| Home | Subscribe to the Journal | Sign up for E-Lerts to your inbox |
| This entire article is available in PDF format to paid subscribers (certain restrictions apply). If you have not already registered for Full Text Access to The Journal, then visit our registration page. |
Response to a Selective Serotonin Reuptake Inhibitor (Citalopram) in Major Depressive Disorder With Melancholic Features: A STAR*D ReportPatrick J. McGrath, M.D.; Ahsan Y. Khan, M.D.; Madhukar H. Trivedi, M.D.; Jonathan W. Stewart, M.D.; David W. Morris, Ph.D.; Stephen R. Wisniewski, Ph.D.; Sachiko Miyahara, M.S.; Andrew A. Nierenberg, M.D.; Maurizio Fava, M.D.; and A. John Rush, M.D.Objective: This study examined demographic and clinical correlates of DSM-IV major depressive disorder with melancholic features and assessed whether melancholic features were predictive of response to a selective serotonin reuptake inhibitor antidepressant. Method: Participants with major depressive disorder (N = 2875) at primary and specialty care sites who received the first step treatment with citalopram in the Sequenced Treatment Alternatives to Relieve Depression study were included. Patients were enrolled between July 2001 and April 2004. Melancholic features were ascribed by previously developed algorithms of telephone interview ratings prior to treatment. Demographics, clinical features, and treatment response were compared between those with and without melancholic features. Results: The 23.5% of participants with melancholic features were characterized by higher severity scores, greater rates of previous suicide attempts and ratings of current suicidal risk, and more concurrent psychiatric comorbidity. Unadjusted remission rates for those with melancholic features were statistically significantly reduced in absolute terms by up to 8.4% compared to those without melancholic features, which is a 24.1% decrease in relative chance of remission (p < .0001). Following adjustments for between-group baseline differences, remission rates were no longer different. Conclusion: Melancholic features are associated with a significantly reduced remission rate with an SSRI. This effect appears to be accounted for by demographic and clinical features associated with melancholic features. Trial Registration: clinicaltrials.gov Identifier: NCT0021528
(J Clin Psychiatry 2008;69:1847-1855. Online Ahead of Print November 18, 2008.) Received Aug. 30, 2007; accepted March 25, 2008. From the Department of Psychiatry, College of Physicians and Surgeons of Columbia University and the New York State Psychiatric Institute, New York (Drs. McGrath and Stewart); Department of Psychiatry, University of Kansas School of Medicine-Wichita (Dr. Khan); Department of Psychiatry, University of Texas Southwestern Medical School, Dallas (Drs. Trivedi, Morris, and Rush); Epidemiology Data Center, Graduate School of Public Health, University of Pittsburgh, Pa. (Dr. Wisniewski and Ms. Miyahara); and Department of Psychiatry, Harvard Medical School, and the Depression Clinical and Research Program, Massachusetts General Hospital, Boston, Mass. (Drs. Nierenberg and Fava). This project has been funded by the National Institute of Mental Health under contract N01MH90003 to University of Texas Southwestern Medical Center at Dallas (primary investigator, A.J.R.). Bristol-Myers Squibb, Forest, GlaxoSmithKline, King Pharmaceuticals, Organon, Pfizer, and Wyeth-Ayerst provided medications at no cost for this trial. The content of this publication does not necessarily reflect the views or policies of the U.S. Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government. Financial disclosure appears at the end of the article. Corresponding author and reprints: Patrick J. McGrath, M.D., Depression Evaluation Service, New York State Psychiatric Institute, 1051 Riverside Dr., Unit #51, New York, NY 10032 (e-mail: mcgrath@pi.cpmc.columbia.edu). |