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Clinical and Functional Outcomes of Patients Who Experience Partial Response to Citalopram: Secondary Analysis of STAR*D

DENNEHY, ELLEN B. PhD; MARANGELL, LAUREN B. MD; MARTINEZ, JAMES MD; BALASUBRAMANI, G.K. PhD; WISNIEWSKI, STEPHEN R. PhD

Journal of Psychiatric Practice®: May 2014 - Volume 20 - Issue 3 - p 178–187
doi: 10.1097/01.pra.0000450317.76117.62
Articles

Background. We analyzed the public STAR*D database to better characterize the baseline clinical characteristics and functional outcomes of patients with major depressive disorder (MDD) who experienced partial response in order to better understand the burden associated with this outcome. Method. Patients (n=2,876) received treatment with citalopram. The last available Quick Inventory of Depressive Symptoms (QIDS-SR) from the 12-week treatment period was used to assign subjects to one of three groups: remitters QIDS-SR≤5; non-responders QIDS-SR >5 and <25% reduction from baseline; and partial responders QIDS-SR >5 and ≥25% reduction from baseline. Baseline sociodemographic and clinical characteristics were compared across groups, as well as functional outcomes at Level 1 exit. Results. Of the 2,876 patients, 943 patients (33%) were classified as remitters, 1069 (37%) as partial responders, and 854 (30%) as non-responders. The groups differed on a number of pre-treatment course of illness variables and comorbidities. In addition, remitters, partial responders, and non-responders all separated on posttreatment quality of life and functional outcomes at Level 1 exit. Conclusion. Partial responders demonstrated significant functional impairment at Level 1 exit, differing significantly from the patients who remitted on quality of life, mental and physical functioning, and social and work-related impairment. Adjusted outcomes showed similar differences. Differences in baseline rates of suicidality, comorbidity, and atypical presentations of depression were also observed between outcome groups. Given the substantial clinical and economic burden associated with functional impairment in depression, the need to fully treat partially responding patients to achieve depression remission and restoration of functioning is highlighted by this work. (Journal of Psychiatric Practice 2014;20:178–187)

DENNEHY: Eli Lilly and Company, Indianapolis, IN, and Purdue University, West Lafayette, IN; MARANGELL: Eli Lilly and Company and The University of Texas Health Science Center, Houston, TX; MARTINEZ: Eli Lilly and Company; BALASUBRAMANI and WISNIEWSKI: Epidemiology Data Center, University of Pittsburgh, Pittsburgh, PA.

The authors acknowledge the contributions of Peter Classi, MS, for his early work on study concept and design.

Conflicts of interest and source of funding: Dr. Dennehy, Dr. Marangell, and Dr. Martinez are all employees and stockholders, Eli Lilly and Company. Ellen B. Dennehy, PhD: Royalties, Jones & Bartlett Learning. Stephen R. Wisniewski, PhD: Consulting: Cyberonic Inc. (2005-2009), ImaRx Therapeutics, Inc. (2006), Bristol-Myers Squibb Company (2007-08), Organon (2007), Case-Western University (2007), Singapore Clinical Research Institute (2009), Dey Pharmaceuticals (2010), Venebio (2010), grant support: Eli Lilly (2012). G.K. Balasubramani: grant support: Eli Lilly.

Please send correspondence to: Ellen B. Dennehy, Eli Lilly and Company, Lilly Corporate Center DC 1544, Indianapolis, IN 46285. dennehy_ellen_b@lilly.com

© 2014 by Lippincott Williams & Wilkins, Inc.