Short-Term Spontaneous Improvement Rates in Depressed Outpatients

Abstract

The objectives of the present report were: a) to determine the spontaneous remission rate in depressed outpatients who do not receive antidepressant medication; b) to develop a novel method for obtaining a control group that can be used to gauge the effectiveness of antidepressant medication in clinical practice; and c) to compare response rates from the present sample with outcomes of depressed patients in our practice who were treated with antidepressant medications. By using a naturalistic design, prospective assessments were made on all depressed outpatients. Twenty-five patients who met full criteria for a major depressive episode ended up not taking antidepressant medication for a variety of reasons. "Response" rates to a no-treatment trial were determined with standard outcome criteria using the Clinical Global Impression-Improvement scale. Eight patients (32.0%) had a positive response, 5 patients (20.0%) had a partial response, and 12 patients (48.0%) were nonresponders to a no-treatment trial. These response rates were higher than expected, but significantly lower than what we had found in a cohort of depressed patients who underwent an antidepressant trial (p = .02). Likewise, treatment-resistant patients fared better on pharmacotherapy, though this difference was not statistically significant. These results suggest that the occurrence of spontaneous remissions may be common in clinical practice, and therefore the specific short-term benefits of antidepressant medication in clinical practice may frequently be overestimated. Despite the high rate of spontaneous remission in our sample, the present study allowed us to confirm the effectiveness of antidepressant medication in clinical practice using a novel method for obtaining a control comparison group.

Empirical Testing of Two Models for Staging Antidepressant Treatment Resistance

“…In fact, at end point, almost one-third of the original sample was receiving treatment with an augmentation strategy. The response and remission rates observed in our study are in accordance with response rates from a number of other naturalistic studies of MDD [15][16][17][18][19] and support the notion that improvement with residual symptoms is the most common outcome among MDD patients treated in outpatient settings. Cuffel et al, 19 for instance, reported a 27% to 39% remission rate among 1859 MDD outpatients during a 3-year period in the national provider network of a managed behavioral health organization.…”

“…17,[21][22][23][24][25][26] Without such measures, we are unable to determine where change in symptoms occurred (eg, sleep, mood, etc.). Similarly, no formal measures of medication adherence were used.…”

A Description of Next-Step Switching Versus Augmentation Practices for Outpatients with Treatment-Resistant Major Depressive Disorder Enrolled in an Academic Specialty Clinic

“…Although commonly used as the primary outcome measure in other naturalistic studies and chart reviews (9,(10)(11)(12)(13)(14), and recently reported as a sensitive measure of early global improvement in clinical trials (15), the CGI certainly does not assess specific symptom change as do measures used in other clinical trials (e.g., Hamilton Depression Rating Scale; 16). Without the consistent use among clinicians of more sensitive measures, we are unable to determine where change in symptoms occurred (e.g., sleep, mood, etc.).…”

The Naturalistic Course of Unipolar Major Depression in the Absence of Somatic Therapy

“…Outcomes of subjects who enrolled in a treatment trial and were randomized to a waiting list provide perhaps the most valid insight we have into the naturalistic course of depression, and a meta-analysis of such studies was conducted by one of the authors (Posternak and Miller, 2001). Another study we conducted (Posternak and Zimmerman, 2001) evaluated outcomes of a cohort of depressed patients who presented for treatment but who ended up not receiving antidepressant therapy for a variety of reasons (e.g., never filled prescription, intolerable side effects). Both studies were limited by modest sample sizes (N ϭ 76 and N ϭ 25, respectively) and their results are, of course, generalizable only to treatment-seeking subjects.…”