title: Clinical characteristics and treatment outcome in a representative sample of depressed inpatients - findings from the Munich Antidepressant Response Signature (MARS) project.
abstract: 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.
authors.affiliation: Max Planck Institute of Psychiatry, Kraepelinstr. 2-10, 80804 Munich, Germany. hennings@mpipsukl.mpg.de
authors.forename: Johannes M
authors.initials: JM
authors.lastname: Hennings
authors.forename: Toshimi
authors.initials: T
authors.lastname: Owashi
authors.forename: Elisabeth B
authors.initials: EB
authors.lastname: Binder
authors.forename: Sonja
authors.initials: S
authors.lastname: Horstmann
authors.forename: Andreas
authors.initials: A
authors.lastname: Menke
authors.forename: Stefan
authors.initials: S
authors.lastname: Kloiber
authors.forename: Tatjana
authors.initials: T
authors.lastname: Dose
authors.forename: Bastian
authors.initials: B
authors.lastname: Wollweber
authors.forename: Derek
authors.initials: D
authors.lastname: Spieler
authors.forename: Thomas
authors.initials: T
authors.lastname: Messer
authors.forename: Rita
authors.initials: R
authors.lastname: Lutz
authors.forename: Heike
authors.initials: H
authors.lastname: Künzel
authors.forename: Thomas
authors.initials: T
authors.lastname: Bierner
authors.forename: Thomas
authors.initials: T
authors.lastname: Pollmächer
authors.forename: Hildegard
authors.initials: H
authors.lastname: Pfister
authors.forename: Thomas
authors.initials: T
authors.lastname: Nickel
authors.forename: Annette
authors.initials: A
authors.lastname: Sonntag
authors.forename: Manfred
authors.initials: M
authors.lastname: Uhr
authors.forename: Marcus
authors.initials: M
authors.lastname: Ising
authors.forename: Florian
authors.initials: F
authors.lastname: Holsboer
authors.forename: Susanne
authors.initials: S
authors.lastname: Lucae
mesh_terms: 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
chemical_list: D000928:Antidepressive Agents; D000324:Adrenocorticotropic Hormone; D006854:Hydrocortisone