The Antidepressant Treatment Response (ATR) index, a biomarker developed in previous research, may be effective for identifying which patients with major depressive disorder (MDD) will gain remission with their antidepressant medication. Combining the ATR index with early changes in depression symptoms may enhance the accuracy of this identification, according to a study published in the Journal of Psychiatric Research.
In the Personalized Response Indicators of SSRI Effectiveness in Major Depression (PRISE-MD) trial, patients with unipolar MDD received single-blind escitalopram for 1 week to measure the ATR index biomarker. Participants were then randomly assigned to continue on either escitalopram (n=73) or switch to bupropion (n=56) for a remaining duration of 7 weeks. The randomization protocol was stratified based on high vs low ATR. The predefined primary endpoint was 7 weeks of continuous escitalopram. Additionally, the primary endpoint for the bupropion group was 7 weeks of continuous bupropion. Assessments included the Mini-International Neuropsychiatric Interview, Quick Inventory of Depressive Symptomatology, and the Hamilton Depression rating scale.
The remission rate was significantly higher in escitalopram-treated patients who had high vs low ATR index values (60.5% vs 30.0%, respectively; P =.010). Based on a cut-point of 46.2, the ATR biomarker predicted remission with a sensitivity of 74.3%, specificity of 55.3%, positive predictive value of 60.5%, negative predictive value of 70.0%, and overall accuracy of 64.4%.
The accuracy of the ATR index was enhanced when the researchers combined the biomarker with 1-week depressive symptom change compared to ATR alone (68.6% vs 28.9%, respectively; P =.003). Overall, this hybrid model comprising ATR and early change in depressive symptoms resulted in the correct prediction of remission chances in 68.6% of escitalopram-treated patients.
Limitations of the study included the lack of a placebo group, the single-center design, and the inclusion of a relatively small number of participants with MDD.
The investigators suggested that the ATR biomarker could improve patient care by identifying the likelihood of therapeutic success in patients with MDD and may “support [the] decision to change treatment after 1 week rather than after failing a full, multi-week course of medication.”
Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.
Cook IA, Hunter AM, Caudill MM, Abrams MJ, Leuchter AF. Prospective testing of a neurophysiologic biomarker for treatment decisions in major depressive disorder: the PRISE-MD trial. J Psychiatr Res. 2020;124:159-165.