title: Dynamic prediction of treatment response in late-life depression.
abstract: OBJECTIVE
  To identify actionable predictors of remission to antidepressant pharmacotherapy in depressed older adults and to use signal detection theory to develop decision trees to guide clinical decision making.
  
  
  METHODS
  We treated 277 participants with current major depression using open-label venlafaxine XR (up to 300 mg/day) for 12 weeks, in an NIMH-sponsored randomized, placebo-controlled augmentation trial of adjunctive aripiprazole. Multiple logistic regression and signal detection approaches identified predictors of remission in both completer and intent-to-treat samples.
  
  
  RESULTS
  Higher baseline depressive symptom severity (odds ratio [OR]: 0.86, 95% confidence interval [CI]: 0.80-0.93; p <0.001), smaller symptom improvement during the first two weeks of treatment (OR: 0.96, 95% CI: 0.94-0.97; p <0.001), male sex (OR: 0.41 95% CI: 0.18-0.93; p = 0.03), duration of current episode ≥2 years (OR: 0.26, 95% CI: 0.12-0.57; p <0.001) and adequate past depression treatment (ATHF ≥3) (OR: 0.34, 95% CI: 0.16-0.74; p = 0.006) predicted lower probability of remission in the completer sample. Subjects with Montgomery Asberg (MADRS) decreasing by greater than 27% in the first 2 weeks and with baseline MADRS scores of less than 27 (percentile rank = 51) had the best chance of remission (89%). Subjects with small symptom decrease in the first 2 weeks with adequate prior treatment and younger than 75 years old had the lowest chance of remission (16%).
  
  
  CONCLUSIONS
  Our results suggest the clinical utility of measuring pre-treatment illness severity and change during the first 2 weeks of treatment in predicting remission of late-life major depression.
authors.affiliation: Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA.
authors.forename: Ian
authors.initials: I
authors.lastname: Joel
authors.affiliation: Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA.
authors.forename: Amy E
authors.initials: AE
authors.lastname: Begley
authors.affiliation: Centre for Addiction and Mental Health and Department of Psychiatry, University of Toronto, Ontario, Canada.
authors.forename: Benoit H
authors.initials: BH
authors.lastname: Mulsant
authors.affiliation: Department of Psychiatry, Washington University, St. Louis, MO.
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Lenze
authors.affiliation: Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA.
authors.forename: Sati
authors.initials: S
authors.lastname: Mazumdar
authors.affiliation: Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA.
authors.forename: Mary Amanda
authors.initials: MA
authors.lastname: Dew
authors.affiliation: Centre for Addiction and Mental Health and Department of Psychiatry, University of Toronto, Ontario, Canada.
authors.forename: Daniel
authors.initials: D
authors.lastname: Blumberger
authors.affiliation: Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA.
authors.forename: Meryl
authors.initials: M
authors.lastname: Butters
authors.affiliation: Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA. Electronic address: reynoldscf@upmc.edu.
authors.forename: Charles F
authors.initials: CF
authors.lastname: Reynolds
mesh_terms: D017668:Age of Onset; D000368:Aged; D000369:Aged, 80 and over; D000068180:Aripiprazole; D003511:Cyclohexanols / Q000008:administration & dosage / Q000627:therapeutic use*; D003692:Delayed-Action Preparations; D003865:Major Depressive Disorder / Q000188:drug therapy* / Q000453:epidemiology*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010879:Piperazines / Q000627:therapeutic use*; D011237:Predictive Value of Tests; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data*; D015363:Quinolones / Q000627:therapeutic use*; D012074:Remission Induction; D012720:Severity of Illness Index; D017603:Signal Detection, Psychological; D063189:Symptom Assessment / Q000706:statistics & numerical data; D016896:Treatment Outcome; D000069470:Venlafaxine Hydrochloride
chemical_list: D003511:Cyclohexanols; D003692:Delayed-Action Preparations; D010879:Piperazines; D015363:Quinolones; D000069470:Venlafaxine Hydrochloride; D000068180:Aripiprazole
keywords: Late-life depression; decision trees; dynamic remission prediction