Clinical significance of early non‐response in depressed patients

This is the authors' abstract. We don't add key points for this paper.

Many authorities recommend a 6‐week trial of an antidepressant before deciding whether the patient will have a favorable response. However, this length of time is frequently impractical, especially for hospitalized patients. Some data suggests that ultimate response to a tricyclic antidepressant may be predicted from improvement within the first few weeks. To investigate this issue the authors analyzed data from six 6‐week double‐blind, controlled trials of selective serotonin reuptake inhibitors. Five studies included a placebo control group and all had an active antidepressant control. Overall the data showed that if there is no improvement early in treatment the chance of meaningful response by week 6 is poor. If a patient on active drug does not have at least a 20% improvement in the HAMD score at any point during the first 4 weeks the chance of 6‐week response was 3.7%. If a patient did not have a 20% improvement at 4 weeks but did at one or more previous weeks the chance of 6‐week response was 23.1%. The overall response rate for the whole sample was 60.7%. Very similar results were obtained using the Clinical Global Impressions Scale. These data suggest that a full 6‐week trial of an antidepressant is usually not warranted if there is not at least some improvement during the first 4 weeks of the trial. Depression 2:32–35 (1994).