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

• NCJ Number: 225658
• Journal: Journal of the American Academy of Child & Adolescent Psychiatry Volume: 48 Issue: 1 Dated: January 2009 Pages: 71-78
• Author(s): Rongrong Tao M.D.; Graham Emslie M.D.; Taryn Mayes M.S.; Paul Nakonezny Ph.D.; Betsy Kennard Psy.D.; Carroll Hughes Ph.D.
• Date Published: January 2009
• Length: 8 pages
• Grant Number(s): R01 MH39188
• Sponsoring Agency: National Institute of Mental Health
• Publication Format: Article
• Publication Type: Report (Study/Research)
• Language: English
• Country: United States of America

Annotation

This prospective open-label fluoxetine study examined indicators of acute treatment response and remission of youths with major depressive disorder (MDD).

Abstract

Positive first-degree family history of depression was the only baseline demographic and clinical characteristic that predicted a favorable treatment response. Positive first-degree family history of depression was predictive of remission at the end of 12 weeks of acute fluoxetine treatment. It is possible that a more “biological” depression responds to biological treatment (fluoxetine) more favorably than depression without predisposed biological factors. The rate of symptom reduction early in treatment identified remission status by the end of acute treatment. As early as 1 week, the patients who eventually achieved remission had significantly greater symptom improvement than the patients who did not. Improvement in depression severity by week four was as good at discriminating remitters from nonremitters as that of weeks six and eight. This finding is of significant clinical value, in that most guidelines currently recommend waiting until after week six to increase dose and even later (after week eight) to change treatment approach. Based on these findings, both children and adolescents should have sufficient (above 50 percent) improvement by week four in order to have a strong likelihood of achieving remission by 12 weeks. If there is no significant reduction in their depressive symptoms by week 4, the likelihood of achieving remission by week 12 decreases. Therefore, a change in treatment may be warranted earlier than previously recommended. A total of 168 children and adolescents, ages 7 to 18, with primary diagnoses of MDD, received 12 weeks of fluoxetine treatment. The youths were evaluated with the Kiddie Schedule for Affective Disorders and Schizophrenia. The outcome measures include the children’s Depression Rating Scale-revised. 2 tables, 2 figures, and 28 references