Method: Following a one-week, single-blind, wash-out, patients with MDD diagnosed by SCID were randomized to 12 weeks of double-blind treatment with LI 160 St. John’s wort extract (900 mg/day), fluoxetine (20 mg/day), or placebo. The 17-item Hamilton Rating Scale for Depression (HAM-D-17) was the primary efficacy measure. While anxious depression was defined as having a baseline HAM-D anxiety/somatization factor score = or > 7, remission was defined as a HAM-D-17 score = or < 7 at endpoint. The ability of both anxious depression and the individual baseline HAM-D anxiety/somatization factor scores to predict treatment outcome were assessed separately for patients treated with active treatment (St. John’s Wort or fluoxetine) and placebo with a logistic regression method. Results: 135 patients (57% women, mean age: 37.3 ± 11.0; mean HAM-D; 19.7 ± 3.2) were randomized to double-blind treatment and were included in the intent-to-treat analyses, and the remission rates were 38% in the St. John’s wort group, 30% in the fluoxetine group, and 21% in the placebo group. After adjusting for baseline HAM-D-17 scores (minus the anxiety/somatization items), anxious depression had significantly (p < .05) lower remission rates than nonanxious depression with active treatment, but not with placebo. When the six individual items of the HAM-D anxiety/somatization facto were assessed, only psychic and somatic anxiety significantly (p < .05) predicted poorer outcome with active treatment, again after adjusting for baseline HAM-D-17 scores (minus the anxiety/somatization items). Conclusion: The presence of anxious depression and, in particular, of psychic and somatic anxiety, significantly predicted poorer outcome following antidepressant treatment, but such relationship was not present among the placebo-treated patients. Funding Source: Lichtwer 1. Joffe RT, Bagby RM, Levitt A: Anxious and nonanxious depression. Am J Psychiatry 150:1257–1258, 1993. 2. Fava M, Rankin MA, Wright EC, Alpert JE, Nierenberg AA, Pava J, Rosenbaum JF: Anxiety disorders in major depression. Comprehensive Psychiatry 41:97–102, 2000.
E. Tossani, A. Mascarini, J. E. Alpert, D. Mischoulon, G. I. Papakostas, J. L. Ryan, et al. (2004). Relationship Between Anxious Depression and Treatment Outcome in Outpatients With Depression. WASHINGTON : American Psychiatric Association.
Relationship Between Anxious Depression and Treatment Outcome in Outpatients With Depression
TOSSANI, ELIANA;
2004
Abstract
Method: Following a one-week, single-blind, wash-out, patients with MDD diagnosed by SCID were randomized to 12 weeks of double-blind treatment with LI 160 St. John’s wort extract (900 mg/day), fluoxetine (20 mg/day), or placebo. The 17-item Hamilton Rating Scale for Depression (HAM-D-17) was the primary efficacy measure. While anxious depression was defined as having a baseline HAM-D anxiety/somatization factor score = or > 7, remission was defined as a HAM-D-17 score = or < 7 at endpoint. The ability of both anxious depression and the individual baseline HAM-D anxiety/somatization factor scores to predict treatment outcome were assessed separately for patients treated with active treatment (St. John’s Wort or fluoxetine) and placebo with a logistic regression method. Results: 135 patients (57% women, mean age: 37.3 ± 11.0; mean HAM-D; 19.7 ± 3.2) were randomized to double-blind treatment and were included in the intent-to-treat analyses, and the remission rates were 38% in the St. John’s wort group, 30% in the fluoxetine group, and 21% in the placebo group. After adjusting for baseline HAM-D-17 scores (minus the anxiety/somatization items), anxious depression had significantly (p < .05) lower remission rates than nonanxious depression with active treatment, but not with placebo. When the six individual items of the HAM-D anxiety/somatization facto were assessed, only psychic and somatic anxiety significantly (p < .05) predicted poorer outcome with active treatment, again after adjusting for baseline HAM-D-17 scores (minus the anxiety/somatization items). Conclusion: The presence of anxious depression and, in particular, of psychic and somatic anxiety, significantly predicted poorer outcome following antidepressant treatment, but such relationship was not present among the placebo-treated patients. Funding Source: Lichtwer 1. Joffe RT, Bagby RM, Levitt A: Anxious and nonanxious depression. Am J Psychiatry 150:1257–1258, 1993. 2. Fava M, Rankin MA, Wright EC, Alpert JE, Nierenberg AA, Pava J, Rosenbaum JF: Anxiety disorders in major depression. Comprehensive Psychiatry 41:97–102, 2000.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
