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Cited by 71Treatment of Major DepressionAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesMental Health Treatment and Access

Antidepressant response trajectories and associated clinical prognostic factors among older adults

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Smagula, Stephen F., Butters, Meryl A., Anderson, Stewart J., Lenze, Eric J., Dew, Mary Amanda, Mulsant, Benoit H., Lotrich, Francis E., Aizenstein, Howard +1 more·2015·JAMA Psychiatry
DOI 10.1001/jamapsychiatry.2015.1324PMC PMC4718144
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Abstract

IMPORTANCE: More than 50% of older adults with late-life major depressive disorder fail to respond to initial treatment with first-line pharmacological therapy. OBJECTIVES: To assess typical patterns of response to an open-label trial of extended-release venlafaxine hydrochloride (venlafaxine XR) for late-life depression and to evaluate which clinical factors are associated with the identified longitudinal response patterns. DESIGN, SETTING, AND PARTICIPANTS: Group-based trajectory modeling was applied to data from a 12-week open-label pharmacological trial conducted in specialty care as part of the Incomplete Response in Late Life: Getting to Remission Study. Clinical prognostic factors, including domain-specific cognitive performance and individual depression symptoms, were examined in relation to response trajectories. Participants included 453 adults aged 60 years or older with current major depressive disorder. The study was conducted between August 2009 and August 2014. INTERVENTION: Open-label venlafaxine XR (titrated up to 300 mg/d) for 12 weeks. MAIN OUTCOMES AND MEASURES: Subgroups exhibiting similar response patterns were derived from repeated measures of overall depression severity obtained using the Montgomery-Asberg Depression Rating Scale. RESULTS: Among the 453 study participants, 3 subgroups with differing baseline depression severity clearly responded to treatment: one group with the lowest baseline severity had a rapid response (n = 69 [15.23%]), and distinct responses were also apparent among groups starting at moderate (n = 108 [23.84%]) and higher (n = 25 [5.52%]) baseline symptom levels. Three subgroups had nonresponding trajectories: 2 with high baseline symptom levels (totaling 35.98%: high, nonresponse 1, n = 110 [24.28%]; high, nonresponse 2, n = 53 [11.70%]) and 1 with moderate baseline symptom levels (n = 88 [19.43%]). Several factors were independently associated with having a nonresponsive trajectory, including greater baseline depression severity, longer episode duration, less subjective sleep loss, more guilt, and more work/activity impairment (P < .05). Higher delayed memory (list recognition) performance was independently associated with having a rapid response (adjusted odds ratio = 2.22; 95% CI, 1.18-4.20). CONCLUSIONS AND RELEVANCE: Based on the observed trajectory patterns, patients who have late-life depression with high baseline depression severity are unlikely to respond after 12 weeks of treatment with venlafaxine XR. However, high baseline depression severity alone may be neither a necessary nor sufficient predictor of treatment nonresponse. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00892047.

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  • Older adults with late-life major depression show considerable variability in antidepressant response, with over 50% failing to respond to initial psychopharmacological treatment.

    “Older adults with late-life depression (LLD) exhibit considerable variability in their response to antidepressants, with over 50% of patients failing to respond to initial psychopharmacological treatment (1).”

    From Neuroticism Traits Selectively Impact Long Term Illness Course and Cognitive Decline in Late-Life Depression (2017) · cites this paper as [1]

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  1. [21]First MB Spitzer Robert L Gibbon Miriam Williams Janet BW Structured Clinical Interview for DSM-IV-TR Axis I Disorders, Research Version, Patient Edition. (SCID-I/P) 2002 New York Biometrics Research, New York State Psychiatric Institute

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Authors
Smagula, S. F., Butters, M. A., Anderson, S. J., Lenze, E. J., Dew, M. A., Mulsant, B. H., Lotrich, F. E., Aizenstein, H., & Reynolds, C. F.
Affiliations
  • University of Pittsburgh (US)
  • University of Pittsburgh Medical Center (US)
  • Washington University in St. Louis (US)
  • Centre for Addiction and Mental Health (CA)
ORCID
Venue
JAMA Psychiatry
Publisher
American Medical Association (AMA)
Published
2015-10-01
Volume
72
Issue
10
Pages
1021
ISSN
2168-622X (ISSN-L)
DOI
10.1001/jamapsychiatry.2015.1324
PMC
PMC4718144
OpenAlex
W1531988994
Cited by
71
References
43
Citations by year
2026: 7 · 2025: 5 · 2024: 8 · 2023: 6 · 2022: 4 · 2021: 8 · 2020: 8 · 2019: 6 · 2018: 5 · 2017: 5 · 2016: 9
FWCI
4.56
Type
journal article
Language
en
Open access
Locations
  • JAMA Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institutes of Health (UL1TR000005)
  • National Institute on Aging (P30AG024827, T32AG000181)
  • National Institute of Mental Health (P30MH090333, P30 MH90333, R01MH083648, R01MH083643, R01MH083660, T32MH019986)
  • National Center for Advancing Translational Sciences
Topics
  • Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
Keywords
geriatric depression, major depressive disorder, venlafaxine, treatment non-response, prognostic factors, baseline depression severity, episode duration, sleep deprivation, guilt, delayed memory, cognitive performance, group-based trajectory modeling, older adults, remission, Montgomery-Asberg Depression Rating Scale
MeSH terms
Venlafaxine Hydrochloride, Aged, Antidepressive Agents, Bayes Theorem, Major Depressive Disorder, Female, Guilt, Humans, Sleep Initiation and Maintenance Disorders, Male, Middle Aged, Prognosis, Linear Models, Treatment Outcome, Disease Progression

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