Is partial response good enough?
In order to help address partial response, many patients with MDD need more than an antidepressant alone
In the STAR*D study, >4 OUT OF 5 patients continued to have a partial response after their second antidepressant treatment1,a
Despite evidence supporting appropriate use, adjunctive atypical antipsychotics were prescribed late in the MDD treatment journey2
A chart review study showed that a patient may undergo ~5 TREATMENT CHANGES before being prescribed an adjunctive atypical antipsychotic2
Continuous antidepressant treatment changes may affect response rates
In the STAR*D study, rates of response decreased with each additional switch in antidepressant treatment (48.6% in Step 1 to 16.3% in Step 4)1
Patients struggling with partial response on an antidepressant may continue to experience some of these symptoms
MÅDRS clinician-rated symptoms3:
- Apparent sadness
- Reported sadness
- Inability to feel
- Inner tension
- Reduced appetite
- Reduced sleep
- Concentration difficulties
- Pessimistic thoughts
- Suicidal thoughts
Atypical antipsychotics may increase response rates for patients
According to a meta-analysis,
The chance of response doubled in patients treated with adjunctive atypical antipsychotics vs antidepressant treatments alone (odds ratio=1.68)4,b
aAs demonstrated in almost 3700 adult patients with MDD who were prescribed antidepressants. In the STAR*D study, partial response was defined as a less-than-50% reduction from treatment step entry in Quick Inventory of Depressive Symptomatology Self-Report score at 12-14 weeks. The patient sample received successive acute treatment steps: 3671 patients entered at Step 1; 1439 patients continued at Step 2; 390 patients proceeded to Step 3; 123 patients advanced through all 4 steps. After SSRI monotherapy in Step 1, treatment options included switching medications or augmentation with either medication or cognitive therapy. Adjunctive atypical antipsychotics were not included at any step. Patients who either did not achieve response with a treatment or were unable to tolerate a treatment were encouraged to move to the next step.1
bIn a meta-analysis, response was defined as a 50% improvement from baseline to endpoint on either the MÅDRS or HAM-D17. Meta-analysis included 17 randomized trials with 3807 patients (duration range: 4-12 weeks) comparing adjunctive antipsychotic treatment to SSRI/SNRI treatment in adult patients (age range: 18-65 years) with MDD. There was a 68% greater chance of response from the antidepressant + adjunctive antipsychotic group vs the antidepressant + placebo group.4
HAM-D17, 17-item Hamilton Depression Rating Scale; MÅDRS, Montgomery-Åsberg Depression Rating Scale; MDD, major depressive disorder; SNRI, serotonin and norepinephrine reuptake inhibitor; SSRI, selective serotonin reuptake inhibitor; STAR*D, Sequenced Treatment Alternatives to Relieve Depression.
Watch Dr. Jain discuss the prevalence of partial response
in MDD and considerations for addressing it
Rakesh Jain, MD, MPH
Department of Psychiatry
Texas Tech University School of Medicine
The presenter is a paid consultant of Otsuka America Pharmaceutical, Inc. and Lundbeck.
Review treatment history data for patients with MDD experiencing partial response to antidepressants, and learn about REXULTI as an adjunctive treatment option.