Melancholic, atypical and anxious depression subtypes and outcome of treatment with escitalopram and nortriptyline

Rudolf Uher; Mojca Zvezdana Dernovsek; Ole Mors; Joanna Hauser; Daniel Souery; Astrid Zobel; Wolfgang Maier; Neven Henigsberg; Petra Kalember; Marcella Rietschel; Anna Placentino; Julien Mendlewicz; Katherine J. Aitchison; Peter McGuffin; Anne Farmer

doi:10.1016/j.jad.2011.02.014

Melancholic, atypical and anxious depression subtypes and outcome of treatment with escitalopram and nortriptyline

Rudolf Uher, Mojca Zvezdana Dernovsek, Ole Mors, Joanna Hauser, Daniel Souery, Astrid Zobel, Wolfgang Maier, Neven Henigsberg, Petra Kalember, Marcella Rietschel, Anna Placentino, Julien Mendlewicz, Katherine J. Aitchison, Peter McGuffin, Anne Farmer

Social Genetic & Developmental Psychiatry

Research output: Contribution to journal › Article › peer-review

96 Citations (Scopus)

Abstract

Objective: To investigate whether subtypes of depression predict differential outcomes of treatment with selective serotonin-reuptake inhibitor (SSRI) and a tricyclic antidepressant in major depression. Method: Among 811 adults with moderate-to-severe depression, melancholic, atypical, anxious and anxious-somatizing depression subtypes established at baseline were evaluated as predictors of outcome of treatment with flexible dosage of the SSRI escitalopram or the tricyclic antidepressant nortriptyline. The primary outcome measure was the Montgomery-Asberg Depression Rating Scale (MADRS). Secondary outcome measures were the 17-item Hamilton Rating Scale for Depression (HRSD-17) and the Beck Depression Inventory (BM). Results: Melancholic depression was associated with slightly worse outcomes among individuals treated with escitalopram, but did not affect outcome of treatment with nortriptyline. The interaction between melancholic depression and drug did not reach statistical significance for the primary outcome measure and significant results for secondary outcome measures were not robust in sensitivity analyses. Atypical depression was unrelated to outcome of treatment with either antidepressant. Anxious and anxious-somatizing depression did not predict outcome on the primary measure, but inconsistently predicted worse outcome in some secondary analyses. Limitations: Some participants were non-randomly allocated to drug. Therefore, drug-by-predictor interactions had to be validated in sensitivity analyses restricted to the 468 randomly allocated individuals. Conclusions: Melancholic, atypical or anxious depression, are not sufficiently robust differential predictors of outcome to help clinician choose between SSRI and tricyclic antidepressants. There is a need to investigate other predictors of outcome. (C) 2011 Elsevier B.V. All rights reserved.

Original language	English
Pages (from-to)	112 - 120
Number of pages	9
Journal	Journal of Affective Disorders
Volume	132
Issue number	1-2
DOIs	https://doi.org/10.1016/j.jad.2011.02.014
Publication status	Published - Jul 2011

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10.1016/j.jad.2011.02.014

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Uher, R., Dernovsek, M. Z., Mors, O., Hauser, J., Souery, D., Zobel, A., Maier, W., Henigsberg, N., Kalember, P., Rietschel, M., Placentino, A., Mendlewicz, J., Aitchison, K. J., McGuffin, P., & Farmer, A. (2011). Melancholic, atypical and anxious depression subtypes and outcome of treatment with escitalopram and nortriptyline. Journal of Affective Disorders, 132(1-2), 112 - 120. https://doi.org/10.1016/j.jad.2011.02.014

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title = "Melancholic, atypical and anxious depression subtypes and outcome of treatment with escitalopram and nortriptyline",

abstract = "Objective: To investigate whether subtypes of depression predict differential outcomes of treatment with selective serotonin-reuptake inhibitor (SSRI) and a tricyclic antidepressant in major depression. Method: Among 811 adults with moderate-to-severe depression, melancholic, atypical, anxious and anxious-somatizing depression subtypes established at baseline were evaluated as predictors of outcome of treatment with flexible dosage of the SSRI escitalopram or the tricyclic antidepressant nortriptyline. The primary outcome measure was the Montgomery-Asberg Depression Rating Scale (MADRS). Secondary outcome measures were the 17-item Hamilton Rating Scale for Depression (HRSD-17) and the Beck Depression Inventory (BM). Results: Melancholic depression was associated with slightly worse outcomes among individuals treated with escitalopram, but did not affect outcome of treatment with nortriptyline. The interaction between melancholic depression and drug did not reach statistical significance for the primary outcome measure and significant results for secondary outcome measures were not robust in sensitivity analyses. Atypical depression was unrelated to outcome of treatment with either antidepressant. Anxious and anxious-somatizing depression did not predict outcome on the primary measure, but inconsistently predicted worse outcome in some secondary analyses. Limitations: Some participants were non-randomly allocated to drug. Therefore, drug-by-predictor interactions had to be validated in sensitivity analyses restricted to the 468 randomly allocated individuals. Conclusions: Melancholic, atypical or anxious depression, are not sufficiently robust differential predictors of outcome to help clinician choose between SSRI and tricyclic antidepressants. There is a need to investigate other predictors of outcome. (C) 2011 Elsevier B.V. All rights reserved.",

author = "Rudolf Uher and Dernovsek, {Mojca Zvezdana} and Ole Mors and Joanna Hauser and Daniel Souery and Astrid Zobel and Wolfgang Maier and Neven Henigsberg and Petra Kalember and Marcella Rietschel and Anna Placentino and Julien Mendlewicz and Aitchison, {Katherine J.} and Peter McGuffin and Anne Farmer",

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doi = "10.1016/j.jad.2011.02.014",

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Uher, R, Dernovsek, MZ, Mors, O, Hauser, J, Souery, D, Zobel, A, Maier, W, Henigsberg, N, Kalember, P, Rietschel, M, Placentino, A, Mendlewicz, J, Aitchison, KJ , McGuffin, P & Farmer, A 2011, 'Melancholic, atypical and anxious depression subtypes and outcome of treatment with escitalopram and nortriptyline', Journal of Affective Disorders, vol. 132, no. 1-2, pp. 112 - 120. https://doi.org/10.1016/j.jad.2011.02.014

TY - JOUR

T1 - Melancholic, atypical and anxious depression subtypes and outcome of treatment with escitalopram and nortriptyline

AU - Uher, Rudolf

AU - Dernovsek, Mojca Zvezdana

AU - Mors, Ole

AU - Hauser, Joanna

AU - Souery, Daniel

AU - Zobel, Astrid

AU - Maier, Wolfgang

AU - Henigsberg, Neven

AU - Kalember, Petra

AU - Rietschel, Marcella

AU - Placentino, Anna

AU - Mendlewicz, Julien

AU - Aitchison, Katherine J.

AU - McGuffin, Peter

AU - Farmer, Anne

PY - 2011/7

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N2 - Objective: To investigate whether subtypes of depression predict differential outcomes of treatment with selective serotonin-reuptake inhibitor (SSRI) and a tricyclic antidepressant in major depression. Method: Among 811 adults with moderate-to-severe depression, melancholic, atypical, anxious and anxious-somatizing depression subtypes established at baseline were evaluated as predictors of outcome of treatment with flexible dosage of the SSRI escitalopram or the tricyclic antidepressant nortriptyline. The primary outcome measure was the Montgomery-Asberg Depression Rating Scale (MADRS). Secondary outcome measures were the 17-item Hamilton Rating Scale for Depression (HRSD-17) and the Beck Depression Inventory (BM). Results: Melancholic depression was associated with slightly worse outcomes among individuals treated with escitalopram, but did not affect outcome of treatment with nortriptyline. The interaction between melancholic depression and drug did not reach statistical significance for the primary outcome measure and significant results for secondary outcome measures were not robust in sensitivity analyses. Atypical depression was unrelated to outcome of treatment with either antidepressant. Anxious and anxious-somatizing depression did not predict outcome on the primary measure, but inconsistently predicted worse outcome in some secondary analyses. Limitations: Some participants were non-randomly allocated to drug. Therefore, drug-by-predictor interactions had to be validated in sensitivity analyses restricted to the 468 randomly allocated individuals. Conclusions: Melancholic, atypical or anxious depression, are not sufficiently robust differential predictors of outcome to help clinician choose between SSRI and tricyclic antidepressants. There is a need to investigate other predictors of outcome. (C) 2011 Elsevier B.V. All rights reserved.

AB - Objective: To investigate whether subtypes of depression predict differential outcomes of treatment with selective serotonin-reuptake inhibitor (SSRI) and a tricyclic antidepressant in major depression. Method: Among 811 adults with moderate-to-severe depression, melancholic, atypical, anxious and anxious-somatizing depression subtypes established at baseline were evaluated as predictors of outcome of treatment with flexible dosage of the SSRI escitalopram or the tricyclic antidepressant nortriptyline. The primary outcome measure was the Montgomery-Asberg Depression Rating Scale (MADRS). Secondary outcome measures were the 17-item Hamilton Rating Scale for Depression (HRSD-17) and the Beck Depression Inventory (BM). Results: Melancholic depression was associated with slightly worse outcomes among individuals treated with escitalopram, but did not affect outcome of treatment with nortriptyline. The interaction between melancholic depression and drug did not reach statistical significance for the primary outcome measure and significant results for secondary outcome measures were not robust in sensitivity analyses. Atypical depression was unrelated to outcome of treatment with either antidepressant. Anxious and anxious-somatizing depression did not predict outcome on the primary measure, but inconsistently predicted worse outcome in some secondary analyses. Limitations: Some participants were non-randomly allocated to drug. Therefore, drug-by-predictor interactions had to be validated in sensitivity analyses restricted to the 468 randomly allocated individuals. Conclusions: Melancholic, atypical or anxious depression, are not sufficiently robust differential predictors of outcome to help clinician choose between SSRI and tricyclic antidepressants. There is a need to investigate other predictors of outcome. (C) 2011 Elsevier B.V. All rights reserved.

U2 - 10.1016/j.jad.2011.02.014

DO - 10.1016/j.jad.2011.02.014

M3 - Article

SN - 1573-2517

VL - 132

SP - 112

EP - 120

JO - Journal of Affective Disorders

JF - Journal of Affective Disorders

IS - 1-2

ER -

Melancholic, atypical and anxious depression subtypes and outcome of treatment with escitalopram and nortriptyline

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