title: Neurocognitive predictors of antidepressant clinical response.
abstract: BACKGROUND
  Executive dysfunction and psychomotor slowing in depressed patients have been associated with poor antidepressant clinical response, but little is known about the value of neurocognitive tests for differential prediction of response.
  
  
  METHODS
  This report presents new findings for 70 depressed patients tested on neurocogntive tests before receiving treatment with a SSRI (escitalopram or citalopram), NDRI (bupropion) or dual mechanism therapy including a serotonergic agent, and for 57 healthy controls.
  
  
  RESULTS
  As predicted from previous research, patients who did not respond to a SSRI or dual therapy showed poorer word fluency than responders, whereas this was not seen for patients treated with bupropion alone. Longer choice reaction time (RT) was also found in nonresponders to a SSRI or dual therapy, but the opposite trend was seen for bupropion. Using a combined index of word fluency and RT (with normative performance as a cutoff) yielded differential predictions of response. Equal to or above normal performance predicted good response to a SSRI or dual therapy, with high positive predictive value (90%) and specificity (78%) but lower sensitivity (53%). In contrast, less than normal performance predicted good response to bupropion alone (positive predictive value=82%; specificity=67%; sensitivity=90%).
  
  
  CONCLUSIONS
  Relatively small sample size, no placebo control, and combining across SSRI alone and dual treatments.
  
  
  CONCLUSIONS
  Although findings are preliminary due to small sample size, brief tests of word fluency and psychomotor speed may help identify depressed patients who are unresponsive to a serotonergic agent, but who may respond to bupropion alone.
authors.affiliation: Department of Psychiatry, Columbia University College of Physicians & Surgeons, New York, NY, USA; Division of Cognitive Neuroscience, New York State Psychiatric Institute, New York, NY, USA. Electronic address: bruderg@nyspi.columbia.edu.
authors.forename: Gerard E
authors.initials: GE
authors.lastname: Bruder
authors.affiliation: Division of Cognitive Neuroscience, New York State Psychiatric Institute, New York, NY, USA.
authors.forename: Jorge E
authors.initials: JE
authors.lastname: Alvarenga
authors.affiliation: Division of Cognitive Neuroscience, New York State Psychiatric Institute, New York, NY, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Alschuler
authors.affiliation: Division of Cognitive Neuroscience, New York State Psychiatric Institute, New York, NY, USA.
authors.forename: Karen
authors.initials: K
authors.lastname: Abraham
authors.affiliation: Department of Psychiatry, Columbia University College of Physicians & Surgeons, New York, NY, USA; Division of Molecular Imaging & Neuropathology, New York State Psychiatric Institute, New York, NY, USA.
authors.forename: John G
authors.initials: JG
authors.lastname: Keilp
authors.affiliation: Department of Psychiatry, Columbia University College of Physicians & Surgeons, New York, NY, USA; Depression Evaluation Service, New York State Psychiatric Institute, New York, NY, USA.
authors.forename: David J
authors.initials: DJ
authors.lastname: Hellerstein
authors.affiliation: Department of Psychiatry, Columbia University College of Physicians & Surgeons, New York, NY, USA; Depression Evaluation Service, New York State Psychiatric Institute, New York, NY, USA.
authors.forename: Jonathan W
authors.initials: JW
authors.lastname: Stewart
authors.affiliation: Department of Psychiatry, Columbia University College of Physicians & Surgeons, New York, NY, USA; Depression Evaluation Service, New York State Psychiatric Institute, New York, NY, USA.
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: McGrath
mesh_terms: D000328:Adult; D018687:Antidepressive Agents, Second-Generation / Q000627:therapeutic use*; D016642:Bupropion / Q000627:therapeutic use; D016022:Case-Control Studies; D015283:Citalopram / Q000627:therapeutic use; D003866:Depressive Disorder / Q000188:drug therapy*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D018687:Antidepressive Agents, Second-Generation; D016642:Bupropion; D015283:Citalopram; D017367:Selective Serotonin Reuptake Inhibitors
keywords: Antidepressants; Depression; Neurocognitive tests; Psychomotor speed; Treatment response