Difference in treatment outcome in outpatients with anxious versus nonanxious depression: A STAR*D report

Maurizio Fava, A. John Rush, Jonathan E. Alpert, G. K. Balasubramani, Stephen R. Wisniewski, Cheryl N. Carmin, Melanie M. Biggs, Sidney Zisook, Andrew Leuchter, Robert Howland, Diane Warden, Madhukar H. Trivedi

Research output: Contribution to journalArticle

491 Citations (Scopus)

Abstract

Objective: About half of outpatients with major depressive disorder also have clinically meaningful levels of anxiety. The authors conducted a secondary data analysis to compare antidepressant treatment outcomes for patients with anxious and nonanxious major depression in Levels 1 and 2 of the STAR*D study. Method: A total of 2,876 adult outpatients with major depressive disorder, enrolled from 18 primary and 23 psychiatric care sites, received citalopram in Level 1 of STAR*D. In Level 2, a total of 1,292 patients who did not remit with or tolerate citalopram were randomly assigned either to switch to sustained-release bupropion (N=239), sertraline (N=238), or extended-release venlafaxine (N=250) or to continue taking citalopram and receive augmentation with sustained-release bupropion (N=279) or buspirone (N=286). Treatment could last up to 14 weeks in each level. Patients were designated as having anxious depression if their anxiety/somatization factor score from the 17-item Hamilton Depression Rating Scale (HAM-D) was 7 or higher at baseline. Rates of remission and response as well as times to remission and response were compared between patients with anxious depression and those with nonanxious depression. Results: In Level 1 of STAR*D, 53.2% of patients had anxious depression. Remission was significantly less likely and took longer to occur in these patients than in those with nonanxious depression. Ratings of side effect frequency, intensity, and burden, as well as the number of serious adverse events, were significantly greater in the anxious depression group. Similarly, in Level 2, patients with anxious depression fared significantly worse in both the switching and augmentation options. Conclusions: Anxious depression is associated with poorer acute outcomes than nonanxious depression following antidepressant treatment.

Original languageEnglish (US)
Pages (from-to)342-351
Number of pages10
JournalAmerican Journal of Psychiatry
Volume165
Issue number3
DOIs
StatePublished - Mar 2008
Externally publishedYes

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Outpatients
Depression
Citalopram
Bupropion
Major Depressive Disorder
Antidepressive Agents
Anxiety
Buspirone
Sertraline
Psychiatry
Therapeutics

ASJC Scopus subject areas

  • Psychiatry and Mental health

Cite this

Difference in treatment outcome in outpatients with anxious versus nonanxious depression : A STAR*D report. / Fava, Maurizio; Rush, A. John; Alpert, Jonathan E.; Balasubramani, G. K.; Wisniewski, Stephen R.; Carmin, Cheryl N.; Biggs, Melanie M.; Zisook, Sidney; Leuchter, Andrew; Howland, Robert; Warden, Diane; Trivedi, Madhukar H.

In: American Journal of Psychiatry, Vol. 165, No. 3, 03.2008, p. 342-351.

Research output: Contribution to journalArticle

Fava, M, Rush, AJ, Alpert, JE, Balasubramani, GK, Wisniewski, SR, Carmin, CN, Biggs, MM, Zisook, S, Leuchter, A, Howland, R, Warden, D & Trivedi, MH 2008, 'Difference in treatment outcome in outpatients with anxious versus nonanxious depression: A STAR*D report', American Journal of Psychiatry, vol. 165, no. 3, pp. 342-351. https://doi.org/10.1176/appi.ajp.2007.06111868
Fava, Maurizio ; Rush, A. John ; Alpert, Jonathan E. ; Balasubramani, G. K. ; Wisniewski, Stephen R. ; Carmin, Cheryl N. ; Biggs, Melanie M. ; Zisook, Sidney ; Leuchter, Andrew ; Howland, Robert ; Warden, Diane ; Trivedi, Madhukar H. / Difference in treatment outcome in outpatients with anxious versus nonanxious depression : A STAR*D report. In: American Journal of Psychiatry. 2008 ; Vol. 165, No. 3. pp. 342-351.
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abstract = "Objective: About half of outpatients with major depressive disorder also have clinically meaningful levels of anxiety. The authors conducted a secondary data analysis to compare antidepressant treatment outcomes for patients with anxious and nonanxious major depression in Levels 1 and 2 of the STAR*D study. Method: A total of 2,876 adult outpatients with major depressive disorder, enrolled from 18 primary and 23 psychiatric care sites, received citalopram in Level 1 of STAR*D. In Level 2, a total of 1,292 patients who did not remit with or tolerate citalopram were randomly assigned either to switch to sustained-release bupropion (N=239), sertraline (N=238), or extended-release venlafaxine (N=250) or to continue taking citalopram and receive augmentation with sustained-release bupropion (N=279) or buspirone (N=286). Treatment could last up to 14 weeks in each level. Patients were designated as having anxious depression if their anxiety/somatization factor score from the 17-item Hamilton Depression Rating Scale (HAM-D) was 7 or higher at baseline. Rates of remission and response as well as times to remission and response were compared between patients with anxious depression and those with nonanxious depression. Results: In Level 1 of STAR*D, 53.2{\%} of patients had anxious depression. Remission was significantly less likely and took longer to occur in these patients than in those with nonanxious depression. Ratings of side effect frequency, intensity, and burden, as well as the number of serious adverse events, were significantly greater in the anxious depression group. Similarly, in Level 2, patients with anxious depression fared significantly worse in both the switching and augmentation options. Conclusions: Anxious depression is associated with poorer acute outcomes than nonanxious depression following antidepressant treatment.",
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T2 - A STAR*D report

AU - Fava, Maurizio

AU - Rush, A. John

AU - Alpert, Jonathan E.

AU - Balasubramani, G. K.

AU - Wisniewski, Stephen R.

AU - Carmin, Cheryl N.

AU - Biggs, Melanie M.

AU - Zisook, Sidney

AU - Leuchter, Andrew

AU - Howland, Robert

AU - Warden, Diane

AU - Trivedi, Madhukar H.

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N2 - Objective: About half of outpatients with major depressive disorder also have clinically meaningful levels of anxiety. The authors conducted a secondary data analysis to compare antidepressant treatment outcomes for patients with anxious and nonanxious major depression in Levels 1 and 2 of the STAR*D study. Method: A total of 2,876 adult outpatients with major depressive disorder, enrolled from 18 primary and 23 psychiatric care sites, received citalopram in Level 1 of STAR*D. In Level 2, a total of 1,292 patients who did not remit with or tolerate citalopram were randomly assigned either to switch to sustained-release bupropion (N=239), sertraline (N=238), or extended-release venlafaxine (N=250) or to continue taking citalopram and receive augmentation with sustained-release bupropion (N=279) or buspirone (N=286). Treatment could last up to 14 weeks in each level. Patients were designated as having anxious depression if their anxiety/somatization factor score from the 17-item Hamilton Depression Rating Scale (HAM-D) was 7 or higher at baseline. Rates of remission and response as well as times to remission and response were compared between patients with anxious depression and those with nonanxious depression. Results: In Level 1 of STAR*D, 53.2% of patients had anxious depression. Remission was significantly less likely and took longer to occur in these patients than in those with nonanxious depression. Ratings of side effect frequency, intensity, and burden, as well as the number of serious adverse events, were significantly greater in the anxious depression group. Similarly, in Level 2, patients with anxious depression fared significantly worse in both the switching and augmentation options. Conclusions: Anxious depression is associated with poorer acute outcomes than nonanxious depression following antidepressant treatment.

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