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Gonzalez N, Mead KH, Pratt-Chapman ML, Arem H. Healthcare utilization in cancer survivors: six-month longitudinal cohort data. Cancer Causes Control 2022; 33:1005-1012. [PMID: 35576025 DOI: 10.1007/s10552-022-01587-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 04/27/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE To describe healthcare utilization and reasons for delaying medical care and to identify factors that influence high healthcare utilization and care delay among cancer survivors. METHODS Baseline (n = 991) and 6 month follow-up data (n = 777) were collected among breast, prostate, and colorectal cancer survivors from 32 US cancer centers. Participants completed surveys on healthcare utilization (e.g., number of visits to specific providers) and delay of medical care. We categorized participants as high or low users based on median number of visits. We used logistic regression models to examine factors that predicted high healthcare utilization or delay. RESULTS Survivors reported a median of 10.5 visits to healthcare providers and 28% reported ever delaying medical care over 6 months. Compared to prostate cancer survivors, breast and colorectal survivors were 2.4 times more likely (CI = 1.2-4.8) and 4 times more likely (CI = 2.2-7.3) to be high healthcare users, respectively. A higher quality of life score predicted high healthcare utilization (OR = 2.4, CI = 2.0-2.8) and delay of medical care (OR = 1.8, CI = 1.5-2.2). Black survivors were 1.5 times more likely than White survivors to be high healthcare users (CI = 1.1-2.0) and respondents reporting a race category other than White or Black were 1.8 times more likely to delay care (CI = 1.3-2.5). Lower levels of self-efficacy predicted greater healthcare use (OR = 0.7, CI = 0.6-0.8) and delay (OR = 0.6, CI = 0.5-0.7). CONCLUSION Our findings suggest that race, education, marital status, cancer type, time since diagnosis, quality of life, and self-efficacy are associated with both high healthcare utilization and delay among cancer survivors.
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Affiliation(s)
- Nicole Gonzalez
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC, 20052, USA
| | - K Holly Mead
- Department of Health Policy and Management, Milken Institute School of Public Health, George Washington University, Washington, DC, 20052, USA
| | - Mandi L Pratt-Chapman
- Department of Medicine, School of Medicine and Health Sciences, George Washington University, Washington, DC, 20052, USA.,GW Cancer Center, Washington, DC, 20052, USA
| | - Hannah Arem
- Healthcare Delivery Research Program, MedStar Health Research Institute, Washington, DC, 20008, USA. .,Department of Oncology, Georgetown University School of Medicine, Washington, DC, USA.
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Vilardaga JCP, Fisher HM, Winger JG, Miller SN, Nuñez C, Majestic C, Kelleher SA, Somers TJ. Pain, depressive symptoms, and self-efficacy for pain management: examination in African-American women with breast cancer. Support Care Cancer 2022; 30:6633-6640. [PMID: 35501516 DOI: 10.1007/s00520-022-07083-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 04/21/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE African-American women with breast cancer face significant disparities, including high levels of pain. Depressive symptoms and self-efficacy for pain management impact how women with breast cancer manage pain, yet little is known about how these variables relate to pain specifically for African-American women with breast cancer. METHODS Baseline linear regression analyses were conducted using a sample of women (n = 98) with stage I-III breast cancer identifying as Black or African-American who were part of a larger intervention trial. Linear regressions explored the effect of depressive symptoms on pain (i.e., severity and interference), and the effect of self-efficacy for pain management on pain. Covariates were age (M = 57.22, SD = 10.76), cancer stage (50% = stage 1), and education level (36% = some college). RESULTS Participants reported moderate levels of pain severity and interference. Higher depressive symptoms were related to both higher pain severity and interference; (B = 0.06, p < 0.01, 95% CI [0.02,0.09]) and (B = 0.13, p < 0.001, 95% CI [0.09, 0.17]) respectively. Likewise, lower self-efficacy for pain management was also related to both higher pain severity and interference; (B = - 0.04, p < 0.001, 95% CI [- 0.05, - 0.02]) and (B = - 0.06, p < 0.001, 95% CI [- 0.08, - 0.04]) respectively. Women reporting less than a high school diploma endorsed significantly higher pain severity and interference than women reporting some college. Age and cancer stage were not significantly related to pain. CONCLUSION Pain for African-American women with breast cancer may be influenced by depressive symptoms and self-efficacy for pain management, in addition to other important variables. Attending to better assessment and treatment of depressive symptoms and self-efficacy for pain management may improve outcomes.
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Affiliation(s)
- Jennifer C Plumb Vilardaga
- Duke University Medical Center, Pain Prevention and Treatment Research Program, 2400, Pratt Street, 7th Floor, Durham, NC, 27705, USA.
| | - Hannah M Fisher
- Duke University Medical Center, Pain Prevention and Treatment Research Program, 2400, Pratt Street, 7th Floor, Durham, NC, 27705, USA
| | - Joseph G Winger
- Duke University Medical Center, Pain Prevention and Treatment Research Program, 2400, Pratt Street, 7th Floor, Durham, NC, 27705, USA
| | - Shannon N Miller
- Duke University Medical Center, Pain Prevention and Treatment Research Program, 2400, Pratt Street, 7th Floor, Durham, NC, 27705, USA
| | - Christine Nuñez
- University of Miami Miller School of Medicine, Miami, FL, USA
| | - Catherine Majestic
- Duke University Medical Center, Pain Prevention and Treatment Research Program, 2400, Pratt Street, 7th Floor, Durham, NC, 27705, USA
| | - Sarah A Kelleher
- Duke University Medical Center, Pain Prevention and Treatment Research Program, 2400, Pratt Street, 7th Floor, Durham, NC, 27705, USA
| | - Tamara J Somers
- Duke University Medical Center, Pain Prevention and Treatment Research Program, 2400, Pratt Street, 7th Floor, Durham, NC, 27705, USA
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Assessing the relationship between symptoms and health care utilization in colorectal cancer survivors of different sexual orientations. Support Care Cancer 2021; 29:5821-5830. [PMID: 33742243 DOI: 10.1007/s00520-021-06157-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 03/16/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The purpose of this study was to determine the association of physical and psychological symptoms with health care utilization in sexual minority and heterosexual colorectal cancer survivors. METHODS Four hundred eighteen colorectal cancer survivors who were in remission an average of 3 years after their diagnosis were surveyed about their non-emergency health care visits during the preceding 3 months. Survivors reported whether they had experienced any of 21 symptoms common among colorectal cancer survivors in the past week. The relation between having had two or more health care visits in the preceding 3 months and symptoms experienced was assessed using logistic regression, controlling for cancer registry, sexual orientation, sex, age, race/ethnicity, income, and comorbidities. RESULTS Of the survivors, 12% reported no symptoms, while 12% reported six or more symptoms. Sexual minority survivors reported significantly more weight concerns and more health-related and general anxiety as well as worse body image than heterosexual survivors. Frequent worrying about weight and experiencing sore skin around the anal area or stoma were the two symptoms that significantly contributed towards explaining survivors' increased health care utilization. CONCLUSION Weight concerns, which are more common among the heaviest survivors, may prompt survivors to seek help from health care providers, which may lead to more frequent visits. On the other hand, some symptoms, despite their prevalence, had no relationship with the frequency of health care visits, raising questions about whether survivors share these concerns with providers.
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Kang Y, Meghani SH, Bruner DW, Yeager KA. Factors Associated with Depression in African American Patients Being Treated for Cancer Pain. Pain Manag Nurs 2020; 21:410-415. [PMID: 32513560 DOI: 10.1016/j.pmn.2020.03.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 02/17/2020] [Accepted: 03/17/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Among cancer patients in the United States, African American cancer patients have the highest mortality rate and shortest survival rate. Although depression is known as a predictor of mortality in cancer and a potential barrier to health care utilization, research on depression in African American patients is limited. Cancer pain can interfere with an individual's ability to cope with depression. AIMS To identify factors that are associated with a positive screening of depressive symptoms assessed by the PHQ-8 in African American patients treated for cancer pain. DESIGN Secondary data analysis of a cross-sectional study of opioid adherence. SETTING Medical oncology, palliative care, and radiation oncology clinics in Atlanta, Georgia. PARTICIPANTS/SUBJECTS African American patients with cancer pain in the parent study. METHODS Independent samples t-test was used to assess variable correlations with and without depressive symptoms. Adjusted logistic regression was conducted to identify factors that were associated with presence of depressive symptoms. RESULTS Mean patient age was 55.6 years, and nearly 38% had a PHQ-8 score of >10 indicating presence of moderate to severe depressive symptoms. Participants with depressive symptoms had significantly higher means for anxiety and pain interference with mood than those without depressive symptoms. Factors that were significantly associated with depressive symptoms were anxiety, pain interfering with mood, and lack of involvement with a religious congregation. CONCLUSIONS The findings of this study help to identify African American cancer patients at risk for depression and demonstrates the need for increased screening for depression in this underserved population.
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Affiliation(s)
- Youjeong Kang
- University of Utah College of Nursing, Salt Lake City, Utah.
| | - Salimah H Meghani
- Department of Biobehavioral Health Sciences, University of Pennsylvania, School of Nursing, Philadelphia, Pennsylvania
| | - Deborah W Bruner
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
| | - Katherine A Yeager
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
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Pace TWW, Dodds SE, Sikorskii A, Badger TA, Segrin C, Negi LT, Harrison T, Crane TE. Cognitively-Based Compassion Training versus cancer health education to improve health-related quality of life in survivors of solid tumor cancers and their informal caregivers: study protocol for a randomized controlled pilot trial. Trials 2019; 20:247. [PMID: 31036091 PMCID: PMC6489281 DOI: 10.1186/s13063-019-3320-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 03/25/2019] [Indexed: 01/04/2023] Open
Abstract
Background Cancer survivors and their informal caregivers (family members, close friends) often experience significant impairments in health-related quality of life (HRQOL), including disruptions in psychological, physical, social, and spiritual well-being both during and after primary cancer treatment. The purpose of this in-progress pilot trial is to determine acceptability and preliminary efficacy (as reflected by effect sizes) of CBCT® (Cognitively-Based Compassion Training) compared with a cancer health education (CHE) attention control to improve the primary outcome of depressive symptoms and secondary outcomes of other HRQOL domains (e.g., anxiety, fatigue), biomarkers of inflammation and diurnal cortisol rhythm, and healthcare utilization-related outcomes in both cancer survivors and informal caregivers. Methods Forty dyads consisting of solid tumor survivors who have completed primary treatments (chemotherapy, radiation, surgery) and their informal caregivers, with at least one dyad member with ≥ mild depressive symptoms or anxiety, will be recruited from Tucson, Arizona, USA. Survivor-caregiver dyads will be randomized together to complete either CBCT or CHE. CBCT is a manualized, 8-week, group meditation-based intervention that starts with attention and mindfulness and builds to contemplative practices aimed at cultivating compassion to the self and others. The goal of CBCT is to challenge unexamined assumptions about feelings and behaviors, with a focus on generating spontaneous self-compassion and increased empathic responsiveness and compassion for others. CHE is an 8-week, manualized group intervention that provides cancer-specific education on various topics (e.g., cancer advocacy, survivorship wellness). Patient-reported HRQOL outcomes will be assessed before, immediately after (week 9), and 1 month after CBCT or CHE (week 13). At the same time points, stress-related biomarkers of inflammation (e.g., plasma interleukin-6) and saliva cortisol relevant for survivor and informal caregiver wellness and healthcare utilization will be measured. Discussion If CBCT shows acceptability, a larger trial will be warranted and appropriately powered to formally test the efficacy of this dyadic intervention. Interventions such as CBCT directed toward both survivors and caregivers may eventually fill a gap in supportive oncology care programs to improve HRQOL and healthcare utilization in both dyad members. Trial registration Clinicaltrials.gov, NCT03459781. Prospectively registered on 9 March 2018. Electronic supplementary material The online version of this article (10.1186/s13063-019-3320-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Thaddeus W W Pace
- Division of Community and Systems Health Science, College of Nursing, University of Arizona, 1305 N Martin Ave, Tucson, AZ, 85721, USA. .,Department of Psychiatry, College of Medicine, University of Arizona, Tucson, AZ, USA. .,Department of Psychology, College of Science, University of Arizona, Tucson, AZ, USA. .,University of Arizona Cancer Center, Tucson, AZ, USA.
| | - Sally E Dodds
- Division of Community and Systems Health Science, College of Nursing, University of Arizona, 1305 N Martin Ave, Tucson, AZ, 85721, USA
| | - Alla Sikorskii
- Division of Community and Systems Health Science, College of Nursing, University of Arizona, 1305 N Martin Ave, Tucson, AZ, 85721, USA.,Department of Psychiatry, College of Osteopathic Medicine, Michigan State University, East Lansing, MI, USA
| | - Terry A Badger
- Division of Community and Systems Health Science, College of Nursing, University of Arizona, 1305 N Martin Ave, Tucson, AZ, 85721, USA.,Department of Psychiatry, College of Medicine, University of Arizona, Tucson, AZ, USA.,University of Arizona Cancer Center, Tucson, AZ, USA
| | - Chris Segrin
- Department of Communication, College of Social and Behavioral Sciences, University of Arizona, Tucson, AZ, USA
| | - Lobsang Tenzin Negi
- Emory-Tibet Partnership, Department of Religion, Emory College, Emory University, Atlanta, GA, USA.,Emory-Tibet Partnership, CBCT Teacher Training, Emory University, Atlanta, GA, USA
| | - Timothy Harrison
- Emory-Tibet Partnership, CBCT Teacher Training, Emory University, Atlanta, GA, USA
| | - Tracy E Crane
- University of Arizona Cancer Center, Tucson, AZ, USA.,Division of Biobehavioral Healthscience, College of Nursing, University of Arizona, Tucson, AZ, USA
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Niazi S, Frank RD, Sharma M, Roy V, Ames S, Rummans T, Spaulding A, Sher T, Ailawadhi M, Bhatia K, Ahmed S, Tan W, Chanan-Khan A, Ailawadhi S. Impact of psychiatric comorbidities on health care utilization and cost of care in multiple myeloma. Blood Adv 2018; 2:1120-1128. [PMID: 29776984 PMCID: PMC5965054 DOI: 10.1182/bloodadvances.2018016717] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 04/16/2018] [Indexed: 12/13/2022] Open
Abstract
Approximately one third of cancer patients suffer from comorbid mood disorders that are associated with increased cost and poorer outcomes. The majority of patients with multiple myeloma (MM) are treated with corticosteroids; as many as three fourths of those taking corticosteroids develop neuropsychiatric complications, likely increasing morbidity and cost of care. MM patients diagnosed between 1991 and 2010 and reported in the Surveillance Epidemiology, and End Results-Medicare database were characterized as MM-Only, MM+Psychiatric (any psychiatric condition, preexisting or post-MM), or MM+Depression (depression as the only psychiatric diagnosis, preexisting or post-MM). Differences in demographic characteristics, occurrence of clinical myeloma-defining events (MDEs), health care utilization (inpatient, outpatient, ambulatory claims), and cost of care during the first 6 months of MM diagnosis were analyzed. Psychiatric comorbidities were reported more frequently in females, and racial minorities had lower rates of psychiatric comorbidities. All clinical MDEs were more common in the MM+Psychiatric and MM+Depression groups; within them, the majority were more common in patients diagnosed with the psychiatric condition or depression after MM compared with it being a preexisting condition. Health care utilization in all treatment settings was higher in those with psychiatric comorbidities. Cost of care within the first 6 months after MM diagnosis was significantly higher in the MM+Psychiatric and MM+Depression groups. This increase in cost was more pronounced for patients from racial minorities diagnosed with a psychiatric condition, including depression. Psychiatric comorbidities significantly impact the clinical presentations, health care utilization, and cost among patients with MM. These findings need to be addressed for improved survivorship of MM patients.
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Affiliation(s)
- Shehzad Niazi
- Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, FL
| | - Ryan D Frank
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN; and
| | | | | | - Steve Ames
- Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, FL
| | - Teresa Rummans
- Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, FL
| | - Aaron Spaulding
- Division of Healthcare Policy and Research, Mayo Clinic, Jacksonville, FL
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Barakat S, Boehmer K, Abdelrahim M, Ahn S, Al-Khateeb AA, Villalobos NÁ, Prokop L, Erwin PJ, Fleming K, Serrano V, Spencer-Bonilla G, Murad MH. Does Health Coaching Grow Capacity in Cancer Survivors? A Systematic Review. Popul Health Manag 2017. [PMID: 28636526 DOI: 10.1089/pop.2017.0040] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Interventions that grow patient capacity to do the work of health care and life are needed to support the health of cancer survivors. Health coaching may grow capacity. This systematic review of health coaching interventions explored coaching's ability to grow capacity of cancer survivors. The authors included randomized trials or quasi-experimental studies comparing coaching to alternative interventions, and adhered to PRISMA reporting guidelines. Data were analyzed using the Theory of Patient Capacity (BREWS: Capacity is affected by factors that influence ability to reframe Biography ["B"], mobilize or recruit Resources ["R"], interact with the Environment of care ["E"], accomplish Work ["W"]), and function Socially ["S"]). The authors reviewed 2210 references and selected 12 studies (6 randomized trials and 6 pre-post). These studies included 1038 cancer survivors, mean age 57.2 years, with various type of cancers: breast, colorectal, prostate, and lung. Health coaching was associated with improved quality of life, mood, and physical activity but not self-efficacy. Classified by potential to support growth in patient capacity, 67% of included studies reported statistically significant outcomes that support "B" (quality of life, acceptance, spirituality), 75% "R" (decreased fatigue, pain), 67% "W" (increased physical activity), and 33% "S" (social deprivation index). None addressed changing the patient's environment of care. In cancer survivors, health coaching improved quality of life and supported patient capacity by several mechanisms, suggesting an important role for "Capacity Coaching." Future interventions that improve self-efficacy and patients' environments of care are needed. Capacity Coaching may improve health and quality of life of cancer survivors.
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Affiliation(s)
| | | | | | - Sangwoo Ahn
- 2 University of Minnesota , Minneapolis, Minnesota
| | | | - Neri Álvarez Villalobos
- 1 Mayo Clinic , Rochester, Minnesota.,4 Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario "Dr. José E. González," Monterrey, México
| | | | | | | | - Valentina Serrano
- 1 Mayo Clinic , Rochester, Minnesota.,5 Pontificia Universidad Católica de Chile , Escuela de Medicina, Alameda, Chile
| | - Gabriela Spencer-Bonilla
- 1 Mayo Clinic , Rochester, Minnesota.,6 University of Puerto Rico Medical Sciences Campus , San Juan, Puerto Rico
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Salgado TM, Davis EJ, Farris KB, Fawaz S, Batra P, Henry NL. Identifying socio-demographic and clinical characteristics associated with medication beliefs about aromatase inhibitors among postmenopausal women with breast cancer. Breast Cancer Res Treat 2017; 163:311-319. [DOI: 10.1007/s10549-017-4177-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 02/25/2017] [Indexed: 01/19/2023]
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Leptin-LepRb Expressed in Gastric Cancer Patients and Related to Cancer-Related Depression. BIOMED RESEARCH INTERNATIONAL 2017; 2017:6482842. [PMID: 28316984 PMCID: PMC5337857 DOI: 10.1155/2017/6482842] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 01/12/2017] [Accepted: 01/22/2017] [Indexed: 12/27/2022]
Abstract
Depression is the most common psychiatric disorder among cancer patients. Studies have not only highlighted that leptin and its receptor (LepRb) are independent poor prognostic factors in gastric cancer (GC) patients but also shown that the leptin-LepRb is necessary for antidepressant-like behaviors. In this study, we examined the serum and tissue leptin-LepRb expression in GC patients. Enzyme-linked immunosorbent assay showed that depressive GC patients had significantly higher serum leptin-LepRb than healthy donors. Leptin-LepRb levels in GC tissues were also significantly higher than in matched paracarcinoma tissues using real-time RT-PCR. Moreover, we observed that both serum and tissue leptin-LepRb were significantly higher in depressive GC patients than those in nondepressive GC patients. Further, the patients with high tumor stage tend to have higher leptin-LepRb mRNA levels than that with low tumor stage. Together, our findings suggest that leptin-LepRb plays an important role in the pathogenesis and depression in GC. Leptin-LepRb therefore could be a potential diagnostic marker and therapeutic target in GC patients with depression.
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Abstract
INTRODUCTION Treatment of patients suffering from major depression could be highly challenging for psychiatrists. Intractability as well as relapse is commonly seen among these patients, leading to functional impairment and poor quality of life. The present review discusses some of the novel investigational drugs that are under pre-clinical or clinical phases in the treatment of major depression. Areas covered: Molecules belonging to different classes such as triple reuptake inhibitors, opioid receptors, ionotropic and metabotropic glutamate receptors, and neurotrophin in the treatment of major depression are covered in this article. Expert opinion: Although the historical discovery of earlier antidepressant molecules (iproniazid and imipramine) is through serendipitous discovery, the present research focuses on discovering novel molecules based on our current pathophysiological knowledge of the disease condition. The fast-acting antidepressant property of N-methyl-d-aspartate (NMDA) receptor molecules, including ketamine is an exciting area of research. Other drug molecules such as amitifadine (triple reuptake inhibitor), ALKS-5461 (kappa receptor antagonist and mu opioidergic receptor agonist), rapastinel (NMDA glutamatergic receptor modulator) are under Phase-III clinical trials and could be approved in the near future for the treatment of major depression.
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Affiliation(s)
- Ashish Dhir
- a Department of Neurology, School of Medicine , University of California Davis , Sacramento , CA , USA
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