Prediction of Antidepressant Outcomes

Abstract

Major depressive disorder (MDD) is the most common mental illness. It is a frequent and disabling disorder with prevalence rates of about 16%. It is not surprising that, under the current treatment paradigm, most patients face a long and frustrating course of treatment. The Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study, the largest study of MDD conducted in the United States, showed that even with enriched resources devoted to treatment, recovery with the first selected SSRI occurred only about 30% of the time, more than 40% of patients with MDD did not achieve remission even after two optimally delivered trials of antidepressant medications. This low recovery rate is not simply a matter of needing more or better medications. There are more than 20 treatments for MDD approved as effective by the Food and Drug Administration (FDA). but they do not go on to address specific choices of antidepressants depending on clinical symptoms. The current treatment guidelines for MDD of the American Psychiatric Association support a “watchful waiting” approach to determine if a particular medication will be useful for an individual patient. The challenge is choosing the best treatment for each patient.