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Residual symptoms after remission of major depressive disorder with citalopram and risk of relapse: a STAR*D report

  • A. A. Nierenberg (a1), M. M. Husain (a2), M. H. Trivedi (a2), M. Fava (a1), D. Warden (a2), S. R. Wisniewski (a3), S. Miyahara (a3) and A. J. Rush (a4)...
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.

Copyright
Corresponding author
*Address for correspondence: A. A. Nierenberg, M.D., Massachusetts General Hospital, Suite 580, 50 Staniford Street, Boston, MA02114, USA. (Email: anierenberg@partners.org)
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C Bockting , P Spinhoven , M Koeter , L Wouters , A Schene ; Depression Evaluation Longitudinal Therapy Assessment (DELTA) Study Group (2006). Prediction of recurrence in recurrent depression and the influence of consecutive episodes on vulnerability for depression: a 2-year prospective study. Journal of Clinical Psychiatry 67, 747755.

CE Carney , ZV Segal , JD Edinger , AD Krystal (2007). A comparison of rates of residual insomnia symptoms following pharmacotherapy or cognitive-behavioral therapy for major depressive disorder. Journal of Clinical Psychiatry 68, 254260.

C DeBattista , K Doghramji , M Menza , M Rosenthal , R Fieve (2003). Adjunct modafinil for the short-term treatment of fatigue and sleepiness in patients with major depressive disorder: a preliminary double-blind, placebo-controlled study. Journal of Clinical Psychiatry 64, 10571064.

GA Fava , S Fabbri , N Sonino (2002). Residual symptoms in depression: an emerging therapeutic target. Progress in Neuro-Psychopharmacology and Biological Psychiatry 26, 10191027.

M Fava , AJ Rush , MH Trivedi , AA Nierenberg , ME Thase , HA Sackeim , FM Quitkin , S Wisniewski , PW Lavori , JF Rosenbaum , DJ Kupfer (2003). Background and rationale for the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study. Psychiatric Clinics of North America 26, 457494.

M Fava , ME Thase , C DeBattista (2005). A multicenter, placebo-controlled study of modafinil augmentation in partial responders to selective serotonin reuptake inhibitors with persistent fatigue and sleepiness. Journal of Clinical Psychiatry 66, 8593.

M Hamilton (1960). A rating scale for depression. Journal of Neurology, Neurosurgery and Psychiatry 23, 5661.

M Hamilton (1967). Development of a rating scale for primary depressive illness. British Journal of Social and Clinical Psychology 6, 278296.

LL Judd , HS Akiskal , JD Maser , PJ Zeller , J Endicott , W Coryell , MP Paulus , JL Kunovac , AC Leon , TI Mueller , JA Rice , MB Keller (1998 a). Major depressive disorder: a prospective study of residual subthreshold depressive symptoms as predictor of rapid relapse. Journal of Affective Disorders 50, 97–108.

LL Judd , HS Akiskal , JD Maser , PJ Zeller , J Endicott , W Coryell , MP Paulus , JL Kunovac , AC Leon , TI Mueller , JA Rice , MB Keller (1998 b). A prospective 12-year study of subsyndromal and syndromal depressive symptoms in unipolar major depressive disorders. Archives of General Psychiatry 55, 694700.

N Kennedy , E Paykel (2004). Residual symptoms at remission from depression: impact on long-term outcome. Journal of Affective Disorders 80, 135144.

AC Leon (2007). The revised warning for antidepressants and suicidality: unveiling the black box of statistical analyses. American Journal of Psychiatry 164, 17861789.

AC Leon , PM Marzuk , K Tardiff , A Bucciarelli , M Stajic , TM Piper , S Galea (2007). Antidepressants in adult suicides in New York City: 2001–2004. Journal of Clinical Psychiatry 68, 13991403.

J Mintz , LI Mintz , MJ Arruda , SS Hwang (1992). Treatments of depression and the functional capacity to work. Archives of General Psychiatry 49, 761768.

R Mojtabai (2001). Residual symptoms and impairment in major depression in the community. American Journal of Psychiatry 158, 16451651.

AA Nierenberg , BR Keefe , VC Leslie , JE Alpert , JA Pava , JJ Worthington , JF Rosenbaum , M Fava (1999). Residual symptoms in depressed patients who respond acutely to fluoxetine. Journal of Clinical Psychiatry 60, 221225.

AJ Rush , IH Bernstein , MH Trivedi , TJ Carmody , S Wisniewski , JC Mundt , K Shores-Wilson , MM Biggs , A Woo , AA Nierenberg , M Fava (2006 a). An evaluation of the Quick Inventory of Depressive Symptomatology and the Hamilton Rating Scale for Depression: a Sequenced Treatment Alternatives to Relieve Depression trial report. Biological Psychiatry 59, 493501.

AJ Rush , M Fava , SR Wisniewski , PW Lavori , MH Trivedi , HA Sackeim , ME Thase , AA Nierenberg , FM Quitkin , TM Kashner , DJ Kupfer , JF Rosenbaum , J Alpert , JW Stewart , PJ McGrath , MM Biggs , K Shores-Wilson , BD Lebowitz , L Ritz , G Niederehe (2004). Sequenced Treatment Alternatives to Relieve Depression (STAR*D): rationale and design. Controlled Clinical Trials 25, 119142.

AJ Rush , HC Kraemer , HA Sackeim , M Fava , MH Trivedi , E Frank , PT Ninan , ME Thase , AJ Gelenberg , DJ Kupfer , DA Regier , JF Rosenbaum , O Ray , AF Schatzberg (2006 b). Report by the ACNP Task Force on Response and Remission in Major Depressive Disorder. Neuropsychopharmacology 31, 18411853.

AJ Rush , MH Trivedi , HM Ibrahim , TJ Carmody , B Arnow , DN Klein , JC Markowitz , PT Ninan , S Kornstein , R Manber , ME Thase , JH Kocsis , MB Keller (2003). The 16-Item Quick Inventory of Depressive Symptomatology (QIDS), clinician rating (QIDS-C), and self-report (QIDS-SR): a psychometric evaluation in patients with chronic major depression. Biological Psychiatry 54, 573583.

GE Simon (2006). How can we know whether antidepressants increase suicide risk? American Journal of Psychiatry 163, 18611863.

SM Stahl , LS Zhang , C Damatarca , M Grady (2003). Brain-circuits determine destiny in depression: a novel approach to the psychopharmacology of wakefulness, fatigue, and executive dysfunction in major depressive disorder. Journal of Clinical Psychiatry 64, 6–17.

MH Trivedi , AJ Rush , HM Ibrahim , TJ Carmody , MM Biggs , T Suppes , ML Crismon , K Shores-Wilson , MG Toprac , EB Dennehy , B Witte , TM Kashner (2004). The Inventory of Depressive Symptomatology, Clinician Rating (IDS-C) and Self-Report (IDS-SR), and the Quick Inventory of Depressive Symptomatology, Clinician Rating (QIDS-C) and Self-Report (QIDS-SR) in public sector patients with mood disorders: a psychometric evaluation. Psychological Medicine 34, 7382.

MH Trivedi , AJ Rush , SR Wisniewski , AA Nierenberg , D Warden , L Ritz , G Norquist , RH Howland , B Lebowitz , PJ McGrath , K Shores-Wilson , MM Biggs , GK Balasubramani , M Fava (2006). Evaluation of outcomes with citalopram for depression using measurement-based care in STAR*D: implications for clinical practice. American Journal of Psychiatry 163, 2840.

SR Wisniewski , AJ Rush , GK Balasubramani , MH Trivedi , AA Nierenberg , for the STAR*D Investigators (2006). Self-rated global measure of the frequency, intensity, and burden of side effects. Journal of Psychiatric Practice 12, 7179.

M Zimmerman , MA Posternak , I Chelminski (2007). Heterogeneity among depressed outpatients considered to be in remission. Comprehensive Psychiatry 48, 113117.

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Psychological Medicine
  • ISSN: 0033-2917
  • EISSN: 1469-8978
  • URL: /core/journals/psychological-medicine
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