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Cited by 9Treatment of Major DepressionAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesPsychotherapy Techniques and Applications

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Toward a Definition of “No Meaningful Benefit” From Antidepressant Treatment: An Equipercentile Analysis With Cross-Trial Validation Across Multiple Rating Scales

Zhang, Carl, Virani, Sanya, Mayes, Taryn, Carmody, Thomas, Croarkin, Paul E., Weinshilboum, Richard, Rush, A. John, Trivedi, Madhukar, Athreya, Arjun P., Bobo, William V.·2022·The Journal of Clinical Psychiatry
DOI 10.4088/jcp.21m14239
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Abstract

Many patients with major depressive disorder (MDD) who experience no meaningful benefit (NMB) from antidepressive treatment go undetected. However, there is a lack of consensus on the definition of NMB from antidepressants. Equipercentile linking was used to identify a threshold for percent change in 17-item Hamilton Depression Rating Scale (HDRS-17) scores that equated with a Clinical Global Impressions-Improvement (CGI-I) score of 3 (minimally improved), a proxy for NMB, after 4 and 8 weeks of citalopram or escitalopram treatment, using data from the Pharmacogenomic Research Network Antidepressant Medication Pharmacogenomic Study (PGRN-AMPS). The NMB threshold for the HDRS-17 was validated by equating a CGI-I rating of 3 with percent change values from the clinician- and patient-rated versions of the Quick Inventory of Depressive Symptomatology (QIDS-C and QIDS-SR) using data from PGRN-AMPS and phase 1 of the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial. This study was conducted between June 2021 and September 2021. In PGRN-AMPS, a 30% improvement in HDRS-17 score corresponded to a CGI-I rating of 3 at 4 and 8 weeks. The 30% improvement threshold was also observed for QIDS-C and QIDS-SR scores in both PGRN-AMPS and STAR*D. Similar results were observed for percent change in HDRS-17 and QIDS-based measures in lower- and higher-severity groups based on a median split of baseline total scores. Improvement in depressive severity of ≤ 30%, as assessed using the HDRS-17, QIDS-C, and QIDS-SR, may validly define NMB from antidepressants during short-term treatment.

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  • For several patients, despite non-remission status, more modest improvement in overall depressive symptom severity may result in significant self-assessed improvement in well-being.

    “For several patients, despite non-­ remis­ sion status, more modest improvement in overall depressive symptom severity may re­ sult in significant self-­ assessed improvement in well-­ being 85-­ 87 .”

    From Treatment‐resistant depression: definition, prevalence, detection, management, and investigational interventions (2023) · cites this paper as [85]

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Authors
Zhang, C., Virani, S., Mayes, T., Carmody, T., Croarkin, P. E., Weinshilboum, R., Rush, A. J., Trivedi, M., Athreya, A. P., & Bobo, W. V.
Affiliations
  • Mayo Clinic (US)
  • Brown University (US)
  • The University of Texas Southwestern Medical Center (US)
  • National University of Singapore (SG)
ORCID
Venue
The Journal of Clinical Psychiatry
Publisher
Physicians Postgraduate Press, Inc
Published
2022-06-27
Volume
83
Issue
4
ISSN
  • 0160-6689 (ISSN-L)
  • 1555-2101
DOI
10.4088/jcp.21m14239
OpenAlex
W4283641437
Cited by
9
References
0
Citations by year
2026: 3 · 2025: 2 · 2024: 3 · 2023: 1
FWCI
0.90
Type
journal article
Language
en
Open access
closed
Locations
  • The Journal of Clinical Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Pharmacology (medical) › Treatment of Major Depression
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
  • Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
Keywords
antidepressant response, major depressive disorder, Hamilton Depression Rating Scale, citalopram, escitalopram, antidepressant non-response, STAR*D trial
MeSH terms
Antidepressive Agents, Clinical Trials as Topic, Major Depressive Disorder, Depressive Disorder, Major, Humans, Pharmacogenetics, Psychiatric Status Rating Scales, Citalopram, Treatment Outcome

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