Response to a selective serotonin reuptake inhibitor (citalopram) in major depressive disorder with melancholic features: a STAR*D report.
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.


METHODS
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.


CONCLUSIONS
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.


BACKGROUND
clinicaltrials.gov Identifier: NCT0021528.
McGrath
Patrick J
PJ
Department of Psychiatry, College of Physicians and Surgeons of Columbia University and New York State Psychiatric Institute, New York, NY 10032, USA. mcgrath@pi.cpmc.columbia.edu
Khan
Ahsan Y
AY
Trivedi
Madhukar H
MH
Stewart
Jonathan W
JW
Morris
David W
DW
Wisniewski
Stephen R
SR
Miyahara
Sachiko
S
Nierenberg
Andrew A
AA
Fava
Maurizio
M
Rush
A John
AJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D000553:Ambulatory Care; D018687:Antidepressive Agents, Second-Generation / Q000009:adverse effects / Q000627:therapeutic use*; D002908:Chronic Disease; D015283:Citalopram / Q000009:adverse effects / Q000627:therapeutic use*; D003866:Depressive Disorder / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010555:Personality Inventory / Q000706:statistics & numerical data; D011379:Prognosis; D011594:Psychometrics; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D016896:Treatment Outcome; D055815:Young Adult
D018687:Antidepressive Agents, Second-Generation; D015283:Citalopram; D017367:Selective Serotonin Reuptake Inhibitors