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Am J Psychiatry 1995; 152:1500-1503
Copyright © 1995 by American Psychiatric Association
Early nonresponse to fluoxetine as a predictor of poor 8-week outcome
AA Nierenberg, NE McLean, JE Alpert, JJ Worthington, JF Rosenbaum and M Fava
Depression Research Program, Massachusetts General Hospital, Boston 02114, USA.
OBJECTIVE: The purpose of this study was to quantify the proportion of
patients who show no response to a fixed dose of fluoxetine after 2, 4, and
6 weeks of treatment and then respond by week 8. METHOD: In an open trial,
143 outpatients who met DSM-III-R criteria for major depressive disorder
were treated with a regimen of fluoxetine, 20 mg/day. The authors analyzed
the proportion of patients who had less than a 20% decrease from baseline
in their scores on the Hamilton Rating Scale for Depression after 2, 4, and
6 weeks and who went on to have a 50% or greater reduction by week 8. A
last-observation-carried-forward strategy was used to calculate conditional
probabilities of 8-week response. Kaplan-Meier survival analysis was used
to estimate probabilities of response at week 8 given degrees of response
at week 2. RESULTS: Eighty-two subjects (57.3%) who started the trial
responded by week 8. Of those subjects who showed no improvement at weeks
2, 4, and 6, the proportions of responders at week 8 were 36.4%, 18.9%, and
6.5%, respectively. The Kaplan-Meier estimate of 8-week response given
nonresponse at week 2 was 0.45. CONCLUSIONS: The proportion of patients
with no response to antidepressant treatment by 4 or 6 weeks who responded
by week 8 was substantially less than that for subjects who had at least a
partial response. Nonresponse as early as week 2 predicted 8-week outcome.
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EARLY RESPONSE TO FLUOXETINE PREDICTS LATER OUTCOME
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1995(1024):
1 - 1.
[Full Text]
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