A comparison of characteristics of depressed patients and efficacy of sertraline and amitriptyline between Japan and the West

Excellent reliability of the Hamilton Depression Rating Scale (HDRS-21) in Indonesia after training

INTRODUCTION

The Hamilton Depression Rating Scale (HDRS) is the most widely used depression rating scale worldwide. Reliability of HDRS has been reported mainly from Western countries. The current study tested the reliability of HDRS ratings among psychiatric residents in Indonesia, before and after HDRS training. The hypotheses were that: (i) prior to the training reliability of HDRS ratings is poor; and (ii) HDRS training can improve reliability of HDRS ratings to excellent levels. Furthermore, we explored cultural validity at item level.

METHODS

Videotaped HDRS interviews were rated by 30 psychiatric residents before and after 1 day of HDRS training. Based on a gold standard rating, percentage correct ratings and deviation from the standard were calculated.

RESULTS

Correct ratings increased from 83% to 99% at item level and from 70% to 100% for the total rating. The average deviation from the gold standard rating improved from 0.07 to 0.02 at item level and from 2.97 to 0.46 for the total rating.

DISCUSSION

HDRS assessment by psychiatric trainees in Indonesia without prior training is unreliable. A short, evidence-based HDRS training improves reliability to near perfect levels. The outlined training program could serve as a template for HDRS trainings. HDRS items that may be less valid for assessment of depression severity in Indonesia are discussed.

Grapefruit juice alters plasma sertraline levels after single ingestion of sertraline in healthy volunteers

OBJECTIVE

Grapefruit juice contains a number of natural substances that have the capacity to inhibit the activity of human cytochrome P450 (CYP) 3A4, CYP1A2, and p-glycoprotein. We investigated the effects of grapefruit juice on the pharmacokinetics of sertraline in healthy volunteers.

METHODS

Eight healthy subjects volunteered for the study after providing written informed consent to participate. The study used a crossover design with two phases separated by an interval of at least 2 weeks. The subjects ingested 250 ml of grapefruit juice or 250 ml of water 3 times daily for 5 days. On day 6, each subject was given 75 mg of sertraline with 250 ml of grapefruit juice or water. Blood samples were taken 2, 4, 6, 8, 10, 24, and 48 h later. Plasma levels of sertraline were determined by high-performance liquid chromatography.

RESULTS

Grapefruit juice increased the mean peak concentrations in plasma (C(max)) of sertraline from 17.6+/-6.1 to 29.3+/-11.5 ng/ml (mean+/-SD, P=0.003) and the mean area under the plasma sertraline concentration-time curve (AUC) from 0 to infinity of sertraline from 402.0+/-151.9 to 820.5+/-313.0 h ng/ml (mean+/-SD, P=0.002).

CONCLUSION

These results suggest that grapefruit juice affects the pharmacokinetics of sertraline.

An exploratory factor analysis of the children's depression rating scale-revised

An exploratory factor analysis was performed in a clinical sample of 314 children and adolescents to investigate the factor structure of the Children's Depression Rating Scale-Revised (CDRS-R; Poznanski et al. 1984). A maximum likelihood method followed by a Promax rotation yielded five factors: observed depressive mood, anhedonia, morbid thoughts, somatic symptoms and reported depressive mood. The age group and gender differences on the factors scores are evaluated. After controlling for gender, the adolescents had more severe depression in terms of observed depressive mood, anhedonia, and somatic symptoms. After controlling for age groups, girls had higher scores for reported depressive mood.

A placebo-controlled, randomized withdrawal study of sertraline for major depressive disorder in Japan

The objective of this double-blind, placebo-controlled, multicentre randomized withdrawal study was to evaluate the efficacy and tolerability of sertraline for 16 weeks in treating Japanese patients with major depressive disorder (MDD) who had achieved a response to 8 weeks of sertraline treatment. Patients (n=361) were initially treated with 8 weeks of open-label sertraline treatment followed by 16 weeks of double-blind treatment with either sertraline (50-100 mg/day) or placebo. Responders during the open-label phase were eligible to be entered into the double-blind phase. A total of 235 patients (65.1%) were entered to the double-blind phase and randomly assigned to receive sertraline (n=117) or placebo (n=118). A significantly (P=0.016) lower relapse rate was found for sertraline (8.5%) compared to placebo (19.5%) during the double-blind phase. Examination of time-to-relapse showed that the relapse free rate curve was significantly higher for sertraline (log-rank test, P=0.026) than placebo. Mean changes from beginning to end of the double-blind phase on measure of depressive symptoms, quality of life and global improvement also significantly favoured sertraline over placebo. Sertraline was well-tolerated, with similar adverse events as found in previous studies. These results confirm the efficacy of sertraline in preventing the relapse of MDD in Japanese patients.

Cross-cultural equivalence in depression assessment: Japan-Europe-North American study

OBJECTIVE

Worldwide use of the Hamilton Rating Scale for Depression (HRSD) presupposes that depression symptomatology can be measured the same way across countries but no empirical study has yet examined this issue. We therefore examined cross-cultural consistency of factor structure of HRSD.

METHOD

A 17-item HRSD data were sought for 5,185 individuals diagnosed with major depression in Japan, Europe and North America. Candidate factor structures were obtained with simultaneous component analysis (SCA) across the three cultures. They were then submitted to multiple-group confirmatory factor analysis (CFA).

RESULTS

According to SCA, 3-, 4- or 5-factor solutions were found to optimally and adequately summarize the variables for all the three populations. When submitted to CFA, the 5-factor solution was the best fitting and the most parsimonious: they were 'anhedonia/retardation,''guilt/agitation,''bodily symptoms,''insomnia' and 'appetite.'

CONCLUSION

Common underlying factors exist for HRSD among Japanese, European and American patients with major depression.

Dimensional structure of the Hamilton Depression Rating Scale in patients with obsessive-compulsive disorder

Comorbid depression is frequent in obsessive-compulsive disorder (OCD) and is acknowledged as a major confound in biological and neurocognitive investigations in OCD. The aim of the present study was to assess the distribution of depressive symptoms in a large OCD sample (n=162) and to analyze the dimensional structure of the Hamilton Depression Rating Scale (HDRS) in OCD. Major depressive disorder according to DSM-IV criteria was apparent in approximately one third of the patients. Frequent symptoms were depressed mood, reduced ability to work, anxiety symptoms and guilt feelings. HDRS scores were submitted to a varimax-rotated factor analysis. In accordance with studies conducted with depressed samples, multi-dimensional solutions suggesting three to six factors emerged. Subsequent confirmatory factor analysis revealed satisfactory fit indices for a four-factorial solution comprising core depressive symptoms, sleep disturbance, anxiety and gastrointestinal problems. Aggression-related obsessions as well as the overall severity of obsessions were related to core depressive symptoms. Anxiety symptoms were associated with excessive rituals. Greater recognition of depressive sub-components may help to raise the replicability of empirical findings in OCD research as there is evidence from both depression and OCD samples that distinct depressive syndromes have different biological correlates.