Depression can be viewed as a network of depressive symptoms that tend to reinforce each other via feedback loops. Specific symptoms of depression may be differently responsive to
antidepressant treatment, and some symptoms may be more important than others in the overall improvement of depression associated with treatment. We pooled prospective data from eight industry-sponsored placebo-controlled trials for
paroxetine,
fluoxetine and
imipramine (total n = 3559) to examine whether improvements in specific depressive symptoms were more strongly related to improvements in other depressive symptoms among patients on active
antidepressant treatment as compared to placebo. Depressive symptoms were assessed with the 17-item Hamilton Depression Rating Scale. Data on treatment was dichotomized into active treatment (receiving any
antidepressant agent) vs. placebo. Time-lagged longitudinal analyses suggested that improvement in three symptoms-depressed mood,
insomnia, and suicidality-had a broader overall impact on subsequent improvement in other depressive symptoms in the
antidepressant condition compared to placebo (i.e., greater out-strength). Moreover, improvements in depressed mood and
insomnia were more likely to follow the improvements in other symptoms in the
antidepressant condition compared to placebo (i.e., greater in-strength). These results from clinical trial data suggest that depressed mood,
insomnia, and suicidality may be particularly important in accounting for the remission and recovery in response to
antidepressant treatment.