Clinical milestones predict symptom remission over 6-month and choice of treatment of patients with major depressive disorder (MDD)

Background: It is uncertain as to what short-term outcomes predict long-term treatment compliance and outcomes in patients with MDD. Aims: To determine what treatment milestones predict symptom remission with long-term treatment with antidepressant medication. Method: Pooled analysis of four randomised, double-blind, active comparator, 6-month trials in MDD. Results: Patients received double-blind treatment with escitalopram (N = 699) or a comparator (citalopram, duloxetine, or paroxetine) (N = 699). Onset of effect at week 2 was correlated with response at week 8, and response at week 8 with completion of 6-month treatment. Week 8 response was associated with a greater probability of achieving later remission. Week 24 remission (MADRS ≥ 10) was significantly (p < 0.01) higher for patients treated with escitalopram (70.7%) than for the pooled comparators (64.7%). Week 24 complete remission (MADRS ≤ 5) was significantly (p < 0.01) higher for escitalopram (51.7%) than for the pooled comparators (45.6%). Fewer patients discontinued treatment with escitalopram (15.9%) than with the pooled comparators (23.9%) (p < 0.001). Conclusion: A higher probability of achieving remission is associated with responding after 8 weeks and with completing 6 months of treatment.