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Ayvaci ER, Nandy K, Gorman A, Minhajuddin A, Riddle D, Storch EA, Soutullo CA, Hettema JM, Slater H, Wakefield SM, Trivedi MH. Clinical correlates of anxious depression in youth from the Texas Youth Depression and Suicide Research Network (TX-YDSRN). J Affect Disord 2024; 362:510-517. [PMID: 39009313 DOI: 10.1016/j.jad.2024.07.035] [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: 03/20/2024] [Revised: 06/14/2024] [Accepted: 07/12/2024] [Indexed: 07/17/2024]
Abstract
BACKGROUND Anxious depression is a prevalent subtype of depression associated with adverse outcomes such as higher depression severity and higher rates of suicidality. This study leveraged a state-wide research registry of depressed and/or suicidal youth to compare the prevalence, clinical correlates, and symptom patterns of those with versus without anxious depression. METHODS We included baseline data from 797 participants (ages 8-20) with a diagnosis of a depressive disorder. A score on the Generalized Anxiety Disorder Scale (GAD-7) ≥ 10 was used to define individuals with and without anxious depression. A structured battery was used to capture psychiatric diagnostic status, depression/anxiety severity, suicide risk, history of trauma, functioning, and resilience. RESULTS The prevalence of anxious depression among youth with depressive disorders was 59.5 % (n = 474). Youth with anxious depression had greater depression severity and anxiety symptoms, higher suicidality, and a higher prevalence of comorbid anxiety disorders than those without. Youth with anxious depression had greater impairment in functioning defined as worse pain interference, pain severity, fatigue, and social relationships compared to those without anxious depression. Youth with anxious depression also reported higher rates of depressive symptoms such as irritable mood, feelings of guilt, and psychomotor agitation compared to those without anxious depression. CONCLUSION Anxious depression is associated with worse depression severity, higher suicidality, and lower functioning. Longitudinal work is needed to examine long-term courses of anxious depression to explore its stability as a diagnostic subcategory.
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Affiliation(s)
- Emine Rabia Ayvaci
- Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute and Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA; Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Karabi Nandy
- Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute and Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA; Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - April Gorman
- Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute and Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Abu Minhajuddin
- Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute and Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA; Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - David Riddle
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Eric A Storch
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Cesar A Soutullo
- Louis A. Faillace Department of Psychiatry and Behavioral Health, The University of Texas (UT Health) at Houston, Houston, TX, USA
| | - John M Hettema
- Department of Psychiatry and Behavioral Sciences, Texas A&M Health Sciences Center, Bryan, TX, USA
| | - Holli Slater
- Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute and Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Sarah M Wakefield
- Department of Psychiatry, Texas Tech University Health Science Center, Lubbock, TX, USA
| | - Madhukar H Trivedi
- Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute and Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA.
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Tohen M, Yu J, Kramer K, Nguyen HB. Early improvement with cariprazine as a predictor of antidepressant, anxiolytic, and antimanic response in bipolar I mania and depression: A pooled post hoc analysis of randomized cariprazine trials. J Affect Disord 2024; 362:194-200. [PMID: 38942209 DOI: 10.1016/j.jad.2024.06.100] [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: 12/18/2023] [Revised: 06/03/2024] [Accepted: 06/25/2024] [Indexed: 06/30/2024]
Abstract
BACKGROUND Early symptomatic improvement may predict treatment response in bipolar I disorder. Cariprazine has demonstrated early treatment effects in bipolar I depression and mania studies; therefore, we assessed whether early improvement with cariprazine predicts eventual treatment response. METHODS Post hoc analyses used pooled data from randomized, double-blind, placebo-controlled bipolar I depression (NCT02670538, NCT02670551) and mania (NCT00488618, NCT01058096, NCT01058668) trials. In depression studies (cariprazine 1.5 mg/d, 3 mg/d, or placebo), early improvement in Montgomery-Åsberg Depression Rating Scale (MADRS) and Hamilton Anxiety Rating Scale (HAM-A) total scores (≥25 % improvement at day 15) and subsequent depressive/anxiety symptom response status (≥50 % improvement at week 6) were assessed. In mania studies (cariprazine 3-12 mg/d or placebo), early improvement in Young Mania Rating Scale (YMRS) total scores (≥25 % improvement at day 7) and manic symptom response status (≥50 % improvement at week 3) were assessed. RESULTS Patients with bipolar I depression and early MADRS improvement were approximately 4- to 6-times as likely to achieve MADRS or HAM-A response than those without early improvement; patients with early HAM-A improvement were approximately 3- to 4-times as likely to achieve MADRS or HAM-A response. A subset of patients without early improvement with cariprazine 1.5 mg/d (20 %-31 %) subsequently responded following up-titration. Patients with mania and early YMRS improvement were approximately 5 times more likely to have manic symptom response than those without early improvement. LIMITATIONS Post hoc analysis; relatively short study durations; flexible-dosing (mania studies). CONCLUSIONS Early symptom improvement with cariprazine may inform therapeutic decisions for patients with bipolar I disorder.
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Affiliation(s)
- Mauricio Tohen
- Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Jun Yu
- AbbVie, Florham Park, NJ, USA
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Simon GE, Cruz M, Boggs JM, Beck A, Shortreed SM, Coley RY. Predicting Outcomes of Antidepressant Treatment in Community Practice Settings. Psychiatr Serv 2024; 75:419-426. [PMID: 38050444 DOI: 10.1176/appi.ps.20230380] [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] [Indexed: 12/06/2023]
Abstract
OBJECTIVE The authors examined whether machine-learning models could be used to analyze data from electronic health records (EHRs) to predict patients' responses to antidepressant medications. METHODS EHR data from a Washington State health system identified patients ages ≥13 years who started an antidepressant medication in 2016 in a community practice setting and had a baseline Patient Health Questionnaire-9 (PHQ-9) score of ≥10 and at least one PHQ-9 score recorded 14-180 days later. Potential predictors of a response to antidepressants were extracted from the EHR and included demographic characteristics, psychiatric and substance use diagnoses, past psychiatric medication use, mental health service use, and past PHQ-9 scores. Random-forest and penalized regression analyses were used to build models predicting follow-up PHQ-9 score and a favorable treatment response (≥50% improvement in score). RESULTS Among 2,469 patients starting antidepressant medication treatment, the mean±SD baseline PHQ-9 score was 17.3±4.5, and the mean lowest follow-up score was 9.2±5.9. Outcome data were available for 72% of the patients. About 48% of the patients had a favorable treatment response. The best-fitting random-forest models yielded a correlation between predicted and observed follow-up scores of 0.38 (95% CI=0.32-0.45) and an area under the receiver operating characteristic curve for a favorable response of 0.57 (95% CI=0.52-0.61). Results were similar for penalized regression models and for models predicting last PHQ-9 score during follow-up. CONCLUSIONS Prediction models using EHR data were not accurate enough to inform recommendations for or against starting antidepressant medication. Personalization of depression treatment should instead rely on systematic assessment of early outcomes.
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Affiliation(s)
- Gregory E Simon
- Kaiser Permanente Washington Health Research Institute, Seattle (Simon, Cruz, Shortreed, Coley); Kaiser Permanente Colorado Institute for Health Research, Aurora (Boggs, Beck)
| | - Maricela Cruz
- Kaiser Permanente Washington Health Research Institute, Seattle (Simon, Cruz, Shortreed, Coley); Kaiser Permanente Colorado Institute for Health Research, Aurora (Boggs, Beck)
| | - Jennifer M Boggs
- Kaiser Permanente Washington Health Research Institute, Seattle (Simon, Cruz, Shortreed, Coley); Kaiser Permanente Colorado Institute for Health Research, Aurora (Boggs, Beck)
| | - Arne Beck
- Kaiser Permanente Washington Health Research Institute, Seattle (Simon, Cruz, Shortreed, Coley); Kaiser Permanente Colorado Institute for Health Research, Aurora (Boggs, Beck)
| | - Susan M Shortreed
- Kaiser Permanente Washington Health Research Institute, Seattle (Simon, Cruz, Shortreed, Coley); Kaiser Permanente Colorado Institute for Health Research, Aurora (Boggs, Beck)
| | - R Yates Coley
- Kaiser Permanente Washington Health Research Institute, Seattle (Simon, Cruz, Shortreed, Coley); Kaiser Permanente Colorado Institute for Health Research, Aurora (Boggs, Beck)
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Tan Y, Duan R, Wen C. Efficacy of acupuncture for depression: a systematic review and meta-analysis. Front Neurosci 2024; 18:1347651. [PMID: 38745939 PMCID: PMC11091333 DOI: 10.3389/fnins.2024.1347651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 04/12/2024] [Indexed: 05/16/2024] Open
Abstract
Introduction Depression is a pervasive mental health challenge with substantial global ramifications. Contemporary therapeutic strategies predominantly consist of psychological interventions and pharmacological treatments. Acupuncture, deeply rooted in ancient traditions and bolstered by a plethora of clinical trials, demonstrates considerable efficacy in depression. This study aims to elucidate the efficacy and safety of acupuncture as a standalone therapy for depression patients by reviewing randomized controlled trials that compare acupuncture treatment with conventional drug therapy. Methods Comprehensive searches were conducted across six databases in both Chinese and English: CNKI, Wanfang, VIP, Embase, Medline, and CENTRAL. The literature search spanned from 1 July 2013, to 1 July 2023. Two researchers independently carried out literature screening and data extraction. Review Manager 5.4 was utilized for data analysis and bias risk assessment. A total of 20 randomized controlled trials were included in the qualitative synthesis, involving 1,376 participants and 43 relevant acupoints. Results The Meta-analysis results, based on the HAMD scale scores, revealed that acupuncture regimens (RR: -1.63; 95% CI: -2.49 to -0.76; P = 0.0002; I2 = 86%; n = 1,668) were significantly more effective compared to standalone medication. Moreover, efficacy metrics from the HAMD highlighted a substantial advantage of acupuncture (RR: 2.6; 95% CI: 1.6 to 4.23; P = 0.0001; I2 = 0; n = 614). Further assessments utilizing SERS and TESS demonstrated a lower incidence of side effects and adverse outcomes in the acupuncture group. Conclusions Acupuncture, when compared to conventional pharmacotherapy, exhibits significant efficacy as a standalone treatment after four weeks of intervention, with fewer side effects and adverse reactions. However, further investigation is needed to determine the most effective acupoints and appropriate types of acupuncture techniques for treating depression. Systematic review registration https://www.crd.york.ac.uk/prospero/, identifier CRD42023443711.
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Affiliation(s)
| | | | - Chuanbiao Wen
- School of Intelligent Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, China
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Baumel WT, Strawn JR. Neurobiology of Treatment in Pediatric Anxiety Disorders. Child Adolesc Psychiatr Clin N Am 2023; 32:589-600. [PMID: 37201969 DOI: 10.1016/j.chc.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Both pharmacologic and psychotherapeutic treatment-related changes increase activity in brain regions implicated in prefrontal regulatory circuits, and the functional connectivity of these regions with the amygdala is enhanced following pharmacological treatment. This may suggest overlapping mechanisms of action across therapeutic modalities. The existing literature is best viewed as a partially constructed scaffold on which to construct a vigorous understanding of biomarkers in pediatric anxiety syndromes. As the field approaches leveraging "fingerprints" in neuroimaging with "outputs" in neuropsychiatric tasks and scale, we can move beyond one-size-fits-all selection of psychiatric interventions toward more nuanced therapeutic strategies that recognize individual differences.
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Affiliation(s)
- W Thomas Baumel
- Department of Psychiatry and Behavioral Neuroscience, Anxiety Disorders Research Program, College of Medicine, University of Cincinnati, Box 670559, 260 Stetson Street, Suite 3200, Cincinnati, OH 45267-0559, USA.
| | - Jeffrey R Strawn
- Department of Psychiatry and Behavioral Neuroscience, Anxiety Disorders Research Program, College of Medicine, University of Cincinnati, Box 670559, 260 Stetson Street, Suite 3200, Cincinnati, OH 45267-0559, USA; Division of Child and Adolescent Psychiatry, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Division of Clinical Pharmacology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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