Predicting relapse with individual residual symptoms in major depressive disorder: a reanalysis of the STAR*D data

Hitoshi Sakurai, Takefumi Suzuki, Kimio Yoshimura, Masaru Mimura, Hiroyuki Uchida

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Background: Residual symptoms are detrimental to prognosis in major depressive disorder (MDD); however, little is known about the contribution of each residual symptom in predicting outcomes. The objective of this analysis was to identify which individual symptoms, based on self-report and clinician interview, could predict subsequent relapse. Methods: The data of 1133 outpatients with nonpsychotic MDD who entered a 12-month naturalistic follow-up phase after achieving remission with level 1 treatment (i.e., citalopram for up to 14 weeks) and had at least one post-baseline contact in the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial were analyzed. Specific residual symptoms in the 16-item Quick Inventory of Depressive Symptomatology, self-report (QIDS-SR16) and clinician rating (QIDS-C16), at the follow-up entry that predicted relapse were identified, using a Cox proportional hazards model. Results: The following three QIDS-SR16 symptoms were significantly associated with subsequent relapse: restlessness (HR = 1.197, p = 0.018), hypersomnia (HR = 1.190, p = 0.009), and weight change (HR = 1.127, p = 0.041). On the other hand, the following three symptoms in the QIDS-C16 at the follow-up entry were significantly associated with relapse in the follow-up phase: restlessness (HR = 1.328, p = 0.001), sleep onset insomnia (HR = 1.129, p = 0.047), and weight change (HR = 1.125, p = 0.045). Limitations: The original trial was not designed to evaluate the issue addressed herein. Individual symptoms may be associated with each other and functional status was not addressed. Conclusions: Some residual symptoms, including restlessness, insomnia, and weight change, may help better identify patients with MDD vulnerable to relapse. Contribution of individual residual symptoms to subsequent relapse was similar between self-report and clinician-rated symptoms.

Original languageEnglish
Pages (from-to)1-9
Number of pages9
JournalPsychopharmacology
DOIs
Publication statusAccepted/In press - 2017 May 3

Fingerprint

Major Depressive Disorder
Depression
Recurrence
Psychomotor Agitation
Self Report
Sleep Initiation and Maintenance Disorders
Weights and Measures
Therapeutics
Disorders of Excessive Somnolence
Citalopram
Proportional Hazards Models
Sleep
Outpatients
Interviews
Equipment and Supplies

Keywords

  • Depression
  • Major depressive disorder
  • Prediction
  • Recurrence
  • Relapse
  • Residual symptom

ASJC Scopus subject areas

  • Pharmacology

Cite this

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title = "Predicting relapse with individual residual symptoms in major depressive disorder: a reanalysis of the STAR*D data",
abstract = "Background: Residual symptoms are detrimental to prognosis in major depressive disorder (MDD); however, little is known about the contribution of each residual symptom in predicting outcomes. The objective of this analysis was to identify which individual symptoms, based on self-report and clinician interview, could predict subsequent relapse. Methods: The data of 1133 outpatients with nonpsychotic MDD who entered a 12-month naturalistic follow-up phase after achieving remission with level 1 treatment (i.e., citalopram for up to 14 weeks) and had at least one post-baseline contact in the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial were analyzed. Specific residual symptoms in the 16-item Quick Inventory of Depressive Symptomatology, self-report (QIDS-SR16) and clinician rating (QIDS-C16), at the follow-up entry that predicted relapse were identified, using a Cox proportional hazards model. Results: The following three QIDS-SR16 symptoms were significantly associated with subsequent relapse: restlessness (HR = 1.197, p = 0.018), hypersomnia (HR = 1.190, p = 0.009), and weight change (HR = 1.127, p = 0.041). On the other hand, the following three symptoms in the QIDS-C16 at the follow-up entry were significantly associated with relapse in the follow-up phase: restlessness (HR = 1.328, p = 0.001), sleep onset insomnia (HR = 1.129, p = 0.047), and weight change (HR = 1.125, p = 0.045). Limitations: The original trial was not designed to evaluate the issue addressed herein. Individual symptoms may be associated with each other and functional status was not addressed. Conclusions: Some residual symptoms, including restlessness, insomnia, and weight change, may help better identify patients with MDD vulnerable to relapse. Contribution of individual residual symptoms to subsequent relapse was similar between self-report and clinician-rated symptoms.",
keywords = "Depression, Major depressive disorder, Prediction, Recurrence, Relapse, Residual symptom",
author = "Hitoshi Sakurai and Takefumi Suzuki and Kimio Yoshimura and Masaru Mimura and Hiroyuki Uchida",
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doi = "10.1007/s00213-017-4634-5",
language = "English",
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journal = "Psychopharmacology",
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TY - JOUR

T1 - Predicting relapse with individual residual symptoms in major depressive disorder

T2 - a reanalysis of the STAR*D data

AU - Sakurai, Hitoshi

AU - Suzuki, Takefumi

AU - Yoshimura, Kimio

AU - Mimura, Masaru

AU - Uchida, Hiroyuki

PY - 2017/5/3

Y1 - 2017/5/3

N2 - Background: Residual symptoms are detrimental to prognosis in major depressive disorder (MDD); however, little is known about the contribution of each residual symptom in predicting outcomes. The objective of this analysis was to identify which individual symptoms, based on self-report and clinician interview, could predict subsequent relapse. Methods: The data of 1133 outpatients with nonpsychotic MDD who entered a 12-month naturalistic follow-up phase after achieving remission with level 1 treatment (i.e., citalopram for up to 14 weeks) and had at least one post-baseline contact in the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial were analyzed. Specific residual symptoms in the 16-item Quick Inventory of Depressive Symptomatology, self-report (QIDS-SR16) and clinician rating (QIDS-C16), at the follow-up entry that predicted relapse were identified, using a Cox proportional hazards model. Results: The following three QIDS-SR16 symptoms were significantly associated with subsequent relapse: restlessness (HR = 1.197, p = 0.018), hypersomnia (HR = 1.190, p = 0.009), and weight change (HR = 1.127, p = 0.041). On the other hand, the following three symptoms in the QIDS-C16 at the follow-up entry were significantly associated with relapse in the follow-up phase: restlessness (HR = 1.328, p = 0.001), sleep onset insomnia (HR = 1.129, p = 0.047), and weight change (HR = 1.125, p = 0.045). Limitations: The original trial was not designed to evaluate the issue addressed herein. Individual symptoms may be associated with each other and functional status was not addressed. Conclusions: Some residual symptoms, including restlessness, insomnia, and weight change, may help better identify patients with MDD vulnerable to relapse. Contribution of individual residual symptoms to subsequent relapse was similar between self-report and clinician-rated symptoms.

AB - Background: Residual symptoms are detrimental to prognosis in major depressive disorder (MDD); however, little is known about the contribution of each residual symptom in predicting outcomes. The objective of this analysis was to identify which individual symptoms, based on self-report and clinician interview, could predict subsequent relapse. Methods: The data of 1133 outpatients with nonpsychotic MDD who entered a 12-month naturalistic follow-up phase after achieving remission with level 1 treatment (i.e., citalopram for up to 14 weeks) and had at least one post-baseline contact in the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial were analyzed. Specific residual symptoms in the 16-item Quick Inventory of Depressive Symptomatology, self-report (QIDS-SR16) and clinician rating (QIDS-C16), at the follow-up entry that predicted relapse were identified, using a Cox proportional hazards model. Results: The following three QIDS-SR16 symptoms were significantly associated with subsequent relapse: restlessness (HR = 1.197, p = 0.018), hypersomnia (HR = 1.190, p = 0.009), and weight change (HR = 1.127, p = 0.041). On the other hand, the following three symptoms in the QIDS-C16 at the follow-up entry were significantly associated with relapse in the follow-up phase: restlessness (HR = 1.328, p = 0.001), sleep onset insomnia (HR = 1.129, p = 0.047), and weight change (HR = 1.125, p = 0.045). Limitations: The original trial was not designed to evaluate the issue addressed herein. Individual symptoms may be associated with each other and functional status was not addressed. Conclusions: Some residual symptoms, including restlessness, insomnia, and weight change, may help better identify patients with MDD vulnerable to relapse. Contribution of individual residual symptoms to subsequent relapse was similar between self-report and clinician-rated symptoms.

KW - Depression

KW - Major depressive disorder

KW - Prediction

KW - Recurrence

KW - Relapse

KW - Residual symptom

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