Factors influencing response and remission in the treatment of major depressive disorder: Can social adaptation be a determinant factor?

Abstract

Objective: Major depression is a frequent disorder successfully treated with antidepressants (1). Response and remission depend on the type of pharmacological treatment as well as patient characteristics. The aim of the study is to evaluate the factors influencing response and remission rates.

Method: Data from 4 studies (2-4) sharing the same methodology is pooled and reanalyzed. Subjects with major depression were assigned to reboxetine, sertraline or venlafaxine XR treatment in an open label fashion. The initial dose of reboxetine and venlafaxine XR were 4mg/day and 75mg/day respectively. The dose was increased at the second week to 8mg/day for reboxetine and 150mg/day for venlafaxine XR. Sertraline dose was 50mg/day throughout the study. Subjects were assessed at baseline, 2 weeks, 4 weeks, 7 weeks and 10 weeks with Hamilton Depression Rating Scale (HDRS) (5), Hamilton Anxiety Rating Scale (HARS) (6) and, Social Adaptation Self-Evaluation Scale (SASS) (7).

Results: Characteristics of the study population (n=149) are summarized in Table 1. The response and remission rates were 67.8% (n=101) and 55% (n=82) respectively. Total number of episodes, time since first episode, baseline HDRS and HARS scores were significantly lower and baseline SASS score was significantly higher in responders and remitters when compared to non-responders and non-remitters respectively (Table 2). Logistic regression analyses where response and remission were dependent variables and, treatment arm, gender, age, duration of last episode, number of past episodes,.time since first episode and baseline HDRS, HADRS and SASS scores were independent variables revealed that baseline SASS score was the only factor significantly increasing the odds of response (p=0.035 OR:1.06 %95 CI: 1.005-1.131) and remission (p=0,019 OR:1,07 %95CI: 1,012-1,140).

Conclusion: Our findings suggest that baseline social adaptation may have a modest impact on response and remission but other factors not evaluated in our study may also influence the rates of response and remission.