Hopelessness as a predictor of non-response to fluoxetine in major depressive disorder

Background. The purpose of this study was to study hopelessness as a predictor of response to fluoxetine in outpatients with Major Depressive Disorder (MDD). Methods. The degree of hopelessness was assessed during the baseline visit with the use of the Beck Hopelessness Scale (BHS) in 312 patients with MDD (56.1% women; 39.8 ± 10.3 years of age) who entered an 8-week, 20-mg, fixed-dose, open trial of fluoxetine. With the use of a logistic regression we tested whether BHS scores at baseline predicted clinical response, controlling for the severity of depression as reflected by the total score on the 17-item Hamilton Depression Rating Scale (HAM-D-17). With the use of a multiple regression we also tested whether BHS scores at baseline predicted HAM-D-17 scores at endpoint, controlling for HAM-D-17 scores at baseline. Results. After controlling for depression severity at baseline, a greater degree of hopelessness was found to significantly increase the risk of non-response to fluoxetine (p = 0.0413), as well as the risk of greater endpoint depression severity (p = 0.0305). Conclusions. Hopelessness appeared to be associated with poorer response to treatment with fluoxetine in MDD, and this was independent of depression severity. Similar studies involving treatment with higher doses of fluoxetine and for greater duration as well as a placebo comparator arm are needed to further explore the relationship between hopelessness, placebo response and drug response.