associated with the duration of the index major
depressive episode (MDE) and to assess the effect of the
current MDE duration on response and remission rates
with up to 14 weeks of citalopram.
Method: Eligible participants met DSM-IV
criteria for nonpsychotic major depressive disorder, scored
>= 14 on the 17-item Hamilton Rating Scale for
Depression (HAM-D-17), and were not resistant to
adequate antidepressant treatment in the current episode.
The first patient was enrolled in July 2001 and the
last visit for the last patient in follow-up was in
March 2006. The evaluable sample (N = 2851) was
divided into 4 groups based on the index MDE duration
at study entry: acute (<= 6 months, N = 1324),
subchronic (7-23 months, N = 807), chronic (24-41 months, N = 326), and ultrachronic (>= 42 months,
N = 394). These 4 groups were compared in terms of baseline sociodemographic and clinical
characteristics and treatment outcomes. Citalopram was
generally begun at 20 mg/day and raised to 40 mg/day by
weeks 2 through 4 and to 60 mg/day (final dose) by weeks
4 through 6. Logistic regression models with
adjusted post hoc analyses were used to control for
associated baseline characteristics. Response was defined as
>= 50% reduction in baseline 16-item Quick Inventory
of Depressive Symptomatology-Self-Report (QIDS-SR-16) scores at exit. Remission was defined as <= 7
on the HAM-D-17 or <= 5 on the QIDS-SR-16.
Results: MDE duration was longer in primary
care settings, blacks, Hispanics, single or widowed,
unemployed, publicly insured or uninsured, older, and
less educated participants and in those with lower
income, less recurrence, or greater concurrent general
medical or Axis I comorbidities. HAM-D-17 remission
rates ranged from 31.0% (acute group) to 24.1% (ultrachronic group). HAM-D-17 remission rates
were significantly related to MDE duration (p = .0010),
but after adjustments for baseline differences among the
4 groups, remission rates were not different.
QIDS-SR-16 response rates were lower for the subacute
and chronic groups but not different for the acute
and ultrachronic groups after adjustment.
Conclusion: Longer MDE duration is
associated with socioeconomic disadvantage and greater Axis
I and medical comorbidity. Episode duration per se
does not significantly affect the likelihood of remission.
Trial Registration: clinicaltrials.gov