Residual symptoms after remission of major depressive disorder with citalopram and risk of relapse: A STARßD report

A. A. Nierenberg, M. M. Husain, M. H. Trivedi, M. Fava, D. Warden, S. R. Wisniewski, S. Miyahara, A. J. Rush

Research output: Contribution to journalArticle

243 Citations (Scopus)

Abstract

Background Many patients with major depressive disorder (MDD) who experience full symptomatic remission after antidepressant treatment still have residual depressive symptoms. We describe the types and frequency of residual depressive symptoms and their relationship to subsequent depressive relapse after treatment with citalopram in the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial.Method Participants in primary (n=18) and psychiatric (n=23) practice settings were openly treated with citalopram using measurement-based care for up to 14 weeks and follow-up for up to 1 year. We assessed 943 (32.8% of 2876) participants who met criteria for remission to determine the proportions with individual residual symptoms and any of the nine DSM-IV criterion symptom domains to define a major depressive episode. At each visit, the 16-item Quick Inventory of Depressive Symptomatology, Self-Report (QIDS-SR16) and the self-report Frequency, Intensity, and Burden of Side Effects Rating (FIBSER) scale were used to assessed depressive symptoms and side-effects respectively.Results More than 90% of remitters had at least one residual depressive symptom (median=3). The most common were weight increase (71.3%) and mid-nocturnal insomnia (54.9%). The most common residual symptom domains were sleep disturbance (71.7%) and appetite/weight disturbance (35.9%). Those who remitted before 6 weeks had fewer residual symptoms at study exit than did later remitters. Residual sleep disturbance did not predict relapse during follow-up. Having a greater number of residual symptom domains was associated with a higher probability of relapse.Conclusions Patients with remission of MDD after treatment with citalopram continue to experience selected residual depressive symptoms, which increase the risk of relapse.

Original languageEnglish (US)
Pages (from-to)41-50
Number of pages10
JournalPsychological Medicine
Volume40
Issue number1
DOIs
StatePublished - Jan 2010

Fingerprint

Citalopram
Major Depressive Disorder
Depression
Recurrence
Self Report
Sleep
Weights and Measures
Sleep Initiation and Maintenance Disorders
Appetite
Therapeutics
Diagnostic and Statistical Manual of Mental Disorders
Antidepressive Agents
Psychiatry
Equipment and Supplies

Keywords

  • Major depression
  • Remission
  • Residual symptoms

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Applied Psychology

Cite this

Residual symptoms after remission of major depressive disorder with citalopram and risk of relapse : A STARßD report. / Nierenberg, A. A.; Husain, M. M.; Trivedi, M. H.; Fava, M.; Warden, D.; Wisniewski, S. R.; Miyahara, S.; Rush, A. J.

In: Psychological Medicine, Vol. 40, No. 1, 01.2010, p. 41-50.

Research output: Contribution to journalArticle

Nierenberg, A. A. ; Husain, M. M. ; Trivedi, M. H. ; Fava, M. ; Warden, D. ; Wisniewski, S. R. ; Miyahara, S. ; Rush, A. J. / Residual symptoms after remission of major depressive disorder with citalopram and risk of relapse : A STARßD report. In: Psychological Medicine. 2010 ; Vol. 40, No. 1. pp. 41-50.
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abstract = "Background Many patients with major depressive disorder (MDD) who experience full symptomatic remission after antidepressant treatment still have residual depressive symptoms. We describe the types and frequency of residual depressive symptoms and their relationship to subsequent depressive relapse after treatment with citalopram in the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial.Method Participants in primary (n=18) and psychiatric (n=23) practice settings were openly treated with citalopram using measurement-based care for up to 14 weeks and follow-up for up to 1 year. We assessed 943 (32.8{\%} of 2876) participants who met criteria for remission to determine the proportions with individual residual symptoms and any of the nine DSM-IV criterion symptom domains to define a major depressive episode. At each visit, the 16-item Quick Inventory of Depressive Symptomatology, Self-Report (QIDS-SR16) and the self-report Frequency, Intensity, and Burden of Side Effects Rating (FIBSER) scale were used to assessed depressive symptoms and side-effects respectively.Results More than 90{\%} of remitters had at least one residual depressive symptom (median=3). The most common were weight increase (71.3{\%}) and mid-nocturnal insomnia (54.9{\%}). The most common residual symptom domains were sleep disturbance (71.7{\%}) and appetite/weight disturbance (35.9{\%}). Those who remitted before 6 weeks had fewer residual symptoms at study exit than did later remitters. Residual sleep disturbance did not predict relapse during follow-up. Having a greater number of residual symptom domains was associated with a higher probability of relapse.Conclusions Patients with remission of MDD after treatment with citalopram continue to experience selected residual depressive symptoms, which increase the risk of relapse.",
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T1 - Residual symptoms after remission of major depressive disorder with citalopram and risk of relapse

T2 - A STARßD report

AU - Nierenberg, A. A.

AU - Husain, M. M.

AU - Trivedi, M. H.

AU - Fava, M.

AU - Warden, D.

AU - Wisniewski, S. R.

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N2 - Background Many patients with major depressive disorder (MDD) who experience full symptomatic remission after antidepressant treatment still have residual depressive symptoms. We describe the types and frequency of residual depressive symptoms and their relationship to subsequent depressive relapse after treatment with citalopram in the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial.Method Participants in primary (n=18) and psychiatric (n=23) practice settings were openly treated with citalopram using measurement-based care for up to 14 weeks and follow-up for up to 1 year. We assessed 943 (32.8% of 2876) participants who met criteria for remission to determine the proportions with individual residual symptoms and any of the nine DSM-IV criterion symptom domains to define a major depressive episode. At each visit, the 16-item Quick Inventory of Depressive Symptomatology, Self-Report (QIDS-SR16) and the self-report Frequency, Intensity, and Burden of Side Effects Rating (FIBSER) scale were used to assessed depressive symptoms and side-effects respectively.Results More than 90% of remitters had at least one residual depressive symptom (median=3). The most common were weight increase (71.3%) and mid-nocturnal insomnia (54.9%). The most common residual symptom domains were sleep disturbance (71.7%) and appetite/weight disturbance (35.9%). Those who remitted before 6 weeks had fewer residual symptoms at study exit than did later remitters. Residual sleep disturbance did not predict relapse during follow-up. Having a greater number of residual symptom domains was associated with a higher probability of relapse.Conclusions Patients with remission of MDD after treatment with citalopram continue to experience selected residual depressive symptoms, which increase the risk of relapse.

AB - Background Many patients with major depressive disorder (MDD) who experience full symptomatic remission after antidepressant treatment still have residual depressive symptoms. We describe the types and frequency of residual depressive symptoms and their relationship to subsequent depressive relapse after treatment with citalopram in the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial.Method Participants in primary (n=18) and psychiatric (n=23) practice settings were openly treated with citalopram using measurement-based care for up to 14 weeks and follow-up for up to 1 year. We assessed 943 (32.8% of 2876) participants who met criteria for remission to determine the proportions with individual residual symptoms and any of the nine DSM-IV criterion symptom domains to define a major depressive episode. At each visit, the 16-item Quick Inventory of Depressive Symptomatology, Self-Report (QIDS-SR16) and the self-report Frequency, Intensity, and Burden of Side Effects Rating (FIBSER) scale were used to assessed depressive symptoms and side-effects respectively.Results More than 90% of remitters had at least one residual depressive symptom (median=3). The most common were weight increase (71.3%) and mid-nocturnal insomnia (54.9%). The most common residual symptom domains were sleep disturbance (71.7%) and appetite/weight disturbance (35.9%). Those who remitted before 6 weeks had fewer residual symptoms at study exit than did later remitters. Residual sleep disturbance did not predict relapse during follow-up. Having a greater number of residual symptom domains was associated with a higher probability of relapse.Conclusions Patients with remission of MDD after treatment with citalopram continue to experience selected residual depressive symptoms, which increase the risk of relapse.

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KW - Remission

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