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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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Ran LY, Liu XY, Wang W, Tao WQ, Xiang JJ, Zeng Q, Kong YT, Zhang CY, Liao J, Qiu HT, Kuang L. Personality traits predict treatment outcome of an antidepressant in untreated adolescents with depression: An 8-week, open-label, flexible-dose study. J Affect Disord 2024; 350:102-109. [PMID: 38199422 DOI: 10.1016/j.jad.2024.01.015] [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: 06/17/2023] [Revised: 11/25/2023] [Accepted: 01/03/2024] [Indexed: 01/12/2024]
Abstract
BACKGROUND Antidepressant response in adults with major depressive disorder (MDD) is probably influenced by personality dimensions. However, personality dimensions in depression and their association with antidepressant treatment in adolescents are relatively unknown. We sought to investigate whether personality traits (PTs) can influence antidepressant treatment response in adolescents with depression. METHODS Eighty-two adolescents with MDD who had completed the 8 weeks of treatment with selective serotonin reuptake inhibitors (SSRI) were enrolled. The Revised NEO Five-Factor Inventory (NEO-FFI-R) was used to measure their personality at baseline, and the 17-item Hamilton Depression Rating Scale (HAMD-17) and Children's Depression Rating Scale-Revised (CDRS-R) were used to evaluate depressive symptoms at baseline and 8 weeks. Moreover, logistic regression was performed to investigate the relationship between personality dimensions and antidepressant response. Receiver operating characteristic analyses were employed to determine the accuracy of a PT-based model in predicting the antidepressant response rate. RESULTS Adolescents with MDD had significantly different PTs at baseline. Multivariable logistic regression analysis showed that extroversion scores were associated with response to antidepressant treatment, the lower the extroversion score, the better the response to antidepressant treatment, after correcting for variables with significant differences and trends or all potential confounding variables. It was also found that the combination of disease duration, extraversion-gregariousness, and agreeableness-trust effectively predicted antidepressant response in adolescents with MDD, with a sensitivity of 79.4 % and specificity of 68.7 %. CONCLUSION Personality dysfunction in adolescents is associated with MDD. The antidepressant treatment response is influenced by the degree of extroversion in adolescents with MDD.
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Affiliation(s)
- Liu-Yi Ran
- Mental Health Center, University-Town Hospital of Chongqing Medical University, NO.55, University Town Middle Road, Shapingba District, Chongqing 401331, China; Chongqing Clinical Medical Research Center for Psychiatric and Psychological Disorders, China
| | - Xin-Yi Liu
- Mental Health Center, University-Town Hospital of Chongqing Medical University, NO.55, University Town Middle Road, Shapingba District, Chongqing 401331, China
| | - Wo Wang
- Mental Health Center, University-Town Hospital of Chongqing Medical University, NO.55, University Town Middle Road, Shapingba District, Chongqing 401331, China; Chongqing Clinical Medical Research Center for Psychiatric and Psychological Disorders, China
| | - Wan-Qing Tao
- Mental Health Center, University-Town Hospital of Chongqing Medical University, NO.55, University Town Middle Road, Shapingba District, Chongqing 401331, China
| | - Jiao-Jiao Xiang
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Yuzhong District, Chongqing 400016, China
| | - Qi Zeng
- Mental Health Center, University-Town Hospital of Chongqing Medical University, NO.55, University Town Middle Road, Shapingba District, Chongqing 401331, China
| | - Yi-Ting Kong
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Yuzhong District, Chongqing 400016, China
| | - Chen-Yu Zhang
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Yuzhong District, Chongqing 400016, China
| | - Jing Liao
- Mental Health Center, University-Town Hospital of Chongqing Medical University, NO.55, University Town Middle Road, Shapingba District, Chongqing 401331, China
| | - Hai-Tang Qiu
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Yuzhong District, Chongqing 400016, China; Chongqing Clinical Medical Research Center for Psychiatric and Psychological Disorders, China.
| | - Li Kuang
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Yuzhong District, Chongqing 400016, China; Chongqing Clinical Medical Research Center for Psychiatric and Psychological Disorders, China.
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Tao Y, Liang Q, Zhang F, Guo S, Fan L, Zhao F. Efficacy of non-invasive brain stimulation combined with antidepressant medications for depression: a systematic review and meta-analysis of randomized controlled trials. Syst Rev 2024; 13:92. [PMID: 38509623 PMCID: PMC10953221 DOI: 10.1186/s13643-024-02480-w] [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: 08/09/2023] [Accepted: 02/06/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND Antidepressants, noninvasive brain stimulation (NIBS), and their combination are commonly used in routine clinical practice. Nevertheless, there is a continuous dispute regarding whether the effectiveness of NIBS in combination with antidepressants exceeds that of antidepressants alone. This meta-analysis aimed to evaluate the existing evidence and draw a definitive conclusion on this issue. METHODS We conducted a comprehensive search of five databases: Embase, PubMed, Web of Science, SinoMed, and the Cochrane Database of Randomized Controlled Trials. The search was conducted until October 6, 2023. The primary outcomes were the pre- and post-intervention depression and anxiety scores. Secondary outcomes included dropout rates, response rates, and certain levels of neurotransmitters [ 5-hydroxytryptamine (5-HT), dopamine (DA), and gamma-aminobutyric acid (GABA)] at the end of the intervention. Subgroup, meta-regression, and sensitivity analyses were performed to explore the sources of heterogeneity. The data were analysed using R 4.2.2. RESULTS We included 18 RCTs [1357 participants; 11 studies used repetitive transcranial magnetic stimulation (rTMS) and 7 studies used transcranial direct current stimulation (tDCS)]. The follow-up duration varied from two weeks to three months. Overall, whether in combination with rTMS or tDCS, antidepressants proved more effective in alleviating depressive symptoms compared to when used as monotherapy. However, this advantage was not evident during the follow-up period. (p > 0.05). And the combination's efficacy in improving anxiety was found to be lacking. Post-treatment serum levels of 5-HT, DA, and GABA were higher in the rTMS group were higher than antidepressant medication group (p < 0.05). Furthermore, subgroup analysis results indicated that only the rTMS + antidepressant medication treatment significantly improved remission and remission rates. The meta-regression results showed that the type of antidepressant and the sex of the participants had a significant association with the depression score. CONCLUSION Combination treatment with NIBS was significantly more effective in improving depression symptoms than medication alone. rTMS combined with antidepressants appears to be more effective in improving response and remission rates. However, efficacy may be influenced by the type of medicine used in combination, and long-term efficacy data is lacking. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42023388259.
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Affiliation(s)
- Yuan Tao
- School of Nursing, Gansu University of Chinese Medicine, Lanzhou, 73000, PR China
| | - Qian Liang
- School of Nursing, Gansu University of Chinese Medicine, Lanzhou, 73000, PR China
| | - Fenghong Zhang
- Second Provincial Peoples Hospital of Gansu, Lanzhou, 73000, PR China
| | - Shaofan Guo
- School of Nursing, Gansu University of Chinese Medicine, Lanzhou, 73000, PR China
| | - Lingyun Fan
- Second Provincial Peoples Hospital of Gansu, Lanzhou, 73000, PR China
| | - Fei Zhao
- Key Laboratory of Environmental Ecology and Population Health in Northwest Minority Areas, Medical College of Northwest Minzu University, Lanzhou, 730030, PR China.
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Kato M, Baba H, Takekita Y, Naito M, Koshikawa Y, Bandou H, Kinoshita T. Usefulness of mirtazapine and SSRIs in late-life depression: post hoc analysis of the GUNDAM study. Eur J Clin Pharmacol 2023; 79:1515-1524. [PMID: 37700038 DOI: 10.1007/s00228-023-03563-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 09/07/2023] [Indexed: 09/14/2023]
Abstract
OBJECTIVE Mirtazapine and SSRIs are widely prescribed as first-line agents for late-life depression. However, evidence for these drugs is mostly based on non-elderly patients. Therefore, we reanalyzed a randomized controlled trial of mirtazapine versus SSRIs for depression in a sub-population of late-life patients. METHODS A randomized controlled trial was conducted with 141 patients, of whom 41 were elderly, and 100 were non-elderly. This study compared SSRIs and mirtazapine in late-life depression, examined late-onset and early adult-onset separately and compared elderly and non-elderly patients for each drug. Treatment effects and adverse events were assessed using the Hamilton Depression Rating Scale and the Udvalg for Kliniske Undersøgelser Side Effect Rating Scale, respectively. RESULTS In late-life depression, mirtazapine showed faster HAM-D total score improvement (3.3 points difference, p = 0.021) and higher improvement in insomnia (1.7 points difference, p = 0.001) and appetite (1.2 points difference, p = 0.020). Similar findings were observed for late-onset depression with the HAM-D total score (4.3 points difference, p = 0.007) and appetite (0.9 points difference, p = 0.004), favoring mirtazapine. Depressive symptoms were generally less improved in late-life depression than in non-late-life depression. Regarding the effect of mirtazapine on appetite, late-life depression showed greater improvement (0.7 points difference, p = 0.008). Nausea and micturition disturbances were more common with SSRIs in late-life depression than in non-late-life depression. In contrast, somnolence was less common in late-life depression with mirtazapine. CONCLUSION The potential usefulness of mirtazapine in elderly patients was demonstrated. The results also showed differences in the treatment response to SSRIs and mirtazapine between elderly and non-elderly patients.
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Affiliation(s)
- Masaki Kato
- Department of Neuropsychiatry, Kansai Medical University, 2-3-1 Shin-Machi Hirakata-City, Osaka, 573-1191, Japan.
| | - Hajime Baba
- Department of Psychiatry, Faculty of Medicine, Juntendo Koshigaya Hospital, Juntendo University, Saitama, Japan
| | - Yoshiteru Takekita
- Department of Neuropsychiatry, Kansai Medical University, 2-3-1 Shin-Machi Hirakata-City, Osaka, 573-1191, Japan
| | - Minami Naito
- Department of Neuropsychiatry, Kansai Medical University, 2-3-1 Shin-Machi Hirakata-City, Osaka, 573-1191, Japan
| | - Yosuke Koshikawa
- Department of Neuropsychiatry, Kansai Medical University, 2-3-1 Shin-Machi Hirakata-City, Osaka, 573-1191, Japan
| | - Hiroki Bandou
- Seishokai Sephiroth Hospital, Nagahama, Shiga, Japan
| | - Toshihiko Kinoshita
- Department of Neuropsychiatry, Kansai Medical University, 2-3-1 Shin-Machi Hirakata-City, Osaka, 573-1191, Japan
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