Early symptom non-improvement and aggravation are associated with the treatment response to SSRIs in MDD: a real-world study

Hsinsung Yuan,1,2 Xiao Zhu,1 Qiang Luo,3,4 Alice Halim,5 Michael Halim,5 Hao Yao,5 Yiyun Cai,1,6 Shenxun Shi1,6 1Psychiatry Department of Huashan Hospital, Fudan University, Shanghai, People’s Republic of China; 2Psychiatry Department of Nanjing Brain Hospital, Nanjing, People&am...

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Autores principales:	Yuan H, Zhu X, Luo Q, Halim A, Halim M, Yao H, Cai Y, Shi S
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2019
Materias:	early improvement major depressive disorder antidepressants selective serotonin reuptake inhibitors Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429
Acceso en línea:	https://doaj.org/article/a3fffb5ebc9d42b394a69c5dbf313663
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spelling	oai:doaj.org-article:a3fffb5ebc9d42b394a69c5dbf3136632021-12-02T07:53:35ZEarly symptom non-improvement and aggravation are associated with the treatment response to SSRIs in MDD: a real-world study1178-2021https://doaj.org/article/a3fffb5ebc9d42b394a69c5dbf3136632019-04-01T00:00:00Zhttps://www.dovepress.com/early-symptom-non-improvement-and-aggravation-are-associated-with-the--peer-reviewed-article-NDThttps://doaj.org/toc/1178-2021Hsinsung Yuan,1,2 Xiao Zhu,1 Qiang Luo,3,4 Alice Halim,5 Michael Halim,5 Hao Yao,5 Yiyun Cai,1,6 Shenxun Shi1,6 1Psychiatry Department of Huashan Hospital, Fudan University, Shanghai, People’s Republic of China; 2Psychiatry Department of Nanjing Brain Hospital, Nanjing, People’s Republic of China; 3Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, People’s Republic of China; 4Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence (Ministry of Education), Fudan University, Shanghai, People’s Republic of China; 5Shanghai Medical College, Fudan University, Shanghai, People’s Republic of China; 6Shanghai Mental Health Center, Shanghai, People’s Republic of China Purpose: Early improvement in major depressive disorder is defined as a reduction of ≥20% in the 17-item Hamilton Depression Rating Scale (HAM-D-17) score at the second week after initiation of treatment, predicting long-term treatment response. However, there remains no effective strategy for switching medications when a patient fails to reach early improvement at the second week. This study focused on the predictive value of early symptom changes in each item of the HAM-D-17 scale for treatment response to selective serotonin reuptake inhibitor (SSRI) monotherapy and to provide a reference for switching antidepressants to enhance early treatment efficacy. Patients and methods: Our study was an observational, real-world study that enrolled 90 treatment-naïve patients experiencing their first episode of major depressive disorder in the outpatient department of Huashan Hospital. Patients who did not achieve the threshold of early improvement in the second week after starting treatment were switched to alternative SSRI monotherapy. Patient follow-up occurred at 2, 4, 8, and 12 weeks after the initiation of treatment. We analyzed the relationship between the change in each symptom on the HAM-D-17 scale and treatment efficacy. Results: Early improvement predicted the treatment response at 12 weeks (χ2=19.249, P<0.001), whereas early non-improvement in insomnia and anxiety was associated with a poor response (OR =9.487, 95% CI: 1.312–68.588 and OR =12.947, 95% CI: 1.99–82.246, respectively). At week 2, general somatic symptom aggravation was associated with a poorer response (OR =73.337, 95% CI: 2.232->999.999); treatment-emergent headache and tremor were associated with treatment efficacy (t=-9.521, P<0.001 and t=3.660, P=0.001, respectively). In addition, the increase in suicidal thoughts, once treatment began, had no relationship with the treatment response (OR =0.821, P=0.872). Conclusion: This study suggested that patients with early non-improvement in insomnia and anxiety were not suitable for switches in SSRI monotherapy. Patients with treatment-emergent symptoms, especially headaches and tremors, were not suitable for switching from monotherapy to another SSRI. Keywords: early improvement, major depressive disorder, antidepressants, selective serotonin reuptake inhibitorsYuan HZhu XLuo QHalim AHalim MYao HCai YShi SDove Medical Pressarticleearly improvementmajor depressive disorderantidepressantsselective serotonin reuptake inhibitorsNeurosciences. Biological psychiatry. NeuropsychiatryRC321-571Neurology. Diseases of the nervous systemRC346-429ENNeuropsychiatric Disease and Treatment, Vol Volume 15, Pp 957-966 (2019)
institution	DOAJ
collection	DOAJ
language	EN
topic	early improvement major depressive disorder antidepressants selective serotonin reuptake inhibitors Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429
spellingShingle	early improvement major depressive disorder antidepressants selective serotonin reuptake inhibitors Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429 Yuan H Zhu X Luo Q Halim A Halim M Yao H Cai Y Shi S Early symptom non-improvement and aggravation are associated with the treatment response to SSRIs in MDD: a real-world study
description	Hsinsung Yuan,1,2 Xiao Zhu,1 Qiang Luo,3,4 Alice Halim,5 Michael Halim,5 Hao Yao,5 Yiyun Cai,1,6 Shenxun Shi1,6 1Psychiatry Department of Huashan Hospital, Fudan University, Shanghai, People’s Republic of China; 2Psychiatry Department of Nanjing Brain Hospital, Nanjing, People’s Republic of China; 3Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, People’s Republic of China; 4Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence (Ministry of Education), Fudan University, Shanghai, People’s Republic of China; 5Shanghai Medical College, Fudan University, Shanghai, People’s Republic of China; 6Shanghai Mental Health Center, Shanghai, People’s Republic of China Purpose: Early improvement in major depressive disorder is defined as a reduction of ≥20% in the 17-item Hamilton Depression Rating Scale (HAM-D-17) score at the second week after initiation of treatment, predicting long-term treatment response. However, there remains no effective strategy for switching medications when a patient fails to reach early improvement at the second week. This study focused on the predictive value of early symptom changes in each item of the HAM-D-17 scale for treatment response to selective serotonin reuptake inhibitor (SSRI) monotherapy and to provide a reference for switching antidepressants to enhance early treatment efficacy. Patients and methods: Our study was an observational, real-world study that enrolled 90 treatment-naïve patients experiencing their first episode of major depressive disorder in the outpatient department of Huashan Hospital. Patients who did not achieve the threshold of early improvement in the second week after starting treatment were switched to alternative SSRI monotherapy. Patient follow-up occurred at 2, 4, 8, and 12 weeks after the initiation of treatment. We analyzed the relationship between the change in each symptom on the HAM-D-17 scale and treatment efficacy. Results: Early improvement predicted the treatment response at 12 weeks (χ2=19.249, P<0.001), whereas early non-improvement in insomnia and anxiety was associated with a poor response (OR =9.487, 95% CI: 1.312–68.588 and OR =12.947, 95% CI: 1.99–82.246, respectively). At week 2, general somatic symptom aggravation was associated with a poorer response (OR =73.337, 95% CI: 2.232->999.999); treatment-emergent headache and tremor were associated with treatment efficacy (t=-9.521, P<0.001 and t=3.660, P=0.001, respectively). In addition, the increase in suicidal thoughts, once treatment began, had no relationship with the treatment response (OR =0.821, P=0.872). Conclusion: This study suggested that patients with early non-improvement in insomnia and anxiety were not suitable for switches in SSRI monotherapy. Patients with treatment-emergent symptoms, especially headaches and tremors, were not suitable for switching from monotherapy to another SSRI. Keywords: early improvement, major depressive disorder, antidepressants, selective serotonin reuptake inhibitors
format	article
author	Yuan H Zhu X Luo Q Halim A Halim M Yao H Cai Y Shi S
author_facet	Yuan H Zhu X Luo Q Halim A Halim M Yao H Cai Y Shi S
author_sort	Yuan H
title	Early symptom non-improvement and aggravation are associated with the treatment response to SSRIs in MDD: a real-world study
title_short	Early symptom non-improvement and aggravation are associated with the treatment response to SSRIs in MDD: a real-world study
title_full	Early symptom non-improvement and aggravation are associated with the treatment response to SSRIs in MDD: a real-world study
title_fullStr	Early symptom non-improvement and aggravation are associated with the treatment response to SSRIs in MDD: a real-world study
title_full_unstemmed	Early symptom non-improvement and aggravation are associated with the treatment response to SSRIs in MDD: a real-world study
title_sort	early symptom non-improvement and aggravation are associated with the treatment response to ssris in mdd: a real-world study
publisher	Dove Medical Press
publishDate	2019
url	https://doaj.org/article/a3fffb5ebc9d42b394a69c5dbf313663
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Early symptom non-improvement and aggravation are associated with the treatment response to SSRIs in MDD: a real-world study

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