Study Finds Depression Subtype May Not Be Relevant in Selecting Treatment

From Psychiatric News Alert: There may be no preferential antidepressant pharmacotherapy for treating subtypes of major depressive disorder (MDD), according to a study published online in AJP in Advance, “Depression Subtypes in Predicting Antidepressant Response: A Report From the iSPOT-D Trial.

oweirieoeA. John Rush, M.D., a professor of psychiatry and behavioral sciences at Duke University School of Medicine, and colleagues conducted a study with 1,008 individuals with MDD to assess the proportions of participants who met at least one criteria for MDD subtype—melancholic, atypical, and anxious depression—and compared subtype profiles on remission and change in depressive symptoms after eight weeks of treatment with escitalopram, sertraline, or extended-release venlafaxine. Improvement of symptoms and likelihood of remission were quantified by the 16-item Quick Inventory of Depressive Symptomology-Self Report.

The researchers found that 39 percent of the studied individuals exhibited at least one pure form of a depressive subtype, with atypical subtype being the most prevalent at 15 percent. Approximately 36 percent of the participants met criteria for more than one subtype. As it relates to antidepressant treatment, the results showed that participants in all subtype groups exhibited a similar statistically significant reduction in symptoms and did not differ in the likelihood to remit.

“Whether pure or mixed, subtypes were not differentially predictive of overall acute treatment outcomes or differentially predictive of efficacy among the three antidepressant medications,” the researchers concluded. “If replicated, these findings would suggest that the clinical utility of these subtypes in treatment selection is minimal.”

The iSPOT-D trial (International Study to Predict Optimized Treatment – in Depression) is the largest personalized medicine research study in mental health.

To read more about treatments for major depressive disorder, see the Manual of Clinical Psychopharmacology, Eighth Edition, by Alan Schatzberg, M.D., and Charles DeBattista, M.D., D.M.H., from American Psychiatric Publishing.

Image Credit: MorgueFile

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