title: A meta-analysis of early sustained response rates between antidepressants and placebo for the treatment of major depressive disorder.
abstract: BACKGROUND
  Pattern analysis suggests that "true" drug response is characterized by clinical improvement that is not subsequently followed by a worsening of symptoms (sustained clinical response). To date, several reports demonstrate that early response rates are equivalent between antidepressant-treated and placebo-treated groups of patients with major depressive disorder, suggesting that patients who demonstrate significant and sustained symptom improvement during the first 2 weeks of treatment are not responding to the antidepressant itself, but to nonspecific, placebo-like factors.
  
  
  OBJECTIVE
  To compare early sustained response rates between antidepressant- and placebo-treated adults with major depressive disorder.
  
  
  METHODS
  Medline/Pubmed were searched. No year of publication limits were used.
  
  
  METHODS
  Randomized, double-blind, placebo-controlled antidepressant trials or pooled reports/meta-analyses of such trials reporting early sustained response rates for major depressive disorder. The decision to include studies in the meta-analysis was performed by 2 reviewers.
  
  
  METHODS
  Data were extracted with the use of a precoded form.
  
  
  RESULTS
  Analyses were performed on the proportion of patients who achieved a sustained response the first 2 weeks of treatment, as well as the first week of treatment. A random-effects model with fixed drug effects was used to combine the studies and make comparisons of sustained early response rates between antidepressant- and placebo-treated groups. Data from 8 reports involving a total of 7121 major depressive disorder patients (4076 randomized to treatment with an antidepressant and 3045 randomized to placebo) were analyzed. Antidepressant-treated patients were more likely to demonstrate sustained clinical response by 2 weeks (odds ratio 2.06, 95% CI: 1.52-2.8) or 1 week of treatment (odds ratio 1.50, 95% CI: 1.08-2.08) than placebo-treated patients.
  
  
  CONCLUSIONS
  The results of the present analysis suggest that "true" drug response can occur the first 2 week as well as the first week of treatment of major depressive disorder with conventional antidepressants.
authors.affiliation: Depression Clinical and Research Program, Massachusetts General Hospital,Harvard Medical School, Boston, MA 02114, USA. gpapakostas@patners.org
authors.forename: George I
authors.initials: GI
authors.lastname: Papakostas
authors.forename: Roy H
authors.initials: RH
authors.lastname: Perlis
authors.forename: Margaret J
authors.initials: MJ
authors.lastname: Scalia
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Petersen
authors.forename: Maurizio
authors.initials: M
authors.lastname: Fava
mesh_terms: D000928:Antidepressive Agents / Q000627:therapeutic use*; D003865:Major Depressive Disorder / Q000188:drug therapy*; D006801:Humans; D015990:Placebo Effect; D016032:Randomized Controlled Trials as Topic; D013997:Time Factors
chemical_list: D000928:Antidepressive Agents