Program of algorithm for pharmacological treatment of major depressive disorder in China: Benefits or not?
Yuncheng Zhu,
Fang Wang,
Fan Wang,
Hongmei Liu,
Xiaoyun Guo,
Zuowei Wang,
Ruoqiao He,
Xiaohui Wu,
Lan Cao,
Zhiguo Wu,
Daihui Peng,
Yiru Fang
Affiliations
Yuncheng Zhu
Division of Mood Disorders, Shanghai Hongkou Mental Health Center, Shanghai, 200083, China; Clinical Research Center, Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China; Clinical Research Center for Mental Health, School of Medicine, Shanghai University, Shanghai, 200083, China
Fang Wang
Shanghai Yangpu Mental Health Center, Shanghai, 200093, China
Fan Wang
Clinical Research Center, Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
Hongmei Liu
Clinical Research Center, Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
Xiaoyun Guo
Clinical Research Center, Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
Zuowei Wang
Division of Mood Disorders, Shanghai Hongkou Mental Health Center, Shanghai, 200083, China; Clinical Research Center for Mental Health, School of Medicine, Shanghai University, Shanghai, 200083, China
Ruoqiao He
School of Social Work, New York University, New York, 10003, USA
Xiaohui Wu
Clinical Research Center, Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
Lan Cao
Clinical Research Center, Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
Zhiguo Wu
Shanghai Yangpu Mental Health Center, Shanghai, 200093, China
Daihui Peng
Clinical Research Center, Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
Yiru Fang
Clinical Research Center, Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China; Clinical Research Center for Mental Health, School of Medicine, Shanghai University, Shanghai, 200083, China; Department of Psychiatry & Affective Disorders Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China; CAS Center for Excellence in Brain Science and Intelligence Technology, Shanghai, 200030, China; Shanghai Key Laboratory of Psychotic Disorders, Shanghai, 201108, China
Background: This research was designed to investigate Algorithm Guided Treatment (AGT) and clinical traits for the prediction of antidepressant treatment outcomes in Chinese patients with major depressive disorder (MDD). Methods: This study included 581 patients who had reached treatment response and 406 patients remained non-responded observed after three months of treatment. Sociodemographic factors, clinical traits, and psychiatric rating scales for evaluating therapeutic responses between the two groups were compared. Logistic regression analysis was adopted to determine the risk factors of unresponsive to antidepressant (URA) in MDD. Kaplan-Meier survival analysis was utilized to compare the therapeutic response between AGT and treatment as usual (TAU). Results: Compared to the MDD responsive to antidepressant (RA) group, the URA group had significantly lower rates of the following clinical traits: married status, anxious distress, moderate to severe depressive symptoms, and higher rates of comorbidity (p-value < 0.05). Logistic Regression Analysis showed that eight clinical traits from psychiatric rating scales, such as anxious characteristics, were correlated positively with URA, while the other eight symptoms, such as autonomic symptoms, were negatively correlated. Time to symptomatic remission was longer in TAU without statistically significant (p-value = 0.11) by log-rank testing. Conclusions: The factors may affect the therapeutic responses and compliance of patients, increasing the non-response risk for antidepressants. Therapeutic responses might be improved by increasing the clarification and elucidation of different symptom clusters of patients. Benefits on treatment response to AGT were not found in our study, indicating a one-size-fits-all approach may not work.Trial Registration: We registered as a clinical trial at the International Clinical Trials Registry Platform (No. NCT01764867) and obtained ethical approval 2012-42 from SMHC.
