title: The effectiveness of antidepressant monotherapy in a naturalistic outpatient setting.
abstract: OBJECTIVE
  To assess a representative sample of clinically depressed outpatients during acute treatment with antidepressant medication monotherapy to determine clinical outcomes and evaluate relationships between outcomes and selected baseline/treatment features.
  
  
  METHODS
  This naturalistic study examined data on outpatients at the Department of Psychiatry, Duke University Medical Center, Durham, North Carolina, from January 2000 through December 2010. Eligible patients (N = 1,722) had a diagnosis of clinical depression (major depressive disorder, dysthymic disorder, or depressive disorder not otherwise specified as defined in DSM-IV-TR). Sociodemographic/clinical data were gathered at study entry (date of first treatment). The Clinical Global Impressions-improvement (CGI-I) and -severity of illness (CGI-S) scales were administered at entry and at study exit (end of follow-up) after 1 to 9 weeks of treatment. Analysis of variance, F tests, and t tests determined relationships between outcomes and treatment duration, baseline severity, and sociodemographic/clinical features.
  
  
  RESULTS
  Thirty-nine percent of participants reported substantial improvement (CGI-I score = 1 or 2) from entry to exit, 33% reported minimal improvement (CGI-I score = 3), 22% reported no change, and approximately 7% reported worsened illness. Greater improvement (CGI-I score) and greater reduction in depressive severity (CGI-S score) were associated with greater baseline depressive severity and longer treatment duration (all P < .001). Participants with greater baseline depressive severity experienced larger reductions in depressive severity but reported worse CGI-I scores at exit. Less improvement in CGI-I scores was seen in women compared to men (P = .018). Less improvement in CGI-I scores and less reduction in CGI-S scores were seen in participants ≤ 60 years of age (P = .040 and P = .025, respectively) and those with comorbid substance abuse (P < .001 and P = .010, respectively) or anxiety (P = .018 and P < .001, respectively) disorders.
  
  
  CONCLUSIONS
  Most depressive symptom improvement occurred within the first 4 to 6 weeks of antidepressant monotherapy. Greater baseline severity, comorbid substance abuse, and comorbid anxiety disorders are associated with worse outcomes.
authors.forename: Tih-Shih
authors.initials: TS
authors.lastname: Lee
authors.forename: Pryseley
authors.initials: P
authors.lastname: Nkouibert Assam
authors.forename: Kenneth R
authors.initials: KR
authors.lastname: Gersing
authors.forename: Edwin
authors.initials: E
authors.lastname: Chan
authors.forename: Bruce M
authors.initials: BM
authors.lastname: Burchett
authors.forename: Kang
authors.initials: K
authors.lastname: Sim
authors.forename: Lei
authors.initials: L
authors.lastname: Feng
authors.forename: K Ranga
authors.initials: KR
authors.lastname: Krishnan
authors.forename: A John
authors.initials: AJ
authors.lastname: Rush