Depression subtypes in predicting antidepressant response: A report from the iSPOT-D trial

Bruce A. Arnow, Christine Blasey, Leanne M Williams, Donna M. Palmer, William Rekshan, Alan F. Schatzberg, Amit Etkin, Jayashri Kulkarni, James F. Luther, Augustus John Rush

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Abstract

Objective: The study aims were 1) to describe the proportions of individualswhomet criteria formelancholic, atypical, and anxious depressive subtypes, as well as subtype combinations, in a large sample of depressed outpatients, and 2) to compare subtype profiles on remission and change in depressive symptoms after acute treatment with one of three antidepressant medications. Method: Participants 18-65 years of age (N=1,008) who met criteria formajor depressive disorder were randomlyassigned to 8weeksof treatment with escitalopram, sertraline, or extendedrelease venlafaxine. Participants were classified by subtype. Those who met criteria for no subtype or multiple subtypes were classified separately, resulting in eight mutually exclusive groups.Amixed-effectsmodel using the intent-to-treat sample compared the groups' symptomscore trajectories, and logistic regression compared likelihood of remission (defined as a score #5 on the 16-item Quick Inventory of Depressive Symptomatology-Self-Report). Results: Thirty-nine percent of participants exhibited a pure-form subtype, 36% met criteria for more than one subtype, and 25% did not meet criteria for any subtype. All subtype groups exhibited a similar significant trajectory of symptom reduction across the trial. Likelihood of remission did not differ significantly between subtype groups, and depression subtype was not a moderator of treatment effect. Conclusions: There was substantial overlap of the three depressive subtypes, and individuals in all subtype groups responded similarly to the three antidepressants. The consistency of these findings with those of the Sequenced TreatmentAlternatives to Relieve Depression trial suggests that subtypes may be of minimal value in antidepressant selection.

Original languageEnglish
Pages (from-to)743-750
Number of pages8
JournalAmerican Journal of Psychiatry
Volume172
Issue number8
DOIs
Publication statusPublished - 1 Aug 2015

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