Difference in Treatment Outcome in Outpatients With Anxious Versus Nonanxious Depression: A STAR*D Report.

@article{citeulike:2573442, abstract = {OBJECTIVE: About half of outpatients with major depressive disorder also have clinically meaningful levels of anxiety. The authors conducted a secondary data analysis to compare antidepressant treatment outcomes for patients with anxious and nonanxious major depression in Levels 1 and 2 of the STAR*D study. METHOD: A total of 2,876 adult outpatients with major depressive disorder, enrolled from 18 primary and 23 psychiatric care sites, received citalopram in Level 1 of STAR*D. In Level 2, a total of 1,292 patients who did not remit with or tolerate citalopram were randomly assigned either to switch to sustained-release bupropion (N=239), sertraline (N=238), or extended-release venlafaxine (N=250) or to continue taking citalopram and receive augmentation with sustained-release bupropion (N=279) or buspirone (N=286). Treatment could last up to 14 weeks in each level. Patients were designated as having anxious depression if their anxiety/somatization factor score from the 17-item Hamilton Depression Rating Scale (HAM-D) was 7 or higher at baseline. Rates of remission and response as well as times to remission and response were compared between patients with anxious depression and those with nonanxious depression. RESULTS: In Level 1 of STAR*D, 53.2\% of patients had anxious depression. Remission was significantly less likely and took longer to occur in these patients than in those with nonanxious depression. Ratings of side effect frequency, intensity, and burden, as well as the number of serious adverse events, were significantly greater in the anxious depression group. Similarly, in Level 2, patients with anxious depression fared significantly worse in both the switching and augmentation options. CONCLUSIONS: Anxious depression is associated with poorer acute outcomes than nonanxious depression following antidepressant treatment.}, address = {Depression Clinical and Research Program, Massachusetts General Hospital, 55 Fruit St., Bulfinch 351, Boston, MA 02114. mfava@partners.org.}, author = {Fava, M. and Rush, A. J. and Alpert, J. E. and Balasubramani, G. K. and Wisniewski, S. R. and Carmin, C. N. and Biggs, M. M. and Zisook, S. and Leuchter, A. and Howland, R. and Warden, D. and Trivedi, M. H. }, citeulike-article-id = {2573442}, doi = {10.1176/appi.ajp.2007.06111868}, issn = {0002-953X}, journal = {Am J Psychiatry}, keywords = {anti\_depressant, clinical\_trial, gad, major\_depression, panic\_disorder, ptsd}, month = {March}, number = {3}, pages = {342--351}, posted-at = {2008-03-23 02:07:22}, priority = {0}, title = {Difference in Treatment Outcome in Outpatients With Anxious Versus Nonanxious Depression: A STAR*D Report.}, url = {http://dx.doi.org/10.1176/appi.ajp.2007.06111868}, volume = {165}, year = {2008} }

TY - JOUR ID - citeulike:2573442 L3 - citeulike-article-id:2573442 TI - Difference in Treatment Outcome in Outpatients With Anxious Versus Nonanxious Depression: A STAR*D Report. JF - Am J Psychiatry VL - 165 IS - 3 SP - 342 EP - 351 AD - Depression Clinical and Research Program, Massachusetts General Hospital, 55 Fruit St., Bulfinch 351, Boston, MA 02114. mfava@partners.org. SN - 0002-953X N2 - OBJECTIVE: About half of outpatients with major depressive disorder also have clinically meaningful levels of anxiety. The authors conducted a secondary data analysis to compare antidepressant treatment outcomes for patients with anxious and nonanxious major depression in Levels 1 and 2 of the STAR*D study. METHOD: A total of 2,876 adult outpatients with major depressive disorder, enrolled from 18 primary and 23 psychiatric care sites, received citalopram in Level 1 of STAR*D. In Level 2, a total of 1,292 patients who did not remit with or tolerate citalopram were randomly assigned either to switch to sustained-release bupropion (N=239), sertraline (N=238), or extended-release venlafaxine (N=250) or to continue taking citalopram and receive augmentation with sustained-release bupropion (N=279) or buspirone (N=286). Treatment could last up to 14 weeks in each level. Patients were designated as having anxious depression if their anxiety/somatization factor score from the 17-item Hamilton Depression Rating Scale (HAM-D) was 7 or higher at baseline. Rates of remission and response as well as times to remission and response were compared between patients with anxious depression and those with nonanxious depression. RESULTS: In Level 1 of STAR*D, 53.2% of patients had anxious depression. Remission was significantly less likely and took longer to occur in these patients than in those with nonanxious depression. Ratings of side effect frequency, intensity, and burden, as well as the number of serious adverse events, were significantly greater in the anxious depression group. Similarly, in Level 2, patients with anxious depression fared significantly worse in both the switching and augmentation options. CONCLUSIONS: Anxious depression is associated with poorer acute outcomes than nonanxious depression following antidepressant treatment. KW - anti_depressant KW - clinical_trial KW - gad KW - major_depression KW - panic_disorder KW - ptsd AU - Fava, M AU - Rush, AJ AU - Alpert, JE AU - Balasubramani, GK AU - Wisniewski, SR AU - Carmin, CN AU - Biggs, MM AU - Zisook, S AU - Leuchter, A AU - Howland, R AU - Warden, D AU - Trivedi, MH PY - 2008/03// UR - http://dx.doi.org/10.1176/appi.ajp.2007.06111868 ER -