title: Melancholic, atypical and anxious depression subtypes and outcome of treatment with escitalopram and nortriptyline.
abstract: OBJECTIVE
  To investigate whether subtypes of depression predict differential outcomes of treatment with selective serotonin-reuptake inhibitor (SSRI) and a tricyclic antidepressant in major depression.
  
  
  METHODS
  Among 811 adults with moderate-to-severe depression, melancholic, atypical, anxious and anxious-somatizing depression subtypes established at baseline were evaluated as predictors of outcome of treatment with flexible dosage of the SSRI escitalopram or the tricyclic antidepressant nortriptyline. The primary outcome measure was the Montgomery-Åsberg Depression Rating Scale (MADRS). Secondary outcome measures were the 17-item Hamilton Rating Scale for Depression (HRSD-17) and the Beck Depression Inventory (BDI).
  
  
  RESULTS
  Melancholic depression was associated with slightly worse outcomes among individuals treated with escitalopram, but did not affect outcome of treatment with nortriptyline. The interaction between melancholic depression and drug did not reach statistical significance for the primary outcome measure and significant results for secondary outcome measures were not robust in sensitivity analyses. Atypical depression was unrelated to outcome of treatment with either antidepressant. Anxious and anxious-somatizing depression did not predict outcome on the primary measure, but inconsistently predicted worse outcome in some secondary analyses.
  
  
  CONCLUSIONS
  Some participants were non-randomly allocated to drug. Therefore, drug-by-predictor interactions had to be validated in sensitivity analyses restricted to the 468 randomly allocated individuals.
  
  
  CONCLUSIONS
  Melancholic, atypical or anxious depression, are not sufficiently robust differential predictors of outcome to help clinician choose between SSRI and tricyclic antidepressants. There is a need to investigate other predictors of outcome.
authors.affiliation: MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, United Kingdom. rudolf.uher@kcl.ac.uk
authors.forename: Rudolf
authors.initials: R
authors.lastname: Uher
authors.forename: Mojca Zvezdana
authors.initials: MZ
authors.lastname: Dernovsek
authors.forename: Ole
authors.initials: O
authors.lastname: Mors
authors.forename: Joanna
authors.initials: J
authors.lastname: Hauser
authors.forename: Daniel
authors.initials: D
authors.lastname: Souery
authors.forename: Astrid
authors.initials: A
authors.lastname: Zobel
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Maier
authors.forename: Neven
authors.initials: N
authors.lastname: Henigsberg
authors.forename: Petra
authors.initials: P
authors.lastname: Kalember
authors.forename: Marcella
authors.initials: M
authors.lastname: Rietschel
authors.forename: Anna
authors.initials: A
authors.lastname: Placentino
authors.forename: Julien
authors.initials: J
authors.lastname: Mendlewicz
authors.forename: Katherine J
authors.initials: KJ
authors.lastname: Aitchison
authors.forename: Peter
authors.initials: P
authors.lastname: McGuffin
authors.forename: Anne
authors.initials: A
authors.lastname: Farmer
mesh_terms: D000328:Adult; D018687:Antidepressive Agents, Second-Generation / Q000627:therapeutic use*; D000929:Antidepressive Agents, Tricyclic / Q000627:therapeutic use*; D001008:Anxiety Disorders / Q000145:classification / Q000175:diagnosis* / Q000188:drug therapy* / Q000235:genetics / Q000523:psychology; D015283:Citalopram / Q000627:therapeutic use*; D003866:Depressive Disorder / Q000145:classification / Q000175:diagnosis* / Q000188:drug therapy* / Q000235:genetics / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009661:Nortriptyline / Q000627:therapeutic use*; D010555:Personality Inventory / Q000706:statistics & numerical data; D011379:Prognosis; D011594:Psychometrics; D013001:Somatoform Disorders / Q000145:classification / Q000175:diagnosis* / Q000188:drug therapy* / Q000235:genetics / Q000523:psychology
chemical_list: D018687:Antidepressive Agents, Second-Generation; D000929:Antidepressive Agents, Tricyclic; D015283:Citalopram; D009661:Nortriptyline