Improvement within 2 weeks and later treatment outcomes in patients with depressive disorders: the CRESCEND study.
BACKGROUND
Although antidepressants are conventionally given for 4-6 weeks before deciding on response, several reports suggest that early improvement predicts later outcomes. In a naturalistic national cohort study, we sought to investigate the predictive value of early improvement on Hamilton Depression Rating Scale (HAMD) score for later outcomes (depression (HAMD), anxiety (HAMA), global severity (CGI-s) and functioning (SOFAS)), as well as socio-demographic and clinical correlates of early improvement.


METHODS
Participants were recruited from 18 hospitals across South Korea. All met DSM-IV criteria for depressive disorders, scored ≥14 on the HAMD and received antidepressant treatment for up to 12 weeks. Treatment was naturalistic in that each clinician freely decided the types, doses, and regimes of antidepressant and concomitant medications. Early improvement was defined as a reduction in HAMD score of ≥20% compared with baseline within 2 weeks of treatment. Later treatment outcomes were measured at 4, 8, and 12 weeks.


RESULTS
In a recruited sample of 568 patients, early improvement predicted 12 week treatment outcomes with high sensitivity and high negative predictive values. The predictive values for HAMD and HAMA 12-week responses were higher compared to CGI-s and SOFAS responses. Early improvement was associated with higher monthly income, baseline lower anxiety and higher functioning levels. The patients with early improvement more frequently received antidepressant monotherapy.


CONCLUSIONS
The study was observational, and the treatment modality was naturalistic.


CONCLUSIONS
Early antidepressant improvement strongly predicted later outcomes, and was associated with higher income, lower anxiety, and higher function.
Kim
Jae-Min
JM
Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea. jmkim@chonnam.ac.kr
Kim
Seon-Young
SY
Stewart
Robert
R
Yoo
Joon-An
JA
Bae
Kyung-Yeol
KY
Jung
Sung-Won
SW
Lee
Min-Soo
MS
Yim
Hyeon-Woo
HW
Jun
Tae-Youn
TY
D000928:Antidepressive Agents / Q000627:therapeutic use*; D018687:Antidepressive Agents, Second-Generation / Q000627:therapeutic use; D016009:Chi-Square Distribution; D003866:Depressive Disorder / Q000188:drug therapy* / Q000523:psychology; D003865:Major Depressive Disorder / Q000188:drug therapy / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D012372:ROC Curve; D012074:Remission Induction; D056910:Republic of Korea; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use; D018709:Statistics, Nonparametric; D013997:Time Factors; D016896:Treatment Outcome
D000928:Antidepressive Agents; D018687:Antidepressive Agents, Second-Generation; D017367:Selective Serotonin Reuptake Inhibitors