DOES THE CHRONOLOGICAL RELATIONSHIP BETWEEN THE ONSET OF DYSTHYMIA AND MAJOR DEPRESSION INFLUENCE SUBSEQUENT RESPONSE TO ANTIDEPRESSANTS

Objective: To determine whether the chronological relationship between the onset of dysthymia and the onset of the first major depression in fluences treatment outcome in patients with double depression (DD). Me thod: Clinical and outcome measures previously collected in 77 consecu tive outpatients who presented with major depression and who had pre-e xisting dysthymia (i.e. DD) were reviewed for the current retrospectiv e analysis. Subjects had been administered the Schedule for Affective Disorders and Schizophrenia, Lifetime Version (SADS-LV), and the Hamil ton Rating Scale for Depression (HAM-D) prior to open antidepressant t reatment and after 5 and 12 weeks of therapy. Response was defined as a 50% decline in HAM-D to score +/-8. Subjects were divided into those with the onset of dysthymia before the first major depression (DysB; n = 47), onset of dysthymia after major depression (DysA; n = 12) and those with onset of both condition within 2 years of each other (INDIS T; 12 = 18). Results: There were no significant differences between th ese three groups in baseline HAM-D. However, DysA subjects had signifi cantly higher mean HAM-D scores than the DysB subjects at week 5 and t he INDIST subjects at week 12. Response rates at week 12 were lower in subjects with DysA (33%) as compared with DysB (57%; Fisher's exact t est, P = 0.06) and INDIST (78%; Fisher's Exact test P = 0.02). Conclus ions: These findings suggest that the onset of the first episode of dy sthymia after the first major depressive episode (i.e. DysA) may adver sely affect response to subsequent treatments in patients with DD. (C) 1998 Elsevier Science B.V.