Each of these is discussed separately below. Early changes in depressive symptoms The average time to response in treatment with a prototypical SSRI is 1 month, and to remission is 6 weeks.5 While some patients continue to enter remission up to 12 weeks or even longer after the initiation of treatment, the time to symptomatic improvement is much shorter. Many patients, particularly those with milder symptoms, show improvement (defined by at least a 20% decrease in depressive symptoms) within the first 2 weeks of treatment.68-71 Although some have suggested that early response is likely

Inhibitors,research,lifescience,medical to represent a placebo response,72,73 early response is in fact twice as likely with medication as with Inhibitors,research,lifescience,medical placebo.71 The largest meta-analytic study of this topic was performed by Szegedi and colleagues,74 who examined 6562 subjects treated primarily with mirtazepine, but also with SSRIs, tricyclic antidepressants (TCAs), and venlafaxine. These investigators found that more than 50% of patients had at least a 20% improvement in depression rating scores by the end of 2 weeks of treatment. Of those who did not show early improvement, only 11% and 4.1% showed eventual response and remission,

Inhibitors,research,lifescience,medical respectively. Early improvement was a highly sensitive predictor of stable response (81% to 98%) or stable remission (87% to 100%), and so was a positive prognostic sign. However, the usefulness of early symptom improvement was limited by the poor specificity for stable response (43% to 60%) or remission (19% to 28%). Inhibitors,research,lifescience,medical The results of all of these studies are difficult to evaluate because they come from placebo-controlled treatment trials

Inhibitors,research,lifescience,medical of selected study populations. It is clear that early symptom improvement is a positive prognostic sign, and the absence of early improvement is a negative prognostic sign. The poor specificity of the finding, however, makes it difficult to make treatment decisions based solely upon early symptom improvement; absence of early improvement by itself is insufficiently powerful evidence to prompt a change in treatment. It is possible that early symptom changes could form part of the basis for REs to reliably predict response and remission to the specific medication that from the patient receives within the first 2 weeks of treatment. Early changes in brain electrical activity One biomarker that has shown promise as a predictor of treatment response is quantitative electroencephalography (QEEG). Prefrontal QEEG power75-77 may Alvespimycin order identify patients who are most likely to respond to all major antidepressant medication classes. Research has shown that QEEG changes in the prefrontal region may reliably identify antidepressant medication responders within the first 48 hours to 1 week of treatment.