Brief report A short duration of untreated illness (DUI) improves response outcomes in first-depressive episodes Javier de Diego-Adeliño ⁎, Maria J. Portella, Dolors Puigdemont, Rosario Pérez-Egea, Enric Álvarez, Víctor Pérez Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (UAB), Barcelona, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Spain article info abstract Article history: Received 16 January 2009 Received in revised form 12 March 2009 Accepted 12 March 2009 Available online 5 April 2009 Background: Few studies have addressed the implication of the duration of untreated illness (DUI) on the clinical outcome of mood disorders. Although not focusing on DUI, previous findings suggest that the longer it takes to start appropriate treatment, the worse will be the evolution of depressive disorder. We sought to determine the effect of the duration of untreated episode (DUE) on 1) rates of response to treatment, 2) time to attain a sustained response and 3) rates of remission of MDD, dealing specially with first-depressive episodes. Methods: 141 patients with MDD were grouped into long DUE (N 8 weeks) and short DUE (≤8). Statistical analyses were performed to determine differences in outcome variables. The same analyses were repeated by splitting the sample between first-episode and recurrent depression. Results: The percentage of patients who achieved a sustained response was significantly higher in the group with a short DUE [OR = 2.6; 95% CI 1.3–5.1]. Survival analyses showed that patients with a long DUE delayed longer time to attain a sustained response [39 vs. 20 days, p = 0.012]. Once the sample was split, these results were even more pronounced in the subsample of first- depressive episode patients. Limitations: Given that the sample was originally recruited for two clinical trials, the follow-up period of this study is only six weeks long. Conclusions: Our results indicate that response to antidepressant treatments is faster when the no-treatment interval is reduced. The earliest treatment of first-depressive episodes seems to be crucial since a shorter duration of untreated illness implies better response outcomes. © 2009 Elsevier B.V. All rights reserved. Keywords: Duration of untreated illness (DUI) Major depressive disorder (MDD) First episode Remission Response 1. Introduction In the last two decades, the duration of untreated illness (DUI) has been considered to have implications on the clinical outcome and on the course of different psychiatric disorders, mainly in schizophrenia and psychotic disorders (Barnes et al., 2008; Melle et al., 2008; Marshall et al., 2005; Perkins et al., 2005). However, only a few studies have focused on the possible role of the DUI on the clinical outcome and course of mood disorders (Altamura et al., 2007, 2008; Goldberg and Ernst, 2002). Recently, Altamura et al. (2007, 2008) performed two studies based on different patients' samples with recurrent depression and showed that a DUI longer than 12 months involved poorer outcomes. However, the most robust associa- tion found by these authors was an earlier age of onset, which could have acted as a confusing variable. Although not focusing strictly on DUI, previous studies had reported that a longer no- treatment interval in a given depressive episode entailed higher risk of chronicity (Scott et al., 1992; Gormley et al., 1999) while others failed to found such association (Furukawa et al., 2000). Hence, it seems clear that the longer it takes to start appropriate treatment, the worse will be the evolution of the disorder. In any case, little is known about this effect on the early stages of the illness, and in particular, on the first-depressive episode. Journal of Affective Disorders 120 (2010) 221–225 ⁎ Corresponding author. Tel.: +34 932919472; fax: +34 932919399. E-mail address: fdiego@santpau.cat (J. de Diego-Adeliño). 0165-0327/$ – see front matter © 2009 Elsevier B.V. All rights reserved. doi:10.1016/j.jad.2009.03.012 Contents lists available at ScienceDirect Journal of Affective Disorders journal homepage: www.elsevier.com/locate/jad