Clinical characteristics and treatment outcome in a representative sample of depressed inpatients - findings from the Munich Antidepressant Response Signature (MARS) project.
Depression is a common and often difficult-to-treat clinical condition with a high rate of patients showing insufficient treatment response and persistence of symptoms. We report the characteristics of a representative sample of depressed inpatients participating in the Munich Antidepressant Response Signature (MARS) project. Eight hundred and forty-two inpatients admitted to a psychiatric hospital for treatment of a major depressive episode, recurrent or bipolar depression were thoroughly characterized with respect to demographic factors, clinical history, and the degree of HPA-axis dysregulation evaluated by means of combined dex/CRH tests, and the predictive value of these factors for treatment outcome is investigated. 80.8% of patients responded to treatment (i.e., improvement in symptom severity of at least 50%) and 57.9% reached remission (i.e., near absence of residual depressive symptoms) at discharge after a mean treatment period of 11.8 weeks. Regression analysis identified early partial response (within 2 weeks) as the most important positive predictor for achieving remission. Previous ineffective treatment trials in the current episode and presence of a migration background are potent negative predictors for treatment outcome. In addition, remitters were characterized by a more pronounced normalization of an initially dysregulated HPA-axis. We could show that a large majority of inpatients suffering from depression benefits from antidepressant treatment during hospitalization. However, a considerable number of patients failed to achieve remission. We demonstrated that this subgroup can be characterized by a set of demographic, clinical and neuroendocrine variables allowing to predict unfavorable outcome at an early stage of treatment.
Hennings
Johannes M
JM
Max Planck Institute of Psychiatry, Kraepelinstr. 2-10, 80804 Munich, Germany. hennings@mpipsukl.mpg.de
Owashi
Toshimi
T
Binder
Elisabeth B
EB
Horstmann
Sonja
S
Menke
Andreas
A
Kloiber
Stefan
S
Dose
Tatjana
T
Wollweber
Bastian
B
Spieler
Derek
D
Messer
Thomas
T
Lutz
Rita
R
Künzel
Heike
H
Bierner
Thomas
T
Pollmächer
Thomas
T
Pfister
Hildegard
H
Nickel
Thomas
T
Sonntag
Annette
A
Uhr
Manfred
M
Ising
Marcus
M
Holsboer
Florian
F
Lucae
Susanne
S
D000324:Adrenocorticotropic Hormone / Q000097:blood; D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use*; D003866:Depressive Disorder / Q000145:classification / Q000175:diagnosis / Q000188:drug therapy*; D005260:Female; D005858:Germany; D006778:Hospitals, Psychiatric; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007030:Hypothalamo-Hypophyseal System / Q000187:drug effects* / Q000378:metabolism; D007297:Inpatients / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D010913:Pituitary-Adrenal System / Q000187:drug effects* / Q000378:metabolism; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D011863:Radioimmunoassay; D012008:Recurrence; D012044:Regression Analysis; D016896:Treatment Outcome
D000928:Antidepressive Agents; D000324:Adrenocorticotropic Hormone; D006854:Hydrocortisone