title: Impairment and distress patterns distinguishing the melancholic depression subtype: an iSPOT-D report.
abstract: BACKGROUND
  This study seeks to provide a comprehensive and systematic evaluation of baseline clinical and psychological features and treatment response characteristics that differentiate Major Depressive Disorder (MDD) outpatients with and without melancholic features. Reflecting the emphasis in DSM-5, we also include impairment and distress.
  
  
  METHODS
  Participants were assessed pre-treatment on clinical features (severity, risk factors, comorbid conditions, illness course), psychological profile (personality, emotion regulation), functional capacity (social and occupational function, quality of life) and distress/coping (negativity bias, emotional resilience, social skills, satisfaction with life). Participants were randomized to sertraline, escitalopram or venlafaxine extended-release and re-assessed post-treatment at 8 weeks regarding remission, response, and change in impairment and distress.
  
  
  RESULTS
  Patients with melancholic features (n=339; 33.7%) were distinguished clinically from non-melancholics by more severe depressive symptoms and greater exposure to abuse in childhood. Psychologically, melancholic patients were defined by introversion, and a greater use of suppression to regulate negative emotion. Melancholics also had poorer capacity for social and occupational function, and physical and psychological quality of life, along with poorer coping, reflected in less emotional resilience and capacity for social skills. Post-treatment, melancholic patients had lower remission and response, but some of this effect was due to the more severe symptoms pre-treatment. The distress/coping outcome measure of capacity for social skills remained significantly lower for melancholic participants.
  
  
  CONCLUSIONS
  Due to the cross-sectional nature of this study, causal pathways cannot be concluded.
  
  
  CONCLUSIONS
  Findings provide new insights into a melancholic profile of reduced ability to function interpersonally or effectively deal with one׳s emotions. This distinctly poorer capacity for social skills remained post-treatment. The pre-treatment profile may account for some of the difficulty in achieving remission or response with treatment.
authors.affiliation: Brain Dynamics Center, Psychiatry, University of Sydney Medical School, Sydney, NSW 2145 Australia; Discipline of Psychiatry, Sydney Medical School, University of Sydney, Westmead Clinical School, Australia; Brain Resource Ltd., 235 Jones Street, Sydney, NSW, Australia; Brain Resource Inc., 1000 Sansome Street, San Francisco, CA 94111, USA. Electronic address: claire.day@sydney.edu.au.
authors.forename: Claire V
authors.initials: CV
authors.lastname: Day
authors.affiliation: Duke-National University of Singapore, Graduate Medical School Singapore, 8 College Road, Singapore 169857, Singapore.
authors.forename: A
authors.initials: A
authors.lastname: John Rush
authors.affiliation: Brain Dynamics Center, Psychiatry, University of Sydney Medical School, Sydney, NSW 2145 Australia; Discipline of Psychiatry, Sydney Medical School, University of Sydney, Westmead Clinical School, Australia.
authors.forename: Anthony W F
authors.initials: AW
authors.lastname: Harris
authors.affiliation: Discipline of Psychiatry, Sydney Medical School, University of Sydney, Westmead Clinical School, Australia.
authors.forename: Philip M
authors.initials: PM
authors.lastname: Boyce
authors.affiliation: Brain Resource Ltd., 235 Jones Street, Sydney, NSW, Australia; Brain Resource Inc., 1000 Sansome Street, San Francisco, CA 94111, USA.
authors.forename: William
authors.initials: W
authors.lastname: Rekshan
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA; Sierra-Pacific Mental Illness Research, Education, and Clinical Center (MIRECC) Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304, USA.
authors.forename: Amit
authors.initials: A
authors.lastname: Etkin
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA.
authors.forename: Charles
authors.initials: C
authors.lastname: DeBattista
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA.
authors.forename: Alan F
authors.initials: AF
authors.lastname: Schatzberg
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA.
authors.forename: Bruce A
authors.initials: BA
authors.lastname: Arnow
authors.affiliation: Brain Dynamics Center, Psychiatry, University of Sydney Medical School, Sydney, NSW 2145 Australia; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA; Sierra-Pacific Mental Illness Research, Education, and Clinical Center (MIRECC) Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304, USA.
authors.forename: Leanne M
authors.initials: LM
authors.lastname: Williams
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D000368:Aged; D015283:Citalopram / Q000627:therapeutic use; D003511:Cyclohexanols / Q000008:administration & dosage / Q000627:therapeutic use; D003866:Depressive Disorder / Q000175:diagnosis* / Q000188:drug therapy; D003865:Major Depressive Disorder / Q000175:diagnosis* / Q000188:drug therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D020280:Sertraline / Q000627:therapeutic use; D063189:Symptom Assessment; D016896:Treatment Outcome; D000069470:Venlafaxine Hydrochloride; D055815:Young Adult
chemical_list: D003511:Cyclohexanols; D015283:Citalopram; D000069470:Venlafaxine Hydrochloride; D020280:Sertraline
keywords: Antidepressant response; Distinguishing characteristics; Major Depressive Disorder; Melancholic features; iSPOT-D