Journal of Affective Disorders Reports (Jul 2021)
Does antidepressant treatment response depend on specific symptoms of depression? A multi-trial study
Abstract
Background: There is considerable heterogeneity in antidepressant treatment response across individuals. As people with depression may manifest different symptom profiles, we hypothesized that the constellation of specific depressive symptoms might explain some of the heterogeneity in antidepressant treatment response. To assess this hypothesis, we examined symptom-specific remission related to antidepressant vs placebo treatment among those with and without a treatment response. Methods: Data were from 19 randomized controlled trials (n = 7,344). Depressive symptoms were assessed with the 17-item Hamilton Depression Rating Scale (HDRS-17). Data on treatment were dichotomized into active treatment vs placebo. Treatment response was defined as ≥50% reduction in the HDRS-17 sum score during trial follow-up. Associations of antidepressant treatment with symptom remission were assessed in logistic regression models conducted separately for each symptom, adjusting for age, sex, follow-up time, and the presence of the symptom at baseline. Treatment responders and non-responders were analyzed separately. We also assessed trajectories of symptom remission across the trial follow-up in both treatment conditions among responders and non-responders. Results: There were no coherent differences in symptom remission between the antidepressant and placebo conditions either among responders (OR=0.75–1.28) or non-responders (OR=0.49–1.35). Likewise, there were no coherent differences between the remission trajectories either among treatment responders or non-responders. Limitations: Treatment responders and non-responders were analyzed separately, which may have introduced bias that could affect the validity of our findings. Conclusions: We observed no consistent evidence that treatment response to antidepressants depends on the patient's specific symptom profile.
