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

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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-Åsberg Depression Rating Scale (MADRS). Secondary outcome measures were the 17-item Hamilton Rating Scale for Depression (HRSD-17) and the Beck Depression Inventory (BDI). 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.

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
Externally published	Yes

Bibliographical note

Funding Information:
The GENDEP project was funded by the European Commission Framework 6 grant, EC Contract Ref.: LSHB-CT-2003-503428. Lundbeck provided nortriptyline and escitalopram for the GENDEP study. GlaxoSmithKline and the UK National Institute for Health Research of the Department of Health contributed to the funding of the sample collection at the Institute of Psychiatry, London. RU is supported by a grant from the European Commission (Grant Agreement #115008). The sponsors had no role in the design and conduct of the study, in data collection, analysis, interpretation, writing of the report, or in the decision to submit the paper for publication.

ASJC Scopus Subject Areas

Clinical Psychology
Psychiatry and Mental health

PubMed: MeSH publication types

Comparative Study
Journal Article
Multicenter Study
Randomized Controlled Trial

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.jad.2011.02.014

Cite this

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

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

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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-{\AA}sberg Depression Rating Scale (MADRS). Secondary outcome measures were the 17-item Hamilton Rating Scale for Depression (HRSD-17) and the Beck Depression Inventory (BDI). 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.",

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",

note = "Funding Information: The GENDEP project was funded by the European Commission Framework 6 grant, EC Contract Ref.: LSHB-CT-2003-503428. Lundbeck provided nortriptyline and escitalopram for the GENDEP study. GlaxoSmithKline and the UK National Institute for Health Research of the Department of Health contributed to the funding of the sample collection at the Institute of Psychiatry, London. RU is supported by a grant from the European Commission (Grant Agreement #115008). The sponsors had no role in the design and conduct of the study, in data collection, analysis, interpretation, writing of the report, or in the decision to submit the paper for publication. ",

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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

N1 - Funding Information: The GENDEP project was funded by the European Commission Framework 6 grant, EC Contract Ref.: LSHB-CT-2003-503428. Lundbeck provided nortriptyline and escitalopram for the GENDEP study. GlaxoSmithKline and the UK National Institute for Health Research of the Department of Health contributed to the funding of the sample collection at the Institute of Psychiatry, London. RU is supported by a grant from the European Commission (Grant Agreement #115008). The sponsors had no role in the design and conduct of the study, in data collection, analysis, interpretation, writing of the report, or in the decision to submit the paper for publication.

PY - 2011/7

Y1 - 2011/7

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-Åsberg Depression Rating Scale (MADRS). Secondary outcome measures were the 17-item Hamilton Rating Scale for Depression (HRSD-17) and the Beck Depression Inventory (BDI). 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.

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-Åsberg Depression Rating Scale (MADRS). Secondary outcome measures were the 17-item Hamilton Rating Scale for Depression (HRSD-17) and the Beck Depression Inventory (BDI). 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.

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

Abstract

Bibliographical note

ASJC Scopus Subject Areas

PubMed: MeSH publication types

UN SDGs

Access to Document

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