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Late-life depression severity prior to treatment start affects treatment response

Individuals with higher depression severity were more likely to exhibit non-response trajectories to venlafaxine hydrochloride for late-life depression, according to study findings in JAMA Psychiatry.

“More than 50% of adults treated for late-life depression fail to respond to first-line pharmacological therapy. High pretreatment depression severity may be a powerful marker of first-line resistance; however, past research (including our own) linking baseline severity to treatment response may be limited by a simple and important methodological consideration,” Stephen F. Smagula, PhD, of the Western Psychiatric Institute and Clinic of University of Pittsburgh, and colleagues wrote.

To identify clinical factors associated with longitudinal typical patterns of response to venlafaxine hydrochloride extended-release for late-life depression, researchers applied a group-based trajectory model to data from a 12-week, open-label pharmacological trial conducted among 453 adults aged 60 years or older with current major depressive disorder.

Three subgroups of participants with different baseline depression severity responded to treatment: participants with the lowest baseline severity (n = 69) had rapid response and those with moderate (n = 108) and higher (n = 25) baseline symptom levels had distinct responses.

Two subgroups of participants with high baseline symptom levels and one group with moderate baseline symptom levels exhibited non-responsive trajectories.

Greater baseline depression severity, longer episode duration, less subjective sleep loss, more guilt and more work/activity impairment were independently associated with having a non-responsive trajectory (P < .05).

Higher delayed memory performance was independently associated with having a rapid response (adjusted OR = 2.22; 95% CI, 1.18-4.2).

“We found that even in a specialty care setting, patients with severe pretreatment depression regularly fail to respond to first-line pharmacotherapy. Nevertheless, because we observed treatment response in the presence of high baseline severity as well as treatment nonresponse in its absence, high depression severity alone may not be a completely accurate predictor of treatment response. Several other clinical prognostic factors likely contribute to the risk of treatment nonresponse,” Smagula and colleagues wrote. “Intensive short-term monitoring and/or additional treatment strategies may be important for patients with severe depression, prolonged episode duration, and/or the specific [late-life depression] characteristics or comorbidities discussed earlier.” – by Amanda Oldt

Disclosure: Smagula reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.