Response to antidepressants in major depressive disorder with melancholic features: the CRESCEND study

Abstract

Background: This studyaimedtodeterminewhethermajordepressivedisorderswithmelancholicand withoutmelancholicfeaturesdifferwithrespecttotheirresponsestotreatmentwithantidepressants. Methods: From anationwidesampleof18hospitalsinSouthKorea,559presentingpatientswithmajor depressivedisorderwererecruited.TheDSM-IVbasedStructuredClinicalInterviewwasadministered for confirmatorydiagnosesanddepressionsubtypeswith/withoutmelancholicfeatures.Afterbaseline evaluation,theyreceivednaturalisticclinician-determinedantidepressantinterventions.Assessment scales forevaluatingdepression(HAMD),anxiety(HAMA),globalseverity(CGI-s),andfunctioning (SOFAS)wereadministeredatbaselineandre-evaluatedat1,2,4,8,and12weekslater. Results: At baseline,the243(43.5%)participantswithmelancholicfeaturesweremorelikelytohavea previoushistoryofdepression,andhadhigherHAMAandlowerSOFASscores.Afteradjustmentfor baselinestatus,participantswithmelancholicfeaturesweremorelikelytoachieveandtoexperience shortertimestoCGI-sremissionandassociatedwithanenhancedglobalsymptomaticremissionwith any antidepressanttreatment.TheyweremorelikelytoachieveandtoexperienceshortertimestoCGI- s remissionandthisdifferencewasstrongestinthosereceivingselectiveserotoninreuptakeinhibitor (SSRI) antidepressantstreatment. Limitations: The studywasobservational,andthetreatmentmodalitywasnaturalistic. Conclusions: These findingssuggestafasterandmoreevidentglobalresponsetopharmacotherapyin melancholiacomparedtootherdepressivesyndromes,particularlywhereSSRIagentsareused.