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Is prior course of illness relevant to acute or longer-term outcomes in depressed out-patients? A STAR*D report

  • A. J. Rush (a1), S. R. Wisniewski (a2), S. Zisook (a3), M. Fava (a4), S. C. Sung (a1), C. L. Haley (a1), H. N. Chan (a5), W. S. Gilmer (a6), D. Warden (a7), A. A. Nierenberg (a4), G. K. Balasubramani (a2), B. N. Gaynes (a8), M. H. Trivedi (a6) and S. D. Hollon (a9)...

Abstract

Background

Major depressive disorder (MDD) is commonly chronic and/or recurrent. We aimed to determine whether a chronic and/or recurrent course of MDD is associated with acute and longer-term MDD treatment outcomes.

Method

This cohort study recruited out-patients aged 18–75 years with non-psychotic MDD from 18 primary and 23 psychiatric care clinics across the USA. Participants were grouped as: chronic (index episode >2 years) and recurrent (n=398); chronic non-recurrent (n=257); non-chronic recurrent (n=1614); and non-chronic non-recurrent (n=387). Acute treatment was up to 14 weeks of citalopram (⩽60 mg/day) with up to 12 months of follow-up treatment. The primary outcomes for this report were remission [16-item Quick Inventory of Depressive Symptomatology – Self-Rated (QIDS-SR16) ⩽5] or response (⩾50% reduction from baseline in QIDS-SR16) and time to first relapse [first QIDS-SR16 by Interactive Voice Response (IVR) ⩾11].

Results

Most participants (85%) had a chronic and/or recurrent course; 15% had both. Chronic index episode was associated with greater sociodemographic disadvantage. Recurrent course was associated with earlier age of onset and greater family histories of depression and substance abuse. Remission rates were lowest and slowest for those with chronic index episodes. For participants in remission entering follow-up, relapse was most likely for the chronic and recurrent group, and least likely for the non-chronic, non-recurrent group. For participants not in remission when entering follow-up, prior course was unrelated to relapse.

Conclusions

Recurrent MDD is the norm for out-patients, of whom 15% also have a chronic index episode. Chronic and recurrent course of MDD may be useful in predicting acute and long-term MDD treatment outcomes.

Copyright

Corresponding author

*Address for correspondence: M. H. Trivedi, M.D., University of Texas Southwestern Medical Center at Dallas, Bass Center, 6363 Forest Park Road, 13.354, Dallas, TX 75235, USA. (Email: madhukar.trivedi@utsouthwestern.edu)

References

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Anderson, IM, Ferrier, IN, Baldwin, RC, Cowen, PJ, Howard, L, Lewis, G, Matthews, K, McAllister-Williams, RH, Peveler, RC, Scott, J, Tylee, A (2008). Evidence-based guidelines for treating depressive disorders with antidepressants: a revision of the 2000 British Association for Psychopharmacology guidelines. Journal of Psychopharmacology 22, 343396.
Angst, J, Gamma, A, Rössler, W, Ajdacic, V, Klein, DN (2009). Long-term depression versus episodic major depression: results from the prospective Zurich study of a community sample. Journal of Affective Disorders 115, 112121.
APA (2000 a). Practice guideline for the treatment of patients with major depressive disorder (revision). American Psychiatric Association. American Journal of Psychiatry 157 (Suppl. 4), 145.
APA (2000 b). Diagnostic and Statistical Manual of Mental Disorders, 4th edn, text revision (DSM-IV-TR). American Psychiatric Association: Washington, DC.
Bernstein, IH, Rush, AJ, Carmody, TJ, Woo, A, Trivedi, MH (2007). Clinical vs. self-report versions of the Quick Inventory of Depressive Symptomatology in a public sector sample. Journal of Psychiatric Research 41, 239246.
Blanco, C, Okuda, M, Markowitz, JC, Liu, SM, Grant, BF, Hasin, DS (2010). The epidemiology of chronic major depressive disorder and dysthymic disorder: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Journal of Clinical Psychiatry 71, 16451656.
Bockting, CL, Spinhoven, P, Wouters, LF, Koeter, MW, Schene, AH; DELTA Study Group (2009). Long-term effects of preventive cognitive therapy in recurrent depression: a 5.5-year follow-up study. Journal of Clinical Psychiatry 70, 16211628.
Carmody, TJ, Rush, AJ, Bernstein, IH, Brannan, S, Husain, MM, Trivedi, MH (2006). Making clinicians lives easier: guidance on use of the QIDS self-report in place of the MADRS. Journal of Affective Disorders 95, 115118.
Conradi, HJ, de Jonge, P, Ormel, J (2008). Cognitive-behavioural therapy v. usual care in recurrent depression. British Journal of Psychiatry 193, 505506.
Depression Guideline Panel (1993). Clinical Practice Guideline, Number 5: Depression in Primary Care: Volume 2. Treatment of Major Depression. U.S. Department of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research: Rockville, MD.
Fava, GA, Ruino, C, Rafanelli, C, Finos, L, Conti, S, Grandi, S (2004 a). Six-year outcome of cognitive behaviour therapy for prevention of recurrent depression. American Journal of Psychiatry 161, 18721876.
Fava, M, Alpert, JE, Carmin, CN, Wisniewski, SR, Trivedi, MH, Biggs, MM, Shores-Wilson, K, Morgan, D, Schwartz, T, Balasubramani, GK, Rush, AJ (2004 b). Clinical correlates and symptom patterns of anxious depression among patients with major depressive disorder in STAR*D. Psychological Medicine 34, 12991308.
Fava, M, Rush, AJ, Trivedi, MH, Nierenberg, AA, Thase, ME, Sackeim, HA, Quitkin, FM, Wisniewski, S, Lavori, PW, Rosenbaum, JF, Kupfer, DJ (2003). Background and rationale for the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study. Psychiatric Clinics of North America 26, 457494, x.
Gilmer, WS, Trivedi, MH, Rush, AJ, Wisniewski, SR, Luther, J, Howland, RH, Yohanna, D, Khan, A, Alpert, J (2005). Factors associated with chronic depressive episodes: a preliminary report from the STAR-D project. Acta Psychiatrica Scandinavica 112, 425433.
Guidi, J, Fava, GA, Fava, M, Papakostas, GI (2011). Efficacy of the sequential integration of psychotherapy and pharmacotherapy in major depressive disorder: a preliminary meta-analysis. Psychological Medicine 41, 321331.
Hamilton, M (1960). A rating scale for depression. Journal of Neurology, Neurosurgery, and Psychiatry 23, 5662.
Hamilton, M (1967). Development of a rating scale for primary depressive illness. British Journal of Social and Clinical Psychology 6, 278296.
Hollon, SD, Shelton, RC, Wisniewski, S, Warden, D, Biggs, MM, Friedman, ES, Husain, M, Kupfer, DJ, Nierenberg, AA, Petersen, TJ, Shores-Wilson, K, Rush, AJ (2006). Presenting characteristics of depressed outpatients as a function of recurrence: preliminary findings from the STAR*D clinical trial. Journal of Psychiatric Research 40, 5969.
Jonsson, U, Bohman, H, von Knorring, L, Olsson, G, Paaren, A, von Knorring, AL (2011). Mental health outcome of long-term and episodic adolescent depression: 15-year follow-up of a community sample. Journal of Affective Disorders 130, 395404.
Kanai, T, Takeuchi, H, Furukawa, TA, Yoshimura, R, Imaizumi, T, Kitamura, T, Takahashi, K (2003). Time to recurrence after recovery from major depressive episodes and its predictors. Psychological Medicine 33, 839845.
Kaymaz, N, van Os, J, Loonen, AJ, Nolen, WA (2008). Evidence that patients with single versus recurrent depressive episodes are differentially sensitive to treatment discontinuation: a meta-analysis of placebo-controlled randomized trials. Journal of Clinical Psychiatry 69, 14231436.
Khan, AY, Carrithers, J, Preskorn, SH, Lear, R, Wisniewski, SR, Rush, AJ, Stegman, D, Kelley, C, Kreiner, K, Nierenberg, AA, Fava, M (2006). Clinical and demographic factors associated with DSM-IV melancholic depression. Annals of Clinical Psychiatry 18, 9198.
Klein, DN (2008). Classification of depressive disorders in the DSM-V: proposal for a two-dimension system. Journal of Abnormal Psychology 117, 552560.
Klein, DN (2010). Chronic depression: diagnosis and classification. Current Directions in Psychological Science 19, 96–100.
Kocsis, JH, Rush, AJ, Markowitz, JC, Borian, FE, Dunner, DL, Koran, LM, Klein, DN, Trivedi, MH, Arnow, B, Keitner, G, Kornstein, SG, Keller, MB (2003). Continuation treatment of chronic depression: a comparison of nefazodone, cognitive behavioral analysis system of psychotherapy, and their combination. Psychopharmacology Bulletin 37, 7387.
Kriston, L, von Wolff, A, Hölzel, L (2010). Effectiveness of psychotherapeutic, pharmacological, and combined treatments for chronic depression: a systematic review (METACHRON). BMC Psychiatry 10, 95.
Linn, BS, Linn, MW, Gurel, L (1968). Cumulative illness rating scale. Journal of the American Geriatrics Society 16, 622626.
Miller, MD, Paradis, CF, Houck, PR, Mazumdar, S, Stack, JA, Rifai, AH, Mulsant, B, Reynolds, CF 3rd (1992). Rating chronic medical illness burden in geropsychiatric practice and research: application of the Cumulative Illness Rating Scale. Psychiatry Research 41, 237248.
Mondimore, FM, Zandi, PP, Mackinnon, DF, McInnis, MG, Miller, EB, Crowe, RP, Scheftner, WA, Marta, DH, Weissman, MM, Levinson, DF, Murphy-Ebenez, KP, Depaulo, JR Jr., Potash, JB (2006). Familial aggregation of illness chronicity in recurrent, early-onset major depression pedigrees. American Journal of Psychiatry 163, 15541560.
Nierenberg, AA, Trivedi, MH, Ritz, L, Burroughs, D, Greist, J, Sackeim, H, Kornstein, S, Schwartz, T, Stegman, D, Fava, M, Wisniewski, SR (2004). Suicide risk management for the sequenced treatment alternatives to relieve depression study: applied NIMH guidelines. Journal of Psychiatric Research 38, 583589.
Novick, JS, Stewart, JW, Wisniewski, SR, Cook, IA, Manev, R, Nierenberg, AA, Rosenbaum, JF, Shores-Wilson, K, Balasubramani, GK, Biggs, MM, Zisook, S, Rush, AJ (2005). Clinical and demographic features of atypical depression in outpatients with major depressive disorder: preliminary findings from STAR*D. Journal of Clinical Psychiatry 66, 10021011.
Nutt, DJ (2010). Rationale for, barriers to, and appropriate medication for the long-term treatment of depression. Journal of Clinical Psychiatry 71 (Suppl. E1), e02.
Pettit, JW, Lewinsohn, PM, Roberts, RE, Seeley, JR, Monteith, L (2009). The long-term course of depression: development of an empirical index and identification of early adult outcomes. Psychological Medicine 39, 403412.
Roca, M, Armengol, S, García-García, M, Rodriguez-Bayón, A, Ballesta, I, Serrano, MJ, Comas, A, Gili, M (2011). Clinical differences between first and recurrent episodes in depressive patients. Comprehensive Psychiatry 52, 2632.
Rush, AJ, Bernstein, IH, Trivedi, MH, Carmody, TJ, Wisniewski, S, Mundt, JC, Shores-Wilson, K, Biggs, MM, Woo, A, Nierenberg, AA, Fava, M (2006 a). An evaluation of the Quick Inventory of Depressive Symptomatology and the Hamilton Rating Scale for Depression: a Sequenced Treatment Alternatives to Relieve Depression trial report. Biological Psychiatry 59, 493501.
Rush, AJ, Carmody, TJ, Ibrahim, HM, Trivedi, MH, Biggs, MM, Shores-Wilson, K, Crismon, ML, Toprac, MG, Kashner, TM (2006 b). Comparison of self-report and clinician ratings on two inventories of depressive symptomatology. Psychiatric Services 57, 829837.
Rush, AJ, Carmody, TJ, Reimitz, PE (2000). The Inventory of Depressive Symptomatology (IDS): clinician (IDS-C) and self-report (IDS-SR) ratings of depressive symptoms. International Journal of Methods in Psychiatric Research 9, 4559.
Rush, AJ, Fava, M, Wisniewski, SR, Lavori, PW, Trivedi, MH, Sackeim, HA, Thase, ME, Nierenberg, AA, Quitkin, FM, Kashner, TM, Kupfer, DJ, Rosenbaum, JF, Alpert, J, Stewart, JW, McGrath, PJ, Biggs, MM, Shores-Wilson, K, Lebowitz, BD, Ritz, L, Niederehe, G (2004). Sequenced Treatment Alternatives to Relieve Depression (STAR*D): rationale and design. Controlled Clinical Trials 25, 119142.
Rush, AJ, Gullion, CM, Basco, MR, Jarrett, RB, Trivedi, MH (1996). The Inventory of Depressive Symptomatology (IDS): psychometric properties. Psychological Medicine 26, 477486.
Rush, AJ, Kraemer, HC, Sackeim, HA, Fava, M, Trivedi, MH, Frank, E, Ninan, PT, Thase, ME, Gelenberg, AJ, Kupfer, DJ, Regier, DA, Rosenbaum, JF, Ray, O, Schatzberg, AF (2006 c). Report by the ACNP Task Force on response and remission in major depressive disorder. Neuropsychopharmacology 31, 18421853.
Rush, AJ, Trivedi, MH, Carmody, TJ, Ibrahim, H, Markowitz, JC, Keitner, GI, Kornstein, SG, Arnow, B, Klein, DN, Manber, R, Dunner, DL, Gelenberg, AJ, Kocsis, JH, Nemeroff, CB, Fawcett, J, Thase, ME, Russell, JM, Jody, DN, Borian, FE, Keller, MB (2005 a). Self-reported depressive symptom measures: sensitivity to detecting change in a randomized, controlled trial of chronically depressed, nonpsychotic outpatients. Neuropsychopharmacology 30, 405416.
Rush, AJ, Trivedi, MH, Ibrahim, HM, Carmody, TJ, Arnow, B, Klein, DN, Markowitz, JC, Ninan, PT, Kornstein, S, Manber, R, Thase, ME, Kocsis, JH, Keller, MB (2003). The 16-Item Quick Inventory of Depressive Symptomatology (QIDS), clinician rating (QIDS-C), and self-report (QIDS-SR): a psychometric evaluation in patients with chronic major depression. Biological Psychiatry 54, 573583.
Rush, AJ, Zimmerman, M, Wisniewski, SR, Fava, M, Hollon, SD, Warden, D, Biggs, MM, Shores-Wilson, K, Shelton, RC, Luther, JF, Thomas, B, Trivedi, MH (2005 b). Comorbid psychiatric disorders in depressed outpatients: demographic and clinical features. Journal of Affective Disorders 87, 4355.
Satyanarayana, S, Enns, MW, Cox, BJ, Sareen, J (2009). Prevalence and correlates of chronic depression in the Canadian community health survey: mental health and well-being. Canadian Journal of Psychiatry 54, 389398.
Solomon, DA, Keller, MB, Leon, AC, Mueller, TI, Shea, MT, Warshaw, M, Maser, JD, Coryell, W, Endicott, J (1997). Recovery from major depression. A 10-year prospective follow-up across multiple episodes. Archives of General Psychiatry 54, 10011006.
Stegenga, BT, Kamphuis, MH, King, M, Nazareth, I, Geerlings, MI (2010). The natural course and outcome of major depressive disorder in primary care: the PREDICT-NL study. Social Psychiatry and Psychiatric Epidemiology. Published online: 6 November 2010. doi:10.1007/s00127-010-0317-9.
Trivedi, MH, Rush, AJ, Gaynes, BN, Stewart, JW, Wisniewski, SR, Warden, D, Ritz, L, Luther, JF, Stegman, D, DeVeaugh-Geiss, J, Howland, R (2007). Maximizing the adequacy of medication treatment in controlled trials and clinical practice: STAR*D measurement-based care. Neuropsychopharmacology 32, 24792489.
Trivedi, MH, Rush, AJ, Ibrahim, HM, Carmody, TJ, Biggs, MM, Suppes, T, Crismon, ML, Shores-Wilson, K, Toprac, MG, Dennehy, EB, Witte, B, Kashner, TM (2004). The Inventory of Depressive Symptomatology, Clinician Rating (IDS-C) and Self-Report (IDS-SR), and the Quick Inventory of Depressive Symptomatology, Clinician Rating (QIDS-C) and Self-Report (QIDS-SR) in public sector patients with mood disorders: a psychometric evaluation. Psychological Medicine 34, 7382.
Trivedi, MH, Rush, AJ, Wisniewski, SR, Nierenberg, AA, Warden, D, Ritz, L, Norquist, G, Howland, RH, Lebowitz, B, McGrath, PJ, Shores-Wilson, K, Biggs, MM, Balasubramani, GK, Fava, M (2006). Evaluation of outcomes with citalopram for depression using measurement-based care in STAR*D: implications for clinical practice. American Journal of Psychiatry 163, 2840.
Vuorilehto, MS, Melartin, TK, Isometsä, ET (2009). Course and outcome of depressive disorders in primary care: a prospective 18-month study. Psychological Medicine 39, 16971707.
Wisniewski, SR, Rush, AJ, Balasubramani, GK, Trivedi, MH, Nierenberg, AA, for the STAR*D Investigators (2006). Self-rated global measure of the frequency, intensity, and burden of side effects. Journal of Psychiatric Practice 12, 7179.
Zimmerman, M, Mattia, JI (2001 a). A self-report scale to help make psychiatric diagnoses: the Psychiatric Diagnostic Screening Questionnaire. Archives of General Psychiatry 58, 787794.
Zimmerman, M, Mattia, JI (2001 b). The Psychiatric Diagnostic Screening Questionnaire: development, reliability and validity. Comprehensive Psychiatry 42, 175189.

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