Sex differences in the prediction of the effectiveness of paroxetine for patients with major depressive disorder identified using a receiver operating characteristic curve analysis for early response

Abstract

Background: We investigated cutoff values for the early response of patients with major depressive disorder to paroxetine and their sex differences by using a receiver operating characteristic (ROC) curve analysis to predict the effectiveness of paroxetine.

Methods: In total, 120 patients with major depressive disorder were enrolled and treated with 10-40 mg/day paroxetine for 6 weeks; 89 patients completed the protocol. A clinical evaluation using the Montgomery-Asberg Depression Rating Scale (MADRS) was performed at weeks 0, 1, 2, 4, and 6.

Results: In male subjects, the cutoff values for MADRS improvement rating in week 1, week 2, and week 4 were 20.9%, 34.9%, and 33.3%, respectively. The sensitivities and the specificities were 83.3% and 80.0%, 83.3% and 80.0%, and 100% and 90%, respectively. The areas under the curve (AUC) were 0.908, 0.821, and 0.979, respectively. In female subjects, the cutoff values for the MADRS improvement rating in week 1, week 2, and week 4 were 21.4%, 35.7%, and 32.3%, respectively. The sensitivities and the specificities were 71.4% and 84.6%, 73.8% and 76.9%, and 90.5% and 76.9%, respectively. The AUCs were 0.781, 0.735, and 0.904, respectively.

Conclusion: Early improvement with paroxetine may predict the long-term response. The accuracy of the prediction for the response is higher in male subjects.

Keywords: antidepressants; early response; paroxetine; receiver operating characteristic curve analysis; sex differences.

Figure 1

ROC curves for all subjects. Notes: ROC curves for the response at weeks 1, 2, and 4 for all subjects to determine the cutoff points for the MADRS improvement rating. The circles show the ROC curve for week 1 (AUC =0.829), the triangles show the ROC curve for week 2 (AUC =0.764), and the squares show the ROC curve for week 4 (AUC =0.932). Abbreviations: ROC, receiver operating characteristic; MADRS, Montgomery–Asberg Depression Rating Scale; AUC, area under curve.

Figure 2

ROC curves in male subjects. Notes: ROC curves for response at weeks 1, 2, and 4 in the male subjects to determine the cutoff points for the MADRS improvement rating. The circles show the ROC curve for week 1 (AUC =0.908), the triangles show the ROC curve for week 2 (AUC =0.821), and the squares show the ROC curve for week 4 (AUC =0.979). Abbreviations: ROC, receiver operating characteristic; MADRS, Montgomery-Asberg Depression Rating Scale; AUC, area under curve.

Figure 3

ROC curves in female subjects. Notes: ROC curves for response at weeks 1, 2, and 4 in the female subjects to determine the cutoff points for the MADRS improvement rate. The circles show the ROC curve for week 1 (AUC =0.781), the triangles show the ROC curve for week 2 (AUC =0.735), and the squares show the ROC curve for week 4 (AUC =0.904). Abbreviations: ROC, receiver operating characteristic; MADRS, Montgomery-Asberg Depression Rating Scale; AUC, area under curve.