Response trajectories during escitalopram treatment of patients with major depressive disorder

Depression is a leading global cause of disability, yet about half of patients do not respond to initial antidepressant treatment. This treatment difficulty may be in part due to the heterogeneity of depression and corresponding response to treatment. Unsupervised machine learning allows underlying patterns to be uncovered, and can be used to understand this heterogeneity by finding groups of patients with similar response trajectories. Prior studies attempting this have clustered patients using a narrow range of data primarily from depression scales. In this work, we used unsupervised machine learning to cluster patients receiving escitalopram therapy using a wide variety of subjective and objective clinical features from the first eight weeks of the Canadian Biomarker Integration Network in Depression-1 trial. We investigated how these clusters responded to treatment by comparing changes in symptoms and symptom categories, and by using Principal Component Analysis (PCA). Our algorithm found three clusters, which broadly represented non-responders, responders, and remitters. Most categories of features followed this response pattern except for objective cognitive features. Using PCA with our clusters, we found that subjective mood state/anhedonia is the core feature of response with escitalopram, but there exists other distinct patterns of response around neurovegetative symptoms, activation, and cognition.