Age at onset of first depressive episode as a predictor for escitalopram treatment of major depression comorbid with alcohol dependence

The aim of this study was to determine predictors of the response to escitalopram, a selective serotonin re-uptake inhibitor antidepressant and memantine, a non-competitive glutamate NMDA receptor blocker, for the treatment of major depression comorbid with alcohol dependence. Eighty alcohol dependent treatment-seeking adult patients with comorbid major depressive disorder were randomized to receive either memantine 20 mg or escitalopram 20 mg for 26 weeks. In both treatment groups, depression was reduced significantly. Comparisons were made between patients in remission (final Montgomery-Åsberg Depression Rating Scale (MADRS) ≤ 12) and non-responding patients (MADRS decrease < 50%). The age at onset of the first major depressive episode significantly correlated with the treatment response in the escitalopram group; the mean age at onset of depression among patients on the non-responders group was 13.7 ± 4.0 years and 31.9 ± 11.9 years in remission. These results are significantly different from those with memantine. Our study provides evidence that the onset of the first major depressive episode might be a clinically relevant predictor of a response to escitalopram treatment in patients with major depression and comorbid alcohol dependence.