Predictors of Drug Response in Depression

doi:10.1001/archpsyc.1989.01810010091014

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Vol. 46 No. 1, January 1989

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Predictors of Drug Response in Depression

Peter R. Joyce, MB, ChB, FRANZCP; Eugene S. Paykel, MA, MD, FRCPsych, FRCP

Arch Gen Psychiatry. 1989;46(1):89-99.

Abstract

• Although the major classes of antidepressant drugs havebeen available for over 30 years, clinicians are still unableto predict accurately the response of their depressed patientsto medication. This article reviews both clinical and biologicpredictors of treatment response and makes recommendations forfuture studies. The tricyclic antidepressants remain the drugsof choice in major depressive disorders. Lithium has a placein bipolar depressions. Monoamine oxidase inhibitors have arole in depressions accompanied by marked anxiety and/or panicsymptoms, in patients who have previously responded to them,and as a second-choice treatment in those depressed patientswho have not responded to tricyclic antidepressants. Electroconvulsivetherapy or additional antipsychotic drugs are frequently necessaryin very severe and delusional depressions. Biologic predictorsof response, despite some interesting leads that may in thelong term be of considerable importance, are not yet sufficientlyestablished to be of routine clinical usefulness, although eitherdexamethasone nonsuppression or a shortened rapid eye movementlatency may identify depressed patients who require biologictreatment.

Author Affiliations

From the University Department of Psychological Medicine, Christchurch (New Zealand) School of Medicine, Sunnyside Hospital (Dr Joyce); and Department of Psychiatry, University of Cambridge (England), Addenbrooke's Hospital (Dr Paykel).

Footnotes

Accepted for publication April 15, 1988.

Reprint requests to University Department of Psychological Medicine,Christchurch School of Medicine, Sunnyside Hospital, Christchurch,New Zealand (Dr Joyce).

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