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Residual Symptoms in Depressed Outpatients Who Respond by 50% But Do Not Remit to Antidepressant Medication

McClintock, Shawn M. PhD*†; Husain, Mustafa M. MD*; Wisniewski, Stephen R. PhD; Nierenberg, Andrew A. MD§; Stewart, Jonathan W. MD; Trivedi, Madhukar H. MD*; Cook, Ian MD; Morris, David PhD*; Warden, Diane PhD*; Rush, Augustus John MD#

Journal of Clinical Psychopharmacology: April 2011 - Volume 31 - Issue 2 - p 180-186
doi: 10.1097/JCP.0b013e31820ebd2c
Original Contributions

Little is known about the quantity or quality of residual depressive symptoms in patients with major depressive disorder (MDD) who have responded but not remitted with antidepressant treatment. This report describes the residual symptom domains and individual depressive symptoms in a large representative sample of outpatients with nonpsychotic MDD who responded without remitting after up to 12 weeks of citalopram treatment in the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study. Response was defined as 50% or greater reduction in baseline 16-item Quick Inventory of Depressive Symptomatology-Self-Report (QIDS-SR16) by treatment exit, and remission as a final QIDS-SR16 of less than 6. Residual symptom domains and individual symptoms were based on the QIDS-SR16 and classified as either persisting from baseline or emerging during treatment. Most responders who did not remit endorsed approximately 5 residual symptom domains and 6 to 7 residual depressive symptoms. The most common domains were insomnia (94.6%), sad mood (70.8%), and decreased concentration (69.6%). The most common individual symptoms were midnocturnal insomnia (79.0%), sad mood (70.8%), and decreased concentration/decision making (69.6%). The most common treatment-emergent symptoms were midnocturnal insomnia (51.4%) and decreased general interest (40.0%). The most common persistent symptoms were midnocturnal insomnia (81.6%), sad mood (70.8%), and decreased concentration/decision making (70.6%). Suicidal ideation was the least common treatment-emergent symptom (0.7%) and the least common persistent residual symptom (17.1%). These findings suggest that depressed outpatients who respond by 50% without remitting to citalopram treatment have a broad range of residual symptoms. Individualized treatments are warranted to specifically address each patient's residual depressive symptoms.

From the *Department of Psychiatry, University of Texas Southwestern Medical Center at Dallas, Dallas, TX; †Division of Brain Stimulation and Therapeutic Modulation, Department of Psychiatry, New York State Psychiatric Institute, Columbia University, New York, NY; ‡Epidemiology Data Center, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA; §Massachusetts General Hospital, Harvard University, Boston, MA; ∥Depression Evaluation Service, Department of Psychiatry, New York State Psychiatric Institute and Columbia University, New York, NY; ¶Depression Research and Clinic Program, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA; and #Office of Clinical Sciences, Duke-National University of Singapore Graduate Medical School, Singapore.

Received June 23, 2010; accepted after revision January 5, 2011.

Reprints: Shawn M. McClintock, PhD, Department of Psychiatry, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8898 (e-mail:

This project was funded by the National Institute of Mental Health under contract N01MH90003 to the University of Texas Southwestern Medical Center at Dallas (A. J. Rush and M. H. Trivedi, principal investigators). The NIMH had no further role in the study design; collection, analysis, and interpretation of the data; writing of the report; or in the decision to submit the paper for publication. The content of this publication does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the US Government.

© 2011 Lippincott Williams & Wilkins, Inc.