Symptom profiles at baseline are associated with remission in major depression: a confirmatory analysis of the PANDORA trial

OBJECTIVE: To test whether baseline depressive symptom profiles are associated with remission in Major Depressive Disorder (MDD) and to replicate previous findings from GSRD and STAR∗D in the PANDORA trial. METHODS: We performed a secondary analysis of 215 adults with MDD enrolled in PANDORA and starting a new antidepressant. Baseline severity was assessed with the 17-item Hamilton Depression Rating Scale (HAM-D). Remission at week 12 was defined as HAM-D ≤ 7. Logistic regression models examined associations between baseline HAM-D total and item scores and remission overall and by sex, adjusting for age and sex and other covariates; sensitivity analyses further adjusted for treatment allocation (treatment as usual vs genetically guided therapy). RESULTS: Remission was achieved by 53% of patients (n = 114). Higher baseline HAM-D total score and higher scores on depressed mood, suicide, psychomotor retardation and hypochondriasis were associated with lower odds of remission in the total sample. In women, higher baseline severity, suicide and psychomotor retardation were associated with non-remission, whereas in men hypochondriasis was the only significant prognostic marker. These associations remained significant after adjustment for the treatment arm. CONCLUSIONS: Baseline depressive severity and selected symptom dimensions, particularly suicidal ideation and worry-related symptoms, relate to remission in MDD and may inform sex-sensitive, symptom-guided treatment strategies.