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Möller HJ, Bandelow B, Bauer M, Hampel H, Herpertz SC, Soyka M, Barnikol UB, Lista S, Severus E, Maier W. DSM-5 reviewed from different angles: goal attainment, rationality, use of evidence, consequences--part 1: general aspects and paradigmatic discussion of depressive disorders. Eur Arch Psychiatry Clin Neurosci 2015; 265:5-18. [PMID: 25119146 DOI: 10.1007/s00406-014-0520-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Accepted: 08/01/2014] [Indexed: 01/01/2023]
Abstract
DSM-5 was published in 2013 after about 10 years of preparation. Part 1 of this paper discusses several more general aspects of DSM-5 and offers a detailed, paradigmatic analysis of changes made to the chapter on depressive disorders. The background for the changes is analysed on the basis of a PubMed search and review papers on the classification of mental disorders in general and on empirical knowledge about individual disorders. Contrary to the original plans, DSM-5 has not introduced a primarily dimensional diagnostic system but has widely preserved the categorical system of disorders. Also, it has not adopted a more neurobiological approach to disorders by including biological markers to increase the objectivity of psychiatric diagnoses but has maintained the primarily symptom-based, descriptive approach. The criteria for some disorders have been changed, including affective, schizophrenic and addiction disorders, and a few new disorders have been added. A minimal version of the dimensional approach was realised through the introduction of several transnosological specifiers and the option to make symptom- or syndrome-related severity and dimensional assessments. These specifiers and assessments might allow a more individualised description of a patient's psychopathological state and more personalised treatment. However, most of the symptom- and syndrome-related assessments are not mandatory and therefore may not be used in clinical practice.
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Affiliation(s)
- Hans-Jürgen Möller
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University, Munich, Germany,
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Helgadóttir B, Forsell Y, Ekblom Ö. Physical activity patterns of people affected by depressive and anxiety disorders as measured by accelerometers: a cross-sectional study. PLoS One 2015; 10:e0115894. [PMID: 25585123 PMCID: PMC4293141 DOI: 10.1371/journal.pone.0115894] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Accepted: 11/09/2014] [Indexed: 12/21/2022] Open
Abstract
Background Exercise can relieve both depressive and anxiety disorders and it is therefore of importance to establish movement patterns of mildly to moderately affected sufferers to estimate the treatment potential. The aim is to describe the physical activity patterns of people affected by mild to moderate depressive and/or anxiety symptoms using objective measures of physical activity. Methods The design of the study was cross-sectional using data from 165 people aged 18–65 years, with mild to moderate depressive and/or anxiety disorder symptoms (scoring ≥10 on the PHQ-9). Diagnoses were made using Mini International Neuropsychiatric Interview (MINI) and symptom severity was measured with the Montgomery-Åsberg Depression Rating Scale (MADRS). The participants wore accelerometers for a week to evaluate physical activity patterns. Results No statistically significant differences were detected between different diagnoses, though depressed participants tended to be less active and more sedentary. Only one-fifth of the sample followed public health guidelines regarding physical activity. Each one point increase in MADRS was associated with a 2.4 minute reduction in light physical activity, independent of moderate-to-vigorous physical activity and sedentary time. MADRS was positively associated with number of sedentary bouts. Conclusions The physical activity pattern of people with depressive and/or anxiety disorders was characterized by large amounts of sedentary time and low fulfillment of physical activity guidelines. There is therefore a large treatment potential for this group by increasing exercise. The results suggest that instead of focusing exclusively on high intensity exercise for treating depressive and anxiety disorders, health care providers might encourage patients to reduce sedentary time by increasing light physical activity and decreasing the number of sedentary bouts, though further studies are needed that can determine directionality.
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Affiliation(s)
- Björg Helgadóttir
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- * E-mail:
| | - Yvonne Forsell
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Örjan Ekblom
- The Åstrand Laboratory of Work Physiology, the Swedish School of Sport and Health Sciences, Stockholm, Sweden
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103
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Louise S, Gurvich C, Neill E, Tan EJ, Van Rheenen TE, Rossell S. Schizotypal Traits are Associated with Poorer Executive Functioning in Healthy Adults. Front Psychiatry 2015; 6:79. [PMID: 26082726 PMCID: PMC4450583 DOI: 10.3389/fpsyt.2015.00079] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 05/13/2015] [Indexed: 11/13/2022] Open
Abstract
Previous research has shown mild forms of the neurocognitive impairments seen in schizophrenia among healthy individuals exhibiting high schizotypal traits. This study aimed to explore associations between schizotypy and cognitive performance in an adult community sample. Ninety-five females and 79 males completed the Oxford-Liverpool Inventory of Feelings and Experiences (O-LIFE), which measures four separable aspects of schizotypy: cognitive disorganization, unusual experiences, introvertive anhedonia, and impulsive non-conformity. Subsequently, participants were administered a neurocognitive battery incorporating measures of executive skills including inhibition, cognitive flexibility, reasoning, and problem solving along with measures of attention and processing speed and both verbal and spatial working memory. In line with predictions, the current study found that higher scores on the subscales of unusual experiences, cognitive disorganization, and impulsive non-conformity related to worse performance on a measure of inhibition. Additionally, as introvertive anhedonia increased, both attention and processing speed and reasoning and problem-solving performance became more impaired. In conclusion, this study extends schizotypy literature by examining the subscales of the O-LIFE, and enables inferences to be drawn in relation to cognitive impairment in schizophrenia.
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Affiliation(s)
- Stephanie Louise
- Monash Alfred Psychiatry Research Centre (MAPrc), Alfred Hospital, Central Clinical School, Monash University , Melbourne, VIC , Australia ; Faculty of Health, Arts and Design, Brain and Psychological Sciences Research Centre, Swinburne University of Technology , Melbourne, VIC , Australia
| | - Caroline Gurvich
- Monash Alfred Psychiatry Research Centre (MAPrc), Alfred Hospital, Central Clinical School, Monash University , Melbourne, VIC , Australia
| | - Erica Neill
- Monash Alfred Psychiatry Research Centre (MAPrc), Alfred Hospital, Central Clinical School, Monash University , Melbourne, VIC , Australia ; Faculty of Health, Arts and Design, Brain and Psychological Sciences Research Centre, Swinburne University of Technology , Melbourne, VIC , Australia
| | - Eric J Tan
- Monash Alfred Psychiatry Research Centre (MAPrc), Alfred Hospital, Central Clinical School, Monash University , Melbourne, VIC , Australia ; Faculty of Health, Arts and Design, Brain and Psychological Sciences Research Centre, Swinburne University of Technology , Melbourne, VIC , Australia
| | - Tamsyn E Van Rheenen
- Monash Alfred Psychiatry Research Centre (MAPrc), Alfred Hospital, Central Clinical School, Monash University , Melbourne, VIC , Australia
| | - Susan Rossell
- Monash Alfred Psychiatry Research Centre (MAPrc), Alfred Hospital, Central Clinical School, Monash University , Melbourne, VIC , Australia ; Faculty of Health, Arts and Design, Brain and Psychological Sciences Research Centre, Swinburne University of Technology , Melbourne, VIC , Australia
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104
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Comparison of physician-rating and self-rating scales for patients with major depressive disorder. J Clin Psychopharmacol 2014; 34:716-21. [PMID: 25310200 DOI: 10.1097/jcp.0000000000000229] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Physician-rating scales remain the standard in antidepressant clinical trials. The current study aimed to examine the discrepancies between physician-rating scales and self-rating scales for symptoms and functioning, before and after treatment, in newly hospitalized patients. A total of 131 acutely ill inpatients with major depressive disorder were enrolled to receive 20 mg of fluoxetine daily for 6 weeks. Symptom severity and functioning were assessed at baseline and again at week 6. Symptom severity was rated using the 17-item Hamilton Depression Rating Scale (HDRS-17) and the Zung Self-rating Depression Scale (ZDS). Functioning was measured by the Global Assessment of Functioning (GAF) and the Work and Social Adjustment Scale (WSAS). Pearson correlation coefficients (r) between HDRS-17 and ZDS and between GAF and WSAS were calculated at week 0 and week 6. Sensitivity to change was measured using effect sizes. One-hundred twelve patients completed the 6-week trial. After 6 weeks of treatment, correlations between HDRS-17 and ZDS or correlations between GAF and WSAS became larger from baseline to end point. All correlations were statistically significant (P < 0.001). Effect sizes measured by physician-rating scales (ie, HDRS-17 and GAF) were larger than by self-rating scales (ie, ZDS and WSAS). Correlations between baseline physician-rating scale scores and self-rating scale scores improved after 6 weeks of treatment. Physician-rating scales had larger effect sizes than self-rating scales. Physician-rating scales were more sensitive in detecting symptom or functional changes than self-rating scales.
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105
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Okumura Y, Ichikura K. Efficacy and acceptability of group cognitive behavioral therapy for depression: a systematic review and meta-analysis. J Affect Disord 2014; 164:155-64. [PMID: 24856569 DOI: 10.1016/j.jad.2014.04.023] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Accepted: 04/11/2014] [Indexed: 12/20/2022]
Abstract
BACKGROUND Despite treatment guidelines for depression placing group cognitive behavioral therapy (group CBT) between low- and high-intensity evidence-based psychological interventions, the validity of the placement remains unknown. We aimed to systematically review evidence for the efficacy and acceptability of group CBT in patients with depression compared to four intensity levels of psychosocial interventions. METHODS We searched the Cochrane Central Register of Controlled Trials, MEDLINE, PsycINFO, and Web of Science and hand-searched the references in identified publications. We selected randomized controlled trials comparing group CBT with four levels of interventions for adult patients with depression. Two authors independently assessed risk of bias. RESULTS From 7953 records, we identified 35 studies that compared group CBT to non-active (k=30), low-intensity (k=2), middle-intensity (k=8), and high-intensity (k=1) interventions. Group CBT had a superior efficacy (standardized mean difference [SMD]=-0.68) and a similar acceptability compared to non-active controls. Pooled results showed a small but non-significant excess of group CBT relative to middle-intensity interventions (SMD=-0.21). LIMITATIONS Over 60% of studies did not report enough information to judge selection and selective reporting bias. CONCLUSIONS These results suggest the need for high-quality trials of group CBT compared to low- and high-intensity interventions.
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Affiliation(s)
- Yasuyuki Okumura
- Research Department, Institute for Health Economics and Policy, Association for Health Economics Research and Social Insurance and Welfare, Tokyo 105-0003, Japan.
| | - Kanako Ichikura
- Section of Liaison Psychiatry and Palliative Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8519, Japan; Japan Society for the Promotion of Science, Tokyo 102-0083, Japan
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106
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Bech P, Allerup P, Larsen ER, Csillag C, Licht RW. The Hamilton Depression Scale (HAM-D) and the Montgomery-Åsberg Depression Scale (MADRS). A psychometric re-analysis of the European genome-based therapeutic drugs for depression study using Rasch analysis. Psychiatry Res 2014; 217:226-32. [PMID: 24746391 DOI: 10.1016/j.psychres.2014.03.024] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Revised: 03/19/2014] [Accepted: 03/21/2014] [Indexed: 11/19/2022]
Abstract
The objective of this re-analysis of the European Genome-Based Therapeutic Drugs for Depression Study (GENDEP) was to psychometrically test the unidimensionality of the full Montgomery Åsberg Depression Rating Scale (MADRS10) and the Hamilton Depression Scale (HAM-D17) versus their respective subscales (MADRS5 and HAM-D6) containing the core symptoms of depression severity. Rasch analysis was applied using RUMM 2030 software to assess the overall fit for unidimensionality. Neither the MADRS10 nor the HAM-D17 was found to fit the Rasch model for unidimensionality. The HAM-D6 (containing the items of depressed mood, guilt, work and interests, psychomotor retardation, psychic anxiety, and somatic general) as well as the analogue MADRS5 were tested for unidimensionality by use of the RUMM 2030 programme, and only the HAM-D6 was accepted. When testing for invariance across rating weeks or centres, the RUMM 2030 had to be supplemented with the Friedman two-way analysis of variance by ranks. The HAM-D6 but not the MADRS5 was accepted. It was therefore concluded that the HAM-D6 is a psychometrically valid outcome scale to measure change in clinical trials of antidepressants.
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Affiliation(s)
- Per Bech
- Psychiatric Research Unit, Mental Health Centre North Zealand, Copenhagen University Hospital, Hillerød, Denmark.
| | - Peter Allerup
- Department of Educational Research (IUP), Aarhus University, Denmark
| | - Erik Roj Larsen
- Department of Affective Disorders, Q, Mood Disorders Research Unit, Risskov, Denmark
| | - Claudio Csillag
- Psychiatric Research Unit, Mental Health Centre North Zealand, Copenhagen University Hospital, Hillerød, Denmark
| | - Rasmus W Licht
- Psychiatric Research Unit, Aalborg University Hospital, Aalborg, Denmark
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107
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Uher R, Payne JL, Pavlova B, Perlis RH. Major depressive disorder in DSM-5: implications for clinical practice and research of changes from DSM-IV. Depress Anxiety 2014; 31:459-71. [PMID: 24272961 DOI: 10.1002/da.22217] [Citation(s) in RCA: 233] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2013] [Accepted: 10/28/2013] [Indexed: 12/16/2022] Open
Abstract
The changes in diagnostic criteria for major depressive disorder (MDD) from the fourth to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) may appear small but have important consequences for how the diagnosis is used. In DSM-5, MDD is part of the new "Depressive disorders" section, which is separate from "Bipolar disorders", marking a division in what had been known as "Mood disorders". A small wording change has expanded the core mood criterion to include hopelessness, potentially broadening the diagnosis. The replacement of an operationalized bereavement exclusion with a call for clinical judgment in distinguishing normal reactions to significant loss from a disorder in need of clinical attention makes the diagnosis less objective and complicates investigations of the relationship between adversity and depression. A new persistent depressive disorder category is intended to encompass both dysthymia and chronic depression, but its relationship to MDD is ambiguous with conflicting statements on whether the two diagnoses should be concurrent if both sets of criteria are fulfilled. Clarification is also needed on whether MDD can be concurrent with the new broad "other specified bipolar and related disorders". New specifiers of MDD "with anxious distress" and "with mixed features" allow characterization of additional symptoms. The specifier "with perinatal onset" expands on the DSM-IV "postnatal onset" to include onset during pregnancy. We review the changes in MDD definition, provide guidance on their implementation and discuss their implications for clinical practice and research.
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Affiliation(s)
- Rudolf Uher
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada; Institute of Psychiatry, King's College London, London, UK
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108
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Discrepancy between self- and observer-rated depression severities as a predictor of vulnerability to suicide in patients with mild depression. J Affect Disord 2014; 161:144-9. [PMID: 24751322 DOI: 10.1016/j.jad.2014.03.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Accepted: 03/07/2014] [Indexed: 11/20/2022]
Abstract
BACKGROUND Discrepancies in depression severity between the Hamilton Depression Rating Scale (HAMD) and the Beck Depression Inventory (BDI) have been reported. However, whether these discrepancies impact vulnerability to suicide in patients with major depressive disorder (MDD) remains unclear. METHODS Patients with mild MDD (n=161) were enrolled in the study and divided into the following 3 groups: (1) patients with MDD with the discrepancy (n=45), i.e., those with low HAMD17 scores (8-13) and high BDI-II scores (≥29), (2) patients with MDD without the discrepancy (n=46), i.e., those with low HAMD17 scores and low BDI-II scores (≤28), and (3) patients not currently depressed (n=70), i.e., those with HAMD17 scores ≤7 (affective controls). We examined the relationship of demographic, clinical, and neuropsychological variables with any discrepancy between self-rating and observer rating. RESULTS Patients with MDD with the discrepancy had significantly higher hopelessness than those without the discrepancy and affective controls. Verbal fluency task performance of patients with MDD with the discrepancy was significantly impaired compared with that of those without the discrepancy and affective controls. Stepwise logistic regression analysis revealed that a history of suicide attempt [odds ratio (OR), 3.57; 95% confidence interval (CI), 1.12-11.37] and hopelessness (OR, 1.23; 95% CI, 1.09-1.38) increased odds of the discrepancy. LIMITATIONS Results require replication. CONCLUSIONS Clinicians should examine discrepancies between self- and observer-rated depression severities, which are associated with vulnerability to suicide in patients with MDD, even if objectively evaluated as mild.
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109
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Brütt AL, Schulz H, Andreas S. Psychometric properties of an instrument to measure activities and participation according to the ICF concept in patients with mental disorders. Disabil Rehabil 2014; 37:259-67. [PMID: 24833419 DOI: 10.3109/09638288.2014.918189] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE The International Classification of Functioning, Disability and Health (ICF) conceptualizes the bio-psycho-social model of health and illness, but cannot be used as an assessment instrument in routine care. The objective of this study was to psychometrically test a self-report instrument for measuring activities and social participation (ICF-Mental-A&P) of psychotherapy patients. METHODS For the psychometric evaluation of the ICF-Mental-A&P, participants completed a questionnaire on symptoms, interpersonal problems and quality of life at admission and at discharge of in-patient treatment. A consecutive sample of 2256 patients diagnosed with at least one mental disorder was recruited from eight in-patient units in Germany. RESULTS After item selection, the ICF-Mental-A&P contained 31 items comprising six subscales examined by confirmatory factor analysis. Subscales had acceptable internal consistency (α = 0.78-0.90) and test-retest correlations (r = 0.71-0.86). There were several expected correlations (r ≥ 0.6) between ICF-Mental-A&P scores and measures of symptoms and interpersonal problems. CONCLUSIONS Findings suggest that the ICF-Mental-A&P is a comprehensive, reliable measure of activities and participation according to the ICF concept for patients with mental disorders. It may therefore be an important instrument in clinical practice and could help to determine and evaluate functioning-related and patient-focused treatment outcomes.
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Affiliation(s)
- Anna Levke Brütt
- Department of Medical Psychology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf , Hamburg , Germany and
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110
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Rodkjaer L, Chesney M, Lomborg K, Ostergaard L, Laursen T, Sodemann M. HIV-infected individuals with high coping self-efficacy are less likely to report depressive symptoms: a cross-sectional study from Denmark. Int J Infect Dis 2014; 22:67-72. [DOI: 10.1016/j.ijid.2013.12.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Revised: 12/04/2013] [Accepted: 12/07/2013] [Indexed: 01/28/2023] Open
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111
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Deng AW, Xiong RB, Jiang TT, Luo YP, Chen WZ. Prevalence and risk factors of postpartum depression in a population-based sample of women in Tangxia Community, Guangzhou. ASIAN PAC J TROP MED 2014; 7:244-9. [DOI: 10.1016/s1995-7645(14)60030-4] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 01/15/2014] [Accepted: 02/15/2014] [Indexed: 11/29/2022] Open
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112
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Craighead WE, Dunlop BW. Combination Psychotherapy and Antidepressant Medication Treatment for Depression: For Whom, When, and How. Annu Rev Psychol 2014; 65:267-300. [DOI: 10.1146/annurev.psych.121208.131653] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- W. Edward Craighead
- Department of Psychiatry and Behavioral Sciences and
- Department of Psychology, Emory University, Atlanta, Georgia 30322; ,
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113
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Heidenblut S, Zank S. Screening for Depression with the Depression in Old Age Scale (DIA-S) and the Geriatric Depression Scale (GDS15). GEROPSYCH-THE JOURNAL OF GERONTOPSYCHOLOGY AND GERIATRIC PSYCHIATRY 2014. [DOI: 10.1024/1662-9647/a000101] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Purpose of the study. The Depression in Old Age Scale (DIA-S), a new screening tool for geriatric depression, was designed to be both practical and appropriate for use with medically ill geriatric patients. The diagnostic accuracy of the DIA-S and the short form of the Geriatric Depression Scale (GDS15) were tested and compared. Methods. Using the Montgomery and Asberg Depression Rating Scale (MADRS) as gold standard, the scales were validated with a sample of N = 331 geriatric inpatients. Results. ROC curves, AUC outcomes, sensitivity and specificity, and logistic regression models for impact factors on misclassification rates indicate good psychometrical qualities of the DIA-S, whereas the validity of the GDS15 was lower.
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Affiliation(s)
- Sonja Heidenblut
- Department of Rehabilitative Gerontology, University of Cologne, Germany
| | - Susanne Zank
- Department of Rehabilitative Gerontology, University of Cologne, Germany
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114
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Bajs Janović M, Kalember P, Janović S, Hrabač P, Folnegović Grošić P, Grošić V, Radoš M, Henigsberg N. No change in N-acetyl aspartate in first episode of moderate depression after antidepressant treatment: (1)H magnetic spectroscopy study of left amygdala and left dorsolateral prefrontal cortex. Neuropsychiatr Dis Treat 2014; 10:1753-62. [PMID: 25278754 PMCID: PMC4179760 DOI: 10.2147/ndt.s64702] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The role of brain metabolites as biological correlates of the intensity, symptoms, and course of major depression has not been determined. It has also been inconclusive whether the change in brain metabolites, measured with proton magnetic spectroscopy, could be correlated with the treatment outcome. METHODS Proton magnetic spectroscopy was performed in 29 participants with a first episode of moderate depression occurring in the left dorsolateral prefrontal cortex and left amygdala at baseline and after 8 weeks of antidepressant treatment with escitalopram. The Montgomery-Asberg Depression Rating Scale, the Hamilton Rating Scale for Depression, and the Beck Depression Inventory were used to assess the intensity of depression at baseline and at the endpoint of the study. At endpoint, the participants were identified as responders (n=17) or nonresponders (n=12) to the antidepressant therapy. RESULTS There was no significant change in the N-acetyl aspartate/creatine ratio (NAA/Cr) after treatment with antidepressant medication. The baseline and endpoint NAA/Cr ratios were not significantly different between the responder and nonresponder groups. The correlation between NAA/Cr and changes in the scores of clinical scales were not significant in either group. CONCLUSION This study could not confirm any significant changes in NAA after antidepressant treatment in the first episode of moderate depression, or in regard to therapy response in the left dorsolateral prefrontal cortex or left amygdala. Further research is necessary to conclude whether NAA alterations in the first episode of depression could possibly be different from chronic or late-onset depression, and whether NAA alterations in stress-induced (reactive) depression are different from endogenous depression. The potential role of NAA as a biomarker of a treatment effect has yet to be established.
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Affiliation(s)
- Maja Bajs Janović
- University Department of Psychiatry, Clinical Hospital Center Zagreb, Zagreb, Croatia ; University North, Varaždin, Croatia
| | - Petra Kalember
- Polyclinic Neuron, Croatian Institute for Brain Research, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Spiro Janović
- University Department of Psychiatry, Clinical Hospital Center Zagreb, Zagreb, Croatia ; University North, Varaždin, Croatia
| | - Pero Hrabač
- Polyclinic Neuron, Croatian Institute for Brain Research, School of Medicine, University of Zagreb, Zagreb, Croatia
| | | | | | - Marko Radoš
- University Department of Radiology, Clinical Hospital Center Zagreb, Zagreb, Croatia
| | - Neven Henigsberg
- Polyclinic Neuron, Croatian Institute for Brain Research, School of Medicine, University of Zagreb, Zagreb, Croatia ; Psychiatric Clinic Vrapče, Zagreb, Croatia
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115
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Olino TM, Yu L, McMakin DL, Forbes EE, Seeley JR, Lewinsohn PM, Pilkonis PA. Comparisons across depression assessment instruments in adolescence and young adulthood: an item response theory study using two linking methods. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2013; 41:1267-77. [PMID: 23686132 PMCID: PMC3795839 DOI: 10.1007/s10802-013-9756-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Item response theory (IRT) methods allow for comparing the utility of instruments based on the range and precision of severity assessed by each instrument. As adolescents and young adults can display rapid increases in depressive symptoms, there is a crucial need to sensitively assess mild elevations of symptoms (as an index of initial risk) and moderate-severe symptoms (as an indicator of treatment disposition). We compare the information assessed by the Beck Depression Inventory (BDI) to the newly developed Patient Reported Outcome Measurement Information System - Depression measure (PROMIS-Depression), and the Center for Epidemiologic Studies - Depression (CES-D) scale. The present work is based on data from two fully independent samples of community adolescents and young adults. One sample completed the BDI and CES-D (n = 1,482) and the second sample (n = 673) completed the PROMIS-Depression measure and the CES-D. Using two different IRT-based linking methods, (1) equating based on common items and (2) concurrent calibration methods, analyses revealed that the PROMIS-Depression measure assessed information over the widest range of depressive severity with greatest measurement precision relative to the other instruments. This was true for both the 28-item and 8-item versions of the PROMIS-Depression measure. Findings suggest that the PROMIS-Depression measure assessed depression severity with greatest precision and over the widest severity range of the assessed instruments. However, future work is necessary to demonstrate that the PROMIS-Depression measure has reliable associations with external criteria and is sensitive to treatment response.
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Affiliation(s)
- Thomas M Olino
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, 15213, USA,
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116
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Sakurai H, Uchida H, Abe T, Nakajima S, Suzuki T, Pollock BG, Sato Y, Mimura M. Trajectories of individual symptoms in remitters versus non-remitters with depression. J Affect Disord 2013; 151:506-513. [PMID: 23886402 DOI: 10.1016/j.jad.2013.06.035] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2012] [Revised: 02/04/2013] [Accepted: 06/19/2013] [Indexed: 12/28/2022]
Abstract
BACKGROUND It remains unclear regarding the contribution of each individual symptom in predicting the outcome in major depressive disorder (MDD). The objective of this analysis was to evaluate trajectories of individual symptoms over time to identify which specific depressive item(s) could predict subsequent clinical response. METHODS The data of 2874 outpatients with nonpsychotic MDD who received citalopram for up to 14 weeks in the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial were analyzed. Average trajectories of individual symptoms over time were estimated for remitters and non-remitters. Moreover, specific symptoms whose improvement at week 2 predicted remission were identified, using binary logistic regression analysis. RESULTS Trajectories were significantly different between remitters and non-remitters in all depressive symptoms. All depressive symptoms in the 16-item Quick Inventory of Depressive Symptomatology, Self-Report (QIDS-SR16) in the two groups, except for hypersomnia and weight change in non-remitters, substantially improved within 2 weeks and gradually continued to improve thereafter throughout the 14 weeks. Early improvements in the following five symptoms, in order of magnitude, in the QIDS-SR16 were significantly associated with remission: sad mood, negative self-view, feeling slowed down, low energy, and restlessness (P<0.001, P<0.001, P=0.001, P=0.004, P=0.021). LIMITATIONS The participants were limited to the nonpsychotic MDD outpatients who received citalopram. Further, symptomatology was not evaluated at the very beginning of treatment. CONCLUSIONS While the data pertain to citalopram and replication is necessary for other antidepressants, early improvements in certain core depressive symptoms may serve as a predictor of subsequent remission.
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Affiliation(s)
- Hitoshi Sakurai
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Hiroyuki Uchida
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan; Geriatric Mental Health Program, Centre for Addiction and Mental Health, Toronto, ON, Canada.
| | - Takayuki Abe
- Center for Clinical Research, Keio University School of Medicine, Tokyo, Japan
| | - Shinichiro Nakajima
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan; Geriatric Mental Health Program, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Takefumi Suzuki
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Bruce G Pollock
- Geriatric Mental Health Program, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Yuji Sato
- Center for Clinical Research, Keio University School of Medicine, Tokyo, Japan
| | - Masaru Mimura
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
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Validation and clinical application of a biopsychosocial model of pain intensity and functional disability in patients with a pediatric chronic pain condition referred to a subspecialty clinic. PAIN RESEARCH AND TREATMENT 2013; 2013:143292. [PMID: 24251035 PMCID: PMC3819919 DOI: 10.1155/2013/143292] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Accepted: 09/01/2013] [Indexed: 01/25/2023]
Abstract
Background. Pediatric chronic pain is considered to be a multidimensional construct that includes biological, psychological, and social components. Methods. The 99 enrolled study patients (mean age 13.2 years, 71% female, 81% Caucasian) and an accompanying parent completed a series of health-related questionnaires at the time of their initial appointment in a pediatric chronic pain medicine clinic. Results. Significant correlations (r ≥ 0.30, P < 0.05) were observed between pediatric chronic pain intensity and patient anxiety, patient depression, patient pain coping, parent chronic pain intensity, and parent functional disability. Pediatric chronic pain intensity was significantly associated with patient anxiety (P = 0.002). Significant correlations (r ≥ 0.30, P < 0.05) were observed between pediatric functional disability and patient chronic pain intensity, patient anxiety, patient depression, patient pain coping, parent chronic pain intensity, parent functional disability, parent anxiety, parent depression, and parent stress. Pediatric functional disability was significantly associated with patient chronic pain intensity (P = 0.025), patient anxiety (P = 0.021), patient pain coping (P = 0.009), and parent functional disability (P = 0.027). Conclusions. These findings provide empirical support of a multidimensional Biobehavioral Model of Pediatric Pain. However, the practical clinical application of the present findings and much of the similar previously published data may be tenuous.
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Maneeton N, Maneeton B, Eurviriyanukul K, Srisurapanont M. Efficacy, tolerability, and acceptability of bupropion for major depressive disorder: a meta-analysis of randomized-controlled trials comparison with venlafaxine. DRUG DESIGN DEVELOPMENT AND THERAPY 2013; 7:1053-62. [PMID: 24101861 PMCID: PMC3790834 DOI: 10.2147/dddt.s46849] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background Bupropion and venlafaxine are effective antidepressants with unique pharmacological profiles. Objectives The purpose of this meta-analysis was to determine the efficacy, acceptability, and tolerability of bupropion and venlafaxine therapies for adults with major depressive disorder (MDD). The authors searched clinical trials with low risk of bias, performed from January 1985 to February 2013. Data sources The searches of MEDLINE, EMBASE, CINAHL, PsycINFO, and Cochrane Controlled Trials Register were conducted in February 2013. Included populations consisted of adult patients with MDD or major depression. Study eligible criteria, participants, and interventions Included studies were randomized controlled trials (RCTs) comparing bupropion and venlafaxine in adult patients with MDD and offering endpoint results relevant to: (1) severity of depression; (2) response rate; (3) remission rate; (4) overall discontinuation rate; or (5) discontinuation rate due to adverse events. Limitation of language was not utilized. Study appraisal and synthesis methods The abstracts located from the electronic databases were reviewed. The completed reports from pertinent studies were examined, and essential data were extracted. Based on the Cochrane’s bias assessment, risks of bias were assessed. Any study with two risks or more was excluded. Efficacious outcomes included the mean changed scores of rating scales for depression, overall response rates, and overall remission rates. Acceptability was determined by the overall discontinuation rates. The discontinuation rates due to adverse events were the measurement of tolerability. Relative risks (RR) and weighted mean differences or standardized mean differences with 95% confidence intervals (CI) were computed using a random effect model. Results A total of 1,117 participants in three RCTs were included. Depression rating scales used in one and two studies were the 17-item Hamilton Depression Rating Scale and the Montgomery–Asberg Depression Rating Scale, respectively. The pooled mean changed scores of the bupropion-treated group were comparable to those of the venlafaxine-treated group with standardized mean differences (95% CI) of 0.05 (−0.16 to 0.26). The overall response and remission rates were similar with the RRs (95% CI) of 0.92 (0.79–1.08) and 0.97 (0.75–1.24), respectively. The pooled overall discontinuation rate and discontinuation rate due to adverse events were not different between groups with the RRs (95% CI) of 1.00 (0.80–1.26) and 0.69 (0.44–1.10), respectively. Limitations The small number of RCTs included in the meta-analysis. Conclusion According to the limited data obtained from three RCTs, bupropion XL is as effective and tolerable as venlafaxine XR for adult patients with MDD. Further studies in this area should be conducted to confirm these findings.
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Affiliation(s)
- Narong Maneeton
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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119
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Rosenström T, Jokela M, Hintsanen M, Josefsson K, Juonala M, Kivimäki M, Pulkki-Råback L, Viikari JSA, Hutri-Kähönen N, Heinonen E, Raitakari OT, Keltikangas-Järvinen L. Body-image dissatisfaction is strongly associated with chronic dysphoria. J Affect Disord 2013; 150:253-60. [PMID: 23639211 DOI: 10.1016/j.jad.2013.04.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Revised: 04/02/2013] [Accepted: 04/03/2013] [Indexed: 12/26/2022]
Abstract
BACKGROUND Individual depressive symptoms may contribute to the risk of chronic depression. This study aimed to explore which symptoms predict chronic dysphoria, a hallmark of depression. METHODS 1057 participants from the population-based Young Finns study were examined for four times during a 16-year period. Those with a modified Beck's Depression Inventory score in the upper third at all four screenings were considered to have chronic dysphoria (n=135). Participants with only one high depression score formed the reference group of transient dysphoria (n=179). Individual items of the Inventory were analyzed in terms of their association with dysphoria status and chronicity, controlling for potential confounding factors, such as personality assessed using the Temperament and Character Inventory. RESULTS Body-image dissatisfaction was strongly associated with chronically elevated dysphoria (Bonferroni-corrected p=0.006). The degree of body-image dissatisfaction was associated with the probability for chronic dysphoria in a dose-response manner, with the estimated probability ranging from 0.01 to 0.60 as a function of item response. The association remained after adjustments for a wide range of personality characteristics. LIMITATIONS The study relied on self-reports of mood and personality, and lacked information on external opinion on participants appearances. The requirement of full time-series data may have resulted in attrition-related bias. CONCLUSIONS Body-image dissatisfaction was a strong predictor of chronic depression characterized by dysphoria. This finding suggests that dysfunctional attitude towards oneself might represent a potentially important target for cognitive therapies and preventive interventions.
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Affiliation(s)
- Tom Rosenström
- IBS, Unit of Personality, Work and Health Psychology, University of Helsinki, Helsinki, Finland.
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Tumor necrosis factor and its targets in the inflammatory cytokine pathway are identified as putative transcriptomic biomarkers for escitalopram response. Eur Neuropsychopharmacol 2013; 23:1105-14. [PMID: 23142150 DOI: 10.1016/j.euroneuro.2012.09.009] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Revised: 08/28/2012] [Accepted: 09/21/2012] [Indexed: 11/23/2022]
Abstract
Converging evidence suggests that the activation of the inflammatory cytokine pathway is important in the pathophysiology of unipolar depression. Antidepressants have anti-inflammatory properties and evidence suggests that inter-individual variability in response to antidepressants may reflect genetic differences in the inflammatory cytokine pathway. In particular, protein levels of Tumor Necrosis Factor (TNF) and the SNPs rs1126757 in interleukin-11 (IL11), and rs7801617 in interleukin-6 (IL6), have previously been implicated in the clinical response to the selective serotonin reuptake inhibitor (SSRI) antidepressant escitalopram. This study investigated the transcription of TNF, IL11 and IL6 as well as genes in the wider inflammatory cytokine pathway both at baseline and after escitalopram treatment in depressed patients who were either clinical "responders" (n=25) or "non-responders" (n=21). Samples were obtained as a subset of the Genome-Based Therapeutic Drugs for Depression (GENDEP) project and response status is based on changes in the Montgomery-Asberg Depression Rating Scores over a 12 wk treatment period. Binary logistic regressions revealed significant expression differences at baseline between responders and non-responders in TNF, and after escitalopram treatment in TNF and IL11. Differences in IL11 after treatment were found to be driven by drug-induced allele-specific expression differences relating to rs1126757. Top hits in the wider inflammatory cytokine pathway at both baseline and after escitalopram treatment were found to be targets of TNF. The current study adds substantial support for the role of the inflammatory cytokine pathway in mediating response to the SSRI escitalopram, and is the first to identify TNF and its targets as putative transcriptomic predictors of clinical response.
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121
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Hunter AM, Leuchter AF, Power RA, Muthén B, McGrath PJ, Lewis CM, Cook IA, Garriock HA, McGuffin P, Uher R, Hamilton SP. A genome-wide association study of a sustained pattern of antidepressant response. J Psychiatr Res 2013; 47:1157-65. [PMID: 23726668 PMCID: PMC3710535 DOI: 10.1016/j.jpsychires.2013.05.002] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Revised: 03/25/2013] [Accepted: 05/02/2013] [Indexed: 02/06/2023]
Abstract
Genome-wide association studies (GWAS) have failed to replicate common genetic variants associated with antidepressant response, as defined using a single endpoint. Genetic influences may be discernible by examining individual variation between sustained versus unsustained patterns of response, which may distinguish medication effects from non-specific, or placebo responses to active medication. We conducted a GWAS among 1116 subjects with Major Depressive Disorder from the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial who were characterized using Growth Mixture Modeling as showing a sustained versus unsustained pattern of clinical response over 12 weeks of treatment with citalopram. Replication analyses examined 585 subjects from the Genome-based Therapeutic Drugs for Depression (GENDEP) trial. The strongest association with sustained as opposed to unsustained response in STAR*D involved a single nucleotide polymorphism (SNP; rs10492002) within the acyl-CoA synthetase short-chain family member 3 gene (ACSS3, p-value=4.5×10(-6), odds ratio=0.61). No SNPs met our threshold for genome-wide significance. SNP data were available in GENDEP for 18 of the top 25 SNPs in STAR*D. The most replicable association was with SNP rs7816924 (p=0.008, OR=1.58); no SNP met the replication p-value threshold of 0.003. Joint analysis of these 18 SNPs resulted in the strongest signal coming from rs7816924 (p=2.11×10(-7)), which resides in chondroitin sulfate N-acetylgalactosaminyltransferase 1 gene (CSGALNACT1). An exploratory genetic pathway analysis revealed evidence for an involvement of the KEGG pathway of long-term potentiation (FDR=.02). Results suggest novel genetic associations to sustained response.
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Affiliation(s)
- Aimee M Hunter
- Department of Psychiatry, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, USA.
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DNA methylation in interleukin-11 predicts clinical response to antidepressants in GENDEP. Transl Psychiatry 2013; 3:e300. [PMID: 24002086 PMCID: PMC3784763 DOI: 10.1038/tp.2013.73] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Revised: 06/13/2013] [Accepted: 07/10/2013] [Indexed: 02/01/2023] Open
Abstract
Transcriptional differences in interleukin-11 (IL11) after antidepressant treatment have been found to correspond to clinical response in major depressive disorder (MDD) patients. Expression differences were partly mediated by a single-nucleotide polymorphism (rs1126757), identified as a predictor of antidepressant response as part of a genome-wide association study. Here we attempt to identify whether DNA methylation, another baseline factor known to affect transcription factor binding, might also predict antidepressant response, using samples collected from the Genome-based Therapeutic Drugs for Depression project (GENDEP). DNA samples from 113 MDD individuals from the GENDEP project, who were treated with either escitalopram (n=80) or nortriptyline (n=33) for 12 weeks, were randomly selected. Percentage change in Montgomery-Åsberg Depression Rating Scale scores between baseline and week 12 were utilized as our measure of antidepressant response. The Sequenom EpiTYPER platform was used to assess DNA methylation across the only CpG island located in the IL11 gene. Regression analyses were then used to explore the relationship between CpG unit methylation and antidepressant response. We identified a CpG unit predictor of general antidepressant response, a drug by CpG unit interaction predictor of response, and a CpG unit by rs1126757 interaction predictor of antidepressant response. The current study is the first to investigate the potential utility of pharmaco-epigenetic biomarkers for the prediction of antidepressant response. Our results suggest that DNA methylation in IL11 might be useful in identifying those patients likely to respond to antidepressants, and if so, the best drug suited to each individual.
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123
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Quilty LC, Robinson JJ, Rolland J, Fruyt FD, Rouillon F, Bagby RM. The structure of the Montgomery-Åsberg depression rating scale over the course of treatment for depression. Int J Methods Psychiatr Res 2013; 22:175-84. [PMID: 24038301 PMCID: PMC6878407 DOI: 10.1002/mpr.1388] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The Montgomery-Åsberg Depression Rating Scale (MADRS) is a widely used clinician-rated measure of depressive severity. Empirical support for the factor structure of the MADRS is mixed; further, the comparison of MADRS scores within and between patients requires the demonstration of consistent instrument properties. The objective of the current investigation was to evaluate MADRS factor structure as well as MADRS factorial invariance across time and gender. The MADRS was administered to 821 depressed outpatients participating in a large-scale effectiveness study of combined pharmacotherapy and psychotherapy for depression. Treatment outcome did not differ across treatment groups. Factor structure and invariance was evaluated via confirmatory factor analysis. A four-factor model consisting of Sadness, Negative Thoughts, Detachment and Neurovegetative symptoms demonstrated a good fit to the data. This four-factor structure was invariant across time and gender. A hierarchical model, in which these four factors served as indicators of a general depression factor, was also supported. A limitation of the current study is the lack of comprehensive characterization of patient clinical features; results need to be replicated in more severely depressed or treatment refractory patients. Overall, evidence supported the use of the MADRS total score as well as subscales focused on affective, cognitive, social and somatic aspects of depression in male and female outpatients.
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Affiliation(s)
- Lena C. Quilty
- Centre for Addiction and Mental HealthTorontoCanada
- University of TorontoTorontoCanada
| | - Jennifer J. Robinson
- Centre for Addiction and Mental HealthTorontoCanada
- University of TorontoTorontoCanada
| | | | | | | | - R. Michael Bagby
- Centre for Addiction and Mental HealthTorontoCanada
- University of TorontoTorontoCanada
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124
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Risnes I, Heldal A, Wagner K, Boye B, Haraldsen I, Leganger S, Møkleby K, Svennevig JL, Malt UF. Psychiatric outcome after severe cardio-respiratory failure treated with extracorporeal membrane oxygenation: a case-series. PSYCHOSOMATICS 2013; 54:418-27. [PMID: 23756125 DOI: 10.1016/j.psym.2013.02.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2012] [Revised: 02/11/2013] [Accepted: 02/12/2013] [Indexed: 02/06/2023]
Abstract
BACKGROUND Extracorporeal membrane oxygenation (ECMO) is increasingly used to save patients with severe cardiopulmonary failure at high risk of dying, but the long-term psychiatric outcome of the treatment has not been studied. METHODS Twenty-eight adults who survived ECMO were subjected to psychiatric assessment 5 years after ECMO by means of interviews (MINI-Neuropsychiatric Interview and Montgomery-Åsberg Depression Rating Scale) and psychometrics [Neuroticism and social conformity (EPQ-N+L); General Health Questionnaire (GHQ), Hospital Anxiety Depression Scale; Aggression Questionnaire, Toronto Alexithymia Scale, and Giessener somatic symptom checklist (GBB)]. RESULTS Fifteen patients (54%) suffered lifetime psychiatric disorders prior to ECMO. After ECMO, 11 subjects (39%) developed new psychiatric disorders, mostly organic mental (18%), obsessive-compulsive disorders (OCD) 15%, and/or post-traumatic stress disorders (PTSD) 11%. These 11 patients reported higher scores on Montgomery-Åsberg Depression Rating Scale (MADRS), GHQ, EPQ-N, and GBB. Disregarding the presence of psychiatric disorders at follow-up, ECMO patients reported high levels of distress, physical aggression, anger, and alexithymic traits. CONCLUSIONS Severe life-threatening cardiovascular or pulmonary failure with subsequent ECMO is associated with an increased prevalence of long-term psychiatric disorders and distress. Studies addressing the etiology and prevalence of psychiatric consequences after ECMO are needed.
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Affiliation(s)
- Ivar Risnes
- Departments of Thoracic and Cardiovascular Surgery, Psychosomatic Medicine, Anaesthesiology, Intensive Care Medicine, Oslo University Hospital-Rikshospitalet, Norway.
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Abstract
IMPORTANCE We do not know whether the clinical criteria for major depression (MD) reflect a single or multiple dimensions of genetic risk. OBJECTIVE To determine the structure of genetic and environmental risk factors for the 9 DSM-IV symptomatic MD criteria. DESIGN Population-based twin registry. SETTING Virginia. PARTICIPANTS Seven thousand five hundred members of adult twin pairs from the Virginia Adult Twin Study of Psychiatric and Substance Use Disorders. MAIN OUTCOME MEASURE Symptoms of lifetime MD as assessed at personal interview. RESULTS The best-fit twin model was multidimensional, requiring 3 genetic, 1 common environmental and 3 unique environmental common factors, and criterion-specific unique environmental factors. The first genetic factor was characterized by high loadings on cognitive and psychomotor depressive symptoms. The second and third genetic factors had strong loadings for mood and neurovegetative depressive symptoms, respectively. Genetic factor scores derived from these 3 factors differentially predicted patterns of comorbidity, other historical/clinical features of MD, and demographic variables. These results suggested that the first genetic factor reflected a general liability to internalizing disorders, while the third genetic factor was more specific for melancholic MD. The 3 unique environmental common factors reflected, respectively, global depressive, core mood, and cognitive depressive symptoms. CONCLUSIONS AND RELEVANCE The DSM-IV syndrome of MD does not reflect a single dimension of genetic liability. Rather, these criteria reflect 3 underlying dimensions that index genetic risk for cognitive/psychomotor, mood, and neurovegetative symptoms. While in need of replication, these results, validated by predictions using estimated genetic factor scores, have implications for gene-finding efforts for MD.
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Affiliation(s)
- Kenneth S Kendler
- Virginia Institute for Psychiatric and Behavioral Genetics, Department of Psychiatry, Virginia Commonwealth University, Richmond 23298, USA.
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126
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Kim EY, Hwang SSH, Lee NY, Kim SH, Lee HJ, Kim YS, Ahn YM. Intelligence, temperament, and personality are related to over- or under-reporting of affective symptoms by patients with euthymic mood disorder. J Affect Disord 2013; 148:235-42. [PMID: 23270973 DOI: 10.1016/j.jad.2012.11.065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Revised: 11/29/2012] [Accepted: 11/29/2012] [Indexed: 11/27/2022]
Abstract
BACKGROUND Many patients with mood disorders report subjective indicators of depression that are inconsistent with clinicians' objective ratings. This study used the self-report Beck Depressive Inventory (BDI) and the observer-rated Hamilton Depression Rating Scale (HAMD) to evaluate the extent to which temperament, personality traits, and clinical characteristics accounted for discrepancies between self-reports and clinician ratings of depressive symptoms in patients experiencing the euthymic period of a mood disorder. METHOD The sample consisted of 100 individuals with bipolar disorder (n=72) or major depressive disorder (n=28). The HAMD and Young Mania Rating Scale were administered, and participants completed the BDI and Barratt Impulsivity Scale. Intelligence was assessed with the Korean Wechsler Adult Intelligence Scale. Patients completed the Temperament Evaluation of the Memphis, Pisa, Paris, and San Diego Autoquestionnaire and the NEO-Five-Factor Inventory. RESULTS The BDI and HAMD were significantly but modestly correlated with each other (r=0.319, p<0.001). Lower intelligence and a less conscientious personality were independent contributors to differences between Z-scores for the BDI and the HAMD. Higher impulsivity and a more anxious temperament were also observed in the group that self-reported more symptoms than were noted by clinicians. LIMITATIONS Generalizability of results can be limited in ethnic difference. CONCLUSIONS Subjective and objective assessments of the depressive symptoms of patients with mood disorders in a euthymic mood state are frequently discordant. Clinicians should consider the subjective aspects of depressive symptoms along with objective information about the influence of intelligence and personality on patients' self-reports.
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Affiliation(s)
- Eun Young Kim
- Department of Psychiatry, Seoul National University Hospital, Seoul 110-744, Republic of Korea
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127
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Rosenström T, Jokela M, Hintsanen M, Pulkki-Råback L, Hutri-Kähönen N, Keltikangas-Järvinen L. Longitudinal course of depressive symptoms in adulthood: linear stochastic differential equation modeling. Psychol Med 2013; 43:933-944. [PMID: 22932470 DOI: 10.1017/s0033291712002000] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Although many studies have addressed the topic of stability versus change in depressive symptoms, few have further decomposed the change to continuous accumulation versus non-systematic state fluctuations or measurement errors. This further step requires a longitudinal follow-up and an appropriate stochastic model; it would, for example, evaluate the hypothesis that women accumulate more susceptibility events than men. Method A linear stochastic differential equation model was estimated for a 16-year longitudinal course of depressive symptoms in the Young Finns community sample of 3596 participants (1832 women, 1764 men). This model enabled us to decompose the variance in depression symptoms into a stable trait, cumulative effects and state/error fluctuations. RESULTS Women showed higher mean levels and higher variance of depressive symptoms than men. In men, the stable trait accounted for the majority [61%, 90% confidence interval (CI) 48.9-69.2] of the total variance, followed by cumulative effects (23%, 90% CI 9.9-41.7) and state/error fluctuations (16%, 90% CI 5.6-23.2). In women, the cumulative sources were more important than among men and accounted for 44% (90% CI 23.6-58.9) of the variance, followed by stable individual differences (32%, 90% CI 18.5-54.2) and state fluctuations (24%, 90% CI 19.1-27.3). CONCLUSIONS The results are consistent with previous observations that women suffer more depression than men, and have more variance in depressive symptoms. We also found that continuously accumulating effects are a significant contributor to between-individual differences in depression, especially for women. Although the accumulating effects are often confounded with non-systematic state fluctuations, the latter are unlikely to exceed 27% of the total variance of depressive symptoms.
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Affiliation(s)
- T Rosenström
- IBS, Unit of Personality, Work and Health Psychology, University of Helsinki, Finland.
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128
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Uher R, Mors O, McGuffin P. Antidepressant effects of nortriptyline and escitalopram in the GENDEP study: is one better than the other? Acta Psychiatr Scand 2013; 127:330. [PMID: 23480387 DOI: 10.1111/acps.12068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- R Uher
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada.
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129
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Bech P, Allerup P, Larsen ER, Csillag C, Licht RW. Escitalopram versus nortriptyline: how to let the clinical GENDEP data tell us what they contained. Acta Psychiatr Scand 2013; 127:328-9. [PMID: 23480386 DOI: 10.1111/acps.12067] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- P Bech
- Psychiatric Research Unit, Mental Health Centre North Zealand, Copenhagen University, Hillerød, Denmark.
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Candidate genes expression profile associated with antidepressants response in the GENDEP study: differentiating between baseline 'predictors' and longitudinal 'targets'. Neuropsychopharmacology 2013; 38:377-85. [PMID: 22990943 PMCID: PMC3547188 DOI: 10.1038/npp.2012.191] [Citation(s) in RCA: 312] [Impact Index Per Article: 28.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
To improve the 'personalized-medicine' approach to the treatment of depression, we need to identify biomarkers that, assessed before starting treatment, predict future response to antidepressants ('predictors'), as well as biomarkers that are targeted by antidepressants and change longitudinally during the treatment ('targets'). In this study, we tested the leukocyte mRNA expression levels of genes belonging to glucocorticoid receptor (GR) function (FKBP-4, FKBP-5, and GR), inflammation (interleukin (IL)-1α, IL-1β, IL-4, IL-6, IL-7, IL-8, IL-10, macrophage inhibiting factor (MIF), and tumor necrosis factor (TNF)-α), and neuroplasticity (brain-derived neurotrophic factor (BDNF), p11 and VGF), in healthy controls (n=34) and depressed patients (n=74), before and after 8 weeks of treatment with escitalopram or nortriptyline, as part of the Genome-based Therapeutic Drugs for Depression study. Non-responders had higher baseline mRNA levels of IL-1β (+33%), MIF (+48%), and TNF-α (+39%). Antidepressants reduced the levels of IL-1β (-6%) and MIF (-24%), and increased the levels of GR (+5%) and p11 (+8%), but these changes were not associated with treatment response. In contrast, successful antidepressant response was associated with a reduction in the levels of IL-6 (-9%) and of FKBP5 (-11%), and with an increase in the levels of BDNF (+48%) and VGF (+20%)-that is, response was associated with changes in genes that did not predict, at the baseline, the response. Our findings indicate a dissociation between 'predictors' and 'targets' of antidepressant responders. Indeed, while higher levels of proinflammatory cytokines predict lack of future response to antidepressants, changes in inflammation associated with antidepressant response are not reflected by all cytokines at the same time. In contrast, modulation of the GR complex and of neuroplasticity is needed to observe a therapeutic antidepressant effect.
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131
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Lu G, Brazier JE, Ades AE. Mapping from disease-specific to generic health-related quality-of-life scales: a common factor model. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2013; 16:177-84. [PMID: 23337229 DOI: 10.1016/j.jval.2012.07.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2011] [Revised: 07/10/2012] [Accepted: 07/13/2012] [Indexed: 05/12/2023]
Abstract
OBJECTIVES To develop a coherent method for estimating mappings between treatment effects on disease-specific measurement (DSM) instruments and generic health-related quality-of-life (QOL) measures, when both are subject to measurement errors. METHODS We identified three properties that must be satisfied for mappings to be logically coherent: invertability, transitivity, and invariance to linear transformation. Of the common regressions, ordinary least squares (OLS), geometric mean (GM), and orthogonal regression, only GM has all these properties, and then only in special cases. We developed a common factor model of how DSM and generic QOL scales are related, and derived expressions for coherent mapping coefficients. We showed that these are equivalent to adjusted forms of OLS or GM regressions. Where cohort data are available on just one DSM and one QOL measure, external data on the reproducibility of the DSM are required. In some circumstances, the mappings can be estimated without external data. We illustrated the estimation of mapping coefficients by using data on EuroQol five-dimensional (EQ-5D) questionnaire, 12-item short form health survey (SF-12) Mental Component Summary, and the Beck Depression Inventory (BDI), from a trial of treatments for depression. RESULTS OLS underestimates and GM overestimates mappings from DSMs to generic QOL measures. Mappings estimated by using external data on reliability were similar to those estimated by using internal data, suggesting approximate adequacy of the common factor model. CONCLUSIONS Neither OLS nor GM regression, unless corrected, is suitable for estimating mappings between disease-specific and generic QOL scales. OLS systematically underestimates mappings, but it can be adjusted by using external information on test-retest reliability.
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Affiliation(s)
- Guobing Lu
- School of Social and Community Medicine, University of Bristol, Bristol, UK.
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132
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Ades AE, Lu G, Madan JJ. Which health-related quality-of-life outcome when planning randomized trials: disease-specific or generic, or both? A common factor model. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2013; 16:185-194. [PMID: 23337230 DOI: 10.1016/j.jval.2012.09.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2011] [Revised: 07/12/2012] [Accepted: 09/04/2012] [Indexed: 06/01/2023]
Abstract
The primary outcomes in trials are usually disease-specific measures (DSMs) designed to be responsive to changes in the condition caused by treatment. For purposes of cost-effectiveness analysis, treatment effects on the DSM are often "mapped" into treatment effects on a generic health-related quality-of-life (QOL) scale, such as EuroQol five-dimensional questionnaire. Trialists have the option of including generic QOL measures as trial outcomes. We consider the relative efficiency (estimate divided by its standard error) of treatment effects derived from the DSM, the generic QOL, the generic QOL indirectly estimated from the mapped DSM, and a pooled estimate combining the direct and indirect information on the generic QOL. By using a "common factor" theory of the relationship between the DSM and the generic QOL, we define the circumstances under which indirectly estimated generic QOL is more efficient than the direct one and when a pooled QOL estimate is more efficient than the DSM estimate. As long as the DSM is more responsive, there is always a threshold sample size above which the indirect estimate has better precision than the direct estimate. This threshold, however, increases as the (1) relative responsiveness ratio of the DSM to the generic QOL increases, (2) precision of the estimated mapping coefficient increases, and (3) true effect becomes smaller. The pooled estimate on the generic QOL may be more efficient than the DSM itself unless the reliability of the DSM is particularly high. Trials powered on DSMs are likely to have sufficient power to detect treatment effect on the generic QOL if a pooled estimate is used. We conclude that generic QOL instruments should be routinely included in randomized controlled trials. Information on mapping coefficients and on relative responsiveness should be collected more systematically to facilitate both evidence synthesis and trial design.
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Affiliation(s)
- A E Ades
- School of Social and Community Medicine, University of Bristol, Bristol, UK
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133
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Snyder HR. Major depressive disorder is associated with broad impairments on neuropsychological measures of executive function: a meta-analysis and review. Psychol Bull 2013; 139:81-132. [PMID: 22642228 PMCID: PMC3436964 DOI: 10.1037/a0028727] [Citation(s) in RCA: 1032] [Impact Index Per Article: 93.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Cognitive impairments are now widely acknowledged as an important aspect of major depressive disorder (MDD), and it has been proposed that executive function (EF) may be particularly impaired in patients with MDD. However, the existence and nature of EF impairments associated with depression remain strongly debated. Although many studies have found significant deficits associated with MDD on neuropsychological measures of EF, others have not, potentially due to low statistical power, task impurity, and diverse patient samples, and there have been no recent, comprehensive, meta-analyses investigating EF in patients with MDD. The current meta-analysis uses random-effects models to synthesize 113 previous research studies that compared participants with MDD to healthy control participants on at least one neuropsychological measure of EF. Results of the meta-analysis demonstrate that MDD is reliably associated with impaired performance on neuropsychological measures of EF, with effect sizes ranging from 0.32 to 0.97. Although patients with MDD also have slower processing speed, motor slowing alone cannot account for these results. In addition, some evidence suggests that deficits on neuropsychological measures of EF are greater in patients with more severe current depression symptoms, and those taking psychotropic medications, whereas evidence for effects of age was weaker. The results are consistent with the theory that MDD is associated with broad impairment in multiple aspects of EF. Implications for treatment of MDD and theories of EF are discussed. Future research is needed to establish the specificity and causal link between MDD and EF impairments.
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Affiliation(s)
- Hannah R Snyder
- Department of Psychology and Neuroscience, University of Colorado, Boulder, CO 80309, USA.
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van Loo HM, de Jonge P, Romeijn JW, Kessler RC, Schoevers RA. Data-driven subtypes of major depressive disorder: a systematic review. BMC Med 2012; 10:156. [PMID: 23210727 PMCID: PMC3566979 DOI: 10.1186/1741-7015-10-156] [Citation(s) in RCA: 201] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Accepted: 12/04/2012] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND According to current classification systems, patients with major depressive disorder (MDD) may have very different combinations of symptoms. This symptomatic diversity hinders the progress of research into the causal mechanisms and treatment allocation. Theoretically founded subtypes of depression such as atypical, psychotic, and melancholic depression have limited clinical applicability. Data-driven analyses of symptom dimensions or subtypes of depression are scarce. In this systematic review, we examine the evidence for the existence of data-driven symptomatic subtypes of depression. METHODS We undertook a systematic literature search of MEDLINE, PsycINFO and Embase in May 2012. We included studies analyzing the depression criteria of the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) of adults with MDD in latent variable analyses. RESULTS In total, 1176 articles were retrieved, of which 20 satisfied the inclusion criteria. These reports described a total of 34 latent variable analyses: 6 confirmatory factor analyses, 6 exploratory factor analyses, 12 principal component analyses, and 10 latent class analyses. The latent class techniques distinguished 2 to 5 classes, which mainly reflected subgroups with different overall severity: 62 of 71 significant differences on symptom level were congruent with a latent class solution reflecting severity. The latent class techniques did not consistently identify specific symptom clusters. Latent factor techniques mostly found a factor explaining the variance in the symptoms depressed mood and interest loss (11 of 13 analyses), often complemented by psychomotor retardation or fatigue (8 of 11 analyses). However, differences in found factors and classes were substantial. CONCLUSIONS The studies performed to date do not provide conclusive evidence for the existence of depressive symptom dimensions or symptomatic subtypes. The wide diversity of identified factors and classes might result either from the absence of patterns to be found, or from the theoretical and modeling choices preceding analysis.
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Affiliation(s)
- Hanna M van Loo
- Department of Psychiatry, University Medical Center Groningen, Hanzeplein 1, Groningen, 9713 GZ, The Netherlands
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135
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Uher R, Rutter M. Basing psychiatric classification on scientific foundation: problems and prospects. Int Rev Psychiatry 2012; 24:591-605. [PMID: 23244614 DOI: 10.3109/09540261.2012.721346] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
To examine whether and how the classification of mental disorders can be based on research, we evaluate the relevance of psychiatric science to the major questions in classification. We conclude that most studies cannot inform the validity of diagnostic categories because they are constrained by the classification through a top-down diagnostic approach. Analyses of relationships between diagnostic categories suggest that most interdiagnostic boundaries in current classifications lack validity. Likewise, genetic studies show that the susceptibility to mental illness is at most partly disorder-specific. Neuroimaging research is uninformative due to unsystematic single-diagnosis studies, use of super-healthy controls, and publication bias. Treatment research suggests moderate specificity in several areas of psychopathology (e.g. lithium for bipolar disorder), but lack of specificity is the rule (e.g. the broad indications of serotonin-reuptake inhibitors). In summary, evidence from multiple lines of research converges to indicate that current classifications contain excessively large numbers of categories of limited validity. Dimensional classification will not solve the problem because the number of dimensions is as uncertain as the number of categories. Psychiatric research should discard the assumption that current classification is valid. Instead of diagnosis-specific investigations, studies of unselected groups assessed with bottom-up approaches are needed to advance psychiatry.
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Affiliation(s)
- Rudolf Uher
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada.
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136
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Hosang GM, Uher R, Maughan B, McGuffin P, Farmer AE. The role of loss and danger events in symptom exacerbation in bipolar disorder. J Psychiatr Res 2012; 46:1584-9. [PMID: 22868047 DOI: 10.1016/j.jpsychires.2012.07.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Revised: 06/01/2012] [Accepted: 07/13/2012] [Indexed: 11/18/2022]
Abstract
Research concerned with the association between stressful life events [SLEs] and bipolar disorder [BD] is inconsistent. Drawing on the unipolar depression literature, specific classifications of events (in particular, humiliation and loss events) seem to be especially important, while for anxiety disorders loss and danger events have been found to be pertinent. However, little or nothing is known about the relationship between such events and BD. The aim of the present investigation is to examine the association between danger and loss events and symptom exacerbation in BD. A total of 96 BD participants were interviewed using the Life Events and Difficulties Schedule [LEDS] at two time points: baseline and 4 month follow-up. Self-report and observer-rated symptom measures were administered at both interviews. The Beck Depression Inventory-Second Edition and the Montgomery Asberg Depression Rating Scale were used to measure depressive symptoms. The Self-Report Mania Inventory and Clinician-Administered Rating Scale for Mania were used to rate manic symptoms. Independent severe events, independent loss events and independent danger events were found to be significantly associated with worsening of depressive symptoms over an 8-month period. No significant associations were observed for manic symptoms. Specific relationships with different types of SLEs may explain previous discrepant findings concerning the relationship between SLEs and BD.
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Affiliation(s)
- Georgina M Hosang
- MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, De Crespigny Park, London SE5 8AF, UK.
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137
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Uher R, Perlis RH, Placentino A, Dernovšek MZ, Henigsberg N, Mors O, Maier W, McGuffin P, Farmer A. Self-report and clinician-rated measures of depression severity: can one replace the other? Depress Anxiety 2012; 29:1043-9. [PMID: 22933451 PMCID: PMC3750710 DOI: 10.1002/da.21993] [Citation(s) in RCA: 155] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2012] [Revised: 07/25/2012] [Accepted: 07/27/2012] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND It has been suggested that clinician-rated scales and self-report questionnaires may be interchangeable in the measurement of depression severity, but it has not been tested whether clinically significant information is lost when assessment is restricted to either clinician-rated or self-report instruments. The aim of this study is to test whether self-report provides information relevant to short-term treatment outcomes that is not captured by clinician-rating and vice versa. METHODS In genome-based drugs for depression (GENDEP), 811 patients with major depressive disorder treated with escitalopram or nortriptyline were assessed with the clinician-rated Montgomery-Åsberg Depression Rating Scale (MADRS), Hamilton Rating Scale for Depression (HRSD), and the self-report Beck Depression Inventory (BDI). In sequenced treatment alternatives to relieve depression (STAR*D), 4,041 patients treated with citalopram were assessed with the clinician-rated and self-report versions of the Quick Inventory of Depressive Symptomatology (QIDS-C and QIDS-SR) in addition to HRSD. RESULTS In GENDEP, baseline BDI significantly predicted outcome on MADRS/HRSD after adjusting for baseline MADRS/HRSD, explaining additional 3 to 4% of variation in the clinician-rated outcomes (both P < .001). Likewise, each clinician-rated scale significantly predicted outcome on BDI after adjusting for baseline BDI and explained additional 1% of variance in the self-reported outcome (both P < .001). The results were confirmed in STAR*D, where self-report and clinician-rated versions of the same instrument each uniquely contributed to the prediction of treatment outcome. CONCLUSIONS Complete assessment of depression should include both clinician-rated scales and self-reported measures.
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Affiliation(s)
- Rudolf Uher
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada.
| | - Roy H. Perlis
- Center for Experimental Drugs and Diagnostics, Department of Psychiatry and Center for Human Genetic Research, Massachusetts General Hospital, Boston, Massachusetts
| | - Anna Placentino
- Psychiatric Unit (UOP 23), Department of Mental Health, Spedali Civili Hospital of Brescia, Lombardei, Italy,Biological Psychiatry Unit, IRCCS-FBF, Brescia; Faculty of Psychology, University of Milano-Bicocca, Italy
| | | | - Neven Henigsberg
- Croatian Institute for Brain Research, Medical School University of Zagreb, Croatia
| | - Ole Mors
- Centre for Psychiatric Research, Aarhus University Hospital, Risskov, Denmark
| | | | - Peter McGuffin
- MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, United Kingdom
| | - Anne Farmer
- MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, United Kingdom
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138
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Rosenström T, Jokela M, Puttonen S, Hintsanen M, Pulkki-Råback L, Viikari JS, Raitakari OT, Keltikangas-Järvinen L. Pairwise measures of causal direction in the epidemiology of sleep problems and depression. PLoS One 2012; 7:e50841. [PMID: 23226400 PMCID: PMC3511346 DOI: 10.1371/journal.pone.0050841] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2012] [Accepted: 10/25/2012] [Indexed: 11/29/2022] Open
Abstract
Depressive mood is often preceded by sleep problems, suggesting that they increase the risk of depression. Sleep problems can also reflect prodromal symptom of depression, thus temporal precedence alone is insufficient to confirm causality. The authors applied recently introduced statistical causal-discovery algorithms that can estimate causality from cross-sectional samples in order to infer the direction of causality between the two sets of symptoms from a novel perspective. Two common-population samples were used; one from the Young Finns study (690 men and 997 women, average age 37.7 years, range 30–45), and another from the Wisconsin Longitudinal study (3101 men and 3539 women, average age 53.1 years, range 52–55). These included three depression questionnaires (two in Young Finns data) and two sleep problem questionnaires. Three different causality estimates were constructed for each data set, tested in a benchmark data with a (practically) known causality, and tested for assumption violations using simulated data. Causality algorithms performed well in the benchmark data and simulations, and a prediction was drawn for future empirical studies to confirm: for minor depression/dysphoria, sleep problems cause significantly more dysphoria than dysphoria causes sleep problems. The situation may change as depression becomes more severe, or more severe levels of symptoms are evaluated; also, artefacts due to severe depression being less well presented in the population data than minor depression may intervene the estimation for depression scales that emphasize severe symptoms. The findings are consistent with other emerging epidemiological and biological evidence.
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Affiliation(s)
- Tom Rosenström
- IBS, Unit of Personality, Work and Health Psychology, University of Helsinki, Helsinki, Finland.
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139
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Uher R, Carver S, Power RA, Mors O, Maier W, Rietschel M, Hauser J, Dernovsek MZ, Henigsberg N, Souery D, Placentino A, Farmer A, McGuffin P. Non-steroidal anti-inflammatory drugs and efficacy of antidepressants in major depressive disorder. Psychol Med 2012; 42:2027-2035. [PMID: 22391106 DOI: 10.1017/s0033291712000190] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND It has been proposed that non-steroidal anti-inflammatory drugs (NSAIDs) may interfere with the efficacy of antidepressants and contribute to treatment resistance in major depressive disorder (MDD). This effect requires replication and a test of whether it is specific to serotonin-reuptake inhibiting (SRI) antidepressants. METHOD We tested the effect of concomitant medication with NSAIDs on the efficacy of escitalopram, a SRI antidepressant, and nortriptyline, a tricyclic antidepressant, among 811 subjects with MDD treated for up to 12 weeks in the GENDEP study. Effects of NSAIDs on improvement of depressive symptoms were tested in mixed-effect linear models. Effects on remission were tested in logistic regression. Age, sex, baseline severity and centre of recruitment were considered as potential confounding factors. RESULTS Ten percent (n=78) of subjects were taking NSAIDs during the antidepressant treatment. Older subjects were significantly more likely to take NSAIDs. After controlling for age, sex, centre of recruitment and baseline severity, concomitant medication with NSAIDs did not significantly influence the efficacy of escitalopram [β=0.035, 95% confidence interval (CI) -0.145 to 0.215, p=0.704] or nortriptyline (β=0.075, 95% CI -0.131 to 0.281, p=0.476). Although slightly fewer subjects who took NSAIDs reached remission [odds ratio (OR) 0.80, 95% CI 0.49-1.31, p=0.383], this non-significant effect was reversed after controlling for age, sex, baseline severity and recruitment centre effects (OR 1.04, 95% CI 0.61-1.77, p=0.882). CONCLUSIONS NSAIDs are unlikely to affect the efficacy of SRI or other antidepressants. Concurrent use of NSAIDs and antidepressants does not need to be avoided.
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Affiliation(s)
- R Uher
- MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, UK.
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Power RA, Muthén B, Henigsberg N, Mors O, Placentino A, Mendlewicz J, Maier W, McGuffin P, Lewis CM, Uher R. Non-random dropout and the relative efficacy of escitalopram and nortriptyline in treating major depressive disorder. J Psychiatr Res 2012; 46:1333-8. [PMID: 22770672 DOI: 10.1016/j.jpsychires.2012.06.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Revised: 04/27/2012] [Accepted: 06/19/2012] [Indexed: 11/24/2022]
Abstract
Most comparisons of the efficacy of antidepressants have relied on the assumption that missing data are randomly distributed. Dropout rates differ between drugs, suggesting this assumption may not hold true. This paper examines the effect of non-random dropout on a comparison of two antidepressant drugs, escitalopram and nortriptyline, in the treatment of major depressive disorder. The GENDEP study followed adult patients with major depressive disorder over 12 weeks of treatment, and the primary analysis found no difference in efficacy of the two antidepressants under missing at random assumption. By applying the recently developed Muthén-Roy model, we compared the relative efficacy of these two antidepressants taking into account non-random distribution of missing outcomes (NMAR). Individuals who dropped out of the study were those who were not responding to treatment. Based on the best fitting NMAR model, it was found that escitalopram reduced symptom scores by an additional 1.4 points on the Montgomery-Åsberg Depression Rating Scale (p = 0.02), equivalent to 5% of baseline depression severity, compared to nortriptyline. We conclude that association between dropout and worsening symptoms led to an overestimate of the effectiveness of treatment, especially with nortriptyline, in the primary analysis. These findings review the primary analysis of GENDEP and suggest that, when non-random dropout is accounted for, escitalopram is more effective than nortriptyline in reducing symptoms of major depression.
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Affiliation(s)
- Robert A Power
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, London, United Kingdom.
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Reininghaus U, Priebe S. Measuring patient-reported outcomes in psychosis: conceptual and methodological review. Br J Psychiatry 2012; 201:262-7. [PMID: 23028084 DOI: 10.1192/bjp.bp.111.107615] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND There are calls to use patient-reported outcomes (PROs) routinely across mental health services. However, the use of PROs in patients with psychosis has been questioned. AIMS To examine the concepts and measures of four widely used PROs: treatment satisfaction, subjective quality of life, needs for care and the quality of the therapeutic relationship. METHOD We conducted a literature search of academic databases on concepts, characteristics and psychometric properties of the four PROs in patients with psychosis. RESULTS Although numerous concepts and measures have been published, evidence on the methodological quality of existing PROs is limited. Measures designed to assess distinct PROs showed a considerable conceptual, operational and empirical overlap, and some of them also included specific aspects. The impact of symptoms and cognitive deficits appears unlikely to be of clinical significance. CONCLUSIONS The popularity of PROs has not been matched with progress in their conceptualisation and measurement. Based on current evidence, some recommendations can be made. Distinct and short measures with clinical relevance and sufficient psychometric properties should be preferred. Future research should optimise the validity and measurement precision of PROs, while reducing assessment burden.
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Maneeton N, Maneeton B, Srisurapanont M, Martin SD. Quetiapine monotherapy in acute phase for major depressive disorder: a meta-analysis of randomized, placebo-controlled trials. BMC Psychiatry 2012; 12:160. [PMID: 23017200 PMCID: PMC3549283 DOI: 10.1186/1471-244x-12-160] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Accepted: 09/20/2012] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Schizophrenia and bipolar depression trials suggest that quetiapine may have an antidepressant effect. OBJECTIVES This meta-analysis aimed to determine the efficacy, acceptability and tolerability of quetiapine treatment for major depressive disorder (MDD). Only the randomized controlled trials (RCTs) comparison between quetiapine and placebo were included. The authors searched such clinical trials carried out between 1991 and February 2012. DATA SOURCES MEDLINE, EMBASE, CINHL, PsycINFO and Cochrane Controlled Trials Register were searched in February 2012. Study populations comprised adults with MDD or major depression. STUDY ELIGIBLE CRITERIA, PARTICIPANTS AND INTERVENTIONS: Eligible studies were randomized, placebo-controlled trials of quetiapine monotherapy carried out in adults with MDD and presenting endpoint outcomes relevant to: i) depression severity, ii) response rate, iii) overall discontinuation rate, or iv) discontinuation rate due to adverse events. No language restriction was applied. STUDY APPRAISAL AND SYNTHESIS METHODS All abstracts identified by the electronic searches were examined. The full reports of relevant studies were assessed, and the data of interest were extracted. Based on the Cochrane methods of bias assessment, risks of bias were determined. The studies with two risks or less were included. The efficacy outcomes were the mean change scores of depression rating scales, the overall response rate, and the overall remission rates. The overall discontinuation rate was considered as a measure of acceptability. The discontinuation rate due to adverse events was a measure of tolerability. Relative risks (RRs) and weighted mean differences (WMDs) with 95% confidence intervals (CIs) were computed by using a random effect model. RESULTS A total of 1,497 participants in three RCTs were included. All trials examined the quetiapine extended-release (XR). The pooled mean change scores of the Montgomery-Asberg Depression Rating Scale (MADRS) and the Hamilton Depression Rating Scale (HAM-D) of the quetiapine-treated group were higher than those of the placebo-treated group with the WMDs (95%CI) of -3.37 (-3.95, -2.79) and -2.46 (-3.47, -1.45), respectively. All studies defined the response and remission as ≥ 50% reduction of the MADRS total score and the MADRS total score of ≤8 at endpoint, respectively. The overall response and remission rates were significantly greater in the quetiapine-treated group with RRs (95%CIs) of 1.44 (1.26, 1.64) and 1.37 (1.12, 1.68), respectively. The pooled discontinuation rate was not significantly different between groups with an RR (95%CI) of 1.16 (0.97, 1.39). The pooled discontinuation rate due to adverse event was greater in the quetiapine group with an RR (95%CI) of 2.90 (1.87, 4.48). With respect to sleep time, the pooled mean change Pittsburgh Sleep Quality Index (PSQI) scores of the quetiapine-treated group was also significantly higher than that of the placebo-treated group [WMD (95%CI) of -1.21 (-1.81, -0.61)]. LIMITATIONS Variety of quetiapine XR doses and the small number of RCTs were key limitations of this meta-analysis. CONCLUSIONS Based on the limited evidence obtained from three RCTs, quetiapine XR is effective for adult patients with MDD. The high dropout rate due to adverse events suggests that some MDD patients may not be able to tolerate quetiapine XR. Due to the balance of its efficacy benefit and risk of side effects, as the overall discontinuation rate shown, the acceptability of this agent is not more than placebo. These results should be viewed as the very preliminary one. Further studies in this area are warranted. IMPLICATION OF KEY FINDINGS: Quetiapine may be an alternative antidepressant. However, both risk and benefit of this agent should be taken into account for an individual patient with MDD.
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Affiliation(s)
- Narong Maneeton
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Benchalak Maneeton
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Manit Srisurapanont
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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143
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Uher R, Tansey KE, Malki K, Perlis RH. Biomarkers predicting treatment outcome in depression: what is clinically significant? Pharmacogenomics 2012; 13:233-40. [PMID: 22256872 DOI: 10.2217/pgs.11.161] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
AIM To extend to biomarker studies the consensus clinical significance criterion of a three-point difference in Hamilton Rating Scale for Depression. MATERIALS & METHODS We simulated datasets modeled on large clinical trials. RESULTS In a typical clinical trial comparing active treatment and placebo, a difference of three Hamilton Rating Scale for Depression (HRSD) points at the end of treatment corresponds to 6.3% of variance in outcome explained. To achieve a similar explanatory power, genotypes with minor allele frequencies of 5, 10, 20, 30 and 50% need to attain a per allele difference of 4.7, 3.6, 2.8, 2.4 and 2.2 HRSD points, respectively. A normally distributed continuous biomarker will need an effect size of 1.5 HRSD points per standard deviation. A number needed to assess of three suggests that with this effect size, a biomarker will significantly improve the prediction of outcome in one out of every three patients assessed. CONCLUSION This report provides guidance on assessing clinical significance of biomarkers predictive of outcome in depression treatment.
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Affiliation(s)
- Rudolf Uher
- Institute of Psychiatry, King's College London, 16 De Crespigny Park, SE5 8AF, London, UK.
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144
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Hodgson K, Mufti SJ, Uher R, McGuffin P. Genome-wide approaches to antidepressant treatment: working towards understanding and predicting response. Genome Med 2012; 4:52. [PMID: 22738351 PMCID: PMC3698532 DOI: 10.1186/gm351] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Antidepressants are among the most commonly prescribed drugs, and a range of medications are available. However, treatment response to a particular drug varies greatly between patients, with only 30% of patients responding well to the first treatment administered. Given evidence that antidepressant treatment response is a heritable trait, together with technological advances in genetic research, three recently published genome-wide investigations into antidepressant responses have examined the determinants of variability in treatment outcomes between depressed patients. Here, we review these studies within the context of wider research efforts to identify treatment response predictors. Some interesting genes have been implicated, but no variants have yet been robustly and reliably linked to response. This may suggest that genetic effect sizes are smaller than originally anticipated. Candidate gene approaches in these samples have lent support to the involvement of serotonergic, glutamatergic and stress-response systems in treatment response, although corroborative evidence from genome-wide analyses indicates these results should be interpreted cautiously. Closer examination of antidepressant response, considering it as a complex trait, has indicated that multiple genes of small effect are likely to be involved. Furthermore, there is some evidence that genetic influence on response to treatment may vary between patients with different symptom profiles or environmental exposures. This has implications for the translation of pharmacogenetic findings into clinical practice: genotypic information from multiple loci and data on non-genetic factors are likely to be needed to tailor antidepressant treatment to the individual patient.
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Affiliation(s)
- Karen Hodgson
- MRC SGDP Centre, Institute of Psychiatry, King's College London, London, SE5 A8F, UK.
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145
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Abstract
RATIONALE Selecting an effective treatment for patients with major depressive disorder is a perpetual problem for psychiatrists. It is of particular interest to explore the interaction between genetic predisposition and environmental factors. OBJECTIVES Mouse inbred strains vary in baseline performance in depression-related behaviour tests, which were originally validated as tests of antidepressant response. Therefore, we investigated interactions between environmental stress, genotype, and drug response in a multifactorial behaviour study. METHOD Our study design included four inbred mouse strains (129S1/SvlmJ, C57LB/6J, DBA/2J and FVB/NJ) of both sexes, two subjected to environmental manipulations (maternal separation and unpredictable chronic mild stress) and two representative of treatment with antidepressants (escitalopram and nortryptiline vs. vehicle). The mice treated with antidepressants were further divided into those administered acute (1 day) and subchronic (14 days) regimes, giving 144 experimental groups in all, each with at least seven animals. All animals were tested using the Porsolt forced-swim test (FST) and the hole-board test. RESULTS Despite a 24-h maternal separation (MS) or a 14-day unpredictable chronic mild stress protocol, most animals seemed to be resilient to the stress induced. One compelling finding is the long-lasting, strain-specific effect of MS resulting in an increased depression-like behaviour in the Porsolt FST and elevated anxiety-related behaviour in the hole-board test seen in 129S1/SvImJ mice. Nortriptyline was effective in reversing the effect of MS in the FST in 129S1/SvlmJ male mice. CONCLUSION A single 24-h maternal separation of pups from their mother on postnatal day 9 is a sufficient insult to result in a depression-like phenotype in adult 129S1/SvImJ mice but not in C57LB/6 J, DBA/2 J, and FVB/NJ mice.
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146
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van Noorden MS, van Fenema EM, van der Wee NJA, Zitman FG, Giltay EJ. Predicting outcome of depression using the depressive symptom profile: the Leiden Routine Outcome Monitoring Study. Depress Anxiety 2012; 29:523-30. [PMID: 22555849 DOI: 10.1002/da.21958] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2012] [Revised: 03/26/2012] [Accepted: 03/30/2012] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND To investigate the predictive value of items for individual depressive symptoms measured with the self-rated Beck Depression Inventory-Revised (BDI-II) self-report scale on outcome in a large naturalistic cohort of depressive outpatients. METHODS We used a cohort of 1,489 adult patients aged 18-65 years with major depressive disorder or dysthymic disorder established with the MINI-Plus diagnostic interview. All patients had a routine outcome monitoring baseline measurement in 2004-2009, with a maximum of 2 years follow-up. We used multivariable Cox regression models to predict remission (MADRS < 10; where MADRS stands for Montgomery-Åsberg Depression Rating Scale) and response (≥50% improvement), and adjusted for clinical and demographic characteristics (i.e. marital status, level of education, working status, comorbid anxiety, avoidant and borderline personality traits, and suicidality) that were identified as predictors in earlier studies. RESULTS Of the 21 BDI-II items, the items "pessimism" and "loss of energy" independently predicted for both remission and response. For pessimism, the hazard ratio (HR) for remission was 0.81 (95% confidence interval [CI]: 0.73-0.89, P < .001) and for loss of energy, the HR was 0.81 (95% CI: 0.72-0.92, P = .001). CONCLUSIONS These findings of robust prediction of poor outcome by baseline items of "pessimism" and "loss of energy" in a naturalistic treatment setting may help clinicians to identify depressive patients in need for additional or alternative therapeutic approaches.
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Affiliation(s)
- Martijn S van Noorden
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands.
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147
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Uher R, Perlis RH, Henigsberg N, Zobel A, Rietschel M, Mors O, Hauser J, Dernovsek MZ, Souery D, Bajs M, Maier W, Aitchison KJ, Farmer A, McGuffin P. Depression symptom dimensions as predictors of antidepressant treatment outcome: replicable evidence for interest-activity symptoms. Psychol Med 2012; 42:967-980. [PMID: 21929846 PMCID: PMC3787526 DOI: 10.1017/s0033291711001905] [Citation(s) in RCA: 261] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Symptom dimensions have not yet been comprehensively tested as predictors of the substantial heterogeneity in outcomes of antidepressant treatment in major depressive disorder. METHOD We tested nine symptom dimensions derived from a previously published factor analysis of depression rating scales as predictors of outcome in 811 adults with moderate to severe depression treated with flexibly dosed escitalopram or nortriptyline in Genome-based Therapeutic Drugs for Depression (GENDEP). The effects of symptom dimensions were tested in mixed-effect regression models that controlled for overall initial depression severity, age, sex and recruitment centre. Significant results were tested for replicability in 3637 adult out-patients with non-psychotic major depression treated with citalopram in level I of Sequenced Treatment Alternatives to Relieve Depression (STAR*D). RESULTS The interest-activity symptom dimension (reflecting low interest, reduced activity, indecisiveness and lack of enjoyment) at baseline strongly predicted poor treatment outcome in GENDEP, irrespective of overall depression severity, antidepressant type and outcome measure used. The prediction of poor treatment outcome by the interest-activity dimension was robustly replicated in STAR*D, independent of a comprehensive list of baseline covariates. CONCLUSIONS Loss of interest, diminished activity and inability to make decisions predict poor outcome of antidepressant treatment even after adjustment for overall depression severity and other clinical covariates. The prominence of such symptoms may require additional treatment strategies and should be accounted for in future investigations of antidepressant response.
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Affiliation(s)
- R Uher
- MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, UK.
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148
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Guillén V, Santos B, Yllá L, Bulbena A, Bilbao J, Fernández E, de Lazarraga IP, González-Pinto AM, González-Pinto A. Depressive dimensions and item response analysis of the Hamilton Depression Rating Scale-17 in eating disorders. Compr Psychiatry 2012; 53:396-402. [PMID: 21741039 DOI: 10.1016/j.comppsych.2011.05.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2011] [Accepted: 05/23/2011] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Most patients having eating disorders (EDs) experience depressive symptoms. To date, there have been few reports about the different depressive dimensions in EDs. OBJECTIVE The aim of this study was to investigate the dimensions of depressive symptoms and highlight the distribution of the symptoms. The psychometric properties of these measures were tested using item response theory methods. METHODS A total of 103 consecutively admitted inpatients and outpatients who met the Diagnostic and Statistical Manual of Mental Disorders, Revised Fourth Edition, criteria for anorexia nervosa, bulimia nervosa, and EDs not otherwise specified were rated with the Hamilton Depression Rating Scale (HDRS-17). A factor analysis of the HDRS-17 was carried out with the Cf-varimax rotation. RESULTS Factor analysis showed 2 independent and clinically interpretable factors corresponding to "anxious depression" and "somatic complaints" that constituted the core of depression. For the HDRS-17, item response theory analyses revealed that most of the items were maximally related to the core concept of depression and provided a good functioning. The 17 items were distributed in almost the same way as in the factor analyses found by other authors with different clinical groups. We conclude therefore that for the sample of EDs, 2 factors constitute the core symptoms of depression and most of the items provided a good functioning.
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Affiliation(s)
- Virginia Guillén
- Department of Neurosciences, Psychiatry, University of the Basque Country, Spain.
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149
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Olino TM, Yu L, Klein DN, Rohde P, Seeley JR, Pilkonis PA, Lewinsohn PM. Measuring depression using item response theory: an examination of three measures of depressive symptomatology. Int J Methods Psychiatr Res 2012; 21:76-85. [PMID: 22290656 PMCID: PMC3302969 DOI: 10.1002/mpr.1348] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2010] [Revised: 11/03/2010] [Accepted: 11/18/2010] [Indexed: 11/11/2022] Open
Abstract
Evaluations of assessment instruments using classical test theory typically rely on indices of internal consistency, test-retest reliability, and construct validity. However, the use of models from item response theory (IRT) allows comparison of instruments (and items) in terms of the information they provide and where they provide it along the continuum of severity of the construct being assessed. Such results help to identify the measures most appropriate for specific clinical and research contexts. The present study examined the functioning of the Beck Depression Inventory (BDI), the Center for Epidemiologic Studies-Depression (CES-D) scale, and the nine primary symptoms from the depression module of the Schedule for Affective Disorders and Schizophrenia-Children (K-SADS) using IRT methods. A large sample of adolescents (n = 1709) completed the BDI, CES-D scale, and K-SADS. IRT calibration analyses demonstrated that the BDI and CES-D scale performed well in similar ranges of depressive severity (approximately -1 to +3 standard deviations [SDs]), although the BDI provided more information at higher severity levels and the CES-D scale at lower severity levels. The K-SADS depression items, which are dichotomous and focused on clinical disorder, provided the least information that was restricted to the narrowest range (approximately +1 to +3 SDs). This work finds consistency between past rationale for the use of the BDI in clinical samples while using the CES-D scale in epidemiological studies. The results for the K-SADS suggest that interview measures may benefit from increasing the number of items and/or response options to collect more psychometric information.
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Affiliation(s)
- Thomas M Olino
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA 15217-2593, USA.
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150
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Huezo-Diaz P, Perroud N, Spencer EP, Smith R, Sim S, Virding S, Uher R, Gunasinghe C, Gray J, Campbell D, Hauser J, Maier W, Marusic A, Rietschel M, Perez J, Giovannini C, Mors O, Mendlewicz J, McGuffin P, Farmer AE, Ingelman-Sundberg M, Craig IW, Aitchison KJ. CYP2C19 genotype predicts steady state escitalopram concentration in GENDEP. J Psychopharmacol 2012; 26:398-407. [PMID: 21926427 DOI: 10.1177/0269881111414451] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In vitro work shows CYP2C19 and CYP2D6 contribute to the metabolism of escitalopram to its primary metabolite, N-desmethylescitalopram. We report the effect of CYP2C19 and CYP2D6 genotypes on steady state morning concentrations of escitalopram and N-desmethylescitalopram and the ratio of this metabolite to the parent drug in 196 adult patients with depression in GENDEP, a clinical pharmacogenomic trial. Subjects who had one CYP2D6 allele associated with intermediate metabolizer phenotype and one associated with poor metabolizer (i.e. IM/PM genotypic category) had a higher mean logarithm escitalopram concentration than CYP2D6 extensive metabolizers (EMs) (p = 0.004). Older age was also associated with higher concentrations of escitalopram. Covarying for CYP2D6 and age, we found those homozygous for the CYP2C19*17 allele associated with ultrarapid metabolizer (UM) phenotype had a significantly lower mean escitalopram concentration (2-fold, p = 0.0001) and a higher mean metabolic ratio (p = 0.0003) than EMs, while those homozygous for alleles conferring the PM phenotype had a higher mean escitalopram concentration than EMs (1.55-fold, p = 0.008). There was a significant overall association between CYP2C19 genotypic category and escitalopram concentration (p = 0.0003; p = 0.0012 Bonferroni corrected). In conclusion, we have demonstrated an association between CYP2C19 genotype, including the CYP2C19*17 allele, and steady state escitalopram concentration.
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Affiliation(s)
- Patricia Huezo-Diaz
- MRC SGDP Centre, Institute of Psychiatry at King's College London, London, UK
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