Is prior course of illness relevant to acute or longer-term outcomes in depressed out-patients? A STAR*D report.
BACKGROUND
Major depressive disorder (MDD) is commonly chronic and/or recurrent. We aimed to determine whether a chronic and/or recurrent course of MDD is associated with acute and longer-term MDD treatment outcomes.


METHODS
This cohort study recruited out-patients aged 18-75 years with non-psychotic MDD from 18 primary and 23 psychiatric care clinics across the USA. Participants were grouped as: chronic (index episode >2 years) and recurrent (n = 398); chronic non-recurrent (n=257); non-chronic recurrent (n=1614); and non-chronic non-recurrent (n = 387). Acute treatment was up to 14 weeks of citalopram (≤ 60 mg/day) with up to 12 months of follow-up treatment. The primary outcomes for this report were remission [16-item Quick Inventory of Depressive Symptomatology - Self-Rated (QIDS-SR(16)) ≤ 5] or response (≥ 50% reduction from baseline in QIDS-SR(16)) and time to first relapse [first QIDS-SR16 by Interactive Voice Response (IVR) ≥ 11].


RESULTS
Most participants (85%) had a chronic and/or recurrent course; 15% had both. Chronic index episode was associated with greater sociodemographic disadvantage. Recurrent course was associated with earlier age of onset and greater family histories of depression and substance abuse. Remission rates were lowest and slowest for those with chronic index episodes. For participants in remission entering follow-up, relapse was most likely for the chronic and recurrent group, and least likely for the non-chronic, non-recurrent group. For participants not in remission when entering follow-up, prior course was unrelated to relapse.


CONCLUSIONS
Recurrent MDD is the norm for out-patients, of whom 15% also have a chronic index episode. Chronic and recurrent course of MDD may be useful in predicting acute and long-term MDD treatment outcomes.
Office of Clinical Sciences, Duke-NUS Graduate Medical School Singapore, Singapore.
A J
AJ
Rush
S R
SR
Wisniewski
S
S
Zisook
M
M
Fava
S C
SC
Sung
C L
CL
Haley
H N
HN
Chan
W S
WS
Gilmer
D
D
Warden
A A
AA
Nierenberg
G K
GK
Balasubramani
B N
BN
Gaynes
M H
MH
Trivedi
S D
SD
Hollon
D000293:Adolescent; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D018687:Antidepressive Agents, Second-Generation / Q000008:administration & dosage / Q000627:therapeutic use*; D002908:Chronic Disease; D015283:Citalopram / Q000008:administration & dosage / Q000627:therapeutic use*; D015331:Cohort Studies; D003865:Major Depressive Disorder / Q000188:drug therapy / Q000523:psychology*; D018450:Disease Progression; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D011569:Psychiatric Status Rating Scales; D012008:Recurrence; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014481:United States; D055815:Young Adult
D018687:Antidepressive Agents, Second-Generation; D015283:Citalopram