The clinical effectiveness of using a predictive algorithm to guide antidepressant treatment in primary care (PReDicT): an open-label, randomised controlled trial

Depressed patients often do not respond to the first antidepressant prescribed, resulting in sequential trials of different medications. Personalised medicine offers a means of reducing this delay; however, the clinical effectiveness of personalised approaches to antidepressant treatment has not pre...

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Published in:Neuropsychopharmacology Vol. 46; no. 7; pp. 1307 - 1314
Main Authors: Browning, Michael, Bilderbeck, Amy C, Dias, Rebecca, Dourish, Colin T, Kingslake, Jonathan, Deckert, Jürgen, Goodwin, Guy M, Gorwood, Philip, Guo, Boliang, Harmer, Catherine J, Morriss, Richard, Reif, Andreas, Ruhe, Henricus G, van Schaik, Anneke, Simon, Judit, Sola, Victor Perez, Veltman, Dick J, Elices, Matilde, Lever, Anne G, Menke, Andreas, Scanferla, Elisabetta, Stäblein, Michael, Dawson, Gerard R
Format: Journal Article
Language:English
Published: England Nature Publishing Group 01.06.2021
Subjects:
Algorithms
Antidepressants
Anxiety
Clinical trials
Cognition
Human health and pathology
Life Sciences
Mental depression
Patients
Precision medicine
ISSN:0893-133X, 1740-634X, 1740-634X, 0007-0920
Online Access:Get full text
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Summary:Depressed patients often do not respond to the first antidepressant prescribed, resulting in sequential trials of different medications. Personalised medicine offers a means of reducing this delay; however, the clinical effectiveness of personalised approaches to antidepressant treatment has not previously been tested. We assessed the clinical effectiveness of using a predictive algorithm, based on behavioural tests of affective cognition and subjective symptoms, to guide antidepressant treatment. We conducted a multicentre, open-label, randomised controlled trial in 913 medication-free depressed patients. Patients were randomly assigned to have their antidepressant treatment guided by a predictive algorithm or treatment as usual (TaU). The primary outcome was the response of depression symptoms, defined as a 50% or greater reduction in baseline score of the QIDS-SR-16 scale, at week 8. Additional prespecified outcomes included symptoms of anxiety at week 8, and symptoms of depression and functional outcome at weeks 8, 24 and 48. The response rate of depressive symptoms at week 8 in the PReDicT (55.9%) and TaU (51.8%) arms did not differ significantly (odds ratio: 1.18 (95% CI: 0.89-1.56), P = 0.25). However, there was a significantly greater reduction of anxiety in week 8 and a greater improvement in functional outcome at week 24 in the PReDicT arm. Use of the PReDicT test did not increase the rate of response to antidepressant treatment estimated by depressive symptoms but did improve symptoms of anxiety at week 8 and functional outcome at week 24. Our findings indicate that personalisation of antidepressant treatment may improve outcomes in depressed patients.
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PMCID: PMC8134561
ISSN:0893-133X
1740-634X
1740-634X
0007-0920
DOI:10.1038/s41386-021-00981-z