TY - JOUR
T1 - The International Study to Predict Optimized Treatment in Depression (iSPOT-D)
T2 - Outcomes from the acute phase of antidepressant treatment
AU - Saveanu, Radu
AU - Etkin, Amit
AU - Duchemin, Anne Marie
AU - Goldstein-Piekarski, Andrea
AU - Gyurak, Anett
AU - Debattista, Charles
AU - Schatzberg, Alan F.
AU - Sood, Satish
AU - Day, Claire V.A.
AU - Palmer, Donna M.
AU - Rekshan, William R.
AU - Gordon, Evian
AU - Rush, A. John
AU - Williams, Leanne M.
N1 - Funding Information:
Dr. Saveanu has received research funding from Brain Resource.
Funding Information:
Dr. Etkin has received research funding from Brain Resource.
Funding Information:
Dr. Duchemin has received research funding from Brain Resource.
Funding Information:
Dr. DeBattista has received research funding from Brain Resource, Takeda, CNS response, St Jude Medical, Aztra Zeneca, and Roche. He has served as a consultant to Genentech and Pfizer.
Funding Information:
Dr. Sood has received research funding from Brain Resource.
Funding Information:
Dr. A.J. Rush has received consulting fees from Brain Resource Ltd,,H. Eli Lilly, Lundbeck A/S, Medavante, Inc; National Institute of Drug Abuse, Santium Inc.,Takeda USA,; speaking fees from the University of California at San Diego, Hershey Penn State Medical Center, and the American Society for Clinical Psychopharmacology; royalties from Guilford Publications and the University of Texas Southwestern Medical Center; a travel grant from CINP and research support from Duke-National University of Singapore.
PY - 2015/2/1
Y1 - 2015/2/1
N2 - We aimed to characterize a large international cohort of outpatients with MDD within a practical trial design, in order to identify clinically useful predictors of outcomes with three common antidepressant medications in acute-phase treatment of major depressive disorder (MDD). The international Study to Predict Optimized Treatment in Depression has presently enrolled 1008 treatment-seeking outpatients (18-65 years old) at 17 sites (five countries). At pre-treatment, we characterized participants by symptoms, clinical history, functional status and comorbidity. Participants were randomized to receive escitalopram, sertraline or venlafaxine-extended release and managed by their physician following usual treatment practices. Symptoms, function, quality of life, and side-effect outcomes were assessed 8 weeks later. The relationship of anxiety to response and remission was assessed by comorbid Axis I diagnosis, presence/absence of anxiety symptoms, and dimensionally by anxiety symptom severity. The sample had moderate-to-severe symptoms, but substantial comorbidity and functional impairment. Of completers at week 8, 62.2% responded and 45.4% reached remission on the 17-item Hamilton Rating Scale for Depression; 53.3% and 37.6%, respectively on the 16-item Quick Inventory of Depressive Symptoms. Functional improvements were seen across all domains. Most participants had side effects that occurred with a frequency of 25% or less and were reported as being in the "none" to minimal/mild range for intensity and burden. Outcomes did not differ across medication groups. More severe anxiety symptoms at pre-treatment were associated with lower remission rates across all medications, independent of depressive severity, diagnostic comorbidity or side effects. Across medications, we found consistent and similar improvements in symptoms and function, and a dimensional prognostic effect of comorbid anxiety symptoms. These equivalent outcomes across treatments lay the foundation for identifying potential neurobiological and genetic predictors of treatment outcome in this sample.
AB - We aimed to characterize a large international cohort of outpatients with MDD within a practical trial design, in order to identify clinically useful predictors of outcomes with three common antidepressant medications in acute-phase treatment of major depressive disorder (MDD). The international Study to Predict Optimized Treatment in Depression has presently enrolled 1008 treatment-seeking outpatients (18-65 years old) at 17 sites (five countries). At pre-treatment, we characterized participants by symptoms, clinical history, functional status and comorbidity. Participants were randomized to receive escitalopram, sertraline or venlafaxine-extended release and managed by their physician following usual treatment practices. Symptoms, function, quality of life, and side-effect outcomes were assessed 8 weeks later. The relationship of anxiety to response and remission was assessed by comorbid Axis I diagnosis, presence/absence of anxiety symptoms, and dimensionally by anxiety symptom severity. The sample had moderate-to-severe symptoms, but substantial comorbidity and functional impairment. Of completers at week 8, 62.2% responded and 45.4% reached remission on the 17-item Hamilton Rating Scale for Depression; 53.3% and 37.6%, respectively on the 16-item Quick Inventory of Depressive Symptoms. Functional improvements were seen across all domains. Most participants had side effects that occurred with a frequency of 25% or less and were reported as being in the "none" to minimal/mild range for intensity and burden. Outcomes did not differ across medication groups. More severe anxiety symptoms at pre-treatment were associated with lower remission rates across all medications, independent of depressive severity, diagnostic comorbidity or side effects. Across medications, we found consistent and similar improvements in symptoms and function, and a dimensional prognostic effect of comorbid anxiety symptoms. These equivalent outcomes across treatments lay the foundation for identifying potential neurobiological and genetic predictors of treatment outcome in this sample.
KW - Escitalopram
KW - International practical trial
KW - Major depressive disorder
KW - Response and remission
KW - Sertraline
KW - Venlafaxine-XR
UR - http://www.scopus.com/inward/record.url?scp=84921538482&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84921538482&partnerID=8YFLogxK
U2 - 10.1016/j.jpsychires.2014.12.018
DO - 10.1016/j.jpsychires.2014.12.018
M3 - Article
C2 - 25586212
AN - SCOPUS:84921538482
VL - 61
SP - 1
EP - 12
JO - Journal of Psychiatric Research
JF - Journal of Psychiatric Research
SN - 0022-3956
ER -