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A practical approach to the early identification of antidepressant medication non-responders.

Publication ,  Journal Article
Li, J; Kuk, AYC; Rush, AJ
Published in: Psychol Med
February 2012

BACKGROUND: The aim of the present study was to determine whether a combination of baseline features and early post-baseline depressive symptom changes have clinical value in predicting out-patient non-response in depressed out-patients after 8 weeks of medication treatment. METHOD: We analysed data from the Combining Medications to Enhance Depression Outcomes study for 447 participants with complete 16-item Quick Inventory of Depressive Symptomatology - Self-Report (QIDS-SR16) ratings at baseline and at treatment weeks 2, 4 and 8. We used a multi-time point, recursive subsetting approach that included baseline features and changes in QIDS-SR16 scores from baseline to weeks 2 and 4, to identify non-responders (<50% reduction in QIDS-SR16) at week 8 with a pre-specified accuracy level. RESULTS: Pretreatment clinical features alone were not clinically useful predictors of non-response after 8 weeks of treatment. Baseline to week 2 symptom change identified 48 non-responders (of which 36 were true non-responders). This approach gave a clinically meaningful negative predictive value of 0.75. Symptom change from baseline to week 4 identified 79 non-responders (of which 60 were true non-responders), achieving the same accuracy. Symptom change at both weeks 2 and 4 identified 87 participants (almost 20% of the sample) as non-responders with the same accuracy. More participants with chronic than non-chronic index episodes could be accurately identified by week 4. CONCLUSIONS: Specific baseline clinical features combined with symptom changes by weeks 2-4 can provide clinically actionable results, enhancing the efficiency of care by personalizing the treatment of depression.

Published In

Psychol Med

DOI

EISSN

1469-8978

Publication Date

February 2012

Volume

42

Issue

2

Start / End Page

309 / 316

Location

England

Related Subject Headings

  • Treatment Outcome
  • Time Factors
  • Randomized Controlled Trials as Topic
  • Psychiatry
  • Humans
  • Depressive Disorder, Major
  • Antidepressive Agents
  • Algorithms
  • Adult
  • 5203 Clinical and health psychology
 

Citation

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Li, J., Kuk, A. Y. C., & Rush, A. J. (2012). A practical approach to the early identification of antidepressant medication non-responders. Psychol Med, 42(2), 309–316. https://doi.org/10.1017/S0033291711001280
Li, J., A. Y. C. Kuk, and A. J. Rush. “A practical approach to the early identification of antidepressant medication non-responders.Psychol Med 42, no. 2 (February 2012): 309–16. https://doi.org/10.1017/S0033291711001280.
Li J, Kuk AYC, Rush AJ. A practical approach to the early identification of antidepressant medication non-responders. Psychol Med. 2012 Feb;42(2):309–16.
Li, J., et al. “A practical approach to the early identification of antidepressant medication non-responders.Psychol Med, vol. 42, no. 2, Feb. 2012, pp. 309–16. Pubmed, doi:10.1017/S0033291711001280.
Li J, Kuk AYC, Rush AJ. A practical approach to the early identification of antidepressant medication non-responders. Psychol Med. 2012 Feb;42(2):309–316.
Journal cover image

Published In

Psychol Med

DOI

EISSN

1469-8978

Publication Date

February 2012

Volume

42

Issue

2

Start / End Page

309 / 316

Location

England

Related Subject Headings

  • Treatment Outcome
  • Time Factors
  • Randomized Controlled Trials as Topic
  • Psychiatry
  • Humans
  • Depressive Disorder, Major
  • Antidepressive Agents
  • Algorithms
  • Adult
  • 5203 Clinical and health psychology