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Do not change antidepressant treatment early based on a lack of response
Clinical Question
Does a lack of early symptom improvement in patients treated for depression predict treatment failure?
Bottom line
Don't be in a hurry to change treatment in patients with severe depression who do not respond to treatment within the first 2 weeks. Early response to treatment predicts eventual response or remission, but a lack of early response does not predict treatment failure. Approximately one third of patients who do not show an early response will respond by 6 weeks. No individual symptom response predicts eventual improvement. 1a
Reference
Study design: Meta-analysis (randomized controlled trials)
Funding: Unknown/not stated
Setting: Various (meta-analysis)
Synopsis
These researchers used individual patient data derived from 30 studies of the treatment of severe major depressive disorder with a second-generation antidepressant. Overall, they had data on 2184 patients who received a placebo and 6058 who received an antidepressant. By 6 weeks of treatment, approximately 50% of treated patients had responded, with 32% achieving remission of symptoms. By 12 weeks, the rate was up to approximately 68% response with 49% achieving remission. Patients with early improvement—by 2 weeks—were likely to respond by 6 weeks, but almost 33% of patients without early improvement responded by 6 weeks and 43% of them responded by 12 weeks. No individual symptom response predicted eventual response or remission.
Reviewer
Allen F. Shaughnessy, PharmD, MMedEd
Professor of Family Medicine
Tufts University
Boston, MA