Association between anxious depression and clinical outcomes in subjects with treatment-resistant depression: a comparative effectiveness research trial for antidepressant incomplete and non-responders with treatment-resistant depression (ASCERTAIN-TRD)

Objective Anxious depression is a negative prognostic factor linked to worse outcomes in major depressive disorder (MDD). However, its role in treatment-resistant depression (TRD) remains unclear. This secondary analysis of the ASCERTAIN-TRD trial investigates the role of anxious depression as a predictor or moderator of treatment response. Methods A Hamilton Depression Rating Scale Anxiety and Somatization Subscale score of at least 7 identified subjects with the anxious depressive subtype. Treatment response was evaluated based on changes in Montgomery–Asberg Depression Rating Scale scores using mixed-effects models with repeated measures and included additional terms accounting for the presence or absence of anxious depression. Two hundred fifty-three patients, who had at least one post-baseline Montgomery–Asberg Depression Rating Scale and Hamilton Depression Rating Scale score were included in the analysis. Of them, 182 subjects presented anxious and 71 nonanxious depression. Results Treatment outcomes were similar across the three treatment groups regardless of anxious MDD status ( P -value > 0.5 for all comparisons) suggesting that anxious depression was not a significant predictor or moderator of treatment outcome. Conclusion These findings indicate that anxious depression alone may be prognostic rather than predictive. These findings may be a useful guidance for clinicians, suggesting that standard TRD treatments remain applicable in the anxious MDD subtype.