Overview
The primary purpose of this study is to compare the short (12 week) and long-term (1-year) efficacy and the tolerability between stepwise psychopharmacotherapy and antidepressant monotherapy for 12 weeks in adult patients with major depressive disorders, stratified by the multimodal serum biomarker scores.
Description
This is prospective randomized controlled trials (RCT) to evaluate clinical impact of antidepressant monotherapy vs stepwise psychopharmacotherapy in patients with major depressive disorders, stratified by multimodal serum biomarker scores. Participants will be predicted treatment response based on the multimodal serum biomarker scores at baseline, will be categorized into good and poor treatment responders and then randomly assigned to two groups: stepwise pharmacotherapy group and antidepressant monotherapy group. The hypothesis is that in the good treatment responder, the depression remission will be achieved irrespective of treatment modality (stepwise pharmacotherapy or antidepressant monotherapy) group while in poor treatment responders, the treatment response of stepwise pharmacotherapy will be superior to those of antidepressant monotherapy.
Eligibility
Inclusion Criteria:
- 19 to 65 years
- Diagnostic and Statistical Manual of Mental Disorders-IV criteria for major depressive disorder by study psychiatrists
- Scoreā„17 on Hamilton Depression Rating Scale-17
- With ability to understand the objective of the study and sign informed consent
- Initiation of an antidepressant treatment for the current episode or no psychotropics excluding sleep pills or benzodiazepines within 1 month of participation
Exclusion Criteria:
- Current or lifetime diagnosis of bipolar disorder, schizophrenia, schizoaffective disorder, schizophreniform disorder, psychotic disorder not otherwise specified, or other psychotic disorders
- current major depressive disorder with psychotic features
- History of organic psychosis, epilepsy, or seizure disorder
- Current anorexia nervosa or obsessive compulsive disorder
- Unstable or uncontrolled medical condition
- Unable to complete the psychiatric assessment or comply with the medication regimen due to a severe physical illness
- History of anticonvulsant treatment
- Electroconvulsive therapy for the current depressive episode
- Hospitalization for any psychiatric diagnosis except depressive disorder (e.g., alcohol/drug dependence)
- severly high risk of suicide, self-harm or homicide by investigator's assessment
- Pregnant or breastfeeding
- lack of treatment information on the current depressive episode