title: Predictive value of baseline resistance in early response to antidepressants.
abstract: BACKGROUND
  Major Depressive Disorder (MDD) is the 3rd source for burden worldwide according to the World Health Organization (WHO). This comes partly from unsatisfactory response rates after usual treatment, highlighting the need for early indicators such as early improvement of depressive symptoms to adapt treatment strategies, especially for severe inpatients. Thus our objective was to assess the predictive value of baseline partial resistance in early antidepressant response (EAR), hypothesizing that previous treatment failures would decrease the probability of early response.
  
  
  METHODS
  We included 122 consecutive inpatients with current unipolar MDE. The Mini-Neuropsychiatric Interview was used to ascertain DSM-IV diagnoses of MDD as well as psychiatric comorbidities, and to exclude patients with a history of bipolar disorder. A specifically designed questionnaire was used to collect data on previous treatment trials for the current episode so as to generate scores on the five existing methods for quantifying treatment resistance. We prospectively assessed EAR, defined as a 50% decrease in MADRS after 14 days of steady regimen of antidepressant.
  
  
  RESULTS
  In the per protocol sample (N=76), multivariate analyses showed that psychotic features at baseline remained an independent predictor of absence of EAR (p<.01), unlike baseline partial resistance, which may rather be associated with a lack of any improvement.
  
  
  CONCLUSIONS
  Lack of data about further response and non-randomized treatment allocation.
  
  
  CONCLUSIONS
  Available methods for quantifying treatment resistance are heterogeneous and do not predict short-term response among severely depressed inpatients, despite potential usefulness in predicting a lack of early improvement.
authors.affiliation: Service de Psychiatrie d׳Adultes du Pr F. Bellivier, AP-HP, Groupe Hospitalier Saint-Louis - Lariboisière - Fernand Widal, Paris, France; Inserm UMR-S 1144, Universités Paris Descartes - Paris Diderot, Paris, France. Electronic address: romain.icick@lrb.aphp.fr.
authors.forename: Romain
authors.initials: R
authors.lastname: Icick
authors.affiliation: Groupe Hospitalier Paul Guiraud, Villejuif, France.
authors.forename: Élodie
authors.initials: É
authors.lastname: Millet
authors.affiliation: Inserm UMR-S 1144, Universités Paris Descartes - Paris Diderot, Paris, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Curis
authors.affiliation: Service de Psychiatrie d׳Adultes du Pr F. Bellivier, AP-HP, Groupe Hospitalier Saint-Louis - Lariboisière - Fernand Widal, Paris, France; Fondation FondaMental, Hôpital Albert Chenevier, AP-HP, Créteil, France; Inserm U955 - Équipe 15, Université Paris Est, Faculté de Médecine, Créteil, France.
authors.forename: Frank
authors.initials: F
authors.lastname: Bellivier
authors.affiliation: Service de Psychiatrie d׳Adultes du Pr F. Bellivier, AP-HP, Groupe Hospitalier Saint-Louis - Lariboisière - Fernand Widal, Paris, France; Inserm UMR-S 1144, Universités Paris Descartes - Paris Diderot, Paris, France; Fondation FondaMental, Hôpital Albert Chenevier, AP-HP, Créteil, France.
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Lépine
mesh_terms: D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use*; D003865:Major Depressive Disorder / Q000188:drug therapy*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D004351:Drug Resistance; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D017211:Treatment Failure
chemical_list: D000928:Antidepressive Agents
keywords: Antidepressant; Early response; Major Depressive Disorder; Staging methods for treatment resistant depression; Unipolar disorder