Major depressive disorder (MDD) with psychotic features, also known as psychotic depression, accounts for approximately 17 percent of MDD cases in the community. Compared with non-psychotic depression, psychotic depression is associated with a longer recovery time and increased rates of relapse and recurrence, hospitalization, suicide attempts, completed suicide, and all-cause mortality.
The combination of an antidepressant and an antipsychotic is shown to be more effective than either drug class alone in the acute treatment of psychotic depression. However, there is an absence of data on predictors of remission of psychotic depression treated with combination pharmacotherapy.
To address this gap, Emily Carter, research assistant in population health sciences, Dr. Samprit Banerjee, associate professor of population health sciences, and colleagues published a study in the Journal of Affective Disorders. The study used machine learning approaches to identify sociodemographic and clinical predictors of remission of psychotic depression treated with combination pharmacotherapy.
Researchers evaluated 74 baseline sociodemographic and clinical variables from 269 participants aged 18 to 85 years with psychotic depression who were acutely treated with protocolized sertraline plus olanzapine, a form of combination pharmacotherapy, for up to 12 weeks.
The multivariate models had 65 to 67 percent accuracy in predicting remission of psychotic depression. Researchers found that longer duration of depressive episodes, somatic or tactile hallucinations, higher cumulative burden of physical comorbidity, and single or divorced marital status were independent predictors of longer time to remission of psychotic depression treated with combination pharmacotherapy. A higher number of lifetime depressive episodes and peripheral vascular or cardiovascular disease were predictors of a shorter time to remission.
Many of these factors are consistent predictors of worse treatment outcomes of MDD. These findings now extend to psychotic depression. Results support a novel finding regarding somatic or tactile hallucinations as a marker of poorer treatment response in psychotic depression.
Future research should examine predictors of differential treatment response and whether models that include measures of brain structure and function, as well as peripheral and digital biomarkers, can improve the accuracy of prediction of remission. Future research may also examine predictors of differential treatment response, namely one type of combination therapy versus another, or pharmacotherapy versus electroconvulsive therapy.
- Highlights