Early Prediction of Acute Antidepressant Treatment Response and Remission in Pediatric Major Depressive Disorder

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Abstract

Objective

Less than half of youths achieve remission (minimal to no symptoms) after acute antidepressant treatment. Early identification of who will or will not respond to treatment and achieve remission may help clinicians formulate treatment decisions and shorten the time spent on ineffective treatments. In a prospective open-label fluoxetine study, we investigate indicators of acute treatment response and remission.

Method

One hundred sixty-eight children and adolescents, ages 7 to 18 years, with primary diagnoses of major depressive disorder received 12 weeks of fluoxetine treatment. The youths were evaluated using the Kiddie Schedule for Affective Disorders and Schizophrenia. The outcome measure included the Children's Depression Rating Scale-Revised.

Results

Positive first-degree family history of depression was the only baseline demographic and clinical characteristic that predicted a favorable treatment response (p = .01). The rate of symptom improvement, however, is a good indicator of acute treatment response. A significant symptom reduction (approximately 50%) by week 4 is needed to achieve remission at the end of acute treatment.

Conclusions

This study demonstrated that the rate of symptom improvement during early weeks of acute fluoxetine treatment is a good indicator of remission. Treatment approach may be reevaluated and modified as early as week 4 during acute treatment.

Section snippets

Method

The data presented here are from the acute phase treatment of a single-site continuation study, Childhood Depression: Remission and Relapse (R01 MH39188; principal investigator: G.E.), the primary results of which have been published previously.16 The study was approved by the University of Texas Southwestern Medical Center at Dallas institutional review board. All participants and their parents provided written informed consent and assent before entering the study.

Participant Characteristics

More than 80% of the 168 participants completed the entire 12 weeks of acute phase of treatment. Reasons for discontinuation during the acute treatment were lack of efficacy (n = 6/168; 3.6%), moved or lost to follow-up (n = 5/168; 3.0%), withdrew consent (n = 11/168; 6.5%), noncompliance (n = 2/168; 1.2%), and adverse events (n = 8/168; 4.8%). Adverse events leading to discontinuation included rash (n = 2/168; 1.2%), multiple physical adverse events (n = 1; 0.6%), and suicide-related behaviors

Discussion

Most demographic and baseline clinical features did not predict treatment outcome in this well-characterized pediatric sample with MDD. Although some earlier studies demonstrated a few clinical characteristics that predicted outcome (e.g., depression severity, previous episodes),7, 8, 9 this study found no demographic or illness characteristics at baseline that predicted remission. Previous studies of predictors of response have not yielded consistent results, so our lack of finding here is not

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  • Cited by (0)

    The study was supported by a grant entitled Childhood Depression: Remission and Relapse (R01 MH39188) from the National Institute of Mental Health (principal investigator: G.E.). In addition, support for Dr. Tao was provided in part by the Klingenstein Third Generation Foundation Fellowship in Child and Adolescent Psychiatry. Eli Lilly provided the medication for the study but had no role in the study design or implementation, analysis of data, or authorship of this article.

    Clinical trials registration information—Determining Optimal Continuation Treatment Duration for Depressed Children and Adolescents. URL: http://www.clinicaltrials.gov. Unique identifier: NCT00332787.

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