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Abstract

This analysis of the VAST-D data aimed to explore the utility of using early improvement at 1, 2, 4, and 6 weeks of antidepressant medication treatment (i.e., a drop from baseline depression severity as measured by the QIDS-C) to predict remission, response, or greater than minimal improvement by week 12.

Abstract

Objective:

In this secondary analysis of data from the Veterans Affairs Augmentation and Switching Treatments for Improving Depression Outcomes (VAST-D) study, the authors sought to determine the effectiveness of early improvement (or lack thereof) for predicting remission from depression with antidepressant therapy.

Methods:

This study used data from the VAST-D study, a multisite, randomized, single-blind trial with parallel assignment to one of three medication interventions for 1,522 veterans whose major depressive disorder was unresponsive to at least one course of antidepressant treatment meeting minimal standards for dosage and duration. The authors calculated the positive predictive value (PPV) and negative predictive value (NPV) of early improvement on remission, response, or greater than minimal improvement from depression for various degrees of improvement (10%–50%) on the Quick Inventory of Depressive Symptomatology–Clinician Rated (QIDS-C) at 1, 2, 4, and 6 weeks.

Results:

The end of week 2 of treatment was identified as the best time to evaluate early improvement. The presence of a ≥20% drop from the baseline QIDS-C score by the end of week 2 resulted in a PPV for remission of 38% and an NPV of 93% by week 12. Extending the observational window to week 6 minimally improved NPV (97%). This association did not differ across treatment groups.

Conclusions:

A lack of early improvement at the end of week 2 of antidepressant therapy can be used to inform clinical decisions on the likelihood of nonremission of depression during the subsequent 10 weeks, even when dosage optimization is incomplete.

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Information & Authors

Information

Published In

Go to Psychiatric Research and Clinical Practice
Psychiatric Research and Clinical Practice
Pages: 58 - 67

History

Received: 26 September 2018
Revision received: 12 May 2019
Accepted: 18 June 2019
Published in print: October 01, 2019
Published online: 3 October 2019

Keywords

  1. Early improvement
  2. Antidepressant response
  3. Negative predictive value
  4. Treatment-resistant depression

Authors

Details

Paul B. Hicks, M.D., Ph.D. [email protected]
Department of Psychiatry, Baylor Scott & White Health, and Texas A&M College of Medicine, Temple, Texas (Hicks); Yale University School of Public Health, New Haven, Connecticut (Sevilimedu); Cooperative Studies Program Coordinating Center, Veterans Affairs (VA) Connecticut Healthcare System, West Haven (Sevilimedu, Johnson); VA San Diego Healthcare System, San Diego (Tal, Zisook); Louis Stokes Cleveland VA Medical Center, Clevelend (Chen); Tuscaloosa VA Medical Center, Tuscaloosa, Alabama, and University of Alabama School of Medicine, Birmingham (Davis); Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, New Mexico (Vertrees); VA New England Mental Illness Research, Education, and Clinical Center, VA Connecticut Healthcare System, West Haven (Mohamed); Department of Psychiatry, University of California, San Diego (Zisook).
Varadan Sevilimedu, M.B.B.S., Dr.P.H.
Department of Psychiatry, Baylor Scott & White Health, and Texas A&M College of Medicine, Temple, Texas (Hicks); Yale University School of Public Health, New Haven, Connecticut (Sevilimedu); Cooperative Studies Program Coordinating Center, Veterans Affairs (VA) Connecticut Healthcare System, West Haven (Sevilimedu, Johnson); VA San Diego Healthcare System, San Diego (Tal, Zisook); Louis Stokes Cleveland VA Medical Center, Clevelend (Chen); Tuscaloosa VA Medical Center, Tuscaloosa, Alabama, and University of Alabama School of Medicine, Birmingham (Davis); Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, New Mexico (Vertrees); VA New England Mental Illness Research, Education, and Clinical Center, VA Connecticut Healthcare System, West Haven (Mohamed); Department of Psychiatry, University of California, San Diego (Zisook).
Gary R. Johnson, M.S.
Department of Psychiatry, Baylor Scott & White Health, and Texas A&M College of Medicine, Temple, Texas (Hicks); Yale University School of Public Health, New Haven, Connecticut (Sevilimedu); Cooperative Studies Program Coordinating Center, Veterans Affairs (VA) Connecticut Healthcare System, West Haven (Sevilimedu, Johnson); VA San Diego Healthcare System, San Diego (Tal, Zisook); Louis Stokes Cleveland VA Medical Center, Clevelend (Chen); Tuscaloosa VA Medical Center, Tuscaloosa, Alabama, and University of Alabama School of Medicine, Birmingham (Davis); Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, New Mexico (Vertrees); VA New England Mental Illness Research, Education, and Clinical Center, VA Connecticut Healthcare System, West Haven (Mohamed); Department of Psychiatry, University of California, San Diego (Zisook).
Ilanit Tal, Ph.D.
Department of Psychiatry, Baylor Scott & White Health, and Texas A&M College of Medicine, Temple, Texas (Hicks); Yale University School of Public Health, New Haven, Connecticut (Sevilimedu); Cooperative Studies Program Coordinating Center, Veterans Affairs (VA) Connecticut Healthcare System, West Haven (Sevilimedu, Johnson); VA San Diego Healthcare System, San Diego (Tal, Zisook); Louis Stokes Cleveland VA Medical Center, Clevelend (Chen); Tuscaloosa VA Medical Center, Tuscaloosa, Alabama, and University of Alabama School of Medicine, Birmingham (Davis); Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, New Mexico (Vertrees); VA New England Mental Illness Research, Education, and Clinical Center, VA Connecticut Healthcare System, West Haven (Mohamed); Department of Psychiatry, University of California, San Diego (Zisook).
Peijun Chen, M.D., Ph.D.
Department of Psychiatry, Baylor Scott & White Health, and Texas A&M College of Medicine, Temple, Texas (Hicks); Yale University School of Public Health, New Haven, Connecticut (Sevilimedu); Cooperative Studies Program Coordinating Center, Veterans Affairs (VA) Connecticut Healthcare System, West Haven (Sevilimedu, Johnson); VA San Diego Healthcare System, San Diego (Tal, Zisook); Louis Stokes Cleveland VA Medical Center, Clevelend (Chen); Tuscaloosa VA Medical Center, Tuscaloosa, Alabama, and University of Alabama School of Medicine, Birmingham (Davis); Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, New Mexico (Vertrees); VA New England Mental Illness Research, Education, and Clinical Center, VA Connecticut Healthcare System, West Haven (Mohamed); Department of Psychiatry, University of California, San Diego (Zisook).
Lori L. Davis, M.D.
Department of Psychiatry, Baylor Scott & White Health, and Texas A&M College of Medicine, Temple, Texas (Hicks); Yale University School of Public Health, New Haven, Connecticut (Sevilimedu); Cooperative Studies Program Coordinating Center, Veterans Affairs (VA) Connecticut Healthcare System, West Haven (Sevilimedu, Johnson); VA San Diego Healthcare System, San Diego (Tal, Zisook); Louis Stokes Cleveland VA Medical Center, Clevelend (Chen); Tuscaloosa VA Medical Center, Tuscaloosa, Alabama, and University of Alabama School of Medicine, Birmingham (Davis); Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, New Mexico (Vertrees); VA New England Mental Illness Research, Education, and Clinical Center, VA Connecticut Healthcare System, West Haven (Mohamed); Department of Psychiatry, University of California, San Diego (Zisook).
Julia E. Vertrees, Pharm.D.
Department of Psychiatry, Baylor Scott & White Health, and Texas A&M College of Medicine, Temple, Texas (Hicks); Yale University School of Public Health, New Haven, Connecticut (Sevilimedu); Cooperative Studies Program Coordinating Center, Veterans Affairs (VA) Connecticut Healthcare System, West Haven (Sevilimedu, Johnson); VA San Diego Healthcare System, San Diego (Tal, Zisook); Louis Stokes Cleveland VA Medical Center, Clevelend (Chen); Tuscaloosa VA Medical Center, Tuscaloosa, Alabama, and University of Alabama School of Medicine, Birmingham (Davis); Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, New Mexico (Vertrees); VA New England Mental Illness Research, Education, and Clinical Center, VA Connecticut Healthcare System, West Haven (Mohamed); Department of Psychiatry, University of California, San Diego (Zisook).
Somaia Mohamed, M.D., Ph.D.
Department of Psychiatry, Baylor Scott & White Health, and Texas A&M College of Medicine, Temple, Texas (Hicks); Yale University School of Public Health, New Haven, Connecticut (Sevilimedu); Cooperative Studies Program Coordinating Center, Veterans Affairs (VA) Connecticut Healthcare System, West Haven (Sevilimedu, Johnson); VA San Diego Healthcare System, San Diego (Tal, Zisook); Louis Stokes Cleveland VA Medical Center, Clevelend (Chen); Tuscaloosa VA Medical Center, Tuscaloosa, Alabama, and University of Alabama School of Medicine, Birmingham (Davis); Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, New Mexico (Vertrees); VA New England Mental Illness Research, Education, and Clinical Center, VA Connecticut Healthcare System, West Haven (Mohamed); Department of Psychiatry, University of California, San Diego (Zisook).
Sidney Zisook, M.D.
Department of Psychiatry, Baylor Scott & White Health, and Texas A&M College of Medicine, Temple, Texas (Hicks); Yale University School of Public Health, New Haven, Connecticut (Sevilimedu); Cooperative Studies Program Coordinating Center, Veterans Affairs (VA) Connecticut Healthcare System, West Haven (Sevilimedu, Johnson); VA San Diego Healthcare System, San Diego (Tal, Zisook); Louis Stokes Cleveland VA Medical Center, Clevelend (Chen); Tuscaloosa VA Medical Center, Tuscaloosa, Alabama, and University of Alabama School of Medicine, Birmingham (Davis); Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, New Mexico (Vertrees); VA New England Mental Illness Research, Education, and Clinical Center, VA Connecticut Healthcare System, West Haven (Mohamed); Department of Psychiatry, University of California, San Diego (Zisook).

Notes

Send correspondence to Dr. Hicks ([email protected]).

Competing Interests

Mr. Johnson owns stock in Bristol-Myers Squibb, where his spouse is an employee. Dr. Davis has received research funding from Tonix and Merck as well as personal consulting fees from Bracket, Janssen, Otsuka, Lundbeck, and Tonix. Dr. Zisook receives funding from Defender Pharmaceuticals and COMPASS Pathways. The other authors report no financial relationships with commercial interests.

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