Outcomes of 1014 naturalistically treated inpatients with major depressive episode

Received 5 March 2009; received in revised form 6 November 2009; accepted 26 November 2009. published online 25 January 2010.

Abstract

Due to strict exclusion criteria the generalizability of randomized controlled trials appears to be limited. Therefore, outcomes of naturalistically treated depressive inpatients with respect to depression mean scores, response and remission rates were evaluated. This was a multicenter trial, conducted in 12 psychiatric hospitals in Germany with a follow-up period of 4years. Patients were assessed biweekly from admission to discharge with diverse psychopathological rating scales. All patients (n=1014) met DSM-IV criteria for major depressive episode. Results are presented only for the acute inpatient treatment period. Mean inpatient treatment duration was 53.6±47.5days. Reduction on depression scales was evident as soon as week 2 and remained significant. Mean HAMD-17 total score decreased from 22.3 to 8.8. A total of 68.9% were classified as responders (≥50% reduction of the initial HAMD-17 score), whereas 51.9% achieved remission (HAMD-17 total score≤7). Of those who ultimately achieved response more than 40% did so within the first 2weeks. An individualized naturalistic inpatient treatment approach appears to be beneficial in terms of effectiveness.

Keywords: Depression, Inpatient, Outcome

a Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University Munich, Nussbaumstrasse 7, 80336 Munich, Germany

b Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Dresden, Technical University Dresden, Fetscherstr. 74, 01307 Dresden, Germany

c Department of Psychiatry and Psychotherapy, Campus, Charité Mitte (CCM), Charitéplatz 1, 10117 Berlin, Germany

d Department of Psychiatry and Psychotherapy, University of Heidelberg, Voßstr. 2, 69115 Heidelberg, Germany

e Department of Psychiatry and Psychotherapy, Max Planck Institute of Psychiatry, Kraepelinstr. 2-7, 80804 Munich, Germany

f Department of Psychiatry and Psychotherapy, Martin-Luther University Halle-Wittenberg, Julius-Kühn-Str.7, 06097 Halle, Germany

g Department of Psychiatry and Psychotherapy, Inn-Salzach-Klinikum, Garbersee 7, 83512 Wasserburg, Germany

h Department of Psychiatry and Psychotherapy, Isar-Amper-Klinikum Munich East, Vockestr. 72, 85540 Haar, Germany

i Department of Psychiatry and Psychotherapy, Campus Charité Benjamin Franklin (CFB), Eschenallee 3, 14050 Berlin, Germany

j Department of Psychiatry and Psychotherapy, Auguste-Viktoria-Krankenhaus, Rubensstr. 125, 12157 Berlin, Germany

k Department of Psychiatry and Psychotherapy, University of Düsseldorf, Bergische Landstr. 2, 40629 Düsseldorf, Germany

Corresponding author. Department of Psychiatry, Ludwig-Maximilians-University, Nussbaumstr. 7, 80336 Munich, Germany. Tel.: +49 89 5160 5846; fax: +49 89 5160 5774.

PII: S0924-977X(09)00276-4

doi:10.1016/j.euroneuro.2009.11.011

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