Research report Response to antidepressants in major depressive disorder with melancholic features: the CRESCEND study Su-Jin Yang a , Robert Stewart b , Hee-Ju Kang a , Seon-Young Kim a , Kyung-Yeol Bae a , Jae-Min Kim a,n , Sung-Won Jung c , Min-Soo Lee d , Hyeon-Woo Yim e , Tae-Youn Jun f a Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea b King’s College London (Institute of Psychiatry), London, United Kingdom c Department of Psychiatry, Keimyung University, School of Medicine, Daegu, Republic of Korea d Department of Psychiatry, College of Medicine, Korea University, Seoul, Republic of Korea e Department of Preventive Medicine, Catholic University of Korea College of Medicine, Seoul, Republic of Korea f Department of Psychiatry, Catholic University of Korea College of Medicine, Seoul, Republic of Korea article info Article history: Received 22 February 2012 Received in revised form 1 June 2012 Accepted 2 June 2012 Available online 26 July 2012 Keywords: Depression Melancholia Antidepressants Response Korea abstract Background: This study aimed to determine whether major depressive disorders with melancholic and without melancholic features differ with respect to their responses to treatment with antidepressants. Methods: From a nationwide sample of 18 hospitals in South Korea, 559 presenting patients with major depressive disorder were recruited. The DSM-IV based Structured Clinical Interview was administered for confirmatory diagnoses and depression subtypes with/without melancholic features. After baseline evaluation, they received naturalistic clinician-determined antidepressant interventions. Assessment scales for evaluating depression (HAMD), anxiety (HAMA), global severity (CGI-s), and functioning (SOFAS) were administered at baseline and re-evaluated at 1, 2, 4, 8, and 12 weeks later. Results: At baseline, the 243 (43.5%) participants with melancholic features were more likely to have a previous history of depression, and had higher HAMA and lower SOFAS scores. After adjustment for baseline status, participants with melancholic features were more likely to achieve and to experience shorter times to CGI-s remission and associated with an enhanced global symptomatic remission with any antidepressant treatment. They were more likely to achieve and to experience shorter times to CGI- s remission and this difference was strongest in those receiving selective serotonin reuptake inhibitor (SSRI) antidepressants treatment. Limitations: The study was observational, and the treatment modality was naturalistic. Conclusions: These findings suggest a faster and more evident global response to pharmacotherapy in melancholia compared to other depressive syndromes, particularly where SSRI agents are used. & 2012 Elsevier B.V. All rights reserved. 1. Introduction Although the term ‘‘melancholia’’ dates back to Robert Burton’s 17th century work and earlier (Jackson, 1986), its use was declining in the latter half of the 20th century until it was readopted in 1980 by the authors of the Diagnostic and Statistical Manual of Mental Disorders, 3rd Edition (DSM-III) to describe a subtype of major depressive disorder (MDD). Although revised in DSM-III-R, the current DSM-IV ‘‘with melancholic features speci- fied’’ represents a return to the older definition (Zimmerman and Spitzer, 1989). According to DSM-IV criteria, the principal diagnostic feature exhibited by patients with melancholic depres- sion is a loss of pleasure in all, or almost all, activities or a lack of reactivity to usually pleasurable stimuli (American Psychiatric Association, 2000). Additional symptoms include distinctive qual- ity of mood, diurnal variation (depression worse in the morning), psychomotor disturbances, anorexia, excessive guilt, and early awakening from sleep. Today ‘melancholia’ is mainly used as a descriptive syndromal sub-category of major depressive episodes (MDE), as defined by DSM-IV-TR (American Psychiatric Association, 2000). In this respect, melancholia describes a more severe depressive syndrome with a longer duration, lower like- lihood of spontaneous remission, and poorer long-term outcome (American Psychiatric Association, 2000; Rush and Weissenburger, 1994; Thase, 2000; Zimmerman and Spitzer, 1989). The clinical relevance of melancholia in predicting treatment response to antidepressants has also been suggested. Early Contents lists available at SciVerse ScienceDirect journal homepage: www.elsevier.com/locate/jad Journal of Affective Disorders 0165-0327/$ - see front matter & 2012 Elsevier B.V. All rights reserved. http://dx.doi.org/10.1016/j.jad.2012.06.004 n Corresponding author at: Department of Psychiarty, Chonnam National University Medical School, Gwangju 501–757, Republic of Korea. Tel.: þ82 62 220 6143; fax: þ82 62 2252351. E-mail address: jmkim@chonnam.ac.kr (J.-M. Kim). Journal of Affective Disorders 144 (2013) 42–50