Predictors of attrition during initial (Citalopram) treatment for depression: A STAR*D report

Diane Warden, Madhukar H. Trivedi, Stephen R. Wisniewski, Lori Davis, Andrew A. Nierenberg, Bradley N. Gaynes, Sidney Zisook, Steven D. Hollon, G. K. Balasubramani, Robert Howland, Maurizio Fava, Jonathan W. Stewart, A. John Rush

Research output: Contribution to journalArticle

100 Citations (Scopus)

Abstract

Objective: Premature attrition from treatment may lead to worse outcomes and compromise the integrity of clinical trials in major depressive disorder. The purpose of this study was to identify the pretreatment predictors of attrition during acute treatment with citalopram in a large, "real world" clinical trial. Method: A total of 4,041 adult outpatients with nonpsychotic major depressive disorder were enrolled in treatment with citalopram for up to 14 weeks. Attrition was defined as "immediate" (patients who attended a baseline visit only) or "later" (patients who attended at least one postbaseline visit but who dropped out before the 12-week visit). Results: Overall, 26% of enrolled patients dropped out of the acute phase treatment for nonmedical reasons. Of these, 34% dropped out immediately, 59% dropped out by week 12, and 7% dropped out after 12 weeks. Immediate attrition was associated with younger age, less education, and higher perceived mental health functioning. Attrition later in treatment was associated with younger age, less education, and African American race. Experience with more than one episode of depression was associated with less attrition. Conclusions: In clinical trials and clinical practice, several time points in treatment may provide opportunities to engage and encourage populations at higher risk for attrition and populations with high-risk presentation of illness. Additionally, more aggressive forms of treatment implemented earlier in the treatment process in order to increase the likelihood of more rapid efficacy may reduce dropout rates.

Original languageEnglish (US)
Pages (from-to)1189-1197
Number of pages9
JournalAmerican Journal of Psychiatry
Volume164
Issue number8
DOIs
StatePublished - Aug 2007

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Citalopram
Depression
Major Depressive Disorder
Therapeutics
Pragmatic Clinical Trials
Clinical Trials
Education
African Americans
Mental Health
Outpatients

ASJC Scopus subject areas

  • Psychiatry and Mental health

Cite this

Predictors of attrition during initial (Citalopram) treatment for depression : A STAR*D report. / Warden, Diane; Trivedi, Madhukar H.; Wisniewski, Stephen R.; Davis, Lori; Nierenberg, Andrew A.; Gaynes, Bradley N.; Zisook, Sidney; Hollon, Steven D.; Balasubramani, G. K.; Howland, Robert; Fava, Maurizio; Stewart, Jonathan W.; Rush, A. John.

In: American Journal of Psychiatry, Vol. 164, No. 8, 08.2007, p. 1189-1197.

Research output: Contribution to journalArticle

Warden, D, Trivedi, MH, Wisniewski, SR, Davis, L, Nierenberg, AA, Gaynes, BN, Zisook, S, Hollon, SD, Balasubramani, GK, Howland, R, Fava, M, Stewart, JW & Rush, AJ 2007, 'Predictors of attrition during initial (Citalopram) treatment for depression: A STAR*D report', American Journal of Psychiatry, vol. 164, no. 8, pp. 1189-1197. https://doi.org/10.1176/appi.ajp.2007.06071225
Warden, Diane ; Trivedi, Madhukar H. ; Wisniewski, Stephen R. ; Davis, Lori ; Nierenberg, Andrew A. ; Gaynes, Bradley N. ; Zisook, Sidney ; Hollon, Steven D. ; Balasubramani, G. K. ; Howland, Robert ; Fava, Maurizio ; Stewart, Jonathan W. ; Rush, A. John. / Predictors of attrition during initial (Citalopram) treatment for depression : A STAR*D report. In: American Journal of Psychiatry. 2007 ; Vol. 164, No. 8. pp. 1189-1197.
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AU - Zisook, Sidney

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