MIDAS Project Publication Abstracts
Posternak, M.A., Zimmerman, M. Short-term spontaneous improvement rates
in depressed outpatients. Journal of Nervous and Mental Disease, in
press.
The objectives of the present report were to: 1). To determine
the spontaneous remission rate in depressed outpatients who do not receive
antidepressant medication. 2). To develop a novel method for obtaining a
control group which can be used to gauge the effectiveness of
antidepressant medication in clinical practice, and 3). To compare
response rates from the present sample with outcomes of depressed patients
in our practice who were treated with antidepressant medications. 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.
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