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Cited by 112Treatment of Major DepressionAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesMental Health Treatment and Access

Melancholic, atypical and anxious depression subtypes and outcome of treatment with escitalopram and nortriptyline

Uher, Rudolf, Dernovsek, Mojca Zvezdana, Mors, Ole, Hauser, Joanna, Souery, Daniel, Zobel, Astrid, Maier, Wolfgang, Henigsberg, Neven +7 more·2011·Journal of Affective Disorders
DOI 10.1016/j.jad.2011.02.014
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Abstract

Objective To investigate whether subtypes of depression predict differential outcomes of treatment with selective serotonin-reuptake inhibitor (SSRI) and a tricyclic antidepressant in major depression.Method Among 811 adults with moderate-to-severe depression, melancholic, atypical, anxious and anxious-somatizing depression subtypes established at baseline were evaluated as predictors of outcome of treatment with flexible dosage of the SSRI escitalopram or the tricyclic antidepressant nortriptyline. The primary outcome measure was the Montgomery-Åsberg Depression Rating Scale (MADRS). Secondary outcome measures were the 17-item Hamilton Rating Scale for Depression (HRSD-17) and the Beck Depression Inventory (BDI).Results Melancholic depression was associated with slightly worse outcomes among individuals treated with escitalopram, but did not affect outcome of treatment with nortriptyline. The interaction between melancholic depression and drug did not reach statistical significance for the primary outcome measure and significant results for secondary outcome measures were not robust in sensitivity analyses. Atypical depression was unrelated to outcome of treatment with either antidepressant. Anxious and anxious-somatizing depression did not predict outcome on the primary measure, but inconsistently predicted worse outcome in some secondary analyses.Limitations Some participants were non-randomly allocated to drug. Therefore, drug-by-predictor interactions had to be validated in sensitivity analyses restricted to the 468 randomly allocated individuals.Conclusions Melancholic, atypical or anxious depression, are not sufficiently robust differential predictors of outcome to help clinician choose between SSRI and tricyclic antidepressants. There is a need to investigate other predictors of outcome.

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  • Anxious depression defined with the anxious distress specifier was associated with greater depression severity, higher suicidal ideation, decreased quality of life, greater self-reported impairment, severe insomnia, and increased incidence of cardiovascular disease.

    “Also anxious depression defined with the anxious distress specifier was associated with greater depression severity, higher suicidal ideation, decreased QOL, greater self-reported impairment, severe insomnia [10,40], and increased incidence of cardiovascular disease [43].”

    From Patients with anxious depression: overview of prevalence, pathophysiology and impact on course and treatment outcome (2018) · cites this paper as [40]

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Authors
Uher, R., Dernovsek, M. Z., Mors, O., Hauser, J., Souery, D., Zobel, A., Maier, W., Henigsberg, N., Kalember, P., Rietschel, M., Placentino, A., Mendlewicz, J., Aitchison, K. J., McGuffin, P., & Farmer, A.
Affiliations
King's College London (GB)
ORCID
Venue
Journal of Affective Disorders
Publisher
Elsevier BV
Published
2011-07
Volume
132
Issue
1-2
Pages
112-120
ISSN
0165-0327 (ISSN-L)
DOI
10.1016/j.jad.2011.02.014
OpenAlex
W2165707326
Cited by
112
References
50
Citations by year
2026: 4 · 2025: 5 · 2024: 3 · 2023: 5 · 2022: 4 · 2021: 11 · 2020: 13 · 2019: 5 · 2018: 7 · 2017: 11 · 2016: 6 · 2015: 5 · 2014: 10 · 2013: 9 · 2012: 11
FWCI
7.73
Type
journal article
Language
en
Open access
closed
Licence
Locations
  • Journal of Affective Disorders (publishedVersion)
  • PubMed (publishedVersion)
  • Dépôt institutionnel de l'Université libre de Bruxelles (Université Libre de Bruxelles) (submittedVersion)
  • Research Portal (King's College London) (submittedVersion)
Funders
  • Sixth Framework Programme
  • European Commission (115008, LSHB-CT-2003-503428)
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
endogenous depression, atypical depression, anxious depression, major depressive disorder, escitalopram, nortriptyline, antidepressant treatment outcome, selective serotonin reuptake inhibitors, tricyclic antidepressants
MeSH terms
Adult, Antidepressive Agents, Tricyclic, Anxiety Disorders, Depressive Disorder, Female, Humans, Male, Middle Aged, Nortriptyline, Personality Inventory, Prognosis, Psychometrics, Somatoform Disorders, Citalopram, Antidepressive Agents, Second-Generation

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