Clinical characteristics and treatment outcome in a representative sample of depressed inpatients - findings from the Munich Antidepressant Response Signature (MARS) project

J Psychiatr Res. 2009 Jan;43(3):215-29. doi: 10.1016/j.jpsychires.2008.05.002. Epub 2008 Jun 30.


Depression is a common and often difficult-to-treat clinical condition with a high rate of patients showing insufficient treatment response and persistence of symptoms. We report the characteristics of a representative sample of depressed inpatients participating in the Munich Antidepressant Response Signature (MARS) project. Eight hundred and forty-two inpatients admitted to a psychiatric hospital for treatment of a major depressive episode, recurrent or bipolar depression were thoroughly characterized with respect to demographic factors, clinical history, and the degree of HPA-axis dysregulation evaluated by means of combined dex/CRH tests, and the predictive value of these factors for treatment outcome is investigated. 80.8% of patients responded to treatment (i.e., improvement in symptom severity of at least 50%) and 57.9% reached remission (i.e., near absence of residual depressive symptoms) at discharge after a mean treatment period of 11.8 weeks. Regression analysis identified early partial response (within 2 weeks) as the most important positive predictor for achieving remission. Previous ineffective treatment trials in the current episode and presence of a migration background are potent negative predictors for treatment outcome. In addition, remitters were characterized by a more pronounced normalization of an initially dysregulated HPA-axis. We could show that a large majority of inpatients suffering from depression benefits from antidepressant treatment during hospitalization. However, a considerable number of patients failed to achieve remission. We demonstrated that this subgroup can be characterized by a set of demographic, clinical and neuroendocrine variables allowing to predict unfavorable outcome at an early stage of treatment.

Publication types

  • Clinical Trial

MeSH terms

  • Adrenocorticotropic Hormone / blood
  • Adult
  • Antidepressive Agents / therapeutic use*
  • Depressive Disorder / classification
  • Depressive Disorder / diagnosis
  • Depressive Disorder / drug therapy*
  • Female
  • Germany
  • Hospitals, Psychiatric*
  • Humans
  • Hydrocortisone / blood
  • Hypothalamo-Hypophyseal System / drug effects*
  • Hypothalamo-Hypophyseal System / metabolism
  • Inpatients / statistics & numerical data*
  • Male
  • Middle Aged
  • Pituitary-Adrenal System / drug effects*
  • Pituitary-Adrenal System / metabolism
  • Psychiatric Status Rating Scales / statistics & numerical data
  • Radioimmunoassay
  • Recurrence
  • Regression Analysis
  • Treatment Outcome


  • Antidepressive Agents
  • Adrenocorticotropic Hormone
  • Hydrocortisone