Machine learning to predict clinical remission in depressed patients after acute phase selective serotonin reuptake inhibitor treatment

•Machine learning approaches with inexpensive and highly accessible variables are workable measures to accurately predict the 8-week treatment outcome of SSRIs in MDD.•Neurocognition impairment, especially attention and inhibition of executive functioning, affected the effectiveness of treatment and should be assessed before intervention.•Support vector machine algorithm was established with only 13 features, including 6 sociodemographic characteristics, 5 clinical features, and 2 neurocognitive domains, namely alcohol drinking, years of education, gender, drug allergy history, occupation, history of cardiovascular and cerebrovascular disease, HAM-D items 4, 6, 13, and 15, precipitating factor, attention/vigilance domain, and inhibition of executive function domain. Selective serotonin reuptake inhibitors (SSRIs) are suggested as the first-line treatment for patients with major depressive disorder (MDD), but the remission rate is unsatisfactory. We aimed to establish machine learning models and explore variables available at baseline to predict the 8-week outcome among patients taking SSRIs. Data from 400 patients were used to build machine learnings. The last observation carried forward approach was used to determine the remitter/non-remitter status of the patients at week 8. Using least absolute shrinkage and selection operator (LASSO) to select features, we built 4 different machine learning algorithms including gradient boosting decision tree, support vector machine (SVM), random forests, and logistic regression with five-fold cross-validation. Then, we adopted Shapley additive explanations (SHAP) values to interpret the model output. The remission rate is 67.8%. We obtained 78 features from the baseline characteristics, including 25 sociodemographic characteristics, 31 clinical features, 15 psychological traits and 7 neurocognitive functions, and 13 of these features were selected to establish SVM. The accuracy of the SVM prediction is 74.49%, reaching an average area under the curve of 0.734±0.043. The sensitivity is 0.899±0.038 with a positive predictive value of 0.776±0.028. The specificity is 0.422±0.091 with a negative predictive value of 0.674±0.086. According to the SHAP values, neurocognitive functions and anxiety and hypochondriasis symptoms were important predictors. Our study supports the utilization of machine learning approaches with inexpensive and highly accessible variables to accurately predict the 8-week treatment outcome of SSRIs in