Early improvement as a resilience signal predicting later remission to antidepressant treatment in patients with Major Depressive Disorder: Systematic review and meta-analysis

Wagner, Stefanie; Engel, Alice; Engelmann, Jan; Herzog, David; Dreimüller, Nadine; Müller, Marianne B.; Tadić, André; Lieb, Klaus

doi:10.1016/j.jpsychires.2017.07.003

Cited by 73Treatment of Major DepressionMental Health Treatment and AccessPsychotherapy Techniques and Applications

Early improvement as a resilience signal predicting later remission to antidepressant treatment in patients with Major Depressive Disorder: Systematic review and meta-analysis

Wagner, Stefanie, Engel, Alice, Engelmann, Jan, Herzog, David, Dreimüller, Nadine, Müller, Marianne B., Tadić, André, Lieb, Klaus·2017·Journal of Psychiatric Research

DOI 10.1016/j.jpsychires.2017.07.003

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Abstract

Early improvement of depressive symptoms during the first two weeks of antidepressant treatment has been discussed to be a resilience signal predicting a later positive treatment outcome in patients with Major Depressive Disorder (MDD). However, the predictive value of early improvement varies between studies, and the use of different antidepressants may explain heterogeneous results. The objective of this review was to assess the predictive value of early improvement on later response and remission and to identify antidepressants with the highest chance of early improvement. We included 17 randomized controlled trials investigating early improvement in 14,779 adult patients with MDD comparing monotherapy with an antidepressant against placebo or another antidepressant drug. 62% (range: 35-85%) of patients treated with an antidepressant and 47% (range: 21-69%) with placebo were early improver, defined as a >20%/25% symptom reduction after two weeks of treatment. Early improvement predicted response and remission after 5-12 weeks of treatment with high sensitivity (85%; 95%-CI: 84.3 to 85.7) and low to moderate specificity (54%; 95%-CI: 53.1 to 54.9). Early improver had a 8.37 fold (6.97-10.05) higher likelihood to become responder and a 6.38 fold (5.07-8.02) higher likelihood to be remitter at endpoint than non-improver. The highest early improver rates were achieved in patients treated with mirtazapine or a tricyclic antidepressant. This finding of a high predictive value of early improvement on treatment outcome may be important for treatment decisions in the early course of antidepressant treatment. Further studies should test the efficacy of such early treatment decisions.

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Partial responses at 2 weeks have been shown to be strongly correlated with subsequent remission.
“the partial responses at 2 weeks have, nonetheless, been shown to be strongly correlated with subsequent remission [19,51].”
From Multiple Pre-Treatment miRNAs Levels in Untreated Major Depressive Disorder Patients Predict Early Response to Antidepressants and Interact with Key Pathways (2022) · cites this paper as [51]

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Authors: Wagner, S., Engel, A., Engelmann, J., Herzog, D., Dreimüller, N., Müller, M. B., Tadić, A., & Lieb, K.
Affiliations: Johannes Gutenberg University Mainz (DE)
Corresponding author: Wagner, Stefanie
Lieb, Klaus
ORCID: Wagner, Stefanie
Engelmann, Jan
Herzog, David
Dreimüller, Nadine
Müller, Marianne B.
Lieb, Klaus
Venue: Journal of Psychiatric Research
Publisher: Elsevier BV
Published: 2017-11
Volume: 94
Pages: 96-106
ISSN: 0022-3956 (ISSN-L)
DOI: 10.1016/j.jpsychires.2017.07.003
OpenAlex: W2725636785
Cited by: 73
References: 53
Citations by year: 2026: 6 · 2025: 4 · 2024: 7 · 2023: 10 · 2022: 10 · 2021: 11 · 2020: 9 · 2019: 9 · 2018: 5 · 2017: 2
FWCI: 0.87
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: Journal of Psychiatric Research (publishedVersion)
PubMed (publishedVersion)
Funders: University Medical Center Mainz, Department of Psychiatry and Psychotherapy, Mainz, Germany
Topics: Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
Keywords: major depressive disorder, early improvement, antidepressant response, remission prediction, treatment outcome prediction, antidepressants, mirtazapine, tricyclic antidepressants, placebo response, treatment decision-making
MeSH terms: Antidepressive Agents, Major Depressive Disorder, Humans, Outcome Assessment, Health Care, Resilience, Psychological

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Early improvement as a resilience signal predicting later remission to antidepressant treatment in patients with Major Depressive Disorder: Systematic review and meta-analysis

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