title: Does early-onset chronic or recurrent major depression impact outcomes with antidepressant medications? A CO-MED trial report.
abstract: BACKGROUND
  Prior studies have suggested that major depressive disorder (MDD) with pre-adult onset represents a distinct subtype with greater symptom severity and higher rates of suicidal ideation. Whether these patients have poorer response to various types of antidepressant treatment than those with adult-onset MDD is unclear. Method A total of 665 psychiatric and primary care out-patients (aged 18-75 years) with non-psychotic chronic or recurrent MDD participated in a single-blind, randomized trial that compared the efficacy of escitalopram plus placebo, bupropion sustained-release plus escitalopram, or venlafaxine extended-release plus mirtazapine. We compared participants who self-reported MDD onset (before age 18) to those with a later onset (adult onset) with respect to baseline characteristics and treatment/outcome variables at 12 and 28 weeks.
  
  
  RESULTS
  Early-onset chronic/recurrent MDD was associated with a distinct set of sociodemographic (female, younger age) and clinical correlates (longer duration of illness, greater number of prior episodes, greater likelihood of atypical features, higher rates of suicidality and psychiatric co-morbidity, fewer medical problems, poorer quality of life, greater history of child abuse/neglect). However, results from unadjusted and adjusted analyses showed no significant differences in response, remission, tolerability of medications, quality of life, or retention at 12 or 28 weeks.
  
  
  CONCLUSIONS
  Although early-onset chronic/recurrent MDD is associated with a more severe clinical picture, it does not seem to be useful for predicting differential treatment response to antidepressant medication. Clinicians should remain alert to an increased risk of suicidality in this population.
authors.affiliation: Office of Clinical Sciences, Duke-NUS Graduate Medical School Singapore, Singapore. sharon.sung@duke-nus.edu.sg
authors.forename: S C
authors.initials: SC
authors.lastname: Sung
authors.forename: S R
authors.initials: SR
authors.lastname: Wisniewski
authors.forename: G K
authors.initials: GK
authors.lastname: Balasubramani
authors.forename: S
authors.initials: S
authors.lastname: Zisook
authors.forename: B
authors.initials: B
authors.lastname: Kurian
authors.forename: D
authors.initials: D
authors.lastname: Warden
authors.forename: M H
authors.initials: MH
authors.lastname: Trivedi
authors.forename: A J
authors.initials: AJ
authors.lastname: Rush
mesh_terms: D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D000368:Aged; D018687:Antidepressive Agents, Second-Generation / Q000008:administration & dosage / Q000627:therapeutic use*; D016642:Bupropion / Q000008:administration & dosage / Q000627:therapeutic use; D002649:Child Abuse / Q000523:psychology / Q000706:statistics & numerical data; D015283:Citalopram / Q000008:administration & dosage / Q000627:therapeutic use*; D015897:Comorbidity; D003511:Cyclohexanols / Q000008:administration & dosage / Q000627:therapeutic use; D003692:Delayed-Action Preparations / Q000008:administration & dosage / Q000627:therapeutic use; D003865:Major Depressive Disorder / Q000188:drug therapy* / Q000453:epidemiology*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008803:Mianserin / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000627:therapeutic use; D008875:Middle Aged; D000078785:Mirtazapine; D010919:Placebos; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D011788:Quality of Life; D012008:Recurrence; D057566:Self Report; D012720:Severity of Illness Index; D016037:Single-Blind Method; D059020:Suicidal Ideation; D013406:Suicide, Attempted / Q000523:psychology / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D000069470:Venlafaxine Hydrochloride; D055815:Young Adult
chemical_list: D018687:Antidepressive Agents, Second-Generation; D003511:Cyclohexanols; D003692:Delayed-Action Preparations; D010919:Placebos; D016642:Bupropion; D015283:Citalopram; D008803:Mianserin; D000069470:Venlafaxine Hydrochloride; D000078785:Mirtazapine