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Does early-onset chronic or recurrent major depression impact outcomes with antidepressant medications? A CO-MED Trial Report

Published online by Cambridge University Press:  11 December 2012

S. C. Sung ,
S. R. Wisniewski ,
G. K. Balasubramani ,
S. Zisook ,
B. Kurian ,
D. Warden ,
M. H. Trivedi  and
A. J. Rush
S. C. Sung*
Affiliation:
Office of Clinical Sciences, Duke-NUS Graduate Medical School Singapore, Singapore
S. R. Wisniewski
Affiliation:
Epidemiology Data Center, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
G. K. Balasubramani
Affiliation:
Epidemiology Data Center, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
S. Zisook
Affiliation:
Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
B. Kurian
Affiliation:
Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX, USA
D. Warden
Affiliation:
Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX, USA
M. H. Trivedi
Affiliation:
Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX, USA
A. J. Rush
Affiliation:
Office of Clinical Sciences, Duke-NUS Graduate Medical School Singapore, Singapore
*
*Address for correspondence: S. C. Sung, Ph.D., Office of Clinical Sciences, Duke-NUS Graduate Medical School Singapore, 8 College Road, Singapore169857. (Email: sharon.sung@duke-nus.edu.sg)
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Abstract

Background

Prior studies have suggested that major depressive disorder (MDD) with pre-adult onset represents a distinct subtype with greater symptom severity and higher rates of suicidal ideation. Whether these patients have poorer response to various types of antidepressant treatment than those with adult-onset MDD is unclear.

Method

A total of 665 psychiatric and primary care out-patients (aged 18–75 years) with non-psychotic chronic or recurrent MDD participated in a single-blind, randomized trial that compared the efficacy of escitalopram plus placebo, bupropion sustained-release plus escitalopram, or venlafaxine extended-release plus mirtazapine. We compared participants who self-reported MDD onset (before age 18) to those with a later onset (adult onset) with respect to baseline characteristics and treatment/outcome variables at 12 and 28 weeks.

Results

Early-onset chronic/recurrent MDD was associated with a distinct set of sociodemographic (female, younger age) and clinical correlates (longer duration of illness, greater number of prior episodes, greater likelihood of atypical features, higher rates of suicidality and psychiatric co-morbidity, fewer medical problems, poorer quality of life, greater history of child abuse/neglect). However, results from unadjusted and adjusted analyses showed no significant differences in response, remission, tolerability of medications, quality of life, or retention at 12 or 28 weeks.

Conclusions

Although early-onset chronic/recurrent MDD is associated with a more severe clinical picture, it does not seem to be useful for predicting differential treatment response to antidepressant medication. Clinicians should remain alert to an increased risk of suicidality in this population.

Keywords

Age-of-onsetchronicdepressionearly-onsetrecurrent
Type
Original Articles
Information
Psychological Medicine , Volume 43 , Issue 5 , May 2013 , pp. 945 - 960
Copyright
Copyright © Cambridge University Press 2012

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