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Peters EM, Yilmaz O, Li C, Balbuena L. Interpersonal sensitivity and response to selective serotonin reuptake inhibitors in patients with acute major depressive disorder. J Affect Disord 2024; 355:422-425. [PMID: 38537756 DOI: 10.1016/j.jad.2024.03.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 02/29/2024] [Accepted: 03/23/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND Patients with major depression often suffer from excessive interpersonal sensitivity, although it is not typically measured in antidepressant clinical trials. Preliminary evidence suggests selective serotonin reuptake inhibitors have the capacity to reduce interpersonal sensitivity. METHODS This was a pooled analysis of data from 1709 patients in three randomized, double-blind, placebo-controlled trials of fluoxetine and paroxetine for acute major depressive disorder. Depressive symptoms were assessed with the Hamilton Depression Rating Scale. A factor from the Symptom Checklist was used to assess interpersonal sensitivity. Our outcome of interest was change from baseline scores at the last assessment (up to 8 or 12 weeks, depending on the trial). RESULTS Both medications produced significantly greater reductions in interpersonal sensitivity relative to placebo. The effect of medication remained significant after controlling for depression improvement, which explained 18.5% of the variation in interpersonal sensitivity improvement among those treated with active medication. The effect of medication on depressive symptoms, relative to placebo, was not influenced by baseline interpersonal sensitivity. LIMITATIONS The outcome measured interpersonal sensitivity over the last week, and the results do not necessarily reflect changes in long-standing, trait-like patterns of interpersonal sensitivity. Only two medications were studied. CONCLUSIONS Selective serotonin reuptake inhibitors are effective at treating interpersonal sensitivity in acutely depressed patients. This appears to be a unique drug effect that is not only the result of depression improvement. Future clinical trials might benefit from assessing interpersonal sensitivity more routinely.
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Affiliation(s)
- Evyn M Peters
- Department of Psychiatry, College of Medicine, University of Saskatchewan, Canada.
| | - Orhan Yilmaz
- Department of Psychiatry, College of Medicine, University of Saskatchewan, Canada
| | - Cindy Li
- Department of Psychiatry, College of Medicine, University of Saskatchewan, Canada
| | - Lloyd Balbuena
- Department of Psychiatry, College of Medicine, University of Saskatchewan, Canada
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Parente J, Carolyna Gianlorenco A, Rebello-Sanchez I, Kim M, Mario Prati J, Kyung Kim C, Choi H, Song JJ, Fregni F. Neural, Anti-Inflammatory, and Clinical Effects of Transauricular Vagus Nerve Stimulation in Major Depressive Disorder: A Systematic Review. Int J Neuropsychopharmacol 2024; 27:pyad058. [PMID: 37870480 PMCID: PMC10972554 DOI: 10.1093/ijnp/pyad058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 10/22/2023] [Indexed: 10/24/2023] Open
Abstract
BACKGROUND The discovery of effective treatments for major depressive disorder (MDD) may help target different brain pathways. Invasive vagus nerve stimulation (VNS) is an effective neuromodulation technique for the treatment of MDD; however, the effectiveness of the noninvasive technique, transauricular VNS (taVNS), remains unknown. Moreover, a mechanistic understanding of the neural effects behind its biological and therapeutic effects is lacking. This review aimed to evaluate the clinical evidence and the neural and anti-inflammatory effects of taVNS in MDD. METHODS Two searches were conducted using a systematic search strategy reviewed the clinical efficacy and neural connectivity of taVNS in MDD in humans and evaluated the changes in inflammatory markers after taVNS in humans or animal models of depression. A risk of bias assessment was performed in all human studies. RESULTS Only 5 studies evaluated the effects of taVNS in patients with depression. Although the studies demonstrated the efficacy of taVNS in treating depression, they used heterogeneous methodologies and limited data, thus preventing the conduct of pooled quantitative analyses. Pooled analysis could not be performed for studies that investigated the modulation of connectivity between brain areas; of the 6 publications, 5 were based on the same experiment. The animal studies that analyzed the presence of inflammatory markers showed a reduction in the level of pro-inflammatory cytokines or receptor expression. CONCLUSIONS Data on the clinical efficacy of taVNS in the treatment of MDD are limited. Although these studies showed positive results, no conclusions can be drawn regarding this topic considering the heterogeneity of these studies, as in the case of functional connectivity studies. Based on animal studies, the application of taVNS causes a decrease in the level of inflammatory factors in different parts of the brain, which also regulate the immune system. Therefore, further studies are needed to understand the effects of taVNS in patients with MDD.
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Affiliation(s)
- Joao Parente
- Escola Bahiana de Medicina e Saúde Pública, Salvador, Bahia, Brazil
| | | | | | - Minkyung Kim
- Department of Neurology, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Jose Mario Prati
- Department of Physical Therapy, Federal University of Sao Carlos, Sao Paulo, Brazil
| | - Chi Kyung Kim
- Department of Neurology, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Hyuk Choi
- Department of Medical Sciences, Graduate School of Medicine, Korea University, Seoul, Republic of Korea
- Neurive Co., Ltd., Gimhae, Republic of Korea
| | - Jae-Jun Song
- Neurive Co., Ltd., Gimhae, Republic of Korea
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University Medical Center, Seoul, Republic of Korea
| | - Felipe Fregni
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Gafarov VV, Gromova EA, Gubina MA, Gagulin IV, Maksimov VN, Gafarova AV. [The association of polymorphisms of the serotonin transporter gene SLC6A4 with depression]. Zh Nevrol Psikhiatr Im S S Korsakova 2024; 124:135-139. [PMID: 38465822 DOI: 10.17116/jnevro2024124021135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
OBJECTIVE To study the relationship of polymorphic variants of the SLC6A4 gene with depression among people aged 25-44 years in Novosibirsk. MATERIAL AND METHODS Under the WHO program «MONICA-psychosocial (MOPSY)», a random representative sample of people aged 25-44 years from the population of the Oktyabrsky district of Novosibirsk (men n=725, mean age 43.4±0.4 years, response - 71.3%, women n=710, mean age 44.8±0.4 years, response - 72%). Depression was assessed using the MONICA-MOPSY psychosocial questionnaire. Every fourth respondent was examined for polymorphic variants of 5HTTLPR-VNTR SNP rs25531 A>G of the SLC6A4 gene. The study was carried out within the framework of the budget topic Reg. No. 122031700094-5. RESULTS The high level of depression among people aged 25-44 was 12.8% (for men 9.1%, for women - 15.92%); the average level of depression occurred in 24.5% of the population (among men in 21.24%, among women in 26.76%) (χ2=17.071, df=2, p<0.001). The most common genotype of the SLC6A4 gene, among people aged 25--4 years old in Novosibirsk, was SLA - 43.29%, LALA - 26.53% - in second place, SS - 17.87% - third, LALG - 6 genotypes were less represented genotypes. 74%, SLG - 4.18%, LGLG - 1.39%. Carrying the SLA genotype (53.3% and 63.6%) increased the chance of developing both the average level of depression by 2.359 (95% CI 1.278-4.355) times, and depression in general by 1.933 (95% CI 1.142-3.271) times, compared with persons carrying the LALA genotype (32.0% and 46.9%), (χ2=7.674, df=1, p<0.01 and χ2=6.095, df=1, p<0.05). Persons carrying the LALG genotype (54.5%) also had a higher chance of developing a mean level of depression RR=2.929 (95% CI 1.039-8.261), compared with carriers of the LALA genotype (32.0%) (χ2=4.326, df =1, p<0.05) (p<0.05). CONCLUSION Associative links between polymorphic variants of the SLC6A4 gene and depression have been established.
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Affiliation(s)
- V V Gafarov
- Research Institute of Therapy and Preventive Medicine - branch of the Institute of Cytology and Genetics Siberian Branch of the Russian Academy of Sciences, Novosibirsk, Russia
| | - E A Gromova
- Research Institute of Therapy and Preventive Medicine - branch of the Institute of Cytology and Genetics Siberian Branch of the Russian Academy of Sciences, Novosibirsk, Russia
| | - M A Gubina
- Institute of Cytology and Genetics Siberian Branch of the Russian Academy of Sciences, Novosibirsk, Russia
| | - I V Gagulin
- Research Institute of Therapy and Preventive Medicine - branch of the Institute of Cytology and Genetics Siberian Branch of the Russian Academy of Sciences, Novosibirsk, Russia
| | - V N Maksimov
- Research Institute of Therapy and Preventive Medicine - branch of the Institute of Cytology and Genetics Siberian Branch of the Russian Academy of Sciences, Novosibirsk, Russia
| | - A V Gafarova
- Research Institute of Therapy and Preventive Medicine - branch of the Institute of Cytology and Genetics Siberian Branch of the Russian Academy of Sciences, Novosibirsk, Russia
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Chen EG, Oliver AK, Raz A. Irving Kirsch opens a window on antidepressant medications. AMERICAN JOURNAL OF CLINICAL HYPNOSIS 2023; 65:223-240. [PMID: 36638223 DOI: 10.1080/00029157.2022.2121678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
When it comes to antidepressant medications - popular, backbone drugs of modern psychiatry - even learned scholars and savvy clinicians find it difficult to separate honest, rigorous research from that which thrives on hidden agendas and ulterior motives. Fortunately, a mounting corpus of data-based studies, mostly meta-analyses, casts new and critical light on the clinical efficacy, side effects, and therapeutic outcomes of antidepressants. Spearheading these efforts over the past few decades, Irving Kirsch and colleagues have challenged the hegemonic view of antidepressants as an effective therapeutic intervention. Notably, Kirsch illuminates the small difference between antidepressants and placebos in mitigating depression-a difference that may be statistically significant yet fails to reach clinical significance. This piece sketches the important contributions Kirsch has made to the scientific understanding of antidepressant medications.
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Affiliation(s)
| | - Alison Kate Oliver
- Chapman University, Irvine, CA, USA.,University of San Diego, San Diego, CA, USA
| | - Amir Raz
- Chapman University, Irvine, CA, USA.,McGill University, Montreal, QC, Canada
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Menopausal Hormone Therapy and the Mind: The Role of Hormone Replacement in the Prevention and Treatment of Cognitive Decline, Dementia, and Cognitive Dysfunction of Depression. Harv Rev Psychiatry 2022; 30:215-225. [PMID: 35616610 DOI: 10.1097/hrp.0000000000000339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
LEARNING OBJECTIVES After participating in this activity, learners should be better able to:• Outline the clinical recommendations for menopausal hormone treatment related to cognitive concerns• Debate and discuss the various research pieces on the use of menopausal hormone therapy cognitive decline, dysfunction, and dementia. ABSTRACT Menopause has been associated with subjective cognitive dysfunction and elevated rates of depression. While menopausal hormone therapy (MHT) is Food and Drug Administration-approved for the treatment of vasomotor symptoms related to menopause, a potential role for MHT in treating and preventing cognitive decline, dysfunction, and dementia has remained unclear and a topic of continued interest and debate across decades of research. Increasing numbers of patients are seeking help for subjective cognitive decline, and those with poorer mental health are substantially more likely to perceive themselves to be at high risk of developing dementia; thus, mental health professionals are likely to encounter such patients and may be asked to provide advice concerning MHT, cognition, and indications for MHT use. Here, we synthesize the neurobiological effects of MHT, make recommendations for its use in current clinical practice in the contexts of cognitive dysfunction associated with major depressive disorder, cognitive decline, and Alzheimer's disease, and discuss the frontiers being explored by ongoing research on this topic. We conclude that MHT to improve cognitive functioning has only a few scenarios where it would be recommended and that particular caution may be warranted for carriers of the APOE ε4 allele.
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Lurasidone Efficacy in Mixed Depressive States: A Comparison of Standard Rating Scales to the Koukopoulos Mixed Depression Rating Scale. J Clin Psychopharmacol 2021; 40:491-494. [PMID: 32701901 DOI: 10.1097/jcp.0000000000001261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION A new mood rating scale for mixed states of depression along with manic-like excitatory symptoms, the Koukopoulos Mixed Depression Rating Scale (KMDRS), was assessed in a post hoc analysis of a randomized clinical trial of lurasidone versus placebo in major depressive disorder (MDD) with mixed features. METHODS The KMDRS was compared with the Montgomery Asberg Depression Rating Scale (MADRS) and the Young Mania Rating Scale (YMRS). Item weighting was performed and compared with an original KMDRS validation data set. Weighting was used to provide imputed KMDRS scores in the lurasidone study, based on observed MADRS and YMRS scores. RESULTS Standardized effect sizes were larger for MADRS (0.61) and YMRS (0.79) than for KMDRS (0.44, Cohen d). CONCLUSIONS This analysis did not find that the KMDRS produced a larger effect size than the MADRS in Diagnostic and Statistical Manual for Mental Disorder-5 (DSM-5) defined MDD with mixed features. The lower utility of KMDRS may be due to the imputed nature of this analysis, or also to the DSM-5 defined patient population, which may reflect mixed hypomania rather than mixed depression.
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Melancholic Features in Bipolar Depression and Response to Lamotrigine: A Pooled Analysis of Five Randomized Placebo-Controlled Trials. J Clin Psychopharmacol 2021; 41:315-319. [PMID: 33779579 PMCID: PMC8083162 DOI: 10.1097/jcp.0000000000001393] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND A pilot study suggested lamotrigine may be more effective for bipolar depression with melancholic features. We tested this hypothesis in a pooled analysis of 5 randomized double-blind placebo-controlled trials of lamotrigine for acute bipolar depression. METHODS The pooled sample consisted of 1072 adult outpatients. Depressive symptoms were assessed for 7 to 10 weeks with the Hamilton Depression Rating Scale and the Montgomery-Åsberg Depression Rating Scale. The outcome measure was end-trial response (score reduction ≥ 50%). Melancholic features were assessed with both the Structured Clinical Interview for DSM-IV and baseline depression scale items, according to DSM criteria. RESULTS The item-based melancholic specifier was associated with numerically larger treatment effects, although subgroup-treatment interactions in logistic regression models did not reach statistical significance. The small subgroup of patients with severe psychomotor retardation also appeared to benefit from lamotrigine. However, the Structured Clinical Interview for DSM-IV melancholic specifier was not associated with larger treatment effects. Baseline depression severity was inconsistently associated with response, depending on which scale was used to define severity. The 2 melancholia variables had poor agreement despite having similar prevalences. CONCLUSIONS Our results do not clearly support the original hypothesis but do reinforce the importance of replicating secondary analyses of clinical trials with additional data.
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8
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Melancholic depression and response to quetiapine: A pooled analysis of four randomized placebo-controlled trials. J Affect Disord 2020; 276:696-698. [PMID: 32871702 DOI: 10.1016/j.jad.2020.07.071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 05/20/2020] [Accepted: 07/05/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Melancholic depression may preferentially respond to certain treatments. This study examined the efficacy of extended-release quetiapine monotherapy in patients with melancholic and nonmelancholic major depressive disorder. METHODS Data from four randomized placebo-controlled trials was pooled. Melancholic features were assessed with baseline depression scale items according to DSM criteria. The outcome measure was response on the Montgomery-Åsberg Depression Rating Scale. Cox regression models predicting response over time with interactions between treatment condition and melancholic status were used to test for treatment effect heterogeneity. RESULTS The 6-week response rate difference between quetiapine and placebo was roughly 10% greater in the melancholic subgroup, primarily due to a lower placebo response, although the subgroup-treatment interactions did not reach statistical significance. The main effect of quetiapine was significant in every model. LIMITATIONS The main limitations were the retrospective analysis and the post-hoc designation of melancholic depression based on scale items not designed for that purpose. Results should be considered preliminary and exploratory until replicated. CONCLUSIONS The lower placebo response rate in the melancholic subgroup is consistent with past research and reinforces the benefit of pharmacotherapy for these patients.
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Zimmerman M, Balling C, Chelminski I, Dalrymple K. Have Treatment Studies of Depression Become Even Less Generalizable? Applying the Inclusion and Exclusion Criteria in Placebo-Controlled Antidepressant Efficacy Trials Published over 20 Years to a Clinical Sample. PSYCHOTHERAPY AND PSYCHOSOMATICS 2020; 88:165-170. [PMID: 31096246 DOI: 10.1159/000499917] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 03/26/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Antidepressants are amongst the most frequently prescribed medications. More than a decade ago, our clinical research group applied a prototypic set of inclusion/exclusion criteria used in an antidepressant efficacy trial (AET) to patients presenting for treatment in our outpatient practice and found that most patients would not qualify for the trial. In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project, we apply the psychiatric inclusion/exclusion criteria used in 158 placebo-controlled studies to a large sample of depressed patients who presented for outpatient treatment to determine the range and extent of the representativeness of samples treated in AETs and whether this has changed over time. METHOD We applied the inclusion and exclusion criteria used in 158 AETs to 1,271 patients presenting to an outpatient practice who received a principal diagnosis of major depressive disorder. The patients underwent a thorough diagnostic evaluation. RESULTS Across all 158 studies, the percentage of patients that would have been excluded ranged from 44.4 to 99.8% (mean = 86.1%). The percentage of patients that would have been excluded was significantly higher in the studies published in 2010 through 2014 compared to the studies published from 1995 to 2009 (91.4 vs. 83.8%, t(156) = 3.74, p < 0.001). CONCLUSIONS Only a minority of depressed patients seen in clinical practice are likely to be eligible for most AETs. The generalizability of AETs has decreased over time. It is unclear how generalizable the results of AETs are to patients treated in real-world clinical practice.
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Affiliation(s)
- Mark Zimmerman
- Department of Psychiatry and Human Behavior, Brown Medical School, Rhode Island Hospital, Providence, Rhode Island, USA,
| | - Caroline Balling
- Department of Psychiatry and Human Behavior, Brown Medical School, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Iwona Chelminski
- Department of Psychiatry and Human Behavior, Brown Medical School, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Kristy Dalrymple
- Department of Psychiatry and Human Behavior, Brown Medical School, Rhode Island Hospital, Providence, Rhode Island, USA
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Nyer M, Hopkins LB, Farabaugh A, Nauphal M, Parkin S, McKee MM, Miller KK, Streeter C, Uebelacker LA, Fava M, Alpert JE, Pedrelli P, Mischoulon D. Community-Delivered Heated Hatha Yoga as a Treatment for Depressive Symptoms: An Uncontrolled Pilot Study. J Altern Complement Med 2019; 25:814-823. [PMID: 31290694 DOI: 10.1089/acm.2018.0365] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Objectives: There are no known studies of concurrent exposure to high temperature and yoga for the treatment of depression. This study explored acceptability and feasibility of heated (Bikram) yoga as a treatment for individuals with depressive symptoms. Design: An 8-week, open-label pilot study of heated yoga for depressive symptoms. Subjects: 28 medically healthy adults (71.4% female, mean age 36 [standard deviation 13.57]) with at least mild depressive symptoms (Hamilton Rating Scale for Depression [HRSD-17] score ≥10) who attended at least one yoga class and subsequent assessment visit. Intervention: Participants were asked to attend at least twice weekly community held Bikram Yoga classes. Assessments were performed at screening and weeks 1, 3, 5, and 8. Hypotheses were tested using a modified-intent-to-treat approach, including participants who attended at least one yoga class and subsequent assessment visit (N = 28). Results: Almost half of our subjects completed the 8-week intervention, and close to a third attended three quarters or more of the prescribed 16 classes over 8 weeks. Multilevel modeling revealed significant improvements over time in both clinician-rated HRSD-17 (p = 0.003; dGLMM = 1.43) and self-reported Beck Depression Inventory (BDI; p < 0.001, dGLMM = 1.31) depressive symptoms, as well as the four secondary outcomes: hopelessness (p = 0.024, dGLMM = 0.57), anxiety (p < 0.001, dGLMM = 0.78), cognitive/physical functioning (p < 0.001, dGLMM = 1.34), and quality of life (p = 0.007, dGLMM = 1.29). Of 23 participants with data through week 3 or later, 12 (52.2%) were treatment responders (≥50% reduction in HRSD-17 score), and 13 (56.5%) attained remission (HRSD score ≤7). More frequent attendance was significantly associated with improvement in self-rated depression symptoms, hopelessness, and quality of life. Conclusions: The acceptability and feasibility of heated yoga in this particular sample with this protocol warrants further attention. The heated yoga was associated with reduced depressive symptoms, and other improved related mental health symptoms, including anxiety, hopelessness, and quality of life.
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Affiliation(s)
- Maren Nyer
- 1Depression Clinical and Research Program (DCRP), Department of Psychiatry, Massachusetts General Hospital, Boston, MA.,2Harvard Medical School, Boston, MA
| | - Lindsey B Hopkins
- 3Department of Psychiatry, University of California, San Francisco, San Francisco, CA.,4Addiction Research Program, San Francisco VA Health Care System, San Francisco, CA
| | - Amy Farabaugh
- 1Depression Clinical and Research Program (DCRP), Department of Psychiatry, Massachusetts General Hospital, Boston, MA.,2Harvard Medical School, Boston, MA
| | - Maya Nauphal
- 1Depression Clinical and Research Program (DCRP), Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | - Susannah Parkin
- 1Depression Clinical and Research Program (DCRP), Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | - Madison M McKee
- 1Depression Clinical and Research Program (DCRP), Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | - Karen K Miller
- 2Harvard Medical School, Boston, MA.,5Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA
| | - Chris Streeter
- 2Harvard Medical School, Boston, MA.,6Department of Psychiatry and Neurology, Boston University School of Medicine, Boston, MA.,7Department of Psychiatry, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA
| | - Lisa A Uebelacker
- 8Alpert Medical School, Brown University, Providence, RI.,9Butler Hospital, Providence, RI
| | - Maurizio Fava
- 1Depression Clinical and Research Program (DCRP), Department of Psychiatry, Massachusetts General Hospital, Boston, MA.,2Harvard Medical School, Boston, MA
| | - Jonathan E Alpert
- 10Albert Einstein College of Medicine, Bronx, NY.,11Montefiore Health System, Bronx, NY
| | - Paola Pedrelli
- 1Depression Clinical and Research Program (DCRP), Department of Psychiatry, Massachusetts General Hospital, Boston, MA.,2Harvard Medical School, Boston, MA
| | - David Mischoulon
- 1Depression Clinical and Research Program (DCRP), Department of Psychiatry, Massachusetts General Hospital, Boston, MA.,2Harvard Medical School, Boston, MA
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Abstract
Severity is an important consideration in treatment decision-making for depression. Two controversies in the treatment of depression are related to the issue of severity. First, are antidepressants only effective for severely depressed patients? Second, should the severity of depression be used as the basis for recommending medication or psychotherapy as first-line treatment? More specifically, should patients with severe depression preferentially be treated with medication? A related question is whether psychotherapy is beneficial for severely depressed patients. Some controversial articles sparked coverage in the popular press related to these questions and stimulated subsequent research on the impact of depression severity on treatment efficacy. The results of three recent large pooled analyses of patient level data indicate that the efficacy of antidepressants is not limited to the narrow band of patients who score highest on symptom severity scales. A meta-analysis of 132 controlled psychotherapy studies of more than 10,000 patients found that greater mean baseline symptom severity did not predict poorer response. A pooled analysis of individual patient data from 16 studies comparing antidepressants and cognitive behavior therapy found that severity was not associated with differential treatment outcome. These results are discussed in the context of recommendations in official treatment guidelines.
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Safer DJ, Zito JM. Short- and Long-Term Antidepressant Clinical Trials for Major Depressive Disorder in Youth: Findings and Concerns. Front Psychiatry 2019; 10:705. [PMID: 31681028 PMCID: PMC6797591 DOI: 10.3389/fpsyt.2019.00705] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Accepted: 09/02/2019] [Indexed: 01/20/2023] Open
Abstract
The diagnosis of major depressive disorder (MDD) in U.S. youth is increasing as is the rate of antidepressant medication (ADM) treatment for the disorder. Fluoxetine and escitalopram are FDA approved for the short term and maintenance treatment of MDD in youth. Placebo-controlled short-term ADM trials represent the basis for Food and Drug Administration (FDA) approval. Meta-analyses in 2007 and 2016 revealed that short-term ADM treatment of youth diagnosed with MDD resulted in no meaningful benefit for children and only marginal benefit for adolescents. Placebo substitution trials of ADM short-term responders represent the basis for FDA approval of ADM maintenance treatment. These ADM placebo substitution maintenance trials for youth with MDD are characterized by high dropout rates, a rapid withdrawal that often can follow the switch to placebo, and relapse rates that are not dissimilar from those in the natural course of the disorder. Without the evidence from problematic ADM placebo substitution trials, there is no acceptable support for the inclusion of ADM in maintenance treatment for MDD in youth.
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Affiliation(s)
- Daniel J Safer
- Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD, United States.,Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Julie Magno Zito
- Department of Pharmaceutical Health Services Research, University of Maryland Baltimore, Baltimore, MD, United States.,Department of Psychiatry, University of Maryland, Baltimore, Baltimore, MD, United States
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Yennurajalingam S, Kang DH, Hwu WJ, Padhye NS, Masino C, Dibaj SS, Liu DD, Williams JL, Lu Z, Bruera E. Cranial Electrotherapy Stimulation for the Management of Depression, Anxiety, Sleep Disturbance, and Pain in Patients With Advanced Cancer: A Preliminary Study. J Pain Symptom Manage 2018; 55:198-206. [PMID: 28870799 DOI: 10.1016/j.jpainsymman.2017.08.027] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 08/22/2017] [Accepted: 08/23/2017] [Indexed: 10/18/2022]
Abstract
CONTEXT Cranial electrotherapy stimulation (CES) is a safe modulation of brain activity for treating depression, anxiety, insomnia, and pain. However, there are no published studies in patients with advanced cancer (ACPs). OBJECTIVES The aim of the study was to determine the feasibility and preliminary efficacy of a four-week CES intervention on depression, anxiety, sleep disturbance, and pain scores. Concurrent salivary biomarker studies were conducted. METHODS In this one group open label pre- and post-intervention study with a four-week CES intervention, ACPs with one or more of four moderate intensity (≥3/10) Edmonton Symptom Assessment Scale (ESAS) symptoms (depression, anxiety, sleep disturbance, and pain) were eligible. Adherence (0%-100%), satisfaction rates (0-10), and safety were assessed. ESAS, Hospital Anxiety and Depression Scale (HADS), Pittsburgh Sleep Quality Index, Brief Pain Inventory, and salivary levels (cortisol, alpha amylase, C-reactive protein, and interleukin-1β, and interleukin-6) were assessed from baseline to Week 4. RESULTS Thirty-three of 36 patients (92%) completed the CES. Median (interquartile range) adherence CES use and satisfaction scores were 93% (89-100) and 10% (9-10), respectively, and the adherence criteria was met in the study. CES use was safe (no Grade 3 or higher adverse events). HADS anxiety (P < 0.001), HADS depression (P = 0.024), ESAS anxiety (P = 0.001), ESAS depression (P = 0.025), Brief Pain Inventory pain (P = 0.013), Pittsburgh Sleep Quality Index daytime dysfunction (P = 0.002), and medication use (P = 0.006) scores improved after four-week CES treatment. CONCLUSION In this preliminary study, we found that the use of CES was safe and feasible in ACP. The use of CES was associated with significant improvement of depression, anxiety, pain, and sleep scores. These findings support further studies of CES in ACP for symptom control.
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Affiliation(s)
- Sriram Yennurajalingam
- Department of Palliative Care, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
| | - Duck-Hee Kang
- Center for Nursing Research, University of Texas School of Nursing, Houston, Texas, USA
| | - Wen-Jen Hwu
- Department of Melanoma Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Nikhil S Padhye
- Center for Nursing Research, University of Texas School of Nursing, Houston, Texas, USA
| | - Charles Masino
- Department of Palliative Care, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Seyedeh S Dibaj
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Diane D Liu
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Janet L Williams
- Department of Palliative Care, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Zhanni Lu
- Department of Palliative Care, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Eduardo Bruera
- Department of Palliative Care, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Rickels K, Robinson DS. Antidepressant Trials: Are the Diminishing Effect Sizes of Efficacy Trials Avoidable? J Clin Psychopharmacol 2017; 37:648-650. [PMID: 29045306 DOI: 10.1097/jcp.0000000000000796] [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: 11/25/2022]
Affiliation(s)
- Karl Rickels
- From the *Stuart and Emily Mudd Professor of Human Behavior and Professor of Psychiatry, University of Pennsylvania, Philadelphia, PA; and †Worldwide Drug Development, Shelburne, VT
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Romijn AR, Rucklidge JJ, Kuijer RG, Frampton C. A double-blind, randomized, placebo-controlled trial of Lactobacillus helveticus and Bifidobacterium longum for the symptoms of depression. Aust N Z J Psychiatry 2017; 51:810-821. [PMID: 28068788 PMCID: PMC5518919 DOI: 10.1177/0004867416686694] [Citation(s) in RCA: 193] [Impact Index Per Article: 27.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVES This trial investigated whether probiotics improved mood, stress and anxiety in a sample selected for low mood. We also tested whether the presence or severity of irritable bowel syndrome symptoms, and levels of proinflammatory cytokines, brain-derived neurotrophic factor and other blood markers, would predict or impact treatment response. METHOD Seventy-nine participants (10 dropouts) not currently taking psychotropic medications with at least moderate scores on self-report mood measures were randomly allocated to receive either a probiotic preparation (containing Lactobacillus helveticus and Bifidobacterium longum) or a matched placebo, in a double-blind trial for 8 weeks. Data were analysed as intent-to-treat. RESULTS No significant difference was found between the probiotic and placebo groups on any psychological outcome measure (Cohen's d range = 0.07-0.16) or any blood-based biomarker. At end-point, 9 (23%) of those in the probiotic group showed a ⩾60% change on the Montgomery-Åsberg Depression Rating Scale (responders), compared to 10 (26%) of those in the placebo group ([Formula: see text], p = ns). Baseline vitamin D level was found to moderate treatment effect on several outcome measures. Dry mouth and sleep disruption were reported more frequently in the placebo group. CONCLUSIONS This study found no evidence that the probiotic formulation is effective in treating low mood, or in moderating the levels of inflammatory and other biomarkers. The lack of observed effect on mood symptoms may be due to the severity, chronicity or treatment resistance of the sample; recruiting an antidepressant-naive sample experiencing mild, acute symptoms of low mood, may well yield a different result. Future studies taking a preventative approach or using probiotics as an adjuvant treatment may also be more effective. Vitamin D levels should be monitored in future studies in the area. The results of this trial are preliminary; future studies in the area should not be discouraged.
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Affiliation(s)
- Amy R Romijn
- Department of Psychology, University of Canterbury, Christchurch, New Zealand
- School of Psychology, Early Years and Therapeutic Studies, University of South Wales, Pontypridd, UK
| | - Julia J Rucklidge
- Department of Psychology, University of Canterbury, Christchurch, New Zealand
| | - Roeline G Kuijer
- Department of Psychology, University of Canterbury, Christchurch, New Zealand
| | - Chris Frampton
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
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Alson AR, Robinson DM, Ivanova D, Azer J, Moreno M, Turk ML, Nitturkar A, Blackman KS. Depression in primary care: Strategies for a psychiatry-scarce environment. Int J Psychiatry Med 2017; 51:182-200. [PMID: 27079777 DOI: 10.1177/0091217416636580] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
More than an algorithm to guide primary care providers through treatment options, integrated care, also called collaborative care, is a validated, systematic, multidisciplinary approach to depression treatment in primary care. Historically, integrated care emerged in response to a mismatch between a growing demand for mental health treatment and scarce mental healthcare resources. Working together, psychiatrists and primary care providers have demonstrated that the principles and tools of chronic disease management improve depression outcomes in primary care. Currently, most antidepressants are prescribed by primary care providers, but with disappointing rates of full, sustained remission. Primary care patients may derive the greatest benefit from existing depression treatment guidelines when they are melded with an approach informed by integrated care principles. This paper will present established guidelines for pharmacologic management of depression as part of a broader framework for depression treatment in the primary care office.
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Affiliation(s)
- Amy R Alson
- University of Virginia School of Medicine, Charlottesville, VA, USA
| | | | | | - John Azer
- University of Virginia Health System, VA, USA
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Ghaemi SN, Vohringer PA. Athanasios Koukopoulos' Psychiatry: The Primacy of Mania and the Limits of Antidepressants. Curr Neuropharmacol 2017; 15:402-408. [PMID: 28503112 PMCID: PMC5405615 DOI: 10.2174/1570159x14666160621113432] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 05/03/2016] [Accepted: 05/24/2016] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Athanasios Koukopoulos provided a radical model for understanding depressive and manic conditions. OBJECTIVE To review, explain, and analyze Koukopoulos' concept of the primacy of mania, with special attention to the role of antidepressants. METHOD A conceptual review of Koukopoulos' writings and lectures on this topic is given. RESULTS Koukopoulos held that depressive states are caused by manic states; the former do not occur without the latter. The most common scenario of the inseparability of depressive and manic symptoms occurs in mixed states, which we estimate to represent about one-half of all depressive episodes in all patients (not just bipolar illness). In a review of the empirical evidence for this topic, we conclude that empirical evidence exists to support the primary of mania thesis in almost 80% of depressed patients. Since antidepressants worsen mania, they would be expected to worsen depression as well in this model. We provide evidence that supports this view in most persons with depressive states. CONCLUSION Koukopoulos' model of affective illness is one where manic states are the primary pathology, and depressive conditions are a secondary consequence. Hence treatment of depression with antidepressants would be less effective than treatment with mood stabilizers, since treating an effect is less successful than treating its cause. This approach would reverse current assumptions in psychiatry.
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Efficacy of Desvenlafaxine Compared With Placebo in Major Depressive Disorder Patients by Age Group and Severity of Depression at Baseline. J Clin Psychopharmacol 2017; 37:182-192. [PMID: 28146000 DOI: 10.1097/jcp.0000000000000674] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PURPOSE This post hoc meta-analysis evaluated the efficacy and safety of desvenlafaxine 50 and 100 mg versus placebo across age groups and severity of depression at baseline in patients with major depressive disorder. METHODS Data from placebo and desvenlafaxine 50-mg and 100-mg dose arms were pooled from 9 short-term, placebo-controlled, major depressive disorder studies (N = 4279). Effects of age (18-40 years, >40 to <55 years, 55-<65 years, and ≥65 years) and baseline depression severity (mild, 17-item Hamilton Rating Scale for Depression total score [HAM-D17] ≤18; moderate, HAM-D17 >18 to <25; severe, HAM-D17 ≥25) on desvenlafaxine efficacy were assessed using analysis of covariance for continuous end points and logistic regression for categorical end points. FINDINGS Desvenlafaxine-treated (50 or 100 mg/d) patients had significantly (P < 0.05, 2-sided) greater improvement in most measures of depression and function compared with placebo for patients 18 to 40 years, older than 40 to younger than 55 years, and 55 to younger than 65 years, with no significant evidence of an effect of age. Desvenlafaxine significantly improved most measures of depression and function in moderately and severely depressed patients. There was a significant baseline severity by treatment interaction for HAM-D17 total score only (P = 0.027), with a larger treatment effect for the severely depressed group. IMPLICATIONS Desvenlafaxine significantly improved depressive symptoms in patients younger than 65 years and in patients with moderate or severe baseline depression. Sample sizes were not adequate to assess desvenlafaxine efficacy in patients 65 years or older or with mild baseline depression.
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Lin Z, He H, Zhang C, Wang Z, Jiang M, Li Q, Lan X, Zhang M, Huang X. Influence of Val108/158Met COMT Gene Polymorphism on the Efficacy of Modified Electroconvulsive Therapy in Patients with Treatment Resistant Depression. Cell Biochem Biophys 2016; 71:1387-93. [PMID: 25388840 DOI: 10.1007/s12013-014-0361-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Depression is a common emotional disorder associated with increased risk of suicide and rate of disability. In this double-blinded control study, we tested the efficacy of modified electroconvulsive therapy (MECT) in patients with treatment resistant depression (TRD) using the Hamilton Depression Rating Scale for Depression (HAMD). The total scores of HAMD were found to be significantly decreased after the treatment. The genotyping of catechol-O-methyltransferase (COMT) was carried out with polymerase chain reaction-based testing. Our results demonstrated that frequency of mutant COMT alleles in TRD patients was significantly higher than that of the controls indicating a correlation of the enzyme genotype to the occurrence of TRD. Moreover, the patients homozygous for wild-type COMT gene (G/G) were evidenced to be more sensitive to MECT treatment than those with an heterozygous mutant genotype (A/G).
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Affiliation(s)
- Zhaoyu Lin
- Guangzhou Brain Hospital, Affiliated Hospital of Guangzhou Medical University, 36 Mingxin Rd, Liwan District, Guangzhou, 510370, People's Republic of China
| | - Hongbo He
- Guangzhou Brain Hospital, Affiliated Hospital of Guangzhou Medical University, 36 Mingxin Rd, Liwan District, Guangzhou, 510370, People's Republic of China
| | - Chunping Zhang
- Guangzhou Brain Hospital, Affiliated Hospital of Guangzhou Medical University, 36 Mingxin Rd, Liwan District, Guangzhou, 510370, People's Republic of China
| | - Zhijie Wang
- Guangzhou Brain Hospital, Affiliated Hospital of Guangzhou Medical University, 36 Mingxin Rd, Liwan District, Guangzhou, 510370, People's Republic of China
| | - Miaoling Jiang
- Guangzhou Brain Hospital, Affiliated Hospital of Guangzhou Medical University, 36 Mingxin Rd, Liwan District, Guangzhou, 510370, People's Republic of China
| | - Qirong Li
- Guangzhou Brain Hospital, Affiliated Hospital of Guangzhou Medical University, 36 Mingxin Rd, Liwan District, Guangzhou, 510370, People's Republic of China
| | - Xiaochang Lan
- Guangzhou Brain Hospital, Affiliated Hospital of Guangzhou Medical University, 36 Mingxin Rd, Liwan District, Guangzhou, 510370, People's Republic of China
| | - Minling Zhang
- Guangzhou Brain Hospital, Affiliated Hospital of Guangzhou Medical University, 36 Mingxin Rd, Liwan District, Guangzhou, 510370, People's Republic of China
| | - Xiong Huang
- Guangzhou Brain Hospital, Affiliated Hospital of Guangzhou Medical University, 36 Mingxin Rd, Liwan District, Guangzhou, 510370, People's Republic of China.
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Zeng Q, Wang WC, Fang Y, Mellor D, Mccabe M, Byrne L, Zuo S, Xu Y. Evaluations of treatment efficacy of depression from perspective of both patients' symptoms and general sense of mental health and wellbeing: A large scale, multi-centered, longitudinal study in China. Psychiatry Res 2016; 241:55-60. [PMID: 27156024 DOI: 10.1016/j.psychres.2016.04.111] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 03/02/2016] [Accepted: 04/29/2016] [Indexed: 10/21/2022]
Abstract
Relying on the absence, presence of level of symptomatology may not provide an adequate indication of the effects of treatment for depression, nor sufficient information for the development of treatment plans that meet patients' needs. Using a prospective, multi-centered, and observational design, the present study surveyed a large sample of outpatients with depression in China (n=9855). The 17-item Hamilton Rating Scale for Depression (HRSD-17) and the Remission Evaluation and Mood Inventory Tool (REMIT) were administered at baseline, two weeks later and 4 weeks, to assess patients' self-reported symptoms and general sense of mental health and wellbeing. Of 9855 outpatients, 91.3% were diagnosed as experiencing moderate to severe depression. The patients reported significant improvement over time on both depressive symptoms and general sense after 4-week treatment. The effect sizes of change in general sense were lower than those in symptoms at both two week and four week follow-up. Treatment effects on both general sense and depressive symptomatology were associated with demographic and clinical factors. The findings indicate that a focus on both general sense of mental health and wellbeing in addition to depressive symptomatology will provide clinicians, researchers and patients themselves with a broader perspective of the status of patients.
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Affiliation(s)
- Qingzhi Zeng
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 600 Wan Ping Nan Road, Shanghai 200030, China
| | - Wei Chun Wang
- School of Public Health and Preventive Medicine, Monash University, 99 Commercial Road, Melbourne 3004, Australia
| | - Yiru Fang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 600 Wan Ping Nan Road, Shanghai 200030, China
| | - David Mellor
- School of Psychology, Deakin University, 221 Burwood Highway, Burwood, Victoria 3125, Australia
| | - Marita Mccabe
- School of Psychology, Deakin University, 221 Burwood Highway, Burwood, Victoria 3125, Australia
| | - Linda Byrne
- School of Psychology, Deakin University, 221 Burwood Highway, Burwood, Victoria 3125, Australia
| | - Sai Zuo
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 600 Wan Ping Nan Road, Shanghai 200030, China
| | - Yifeng Xu
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 600 Wan Ping Nan Road, Shanghai 200030, China; Shanghai Key Laboratory of Psychotic Disorders, 600 Wan Ping Nan Road, Shanghai 200030, China.
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The Clinical Applicability of Functional Connectivity in Depression: Pathways Toward More Targeted Intervention. BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2016; 1:262-270. [PMID: 29560882 DOI: 10.1016/j.bpsc.2016.02.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 02/23/2016] [Accepted: 02/24/2016] [Indexed: 12/29/2022]
Abstract
Resting-state functional magnetic resonance imaging provides a noninvasive method to rapidly map large-scale brain networks affected in depression and other psychiatric disorders. Dysfunctional connectivity in large-scale brain networks has been consistently implicated in major depressive disorder (MDD). Although advances have been made in identifying neural circuitry implicated in MDD, this information has yet to be translated into improved diagnostic or treatment interventions. In the first section of this review, we discuss dysfunctional connectivity in affective salience, cognitive control, and default mode networks observed in MDD in association with characteristic symptoms of the disorder. In the second section, we address neurostimulation focusing on transcranial magnetic stimulation and evidence that this approach may directly modulate circuit abnormalities. Finally, we discuss possible avenues of future research to develop more precise diagnoses and targeted interventions within the heterogeneous diagnostic category of MDD as well as the methodological limitations to clinical implementation. We conclude by proposing, with cautious optimism, the future incorporation of neuroimaging into clinical practice as a tool to aid in more targeted diagnosis and treatment guided by circuit-level connectivity dysfunction in patients with depression.
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Abstract
Rates of misdiagnosis between major depressive disorder and bipolar disorder have been reported to be substantial, and the consequence of such misdiagnosis is likely to be a delay in achieving effective control of symptoms, in some cases spanning many years. Particularly in the midst of a depressive episode, or early in the illness course, it may be challenging to distinguish the 2 mood disorders purely on the basis of cross-sectional features. To date, no useful biological markers have been reliably shown to distinguish between bipolar disorder and major depressive disorder.
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Affiliation(s)
- Paul A Vöhringer
- Department of Psychiatry, Tufts University School of Medicine, 800 Washington Street, Boston, MA 02111, USA; Department of Psychiatry, University of Chile, Av. Independencia 1027, Santiago 8071146, Chile
| | - Roy H Perlis
- Department of Psychiatry, Center for Experimental Drugs and Diagnostics, Massachusetts General Hospital, Harvard Medical School, 185 Cambridge Street, Boston, MA 02114, USA.
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24
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Simon GE, Rossom RC, Beck A, Waitzfelder BE, Coleman KJ, Stewart C, Operskalski B, Penfold RB, Shortreed SM. Antidepressants are not overprescribed for mild depression. J Clin Psychiatry 2015; 76:1627-32. [PMID: 26580702 PMCID: PMC4866597 DOI: 10.4088/jcp.14m09162] [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: 03/25/2014] [Accepted: 09/25/2014] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To evaluate overprescribing of antidepressant medication for minimal or mild depression. METHOD Electronic records data from 4 large health care systems identified outpatients aged 18 years or older starting a new episode of antidepressant treatment in 2011 with an ICD-9 diagnosis of depressive disorder (296.2, 296.3, 311, or 300.4). Patient Health Questionnaire-9 (PHQ-9) depression severity scores at time of treatment initiation were used to examine the distribution of baseline severity and the association between baseline severity and patients' demographic and clinical characteristics. RESULTS Of 19,751 adults beginning treatment in 2011, baseline PHQ-9 scores were available for 7,051. In those with a baseline score, 85% reported moderate or severe symptoms (PHQ-9 score of 10 or more), 12% reported mild symptoms (PHQ-9 score of 5 to 9), and 3% reported minimal symptoms (PHQ-9 score of less than 5). The proportion reporting minimal or mild symptoms when starting treatment increased with age, ranging from 11% in those under age 65 years to 26% in those aged 65 and older. The proportion with minimal or mild symptoms was also moderately higher among patients living in wealthier neighborhoods and those treated by psychiatrists. Nevertheless, across all subgroups defined by sex, race/ethnicity, prescriber specialty, and treatment history, the proportions with minimal or mild symptoms did not exceed 18%. Secondary analyses, including weighting and subgroup analyses, found no evidence that estimates of baseline severity were biased by missing PHQ-9 scores. CONCLUSIONS In these health systems, prescribing of antidepressant medication for minimal or mild depression is much less common than suggested by previous reports. Given that this practice may sometimes be clinically appropriate, our findings indicate that overprescribing of antidepressants for mild depression is not a significant public health concern.
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Affiliation(s)
- Gregory E Simon
- Group Health Research Institute, 1730 Minor Ave, Seattle, WA 98101
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25
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Kawaguchi DM, Glatt SJ. GRIK4 polymorphism and its association with antidepressant response in depressed patients: a meta-analysis. Pharmacogenomics 2015; 15:1451-9. [PMID: 25303296 DOI: 10.2217/pgs.14.96] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM This study aimed to evaluate the relationship between a human GRIK4 gene polymorphism (rs1954787) and responsiveness to antidepressant treatment in depressed patients. METHODS A meta-analysis was carried out on five studies. Pooled odds ratios (ORs), 95% CIs and a χ(2) test measuring heterogeneity were calculated. A test of publication bias was also conducted. RESULTS Alleles and genotypes from a total of 2169 depressed patients were analyzed. The results showed that the C allele appeared more frequently than the T allele in responders to treatment (OR: 1.22; 95% CI: 1.035-1.445; z = 2.36; p = 0.018). Similarly, CC homozygotes were more likely than TT homozygotes to respond to treatment (OR: 1.45; 95% CI: 1.107-1.913; z = 2.69; p = 0.007). No evidence of publication bias was detected. CONCLUSION Subjects possessing the C allele or CC genotype of the GRIK4 polymorphism rs1954787 are more likely to respond to antidepressant treatment relative to subjects harboring the T allele and TT genotype. Additional replication of this result is required before this association can be considered definitive, after which it may become possible to employ this marker in conjunction with other known predictors in order to anticipate the outcomes of treatment with antidepressant medications.
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Affiliation(s)
- Daniel M Kawaguchi
- Psychiatric Genetic Epidemiology & Neurobiology Laboratory (PsychGENe Lab), Departments of Psychiatry & Behavioral Sciences & Neuroscience & Physiology, Medical Genetics Research Center, SUNY Upstate Medical University, 750 East Adams Street, Syracuse, NY 13210, USA
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Abstract
INTRODUCTION Current classifications of psychotropic drugs, developed in the 1960s, are based on beliefs about clinical effectiveness. This article evaluates the scientific validity of current drug terms and possible alternative classifications. METHODS A historical, conceptual, and empirical review of the psychopharmacology literature is provided. Consistency of classification is examined by 3 major categories: chemical structure, pharmacodynamic mechanism, and clinical efficacy. RESULTS Current drug terms based on clinical effectiveness are not valid scientifically, either claiming efficacy which is disproven or ignoring other areas of clinical efficacy. Hence, clinical efficacy is not a consistent and scientifically valid way of classifying psychotropic drugs. Chemical structures are also heterogeneous for drugs with similar clinical efficacy. The most consistent way to define drug classes is pharmacodynamic mechanism. Specific drug groups identified are: monoamine agonists ("antidepressants" and "stimulants"), dopamine blockers ("antipsychotics"), second messenger modifiers ("mood stabilizers), and gabaergic agonists ("anxiolytics" or "hypnotics"). CONCLUSIONS Consistent with a recent proposal of psychopharmacology organizations, this article proposes a new nomenclature based mainly on biological pharmacodynamic mechanisms. Specific terms that are scientifically valid and clinically practical are suggested. It is hoped that this new language would allow for more meaningful and accurate communication between clinicians and patients.
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27
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Xu F, Yang J, Chen J, Wu Q, Gong W, Zhang J, Shao W, Mu J, Yang D, Yang Y, Li Z, Xie P. Differential co-expression and regulation analyses reveal different mechanisms underlying major depressive disorder and subsyndromal symptomatic depression. BMC Bioinformatics 2015; 16:112. [PMID: 25880836 PMCID: PMC4434877 DOI: 10.1186/s12859-015-0543-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Accepted: 03/18/2015] [Indexed: 01/17/2023] Open
Abstract
Background Recent depression research has revealed a growing awareness of how to best classify depression into depressive subtypes. Appropriately subtyping depression can lead to identification of subtypes that are more responsive to current pharmacological treatment and aid in separating out depressed patients in which current antidepressants are not particularly effective. Differential co-expression analysis (DCEA) and differential regulation analysis (DRA) were applied to compare the transcriptomic profiles of peripheral blood lymphocytes from patients with two depressive subtypes: major depressive disorder (MDD) and subsyndromal symptomatic depression (SSD). Results Six differentially regulated genes (DRGs) (FOSL1, SRF, JUN, TFAP4, SOX9, and HLF) and 16 transcription factor-to-target differentially co-expressed gene links or pairs (TF2target DCLs) appear to be the key differential factors in MDD; in contrast, one DRG (PATZ1) and eight TF2target DCLs appear to be the key differential factors in SSD. There was no overlap between the MDD target genes and SSD target genes. Venlafaxine (Efexor™, Effexor™) appears to have a significant effect on the gene expression profile of MDD patients but no significant effect on the gene expression profile of SSD patients. Conclusion DCEA and DRA revealed no apparent similarities between the differential regulatory processes underlying MDD and SSD. This bioinformatic analysis may provide novel insights that can support future antidepressant R&D efforts. Electronic supplementary material The online version of this article (doi:10.1186/s12859-015-0543-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Fan Xu
- Department of Neurology, Yongchuan Hospital, Chongqing Medical University, Chongqing, China. .,Institute of Neuroscience, Chongqing Medical University, and Chongqing Key Laboratory of Neurobiology, Chongqing, China.
| | - Jing Yang
- School of Biotechnology, East China University of Science and Technology, Shanghai, China.
| | - Jin Chen
- Department of Neurology, the First Affiliated Hospital, Chongqing Medical University, No. 1 Youyi Road, Chongqing, 400016, China. .,Institute of Neuroscience, Chongqing Medical University, and Chongqing Key Laboratory of Neurobiology, Chongqing, China.
| | - Qingyuan Wu
- Department of Neurology, the First Affiliated Hospital, Chongqing Medical University, No. 1 Youyi Road, Chongqing, 400016, China. .,Institute of Neuroscience, Chongqing Medical University, and Chongqing Key Laboratory of Neurobiology, Chongqing, China.
| | - Wei Gong
- Department of Neurology, Yongchuan Hospital, Chongqing Medical University, Chongqing, China. .,Institute of Neuroscience, Chongqing Medical University, and Chongqing Key Laboratory of Neurobiology, Chongqing, China.
| | - Jianguo Zhang
- Department of Neurology, Yongchuan Hospital, Chongqing Medical University, Chongqing, China. .,Institute of Neuroscience, Chongqing Medical University, and Chongqing Key Laboratory of Neurobiology, Chongqing, China.
| | - Weihua Shao
- Department of Neurology, the First Affiliated Hospital, Chongqing Medical University, No. 1 Youyi Road, Chongqing, 400016, China.
| | - Jun Mu
- Department of Neurology, the First Affiliated Hospital, Chongqing Medical University, No. 1 Youyi Road, Chongqing, 400016, China.
| | - Deyu Yang
- Department of Neurology, Yongchuan Hospital, Chongqing Medical University, Chongqing, China.
| | - Yongtao Yang
- Institute of Neuroscience, Chongqing Medical University, and Chongqing Key Laboratory of Neurobiology, Chongqing, China.
| | - Zhiwei Li
- Department of Neurology, Yongchuan Hospital, Chongqing Medical University, Chongqing, China.
| | - Peng Xie
- Department of Neurology, Yongchuan Hospital, Chongqing Medical University, Chongqing, China. .,Department of Neurology, the First Affiliated Hospital, Chongqing Medical University, No. 1 Youyi Road, Chongqing, 400016, China. .,Institute of Neuroscience, Chongqing Medical University, and Chongqing Key Laboratory of Neurobiology, Chongqing, China.
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An HDAC-dependent epigenetic mechanism that enhances the efficacy of the antidepressant drug fluoxetine. Sci Rep 2015; 5:8171. [PMID: 25639887 PMCID: PMC4313090 DOI: 10.1038/srep08171] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2014] [Accepted: 01/09/2015] [Indexed: 12/02/2022] Open
Abstract
Depression is a prevalent and debilitating psychiatric illnesses. However, currently prescribed antidepressant drugs are only efficacious in a limited group of patients. Studies on Balb/c mice suggested that histone deacetylase (HDAC) inhibition may enhance the efficacy of the widely-prescribed antidepressant drug fluoxetine. This study shows that reducing HDAC activity in fluoxetine-treated Balb/c mice leads to robust antidepressant and anxiolytic effects. While reducing the activity of class I HDACs 1 and 3 led to antidepressant effects, additional class II HDAC inhibition was necessary to exert anxiolytic effects. In fluoxetine-treated mice, HDAC inhibitors increased enrichment of acetylated histone H4 protein and RNA polymerase II at promotor 3 of the brain-derived neurotrophic factor (Bdnf) gene and increased Bdnf transcription from this promotor. Reducing Bdnf-stimulated tropomyosin kinase B receptor activation in fluoxetine-treated mice with low HDAC activity abolished the behavioral effects of fluoxetine, suggesting that the HDAC-triggered epigenetic stimulation of Bdnf expression is critical for therapeutic efficacy.
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Durisko Z, Mulsant BH, Andrews PW. An adaptationist perspective on the etiology of depression. J Affect Disord 2015; 172:315-23. [PMID: 25451432 DOI: 10.1016/j.jad.2014.09.032] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2014] [Revised: 08/20/2014] [Accepted: 09/02/2014] [Indexed: 12/14/2022]
Abstract
Major depressive disorder (MDD) presents with a variety of symptoms and responds to a wide range of treatment interventions. Diagnostic criteria collapse multiple syndromes with distinct etiologies into the same disorder. MDD is typically understood as a malfunction of neurotransmission or brain circuitry regulating mood, pleasure and reward, or executive function. However, research from an evolutionary perspective suggests that the "normal" functioning of adaptations may also generate symptoms meeting diagnostic criteria. Functioning adaptations may be an underappreciated etiological pathway to MDD. Many adaptive functions for depressive symptoms have been suggested: biasing cognition to avoid losses, conserving energy, disengaging from unobtainable goals, signaling submission, soliciting resources, and promoting analytical thinking. We review the potential role of these adaptive functions and how they can lead to specific clusters of depressive symptoms. Understanding MDD from such a perspective reduces the heterogeneity of cases and may help to select the best intervention for each patient. We discuss the implications of different adaptive and maladaptive etiological pathways for the use of antidepressants and various modes of psychotherapy. In particular, instances of MDD caused by functioning adaptations may benefit most from treatments that support the adaptive function, or that target the precipitating causal stressor. We conclude that an evolutionary approach to the study of MDD may be one of the more promising approaches to reduce its heterogeneity and to better match patients and treatment.
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Affiliation(s)
- Zachary Durisko
- Social Aetiology of Mental Illness (SAMI) CIHR Training Program, Centre for Addiction and Mental Health (CAMH), Suite 1111, 33 Russell Street, Toronto, Ontario, Canada M5S 3B1; Evolutionary Ecology of Health Research Laboratories, Department of Psychology, Neuroscience & Behaviour, McMaster University, 1280 Main Street West, Hamilton, Ontario, Canada L8S 4K1.
| | - Benoit H Mulsant
- Centre for Addiction and Mental Health (CAMH), 1001 Queen Street West, Toronto, Ontario, Canada M6J 1H4; Department of Psychiatry, Faculty of Medicine, University of Toronto, 250 College Street, Toronto, Ontario, Canada M5T 1R8
| | - Paul W Andrews
- Evolutionary Ecology of Health Research Laboratories, Department of Psychology, Neuroscience & Behaviour, McMaster University, 1280 Main Street West, Hamilton, Ontario, Canada L8S 4K1.
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Senra H, Barbosa F, Ferreira P, Vieira CR, Perrin PB, Rogers H, Rivera D, Leal I. Psychologic adjustment to irreversible vision loss in adults: a systematic review. Ophthalmology 2015; 122:851-61. [PMID: 25573719 DOI: 10.1016/j.ophtha.2014.10.022] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Revised: 10/14/2014] [Accepted: 10/28/2014] [Indexed: 12/12/2022] Open
Abstract
PURPOSE To summarize relevant evidence investigating the psychologic adjustment to irreversible vision loss (IVL) in adults. DESIGN Irreversible vision loss entails a challenging medical condition in which rehabilitation outcomes are strongly dependent on the patient's psychologic adjustment to illness and impairment. So far, no study has systematically reviewed the psychologic adjustment to IVL in adults. METHODS We reviewed all articles examining the psychologic adjustment to IVL in adults. We included articles published in English in peer-reviewed journals. We performed a keyword literature search using 4 databases (PubMed, EBSCO, Cochrane Library, and Science Direct) for all years through July 2014. We assessed risk of bias of selected studies using the RTI Item Bank for Assessing Risk of Bias and Confounding for Observational Studies of Interventions or Exposures and the Cochrane risk of bias tool for randomized controlled trials. RESULTS Of a total of 3948 citations retrieved, we selected 52 eligible studies published between 1946 and 2014. The majority of studies were observational and cross-sectional in nature. Our review suggests that high levels of depression occur during the adjustment to IVL. Better adjustment to IVL was associated with greater acceptance of vision loss and use of instrumental coping, good social support, positivity, and use of assistive aids. CONCLUSIONS The overall findings indicate that IVL often has negative effects on patients' quality of life and mental health and that such effects tend to remain over time. Specific factors and variables associated with the adjustment to IVL need to be clarified through further in-depth and longitudinal research.
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Affiliation(s)
- Hugo Senra
- Centre of Psychology, University of Porto, Porto, Portugal.
| | - Fernando Barbosa
- Faculty of Psychology and Education Sciences, University of Porto, Portugal
| | | | | | - Paul B Perrin
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia
| | - Heather Rogers
- Department of Methodology and Experimental Psychology, University of Deusto, Spain
| | - Diego Rivera
- Department of Methodology and Experimental Psychology, University of Deusto, Spain
| | - Isabel Leal
- Psychology & Health Research Unit (UIPES, I&D), ISPA - Instituto Universitário, Lisbon, Portugal
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Franck N, Demily C. [Improving functional outcome of schizophrenia with cognitive remediation]. Presse Med 2014; 44:292-7. [PMID: 25544348 DOI: 10.1016/j.lpm.2014.06.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Revised: 06/04/2014] [Accepted: 06/17/2014] [Indexed: 01/29/2023] Open
Abstract
The functional outcome of schizophrenia is partly conditioned by cognitive disorders associated with this disease. The functional outcome of schizophrenia depends not only on psychotropic medications, but also on non-pharmacological measures and in particular on cognitive remediation. All patients suffering from schizophrenia should benefit from a multidisciplinary functional evaluation including neuropsychological assessment. The restitution of the functional evaluation's results values preserved skills rather than deficits. Cognitive remediation should be considered when cognitive disorders have a functional impact. It reduces the impact of the patient's cognitive disorders and improves the success of his/her concrete projects.
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Affiliation(s)
- Nicolas Franck
- Centre hospitalier Le Vinatier, UMR 5229, CNRS et université Lyon 1, service universitaire de réhabilitation, 69006 Lyon, France.
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32
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Understanding the role of adjunctive nonpharmacological therapies in management of the multiple pathways to depression. Psychiatry Res 2014; 220 Suppl 1:S34-44. [PMID: 25539873 DOI: 10.1016/s0165-1781(14)70004-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Accepted: 10/11/2014] [Indexed: 01/28/2023]
Abstract
Major depressive disorder (MDD) is a common disorder with a lifetime prevalence of 16.2% and the fourth highest cause of disability globally. It is hypothesized to be a syndromatic manifestation of multiple pathological processes leading to similar clinical manifestation. MDD is associated with at least three categories of peripheral hormone-type factors including neurotrophic factors, proinflammatory cytokines, and processes that impair regulation of the hypothalamic-pituitary-adrenocortical axis. Neuroimaging studies have identified functional abnormalities including subcortical systems associated with reward and emotion processing, medial prefrontal and anterior cingulate cortical regions and the lateral prefrontal cortical systems involved in cognitive control and voluntary emotion regulation. Studies investigating the effects of psychotherapy and pharmacotherapy on functional brain measures show normalization of brain function with return to euthymia. Nevertheless, approximately 50% of patients with MDD will not respond sufficiently and 60 to 70% will not achieve full remission with first-line pharmacotherapy, therefore clinicians strive to improve patient responses through the use of adjunct therapies. This review discusses recent research in the various biological processes associated with MDD as well as recent data in support of the use of adjunctive non-pharmacological therapies including psychotherapy, bibliotherapy, Internet therapy, "natural" or herbal approaches, exercise therapy, and somatic therapies.
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Popper CW. Single-micronutrient and broad-spectrum micronutrient approaches for treating mood disorders in youth and adults. Child Adolesc Psychiatr Clin N Am 2014; 23:591-672. [PMID: 24975626 DOI: 10.1016/j.chc.2014.04.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Several different vitamins and minerals appear to be effective augmenting agents for mood-modifying drugs, but are not potent monotherapies in themselves for treating psychiatric disorders. In contrast, broad-spectrum micronutrient interventions appear in early trials to be as effective as psychiatric medications with fewer adverse effects for treating mood disorders, ADHD, aggressivity, and misconduct in youth and adults. Broad-spectrum treatments also may improve stress responses, cognition, and sense of well-being in healthy adults, but have been less well studied in youth. Current clinical data justify an extensive expansion of research on micronutrient mechanisms and treatments in psychiatry.
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Affiliation(s)
- Charles W Popper
- Child and Adolescent Psychiatry, McLean Hospital, Belmont, MA, USA; Harvard Medical School, Boston, MA, USA.
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Mulsant BH, Blumberger DM, Ismail Z, Rabheru K, Rapoport MJ. A systematic approach to pharmacotherapy for geriatric major depression. Clin Geriatr Med 2014; 30:517-34. [PMID: 25037293 DOI: 10.1016/j.cger.2014.05.002] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The broadening use of antidepressants among older Americans has not been associated with a notable decrease in the burden of geriatric depression. This article, based on a selective review of the literature, explores several explanations for this paradox. The authors propose that the effectiveness of antidepressants depends in large part on the way they are used. Evidence supports that antidepressant pharmacotherapy leads to better outcomes when guided by a treatment algorithm as opposed to attempting to individualize treatment. Several published guidelines and pharmacotherapy algorithms developed for the treatment of geriatric depression are reviewed, and an updated algorithm proposed.
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Affiliation(s)
- Benoit H Mulsant
- Centre for Addiction and Mental Health, 1001 Queen Street West, Toronto, Ontario M6J 1H4, Canada; Department of Psychiatry, Faculty of Medicine, University of Toronto, 250 College Street, Toronto, ON, M5T 1R8, Canada.
| | - Daniel M Blumberger
- Department of Psychiatry, Faculty of Medicine, University of Toronto, 250 College Street, Toronto, ON, M5T 1R8, Canada; Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, 1001 Queen Street West, Toronto, Ontario M6J 1H4, Canada
| | - Zahinoor Ismail
- Centre for Addiction and Mental Health, 1001 Queen Street West, Toronto, Ontario M6J 1H4, Canada; Hotchkiss Brain Institute, Foothills Hospital, University of Calgary, 1403 29th Street Northwest, Calgary, Alberta T2N 2T9, Canada
| | - Kiran Rabheru
- Geriatric Psychiatry & ECT Program, Department of Psychiatry, The Ottawa Hospital, University of Ottawa, 75 Bruyere Street, Suite 137 Y, Ottawa, Ontario K1N 5C7, Canada
| | - Mark J Rapoport
- Department of Psychiatry, Faculty of Medicine, University of Toronto, 250 College Street, Toronto, ON, M5T 1R8, Canada; Sunnybrook Health Sciences Centre, FG37-2075 Bayview Avenue, Toronto, Ontario M4C 5N6, Canada
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35
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Affiliation(s)
- S N Ghaemi
- Mood Disorders Program, Tufts Medical Center, Boston, MA, USA.
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36
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Warnke I, Nordt C, Moock J, Kawohl W, Rössler W. Antidepressants: relationship to the time to psychiatric readmission and probability of being in hospital in depressive patients. Front Public Health 2014; 2:40. [PMID: 24847477 PMCID: PMC4021117 DOI: 10.3389/fpubh.2014.00040] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Accepted: 04/23/2014] [Indexed: 01/15/2023] Open
Abstract
Introduction: Although antidepressants play a major role in the treatment of patients with depression, it is unclear which specific antidepressants are more efficacious than others. This study aims to analyze the relationship between several antidepressant substances and the time to readmission as well as the probability of being in hospital in a given week by using prescription data. Methods: The database was health-insurance claim data from the new Federal States in Germany. The analysis consisted of all patients with unipolar depression at their index admission in 2007 (N = 1803). Patients were followed up for 2 years after discharge from index hospitalization. Statistical analyses were conducted by discrete-time hazards models and general estimation equation models, accounting for various predictors. Results: Of all prescribed antidepressant substances, sertraline was related to an increased time to readmission by 37% and to a reduction in the probability of being in hospital in a given week by 40%. However, it was prescribed to only about 5% of the patients. Conclusion: In this study, only sertraline appeared to have clinical and economic advantages. It is remarkable that just a minority of patients received sertraline in our study, thus differing from the prescription pattern in the US.
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Affiliation(s)
- Ingeborg Warnke
- Competence Tandem, Innovation Incubator, Leuphana University Lüneburg , Lüneburg , Germany ; Department of Psychiatry, Psychotherapy and Psychosomatics, Center for Social Psychiatry, University Hospital of Psychiatry , Zurich , Switzerland
| | - Carlos Nordt
- Department of Psychiatry, Psychotherapy and Psychosomatics, Center for Social Psychiatry, University Hospital of Psychiatry , Zurich , Switzerland
| | - Jörn Moock
- Competence Tandem, Innovation Incubator, Leuphana University Lüneburg , Lüneburg , Germany
| | - Wolfram Kawohl
- Competence Tandem, Innovation Incubator, Leuphana University Lüneburg , Lüneburg , Germany ; Department of Psychiatry, Psychotherapy and Psychosomatics, Center for Social Psychiatry, University Hospital of Psychiatry , Zurich , Switzerland ; University of Zurich , Zurich , Switzerland
| | - Wulf Rössler
- Competence Tandem, Innovation Incubator, Leuphana University Lüneburg , Lüneburg , Germany ; University of Zurich , Zurich , Switzerland ; Laboratory of Neuroscience, LIM27, Faculty of Medicine, University of Sao Paulo , Sao Paulo , Brazil
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Abstract
Major depression is the commonest psychiatric disorder and in the U.S. has the greatest impact of all biomedical diseases on disability. Here we review evidence of the genetic contribution to disease susceptibility and the current state of molecular approaches. Genome-wide association and linkage results provide constraints on the allele frequencies and effect sizes of susceptibility loci, which we use to interpret the voluminous candidate gene literature. We consider evidence for the genetic heterogeneity of the disorder and the likelihood that subtypes exist that represent more genetically homogenous conditions than have hitherto been analyzed.
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Affiliation(s)
- Jonathan Flint
- Wellcome Trust Centre for Human Genetics, Roosevelt Drive, Oxford, OX3 7BN.
| | - Kenneth S Kendler
- Virginia Commonwealth University, Department of Psychiatry, Virginia Institute for Psychiatric and Behavioral Genetics, Richmond, VA 23298-0126, USA
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38
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McLeod K. The Missing Work of Collaboration: Using Assemblages to Rethink Antidepressant Action. ACTA ACUST UNITED AC 2014. [DOI: 10.1177/009145091404100106] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
How do antidepressants work? This often-asked question continues to attract debate. The depressed individual features in many debates about antidepressants' action. With this focus, discussion oscillates over whether antidepressants work to remedy chemical imbalances in the brains of depressed people, or produce inauthentic states of being. This article argues shifting the analytic focus away from the depressed individual and onto the collective body, or assemblage, moves debates about how antidepressants work into more productive terrain. This provides a new way of looking at how antidepressants work to facilitate recovery from depression through a series of collaborative connections or relationships. Drawing on the charts, photos, and narratives from research encounters with people who take antidepressants, the article illustrates how medication facilitates the creation of active associations in an assemblage of forces. The article concludes by discussing the new ways of thinking about depression, medication and recovery suggested by this understanding of antidepressant action.
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39
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Schumann G, Binder EB, Holte A, de Kloet ER, Oedegaard KJ, Robbins TW, Walker-Tilley TR, Bitter I, Brown VJ, Buitelaar J, Ciccocioppo R, Cools R, Escera C, Fleischhacker W, Flor H, Frith CD, Heinz A, Johnsen E, Kirschbaum C, Klingberg T, Lesch KP, Lewis S, Maier W, Mann K, Martinot JL, Meyer-Lindenberg A, Müller CP, Müller WE, Nutt DJ, Persico A, Perugi G, Pessiglione M, Preuss UW, Roiser JP, Rossini PM, Rybakowski JK, Sandi C, Stephan KE, Undurraga J, Vieta E, van der Wee N, Wykes T, Haro JM, Wittchen HU. Stratified medicine for mental disorders. Eur Neuropsychopharmacol 2014; 24:5-50. [PMID: 24176673 DOI: 10.1016/j.euroneuro.2013.09.010] [Citation(s) in RCA: 115] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Revised: 09/09/2013] [Accepted: 09/26/2013] [Indexed: 12/13/2022]
Abstract
There is recognition that biomedical research into the causes of mental disorders and their treatment needs to adopt new approaches to research. Novel biomedical techniques have advanced our understanding of how the brain develops and is shaped by behaviour and environment. This has led to the advent of stratified medicine, which translates advances in basic research by targeting aetiological mechanisms underlying mental disorder. The resulting increase in diagnostic precision and targeted treatments may provide a window of opportunity to address the large public health burden, and individual suffering associated with mental disorders. While mental health and mental disorders have significant representation in the "health, demographic change and wellbeing" challenge identified in Horizon 2020, the framework programme for research and innovation of the European Commission (2014-2020), and in national funding agencies, clear advice on a potential strategy for mental health research investment is needed. The development of such a strategy is supported by the EC-funded "Roadmap for Mental Health Research" (ROAMER) which will provide recommendations for a European mental health research strategy integrating the areas of biomedicine, psychology, public health well being, research integration and structuring, and stakeholder participation. Leading experts on biomedical research on mental disorders have provided an assessment of the state of the art in core psychopathological domains, including arousal and stress regulation, affect, cognition social processes, comorbidity and pharmacotherapy. They have identified major advances and promising methods and pointed out gaps to be addressed in order to achieve the promise of a stratified medicine for mental disorders.
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Affiliation(s)
- Gunter Schumann
- MRC-Social Genetic Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, PO80, 16 De Crespigny Park, London SE5 8AF, UK.
| | | | - Arne Holte
- Norwegian Institute of Public Health, Oslo, Norway
| | - E Ronald de Kloet
- Department of Endocrinology and Metabolism, Leiden University Medical Centre and Medical Pharmacology, LACDR, Leiden University, The Netherlands
| | - Ketil J Oedegaard
- Department of Clinical Medicine, Section of Psychiatry, University of Bergen and Psychiatric division, Health Bergen, Norway
| | - Trevor W Robbins
- Behavioural and Clinical Neuroscience Institute and Department of Psychology, Cambridge University, Cambridge, UK
| | - Tom R Walker-Tilley
- MRC-Social Genetic Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, PO80, 16 De Crespigny Park, London SE5 8AF, UK
| | - Istvan Bitter
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
| | - Verity J Brown
- Department of Psychology, University of St Andrews, St Andrews, UK
| | - Jan Buitelaar
- Department of Cognitive Neuroscience, University Medical Center, St Radboud and Karakter Child and Adolescent Psychiatry University Center, Nijmegen, The Netherlands
| | - Roberto Ciccocioppo
- Department of Experimental Medicine and Public Health, University of Camerino, Camerino, Macerata, Italy
| | | | - Carles Escera
- Department of Psychiatry and Clinical Psychobiology, University of Barcelona, Barcelona, Spain
| | - Wolfgang Fleischhacker
- Department of Psychiatry and Psychotherapy, Medical University Innsbruck, Innsbruck, Austria
| | - Herta Flor
- Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Chris D Frith
- Wellcome Trust Centre for Neuroimaging, University College London, London, UK
| | - Andreas Heinz
- Berlin School of Mind and Brain, Bernstein Center for Computational Neuroscience (BCCN), Clinic for Psychiatry and Psychotherapy, Charité - Universitätsmedizin, Berlin, Germany
| | - Erik Johnsen
- Department of Clinical Medicine, Section of Psychiatry, University of Bergen and Psychiatric division, Health Bergen, Norway
| | - Clemens Kirschbaum
- Technische Universität Dresden, Department of Psychology, Dresden, Germany
| | | | - Klaus-Peter Lesch
- Division of Molecular Psychiatry, Laboratory of Translational Neuroscience, University of Würzburg, Würzburg, Germany and Department of Neuroscience, School of Mental Health and Neuroscience (MHENS), Maastricht University, Maastricht, The Netherlands
| | - Shon Lewis
- University of Manchester, Manchester, UK
| | - Wolfgang Maier
- Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany
| | - Karl Mann
- Department of Addictive Behaviour and Addiction Medicine, Central Institute of Mental Health, Mannheim, Germany
| | - Jean-Luc Martinot
- Institut National de la Santé et de la Recherche Médicale, INSERM CEA Unit 1000 "Imaging & Psychiatry", University Paris Sud, Orsay; AP-HP Department of Adolescent Psychopathology and Medicine, Maison de Solenn, University Paris Descartes, Paris, France
| | - Andreas Meyer-Lindenberg
- Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Christian P Müller
- Psychiatric University Hospital, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Walter E Müller
- Department of Pharmacology, Biocenter Niederursel, University of Frankfurt, Frankfurt, Germany
| | - David J Nutt
- Neuropsychopharmacology Unit, Division of Brain Sciences, Imperial College, London, UK
| | - Antonio Persico
- Child and Adolescent Neuropsychiatry Unit & Laboratory of Molecular Psychiatry and Neurogenetics, University Campus Bio-Medico, Rome, Italy
| | - Giulio Perugi
- Department of Psychiatry, University of Pisa, Pisa, Italy
| | - Mathias Pessiglione
- Institut du Cerveau et de la Moelle épinière (ICM), Hôpital de la Pitié-Salpêtrière, Paris, France
| | - Ulrich W Preuss
- Department of Psychiatry, Psychotherapy and Psychosomatics, Martin-Luther-University of Halle-Wittenberg, Halle/Saale, Germany
| | - Jonathan P Roiser
- Institute of Cognitive Neuroscience, University College London, London, UK
| | - Paolo M Rossini
- Department of Geriatrics, Neuroscience & Orthopaedics, Catholic University of Sacred Heart, Policlinico A. Gemelli, Rome, Italy
| | - Janusz K Rybakowski
- Department of Adult Psychiatry, Poznan University of Medical Sciences, Poznan, Poland
| | - Carmen Sandi
- Laboratory of Behavioural Genetics, Brain Mind Institute, EPFL, Lausanne, Switzerland
| | - Klaas E Stephan
- Translational Neuromodeling Unit (TNU), Institute for Biomedical Engineering, University of Zurich and ETH Zurich, Zurich, Switzerland
| | - Juan Undurraga
- Translational Neuromodeling Unit (TNU), Institute for Biomedical Engineering, University of Zurich and ETH Zurich, Zurich, Switzerland
| | - Eduard Vieta
- Bipolar Disorders Programme, Institute of Neuroscience, Hospital Clínic Barcelona, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Catalonia, Spain
| | - Nic van der Wee
- Leiden Institute for Brain and Cogntion/Psychiatric Neuroimaging, Dept. of Psychiatry, Leiden University Medical Center, The Netherlands
| | - Til Wykes
- Department of Psychology, Institute of Psychiatry, King's College London, UK
| | - Josep Maria Haro
- Parc Sanitari Sant Joan de Déu, University of Barcelona, CIBERSAM, Barcelona, Spain
| | - Hans Ulrich Wittchen
- Institute of Clinical Psychology and Psychotherapy, TU Dresden, Dresden, Germany
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40
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Citrome L. Levomilnacipran for major depressive disorder: a systematic review of the efficacy and safety profile for this newly approved antidepressant--what is the number needed to treat, number needed to harm and likelihood to be helped or harmed? Int J Clin Pract 2013; 67:1089-104. [PMID: 24016209 DOI: 10.1111/ijcp.12298] [Citation(s) in RCA: 193] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Revised: 08/19/2013] [Accepted: 08/21/2013] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To describe the efficacy and safety of levomilnacipran (extended-release capsules) for the treatment of major depressive disorder (MDD). DATA SOURCES The pivotal registration trials were accessed by querying http://www.ncbi.nlm.nih.gov/pubmed/, http://www.clinicaltrialsregister.eu and http://www.clinicaltrials.gov for the search terms 'levomilnacipran' and 'F2695', and by obtaining posters presented at congresses. Product labelling provided additional information. STUDY SELECTION All available clinical reports of studies were identified. DATA EXTRACTION Descriptions of the principal results and calculation of number needed to treat (NNT) and number needed to harm (NNH) for relevant dichotomous outcomes were extracted from the available study reports and other sources of information. DATA SYNTHESIS Levomilnacipran (1S, 2R-milnacipran) is a potent and selective serotonin-norepinephrine reuptake inhibitor with greater potency for inhibition of norepinephrine relative to serotonin reuptake. Approval for the treatment of MDD was based on a clinical development program that included one 10-week Phase II and four 8-week Phase III randomised placebo-controlled clinical trials in outpatients with MDD where levomilnacipran was titrated to target doses ranging from 40 to 120 mg taken once daily. Four of the five trials demonstrated efficacy as measured by the Montgomery Asberg Depression Rating Scale, with a NNT for response vs. placebo of 9 (95% CI 7-15), and for remission, 14 (95% CI 10-28). Levomilnacipran also demonstrated superiority over placebo as measured by improvement in the Sheehan Disability Scale functional impairment total score. NNH vs. placebo for discontinuation because an adverse event (AE) across all five trials was 19 (95% CI 14-28). The most commonly encountered AEs (incidence ≥ 5% and at least twice the rate of placebo) as identified in product labelling were nausea, hyperhidrosis, constipation, heart rate increased, erectile dysfunction in men, vomiting, tachycardia and palpitations, with NNH values vs. placebo of 10 (95% CI 8-12), 15 (95% CI 12-19), 17 (95% CI 13-24), 21 (95% CI 17-29), 20 (95% CI 14-36), 25 (95% CI 20-37), 25 (95% CI 19-40) and 30 (95% CI 22-49), respectively. Levomilnacipran was not associated with clinically relevant weight change in the short-term trials or in a 48-week open-label extension trial. Mean changes from baseline in systolic blood pressure (BP), diastolic BP and heart rate were +3.0 mmHg, +3.2 mm Hg and +7.4 bpm for levomilnacipran, and -0.4 mmHg, no change and -0.3 bpm for placebo, respectively. Categorical shift in BP from normal or prehypertension at baseline to stage 1 or stage 2 hypertension at end of study was 10.4% for levomilnacipran vs. 7.1% for placebo, for a NNH of 31 (95% CI 18-94). CONCLUSIONS Levomilnacipran represents another option for the treatment of MDD. Levomilnacipran appears to have a favourable weight-gain profile. Additional controlled data regarding long-term efficacy and comparative effectiveness will help characterise this new agent.
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Affiliation(s)
- L Citrome
- New York Medical College, Valhalla, NY, USA
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41
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Stewart ST, Cutler DM, Rosen AB. US trends in quality-adjusted life expectancy from 1987 to 2008: combining national surveys to more broadly track the health of the nation. Am J Public Health 2013; 103:e78-87. [PMID: 24028235 PMCID: PMC3828687 DOI: 10.2105/ajph.2013.301250] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2013] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We used data from multiple national health surveys to systematically track the health of the US adult population. METHODS We estimated trends in quality-adjusted life expectancy (QALE) from 1987 to 2008 by using national mortality data combined with data on symptoms and impairments from the National Medical Expenditure Survey (1987), National Health Interview Survey (1987, 1994-1995, 1996), Medical Expenditure Panel Survey (1992, 1996, 2000-2008), National Nursing Home Survey (1985, 1995, and 1999), and Medicare Current Beneficiary Survey (1992, 1994-2008). We decomposed QALE into changes in life expectancy, impairments, symptoms, and smoking and body mass index. RESULTS Years of QALE increased overall and for all demographic groups-men, women, Whites, and Blacks-despite being slowed by increases in obesity and a rising prevalence of some symptoms and impairments. Overall QALE gains were large: 2.4 years at age 25 years and 1.7 years at age 65 years. CONCLUSIONS Understanding and consistently tracking the drivers of QALE change is central to informed policymaking. Harmonizing data from multiple national surveys is an important step in building this infrastructure.
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Affiliation(s)
- Susan T Stewart
- Susan T. Stewart is with the National Bureau of Economic Research (NBER), Cambridge, MA; she also performed this research in previous positions with the Harvard University Interfaculty Program for Health Systems Improvement (PHSI), and the Harvard Initiative for Global Health, Cambridge. David M. Cutler is with the Department of Economics, Harvard University, Harvard PHSI, and the NBER. Allison B. Rosen is with the Department of Quantitative Health Sciences and Meyer's Primary Care Institute, University of Massachusetts Medical School, Worcester, and the NBER
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Abstract
Bipolar depression remains a major unresolved challenge for psychiatric therapeutics. It is associated with significant disability and mortality and represents the major proportion of the approximately half of follow-up time spent in morbid states despite use of available treatments. Evidence regarding effectiveness of standard treatments, particularly with antidepressants, remains limited and inconsistent. We reviewed available clinical and research literature concerning treatment with antidepressants in bipolar depression and its comparison with unipolar depression. Research evidence concerning efficacy and safety of commonly used antidepressant treatments for acute bipolar depression is very limited. Nevertheless, an updated meta-analysis indicated that overall efficacy was significantly greater with antidepressants than with placebo-treatment and not less than was found in trials for unipolar major depression. Moreover, risks of non-spontaneous mood-switching specifically associated with antidepressant treatment are less than appears to be widely believed. The findings encourage additional efforts to test antidepressants adequately in bipolar depression, and to consider options for depression in types I vs. II bipolar disorder, depression with subsyndromal hypomania and optimal treatment of mixed agitated-dysphoric states--both short- and long-term. Many therapeutic trials considered were small, varied in design, often involved co-treatments, or lacked adequate controls.
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Genetic biomarkers of placebo response: what could it mean for future trial design? ACTA ACUST UNITED AC 2013; 3:311-314. [PMID: 24049631 DOI: 10.4155/cli.13.8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Nassir Ghaemi S, Vohringer PA, Whitham EA. Antidepressants from a public health perspective: re-examining effectiveness, suicide, and carcinogenicity. Acta Psychiatr Scand 2013; 127:89-93. [PMID: 23301720 DOI: 10.1111/acps.12059] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Accepted: 11/05/2012] [Indexed: 11/27/2022]
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Quantifying clinical relevance in treatments for psychiatric disorders. Clin Ther 2012; 33:B1-2. [PMID: 22177375 DOI: 10.1016/j.clinthera.2011.10.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2011] [Accepted: 10/11/2011] [Indexed: 11/22/2022]
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Citrome L. Vilazodone for major depressive disorder: a systematic review of the efficacy and safety profile for this newly approved antidepressant - what is the number needed to treat, number needed to harm and likelihood to be helped or harmed? Int J Clin Pract 2012; 66:356-68. [PMID: 22284853 DOI: 10.1111/j.1742-1241.2011.02885.x] [Citation(s) in RCA: 213] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To describe the efficacy and safety of vilazodone for the treatment of major depressive disorder (MDD). DATA SOURCES The pivotal registration trials were accessed by querying http://www.ncbi.nlm.nih.gov/pubmed/, http://www.fda.gov and http://www.clinicaltrials.gov for the search term 'vilazodone'. Product labeling provided additional information. STUDY SELECTION All available clinical reports of studies were identified. DATA EXTRACTION Descriptions of the principal results and calculation of number needed to treat (NNT) and number needed to harm (NNH) for relevant dichotomous outcomes were extracted from the available study reports and other sources of information. DATA SYNTHESIS Vilazodone is a specific serotonin reuptake inhibitor and serotonin 5HT1A receptor partial agonist. In needs to be administered with food to ensure adequate bioavailability. Approval for the treatment of MDD was based on a clinical development programme that included two 8-week placebo-controlled randomised clinical trials in outpatients with MDD where vilazodone was titrated to a target dose of 40 mg/d over the first 2 weeks. Both trials evidenced efficacy for vilazodone as measured by the Montgomery Asberg Depression Rating Scale. NNT for response vs. placebo was 8 (95% CI 6-16) and for remission was 14 (95% CI 8-55). NNH vs. placebo for discontinuation because of an adverse event (AE) was 27 (95% CI 15-104). The most commonly encountered AEs (incidence ≥ 5% and at least twice the rate of placebo) were diarrhoea, nausea, vomiting and insomnia, with NNH values vs. placebo of 6 (95% CI 5-8), 6 (95% CI 5-8), 30 (95% CI 18-82) and 26 (95% CI 16-78), respectively. NNH vs. placebo for any sexual AE was 12 (95% CI 9-18), but systematically collected data using rating scales of sexual function did not reveal treatment associated effects. Vilazodone was not associated with clinically relevant weight change in the short-term trials. In an open-label 1-year study of vilazodone, mean weight increased by 1.7 kg among the observed cases. CONCLUSIONS Vilazodone represents another option for the treatment of MDD. Vilazodone appears to have a favourable weight-gain profile based on short-term studies. Sexual side-effects were not consistently demonstrated when assessed using clinical rating scales but spontaneously reported AEs related to sexual functioning were observed. Additional controlled data regarding long-term efficacy and effectiveness will help characterise this new agent when used in maintenance treatment.
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Affiliation(s)
- L Citrome
- New York Medical College, Valhalla, NY, USA.
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Lam RW. Onset, time course and trajectories of improvement with antidepressants. Eur Neuropsychopharmacol 2012; 22 Suppl 3:S492-8. [PMID: 22959114 DOI: 10.1016/j.euroneuro.2012.07.005] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2012] [Revised: 07/07/2012] [Accepted: 07/10/2012] [Indexed: 12/20/2022]
Abstract
There is still considerable controversy about the onset and time course of improvement with antidepressants in the treatment of major depressive disorder. Previous studies suggested a delayed-onset hypothesis with therapeutic improvement taking several weeks, but recent meta-analyses have shown support for earlier onset of improvement within the first week or two of treatment. This paper briefly reviews the evidence, focused on antidepressant studies published since 2006, for early onset of improvement within the first 2 weeks of treatment. A PubMed electronic search was conducted with selection of relevant studies from 2007 to March 2012. With the caveat of methodological limitations, results from randomized clinical trials, meta-analyses and naturalistic studies consistently show that: (1) antidepressants in general have early onset of improvement, (2) some antidepressants, including the novel mechanism agent, agomelatine, are associated with early improvement in both core and specific symptoms such as anhedonia and sleep-wake disturbances, and (3) early improvement predicts sustained response and remission. Use of newer statistical methods to examine individual response trajectories may address some of the methodological limitations of previous studies. The predictive value of early improvement has important clinical relevance for antidepressant treatment. Measurement-based assessment for response should occur earlier and more frequently. A lack of improvement (defined as ≤20% reduction from baseline in scores on a depression rating scale) at 2-3 weeks after initiation of an antidepressant should prompt the clinician to consider a change in management.
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Affiliation(s)
- Raymond W Lam
- Department of Psychiatry, University of British Columbia, Mood Disorders Centre of Excellence, UBC Hospital, 2255 Wesbrook Mall, Vancouver, BC, Canada V6T 2A1.
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