title: Different levels of lack of improvement at 4 weeks of escitalopram treatment as predictors of poor 8-week outcome in MDD.
abstract: BACKGROUND
  Several post-hoc studies have shown that lack of early improvement reduces the chance of later response or remission. This post-hoc analysis evaluates different cut-off points of non-improvement at 4 weeks of escitalopram treatment to predict 8-week non-response and non-remission.
  
  
  METHODS
  This study consisted of MDD patients with an absence of improvement (<30% reduction in baseline score of the HAMD-17) at Week 4 of escitalopram treatment (10mg/day) that continued escitalopram treatment (10-20mg/day) for a further 4-week period (n=251). Predictive, sensitivity and specificity values for the several definitions of non-improvement (≤ 25%, ≤ 20% and ≤ 15% reduction in the HAMD-17 baseline total score) at 4 weeks were calculated.
  
  
  RESULTS
  Overall, 70.1% (176/251) of patients did not achieve response at Week 8 and 84.5% (212/251) did not achieve remission. The predictive value for non-response was high (71.4-74.3%) for all cut-off points of non-improvement tested. The respective values for non-remission were placed between 85.0% and 87.2%.
  
  
  CONCLUSIONS
  This was a post-hoc subgroup analysis. The only drug assessed was escitalopram.
  
  
  CONCLUSIONS
  Our data indicate that an absence of improvement, <30% reduction in the HAMD-17, after 4 weeks of escitalopram treatment should prompt clinicians to consider a change in treatment strategy. Similar findings were previously reported for other antidepressants.
authors.affiliation: Eli Lilly and Company, Madrid, Spain. gilaberte@lilly.com
authors.forename: I
authors.initials: I
authors.lastname: Gilaberte
authors.forename: I
authors.initials: I
authors.lastname: Romera
authors.forename: V
authors.initials: V
authors.lastname: Perez-Sola
authors.forename: J M
authors.initials: JM
authors.lastname: Menchon
authors.forename: A
authors.initials: A
authors.lastname: Schacht
mesh_terms: D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use*; D015283:Citalopram / Q000627:therapeutic use*; D003865:Major Depressive Disorder / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000928:Antidepressive Agents; D015283:Citalopram