601
|
Yuan H, Zhu X, Luo Q, Halim A, Halim M, Yao H, Cai Y, Shi S. Early symptom non-improvement and aggravation are associated with the treatment response to SSRIs in MDD: a real-world study. Neuropsychiatr Dis Treat 2019; 15:957-966. [PMID: 31354272 PMCID: PMC6586220 DOI: 10.2147/ndt.s196533] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
PURPOSE Early improvement in major depressive disorder is defined as a reduction of ≥20% in the 17-item Hamilton Depression Rating Scale (HAM-D-17) score at the second week after initiation of treatment, predicting long-term treatment response. However, there remains no effective strategy for switching medications when a patient fails to reach early improvement at the second week. This study focused on the predictive value of early symptom changes in each item of the HAM-D-17 scale for treatment response to selective serotonin reuptake inhibitor (SSRI) monotherapy and to provide a reference for switching antidepressants to enhance early treatment efficacy. PATIENTS AND METHODS Our study was an observational, real-world study that enrolled 90 treatment-naïve patients experiencing their first episode of major depressive disorder in the outpatient department of Huashan Hospital. Patients who did not achieve the threshold of early improvement in the second week after starting treatment were switched to alternative SSRI monotherapy. Patient follow-up occurred at 2, 4, 8, and 12 weeks after the initiation of treatment. We analyzed the relationship between the change in each symptom on the HAM-D-17 scale and treatment efficacy. RESULTS Early improvement predicted the treatment response at 12 weeks (χ 2=19.249, P<0.001), whereas early non-improvement in insomnia and anxiety was associated with a poor response (OR =9.487, 95% CI: 1.312-68.588 and OR =12.947, 95% CI: 1.99-82.246, respectively). At week 2, general somatic symptom aggravation was associated with a poorer response (OR =73.337, 95% CI: 2.232->999.999); treatment-emergent headache and tremor were associated with treatment efficacy (t=-9.521, P<0.001 and t=3.660, P=0.001, respectively). In addition, the increase in suicidal thoughts, once treatment began, had no relationship with the treatment response (OR =0.821, P=0.872). CONCLUSION This study suggested that patients with early non-improvement in insomnia and anxiety were not suitable for switches in SSRI monotherapy. Patients with treatment-emergent symptoms, especially headaches and tremors, were not suitable for switching from monotherapy to another SSRI.
Collapse
Affiliation(s)
- Hsinsung Yuan
- Psychiatry Department of Huashan Hospital, Fudan University, Shanghai, People's Republic of China, .,Psychiatry Department of Nanjing Brain Hospital, Nanjing, People's Republic of China
| | - Xiao Zhu
- Psychiatry Department of Huashan Hospital, Fudan University, Shanghai, People's Republic of China,
| | - Qiang Luo
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, People's Republic of China.,Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence (Ministry of Education), Fudan University, Shanghai, People's Republic of China
| | - Alice Halim
- Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - Michael Halim
- Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - Hao Yao
- Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - Yiyun Cai
- Psychiatry Department of Huashan Hospital, Fudan University, Shanghai, People's Republic of China, .,Shanghai Mental Health Center, Shanghai, People's Republic of China,
| | - Shenxun Shi
- Psychiatry Department of Huashan Hospital, Fudan University, Shanghai, People's Republic of China, .,Shanghai Mental Health Center, Shanghai, People's Republic of China,
| |
Collapse
|
602
|
Bares M, Brunovsky M, Stopkova P, Hejzlar M, Novak T. Transcranial Direct-Current Stimulation (tDCS) Versus Venlafaxine ER In The Treatment Of Depression: A Randomized, Double-Blind, Single-Center Study With Open-Label, Follow-Up. Neuropsychiatr Dis Treat 2019; 15:3003-3014. [PMID: 31695391 PMCID: PMC6815763 DOI: 10.2147/ndt.s226577] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 10/04/2019] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Transcranial direct-current stimulation (tDCS), a relatively new neuromodulation approach, provides some evidence of an antidepressant effect. This randomized, 4-week, double-blind study with 8-week, open-label, follow-up compared the efficacy and tolerability of left anodal tDCS with venlafaxine ER (VNF) in the treatment of depression and prevention of early relapse. METHODS Subjects (n = 57) received tDCS (2 mA, 20 sessions, 30 mins) plus placebo (n = 29) or VNF plus sham tDCS (n = 28). Responders to both interventions entered the open-label follow-up. The primary outcome was score change in the Montgomery-Åsberg Depression Rating Scale (MADRS) at week 4 of the study. Secondary outcomes were response, remission, dropout rates and relapse rates within the follow-up. UNLABELLED The mean change in the MADRS score from baseline to week for patients treated with tDCS was 7.69 (95% CI, 5.09-10.29) points and 9.64 (95% CI, 6.20-13.09) points for patients from the VNF group, a nonsignificant difference (1.95, 95% CI -2.25-6.16; t (55) = 0.93, p= 0.36, Cohen´s d = 0.24). There were no significant between-group differences in the MADRS scores from baseline to endpoint (intention-to-treat analysis). The response/remission rate for tDCS (24%/17%) and VNF (43%/32%) as well as the dropout rate (tDCS/VNF; 6/6) did not differ significantly between groups. In the follow-up, relapse (tDCS/VNF; 1/2) and dropout (tDCS/VNF; 2/3) rates were low and comparable. LIMITATIONS A relatively small sample size and short duration of the antidepressant treatment; no placebo arm. CONCLUSION Overall, this study found a similar efficacy of tDCS and VNF in the acute treatment of depression and prevention of early relapse. The real clinical usefulness of tDCS and its optimal parameters in the treatment of depression should be further validated.
Collapse
Affiliation(s)
- Martin Bares
- NIMH Clinical Center, National Institute of Mental Health Czech Republic, Topolova 748, Klecany, Czech Republic.,The Department of Psychiatry and Medical Psychology, 3rd Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Martin Brunovsky
- NIMH Clinical Center, National Institute of Mental Health Czech Republic, Topolova 748, Klecany, Czech Republic.,The Department of Psychiatry and Medical Psychology, 3rd Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Pavla Stopkova
- NIMH Clinical Center, National Institute of Mental Health Czech Republic, Topolova 748, Klecany, Czech Republic.,The Department of Psychiatry and Medical Psychology, 3rd Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Martin Hejzlar
- NIMH Clinical Center, National Institute of Mental Health Czech Republic, Topolova 748, Klecany, Czech Republic.,The Department of Psychiatry and Medical Psychology, 3rd Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Tomas Novak
- NIMH Clinical Center, National Institute of Mental Health Czech Republic, Topolova 748, Klecany, Czech Republic.,The Department of Psychiatry and Medical Psychology, 3rd Faculty of Medicine, Charles University, Prague, Czech Republic
| |
Collapse
|
603
|
Thériault FL, Garber BG, Momoli F, Gardner W, Zamorski MA, Colman I. Mental Health Service Utilization in Depressed Canadian Armed Forces Personnel. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2019; 64:59-67. [PMID: 30016882 PMCID: PMC6364141 DOI: 10.1177/0706743718787792] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Major depression is prevalent, impactful, and treatable in military populations, but not all depressed personnel seek professional care in a given year. Care-seeking patterns (including the use of primary vs. specialty care) and factors associated with the likelihood of mental health service utilization in depressed military personnel are poorly understood. METHODS Our sample included 520 Regular Force respondents to the 2013 Canadian Forces Mental Health Survey. All study participants had past-year major depression. Subjects reported whether they had spoken about their mental health with at least one health professional in the past 12 months. We used multivariate Poisson regression to explore factors associated with past-year mental health service use. RESULTS Three-quarters of Canadian military personnel with past-year depression had sought mental health care in the previous 12 months. Among care-seeking personnel, 70% had seen a psychologist or psychiatrist, while 5% had exclusively received care from a primary care physician. Belief in the effectiveness of mental health care was the factor most strongly associated with care seeking. Female gender, functional impairments, and psychiatric comorbidities were also associated with care seeking. Surprisingly, stigma perceptions had no independent association with care seeking. CONCLUSIONS The proportion of depressed Canadian Armed Forces personnel who seek professional care and who access specialty mental health care is higher than in most other populations. However, an important minority of patients are not accessing health services. Efforts to further increase mental health service utilization in the Canadian military should continue to target beliefs about the effectiveness of mental health care.
Collapse
Affiliation(s)
- François L. Thériault
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario
- Directorate of Force Health Protection, Canadian Forces Health Services Group Headquarters, Department of National Defence, Ottawa, Ontario
| | - Bryan G. Garber
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario
- Directorate of Mental Health, Canadian Forces Health Services Group Headquarters, Department of National Defence, Ottawa, Ontario
| | - Franco Momoli
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario
| | - William Gardner
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario
- Children’s Hospital of Eastern Ontario, Ottawa, Ontario
| | - Mark A. Zamorski
- Directorate of Mental Health, Canadian Forces Health Services Group Headquarters, Department of National Defence, Ottawa, Ontario
- Department of Family Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario
| | - Ian Colman
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario
| |
Collapse
|
604
|
Rush AJ, South CC, Jha MK, Grannemann BD, Trivedi MH. Toward a very brief quality of life enjoyment and Satisfaction Questionnaire. J Affect Disord 2019; 242:87-95. [PMID: 30173063 DOI: 10.1016/j.jad.2018.08.052] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 07/23/2018] [Accepted: 08/12/2018] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To develop and evaluate a new brief self-report measure of satisfaction/quality of life in depressed outpatients. METHODS Using the Quality of Life Enjoyment and Satisfaction Questionnaire Short-Form (Q-LES-Q-SF) self-report from Step-1 (n = 2181) of the STAR*D trial, items were selected based on their magnitude of change with treatment and correlation with 16-item Quick Inventory of Depressive Symptomatology Self-Report (QIDS-SR16). Psychometric analyses were conducted. Replication of scale performance was assessed with STAR*D Step-2 data (n = 250). RESULTS The 7 items selected ("Mini-Q-LES-Q") rated satisfaction with work, household activities, social and family relations, leisure time activities, daily function and sense of well-being in the past week. This uni-dimensional scale captured 83-94% variance in Q-LES-Q-SF and had acceptable Item Response and Classical Test Theory characteristics. Baseline to exit percent changes in the Mini-Q-LES-Q and the QIDS-SR16 were significantly, modestly related (r = -0.552) (Step-1) and replicated (r = -0.562) (Step-2). The Mini-Q-LES-Q detected the expected improvement in satisfaction/quality of life in acute treatment, yet also identified residual deficits expected in many at acute-phase exit. LIMITATIONS Population norms are yet undefined. Concurrent validity with detailed, well-validated scales that assess the seven Quality of Life domains incorporated in the Mini-Q-LES-Q remains unestablished. Sensitivity to symptom changes induced by psychotherapy or somatic therapies or sensitive to the effects of therapies aimed at enhancing quality of life enjoyment and function is unknown. CONCLUSION The 7-item Mini-Q-LES-Q self-report measure satisfaction/quality of life has acceptable psychometric properties, reflects change with depressive symptom reduction, and detects residual deficits in this key clinical outcome.
Collapse
Affiliation(s)
- A John Rush
- Department of Psychiatry, Duke Medical School, Durham, NC, USA; Department of Psychiatry, Texas Tech University Health Sciences Center, Permian Basin, TX, USA; Duke-National University of Singapore, Singapore
| | - Charles C South
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Manish K Jha
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Bruce D Grannemann
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Madhukar H Trivedi
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA.
| |
Collapse
|
605
|
Hori H, Yamato K. Assessment of current clinical practices for major depression in Japan using a web-based questionnaire. Neuropsychiatr Dis Treat 2019; 15:2821-2832. [PMID: 31632030 PMCID: PMC6778451 DOI: 10.2147/ndt.s217098] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 08/06/2019] [Indexed: 12/19/2022] Open
Abstract
PURPOSE To investigate the current clinical practice of Japanese physicians in the diagnosis and management of major depression (major depressive disorder [MDD]). PATIENTS AND METHODS Japanese physicians specializing in psychiatry or psychosomatic medicine in the medical database of Nihon Ultmarc Inc. (Chuo-Ku, Tokyo, Japan), who had treated ≥30 patients with MDD in the past month were invited to complete a web-based questionnaire from January 15 to 29, 2018. The questionnaire was comprised of 28 questions pertaining to the physician's background, the criteria and tools used to diagnose MDD during physician-patient consultation, and actual and preferred duration of physician-patient consultation. Responses were given as single answer numerical values or as multiple-choice answers. RESULTS From the 518 physicians invited to participate, 340 completed questionnaires were analyzed. Respondents were predominantly male (90%), hospital based (73%), affiliated with the Department of Psychiatry (95%), and members of the Japanese Society of Psychiatry and Neurology (87%). The majority of physicians (84%) agreed that "improvement of cognitive dysfunction caused by major depression is an important factor for patients to return to work" was the most challenging aspect of MDD diagnosis and management. Moreover, 83% of physicians conducted psychological assessments using a cognition evaluation test with most of their patients at the time of MDD diagnosis; the most commonly used tool was the Hasegawa Dementia Scale-Revised. Both hospital-based physicians and general practitioners would prefer to have longer consultations with their patients. CONCLUSION Physicians acknowledge the importance of the assessment and management of cognitive dysfunction in patients with MDD. However, most physicians would prefer to have longer consultation times with their patients for the diagnosis of MDD. In the future, it may be useful to introduce digital tools (eg, THINC-it®) for the initial screening of cognitive dysfunction.
Collapse
Affiliation(s)
- Hikaru Hori
- Department of Psychiatry, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan
| | - Kentaro Yamato
- JPBU Department of Medical Affairs, Takeda Pharmaceutical Co. Ltd., Tokyo, Japan
| |
Collapse
|
606
|
De Giorgi R. Vortioxetine for depression: the evidence for its current use in the UK. BJPSYCH ADVANCES 2019. [DOI: 10.1192/bja.2018.62] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
SUMMARYThe pharmacological treatment of depression is often hampered by side-effects and unsatisfactory response to treatment. Vortioxetine is one of the newest antidepressants on the market, purportedly with a different mechanism of action compared with other antidepressants. This month's Cochrane Corner review examines the evidence available for the use of vortioxetine as a first-line treatment for depression in adults. This commentary puts the Cochrane review's findings into their clinical context and revises them in view of earlier and later studies.DECLARATION OF INTERESTNone.
Collapse
|
607
|
Hede V, Devillé C. Treating psychiatric symptoms and disorders with non-psychotropic medications
. DIALOGUES IN CLINICAL NEUROSCIENCE 2019; 21:193-201. [PMID: 31636493 PMCID: PMC6787535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 07/26/2024]
Abstract
A few drugs prescribed in internal medicine, ie, non-psychotropic drugs, can be used to treat certain neuropsychiatric disorders. For most of these situations, the level of evidence remains low. But when sufficient data becomes available, these molecules are then included in official guidelines for the treatment of neuropsychiatric disorders. In this article we review interesting drugs which may be relevant from an evidence-based medicine point of view, and could become part of psychiatric practice in the future.
.
Collapse
Affiliation(s)
- Vincent Hede
- Author affiliations: Liaison Psychiatry Unit (Vincent Hede); Young Adult Psychiatry Unit (Cédric Devillé); Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland. Address for correspondence: Dr Vincent Hede, Hôpitaux Universitaires de Genève, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland. (e-mail: )
| | - Cédric Devillé
- Author affiliations: Liaison Psychiatry Unit (Vincent Hede); Young Adult Psychiatry Unit (Cédric Devillé); Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland. Address for correspondence: Dr Vincent Hede, Hôpitaux Universitaires de Genève, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland. (e-mail: )
| |
Collapse
|
608
|
Wang Z, Ma X, Xiao C. Standardized Treatment Strategy for Depressive Disorder. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1180:193-199. [PMID: 31784964 DOI: 10.1007/978-981-32-9271-0_10] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The treatment strategies of depressive disorder include pharmacological treatment, psychotherapy, and physical therapy (electroconvulsive therapy [ECT], transcranial magnetic stimulation [TMS], etc.). The updated CANMAT guidelines recommended the most second-generation antidepressants as first-line treatments for patients with a major depressive disorder (MDD) of moderate or greater severity. Before antidepressant treatment, comprehensive assessment and safety monitoring are necessary. The application of measurement-based care in the diagnosis and treatment of depression would better ensure that enough dosage and response of antidepressant is achieved at each key point, and the final outcome of disease is improved. It is recommended that antidepressant is used with monotherapy in patients with depression. Antidepressants of different types and different mechanisms could be combined to improve the efficacy for patients with treatment-resistant depression (TRD). To prevent the relapse and recurrence of disease, the long-term treatment comprised of acute treatment, consolidation treatment, and maintenance treatment must be considered for all patients.
Collapse
Affiliation(s)
- Zuowei Wang
- Hongkou District Mental Health Center, Shanghai, China.
| | - Xiancang Ma
- The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Chunlan Xiao
- Hongkou District Mental Health Center, Shanghai, China
| |
Collapse
|
609
|
van Dun K, Mitoma H, Manto M. Cerebellar Cortex as a Therapeutic Target for Neurostimulation. THE CEREBELLUM 2018; 17:777-787. [PMID: 30276522 DOI: 10.1007/s12311-018-0976-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Non-invasive stimulation of the cerebellum is growingly applied both in the clinic and in research settings to modulate the activities of cerebello-cerebral loops. The anatomical location of the cerebellum, the high responsiveness of the cerebellar cortex to magnetic/electrical stimuli, and the implication of the cerebellum in numerous cerebello-cerebral networks make the cerebellum an ideal target for investigations and therapeutic purposes. In this mini-review, we discuss the potentials of cerebellar neuromodulation in major brain disorders in order to encourage large-scale sham-controlled research and explore this therapeutic aid further.
Collapse
Affiliation(s)
- Kim van Dun
- Clinical and Experimental Neurolinguistics, CLIN, Vrije Universiteit Brussels, Pleinlaan 2, 1050, Brussels, Belgium.
| | - Hiroshi Mitoma
- Medical Education Promotion Center, Tokyo Medical University, Tokyo, Japan
| | - Mario Manto
- Service de Neurologie, Médiathèque Jean Jacquy, CHU-Charleroi, Charleroi, Belgium.,Service des Neurosciences, UMons, Mons, Belgium
| |
Collapse
|
610
|
Kamijima K, Yasuda M, Yamamura K, Fukuta Y. Real-world effectiveness and safety of aripiprazole augmentation therapy in patients with major depressive disorder. Curr Med Res Opin 2018; 34:2105-2112. [PMID: 30173568 DOI: 10.1080/03007995.2018.1519317] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
AIMS Augmentation therapy is an option for patients with major depressive disorder who do respond sufficiently to adequate dosages of selective serotonin reuptake inhibitors or serotonin-norepinephrine reuptake inhibitors, but little is known about application of this strategy in everyday practice. METHODS This prospective, multi-center, observational study investigated the effectiveness and safety of aripiprazole augmentation in Japanese patients with inadequate response to conventional antidepressant therapy in real-world clinical practice. The primary endpoint was mean change in the (Japanese version) Montgomery-Åsberg Depression Rating Scale (MADRS) total score from baseline to study end. Safety was assessed by monitoring adverse events. RESULTS There were 1103 patients in the safety population and 1090 patients in the effectiveness population. Mean change in the MADRS total score at study end was -14.9 ± 12.3 (p < .001 vs baseline). The remission rate increased from 34.5% at Month 6 to 43.3% at Month 12, suggesting additional benefit with continued treatment. The type of primary antidepressant (paroxetine, fluvoxamine, sertraline, milnacipran, duloxetine, mirtazapine, or escitalopram) had no influence on the effectiveness of aripiprazole augmentation therapy. A baseline MADRS total score of <33 points and an elapsed time of <176 days from an episode of depression to the start of aripiprazole treatment increased the likelihood of achieving remission; 24.8% of patients experienced at least one adverse event, but no new safety signals were identified. CONCLUSIONS Aripiprazole augmentation therapy appears to be effective and safe in Japanese patients with depression/depressive symptoms treated in everyday clinical practice, taking into account factors associated with achieving remission.
Collapse
|
611
|
Rosenblat JD, Lee Y, McIntyre RS. The effect of pharmacogenomic testing on response and remission rates in the acute treatment of major depressive disorder: A meta-analysis. J Affect Disord 2018; 241:484-491. [PMID: 30149336 DOI: 10.1016/j.jad.2018.08.056] [Citation(s) in RCA: 81] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 07/28/2018] [Accepted: 08/12/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Pharmacogenomic testing has recently become scalable and available to guide the treatment of major depressive disorder (MDD). The objective of the current meta-analysis was to determine if guidance from pharmacogenomic testing results in relatively higher rates of remission and response compared to treatment as usual (i.e., 'unguided' trial-and-error method) in adults with MDD. METHODS Article databases were systematically searched from inception to December 2, 2017 for human studies assessing the clinical utility of pharmacogenomics in the acute treatment of MDD. Treatment outcomes in MDD may be defined continuously or categorically (i.e., response/remission). Herein, we delimit our focus on categorical outcomes. Using a random-effects model, data was pooled to determine the risk ratio (RR) of response and remission, respectively, in the pharmacogenomic-guided treatment group compared to the unguided group. RESULTS Four randomized controlled trials (RCTs) and two open-label, controlled cohort studies were included. The pooled RR for treatment response comparing guided versus unguided treatment was 1.36 (95% confidence interval [CI] = 1.14 to 1.62; p = 0.0006; n = 799) in favour of guided treatment. The pooled RR for remission was 1.74 (95%CI = 1.09 to 2.77; p = 0.02, n = 735) also in favour of guided treatment. Heterogeneity in study results suggest that different genetic tests may variably impact response and remission rates. LIMITATIONS The available evidence is limited, with significant methodological deficiencies. CONCLUSION The current analysis provides preliminary support for improved response and remission rates in MDD when treatment is guided by pharmacogenomics.
Collapse
Affiliation(s)
- Joshua D Rosenblat
- Resident of Psychiatry, Clinician Scientist Stream, University of Toronto, Toronto, Ontario, Canada,.
| | - Yena Lee
- Graduate Student, University of Toronto, Toronto, Ontario, Canada,.
| | - Roger S McIntyre
- Head, Mood Disorder Psychopharmacology Unit, University Health Network, Professor of Psychiatry and Pharmacology, University of Toronto, 399 Bathurst Street, MP 9-325, Toronto, Ontario M5T 2S8, Canada,.
| |
Collapse
|
612
|
Increased adrenocorticotropic hormone (ACTH) levels predict severity of depression after six months of follow-up in outpatients with major depressive disorder. Psychiatry Res 2018; 270:246-252. [PMID: 30269042 DOI: 10.1016/j.psychres.2018.09.047] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 09/18/2018] [Accepted: 09/20/2018] [Indexed: 12/17/2022]
Abstract
Previous studies have reported dysfunction in the hypothalamic-pituitary-adrenal (HPA) axis in patients with major depressive disorder (MDD). Outpatients diagnosed with MDD (n = 199) underwent psychological evaluation, and were followed up with a phone interview after 6 months, using the Patient Health Questionnaire (PHQ-9). At 6-month follow-up, 59 out of 199 patients with MDD were still depressed (29.5%), as shown by scores ≥ 10 on the PHQ-9. The depressed group at follow-up showed significantly higher anxiety and suicidality levels at baseline than the non-depressed group at follow-up. Among the complete blood counts, lipid profiles, and hormone levels, adrenocorticotropic hormone (ACTH) was the only parameter that was significantly increased in the still depressed group. Levels higher than 40 pg/mL of ACTH at baseline were associated with higher depression scores at follow-up. Multiple linear regression analyses revealed that ACTH and cortisol predicted depression scores at follow-up, after controlling for baseline depression scores. Increased ACTH level at baseline may predict ongoing symptoms and severity of depression at follow-up, suggesting the role of dysfunctional HPA axis in MDD prognosis.
Collapse
|
613
|
Tisseverasinghe A, Peschken C, Hitchon C. Anxiety and Mood Disorders in Systemic Lupus Erythematosus: Current Insights and Future Directions. Curr Rheumatol Rep 2018; 20:85. [DOI: 10.1007/s11926-018-0797-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
|
614
|
Simoons M, Seldenrijk A, Mulder H, Birkenhäger T, Groothedde-Kuyvenhoven M, Kok R, Kramers C, Verbeeck W, Westra M, van Roon E, Bakker R, Ruhé H. Limited Evidence for Risk Factors for Proarrhythmia and Sudden Cardiac Death in Patients Using Antidepressants: Dutch Consensus on ECG Monitoring. Drug Saf 2018; 41:655-664. [PMID: 29484613 PMCID: PMC5990562 DOI: 10.1007/s40264-018-0649-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Currently, there is a lack of international and national guidelines or consensus documents with specific recommendations for electrocardiogram (ECG) screening and monitoring during antidepressant treatment. To make a proper estimation of the risk of cardiac arrhythmias and sudden (cardiac) death during antidepressant use, both the drug and patient-specific factors should be taken into account; however, solid evidence on how this should be done in clinical practice is lacking. Available recommendations on the management of QT(c) prolongation (with antidepressant treatment) emphasize that special attention should be given to high-risk patients; however, clinicians are in need of more concrete suggestions about how to select patients for ECG screening and monitoring. Based on a review of the literature, a Dutch multidisciplinary expert panel aimed to formulate specific guidelines to identify patients at risk for cardiac arrhythmias and sudden death by developing a consensus statement regarding ECG screening before, and monitoring during, antidepressant use. We first reviewed the literature to identify the relative risks of various risk factors on cardiac arrhythmia and sudden (cardiac) death during antidepressant use. These relative contributions of risk factors could not be determined since no systematic reviews or meta-analyses quantitatively addressed this topic. Because evidence was insufficient, additional expert opinion was used to formulate recommendations. This resulted in readily applicable recommendations for clinical practice for selection of high-risk patients for ECG screening and monitoring. ECG screening and monitoring is recommended before and following the start of QTc-prolonging antidepressants in the presence of vulnerability to QTc prolongation or two or more risk factors (age > 65 years, female sex, concomitant use of a QTc-prolonging drug or concomitant use of a drug that influences the metabolism of a QTc-prolonging drug, cardiac disease, excessive dosing and specific electrolyte disturbances).
Collapse
Affiliation(s)
- Mirjam Simoons
- Department of Clinical Pharmacy, Wilhelmina Hospital Assen, Assen, The Netherlands.,Department of Psychiatry, Interdisciplinary Centre for Psychopathology and Emotion Regulation, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.,Unit of Pharmacotherapy, -Epidemiology and -Economics, Department of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Adrie Seldenrijk
- Department of Psychiatry, Interdisciplinary Centre for Psychopathology and Emotion Regulation, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.,Department of Research and Innovation, GGZ InGeest, Amsterdam, The Netherlands
| | - Hans Mulder
- Department of Clinical Pharmacy, Wilhelmina Hospital Assen, Assen, The Netherlands.,Psychiatric Hospital GGZ Drenthe, Assen, The Netherlands
| | - Tom Birkenhäger
- Department of Psychiatry, Erasmus Medical Centre, Rotterdam, The Netherlands.,Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp, Antwerp, Belgium
| | | | - Rob Kok
- Department of Old Age Psychiatry, Parnassia Psychiatric Institute, The Hague, The Netherlands
| | - Cornelis Kramers
- Department of Internal Medicine, Radboudumc, Nijmegen, The Netherlands
| | - Wim Verbeeck
- Vincent van Gogh Institute for Psychiatry, ADHD and Autism Circuit, Venray, The Netherlands.,Department of Pharmacology and Toxicology, Radboudumc, Nijmegen, The Netherlands
| | - Mirjam Westra
- Department of Psychiatry, Interdisciplinary Centre for Psychopathology and Emotion Regulation, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Eric van Roon
- Unit of Pharmacotherapy, -Epidemiology and -Economics, Department of Pharmacy, University of Groningen, Groningen, The Netherlands.,Department of Clinical Pharmacy and Clinical Pharmacology, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
| | - Roberto Bakker
- Psychiatric Centre GGz Centraal, Amersfoort, The Netherlands.,Department of Psychiatry and Psychology, South Limburg Mental Health and Teaching Network, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Henricus Ruhé
- Department of Psychiatry, Interdisciplinary Centre for Psychopathology and Emotion Regulation, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands. .,Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK. .,Department of Psychiatry, Radboudumc, Nijmegen, The Netherlands.
| |
Collapse
|
615
|
Mulder R, Hamilton A, Irwin L, Boyce P, Morris G, Porter RJ, Malhi GS. Treating depression with adjunctive antipsychotics. Bipolar Disord 2018; 20 Suppl 2:17-24. [PMID: 30328223 DOI: 10.1111/bdi.12701] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To evaluate the efficacy and safety of using adjunctive antipsychotics in patients with major depressive disorder. METHOD Studies published since the last Cochrane review conducted in 2010 were identified via a literature search of recognised databases, using the keywords "adjunct*", "augment*", "antipsychotic" and "depression", and systematically evaluated. A targeted review of relevant guidelines was undertaken. RESULTS Adjunctive antipsychotics produce a small but significant improvement in depressive symptoms in most studies. Most of the studies focussed on patients with an inadequate response to antidepressants rather than patients with treatment resistant depression. Treatment guidelines were variable but generally supported the use of adjunctive antipsychotics while cautioning about the risk of side effects. Most were non-specific about the length of time adjunctive antipsychotics should be prescribed. CONCLUSIONS The studies do not support the routine use of adjunctive antipsychotics in patients with an inadequate response to antidepressants. They may be beneficial when used short-term in patients with treatment resistant depression who have specific symptoms (severe ruminations, melancholia, major sleep disturbance) that appear to respond well to adjunctive antipsychotics. There is no support for long-term use. Research should focus on specifying which symptom profiles are responsive and how adjunctive antipsychotics compare to other strategies in treatment resistant depression.
Collapse
Affiliation(s)
- Roger Mulder
- Sophisticated Mood Appraisal & Refinement of Treatment (SMART) Group.,Department of Psychological Medicine, University of Otago-Christchurch, Christchurch, New Zealand
| | - Amber Hamilton
- Sophisticated Mood Appraisal & Refinement of Treatment (SMART) Group.,Academic Department of Psychiatry, Northern Sydney Local Health District, St Leonards, NSW, Australia.,Sydney Medical School Northern, University of Sydney, Sydney, NSW, Australia.,CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia
| | - Lauren Irwin
- Sophisticated Mood Appraisal & Refinement of Treatment (SMART) Group.,Academic Department of Psychiatry, Northern Sydney Local Health District, St Leonards, NSW, Australia.,Sydney Medical School Northern, University of Sydney, Sydney, NSW, Australia.,CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia
| | - Philip Boyce
- Sophisticated Mood Appraisal & Refinement of Treatment (SMART) Group.,Discipline of Psychiatry, Sydney Medical School, Westmead Clinical School, University of Sydney, Sydney, NSW, Australia
| | - Grace Morris
- Sophisticated Mood Appraisal & Refinement of Treatment (SMART) Group.,Academic Department of Psychiatry, Northern Sydney Local Health District, St Leonards, NSW, Australia.,Sydney Medical School Northern, University of Sydney, Sydney, NSW, Australia.,CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia
| | - Richard J Porter
- Sophisticated Mood Appraisal & Refinement of Treatment (SMART) Group.,Department of Psychological Medicine, University of Otago-Christchurch, Christchurch, New Zealand
| | - Gin S Malhi
- Sophisticated Mood Appraisal & Refinement of Treatment (SMART) Group.,Academic Department of Psychiatry, Northern Sydney Local Health District, St Leonards, NSW, Australia.,Sydney Medical School Northern, University of Sydney, Sydney, NSW, Australia.,CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia
| |
Collapse
|
616
|
Mangin D, Lawson J, Cuppage J, Shaw E, Ivanyi K, Davis A, Risdon C. Legacy Drug-Prescribing Patterns in Primary Care. Ann Fam Med 2018; 16:515-520. [PMID: 30420366 PMCID: PMC6231929 DOI: 10.1370/afm.2315] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 08/27/2018] [Accepted: 09/10/2018] [Indexed: 12/15/2022] Open
Abstract
PURPOSE Polypharmacy is a key clinical challenge for primary care. Drugs that should be prescribed for an intermediate term (longer than 3 months, but not indefinitely) that are not appropriately discontinued could contribute to polypharmacy. We named this type of prescribing legacy prescribing. Commonly prescribed drugs with legacy prescribing potential include antidepressants, bisphosphonates, and proton pump inhibitors (PPIs). We evaluated the proportion of legacy prescribing within these drug classes. METHODS We conducted a population-based retrospective cohort study using prospectively collected data from the McMaster University Sentinel and Information Collaboration (MUSIC) Primary Care Practice Based Research Network, located in Hamilton, Ontario. All adult patients (aged 18 or older) in the MUSIC data set during 2010-2016 were included (N = 50,813). We calculated rates of legacy prescribing of antidepressants (prescription longer than 15 months), bisphosphonates (longer than 5.5 years), and PPIs (longer than 15 months). RESULTS The proportion of patients having a legacy prescription at some time during the study period was 46% (3,766 of 8,119) for antidepressants, 14% (228 of 1,592) for bisphosphonates, and 45% (2,885 of 6,414) for PPIs. Many of these patients held current prescriptions. The mean duration of prescribing for all legacy prescriptions was significantly longer than that for non-legacy prescriptions (P <.001). Concurrent legacy prescriptions for both antidepressants and PPIs was common, signaling a potential prescribing cascade. CONCLUSIONS The phenomenon of legacy prescribing appears prevalent. These data demonstrate the potential of legacy prescribing to contribute to unnecessary polypharmacy, providing an opportunity for system-level intervention in primary care with enormous potential benefit for patients.
Collapse
Affiliation(s)
- Dee Mangin
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada .,University of Otago, Christchurch, New Zealand
| | - Jennifer Lawson
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | - Elizabeth Shaw
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Katalin Ivanyi
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada.,Stonechurch Family Health Centre, Hamilton, Ontario, Canada
| | - Amie Davis
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada.,Halton McMaster Family Health Centre, Burlington, Ontario, Canada
| | - Cathy Risdon
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| |
Collapse
|
617
|
A systematic review of acupuncture and Chinese herbal medicine for postpartum depression. Complement Ther Clin Pract 2018; 33:85-92. [DOI: 10.1016/j.ctcp.2018.08.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 08/09/2018] [Accepted: 08/27/2018] [Indexed: 12/19/2022]
|
618
|
Cassano P, Petrie SR, Mischoulon D, Cusin C, Katnani H, Yeung A, De Taboada L, Archibald A, Bui E, Baer L, Chang T, Chen J, Pedrelli P, Fisher L, Farabaugh A, Hamblin MR, Alpert JE, Fava M, Iosifescu DV. Transcranial Photobiomodulation for the Treatment of Major Depressive Disorder. The ELATED-2 Pilot Trial. Photomed Laser Surg 2018; 36:634-646. [PMID: 30346890 DOI: 10.1089/pho.2018.4490] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Objective: Our objective was to test the antidepressant effect of transcranial photobiomodulation (t-PBM) with near-infrared (NIR) light in subjects suffering from major depressive disorder (MDD). Background: t-PBM with NIR light is a new treatment for MDD. NIR light is absorbed by mitochondria; it boosts cerebral metabolism, promotes neuroplasticity, and modulates endogenous opioids, while decreasing inflammation and oxidative stress. Materials and methods: We conducted a double-blind, sham-controlled study on the safety and efficacy [change in Hamilton Depression Rating Scale (HAM-D17) total score at end-point] of adjunct t-PBM NIR [823 nm; continuous wave (CW); 28.7 × 2 cm2; 36.2 mW/cm2; up to 65.2 J/cm2; 20-30 min/session], delivered to dorsolateral prefrontal cortex, bilaterally and simultaneously, twice a week, for 8 weeks, in subjects with MDD. Baseline observation carried forward (BOCF), last observation carried forward (LOCF), and completers analyses were performed. Results: The effect size for the antidepressant effect of t-PBM, based on change in HAM-D17 total score at end-point, was 0.90, 0.75, and 1.5 (Cohen's d), respectively for BOCF (n = 21), LOCF (n = 19), and completers (n = 13). Further, t-PBM was fairly well tolerated, with no serious adverse events. Conclusions: t-PBM with NIR light demonstrated antidepressant properties with a medium to large effect size in patients with MDD. Replication is warranted, especially in consideration of the small sample size.
Collapse
Affiliation(s)
- Paolo Cassano
- Depression Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts.,Center for Anxiety and Traumatic Stress Disorders, Massachusetts General Hospital, Boston, Massachusetts
| | - Samuel R Petrie
- Depression Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - David Mischoulon
- Depression Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Cristina Cusin
- Depression Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Husam Katnani
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Albert Yeung
- Depression Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Abigal Archibald
- Depression Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Eric Bui
- Center for Anxiety and Traumatic Stress Disorders, Massachusetts General Hospital, Boston, Massachusetts
| | - Lee Baer
- Depression Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Trina Chang
- Depression Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Justin Chen
- Depression Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Paola Pedrelli
- Depression Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Lauren Fisher
- Depression Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Amy Farabaugh
- Depression Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Michael R Hamblin
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts.,Department of Dermatology, Harvard Medical School, Boston, Massachusetts.,Harvard-MIT Division of Health Sciences and Technology, Cambridge, Massachusetts
| | - Jonathan E Alpert
- Depression Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Maurizio Fava
- Depression Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Dan V Iosifescu
- Adult Psychopharmacology Program, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
| |
Collapse
|
619
|
Herman A, El Mansari M, Adham N, Kiss B, Farkas B, Blier P. Involvement of 5-HT 1A and 5-HT 2A Receptors but Not α 2-Adrenoceptors in the Acute Electrophysiological Effects of Cariprazine in the Rat Brain In Vivo. Mol Pharmacol 2018; 94:1363-1370. [PMID: 30322874 DOI: 10.1124/mol.118.113290] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 10/04/2018] [Indexed: 11/22/2022] Open
Abstract
Cariprazine, an orally active and potent dopamine D3-preferring D3/D2 receptor partial agonist, is approved to treat adults with schizophrenia (in the United States and Europe) and manic or mixed episodes associated with bipolar I disorder (in the United States). Cariprazine also displays partial agonism at serotonin [5-hydroxytryptamine (5-HT)] 5-HT1A receptors and antagonism at 5-HT2A and 5-HT2B receptors in vitro. The study objective was to determine whether cariprazine leads to functional alterations of monoamine systems in vivo via electrophysiological recordings from anesthetized rats. Dorsal raphe nucleus (DRN), locus coeruleus (LC), and hippocampus pyramidal neurons were recorded, and cariprazine was administered systemically or locally through iontophoresis. In the DRN, cariprazine completely inhibited the firing activity of 5-HT neurons, which was fully reversed by the 5-HT1A receptor antagonist, WAY100635. In the LC, cariprazine reversed the inhibitory effect of the preferential 5-HT2A receptor agonist, 2,5-dimethoxy-4-iodoamphetamine, on norepinephrine (NE) neurons (ED50 = 66 µg/kg) but did not block the inhibitory effect of the α 2-adrenergic receptor agonist, clonidine. Cariprazine, iontophorized into the hippocampus, diminished pyramidal neuronal firing through activation of 5-HT1A receptors, while its concomitant administration did not dampen the suppressant effect of 5-HT. These results indicate that, in vivo, cariprazine acted as a 5-HT1A autoreceptor agonist in the DRN, a 5-HT2A receptor antagonist in modulating the firing activity of LC NE neurons, and a full agonist at 5-HT1A receptors mediating the electrophysiological effect of 5-HT on pyramidal neurons. The modulatory actions of cariprazine on these monoaminergic systems may contribute to its therapeutic effectiveness in patients with depressive episodes.
Collapse
Affiliation(s)
- Anna Herman
- Mood Disorders Research Unit, University of Ottawa Institute of Mental Health Research, Ottawa, Ontario, Canada (A.H., M.E.M., P.B.); Allergan, Madison, New Jersey, United States (N.A.); and Gedeon Richter Plc, Budapest, Hungary (B.K., B.F.)
| | - Mostafa El Mansari
- Mood Disorders Research Unit, University of Ottawa Institute of Mental Health Research, Ottawa, Ontario, Canada (A.H., M.E.M., P.B.); Allergan, Madison, New Jersey, United States (N.A.); and Gedeon Richter Plc, Budapest, Hungary (B.K., B.F.)
| | - Nika Adham
- Mood Disorders Research Unit, University of Ottawa Institute of Mental Health Research, Ottawa, Ontario, Canada (A.H., M.E.M., P.B.); Allergan, Madison, New Jersey, United States (N.A.); and Gedeon Richter Plc, Budapest, Hungary (B.K., B.F.)
| | - Béla Kiss
- Mood Disorders Research Unit, University of Ottawa Institute of Mental Health Research, Ottawa, Ontario, Canada (A.H., M.E.M., P.B.); Allergan, Madison, New Jersey, United States (N.A.); and Gedeon Richter Plc, Budapest, Hungary (B.K., B.F.)
| | - Bence Farkas
- Mood Disorders Research Unit, University of Ottawa Institute of Mental Health Research, Ottawa, Ontario, Canada (A.H., M.E.M., P.B.); Allergan, Madison, New Jersey, United States (N.A.); and Gedeon Richter Plc, Budapest, Hungary (B.K., B.F.)
| | - Pierre Blier
- Mood Disorders Research Unit, University of Ottawa Institute of Mental Health Research, Ottawa, Ontario, Canada (A.H., M.E.M., P.B.); Allergan, Madison, New Jersey, United States (N.A.); and Gedeon Richter Plc, Budapest, Hungary (B.K., B.F.)
| |
Collapse
|
620
|
Christensen MC, Florea I, Lindsten A, Baldwin DS. Efficacy of vortioxetine on the physical symptoms of major depressive disorder. J Psychopharmacol 2018; 32:1086-1097. [PMID: 30047820 PMCID: PMC6380624 DOI: 10.1177/0269881118788826] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Efficacy has been proven for vortioxetine in short-term and long-term treatment of major depressive disorder (MDD), with broad beneficial effects on emotional, physical and cognitive symptoms. Limited specific data on the effects of vortioxetine on depression-related physical symptoms have been published. METHODS A meta-analysis was carried out of five short-term multinational, double-blind, placebo-controlled studies. These studies were conducted in a total of 2105 adult MDD outpatients (18-75 years) with a major depressive episode of ⩾3 months' duration. Only patients treated with a dose of 5 or 10 mg vortioxetine (therapeutic doses) or placebo were included in this analysis. Efficacy assessment of vortioxetine on the physical symptoms of depression included all items of the Hamilton Depression Scale (HAM-D) assessing physical symptoms, and all somatic items in the Hamilton Anxiety Scale (HAM-A). A subgroup analysis in MDD patients with coexisting anxiety symptoms (i.e. those with a HAM-A ⩾20 at baseline) was also performed. RESULTS A significant improvement ( p<0.05) of vortioxetine versus placebo was observed on all HAM-D items measuring physical symptoms, except for the somatic gastrointestinal symptoms and loss of weight items. Significant effects were also observed on the HAM-A somatic items: general somatic symptoms, gastrointestinal symptoms, and autonomic symptoms. In patients with a high baseline level of anxiety, a significant effect of vortioxetine was also observed on the physical symptoms of depression. CONCLUSIONS These analyses indicate that patients with MDD, including those with a high level of anxiety symptoms, have significant improvements in MDD-associated physical symptoms when treated with vortioxetine.
Collapse
Affiliation(s)
| | | | | | - David S Baldwin
- Clinical and Experimental Sciences,
Faculty of Medicine, University of Southampton, UK,University Department of Psychiatry and
Mental Health, University of Cape Town, South Africa
| |
Collapse
|
621
|
Keks NA, Hope J, Keogh S, Copolov DL. Milnacipran: serotonin-noradrenaline reuptake inhibitor approved for fibromyalgia may be a useful antidepressant. Australas Psychiatry 2018; 26:537-540. [PMID: 30198305 DOI: 10.1177/1039856218794874] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Milnacipran is a serotonin noradrenaline reuptake inhibitor (SNRI) approved for treatment of fibromyalgia in Australia, but is used for depression in Europe and elsewhere. This paper will briefly review milnacipran and its utility in psychiatry for the treatment of depression. CONCLUSION Milnacipran is a dual reuptake inhibitor of noradrenaline and serotonin, with greater effect on noradrenaline than serotonin, in contrast to the related drugs venlafaxine, desvenlafaxine and duloxetine. Rapidly absorbed irrespective of food, milnacipran has a half-life of approximately 8 hours, reaches steady state in 2 days and is excreted renally. Milnacipran helps a minority of patients with fibromyalgia by reducing pain and fatigue. It is also an effective antidepressant with efficacy comparable to venlafaxine and duloxetine, and a side effect profile characteristic of SNRIs. The dose range is 50-200 mg, in divided doses. Milnacipran may be useful for patients with depression and pain, and endogenous depression characterised by anergia, psychomotor retardation and hypersomnia. Caution is necessary in the presence of heart disease, hypertension, renal impairment, epilepsy, glaucoma, bipolar disorder, and bleeding tendency. Milnacipran is likely to be a useful late antidepressant option in treatment-resistant patients, as well as those with chronic pain, anergia and hypersomnia.
Collapse
Affiliation(s)
- Nicholas A Keks
- Professor and Director, Monash University, Centre of Mental Health Education and Research at Delmont Private Hospital, Monash Medical Centre, Burwood, VIC, Australia
| | - Judy Hope
- Deputy Director, Centre of Mental Health Education and Research at Delmont Private Hospital, Burwood, VIC, and; Senior Lecturer, Monash University, Melbourne, VIC, Australia
| | - Simone Keogh
- Senior Fellow, Centre of Mental Health Education and Research at Delmont Private Hospital, Burwood, VIC, Australia
| | - David L Copolov
- Pro-Vice Chancellor and Professor of Psychiatry, Monash University, Clayton, VIC, and; Professor of Psychiatry, University of Melbourne, Melbourne, VIC, Australia
| |
Collapse
|
622
|
Lauzier S, Kadachi H, Moisan J, Vanasse A, Lesage A, Fleury MJ, Grégoire JP. Neighbourhood Material and Social Deprivation and Exposure to Antidepressant Drug Treatment: A Cohort Study Using Administrative Data. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2018; 63. [PMID: 29514506 PMCID: PMC6187437 DOI: 10.1177/0706743718760290] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To assess whether neighbourhood deprivation is associated with exposure to an antidepressant drug treatment (ADT) and its quality among individuals diagnosed with unipolar depression and insured by the Quebec public drug plan. METHOD We conducted an administrative database cohort study of adults covered by the Quebec public drug plan who were diagnosed with a new episode of unipolar depression. We assessed material and social deprivation using an area-based index. We considered exposure to an ADT as having ≥1 claim for an ADT within the 365 days following depression diagnosis. Among those exposed to ADT, ADT quality was assessed with 3 indicators: first-line recommended ADT, persistence with the ADT, and compliance with the ADT. Generalized linear models were used to estimate adjusted prevalence ratios (aPR) and 95% confidence intervals (95% CI). RESULTS Of 100,432 individuals with unipolar depression, 65,436 (65%) were exposed to an ADT in the year following the diagnosis. Individuals living in the most materially deprived areas were slightly more likely to be exposed to an ADT than those living in the least deprived areas (aPR, 1.04; 95% CI, 1.03 to 1.06). The likelihoods of being exposed to a first-line ADT, persisting for the minimum recommended duration and complying with the ADT were independent of the deprivation levels. CONCLUSIONS Neighbourhood deprivation was not associated with ADT quality among individuals insured by the Quebec public drug plan. It might be partly attributable to the public drug plan whose goal is to provide equitable access to prescription drugs regardless of income.
Collapse
Affiliation(s)
- Sophie Lauzier
- 1 Faculty of Pharmacy, Université Laval Québec, Québec.,2 Population Health and Optimal Health Practices Research Unit, CHU de Québec-Université Laval Research Centre, Quebec City, Québec
| | | | - Jocelyne Moisan
- 1 Faculty of Pharmacy, Université Laval Québec, Québec.,2 Population Health and Optimal Health Practices Research Unit, CHU de Québec-Université Laval Research Centre, Quebec City, Québec
| | - Alain Vanasse
- 4 Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Québec.,5 Groupe de recherche PRIMUS, Centre de recherche du CHUS, Sherbrooke, Québec
| | - Alain Lesage
- 6 Fernand-Seguin Research Center, Institut universitaire en santé mentale de Montréal, Montréal, Québec
| | - Marie-Josée Fleury
- 7 Department of Psychiatry, McGill University, Montréal, Québec.,8 Douglas Mental Health University Institute Research Centre, Montréal, Québec
| | - Jean-Pierre Grégoire
- 1 Faculty of Pharmacy, Université Laval Québec, Québec.,2 Population Health and Optimal Health Practices Research Unit, CHU de Québec-Université Laval Research Centre, Quebec City, Québec
| |
Collapse
|
623
|
Thomas RK, Baker G, Lind J, Dursun S. Rapid effectiveness of intravenous ketamine for ultraresistant depression in a clinical setting and evidence for baseline anhedonia and bipolarity as clinical predictors of effectiveness. J Psychopharmacol 2018; 32:1110-1117. [PMID: 30182797 DOI: 10.1177/0269881118793104] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Intravenous ketamine has been established as an efficacious and safe treatment, with transient effect, for treatment-resistant depression. However, the effectiveness of intravenous ketamine in non-research settings and with ultraresistant depression patients remains understudied. AIMS This study aims to measure the response and remission rates in ultraresistant depression patients in a clinical setting by means of a retrospective, open label, database study. Secondarily, the study will attempt to support previous findings of clinical predictors of effectiveness with intravenous ketamine treatment. METHODS Fifty patients with ultraresistant depression were treated between May 2015-December 2016, inclusive, in two community hospitals in Edmonton using six ketamine infusions of 0.5 mg/kg over 40 min over 2-3 weeks. Data were collected retrospectively from inpatient and outpatient charts. Statistical analysis to investigate clinical predictors of effectiveness included logistic regression analysis using a dependent variable of a 50% reduction in rating scale score at any point during treatment. RESULTS At baseline, the average treatment resistance was severe, with a Maudsley Staging Method score of 12.1 out of 15, 90.0% were resistant to electroconvulsive therapy, and the average Beck Depression Inventory score was 34.2. The response rate was 44% and remission rate was 16%. As a single predictor, moderate or severe anhedonia at baseline predicted a 55% increased likelihood of response. As a combined predictor, this level of anhedonia at baseline with a diagnosis of bipolar depression predicted a 73% increase in likelihood of response. CONCLUSION In a clinical setting, intravenous ketamine showed effectiveness in a complex, severely treatment-resistant, depressed population on multiple medication profiles concurrently. This study gave support to anhedonia and bipolar depression as clinical predictors of effectiveness.
Collapse
Affiliation(s)
- Rejish K Thomas
- 1 Neurochemical Research Unit, Department of Psychiatry, University of Alberta, Edmonton, Canada
| | - Glen Baker
- 1 Neurochemical Research Unit, Department of Psychiatry, University of Alberta, Edmonton, Canada
- 2 Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Canada
| | - John Lind
- 1 Neurochemical Research Unit, Department of Psychiatry, University of Alberta, Edmonton, Canada
| | - Serdar Dursun
- 1 Neurochemical Research Unit, Department of Psychiatry, University of Alberta, Edmonton, Canada
- 2 Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Canada
| |
Collapse
|
624
|
Dai CX, Hu CC, Shang YS, Xie J. Role of Ginkgo biloba extract as an adjunctive treatment of elderly patients with depression and on the expression of serum S100B. Medicine (Baltimore) 2018; 97:e12421. [PMID: 30278520 PMCID: PMC6181482 DOI: 10.1097/md.0000000000012421] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE To explore the effect of ginkgo biloba extract (EGb) as an adjunctive treatment of elderly patients with depression and the effect on the expression of serum S100B. METHODS 136 elderly patients with depression were divided into EGb + citalopram (Cit) group and Cit group equally. Efficacy was evaluated by Hamilton Depression Rating Scale (HAMD). Wisconsin Card Classification Test (WCST) was used to evaluate cognitive function. Serum S100B expression was measured with ELISA. The relationship of S100B with HAMD, Hamilton Anxiety Scale (HAMA) score, and WCST results was evaluated subsequently. RESULTS The time of onset of efficacy was significantly shorter in EGb + Cit group. There were significant differences in HAMD and HAMA scores after treatment than before treatment between groups (all P < .05). After treatment, total number of WCST test, the number of continuous errors and non-persistent errors in both groups were less than those before treatment. The correct number and classifications number were increased than before treatment. In EGb + Cit group, correct numbers and classifications were increased, and the number of persistent errors was decreased. After treatment, S100B level was decreased, and S100B levels change in EGb + Cit group was greater than in Cit group. Serum S100B level was positively correlated with HAMD and HAMA scores before treatment and positively correlated with persistent errors number in WCST. CONCLUSION EGb, as an adjunctive treatment, can effectively improve depressive symptoms and reduce expression of serum S100B, which is a marker of brain injury, suggesting that EGb restores neurologic function during the treatment of depression in elderly patients and S100B participates in the therapeutic mechanism. EGb combined with depressive drugs plays synergistic role, and the time of onset of efficacy is faster than single antidepressants.
Collapse
|
625
|
A dramatic case of a woman discovered after 7 months of untreated catatonia. Ir J Psychol Med 2018; 35:69-73. [PMID: 30115204 DOI: 10.1017/ipm.2016.46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Described is an unusually severe case of catatonia in the context of a major depressive episode. The patient is a 49-year-old Caucasian female who was living with her husband in an urban apartment. In March 2015, she experienced a major depressive episode in the context of financial hardship after being dismissed from her job. She became catatonic and did not leave her apartment for 7 months. For the first 4 months she lay in bed, then after losing bowel and bladder continence, she was transferred by her husband to the bedroom floor where she lay prone for another 3 months before paramedics were notified. She subsequently underwent a 4-month admission to an intensive care unit, surgical ward, and psychiatric ward. This case shows the extreme extent of psychiatric and physical sequelae that can result from prolonged delay of treatment of severe catatonia in the context of depression.
Collapse
|
626
|
Abstract
BACKGROUND Previous studies have demonstrated ketamine to have a rapid antidepressant effect in some patients with treatment-resistant depression (TRD), but the effect is unfortunately not sustained in the long term. In this study, we report on the clinical use of ongoing maintenance ketamine infusions in a group of patients with TRD, beyond an acute course of 6 to 8 ketamine infusions. METHODS This retrospective case series reports on 11 patients with TRD who received maintenance ketamine infusions, defined as treatments beyond an initial series of up to 8 infusions. Charts were reviewed to collect data on response to treatment and side effects. RESULTS All 11 patients in this case series were noted to have a reduction in their Beck Depression Inventory II (BDI-II) score after an acute course of treatment and a lower median BDI-II during their maintenance treatments than their baseline BDI-II. At the study end point, 4 patients were continuing maintenance ketamine and 1 patient had transitioned to maintenance intranasal ketamine. Four patients discontinued ketamine due to loss of effect and 1 due to side effects, and the reason for discontinuation was not noted for the remaining 2 patients. No major adverse events were noted in these patients receiving maintenance treatments, and it was well tolerated overall. CONCLUSIONS Maintenance ketamine treatments may be an effective way of maintaining treatment response in some ketamine responders. Future research is required to determine optimal length of treatment in those who respond to ketamine and to track adverse effects over a longer time.
Collapse
|
627
|
Dodd S, Mitchell PB, Bauer M, Yatham L, Young AH, Kennedy SH, Williams L, Suppes T, Lopez Jaramillo C, Trivedi MH, Fava M, Rush AJ, McIntyre RS, Thase ME, Lam RW, Severus E, Kasper S, Berk M. Monitoring for antidepressant-associated adverse events in the treatment of patients with major depressive disorder: An international consensus statement. World J Biol Psychiatry 2018; 19:330-348. [PMID: 28984491 DOI: 10.1080/15622975.2017.1379609] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES These recommendations were designed to ensure safety for patients with major depressive disorder (MDD) and to aid monitoring and management of adverse effects during treatment with approved antidepressant medications. The recommendations aim to inform prescribers about both the risks associated with these treatments and approaches for mitigating such risks. METHODS Expert contributors were sought internationally by contacting representatives of key stakeholder professional societies in the treatment of MDD (ASBDD, CANMAT, WFSBP and ISAD). The manuscript was drafted through iterative editing to ensure consensus. RESULTS Adequate risk assessment prior to commencing pharmacotherapy, and safety monitoring during pharmacotherapy are essential to mitigate adverse events, optimise the benefits of treatment, and detect and assess adverse events when they occur. Risk factors for pharmacotherapy vary with individual patient characteristics and medication regimens. Risk factors for each patient need to be carefully assessed prior to initiating pharmacotherapy, and appropriate individualised treatment choices need to be selected. Some antidepressants are associated with specific safety concerns which were addressed. CONCLUSIONS Risks of adverse outcomes with antidepressant treatment can be managed through appropriate assessment and monitoring to improve the risk benefit ratio and improve clinical outcomes.
Collapse
Affiliation(s)
- Seetal Dodd
- a School of Medicine, Barwon Health , Deakin University, IMPACT SRC (Innovation in Mental and Physical Health and Clinical Treatment - Strategic Research Centre) , Geelong , Australia.,b Department of Psychiatry , University of Melbourne , Melbourne , Australia.,c Mental Health Drug and Alcohol Services , University Hospital Geelong, Barwon Health , Geelong , Australia.,d Orygen The National Centre of Excellence in Youth Mental Health , Parkville , Australia
| | - Philip B Mitchell
- f School of Psychiatry , University of New South Wales, and Black Dog Institute , Sydney , Australia
| | - Michael Bauer
- g Department of Psychiatry and Psychotherapy , University Hospital Carl Gustav Carus, Technische, Universität Dresden , Dresden , Germany
| | - Lakshmi Yatham
- h Department of Psychiatry , University of British Columbia , British Columbia , BC , Canada
| | - Allan H Young
- i Department of Psychological Medicine , Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK & South London and Maudsley NHS Foundation Trust , London , UK
| | - Sidney H Kennedy
- j Department of Psychiatry , University of Toronto , Toronto , ON , Canada
| | - Lana Williams
- a School of Medicine, Barwon Health , Deakin University, IMPACT SRC (Innovation in Mental and Physical Health and Clinical Treatment - Strategic Research Centre) , Geelong , Australia
| | - Trisha Suppes
- k Department of Psychiatry & Behavioral Sciences , School of Medicine, Stanford University , Stanford , CA , USA
| | | | - Madhukar H Trivedi
- m Department of Psychiatry , University of Texas Southwestern Medical Center , Dallas , TX , USA
| | - Maurizio Fava
- n Division of Clinical Research , Massachusetts General Hospital and Harvard Medical School , Boston , MA , USA
| | - A John Rush
- o Duke-National University of Singapore Medical School , Singapore , Singapore
| | - Roger S McIntyre
- j Department of Psychiatry , University of Toronto , Toronto , ON , Canada.,p Mood Disorders Psychopharmacology Unit, University of Toronto , Toronto , ON , Canada.,q Brain and Cognition Discovery Foundation , Toronto , ON , Canada
| | - Michael E Thase
- r Department of Psychiatry, Perelman School of Medicine , University of Pennsylvania , Pennsylvania , PA , USA
| | - Raymond W Lam
- h Department of Psychiatry , University of British Columbia , British Columbia , BC , Canada
| | - Emanuel Severus
- g Department of Psychiatry and Psychotherapy , University Hospital Carl Gustav Carus, Technische, Universität Dresden , Dresden , Germany
| | - Siegfried Kasper
- s Department of Psychiatry and Psychotherapy , Medical University of Vienna , Wien , Austria
| | - Michael Berk
- a School of Medicine, Barwon Health , Deakin University, IMPACT SRC (Innovation in Mental and Physical Health and Clinical Treatment - Strategic Research Centre) , Geelong , Australia.,b Department of Psychiatry , University of Melbourne , Melbourne , Australia.,c Mental Health Drug and Alcohol Services , University Hospital Geelong, Barwon Health , Geelong , Australia.,d Orygen The National Centre of Excellence in Youth Mental Health , Parkville , Australia.,e The Florey Institute of Neuroscience and Mental Health , Parkville , Australia
| |
Collapse
|
628
|
Ross EL, Zivin K, Maixner DF. Cost-effectiveness of Electroconvulsive Therapy vs Pharmacotherapy/Psychotherapy for Treatment-Resistant Depression in the United States. JAMA Psychiatry 2018; 75:713-722. [PMID: 29800956 PMCID: PMC6145669 DOI: 10.1001/jamapsychiatry.2018.0768] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
IMPORTANCE Electroconvulsive therapy (ECT) is a highly effective treatment for depression but is infrequently used owing to stigma, uncertainty about indications, adverse effects, and perceived high cost. OBJECTIVE To assess the cost-effectiveness of ECT compared with pharmacotherapy/psychotherapy for treatment-resistant major depressive disorder in the United States. DESIGN, SETTING, AND PARTICIPANTS A decision analytic model integrating data on clinical efficacy, costs, and quality-of-life effects of ECT compared with pharmacotherapy/psychotherapy was used to simulate depression treatment during a 4-year horizon from a US health care sector perspective. Model input data were drawn from multiple meta-analyses, randomized trials, and observational studies of patients with depression. Where possible, data sources were restricted to US-based studies of nonpsychotic major depression. Data were analyzed between June 2017 and January 2018. INTERVENTIONS Six alternative strategies for incorporating ECT into depression treatment (after failure of 0-5 lines of pharmacotherapy/psychotherapy) compared with no ECT. MAIN OUTCOMES AND MEASURES Remission, response, and nonresponse of depression; quality-adjusted life-years; costs in 2013 US dollars; and incremental cost-effectiveness ratios. Strategies with incremental cost-effectiveness ratios of $100 000 per quality-adjusted life-year or less were designated cost-effective. RESULTS Based on the Sequenced Treatment Alternatives to Relieve Depression trial, we simulated a population with a mean (SD) age of 40.7 (13.2) years, and 62.2% women. Over 4 years, ECT was projected to reduce time with uncontrolled depression from 50% of life-years to 33% to 37% of life-years, with greater improvements when ECT is offered earlier. Mean health care costs were increased by $7300 to $12 000, with greater incremental costs when ECT was offered earlier. In the base case, third-line ECT was cost-effective, with an ICER of $54 000 per quality-adjusted life-year. Third-line ECT remained cost-effective in a range of univariate, scenario, and probabilistic sensitivity analyses. Incorporating all input data uncertainty, we estimate a 74% to 78% likelihood that at least 1 of the ECT strategies is cost-effective and a 56% to 58% likelihood that third-line ECT is the optimal strategy. CONCLUSIONS AND RELEVANCE For US patients with treatment-resistant depression, ECT may be an effective and cost-effective treatment option. Although many factors influence the decision to proceed with ECT, these data suggest that, from a health-economic standpoint, ECT should be considered after failure of 2 or more lines of pharmacotherapy/psychotherapy.
Collapse
Affiliation(s)
- Eric L. Ross
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor
| | - Kara Zivin
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor,Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor,Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor,Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor
| | - Daniel F. Maixner
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor
| |
Collapse
|
629
|
Valerio MP, Szmulewicz AG, Martino DJ. A quantitative review on outcome-to-antidepressants in melancholic unipolar depression. Psychiatry Res 2018; 265:100-110. [PMID: 29702301 DOI: 10.1016/j.psychres.2018.03.088] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 03/26/2018] [Accepted: 03/31/2018] [Indexed: 10/17/2022]
Abstract
The aim of this study was to explore outcome to antidepressants profile in melancholic unipolar depression. We conducted a systematic review of electronic databases and meta-analysis of randomized and nonrandomized trials comparing: 1) outcome to antidepressants and placebo between melancholic and non-melancholic depression; 2) outcome to different antidepressant classes in melancholic depression. Two outcomes were considered: clinical remission and response. Significant lower odds of remission to antidepressants in melancholic than in non-melancholic depressions were found. Although no significant differences were observed in the response to antidepressants between both subtypes of depression, those with melancholic features had lower odds of response to placebo. Finally, treatment of melancholic depression with serotonin reuptake inhibitors was associated with lower odds of remission compared with tricyclic antidepressants, and similar outcome compared with venlafaxine. Melancholia seems to show a differential pattern of outcome to antidepressants, which could be clinically valuable for a better implementation of personalized medicine of depression. Due to several limitations, further research is needed to support these preliminary findings.
Collapse
Affiliation(s)
- Marina P Valerio
- National Council of Scientific and Technical Research (CONICET), Argentina; Psychiatric Emergencies Hospital Torcuato de Alvear, Buenos Aires, Argentina
| | - Alejandro G Szmulewicz
- Bipolar Disorder Program, Institute of Neurosciences, Favaloro University, Buenos Aires, Argentina; Pharmacology Department, University of Buenos Aires School of Medicine, Buenos Aires, Argentina
| | - Diego J Martino
- National Council of Scientific and Technical Research (CONICET), Argentina; Bipolar Disorder Program, Institute of Neurosciences, Favaloro University, Buenos Aires, Argentina; Institute of Cognitive and Translational Neuroscience (INCyT), INECO Foundation, Favaloro University, Buenos Aires, Argentina.
| |
Collapse
|
630
|
Keating LE, Becker S, McCabe K, Whattam J, Garrick L, Sassi RB, Frey BN, McKinnon MC. Effects of a 12-week running programme in youth and adults with complex mood disorders. BMJ Open Sport Exerc Med 2018; 4:e000314. [PMID: 29955373 PMCID: PMC6018895 DOI: 10.1136/bmjsem-2017-000314] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 04/16/2018] [Accepted: 04/16/2018] [Indexed: 12/23/2022] Open
Abstract
Objective Although numerous studies suggest a salutary effect of exercise on mood, few studies have explored the effect of exercise in patients with complex mental illness. Accordingly, we evaluated the impact of running on stress, anxiety and depression in youth and adults with complex mood disorders including comorbid diagnoses, cognitive and social impairment and high relapse rates. Methods Participants were members of a running group at St Joseph Healthcare Hamilton’s Mood Disorders Program, designed for clients with complex mood disorders. On a weekly basis, participants completed Cohen’s Perceived Stress Scale, Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI) questionnaires, providing an opportunity to evaluate the effect of running in this population. Results Data collected for 46 participants from April 2012 to July 2015 indicated a significant decrease in depression (p<0.0001), anxiety (p<0.0001) and stress (p=0.01) scores. Whereas younger participant age, younger age at onset of illness and higher perceived levels of friendship with other running group members (ps≤0.04) were associated with lower end-of-study depression, anxiety and stress scores, higher attendance was associated with decreasing BDI and BAI (ps≤0.01) scores over time. Conclusions Aerobic exercise in a supportive group setting may improve mood symptoms in youth and adults with complex mood disorders, and perceived social support may be an important factor in programme’s success. Further research is required to identify specifically the mechanisms underlying the therapeutic benefits associated with exercise-based therapy programmes.
Collapse
Affiliation(s)
- Laura E Keating
- McMaster Integrative Neuroscience and Discovery, McMaster University, Hamilton, Canada
| | - Suzanna Becker
- McMaster Integrative Neuroscience and Discovery, McMaster University, Hamilton, Canada.,Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, Canada
| | - Katie McCabe
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada.,Mood Disorders Program, St Joseph's Healthcare Hamilton, Hamilton, Canada
| | - Jeff Whattam
- Mood Disorders Program, St Joseph's Healthcare Hamilton, Hamilton, Canada
| | - Laura Garrick
- Mood Disorders Program, St Joseph's Healthcare Hamilton, Hamilton, Canada
| | - Roberto B Sassi
- McMaster Integrative Neuroscience and Discovery, McMaster University, Hamilton, Canada.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada.,Mood Disorders Program, St Joseph's Healthcare Hamilton, Hamilton, Canada
| | - Benicio N Frey
- McMaster Integrative Neuroscience and Discovery, McMaster University, Hamilton, Canada.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada.,Mood Disorders Program, St Joseph's Healthcare Hamilton, Hamilton, Canada
| | - Margaret C McKinnon
- McMaster Integrative Neuroscience and Discovery, McMaster University, Hamilton, Canada.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada.,Mood Disorders Program, St Joseph's Healthcare Hamilton, Hamilton, Canada.,Homewood Research Institute, Guelph, Canada
| |
Collapse
|
631
|
Abstract
Treatment-resistant mood disorders and anxiety disorders require intensive treatment, but treatment options should balance benefits and adverse effects or other potential detrimental effects on patients, including the risk of developing prescription medication addiction. Some of the newer treatment modalities for mood and anxiety disorders may have similar properties to benzodiazepines. The goal of this review was to identify the potential for developing dependence on the novel treatment approaches to treatment-resistant depression and refractory anxiety disorders. PubMed, MEDLINE, PsycINFO, Ovid, Cochrane Library, and Google Scholar were searched. Ketamine is effective in improving symptoms of major depressive disorder, but with no sustained benefits. Long-term use of oral or intranasal ketamine formulations may be associated with the risk of developing dependence. Augmentation of stimulant medication is usually effective for residual symptoms of depression, but the effects are usually short lasting and there is a potential for abuse. Synthetic cannabinoids and medicinal cannabis are increasingly being prescribed for a number of medical conditions, including anxiety disorders, without enough evidence about their efficacy and with the risk of patients developing dependence. In summary, benzodiazepines, ketamine, stimulant medications, and cannabinoids have some common characteristics, including short-lasting benefits and the risk of developing prescription medication addiction with longer use. All of these treatments may raise ethical dilemmas about the appropriateness of prescribing these medications in the long run for patients with depression and anxiety disorders.
Collapse
Affiliation(s)
- Dusan Kolar
- Mood Disorders Research and Treatment Service, Department of Psychiatry, Queen’s University, Kingston, Ontario, Canada
| |
Collapse
|
632
|
Mora C, Zonca V, Riva MA, Cattaneo A. Blood biomarkers and treatment response in major depression. Expert Rev Mol Diagn 2018; 18:513-529. [DOI: 10.1080/14737159.2018.1470927] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Cristina Mora
- Biological Psychiatry Unit, IRCCS Fatebenefratelli S. Giovanni di Dio, Brescia, Italy
| | - Valentina Zonca
- Biological Psychiatry Unit, IRCCS Fatebenefratelli S. Giovanni di Dio, Brescia, Italy
- Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
| | - Marco A. Riva
- Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
| | - Annamaria Cattaneo
- Biological Psychiatry Unit, IRCCS Fatebenefratelli S. Giovanni di Dio, Brescia, Italy
- Stress, Psychiatry and Immunology Laboratory, Department of Psychological Medicine, Institute of Psychiatry, King’s College, London, UK
| |
Collapse
|
633
|
McIntyre RS, Young AH, Haddad PM. Rethinking the spectrum of mood disorders: implications for diagnosis and management - Proceedings of a symposium presented at the 30th Annual European College of Neuropsychopharmacology Congress, 4 September 2017, Paris, France. Ther Adv Psychopharmacol 2018; 8:1-16. [PMID: 29977518 PMCID: PMC6022880 DOI: 10.1177/2045125318762911] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 02/09/2018] [Indexed: 12/17/2022] Open
Abstract
The simultaneous occurrence of manic and depressive features has been recognized since classical times, but the term 'mixed state' was first used by Kraepelin at the end of the 19th century. From the 1980s, until the advent of the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5), psychiatric disorders were classified using a categorical approach. However, it was recognized that such an approach was too rigid to encompass the range of symptomatology encountered in clinical practice. Therefore, a dimensional approach was adopted in DSM-5, in which affective states are considered to be distributed across a continuum ranging from pure mania to pure depression. In addition, the copresence of symptoms of the opposite pole are captured using a 'with mixed features' specifier, applied when three or more nonoverlapping subthreshold symptoms of the opposite pole are present. Mixed features are common in patients with mood episodes, complicating the course of illness, reducing treatment response and worsening outcomes. However, research in this area is scarce and treatment options are limited. Current evidence indicates that antidepressants should be avoided for the treatment of bipolar mixed states. Evidence for bipolar mixed states supports the use of several second-generation antipsychotics, valproate and electroconvulsive therapy. One randomized controlled trial has demonstrated the efficacy of lurasidone, compared with placebo, in patients with major depressive disorder with mixed features, and there is limited evidence supporting the use of ziprasidone in such patients. Further research is required to determine whether other antipsychotic agents, or additional therapeutic approaches, might also be effective in this setting.
Collapse
Affiliation(s)
- Roger S McIntyre
- UHN-Toronto Western Hospital, Mood Disorders Psychopharmacology Unit, University of Toronto, 399 Bathurst Street, Toronto, ON M5T 2S8, Canada
| | - Allan H Young
- Department of Psychological Medicine, King's College London and South London and Maudsley NHS Foundation Trust, London, UK
| | - Peter M Haddad
- Neuroscience and Psychiatry Unit, University of Manchester, Manchester, UK
| |
Collapse
|
634
|
Belzeaux R, Lin R, Ju C, Chay MA, Fiori LM, Lutz PE, Turecki G. Transcriptomic and epigenomic biomarkers of antidepressant response. J Affect Disord 2018; 233:36-44. [PMID: 28918100 DOI: 10.1016/j.jad.2017.08.087] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 08/09/2017] [Accepted: 08/31/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Antidepressant treatment is associated with a high rate of poor response, and thus, biomarker development is warranted. METHODS We aimed to synthesize studies investigating gene expression, small RNAs, and epigenomic biomarkers of antidepressant response. We conducted a narrative review of the literature. RESULTS Firstly, we detailed the challenges involved, in terms of biological tissues, relevant study time frames, and mandatory statistical tools. Secondly we synthesized results obtained in gene expression studies, focusing mainly on genome-wide studies, particularly small non-coding RNA, including micro-RNA and other small RNA species. In addition, we reviewed the potential biomarkers of antidepressant response arising from studies investigating DNA methylation variation and histone modifications. LIMITATIONS We did not conduct a meta-analysis due to the heterogeneity of the study. CONCLUSION Although promising, the field of gene expression and epigenomic biomarkers of antidepressant response is still in its infancy, and needs further development to define useful biomarkers in clinical practice.
Collapse
Affiliation(s)
- Raoul Belzeaux
- McGill Group for Suicide Studies, Douglas Mental Health University Institute, McGill University, Montreal, Quebec, Canada
| | - Rixing Lin
- McGill Group for Suicide Studies, Douglas Mental Health University Institute, McGill University, Montreal, Quebec, Canada
| | - Chelsey Ju
- McGill Group for Suicide Studies, Douglas Mental Health University Institute, McGill University, Montreal, Quebec, Canada
| | - Marc-Aurele Chay
- McGill Group for Suicide Studies, Douglas Mental Health University Institute, McGill University, Montreal, Quebec, Canada
| | - Laura M Fiori
- McGill Group for Suicide Studies, Douglas Mental Health University Institute, McGill University, Montreal, Quebec, Canada
| | - Pierre-Eric Lutz
- McGill Group for Suicide Studies, Douglas Mental Health University Institute, McGill University, Montreal, Quebec, Canada; Institute of Cellular and Integrative Neuroscience, CNRS, UPR3212, Strasbourg, France
| | - Gustavo Turecki
- McGill Group for Suicide Studies, Douglas Mental Health University Institute, McGill University, Montreal, Quebec, Canada.
| |
Collapse
|
635
|
Lunsky Y, Khuu W, Tadrous M, Vigod S, Cobigo V, Gomes T. Antipsychotic Use With and Without Comorbid Psychiatric Diagnosis Among Adults with Intellectual and Developmental Disabilities. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2018; 63:361-369. [PMID: 28830241 PMCID: PMC5971404 DOI: 10.1177/0706743717727240] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Antipsychotic use is controversial in the management of adults with intellectual and developmental disabilities (IDD) because of inconclusive evidence for efficacy in the absence of a comorbid psychiatric condition, and substantial concerns about adverse effects. We aimed to characterize antipsychotic use among Ontario adults with IDD and compare profiles of those with and without a documented psychiatric diagnosis. METHOD This population-based study included 51,881 adults with IDD under 65 y as of April 2010 receiving provincial drug benefits in Ontario who were followed until March 2016 to identify those dispensed at least one antipsychotic medication. Profiles of those with and without a psychiatric diagnosis were compared. RESULTS Overall, 39.2% of adults ( n = 20,316) were dispensed an antipsychotic medication, which increased to 56.4% in a subcohort residing in group homes. Almost one-third (28.91%) of people prescribed an antipsychotic medication did not have a documented psychiatric diagnosis. Those without a psychiatric diagnosis differed considerably from those with a diagnosis. In particular, those without a psychiatric diagnosis were older, less likely to have used antidepressants or benzodiazepines in the year before, and less likely to have used ambulatory and acute care. CONCLUSIONS Antipsychotic use in IDD is common, and occurs frequently without a psychiatric diagnosis. Attention toward how antipsychotics are prescribed and monitored for people with IDD in Canada is warranted to ensure appropriate prescribing.
Collapse
Affiliation(s)
- Yona Lunsky
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- The Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Department of Psychiatry at the University of Toronto, Toronto, Ontario, Canada
| | - Wayne Khuu
- The Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Mina Tadrous
- The Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, Ontario, Canada
- Leslie Dan Faculty of Pharmacy at the University of Toronto, Toronto, Ontario, Canada
| | - Simone Vigod
- The Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Department of Psychiatry at the University of Toronto, Toronto, Ontario, Canada
- Women’s College Hospital, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation at the University of Toronto, Toronto, Ontario, Canada
| | - Virginie Cobigo
- The Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | - Tara Gomes
- The Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, Ontario, Canada
- Leslie Dan Faculty of Pharmacy at the University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation at the University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
636
|
Bayes AJ, Parker GB. Comparison of guidelines for the treatment of unipolar depression: a focus on pharmacotherapy and neurostimulation. Acta Psychiatr Scand 2018; 137:459-471. [PMID: 29577229 DOI: 10.1111/acps.12878] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/26/2018] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To determine the level of agreement across a set of evidence-based guidelines for management of the unipolar depressive disorders and with a focus on physical treatments. METHOD A literature search was undertaken using the terms 'depression', 'depressive' and 'guidelines', using PubMed, Cochrane Database of Systematic Reviews and the National Guideline Clearinghouse. Twelve national psychiatric or professional guideline-producing organizations were identified from the period 2007-2017, with guidelines qualitatively reviewed by two assessors. RESULTS For major depressive disorder (MDD), there was general consensus to use an antidepressant (AD) in cases of greater severity, although disagreement on AD use in mild to moderate depression. There was some agreement on choice of AD class in first-line treatment recommendations, though great variability in second- and third-line management particularly in recommended augmentation and combined AD strategies. Electroconvulsive therapy was considered in all but one guideline, with other neurostimulation treatments being less consistently covered and with variable recommendations. Finally, there was low consistency in the management of dysthymia, persistent depressive disorder and treatment resistant depression. CONCLUSION Our review identifies varying levels of consistency in guideline recommendations. Strategies to improve reliability in guideline formulation should also improve their validity.
Collapse
Affiliation(s)
- A J Bayes
- School of Psychiatry, UNSW, Sydney, NSW, Australia
| | - G B Parker
- School of Psychiatry, UNSW, Sydney, NSW, Australia.,Black Dog Institute, Sydney, NSW, Australia
| |
Collapse
|
637
|
Santina T, Lauzier S, Gagnon H, Villeneuve D, Moisan J, Grégoire JP, Guillaumie L. The Development of a Community Pharmacy-Based Intervention to Optimize Patients' Use of and Experience with Antidepressants: A Step-by-Step Demonstration of the Intervention Mapping Process. PHARMACY 2018; 6:pharmacy6020039. [PMID: 30720782 PMCID: PMC6025435 DOI: 10.3390/pharmacy6020039] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 04/18/2018] [Accepted: 04/23/2018] [Indexed: 11/16/2022] Open
Abstract
Objective: To describe the development of a community pharmacy-based intervention aimed at optimizing experience and use of antidepressants (ADs) for patients with mood and anxiety disorders. Methods: Intervention Mapping (IM) was used for conducting needs assessment, formulating intervention objectives, selecting change methods and practical applications, designing the intervention, and planning intervention implementation. IM is based on a qualitative participatory approach and each step of the intervention development process was conducted through consultations with a pharmacists' committee. Results: A needs assessment was informed by qualitative and quantitative studies conducted with leaders, pharmacists, and patients. Intervention objectives and change methods were selected to target factors influencing patients' experience with and use of ADs. The intervention includes four brief consultations between the pharmacist and the patient: (1) provision of information (first AD claim); (2) management of side effects (15 days after first claim); (3) monitoring treatment efficacy (30-day renewal); (4) assessment of treatment persistence (2-month renewal, repeated every 6 months). A detailed implementation plan was also developed. Conclusion: IM provided a systematic and rigorous approach to the development of an intervention directly tied to empirical data on patients' and pharmacists' experiences and recommendations. The thorough description of this intervention may facilitate the development of new pharmacy-based interventions or the adaptation of this intervention to other illnesses and settings.
Collapse
Affiliation(s)
- Tania Santina
- Faculty of Nursing, Université Laval, Pavillon Ferdinand-Vandry, 1050, Avenue de la Médecine, Quebec City, QC G1V 0A6, Canada.
| | - Sophie Lauzier
- Faculty of Pharmacy and Centre de Recherche du CHU de Québec-Université Laval, Hôpital Saint-Sacrement, 1050 Chemin Ste-Foy, Quebec City, QC G1S 4L8, Canada.
| | | | | | - Jocelyne Moisan
- Faculty of Pharmacy and Centre de Recherche du CHU de Québec-Université Laval, Hôpital Saint-Sacrement, 1050 Chemin Ste-Foy, Quebec City, QC G1S 4L8, Canada.
| | - Jean-Pierre Grégoire
- Faculty of Pharmacy and Centre de Recherche du CHU de Québec-Université Laval, Hôpital Saint-Sacrement, 1050 Chemin Ste-Foy, Quebec City, QC G1S 4L8, Canada.
| | - Laurence Guillaumie
- Faculty of Nursing, Université Laval, Pavillon Ferdinand-Vandry, 1050, Avenue de la Médecine, Quebec City, QC G1V 0A6, Canada.
| |
Collapse
|
638
|
Kang HJ, Kim JW, Kim SY, Kim SW, Shin HY, Shin MG, Kim JM. The MAKE Biomarker Discovery for Enhancing anTidepressant Treatment Effect and Response (MAKE BETTER) Study: Design and Methodology. Psychiatry Investig 2018; 15:538-545. [PMID: 29614851 PMCID: PMC5975999 DOI: 10.30773/pi.2017.10.2] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 10/02/2017] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE Depression is associated with a major disease burden, and many individuals suffer from depressive symptoms due to an insufficient response to ostensibly adequate antidepressant treatment. Therefore, it is important to identify reliable treatment response predictors for use in developing personalized treatment strategies. METHODS The MAKE Biomarker discovery for Enhancing anTidepressant Treatment Effect and Response (MAKE BETTER) study was performed to identify predictors of antidepressant response using a 2-year naturalistic prospective design. Participants in the MAKE BETTER study were consecutively recruited from patients who visited the Psychiatry Department of Chonnam National University Hospital, Gwangju, South Korea for treatment of a depressive disorder. Data on demographic and clinical characteristics, genetic markers measured by whole-exome sequencing, and blood markers were obtained. The types and doses of antidepressants were determined based on the clinical judgment of the psychiatrist, and the treatment outcomes (e.g., depressive and other psychiatric symptoms and issues related to safety) were assessed. RESULTS We will be able to use the data collected in this study to develop a treatment-response prediction index composed of biomarkers. CONCLUSION The MAKE BETTER study will provide an empirical basis for a personalized medicine approach to depression by enabling the prediction of antidepressant treatment response according the characteristics of each patient. It will thereby support evidence-based decision-making that decreases the use of a trial-and-error approach to the treatment of depressive disorders.
Collapse
Affiliation(s)
- Hee-Ju Kang
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Ju-Wan Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Seon-Young Kim
- Mental Health Clinic, Chonnam National University Hwasun Hospital, Hwasun, Republic of Korea
| | - Sung-Wan Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Hee-Young Shin
- Department of Biomedical Science, Chonnam National University Medical School, and Clinical Trial Center, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Myung-Geun Shin
- Department of Laboratory Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Jae-Min Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| |
Collapse
|
639
|
Xing S, Calip GS, Leow AD, Kim S, Schumock GT, Touchette DR, Lee TA. The impact of depression medications on oral antidiabetic drug adherence in patients with diabetes and depression. J Diabetes Complications 2018; 32:492-500. [PMID: 29544744 PMCID: PMC5920707 DOI: 10.1016/j.jdiacomp.2017.12.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 11/29/2017] [Accepted: 12/21/2017] [Indexed: 12/13/2022]
Abstract
AIMS To compare adherence and persistence to oral antidiabetic drugs (OAD) between patients who are new users of second generation antipsychotics (SGA) versus new users of other depression therapies in adults with type 2 diabetes mellitus (T2DM) and major depressive disorder (MDD). METHODS Adults 18-64 years with previously-treated T2DM and MDD (past OAD and SSRI/SNRI use) who are new users of SGA or non-SGA therapies (bupropion, lithium, mirtazapine, thyroid hormone, tricyclic antidepressant) were identified in the 2009-2015 MarketScan® Commercial Claims and Encounters database. Multivariate regression models were used to determine the odds of a ≥10% decline in OAD adherence over 180- and 365-days, and time to OAD discontinuation, adjusting for differences between groups. RESULTS A total of 8664 (21.5% SGA), 8311 (22.1% SGA), and 17,524 (21.3% SGA) patients met inclusion criteria for the 180-day adherence, 365-day adherence, and persistence cohorts, respectively. Over 180-days, 16.6% of SGA and 13.3% of non-SGA initiators had a ≥10% decline in OAD adherence (adjusted odds ratio [OR] = 1.41, 95% CI 1.21-1.63). Over 365-days, 22.3% of SGA and 18.9% of non-SGA initiators had a ≥ 10% decline (OR = 1.34, 95% CI 1.17-1.53). Time to OAD discontinuation was similar between groups (adjusted hazard ratio = 1.03, 95% CI 0.94-1.12). CONCLUSION Use of SGA was associated with a 1.3-1.4 times higher odds of a ≥10% decline in OAD adherence. Adherence to OAD is critical for optimal diabetes control and reductions in this magnitude may impact A1C. Close monitoring of OAD adherence after SGA initiation is warranted.
Collapse
Affiliation(s)
- Shan Xing
- University of Illinois at Chicago, Department of Pharmacy, Systems, Outcomes and Policy, College of Pharmacy, United States
| | - Gregory S Calip
- University of Illinois at Chicago, Department of Pharmacy, Systems, Outcomes and Policy, College of Pharmacy, United States
| | - Alex D Leow
- University of Illinois at Chicago, Department of Psychiatry, College of Medicine, United States; University of Illinois at Chicago, Department of Bioengineering, College of Engineering, College of Medicine, United States
| | - Shiyun Kim
- University of Illinois at Chicago, Department of Pharmacy Practice, College of Pharmacy, United States
| | - Glen T Schumock
- University of Illinois at Chicago, Department of Pharmacy, Systems, Outcomes and Policy, College of Pharmacy, United States
| | - Daniel R Touchette
- University of Illinois at Chicago, Department of Pharmacy, Systems, Outcomes and Policy, College of Pharmacy, United States
| | - Todd A Lee
- University of Illinois at Chicago, Department of Pharmacy, Systems, Outcomes and Policy, College of Pharmacy, United States.
| |
Collapse
|
640
|
Potentially inappropriate prescription of antidepressants in old people: characteristics, associated factors, and impact on mortality. Int Psychogeriatr 2018; 30:715-726. [PMID: 29145919 DOI: 10.1017/s1041610217002290] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
UNLABELLED ABSTRACTBackground:The increasing use of antidepressants (ADs) has raised concerns about their inappropriate use in old people. OBJECTIVE To examine the prevalence of potentially inappropriate prescribing (PIP) of ADs, their associated factors, and their impact on mortality in a sample of old people in France. METHODS The analysis used data from the SIPAF study, a cross-sectional study consisting of 2,350 people aged ≥ 70 years. Trained nurses interviewed participants at home between 2008 and 2010. Information was collected concerning socio-demographic and health characteristics, including medication use. The study population consisted of the 318 AD users from the SIPAF study (13.5%). PIP of ADs was defined according to national and international criteria. Factors associated with PIP of ADs were assessed using a multivariate logistic regression model. The influence of PIP of ADs on mortality was assessed using a Cox model (median follow-up 2.8 years). RESULTS Among the SIPAF study, 71% of AD users were female and the mean age was 84 ± 7 years. Selective serotonin reuptake inhibitors (SSRIs) were the most prescribed ADs (19.8%). We found PIP of ADs in 36.8% of the study population, mainly the co-prescription of diuretics with SSRIs (17.6%) and the prescription of tricyclics (12.9%). PIP of ADs was associated with polypharmacy (aOR5-9 drugs 2. 61, 95% CI 1.11-6.16 and aOR≥10 drugs 2.69, 95% CI 1.06-6.87) and comorbidity (aOR3-4 chronic diseases 2.59, 95%CI 1.04-6.44 and aOR≥5 chronic diseases 2.33, 95%CI 0.94-5.79), and increased the risk of mortality during follow-up (aHR 2.30, 95%CI 1.28-4.12). CONCLUSIONS This study shows that more than one third of AD prescriptions may be inappropriate in old people. PIP of ADs was related to polypharmacy and comorbidity and increased mortality among AD users.
Collapse
|
641
|
Aboukarr A, Giudice M. Interaction between Monoamine Oxidase B Inhibitors and Selective Serotonin Reuptake Inhibitors. Can J Hosp Pharm 2018; 71:196-207. [PMID: 29955193 PMCID: PMC6019085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Monoamine oxidase B (MAO-B) inhibitors are used to treat the motor symptoms of Parkinson disease. Depression is commonly associated with Parkinson disease, and selective serotonin reuptake inhibitors (SSRIs) are often used for its management. Tertiary sources warn that the combination of MAO-B inhibitors and SSRIs can result in increased serotonergic effects, leading to serotonin syndrome. OBJECTIVE To explore the mechanism, clinical significance, and management of this potential drug interaction through a review of the supporting evidence. DATA SOURCES PubMed, MEDLINE (1946 forward), Embase (1947 forward), PsycINFO (1806 forward), and International Pharmaceutical Abstracts (1970 forward) were searched on February 4, 2017. STUDY SELECTION AND DATA EXTRACTION Studies and case reports describing aspects of the potential interaction between MAO-B inhibitors and SSRIs in patients with Parkinson disease and published in English were identified by both title and abstract. DATA SYNTHESIS The search identified 8 studies evaluating the potential interaction between SSRIs and the MAO-B inhibitors selegiline and rasagiline. The largest, a retrospective cohort study of 1504 patients with Parkinson disease, found no cases of serotonin syndrome with coadministration of rasagiline and an SSRI. A survey of 63 investigators in the Parkinson Study Group identified 11 potential cases of serotonin syndrome among 4568 patients treated with the combination of selegiline and antidepressants (including SSRIs). In addition, 17 case reports describing the onset of serotonin syndrome with coadministration of an SSRI and either selegiline or rasagiline were identified. Following discontinuation or dose reduction of one or both of the agents, the symptoms of serotonin syndrome gradually resolved in most cases, with none being fatal. CONCLUSIONS According to the literature, serotonin syndrome occurs rarely, and the combination of SSRI and MAO-B inhibitor is well tolerated. Therefore, SSRIs and MAO-B inhibitors can be coadministered, provided that their recommended doses are not exceeded and the SSRI dose is kept at the lower end of the therapeutic range. Among the SSRIs, citalopram and sertraline may be preferred.
Collapse
Affiliation(s)
- Abdullah Aboukarr
- , PharmD, was, at the time this review was performed, a PharmD student in the Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario. He is now with Medical Affairs, Purdue Pharma (Canada), Pickering, Ontario
| | - Mirella Giudice
- , BScPharm, is with the Ottawa Valley Regional Drug Information Service, The Ottawa Hospital, Ottawa, Ontario
| |
Collapse
|
642
|
Kennedy SH, Ceniti AK. Unpacking Major Depressive Disorder: From Classification to Treatment Selection. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2018; 63:308-313. [PMID: 29278937 PMCID: PMC5912302 DOI: 10.1177/0706743717748883] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Sidney H. Kennedy
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario
- Arthur Sommer Rotenberg Suicide and Depression Studies Program, St. Michael’s Hospital, Toronto, Ontario
- Krembil Research Institute, Toronto Western Hospital & Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario
- Department of Psychiatry, St. Michael’s Hospital & University Health Network, University of Toronto, Toronto, Ontario
- Sidney H. Kennedy, MD, FRCPC, FCAHS, St. Michael’s Hospital, 193 Yonge Street, Suite 6-001, Toronto, Ontario M5B 1M8, Canada.
| | - Amanda K. Ceniti
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario
- Arthur Sommer Rotenberg Suicide and Depression Studies Program, St. Michael’s Hospital, Toronto, Ontario
| |
Collapse
|
643
|
Lambert C, Da Silva S, Ceniti AK, Rizvi SJ, Foussias G, Kennedy SH. Anhedonia in depression and schizophrenia: A transdiagnostic challenge. CNS Neurosci Ther 2018; 24:615-623. [PMID: 29687627 DOI: 10.1111/cns.12854] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 03/10/2018] [Accepted: 03/12/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Anhedonia, as a dysregulation of the reward circuit, is present in both Major Depressive Disorder (MDD) and schizophrenia (SZ). AIMS To elucidate the clinical and neurobiological differences between schizophrenia (SZ) and depression (MDD) in regard to anhedonia, while reconciling the challenges and benefits of assessing anhedonia as a transdiagnostic feature under the Research Domain Criteria (RDoC) framework. METHODS In this review, we summarize data from publications examining anhedonia or its underlying reward deficits in SZ and MDD. A literature search was conducted in OVID Medline, PsycINFO and EMBASE databases between 2000 and 2017. RESULTS While certain subgroups share commonalities, there are also important differences. SZ may be characterized by a disorganization, rather than a deficiency, in reward processing and cognitive function, including inappropriate energy expenditure and focus on irrelevant cues. In contrast, MDD has been characterized by deficits in anticipatory pleasure, development of reward associations, and integration of information from past experience. Understanding the roles of neurotransmitters and aberrant brain circuitry is necessary to appreciate differences in reward function in SZ and MDD. CONCLUSION Anhedonia as a clinical presentation of reward circuit dysregulation is an important and relatively undertreated symptom of both SZ and MDD. In order to improve patient outcomes and quality of life, it is important to consider how anhedonia fits into both diagnoses.
Collapse
Affiliation(s)
- Clare Lambert
- Arthur Sommer Rotenberg Suicide and Depression Studies Program, St. Michael's Hospital, Toronto, ON, Canada.,Royal College of Surgeons in Ireland, School of Medicine, Dublin, Ireland
| | - Susana Da Silva
- Centre for Addiction and Mental Health, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Amanda K Ceniti
- Arthur Sommer Rotenberg Suicide and Depression Studies Program, St. Michael's Hospital, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Sakina J Rizvi
- Arthur Sommer Rotenberg Suicide and Depression Studies Program, St. Michael's Hospital, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada.,Mental Health and Addiction Service, St. Michael's Hospital, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - George Foussias
- Centre for Addiction and Mental Health, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Sidney H Kennedy
- Arthur Sommer Rotenberg Suicide and Depression Studies Program, St. Michael's Hospital, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada.,Mental Health and Addiction Service, St. Michael's Hospital, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
644
|
Ostuzzi G, Matcham F, Dauchy S, Barbui C, Hotopf M. Antidepressants for the treatment of depression in people with cancer. Cochrane Database Syst Rev 2018; 4:CD011006. [PMID: 29683474 PMCID: PMC6494588 DOI: 10.1002/14651858.cd011006.pub3] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Major depression and other depressive conditions are common in people with cancer. These conditions are not easily detectable in clinical practice, due to the overlap between medical and psychiatric symptoms, as described by diagnostic manuals such as the Diagnostic and Statistical Manual of Mental Disorders (DSM) and International Classification of Diseases (ICD). Moreover, it is particularly challenging to distinguish between pathological and normal reactions to such a severe illness. Depressive symptoms, even in subthreshold manifestations, have been shown to have a negative impact in terms of quality of life, compliance with anti-cancer treatment, suicide risk and likely even the mortality rate for the cancer itself. Randomised controlled trials (RCTs) on the efficacy, tolerability and acceptability of antidepressants in this population are few and often report conflicting results. OBJECTIVES To assess the efficacy, tolerability and acceptability of antidepressants for treating depressive symptoms in adults (aged 18 years or older) with cancer (any site and stage). SEARCH METHODS We searched the following electronic bibliographic databases: the Cochrane Central Register of Controlled Trials (CENTRAL 2017, Issue 6), MEDLINE Ovid (1946 to June week 4 2017), Embase Ovid (1980 to 2017 week 27) and PsycINFO Ovid (1987 to July week 4 2017). We additionally handsearched the trial databases of the most relevant national, international and pharmaceutical company trial registers and drug-approving agencies for published, unpublished and ongoing controlled trials. SELECTION CRITERIA We included RCTs comparing antidepressants versus placebo, or antidepressants versus other antidepressants, in adults (aged 18 years or above) with any primary diagnosis of cancer and depression (including major depressive disorder, adjustment disorder, dysthymic disorder or depressive symptoms in the absence of a formal diagnosis). DATA COLLECTION AND ANALYSIS Two review authors independently checked eligibility and extracted data using a form specifically designed for the aims of this review. The two authors compared the data extracted and then entered data into Review Manager 5 using a double-entry procedure. Information extracted included study and participant characteristics, intervention details, outcome measures for each time point of interest, cost analysis and sponsorship by a drug company. We used the standard methodological procedures expected by Cochrane. MAIN RESULTS We retrieved a total of 10 studies (885 participants), seven of which contributed to the meta-analysis for the primary outcome. Four of these compared antidepressants and placebo, two compared two antidepressants, and one three-armed study compared two antidepressants and placebo. In this update we included one additional unpublished study. These new data contributed to the secondary analysis, while the results of the primary analysis remained unchanged.For acute-phase treatment response (6 to 12 weeks), we found no difference between antidepressants as a class and placebo on symptoms of depression measured both as a continuous outcome (standardised mean difference (SMD) -0.45, 95% confidence interval (CI) -1.01 to 0.11, five RCTs, 266 participants; very low certainty evidence) and as a proportion of people who had depression at the end of the study (risk ratio (RR) 0.82, 95% CI 0.62 to 1.08, five RCTs, 417 participants; very low certainty evidence). No trials reported data on follow-up response (more than 12 weeks). In head-to-head comparisons we only retrieved data for selective serotonin reuptake inhibitors (SSRIs) versus tricyclic antidepressants, showing no difference between these two classes (SMD -0.08, 95% CI -0.34 to 0.18, three RCTs, 237 participants; very low certainty evidence). No clear evidence of a beneficial effect of antidepressants versus either placebo or other antidepressants emerged from our analyses of the secondary efficacy outcomes (dichotomous outcome, response at 6 to 12 weeks, very low certainty evidence). In terms of dropouts due to any cause, we found no difference between antidepressants as a class compared with placebo (RR 0.85, 95% CI 0.52 to 1.38, seven RCTs, 479 participants; very low certainty evidence), and between SSRIs and tricyclic antidepressants (RR 0.83, 95% CI 0.53 to 1.30, three RCTs, 237 participants). We downgraded the certainty (quality) of the evidence because the included studies were at an unclear or high risk of bias due to poor reporting, imprecision arising from small sample sizes and wide confidence intervals, and inconsistency due to statistical or clinical heterogeneity. AUTHORS' CONCLUSIONS Despite the impact of depression on people with cancer, the available studies were very few and of low quality. This review found very low certainty evidence for the effects of these drugs compared with placebo. On the basis of these results, clear implications for practice cannot be deduced. The use of antidepressants in people with cancer should be considered on an individual basis and, considering the lack of head-to-head data, the choice of which agent to prescribe may be based on the data on antidepressant efficacy in the general population of individuals with major depression, also taking into account that data on medically ill patients suggest a positive safety profile for the SSRIs. To better inform clinical practice, there is an urgent need for large, simple, randomised, pragmatic trials comparing commonly used antidepressants versus placebo in people with cancer who have depressive symptoms, with or without a formal diagnosis of a depressive disorder.
Collapse
Affiliation(s)
- Giovanni Ostuzzi
- University of VeronaDepartment of Neuroscience, Biomedicine and Movement Sciences, Section of PsychiatryPoliclinico "GB Rossi"Piazzale L.A. Scuro, 10VeronaItaly37134
| | - Faith Matcham
- The Institute of Psychiatry, King's College LondonDepartment of Psychological MedicineWeston Education CentreLondonUKSE5 9RJ
| | - Sarah Dauchy
- Gustave RoussyChef du Département Interdisciplinaire de Soins de Support114 rue Edouard VaillantVillejuifParisFrance94805
| | - Corrado Barbui
- University of VeronaDepartment of Neuroscience, Biomedicine and Movement Sciences, Section of PsychiatryVeronaItaly
| | - Matthew Hotopf
- The Institute of Psychiatry, King's College LondonDepartment of Psychological MedicineWeston Education CentreLondonUKSE5 9RJ
| | | |
Collapse
|
645
|
Maciukiewicz M, Marshe VS, Hauschild AC, Foster JA, Rotzinger S, Kennedy JL, Kennedy SH, Müller DJ, Geraci J. GWAS-based machine learning approach to predict duloxetine response in major depressive disorder. J Psychiatr Res 2018; 99:62-68. [PMID: 29407288 DOI: 10.1016/j.jpsychires.2017.12.009] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 10/31/2017] [Accepted: 12/14/2017] [Indexed: 12/22/2022]
Abstract
Major depressive disorder (MDD) is one of the most prevalent psychiatric disorders and is commonly treated with antidepressant drugs. However, large variability is observed in terms of response to antidepressants. Machine learning (ML) models may be useful to predict treatment outcomes. A sample of 186 MDD patients received treatment with duloxetine for up to 8 weeks were categorized as "responders" based on a MADRS change >50% from baseline; or "remitters" based on a MADRS score ≤10 at end point. The initial dataset (N = 186) was randomly divided into training and test sets in a nested 5-fold cross-validation, where 80% was used as a training set and 20% made up five independent test sets. We performed genome-wide logistic regression to identify potentially significant variants related to duloxetine response/remission and extracted the most promising predictors using LASSO regression. Subsequently, classification-regression trees (CRT) and support vector machines (SVM) were applied to construct models, using ten-fold cross-validation. With regards to response, none of the pairs performed significantly better than chance (accuracy p > .1). For remission, SVM achieved moderate performance with an accuracy = 0.52, a sensitivity = 0.58, and a specificity = 0.46, and 0.51 for all coefficients for CRT. The best performing SVM fold was characterized by an accuracy = 0.66 (p = .071), sensitivity = 0.70 and a sensitivity = 0.61. In this study, the potential of using GWAS data to predict duloxetine outcomes was examined using ML models. The models were characterized by a promising sensitivity, but specificity remained moderate at best. The inclusion of additional non-genetic variables to create integrated models may improve prediction.
Collapse
Affiliation(s)
- Malgorzata Maciukiewicz
- Pharmacogenetic Research Clinic, Center for Addiction and Mental Health, Toronto, ON, Canada
| | - Victoria S Marshe
- Pharmacogenetic Research Clinic, Center for Addiction and Mental Health, Toronto, ON, Canada; Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Anne-Christin Hauschild
- IBM Life Sciences Discovery Centre, Princess Margaret Cancer Centre, Toronto, ON, Canada; Department of Computer Science, University of Toronto, Toronto, ON, Canada; University Health Network, Toronto, ON, Canada
| | - Jane A Foster
- University Health Network, Toronto, ON, Canada; Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Susan Rotzinger
- University Health Network, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - James L Kennedy
- Pharmacogenetic Research Clinic, Center for Addiction and Mental Health, Toronto, ON, Canada; Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Sidney H Kennedy
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; University Health Network, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, St. Michael's Hospital, Toronto, ON, Canada
| | - Daniel J Müller
- Pharmacogenetic Research Clinic, Center for Addiction and Mental Health, Toronto, ON, Canada; Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
| | - Joseph Geraci
- Department of Molecular Medicine, Queen's University, Kingston, ON, Canada
| |
Collapse
|
646
|
Sareen J, Holens P, Turner S, Jetly R, Kennedy S, Heisel M, Cooper K, Mota N, Comtois K, Stein MB, Schaffer A, Thompson J, Heber A. Report of the 2016 Mental Health Expert Panel on suicide prevention in the Canadian Armed Forces. JOURNAL OF MILITARY VETERAN AND FAMILY HEALTH 2018. [DOI: 10.3138/jmvfh.2017-0043] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Jitender Sareen
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Pamela Holens
- Department of Clinical Health Psychology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Sarah Turner
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Rakesh Jetly
- Directorate of Mental Health, Canadian Forces Health Services Group, Department of National Defense, Ottawa, Ontario, Canada
| | - Sidney Kennedy
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Marnin Heisel
- Departments of Psychiatry, Epidemiology and Biostatistics, University of Western Ontario, London, Ontario, Canada
| | - Ken Cooper
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Natalie Mota
- Department of Clinical Health Psychology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Katherine Comtois
- Department of Psychiatry and Behavioural Sciences, University of Washington, Seattle, Washington, USA
| | - Murray B Stein
- Departments of Psychiatry, Family Medicine and Public Health, University of California San Diego, San Diego, California, USA
| | - Ayal Schaffer
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Jim Thompson
- Research Medical Advisor, Research Directorate, Veterans Affairs Canada, Charlottetown, Prince Edward Island, Canada
| | - Alexandra Heber
- Chief of Psychiatry, Health Professionals Division, Veterans Affairs Canada, Charlottetown, Prince Edward Island, Canada
| |
Collapse
|
647
|
Seo JS, Bahk WM, Wang HR, Woo YS, Park YM, Jeong JH, Kim W, Shim SH, Lee JG, Jon DI, Min KJ. Korean Medication Algorithm for Depressive Disorders 2017: Third Revision. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE : THE OFFICIAL SCIENTIFIC JOURNAL OF THE KOREAN COLLEGE OF NEUROPSYCHOPHARMACOLOGY 2018; 16:67-87. [PMID: 29397669 PMCID: PMC5810446 DOI: 10.9758/cpn.2018.16.1.67] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 08/01/2017] [Indexed: 12/22/2022]
Abstract
OBJECTIVE In 2002, the Korean Society for Affective Disorders developed the guidelines for the treatment of major depressive disorder (MDD), and revised it in 2006 and 2012. The third revision of these guidelines was undertaken to reflect advances in the field. METHODS Using a 44-item questionnaire, an expert consensus was obtained on pharmacological treatment strategies for MDD 1) without or 2) with psychotic features, 3) depression subtypes, 4) maintenance, 5) special populations, 6) the choice of an antidepressant (AD) regarding safety and adverse effects, and 7) non-pharmacological biological therapies. Recommended first, second, and third-line strategies were derived statistically. RESULTS AD monotherapy is recommended as the first-line strategy for non-psychotic depression in adults, children/adolescents, elderly adults, patient with persistent depressive disorder, and pregnant women or patients with postpartum depression or premenstrual dysphoric disorder. The combination of AD and atypical antipsychotics (AAP) was recommended for psychotic depression in adult, child/adolescent, postpartum depression, and mixed features or anxious distress. Most experts recommended stopping the ongoing initial AD and AAP after a certain period in patients with one or two depressive episodes. As an MDD treatment modality, 92% of experts are considering electroconvulsive therapy and 46.8% are applying it clinically, while 86% of experts are considering repetitive transcranial magnetic stimulation but only 31.6% are applying it clinically. CONCLUSION The pharmacological treatment strategy in 2017 is similar to that of Korean Medication Algorithm for Depressive Disorder 2012. The preference of AAPs was more increased.
Collapse
Affiliation(s)
- Jeong Seok Seo
- Department of Psychiatry, Konkuk University School of Medicine, Cheongju,
Korea
| | - Won-Myong Bahk
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Hee Ryung Wang
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Young Sup Woo
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Young-Min Park
- Department of Psychiatry, Ilsan Paik Hospital, Inje University College of Medicine, Goyang,
Korea
| | - Jong-Hyun Jeong
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Won Kim
- Department of Psychiatry, Seoul Paik Hospital, Inje University College of Medicine, Seoul,
Korea
- Korea/Stress Research Institute, Inje University, Seoul,
Korea
| | - Se-Hoon Shim
- Department of Psychiatry, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan,
Korea
| | - Jung Goo Lee
- Department of Psychiatry, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan,
Korea
- Paik Institute for Clinical Research, Department of Health Science and Technology, Graduate School of Inje University, Busan,
Korea
| | - Duk-In Jon
- Department of Psychiatry, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang,
Korea
| | - Kyung Joon Min
- Department of Psychiatry, Chung-Ang University College of Medicine, Seoul,
Korea
| |
Collapse
|
648
|
Serretti A. The Present and Future of Precision Medicine in Psychiatry: Focus on Clinical Psychopharmacology of Antidepressants. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE 2018; 16:1-6. [PMID: 29397661 PMCID: PMC5810453 DOI: 10.9758/cpn.2018.16.1.1] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 10/24/2017] [Indexed: 12/21/2022]
Abstract
Precision medicine is a concept which is recently gaining momentum in all branches of medicine. In particular in psychiatry it is greatly needed given the huge societal costs of psychiatric disorders and given the long time needed to observe benefit from treatments and the response variability. The future will be based on biological determinants, however until such an interesting but still futuristic aim will be reached, at present we may only rely on clinical features to guide our individualized prescription which is currently still frequently based on personal opinion and subjective previous experiences. The aim of this review is to offer an overview of the main aspects to take into consideration when prescribing an antidepressant treatment to reach the best precision medicine using clinical information. More than 40 compounds are available for treating depression and a similar amount of compounds for other psychiatric disorders. The process of matching the profile of the patient with all different profiles of available compounds is therefore quite complex. Our everyday prescribing procedure should take into consideration a number of factors such as the knowledge of the profile of available compounds versus the symptomatology profile of the subject, previous efficacy, medical comorbidities, tolerability profile, individual preferences, and family history. While we are waiting more complex algorithms including biological or genetic measures, it is possible to optimize our current prescription practice by using all available information in order to obtain as much as possible an evidence based precision medicine prescription.
Collapse
Affiliation(s)
- Alessandro Serretti
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy
| |
Collapse
|
649
|
Abstract
Psychiatric and physical conditions often coexist, and there is robust evidence that associates the frequency of depression with single and multiple physical conditions. More than half of patients with depression may have at least one chronic physical condition. Therefore, antidepressants are often used in cotherapy with other medications for the management of both psychiatric and chronic physical illnesses. The risk of drug-drug interactions (DDIs) is augmented by complex polypharmacy regimens and extended periods of treatment required, of which possible outcomes range from tolerability issues to lack of efficacy and serious adverse events. Optimal patient outcomes may be achieved through drug selection with minimal potential for DDIs. Desvenlafaxine is a serotonin-norepinephrine reuptake inhibitor approved for the treatment of adults with major depressive disorder. Pharmacokinetic studies of desvenlafaxine have shown a simple metabolic profile unique among antidepressants. This review examines the DDI profiles of antidepressants, particularly desvenlafaxine, in relation to drugs of different therapeutic areas. The summary and comparison of information available is meant to help clinicians in making informed decisions when using desvenlafaxine in patients with depression and comorbid chronic conditions.
Collapse
Affiliation(s)
- Yvette Low
- Department of Pharmacy, National University of Singapore, Singapore
| | | | - Graca Lima
- Global Medical Affairs, Asia-Pacific Region, Pfizer, Hong Kong
| |
Collapse
|
650
|
Guillaumie L, Ndayizigiye A, Beaucage C, Moisan J, Grégoire JP, Villeneuve D, Lauzier S. Patient perspectives on the role of community pharmacists for antidepressant treatment: A qualitative study. Can Pharm J (Ott) 2018. [PMID: 29531632 DOI: 10.1177/1715163518755814] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives Patients prescribed antidepressant drug treatment (ADT) for major depression report several needs in relation to their treatment, and a large proportion of these patients will end ADT prematurely. Community pharmacists may play an important role in monitoring ADT and supporting these patients. However, little is known about patient experiences of the services provided in community pharmacies. The objectives of this study were to 1) explore patients' experiences with the services community pharmacists provide for ADT and 2) identify potential avenues for improvement of pharmacists' services within the context of ADT. Methods A qualitative descriptive exploratory study was conducted among individuals diagnosed with major depression who had initiated ADT at some point in the 12 months prior to their participation in the study. A total of 14 persons recruited in a local health centre and a community-based organization participated in individual interviews. A thematic analysis of the interview transcripts was conducted. Results Pharmacists tend to concentrate their involvement in treatment at initiation and at the first refill when questions, uncertainties and side effects are major issues. Patients felt that the pharmacists' contributions consisted of providing information and reassurance; in these respects, their needs were met. Participants had few ideas as to what additional services pharmacists could implement to improve patients' experience with ADT. Patients' sole expectations were that pharmacists extend this information role to the whole length of the treatment and enhance the confidentiality of discussions in pharmacy. Conclusion Pharmacists should provide counselling throughout the entire treatment rather than passively waiting for patients to ask their questions. However, facilitation of open discussions may not be achieved unless confidentiality at pharmacies is secured.
Collapse
Affiliation(s)
- Laurence Guillaumie
- Population Health and Optimal Practices in Health Research Unit (Guillaumie, Moisan, Grégoire, Lauzier), CHU de Québec-Université Laval Research Centre.,Faculty of Nursing (Ndayizigiye, Guillaumie), Université Laval.,Faculty of Pharmacy (Moisan, Grégoire, Lauzier), Université Laval.,Direction régionale de la santé publique de la Capitale-Nationale (Beaucage), Quebec, Quebec.,Panacée Conseil (Villeneuve), Quebec, Quebec
| | - Alice Ndayizigiye
- Population Health and Optimal Practices in Health Research Unit (Guillaumie, Moisan, Grégoire, Lauzier), CHU de Québec-Université Laval Research Centre.,Faculty of Nursing (Ndayizigiye, Guillaumie), Université Laval.,Faculty of Pharmacy (Moisan, Grégoire, Lauzier), Université Laval.,Direction régionale de la santé publique de la Capitale-Nationale (Beaucage), Quebec, Quebec.,Panacée Conseil (Villeneuve), Quebec, Quebec
| | - Clément Beaucage
- Population Health and Optimal Practices in Health Research Unit (Guillaumie, Moisan, Grégoire, Lauzier), CHU de Québec-Université Laval Research Centre.,Faculty of Nursing (Ndayizigiye, Guillaumie), Université Laval.,Faculty of Pharmacy (Moisan, Grégoire, Lauzier), Université Laval.,Direction régionale de la santé publique de la Capitale-Nationale (Beaucage), Quebec, Quebec.,Panacée Conseil (Villeneuve), Quebec, Quebec
| | - Jocelyne Moisan
- Population Health and Optimal Practices in Health Research Unit (Guillaumie, Moisan, Grégoire, Lauzier), CHU de Québec-Université Laval Research Centre.,Faculty of Nursing (Ndayizigiye, Guillaumie), Université Laval.,Faculty of Pharmacy (Moisan, Grégoire, Lauzier), Université Laval.,Direction régionale de la santé publique de la Capitale-Nationale (Beaucage), Quebec, Quebec.,Panacée Conseil (Villeneuve), Quebec, Quebec
| | - Jean-Pierre Grégoire
- Population Health and Optimal Practices in Health Research Unit (Guillaumie, Moisan, Grégoire, Lauzier), CHU de Québec-Université Laval Research Centre.,Faculty of Nursing (Ndayizigiye, Guillaumie), Université Laval.,Faculty of Pharmacy (Moisan, Grégoire, Lauzier), Université Laval.,Direction régionale de la santé publique de la Capitale-Nationale (Beaucage), Quebec, Quebec.,Panacée Conseil (Villeneuve), Quebec, Quebec
| | - Denis Villeneuve
- Population Health and Optimal Practices in Health Research Unit (Guillaumie, Moisan, Grégoire, Lauzier), CHU de Québec-Université Laval Research Centre.,Faculty of Nursing (Ndayizigiye, Guillaumie), Université Laval.,Faculty of Pharmacy (Moisan, Grégoire, Lauzier), Université Laval.,Direction régionale de la santé publique de la Capitale-Nationale (Beaucage), Quebec, Quebec.,Panacée Conseil (Villeneuve), Quebec, Quebec
| | - Sophie Lauzier
- Population Health and Optimal Practices in Health Research Unit (Guillaumie, Moisan, Grégoire, Lauzier), CHU de Québec-Université Laval Research Centre.,Faculty of Nursing (Ndayizigiye, Guillaumie), Université Laval.,Faculty of Pharmacy (Moisan, Grégoire, Lauzier), Université Laval.,Direction régionale de la santé publique de la Capitale-Nationale (Beaucage), Quebec, Quebec.,Panacée Conseil (Villeneuve), Quebec, Quebec
| |
Collapse
|