Overall early improvement in depression after commencement of antidepressant treatment could be associated with subsequent response or remission, but its predictive ability is not adequate. We aimed to investigate whether early improvement of individual depressive symptoms and important baseline characteristics of patients including the number of previous depressive episodes and the duration of index episode, better predicts response or remission. We requested pharmaceutical companies in Japan for individual patient data from randomized placebo-controlled trials focusing on the efficacy of second-generation antidepressants. Primary and secondary outcomes were response and remission at week 6, respectively. We compared models that only included improvement in the overall depression severity at week 2 with models that also included improvement in individual symptoms and baseline characteristics, by conducting an individual patient data meta-analysis. We obtained data from three trials comprising 997 participants. For the response outcome, the model incorporating individual symptoms and baseline characteristics demonstrated better predictive values than those in the model including early improvement in overall depression only. However, the area under the receiver operating characteristic curve, and positive and negative predictive values were 0.65, 0.70, and 0.64, respectively, suggesting that 30% and 36% of the participants still had false-negative and false-positive predictions, respectively. For the remission outcome, the corresponding values in the latter model were 0.72, 0.62, and 0.68, respectively. We suggest that clinical judgement on early discontinuation of antidepressant from non-early improvement at week 2 should be carefully made.

中文翻译：

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通过早期改善合并了患者基线特征的抑郁症个体症状来预测抗抑郁药反应：一项个体患者数据荟萃分析。

开始抗抑郁治疗后，抑郁症的总体早期改善可能与随后的缓解或缓解有关，但其预测能力不足。我们旨在调查个体抑郁症状的早期改善以及患者的重要基线特征（包括先前抑郁发作的次数和指数发作的持续时间）是否能更好地预测反应或缓解。我们要求日本的制药公司从随机安慰剂对照试验中获取有关第二代抗抑郁药疗效的个体患者数据。主要和次要结果分别是第6周的缓解和缓解。通过进行单个患者数据的荟萃分析，我们比较了仅包括第2周总体抑郁严重程度改善的模型与还包括个体症状和基线特征改善的模型。我们从包括997名参与者的三项试验中获得了数据。对于反应结果，包含个体症状和基线特征的模型比仅包括总体抑郁的早期改善的模型具有更好的预测价值。但是，接收器工作特性曲线下方的区域以及正和负的预测值分别为0.65、0.70和0.64，这表明30％和36％的参与者仍分别具有假阴性和假阳性预测。对于缓解结果，后一种模型中的相应值分别为0.72、0.62和0.68。我们建议应谨慎做出关于在第2周从非早期改善中早期停用抗抑郁药的临床判断。