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Changes in depression subtypes for women during treatment with citalopram: a latent transition analysis

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Abstract

The aim of this study was to characterize latent subtypes of major depression and changes in these subtypes among women receiving citalopram in the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial. Latent transition analysis was applied to data from 755 women who completed baseline and week 12 study visits in level 1 of STAR*D. Items from the self-report version of the Quick Inventory of Depressive Symptomatology were used as indicators of latent depression subtype. Four subtypes were identified at baseline and week 12. The baseline subtypes were Mild (21 %), Moderate (30 %), Severe with Increased Appetite (16 %), and Severe with Decreased Appetite (34 %). The subtypes at week 12 were Symptom Resolution (65 %), Mild (23 %), Moderate (9 %), and Severe with Psychomotor Disturbances (3 %). Women in the Moderate subtype at baseline had the greatest chance of moving to Symptom Resolution (87 %). Women in the Severe with Decreased Appetite subtype had the lowest chance of transitioning to Symptom Resolution (46 %). Depression severity and appetite distinguished depression subtypes for women before treatment with citalopram. Depression severity and psychomotor disturbances characterized the subtypes after treatment. This work highlights the need to consider how depression treatment changes different symptoms instead of relying exclusively on summary rating scores. Clinical trial registration: www.clinicaltrials.gov, NCT00021528.

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References

  • Akaike H (1987) Factor analysis and AIC. Psychometrika 52:317–332

    Article  Google Scholar 

  • Angst J, Gamma A, Benazzi F et al (2007) Melancholia and atypical depression in the Zurich study: epidemiology, clinical characteristics, course, comorbidity and personality. Acta Psychiatr Scand Suppl 72–84

  • Buyukdura JS, McClintock SM, Croarkin PE (2011) Psychomotor retardation in depression: biological underpinnings, measurement, and treatment. Prog Neuropsychopharmacol Biol Psychiatry 35:395–409

    Article  PubMed  Google Scholar 

  • Collins LM, Lanza ST (2010) Latent class and latent transition analysis: with applications in the social, behavioral, and health sciences. John Wiley & Sons, Hoboken, NJ

    Google Scholar 

  • Ferguson M, Dennehy EB, Marangell LB et al (2014) Impact of fatigue on outcome of selective serotonin reuptake inhibitor treatment: secondary analysis of STAR*D. Curr Med Res Opin 30:2109–2118

    Article  CAS  PubMed  Google Scholar 

  • Fournier JC, DeRubeis RJ, Hollon SD et al (2013) Differential change in specific depressive symptoms during antidepressant medication or cognitive therapy. Behav Res Ther 51:392–398

    Article  PubMed  PubMed Central  Google Scholar 

  • Frank E, Cassano GB, Rucci P et al (2011) Predictors and moderators of time to remission of major depression with interpersonal psychotherapy and SSRI pharmacotherapy. Psychol Med 41:151–162

    Article  CAS  PubMed  Google Scholar 

  • Fried EI, Nesse RM (2015) Depression is not a consistent syndrome: an investigation of unique symptom patterns in the STAR*D study. J Affect Disord 172:96–102

    Article  PubMed  Google Scholar 

  • Gold PW (2014) The organization of the stress system and its dysregulation in depressive illness. Mol Psychiatry 20:32–47

    Article  PubMed  Google Scholar 

  • Insel TR (2014) The NIMH Research Domain Criteria (RDoC) Project: precision medicine for psychiatry. Am J Psychiatry 171:395–397

    Article  PubMed  Google Scholar 

  • Kendler KS, Gardner CO (2014) Sex differences in the pathways to major depression: a study of opposite-sex twin pairs. Am J Psychiatry 171:426–435

    Article  PubMed  PubMed Central  Google Scholar 

  • Khan A, Brodhead AE, Schwartz KA et al (2005) Sex differences in antidepressant response in recent antidepressant clinical trials. J Clin Psychopharmacol 25:318–324

    Article  PubMed  Google Scholar 

  • Kornstein SG, Toups M, Rush AJ et al (2013) Do menopausal status and use of hormone therapy affect antidepressant treatment response? Findings from the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study. J Womens Health 22:121–131

    Article  Google Scholar 

  • Krishnan V, Collop NA (2006) Gender differences in sleep disorders. Curr Opin Pulm Med 12:383–389

    Article  PubMed  Google Scholar 

  • Lamers F, de Jonge P, Nolen WA et al (2010) Identifying depressive subtypes in a large cohort study: results from the Netherlands Study of Depression and Anxiety (NESDA). J Clin Psychiatry 71:1582–1589

    Article  PubMed  Google Scholar 

  • Lamers F, Rhebergen D, Merikangas KR et al (2012) Stability and transitions of depressive subtypes over a 2-year follow-up. Psychol Med 42:2083–2093

    Article  CAS  PubMed  Google Scholar 

  • Lanza ST, Collins LM (2008) A new SAS procedure for latent transition analysis: transitions in dating and sexual risk behavior. Dev Psychol 44:446–456

    Article  PubMed  PubMed Central  Google Scholar 

  • Lanza ST, Dziak JJ, Huang L, et al (2014) PROC LCA & PROC LTA Users’ Guide.

  • Madhoo M, Levine SZ (2015) Initial severity effects on residual symptoms in response and remission. J Clin Psychopharmacol 35:1

    Article  Google Scholar 

  • Marcus SM, Kerber KB, Rush AJ et al (2008) Sex differences in depression symptoms in treatment-seeking adults: confirmatory analyses from the Sequenced Treatment Alternatives to Relieve Depression study. Compr Psychiatry 49:238–246

    Article  PubMed  PubMed Central  Google Scholar 

  • Marks I (1986) Behavioral psychotherapy. John Wright, Bristol

    Google Scholar 

  • McClintock SM, Husain MM, Wisniewski SR et al (2011) Residual symptoms in depressed outpatients who respond by 50 % but do not remit to antidepressant medication. J Clin Psychopharmacol 31:180–186

    Article  PubMed  PubMed Central  Google Scholar 

  • McKnight PE, Kashdan TB (2009) The importance of functional impairment to mental health outcomes: a case for reassessing our goals in depression treatment research. Clin Psychol Rev 29:243–259

    Article  PubMed  PubMed Central  Google Scholar 

  • Substance Abuse and Mental Health Services Administration (2014) Results from the 2013 National Survey on Drug Use and Health: Mental Health Findings. Rockville, MD

  • Menza M, Marin H, Opper RS (2003) Residual symptoms in depression: can treatment be symptom-specific? J Clin Psychiatry 64:516–523

    Article  PubMed  Google Scholar 

  • Nierenberg AA, Husain MM, Trivedi MH et al (2010) Residual symptoms after remission of major depressive disorder with citalopram and risk of relapse: a STAR*D report. Psychol Med 40:41–50

    Article  CAS  PubMed  Google Scholar 

  • Ohayon MM, Roth T (2003) Place of chronic insomnia in the course of depressive and anxiety disorders. J Psychiatr Res 37:9–15

    Article  PubMed  Google Scholar 

  • Oquendo MA, Barrera A, Ellis SP et al (2004) Instability of symptoms in recurrent major depression: a prospective study. Am J Psychiatry 161:255–261

    Article  PubMed  Google Scholar 

  • Ostergaard SD, Jensen SOW, Bech P (2011) The heterogeneity of the depressive syndrome: when numbers get serious. Acta Psychiatr Scand 124:495–496

    Article  CAS  PubMed  Google Scholar 

  • Rodgers S, Ajdacic-Gross V, Müller M et al (2014) The role of sex on stability and change of depression symptom subtypes over 20 years: a latent transition analysis. Eur Arch Psychiatry Clin Neurosci 264:577–588

    Article  PubMed  Google Scholar 

  • Romera I, Pérez V, Ciudad A et al (2013) Residual symptoms and functioning in depression, does the type of residual symptom matter? A post-hoc analysis. BMC Psychiatry 13:51

    Article  PubMed  PubMed Central  Google Scholar 

  • Rumble ME, White KH, Benca RM (2015) Sleep disturbances in mood disorders. Psychiatr Clin North Am 38:743–759

    Article  PubMed  Google Scholar 

  • Rush AJ (2007) The varied clinical presentations of major depressive disorder. J Clin Psychiatry 68(Suppl 8):4–10

    PubMed  Google Scholar 

  • Rush AJ, Trivedi MH, Ibrahim HM et al (2003) The 16-Item Quick Inventory of Depressive Symptomatology (QIDS), clinician rating (QIDS-C), and self-report (QIDS-SR): a psychometric evaluation in patients with chronic major depression. Biol Psychiatry 54:573–583

    Article  PubMed  Google Scholar 

  • Rush AJ, Fava M, Wisniewski SR et al (2004) Sequenced treatment alternatives to relieve depression (STAR*D): rationale and design. Control Clin Trials 25:119–142

    Article  PubMed  Google Scholar 

  • Rush AJ, Zimmerman M, Wisniewski SR et al (2005) Comorbid psychiatric disorders in depressed outpatients: demographic and clinical features. J Affect Disord 87:43–55

    Article  PubMed  Google Scholar 

  • Schuch JJJ, Roest AM, Nolen WA et al (2014) Gender differences in major depressive disorder: results from the Netherlands study of depression and anxiety. J Affect Disord 156:156–163

    Article  PubMed  Google Scholar 

  • Schwarz GE (1978) Estimating the dimension of a model. Ann Stat 6:461–464

    Article  Google Scholar 

  • Silverstein B (2002) Gender differences in the prevalence of somatic versus pure depression: a replication. Am J Psychiatry 159:1051–1052

    Article  PubMed  Google Scholar 

  • Sinclair LI, Christmas DM, Hood SD et al (2009) Antidepressant-induced jitteriness/anxiety syndrome: systematic review. Br J Psychiatry 194:483–490

    Article  PubMed  Google Scholar 

  • Thomas KLH, Ellingrod VL (2009) Pharmacogenetics of selective serotonin reuptake inhibitors and associated adverse drug reactions. Pharmacotherapy 29:822–831

    Article  CAS  PubMed  Google Scholar 

  • Trivedi MH, Rush AJ, Wisniewski SR et al (2006) Evaluation of outcomes with citalopram for depression using measurement-based care in STAR*D: implications for clinical practice. Am J Psychiatry 163:28–40

    Article  PubMed  Google Scholar 

  • Ulbricht CM, Dumenci L, Rothschild AJ, Lapane KL (2015a) Changes in Depression Subtypes Among Men in STAR*D: A Latent Transition Analysis. Am J Mens Health.

  • Ulbricht CM, Rothschild AJ, Lapane KL (2015b) The association between latent depression subtypes and remission after treatment with citalopram: a latent class analysis with distal outcome. J Affect Disord 188:270–277

    Article  CAS  PubMed  Google Scholar 

  • Wisniewski SR, Rush AJ, Nierenberg AA et al (2009) Can phase III trial results of antidepressant medications be generalized to clinical practice? A STAR*D report. Am J Psychiatry 166:599–607

    Article  PubMed  Google Scholar 

  • Young EA, Kornstein SG, Marcus SM et al (2009) Sex differences in response to citalopram: a STAR*D report. J Psychiatr Res 43:503–511

    Article  PubMed  Google Scholar 

  • Zimmerman M (2002) The Psychiatric Diagnostic Screening Questionnaire Manual

  • Zimmerman M, Mattia JI (2001) A self-report scale to help make psychiatric diagnoses: the Psychiatric Diagnostic Screening Questionnaire. Arch Gen Psychiatry 58:787–794

    Article  CAS  PubMed  Google Scholar 

  • Zimmerman M, McGlinchey JB, Posternak MA et al (2006) Discordance between self-reported symptom severity and psychosocial functioning ratings in depressed outpatients: implications for how remission from depression should be defined. Psychiatry Res 141:185–191

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA

    Christine M. Ulbricht & Kate L. Lapane

  2. Department of Epidemiology and Biostatistics, Temple University College of Public Health, Philadelphia, PA, USA

    Levent Dumenci

  3. Department of Psychiatry, University of Massachusetts Medical School and UMassMemorial HealthCare, Worcester, MA, USA

    Anthony J. Rothschild

Authors
  1. Christine M. Ulbricht
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  2. Levent Dumenci
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  3. Anthony J. Rothschild
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  4. Kate L. Lapane
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Correspondence to Christine M. Ulbricht.

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Conflicts of interest

No competing financial interests exist for Drs. Dumenci and Ulbricht. Dr. Rothschild has received research support from St. Jude Medical, AssureRx, Alkermes, Janssen, and Takeda; has served as a consultant to AbbVie, Allergan, GlaxoSmithKline, Eli Lilly, OmniCare, and Pfizer; has received royalties from UpToDate, from UMass Medical School for the Rothschild Scale for Antidepressant Tachyphylaxis (RSAT)™, and from American Psychiatric Press, Inc. for Psychoneuroendocrinology: The Scientific Basis of Clinical Practice (2003), Clinical Manual for Diagnosis and Treatment of Psychotic Depression (2009), The Evidence-Based Guide to Antipsychotic Medications (2010), and The Evidence-Based Guide to Antidepressant Medications (2012). Dr. Lapane has received research support from Merck, Cubist, and the National Institutes of Health (Contract: HHSN268201000020C). She serves as a consultant to GlaxoSmithKline and Janssen.

Dr. Dumenci has received research support from the National Cancer Institute (5R01CA140151). Dr. Rothschild has received research support from the National Institute of Mental Health (5U01MH062624). Dr. Lapane has received support from the National Institute of Aging (1R21AG046839-01).

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Ulbricht, C.M., Dumenci, L., Rothschild, A.J. et al. Changes in depression subtypes for women during treatment with citalopram: a latent transition analysis. Arch Womens Ment Health 19, 769–778 (2016). https://doi.org/10.1007/s00737-016-0606-8

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  • DOI: https://doi.org/10.1007/s00737-016-0606-8

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