1
|
Perlman K, Mehltretter J, Benrimoh D, Armstrong C, Fratila R, Popescu C, Tunteng JF, Williams J, Rollins C, Golden G, Turecki G. Development of a differential treatment selection model for depression on consolidated and transformed clinical trial datasets. Transl Psychiatry 2024; 14:263. [PMID: 38906883 PMCID: PMC11192904 DOI: 10.1038/s41398-024-02970-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 05/09/2024] [Accepted: 05/29/2024] [Indexed: 06/23/2024] Open
Abstract
Major depressive disorder (MDD) is the leading cause of disability worldwide, yet treatment selection still proceeds via "trial and error". Given the varied presentation of MDD and heterogeneity of treatment response, the use of machine learning to understand complex, non-linear relationships in data may be key for treatment personalization. Well-organized, structured data from clinical trials with standardized outcome measures is useful for training machine learning models; however, combining data across trials poses numerous challenges. There is also persistent concern that machine learning models can propagate harmful biases. We have created a methodology for organizing and preprocessing depression clinical trial data such that transformed variables harmonized across disparate datasets can be used as input for feature selection. Using Bayesian optimization, we identified an optimal multi-layer dense neural network that used data from 21 clinical and sociodemographic features as input in order to perform differential treatment benefit prediction. With this combined dataset of 5032 individuals and 6 drugs, we created a differential treatment benefit prediction model. Our model generalized well to the held-out test set and produced similar accuracy metrics in the test and validation set with an AUC of 0.7 when predicting binary remission. To address the potential for bias propagation, we used a bias testing performance metric to evaluate the model for harmful biases related to ethnicity, age, or sex. We present a full pipeline from data preprocessing to model validation that was employed to create the first differential treatment benefit prediction model for MDD containing 6 treatment options.
Collapse
Affiliation(s)
- Kelly Perlman
- Douglas Mental Health University Institute, Montreal, QC, Canada.
- McGill University, Montreal, QC, Canada.
- Aifred Health Inc., Montreal, QC, Canada.
| | | | - David Benrimoh
- Douglas Mental Health University Institute, Montreal, QC, Canada
- McGill University, Montreal, QC, Canada
- Aifred Health Inc., Montreal, QC, Canada
| | | | | | - Christina Popescu
- Aifred Health Inc., Montreal, QC, Canada
- University of Alberta, Edmonton, AB, Canada
| | - Jingla-Fri Tunteng
- McGill University, Montreal, QC, Canada
- Aifred Health Inc., Montreal, QC, Canada
| | - Jerome Williams
- McGill University, Montreal, QC, Canada
- Aifred Health Inc., Montreal, QC, Canada
| | - Colleen Rollins
- McGill University, Montreal, QC, Canada
- University of Cambridge, Cambridge, UK
| | - Grace Golden
- Aifred Health Inc., Montreal, QC, Canada
- University of Waterloo, Waterloo, ON, Canada
| | - Gustavo Turecki
- Douglas Mental Health University Institute, Montreal, QC, Canada
- McGill University, Montreal, QC, Canada
| |
Collapse
|
2
|
Zhang J, Sun R, Cai Y, Peng B, Yang X, Gao K. Efficacy and Safety of Antidiabetic Agents for Major Depressive Disorder and Bipolar Depression: A Meta-Analysis of Randomized, Double-Blind, Placebo-Controlled Trials. J Clin Med 2024; 13:1172. [PMID: 38398483 PMCID: PMC10889473 DOI: 10.3390/jcm13041172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 01/22/2024] [Accepted: 02/07/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND This meta-analysis aimed to determine the efficacy and safety of antidiabetic agents in the treatment of major depressive disorder and bipolar depression. METHODS Randomized controlled trials (RCTs) of antidiabetic agents in major depressive disorder or bipolar depression were searched in three electronic databases and three clinical trial registry websites from their inception up to October 2023. The differences in changes in the depression rating scale scores from baseline to endpoint or pre-defined sessions, response rate, remission rate, rate of side effects and dropout rate between antidiabetic agents and placebo were meta-analyzed. RESULTS Six RCTs involving 399 participants were included in the final meta-analysis, which did not find that antidiabetics outperformed the placebo in reducing depressive symptoms. The standardized mean difference (SMD) in the depression scores from baseline to endpoint was 0.25 (95% CI -0.1, 0.61). However, a subgroup analysis found a significant difference between antidiabetics and placebos in reducing depressive symptoms in Middle Eastern populations, with an SMD of 0.89 (95% CI 0.44, 1.34). CONCLUSIONS The current meta-analysis does not support the efficacy of antidiabetics being superior to the placebo in the treatment of unipolar and bipolar depression. However, a subgroup analysis indicates that patients from the Middle East may benefit from adding an antidiabetic medication to their ongoing medication(s) for their depression. Larger studies with good-quality study designs are warranted.
Collapse
Affiliation(s)
- Jian Zhang
- Shenzhen Mental Health Center, Shenzhen Kangning Hospital, Shenzhen 518020, China; (J.Z.)
- Mood Disorders Program, Department of Psychiatry, University Hospitals Cleveland Medical Center, 10524 Euclid Ave, 12th Floor, Cleveland, OH 44106, USA
| | - Rongyi Sun
- Department of Psychiatry, School of Medicine, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Yang Cai
- Department of Psychiatry, School of Medicine, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Bo Peng
- Shenzhen Mental Health Center, Shenzhen Kangning Hospital, Shenzhen 518020, China; (J.Z.)
| | - Xi Yang
- Shenzhen Mental Health Center, Shenzhen Kangning Hospital, Shenzhen 518020, China; (J.Z.)
| | - Keming Gao
- Mood Disorders Program, Department of Psychiatry, University Hospitals Cleveland Medical Center, 10524 Euclid Ave, 12th Floor, Cleveland, OH 44106, USA
- Department of Psychiatry, School of Medicine, Case Western Reserve University, Cleveland, OH 44106, USA
| |
Collapse
|
3
|
He S, Ikner TP, Taylor BV, Aguiar T, Thakur NP, Chakravorty S. Mirtazapine-associated acute pancreatitis in a patient with insomnia and co-occurring psychiatric disorders. J Natl Med Assoc 2022; 114:617-620. [PMID: 36114064 DOI: 10.1016/j.jnma.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 07/21/2022] [Accepted: 08/24/2022] [Indexed: 12/15/2022]
Abstract
We report the case of an African American patient who developed drug-associated acute pancreatitis without hypertriglyceridemia, after being treated with mirtazapine for major depressive disorder (MDD). Acute pancreatitis is characterized by rapid inflammation and autodigestion of the pancreas, which may become life-threatening. Although heavy alcohol use and gallstones are the most common causes of acute pancreatitis, some medications are also known to cause drug-induced acute pancreatitis. This report describes a 47-year-old African American female with a history of MDD, insomnia, posttraumatic stress disorder (PTSD), and alcohol use disorder, who was prescribed mirtazapine. A literature search implicated mirtazapine as a rare cause of drug-induced acute pancreatitis. Some reports have suggested that mirtazapine-associated acute pancreatitis may be due to hypertriglyceridemia. This case report instead presents with a normal lipid panel, which is consistent with the majority of prior reports, and it is noteworthy for introducing an alternative mechanism. The Naranjo Adverse Drug Reaction (ADR) Probability Scale calculated an ADR of 5, indicating mirtazapine as the probable cause of the patient's drug-associated acute pancreatitis.
Collapse
Affiliation(s)
- Sean He
- Saint Louis University School of Medicine, Saint Louis, MO 63104, USA.
| | - Taylor P Ikner
- University of Pennsylvania College of Liberal and Professional Studies, USA
| | | | - Taylor Aguiar
- Hackensack Meridian School of Medicine, Nutley, NJ, USA
| | - Nina P Thakur
- University of New England College of Osteopathic Medicine, Biddleford, ME 04005, USA
| | - Subhajit Chakravorty
- Cpl. Michael J Crescenz VA Medical Center, Philadelphia, PA 19104, USA; Perelman School of Medicine, Philadelphia, PA 19104, USA
| |
Collapse
|
4
|
Mills JA, Suresh V, Chang L, Mayes T, Croarkin PE, Trivedi MH, Strawn JR. Socioeconomic Predictors of Treatment Outcomes Among Adults With Major Depressive Disorder. Psychiatr Serv 2022; 73:965-969. [PMID: 35354325 PMCID: PMC9629028 DOI: 10.1176/appi.ps.202100559] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE In this study, the authors sought to examine the impact of socioeconomic variables on outcomes of pharmacotherapy treatments for major depressive disorder in analyses that controlled for treatment access and level of care. METHODS The authors used data from the Combining Medications to Enhance Depression Outcomes study, a prospective clinical trial conducted from March 2008 to April 2014 with 665 adults who had major depressive disorder and were randomly assigned to three pharmacotherapeutic treatments, to develop Bayesian hierarchical models of treatment trajectories for change in Quick Inventory of Depressive Symptomatology-Self-Report ratings. Posterior tail probabilities were used to evaluate the effects of education, income, race-ethnicity, and employment on treatment outcomes. RESULTS After sex, age, and treatment type were controlled for in the analyses, not having a college education (<16 years of schooling), being unemployed, or being non-White were each associated with slower and less improvement. At the end of treatment (week 12), not having a college degree reduced treatment responses by 9.6% (p=0.045), being unemployed by 6.6% (p=0.007), and being non-White by 11.3% (p<0.001). Treatment response was significantly related to income; having an income at the 25th percentile of the income distribution decreased improvement by 4.8% compared with having an income at the 75th percentile (p=0.018). CONCLUSIONS Within a short-term, randomized controlled trial, socioeconomic factors had a critical role in the acute response of patients to pharmacotherapy for major depression.
Collapse
Affiliation(s)
- Jeffrey A Mills
- Department of Economics, Carl H. Lindner College of Business (Mills, Suresh, Chang), and Department of Psychiatry and Behavioral Neuroscience, College of Medicine (Strawn), University of Cincinnati, Cincinnati; Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (Mayes, Trivedi); Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota (Croarkin); Department of Pediatrics, Division of Clinical Pharmacology, Cincinnati Children's Hospital Medical Center, Cincinnati (Strawn)
| | - Vikram Suresh
- Department of Economics, Carl H. Lindner College of Business (Mills, Suresh, Chang), and Department of Psychiatry and Behavioral Neuroscience, College of Medicine (Strawn), University of Cincinnati, Cincinnati; Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (Mayes, Trivedi); Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota (Croarkin); Department of Pediatrics, Division of Clinical Pharmacology, Cincinnati Children's Hospital Medical Center, Cincinnati (Strawn)
| | - Lenisa Chang
- Department of Economics, Carl H. Lindner College of Business (Mills, Suresh, Chang), and Department of Psychiatry and Behavioral Neuroscience, College of Medicine (Strawn), University of Cincinnati, Cincinnati; Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (Mayes, Trivedi); Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota (Croarkin); Department of Pediatrics, Division of Clinical Pharmacology, Cincinnati Children's Hospital Medical Center, Cincinnati (Strawn)
| | - Taryn Mayes
- Department of Economics, Carl H. Lindner College of Business (Mills, Suresh, Chang), and Department of Psychiatry and Behavioral Neuroscience, College of Medicine (Strawn), University of Cincinnati, Cincinnati; Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (Mayes, Trivedi); Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota (Croarkin); Department of Pediatrics, Division of Clinical Pharmacology, Cincinnati Children's Hospital Medical Center, Cincinnati (Strawn)
| | - Paul E Croarkin
- Department of Economics, Carl H. Lindner College of Business (Mills, Suresh, Chang), and Department of Psychiatry and Behavioral Neuroscience, College of Medicine (Strawn), University of Cincinnati, Cincinnati; Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (Mayes, Trivedi); Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota (Croarkin); Department of Pediatrics, Division of Clinical Pharmacology, Cincinnati Children's Hospital Medical Center, Cincinnati (Strawn)
| | - Madhukar H Trivedi
- Department of Economics, Carl H. Lindner College of Business (Mills, Suresh, Chang), and Department of Psychiatry and Behavioral Neuroscience, College of Medicine (Strawn), University of Cincinnati, Cincinnati; Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (Mayes, Trivedi); Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota (Croarkin); Department of Pediatrics, Division of Clinical Pharmacology, Cincinnati Children's Hospital Medical Center, Cincinnati (Strawn)
| | - Jeffrey R Strawn
- Department of Economics, Carl H. Lindner College of Business (Mills, Suresh, Chang), and Department of Psychiatry and Behavioral Neuroscience, College of Medicine (Strawn), University of Cincinnati, Cincinnati; Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (Mayes, Trivedi); Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota (Croarkin); Department of Pediatrics, Division of Clinical Pharmacology, Cincinnati Children's Hospital Medical Center, Cincinnati (Strawn)
| |
Collapse
|
5
|
Crutchley RD, Keuler N. Sub-Analysis of CYP-GUIDES Data: Assessing the Prevalence and Impact of Drug-Gene Interactions in an Ethnically Diverse Cohort of Depressed Individuals. Front Pharmacol 2022; 13:884213. [PMID: 35496293 PMCID: PMC9039251 DOI: 10.3389/fphar.2022.884213] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 03/23/2022] [Indexed: 12/02/2022] Open
Abstract
Introduction: Minority groups are underrepresented in pharmacogenomics (PGx) research. Recent sub-analysis of CYP-GUIDES showed reduced length of stay (LOS) in depressed patients with CYP2D6 sub-functional status. Our primary objective was to determine whether PGx guided (G) versus standard treatment (S) influenced LOS among different race/ethnic groups. Secondary objectives included prevalence of drug-gene interactions (DGIs) and readmission rates (RAR). Methods: Retrospective sub-analysis of CYP-GUIDES data comprising CYP2D6 phenotypes was reclassified using standardized CYP2D6 genotype to phenotype recommendations from the Clinical Pharmacogenetics Implementation Consortium (CPIC) and Dutch Pharmacogenetics Working Group (DPWG). The Mann-Whitney test was used to determine differences in LOS between groups G and S and Kruskal Wallis test to compare LOS among different race/ethnic groups. Logistic regression was used to determine covariates associated with RAR. Results: This study included 1,459 patients with 67.3% in G group (n = 982). The majority of patients were White (57.5%), followed by Latinos (25.6%) and Blacks (12.3%). Although there were no differences in LOS between G and S groups, Latinos had significant shorter LOS than Whites (p = 0.002). LOS was significantly reduced by 5.6 days in poor metabolizers in group G compared to S (p = 0.002). The proportion of supra functional and ultra-rapid metabolizers (UMs) were 6 and 20.3% using CYP-GUIDES and CPIC/DPWG definitions, respectively. Prevalence of DGIs was 40% with significantly fewer DGIs in Blacks (p < 0.001). Race/ethnicity was significantly associated with RAR (aOR 1.30; p = 0.003). Conclusion: A greater number of patients were classified as CYP2D6 UMs using CPIC/DPWG definitions as compared to CYP-GUIDES definitions. This finding may have clinical implications for using psychotropics metabolized by CYP2D6.
Collapse
Affiliation(s)
- Rustin D. Crutchley
- Department of Pharmacotherapy, College of Pharmacy and Pharmaceutical Sciences, Washington State University, Yakima, WA, United States
- *Correspondence: Rustin D. Crutchley,
| | - Nicole Keuler
- School of Pharmacy, University of the Western Cape, Cape Town, South Africa
| |
Collapse
|
6
|
Chen X, Lu B, Li HX, Li XY, Wang YW, Castellanos FX, Cao LP, Chen NX, Chen W, Cheng YQ, Cui SX, Deng ZY, Fang YR, Gong QY, Guo WB, Hu ZJY, Kuang L, Li BJ, Li L, Li T, Lian T, Liao YF, Liu YS, Liu ZN, Lu JP, Luo QH, Meng HQ, Peng DH, Qiu J, Shen YD, Si TM, Tang YQ, Wang CY, Wang F, Wang HN, Wang K, Wang X, Wang Y, Wang ZH, Wu XP, Xie CM, Xie GR, Xie P, Xu XF, Yang H, Yang J, Yao SQ, Yu YQ, Yuan YG, Zhang KR, Zhang W, Zhang ZJ, Zhu JJ, Zuo XN, Zhao JP, Zang YF, Yan CG, Chen X, Cao LP, Chen W, Cheng YQ, Fang YR, Gong QY, Guo WB, Kuang L, Li BJ, Li T, Liu YS, Liu ZN, Lu JP, Luo QH, Meng HQ, Peng DH, Qiu J, Shen YD, Si TM, Tang YQ, Wang CY, Wang F, Wang HN, Wang K, Wang X, Wang Y, Wu XP, Xie CM, Xie GR, Xie P, Xu XF, Yang H, Yang J, Yao SQ, Yu YQ, Yuan YG, Zhang KR, Zhang W, Zhang ZJ, Zhu JJ, Zuo XN, Zhao JP, Zang YF, Yan CG. The DIRECT consortium and the REST-meta-MDD project: towards neuroimaging biomarkers of major depressive disorder. PSYCHORADIOLOGY 2022; 2:32-42. [PMID: 38665141 PMCID: PMC10917197 DOI: 10.1093/psyrad/kkac005] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 05/06/2022] [Accepted: 05/06/2022] [Indexed: 02/05/2023]
Abstract
Despite a growing neuroimaging literature on the pathophysiology of major depressive disorder (MDD), reproducible findings are lacking, probably reflecting mostly small sample sizes and heterogeneity in analytic approaches. To address these issues, the Depression Imaging REsearch ConsorTium (DIRECT) was launched. The REST-meta-MDD project, pooling 2428 functional brain images processed with a standardized pipeline across all participating sites, has been the first effort from DIRECT. In this review, we present an overview of the motivations, rationale, and principal findings of the studies so far from the REST-meta-MDD project. Findings from the first round of analyses of the pooled repository have included alterations in functional connectivity within the default mode network, in whole-brain topological properties, in dynamic features, and in functional lateralization. These well-powered exploratory observations have also provided the basis for future longitudinal hypothesis-driven research. Following these fruitful explorations, DIRECT has proceeded to its second stage of data sharing that seeks to examine ethnicity in brain alterations in MDD by extending the exclusive Chinese original sample to other ethnic groups through international collaborations. A state-of-the-art, surface-based preprocessing pipeline has also been introduced to improve sensitivity. Functional images from patients with bipolar disorder and schizophrenia will be included to identify shared and unique abnormalities across diagnosis boundaries. In addition, large-scale longitudinal studies targeting brain network alterations following antidepressant treatment, aggregation of diffusion tensor images, and the development of functional magnetic resonance imaging-guided neuromodulation approaches are underway. Through these endeavours, we hope to accelerate the translation of functional neuroimaging findings to clinical use, such as evaluating longitudinal effects of antidepressant medications and developing individualized neuromodulation targets, while building an open repository for the scientific community.
Collapse
Affiliation(s)
- Xiao Chen
- CAS Key Laboratory of Behavioral Science, Institute of Psychology, Chinese Academy of Sciences , Beijing 100101, China
- International Big-Data Center for Depression Research, Chinese Academy of Sciences , Beijing 100101, China
- Magnetic Resonance Imaging Research Center, Institute of Psychology, Chinese Academy of Sciences , Beijing 100101, China
- Department of Psychology, University of Chinese Academy of Sciences , Beijing 100049, China
| | - Bin Lu
- International Big-Data Center for Depression Research, Chinese Academy of Sciences , Beijing 100101, China
- Magnetic Resonance Imaging Research Center, Institute of Psychology, Chinese Academy of Sciences , Beijing 100101, China
| | - Hui-Xian Li
- International Big-Data Center for Depression Research, Chinese Academy of Sciences , Beijing 100101, China
- Magnetic Resonance Imaging Research Center, Institute of Psychology, Chinese Academy of Sciences , Beijing 100101, China
| | - Xue-Ying Li
- CAS Key Laboratory of Behavioral Science, Institute of Psychology, Chinese Academy of Sciences , Beijing 100101, China
- International Big-Data Center for Depression Research, Chinese Academy of Sciences , Beijing 100101, China
- Magnetic Resonance Imaging Research Center, Institute of Psychology, Chinese Academy of Sciences , Beijing 100101, China
- Department of Psychology, University of Chinese Academy of Sciences , Beijing 100049, China
- Sino-Danish College, University of Chinese Academy of Sciences , Beijing 101408, China
- Sino-Danish Center for Education and Research, Graduate University of Chinese Academy of Sciences , Beijing 101408, China
| | - Yu-Wei Wang
- International Big-Data Center for Depression Research, Chinese Academy of Sciences , Beijing 100101, China
- Magnetic Resonance Imaging Research Center, Institute of Psychology, Chinese Academy of Sciences , Beijing 100101, China
| | - Francisco Xavier Castellanos
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine , New York, NY 10016, USA
- Nathan Kline Institute for Psychiatric Research , Orangeburg, New York, NY 10962, USA
| | - Li-Ping Cao
- Affiliated Brain Hospital of Guangzhou Medical University , Guangzhou 510370, China
| | | | - Wei Chen
- Department of Psychiatry, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine , Hangzhou 310020, Zhejiang, China
| | - Yu-Qi Cheng
- Department of Psychiatry, First Affiliated Hospital of Kunming Medical University , Kunming, Yunnan 650032, China
| | - Shi-Xian Cui
- International Big-Data Center for Depression Research, Chinese Academy of Sciences , Beijing 100101, China
- Sino-Danish College, University of Chinese Academy of Sciences , Beijing 101408, China
- Sino-Danish Center for Education and Research, Graduate University of Chinese Academy of Sciences , Beijing 101408, China
| | - Zhao-Yu Deng
- International Big-Data Center for Depression Research, Chinese Academy of Sciences , Beijing 100101, China
- Magnetic Resonance Imaging Research Center, Institute of Psychology, Chinese Academy of Sciences , Beijing 100101, China
| | - Yi-Ru Fang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine , Shanghai 200030, China
| | - Qi-Yong Gong
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University , Chengdu, Sichuan 610044, China
- Research Unit of Psychoradiology, Chinese Academy of Medical Sciences , Chengdu, Sichuan 610052, China
| | - Wen-Bin Guo
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University , Changsha 410011, Hunan, China
| | - Zheng-Jia-Yi Hu
- International Big-Data Center for Depression Research, Chinese Academy of Sciences , Beijing 100101, China
- Magnetic Resonance Imaging Research Center, Institute of Psychology, Chinese Academy of Sciences , Beijing 100101, China
| | - Li Kuang
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University , Chongqing 400042, China
| | - Bao-Juan Li
- Xijing Hospital of Air Force Military Medical University , Xi'an, Shaanxi 710032, China
| | - Le Li
- Center for Cognitive Science of Language, Beijing Language and Culture University , Beijing 100083, China
| | - Tao Li
- Affiliated Mental Health Center & Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine , Hangzhou, Zhejiang 310063, China
- Mental Health Center and Psychiatric Laboratory, West China Hospital of Sichuan University , Chengdu, Sichuan 610044, China
| | - Tao Lian
- CAS Key Laboratory of Behavioral Science, Institute of Psychology, Chinese Academy of Sciences , Beijing 100101, China
- International Big-Data Center for Depression Research, Chinese Academy of Sciences , Beijing 100101, China
- Magnetic Resonance Imaging Research Center, Institute of Psychology, Chinese Academy of Sciences , Beijing 100101, China
| | - Yi-Fan Liao
- CAS Key Laboratory of Behavioral Science, Institute of Psychology, Chinese Academy of Sciences , Beijing 100101, China
- International Big-Data Center for Depression Research, Chinese Academy of Sciences , Beijing 100101, China
- Magnetic Resonance Imaging Research Center, Institute of Psychology, Chinese Academy of Sciences , Beijing 100101, China
| | - Yan-Song Liu
- Department of Clinical Psychology, Suzhou Psychiatric Hospital, The Affiliated Guangji Hospital of Soochow University , Suzhou, Jiangsu 215003, China
| | - Zhe-Ning Liu
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University , Changsha 410011, Hunan, China
| | - Jian-Ping Lu
- Shenzhen Kangning Hospital , Shenzhen, Guangzhou 518020, China
| | - Qing-Hua Luo
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University , Chongqing 400042, China
| | - Hua-Qing Meng
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University , Chongqing 400042, China
| | - Dai-Hui Peng
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine , Shanghai 200030, China
| | - Jiang Qiu
- Faculty of Psychology, Southwest University , Chongqing 400715, China
| | - Yue-Di Shen
- Department of Diagnostics, Affiliated Hospital, Hangzhou Normal University Medical School , Hangzhou, Zhejiang 311121, China
| | - Tian-Mei Si
- National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital) & Key Laboratory of Mental Health, Ministry of Health (Peking University) , Beijing 100191, China
| | - Yan-Qing Tang
- Department of Psychiatry, First Affiliated Hospital, China Medical University , Shenyang, Liaoning 110122, China
| | - Chuan-Yue Wang
- Beijing Anding Hospital, Capital Medical University , Beijing 100120, China
| | - Fei Wang
- Department of Psychiatry, First Affiliated Hospital, China Medical University , Shenyang, Liaoning 110122, China
- Early Intervention Unit, Department of Psychiatry , Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing 210024, China
| | - Hua-Ning Wang
- Xijing Hospital of Air Force Military Medical University , Xi'an, Shaanxi 710032, China
| | - Kai Wang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University , Hefei, Anhui 230022, China
| | - Xiang Wang
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University , Changsha 410011, Hunan, China
| | - Ying Wang
- The First Affiliated Hospital of Jinan University , Guangzhou, Guangdong 250024, China
| | - Zi-Han Wang
- International Big-Data Center for Depression Research, Chinese Academy of Sciences , Beijing 100101, China
- Magnetic Resonance Imaging Research Center, Institute of Psychology, Chinese Academy of Sciences , Beijing 100101, China
| | - Xiao-Ping Wu
- Xi'an Central Hospital , Xi'an, Shaanxi 710004, China
| | - Chun-Ming Xie
- Department of Neurology, Affiliated ZhongDa Hospital of Southeast University , Nanjing, Jiangsu 210009, China
| | - Guang-Rong Xie
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University , Changsha 410011, Hunan, China
| | - Peng Xie
- Institute of Neuroscience, Chongqing Medical University , Chongqing 400016, China
- Chongqing Key Laboratory of Neurobiology , Chongqing 400000, China
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University , Chongqing 400042, China
| | - Xiu-Feng Xu
- Department of Psychiatry, First Affiliated Hospital of Kunming Medical University , Kunming, Yunnan 650032, China
| | - Hong Yang
- Department of Radiology, The First Affiliated Hospital, College of Medicine, Zhejiang University , Hangzhou, Zhejiang 310058, China
| | - Jian Yang
- Chongqing Key Laboratory of Neurobiology , Chongqing 400000, China
| | - Shu-Qiao Yao
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University , Changsha 410011, Hunan, China
| | - Yong-Qiang Yu
- The First Affiliated Hospital of Anhui Medical University , Hefei, Anhui 230032, China
| | - Yong-Gui Yuan
- Department of Psychosomatics and Psychiatry, Zhongda Hospital, School of Medicine, Southeast University , Nanjing, Jiangsu 210009, China
| | - Ke-Rang Zhang
- First Hospital of Shanxi Medical University , Taiyuan, Shanxi 030001, China
| | - Wei Zhang
- West China Hospital of Sichuan University , Chengdu, Sichuan 610044, China
| | - Zhi-Jun Zhang
- Department of Neurology, Affiliated ZhongDa Hospital of Southeast University , Nanjing, Jiangsu 210009, China
| | - Jun-Juan Zhu
- Department of Psychiatry, Shanghai Jiao Tong University School of Medicine , Shanghai 200025, China
| | - Xi-Nian Zuo
- Developmental Population Neuroscience Research Center, IDG/McGovern Institute for Brain Research, Beijing Normal University , Beijing 100091, China
- National Basic Science Data Center , Beijing 100038, China
| | - Jing-Ping Zhao
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University , Changsha 410011, Hunan, China
| | - Yu-Feng Zang
- Center for Cognition and Brain Disorders, The Affiliated Hospital of Hangzhou Normal University , Hangzhou, Zhejiang 310018, China
- Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments , Hangzhou, Zhejiang 310000, China
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Chao-Gan Yan
- CAS Key Laboratory of Behavioral Science, Institute of Psychology, Chinese Academy of Sciences , Beijing 100101, China
- International Big-Data Center for Depression Research, Chinese Academy of Sciences , Beijing 100101, China
- Magnetic Resonance Imaging Research Center, Institute of Psychology, Chinese Academy of Sciences , Beijing 100101, China
- Department of Psychology, University of Chinese Academy of Sciences , Beijing 100049, China
- Sino-Danish College, University of Chinese Academy of Sciences , Beijing 101408, China
- Sino-Danish Center for Education and Research, Graduate University of Chinese Academy of Sciences , Beijing 101408, China
| | | |
Collapse
|
7
|
Gomaa H, Baweja R, Mukherjee D, He F, Pearl AM, Waschbusch DA, Aksu EA, Liao D, Saunders EFH. Transdiagnostic and functional predictors of depression severity and trajectory in the Penn state psychiatry clinical assessment and rating evaluation system (PCARES) registry. J Affect Disord 2022; 298:86-94. [PMID: 34715185 PMCID: PMC10171723 DOI: 10.1016/j.jad.2021.10.048] [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] [Received: 07/29/2021] [Revised: 10/19/2021] [Accepted: 10/22/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Timely, accurate diagnosis and subsequent identification of risk factors for depression that is difficult-to-treat can aid in decreasing the burden of depressive illness and reducing probability of future disability. We aimed to identify sociodemographic, clinical, and functional factors that predict depression severity over one year in a real-world, naturalistic, transdiagnostic clinical sample. A subset sample with moderate depression was examined to determine the magnitude of improvement. METHODS The Penn State Psychiatry Clinical Assessment and Rating System (PCARES) Registry houses data from systematically-structured patient-reported outcomes and clinical data from an Electronic Medical Record (EMR) gathered during routine clinical care of patients seeking mental health care at a mid-Atlantic clinic. Self-report symptom and functional measures were obtained, and sociodemographic features and clinical diagnoses were extracted from the EMR from 1,766 patients between 2/6/2016 to 9/30/2019. The Patient Health Questionnaire 9 (PHQ-9) depression scale was obtained at each visit. Using a discrete mixture clustering model, the study population was divided into five longitudinal trajectory groups, termed depression severity groups, based on intra-individual PHQ-9 score trajectories over one year. Multinomial logistic regression models were estimated to evaluate associations between characteristics and the likelihood of depression severity group membership. To determine the magnitude of improvement, predictors of the slope of the PHQ-9 trajectory were examined for patients with moderate depression. RESULTS The strongest predictors of high depression severity over one year were poor functioning, high transdiagnostic DSM-5 Level 1 crosscutting symptom score, diagnosis of Post-Traumatic Stress Disorder (PTSD), public/self-pay insurance, female gender, and non-White race. Among the subset of patients with moderate depression, strong predictors of improvement were commercial insurance and exposure to trauma; the strongest predictors of worsening were high functional impairment, high transdiagnostic Level 1 symptom score, diagnosis of PTSD, diagnosis of bipolar disorder, and marital status of single or formerly married; depression-specific symptom measures were not predictive. LIMITATIONS Limitations include inferring education and income status from zip code level-data, the non-random missingness of data, and the use of diagnoses collected from the electronic medical record. CONCLUSION Functional impairment, transdiagnostic measures of symptom burden, and insurance status are strong predictors of depression severity and poor outcome.
Collapse
Affiliation(s)
- Hassaan Gomaa
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine and Penn State Health Milton S. Hershey Medical Center, Hershey, PA, United States
| | - Ritika Baweja
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine and Penn State Health Milton S. Hershey Medical Center, Hershey, PA, United States
| | - Dahlia Mukherjee
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine and Penn State Health Milton S. Hershey Medical Center, Hershey, PA, United States
| | - Fan He
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, United States
| | - Amanda M Pearl
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, United States
| | - Daniel A Waschbusch
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine and Penn State Health Milton S. Hershey Medical Center, Hershey, PA, United States
| | - Errol A Aksu
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine and Penn State Health Milton S. Hershey Medical Center, Hershey, PA, United States
| | - Duanping Liao
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, United States
| | - Erika F H Saunders
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine and Penn State Health Milton S. Hershey Medical Center, Hershey, PA, United States.
| |
Collapse
|
8
|
Jacobsen P, Zhong W, Xu R, Nomikos G. A novel study design for investigating relapse prevention in major depressive disorder: Preliminary data from the open-label period of a phase 4 vortioxetine study. J Affect Disord 2020; 266:173-181. [PMID: 32056873 DOI: 10.1016/j.jad.2020.01.090] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 12/17/2019] [Accepted: 01/20/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Traditional randomized withdrawal studies have assessed the efficacy of antidepressants for reducing relapse and recurrence of major depressive episodes (MDEs) but have not compared dose reduction, increase, or maintenance within the same study. METHODS Here we present the development, implementation, and preliminary data from the open-label period of an ongoing phase 4, non-traditional, randomized withdrawal study. Designed to evaluate the efficacy of vortioxetine across its approved dose range for relapse prevention, the study enrolled adult patients with recurrent major depressive disorder (MDD), Montgomery-Åsberg Depression Rating Scale (MADRS) ≥ 26, and history of ≥2 MDEs. After a 16-week, open-label, fixed-dose (vortioxetine 10 mg once daily) period, patients meeting response criteria (≥50% reduction in MADRS total score, Weeks 8-16) and remission criteria (MADRS total score ≤12, Weeks 14 and 16) were randomized to vortioxetine 5, 10, or 20 mg, or placebo in a 32-week double-blind treatment period. RESULTS Of 1106 patients enrolled, 510 completed the open-label period (mean age: 45.7 years; mean MADRS = 5.0; predominantly female, white, and never smokers) and were eligible for randomization in the ongoing double-blind period. LIMITATIONS Study is ongoing; only data from the open-label period are available for evaluation. CONCLUSIONS Preliminary analysis suggests that patient baseline characteristics were not a factor in response to and stabilization with vortioxetine during the open-label period. The lack of flexibility in dosing, however, may have reduced the number of patients qualifying for randomization. This study design may provide useful information for optimizing the long-term efficacy and tolerability of vortioxetine treatment for MDD.
Collapse
Affiliation(s)
- Paula Jacobsen
- Takeda Development Center Americas, Inc., One Takeda Parkway, Deerfield, IL 60015, USA.
| | - Wei Zhong
- Takeda Development Center Americas, Inc., One Takeda Parkway, Deerfield, IL 60015, USA
| | - Rengyi Xu
- Takeda Development Center Americas, Inc., One Takeda Parkway, Deerfield, IL 60015, USA
| | - George Nomikos
- Takeda Development Center Americas, Inc., One Takeda Parkway, Deerfield, IL 60015, USA
| |
Collapse
|
9
|
Perna G, Alciati A, Daccò S, Grassi M, Caldirola D. Personalized Psychiatry and Depression: The Role of Sociodemographic and Clinical Variables. Psychiatry Investig 2020; 17:193-206. [PMID: 32160691 PMCID: PMC7113177 DOI: 10.30773/pi.2019.0289] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 01/14/2020] [Indexed: 02/06/2023] Open
Abstract
Despite several pharmacological options, the clinical outcomes of major depressive disorder (MDD) are often unsatisfactory. Personalized psychiatry attempts to tailor therapeutic interventions according to each patient's unique profile and characteristics. This approach can be a crucial strategy in improving pharmacological outcomes in MDD and overcoming trial-and-error treatment choices. In this narrative review, we evaluate whether sociodemographic (i.e., gender, age, race/ethnicity, and socioeconomic status) and clinical [i.e., body mass index (BMI), severity of depressive symptoms, and symptom profiles] variables that are easily assessable in clinical practice may help clinicians to optimize the selection of antidepressant treatment for each patient with MDD at the early stages of the disorder. We found that several variables were associated with poorer outcomes for all antidepressants. However, only preliminary associations were found between some clinical variables (i.e., BMI, anhedonia, and MDD with melancholic/atypical features) and possible benefits with some specific antidepressants. Finally, in clinical practice, the assessment of sociodemographic and clinical variables considered in our review can be valuable for early identification of depressed individuals at high risk for poor responses to antidepressants, but there are not enough data on which to ground any reliable selection of specific antidepressant class or compounds. Recent advances in computational resources, such as machine learning techniques, which are able to integrate multiple potential predictors, such as individual/ clinical variables, biomarkers, and genetic factors, may offer future reliable tools to guide personalized antidepressant choice for each patient with MDD.
Collapse
Affiliation(s)
- Giampaolo Perna
- Humanitas University Department of Biomedical Sciences, Milan, Italy.,Department of Clinical Neurosciences, Villa San Benedetto Menni Hospital, Hermanas Hospitalarias, Como, Italy.,Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.,Department of Psychiatry and Behavioral Sciences, Leonard Miller School of Medicine, Miami University, Miami, USA
| | - Alessandra Alciati
- Department of Clinical Neurosciences, Villa San Benedetto Menni Hospital, Hermanas Hospitalarias, Como, Italy.,Humanitas Clinical and Research Center, IRCCS, Milan, Italy
| | - Silvia Daccò
- Humanitas University Department of Biomedical Sciences, Milan, Italy.,Department of Clinical Neurosciences, Villa San Benedetto Menni Hospital, Hermanas Hospitalarias, Como, Italy
| | - Massimiliano Grassi
- Humanitas University Department of Biomedical Sciences, Milan, Italy.,Department of Clinical Neurosciences, Villa San Benedetto Menni Hospital, Hermanas Hospitalarias, Como, Italy
| | - Daniela Caldirola
- Humanitas University Department of Biomedical Sciences, Milan, Italy.,Department of Clinical Neurosciences, Villa San Benedetto Menni Hospital, Hermanas Hospitalarias, Como, Italy
| |
Collapse
|
10
|
Pharmacogenomics in Psychiatric Disorders. Pharmacogenomics 2019. [DOI: 10.1016/b978-0-12-812626-4.00007-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
|
11
|
Quality of life and functioning of Hispanic patients with Major Depressive Disorder before and after treatment. J Affect Disord 2018; 225:117-122. [PMID: 28826087 PMCID: PMC5626642 DOI: 10.1016/j.jad.2017.08.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 05/15/2017] [Accepted: 08/10/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND Similar rates of remission from Major Depressive Disorder (MDD) have been documented between ethnic groups in response to antidepressant treatment. However, ethnic differences in functional outcomes, including patient-reported quality of life (QOL) and functioning, have not been well-characterized. We compared symptomatic and functional outcomes of antidepressant treatment in Hispanic and non-Hispanic patients with MDD. METHODS We analyzed 2280 nonpsychotic treatment-seeking adults with MDD who received citalopram monotherapy in Level 1 of the Sequenced Treatment Alternatives to Relieve Depression study. All subjects (239 Hispanic, 2041 non-Hispanic) completed QOL, functioning, and depressive symptom severity measures at entry and exit. RESULTS Hispanic participants had significantly worse QOL scores at entry and exit (p < 0.01). However, after controlling for baseline QOL, there was no difference between Hispanic and non-Hispanic patients' QOL at exit (p = 0.21). There were no significant between-group differences at entry or at exit for depressive symptom severity or functioning. Both groups had significant improvements in depressive symptom severity, QOL, and functioning from entry to exit (all p values < 0.01). Patients with private insurance had lower depressive symptom severity, greater QOL, and better functioning at exit compared to patients without private insurance. LIMITATIONS This study was a retrospective data analysis, and the Hispanic group was relatively small compared to the non-Hispanic group. CONCLUSIONS Hispanic and non-Hispanic participants with MDD had similar responses to antidepressant treatment as measured by depressive symptom severity scores, quality of life, and functioning. Nevertheless, Hispanic patients reported significantly worse quality of life at entry.
Collapse
|
12
|
Gibbons MBC, Gallop R, Thompson D, Luther D, Crits-Christoph K, Jacobs J, Yin S, Crits-Christoph P. Comparative Effectiveness of Cognitive Therapy and Dynamic Psychotherapy for Major Depressive Disorder in a Community Mental Health Setting: A Randomized Clinical Noninferiority Trial. JAMA Psychiatry 2016; 73:904-11. [PMID: 27487573 PMCID: PMC5627972 DOI: 10.1001/jamapsychiatry.2016.1720] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Dynamic psychotherapy (DT) is widely practiced in the community, but few trials have established its effectiveness for specific mental health disorders relative to control conditions or other evidence-based psychotherapies. OBJECTIVE To determine whether DT is not inferior to cognitive therapy (CT) in the treatment of major depressive disorder (MDD) in a community mental health setting. DESIGN, SETTING, AND PARTICIPANTS From October 28, 2010, to July 2, 2014, outpatients with MDD were randomized to treatment delivered by trained therapists. Twenty therapists employed at a community mental health center in Pennsylvania were trained by experts in CT or DT. A total of 237 adult outpatients with MDD seeking services at this site were randomized to 16 sessions of DT or CT delivered across 5 months. Final assessment was completed on December 9, 2014, and data were analyzed from December 10, 2014, to January 14, 2016. INTERVENTIONS Short-term DT or CT. MAIN OUTCOMES AND MEASURES Expert blind evaluations with the 17-item Hamilton Rating Scale for Depression. RESULTS Among the 237 patients (59 men [24.9%]; 178 women [75.1%]; mean [SD] age, 36.2 [12.1] years) treated by 20 therapists (19 women and 1 man; mean [SD] age, 40.0 [14.6] years), 118 were randomized to DT and 119 to CT. A mean (SD) difference between treatments was found in the change on the Hamilton Rating Scale for Depression of 0.86 (7.73) scale points (95% CI, -0.70 to 2.42; Cohen d, 0.11), indicating that DT was statistically not inferior to CT. A statistically significant main effect was found for time (F1,198 = 75.92; P = .001). No statistically significant differences were found between treatments on patient ratings of treatment credibility. Dynamic psychotherapy and CT were discriminated from each other on competence in supportive techniques (t120 = 2.48; P = .02), competence in expressive techniques (t120 = 4.78; P = .001), adherence to CT techniques (t115 = -7.07; P = .001), and competence in CT (t115 = -7.07; P = .001). CONCLUSIONS AND RELEVANCE This study suggests that DT is not inferior to CT on change in depression for the treatment of MDD in a community mental health setting. The 95% CI suggests that the effects of DT are equivalent to those of CT. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01207271.
Collapse
Affiliation(s)
- Mary Beth Connolly Gibbons
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Robert Gallop
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | | | - Kathryn Crits-Christoph
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Julie Jacobs
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Seohyun Yin
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Paul Crits-Christoph
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
13
|
Genetic ancestry as an effect modifier of naltrexone in smoking cessation among African Americans: an analysis of a randomized controlled trial. Pharmacogenet Genomics 2016; 25:305-12. [PMID: 25918964 DOI: 10.1097/fpc.0000000000000138] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To determine whether there were differential quit rates between African Americans (AA) and European Americans with the experimental treatment naltrexone, and examine the role of genetic ancestry on these outcomes among AAs. METHODS Data from a previous randomized trial of 315 smokers to naltrexone versus placebo were reanalyzed using West African (WA) genetic ancestry to define subpopulations. Logistic regression models were used to estimate treatment effects on early and end of treatment quit rates, by race and WA ancestry. RESULTS Among European Americans (n=136), naltrexone significantly increased quit rates at 4 weeks (62 vs. 43%, P=0.03) with directional, but not statistically significant effects at 12 weeks (30 vs. 18%, P=0.12). In contrast, among the AAs (n=95), quit rates did not differ between naltrexone and placebo groups at either interval (4 weeks: 43 vs. 32%, P=0.27; 12 weeks: 22 vs. 18%, P=0.60). A median split was conducted in AAs for WA ancestry. Among AAs with low WA ancestry, quit rates were significantly higher with naltrexone compared with placebo (60 vs. 27%, P=0.03). There was no advantage in quit rates with naltrexone for the high WA ancestry group. CONCLUSION Naltrexone efficacy for smoking cessation varies across AA individuals with different levels of WA ancestry. These results suggest that genetic background may partially explain racial differences in drug response.
Collapse
|
14
|
Shao Z, Richie WD, Bailey RK. Racial and Ethnic Disparity in Major Depressive Disorder. J Racial Ethn Health Disparities 2015; 3:692-705. [DOI: 10.1007/s40615-015-0188-6] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 11/08/2015] [Accepted: 11/12/2015] [Indexed: 12/15/2022]
|
15
|
Hall CA, Simon KM, Lenze EJ, Dew MA, Begley A, Butters MA, Blumberger DM, Stack JA, Mulsant B, Reynolds CF. Depression Remission Rates Among Older Black and White Adults: Analyses From the IRL-GREY Trial. Psychiatr Serv 2015; 66:1303-11. [PMID: 26278231 PMCID: PMC4666813 DOI: 10.1176/appi.ps.201400480] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study explored whether older black and white adults with major depressive disorder differed in rates of remission or attrition during open-label treatment with venlafaxine and supportive care. METHODS A total of 47 black (10%) and 412 white (90%) adults age ≥60 were treated with open-label venlafaxine extended-release (≤300 mg per day) for 12-14 weeks during the initial phase of an multisite, randomized, placebo-controlled augmentation trial. Participants were help-seeking older adults with nonpsychotic major depressive disorder (single or recurrent episode) referred from specialty clinics, primary care practices, advertisements, and research programs. Remission was defined as a Montgomery-Asberg Depression Rating Scale score of ≤10 for two consecutive assessments at the end of 12 weeks. Kaplan-Meier curves displayed time to dropout and time to initial remission. Cox proportional hazards models assessed differences in attrition and remission rates. RESULTS Black participants had greater baseline general medical comorbidity, worse physical health-related quality of life, and poorer cognitive function than white participants. White participants were more likely to have received an adequate trial of antidepressant and psychotherapy before study entry. Baseline depression severity, depression duration, age at onset, and recurrence history did not differ between groups. The groups had similar final doses of venlafaxine and similar rates of attrition and remission. Side-effect profiles were comparable between the groups. CONCLUSIONS Despite greater medical comorbidity, lower cognitive function, and less adequate prior exposure to antidepressant treatment and psychotherapy, black participants were no more likely to discontinue antidepressant pharmacotherapy and experienced a rate of remission comparable to white participants.
Collapse
Affiliation(s)
- Charles A Hall
- Dr. Hall, Dr. Dew, Ms. Begley, Dr. Butters, Ms. Stack, and Dr. Reynolds are with the Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. Dr. Simon is also with the Department of Psychiatry, Morehouse University School of Medicine, Atlanta. Ms. Begley and Ms. Stack are also with the NIMH Center for Late Life Depression Prevention and Treatment, University of Pittsburgh. Dr. Lenze is with the Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri. Dr. Blumberger and Dr. Mulsant are with the Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. Send correspondence to Dr. Reynolds (e-mail: )
| | - Kevin M Simon
- Dr. Hall, Dr. Dew, Ms. Begley, Dr. Butters, Ms. Stack, and Dr. Reynolds are with the Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. Dr. Simon is also with the Department of Psychiatry, Morehouse University School of Medicine, Atlanta. Ms. Begley and Ms. Stack are also with the NIMH Center for Late Life Depression Prevention and Treatment, University of Pittsburgh. Dr. Lenze is with the Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri. Dr. Blumberger and Dr. Mulsant are with the Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. Send correspondence to Dr. Reynolds (e-mail: )
| | - Eric J Lenze
- Dr. Hall, Dr. Dew, Ms. Begley, Dr. Butters, Ms. Stack, and Dr. Reynolds are with the Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. Dr. Simon is also with the Department of Psychiatry, Morehouse University School of Medicine, Atlanta. Ms. Begley and Ms. Stack are also with the NIMH Center for Late Life Depression Prevention and Treatment, University of Pittsburgh. Dr. Lenze is with the Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri. Dr. Blumberger and Dr. Mulsant are with the Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. Send correspondence to Dr. Reynolds (e-mail: )
| | - Mary Amanda Dew
- Dr. Hall, Dr. Dew, Ms. Begley, Dr. Butters, Ms. Stack, and Dr. Reynolds are with the Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. Dr. Simon is also with the Department of Psychiatry, Morehouse University School of Medicine, Atlanta. Ms. Begley and Ms. Stack are also with the NIMH Center for Late Life Depression Prevention and Treatment, University of Pittsburgh. Dr. Lenze is with the Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri. Dr. Blumberger and Dr. Mulsant are with the Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. Send correspondence to Dr. Reynolds (e-mail: )
| | - Amy Begley
- Dr. Hall, Dr. Dew, Ms. Begley, Dr. Butters, Ms. Stack, and Dr. Reynolds are with the Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. Dr. Simon is also with the Department of Psychiatry, Morehouse University School of Medicine, Atlanta. Ms. Begley and Ms. Stack are also with the NIMH Center for Late Life Depression Prevention and Treatment, University of Pittsburgh. Dr. Lenze is with the Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri. Dr. Blumberger and Dr. Mulsant are with the Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. Send correspondence to Dr. Reynolds (e-mail: )
| | - Meryl A Butters
- Dr. Hall, Dr. Dew, Ms. Begley, Dr. Butters, Ms. Stack, and Dr. Reynolds are with the Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. Dr. Simon is also with the Department of Psychiatry, Morehouse University School of Medicine, Atlanta. Ms. Begley and Ms. Stack are also with the NIMH Center for Late Life Depression Prevention and Treatment, University of Pittsburgh. Dr. Lenze is with the Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri. Dr. Blumberger and Dr. Mulsant are with the Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. Send correspondence to Dr. Reynolds (e-mail: )
| | - Daniel M Blumberger
- Dr. Hall, Dr. Dew, Ms. Begley, Dr. Butters, Ms. Stack, and Dr. Reynolds are with the Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. Dr. Simon is also with the Department of Psychiatry, Morehouse University School of Medicine, Atlanta. Ms. Begley and Ms. Stack are also with the NIMH Center for Late Life Depression Prevention and Treatment, University of Pittsburgh. Dr. Lenze is with the Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri. Dr. Blumberger and Dr. Mulsant are with the Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. Send correspondence to Dr. Reynolds (e-mail: )
| | - Jacqueline A Stack
- Dr. Hall, Dr. Dew, Ms. Begley, Dr. Butters, Ms. Stack, and Dr. Reynolds are with the Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. Dr. Simon is also with the Department of Psychiatry, Morehouse University School of Medicine, Atlanta. Ms. Begley and Ms. Stack are also with the NIMH Center for Late Life Depression Prevention and Treatment, University of Pittsburgh. Dr. Lenze is with the Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri. Dr. Blumberger and Dr. Mulsant are with the Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. Send correspondence to Dr. Reynolds (e-mail: )
| | - Benoit Mulsant
- Dr. Hall, Dr. Dew, Ms. Begley, Dr. Butters, Ms. Stack, and Dr. Reynolds are with the Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. Dr. Simon is also with the Department of Psychiatry, Morehouse University School of Medicine, Atlanta. Ms. Begley and Ms. Stack are also with the NIMH Center for Late Life Depression Prevention and Treatment, University of Pittsburgh. Dr. Lenze is with the Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri. Dr. Blumberger and Dr. Mulsant are with the Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. Send correspondence to Dr. Reynolds (e-mail: )
| | - Charles F Reynolds
- Dr. Hall, Dr. Dew, Ms. Begley, Dr. Butters, Ms. Stack, and Dr. Reynolds are with the Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. Dr. Simon is also with the Department of Psychiatry, Morehouse University School of Medicine, Atlanta. Ms. Begley and Ms. Stack are also with the NIMH Center for Late Life Depression Prevention and Treatment, University of Pittsburgh. Dr. Lenze is with the Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri. Dr. Blumberger and Dr. Mulsant are with the Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. Send correspondence to Dr. Reynolds (e-mail: )
| |
Collapse
|
16
|
Ruglass LM, Pedersen A, Cheref S, Hu MC, Hien DA. Racial differences in adherence and response to combined treatment for full and subthreshold post-traumatic stress disorder and alcohol use disorders: A secondary analysis. J Ethn Subst Abuse 2015; 15:434-448. [PMID: 26422415 DOI: 10.1080/15332640.2015.1056927] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
We conducted a secondary data analysis to examine whether there were racial differences in adherence and treatment outcomes for participants with co-occurring full and subthreshold post-traumatic stress disorder (PTSD) and alcohol/substance use disorders (A/SUD) who were treated with Seeking Safety (a cognitive-behavioral therapy) and sertraline or Seeking Safety and placebo as part of a clinical trial. Bivarate analyses examined the association between race and adherence, and generalized estimating equations assessed whether race moderated the effect of combination treatment on PTSD and alcohol use outcomes. Except for education, there were no statistically significant racial differences in baseline demographic and psychiatric characteristics. African Americans and Caucasians were equally adherent in number of psychotherapy and medication sessions attended and medication compliance. After controlling for baseline demographics and psychiatric symptoms, however, a race by treatment condition interaction emerged suggesting that African Americans who received the Seeking Safety and sertraline treatment had significantly lower PTSD symptom severity posttreatment and at six months follow-up compared to their counterparts who received Seeking Safety and placebo. No differential effect of treatment condition was found for Caucasians. Moreover, results indicated that a diagnosis of major depressive disorder negatively impacted PTSD symptom recovery for African American participants but not for Caucasians. In conclusion, no differences emerged between African Americans and Caucasians in adherence to combination treatments for PTSD and A/SUD. Findings also suggest assessment and treatment of MDD among African Americans may improve treatment outcomes. More research is needed to determine whether the differential response to Seeking Safety and sertraline among African Americans compared to Caucasians can be replicated.
Collapse
Affiliation(s)
- Lesia M Ruglass
- a Department of Psychology , City College of New York of CUNY , New York , NY
| | - Annelisa Pedersen
- a Department of Psychology , City College of New York of CUNY , New York , NY
| | - Soumia Cheref
- b Department of Psychology , University of Houston , Houston , TX
| | - Mei-Chen Hu
- c Department of Psychiatry , Columbia University College of Physicians and Surgeons , New York , NY
| | - Denise A Hien
- d Gordon F. Derner Institute for Advanced Psychological Studies, Adelphi University and Department of Psychiatry , Columbia University College of Physicians and Surgeons , New York , NY
| |
Collapse
|
17
|
Uzoma HN, Reeves GM, Langenberg P, Khabazghazvini B, Balis TG, Johnson MA, Sleemi A, Scrandis DA, Zimmerman SA, Vaswani D, Nijjar GV, Cabassa J, Lapidus M, Rohan KJ, Postolache TT. Light treatment for seasonal Winter depression in African-American vs Caucasian outpatients. World J Psychiatry 2015; 5:138-146. [PMID: 25815263 PMCID: PMC4369543 DOI: 10.5498/wjp.v5.i1.138] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2014] [Revised: 09/07/2014] [Accepted: 11/19/2014] [Indexed: 02/05/2023] Open
Abstract
AIM: To compare adherence, response, and remission with light treatment in African-American and Caucasian patients with Seasonal Affective Disorder.
METHODS: Seventy-eight study participants, age range 18-64 (51 African-Americans and 27 Caucasians) recruited from the Greater Baltimore Metropolitan area, with diagnoses of recurrent mood disorder with seasonal pattern, and confirmed by a Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders-IV, were enrolled in an open label study of daily bright light treatment. The trial lasted 6 wk with flexible dosing of light starting with 10000 lux bright light for 60 min daily in the morning. At the end of six weeks there were 65 completers. Three patients had Bipolar II disorder and the remainder had Major depressive disorder. Outcome measures were remission (score ≤ 8) and response (50% reduction) in symptoms on the Structured Interview Guide for the Hamilton Rating Scale for Depression (SIGH-SAD) as well as symptomatic improvement on SIGH-SAD and Beck Depression Inventory-II. Adherence was measured using participant daily log. Participant groups were compared using t-tests, chi square, linear and logistic regressions.
RESULTS: The study did not find any significant group difference between African-Americans and their Caucasian counterparts in adherence with light treatment as well as in symptomatic improvement. While symptomatic improvement and rate of treatment response were not different between the two groups, African-Americans, after adjustment for age, gender and adherence, achieved a significantly lower remission rate (African-Americans 46.3%; Caucasians 75%; P = 0.02).
CONCLUSION: This is the first study of light treatment in African-Americans, continuing our previous work reporting a similar frequency but a lower awareness of SAD and its treatment in African-Americans. Similar rates of adherence, symptomatic improvement and treatment response suggest that light treatment is a feasible, acceptable, and beneficial treatment for SAD in African-American patients. These results should lead to intensifying education initiatives to increase awareness of SAD and its treatment in African-American communities to increased SAD treatment engagement. In African-American vs Caucasian SAD patients a remission gap was identified, as reported before with antidepressant medications for non-seasonal depression, demanding sustained efforts to investigate and then address its causes.
Collapse
|
18
|
Abstract
Race, ethnicity, and social class differences in the prevalence and effects of cardiovascular risk factors have been observed in many studies. Understanding the drivers of these differences is critical to efforts aimed at reducing racial disparities in health. Two articles in this volume of Psychosomatic Medicine contribute to our understanding of the underlying mechanisms driving racial disparities in health. The first article confirms the deleterious effects of psychosocial stressors on neuroendocrine function and suggests that the effects of stress on cortisol patterning are worse for Black and Latino individuals than for White individuals. The second meta-analysis article indicates that, in comparison to Whites, Black individuals display higher levels of high frequency heart rate variability, a measure of parasympathetic activity that may be an indicator of potential resilience to stress. To interpret these effects, it can be useful to move beyond assessments of phenotype and to consider the psychosocial context in which people live and assessments of risk are made. The psychosocial context includes variables and processes that influence the type, timing, and frequency of stress exposure, and the levels of background stress. Ultimately, these variables may create race and class differences in the underlying mechanisms that contribute to the development of different risk factors for adverse health outcomes such as cardiovascular disease, diabetes, and cancer. This editorial describes the relevance of incorporating the variables associated with psychosocial context when building new models in the next generation of research on health disparities.
Collapse
|
19
|
Rivera VA, Dunlop BW, Ramirez C, Kelley ME, Schneider R, Blastos B, Larson J, Mercado F, Mayberg H, Craighead WE. Enhancing Hispanic participation in mental health clinical research: development of a Spanish-speaking depression research site. Depress Anxiety 2014; 31:258-67. [PMID: 23959771 PMCID: PMC4379482 DOI: 10.1002/da.22153] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2012] [Revised: 06/10/2013] [Accepted: 06/12/2013] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Hispanics, particularly those with limited English proficiency, are underrepresented in psychiatric clinical research studies. We developed a bilingual and bicultural research clinic dedicated to the recruitment and treatment of Spanish-speaking subjects in the Predictors of Remission in Depression to Individual and Combined Treatments (PReDICT) study, a large clinical trial of treatment-naïve subjects with major depressive disorder (MDD). METHODS Demographic and clinical data derived from screening evaluations of the first 1,174 subjects presenting for participation were compared between the Spanish-speaking site (N = 275) and the primary English-speaking site (N = 899). Reasons for ineligibility (N = 888) for the PReDICT study were tallied for each site. RESULTS Compared to English speakers, Spanish speakers had a lower level of education and were more likely to be female, uninsured, and have uncontrolled medical conditions. Clinically, Spanish speakers demonstrated greater depression severity, with higher mean symptom severity scores, and a greater number of previous suicide attempts. Among the subjects who were not randomized into the PReDICT study, Spanish-speaking subjects were more likely to have an uncontrolled medical condition or refuse participation, whereas English-speaking subjects were more likely to have bipolar disorder or a non-MDD depressive disorder. CONCLUSION Recruitment of Hispanic subjects with MDD is feasible and may enhance efforts at signal detection, given the higher severity of depression among Spanish-speaking participants presenting for clinical trials. Specific approaches for the recruitment and retention of Spanish-speaking participants are required.
Collapse
Affiliation(s)
- Vivianne Aponte Rivera
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Boadie W. Dunlop
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Cynthia Ramirez
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Mary E. Kelley
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Rebecca Schneider
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Beatriz Blastos
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Jacqueline Larson
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Flavia Mercado
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Helen Mayberg
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - W. Edward Craighead
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA,Department of Psychology, Emory University, Atlanta, GA USA
| |
Collapse
|
20
|
Specificity profile of venlafaxine and sertraline in major depression: metaregression of double-blind, randomized clinical trials. Int J Neuropsychopharmacol 2014; 17:1-8. [PMID: 23953038 DOI: 10.1017/s1461145713000746] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Despite the well-known efficacy of selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) in the treatment of major depressive disorder, there is a lack of indications for each drug in different groups of patients. The aim of this study is to investigate the possible role of clinical sociodemographic factors as moderators of clinical response to venlafaxine (SNRI) and sertraline (SSRI). Research was performed on Medline and EMBASE for randomized control trials in English focused on sertraline and venlafaxine in the treatment of major depressive disorder and 59 studies were included. Clinical efficacy of each treatment was assessed on the basis of Hamilton Depressive Rating Scale and Montgomery-Asberg Depression Rating Scale. A metaregression analysis was performed to evaluate the role of clinical and sociodemographic factors as moderators of outcome, calculating the effect of each variable with the random-effects method. Gender, ethnicity and duration of depressive episode could have a role in prediction of clinical response to both antidepressants. Venlafaxine seems to have better effects in females and in Caucasian patients. Sertraline seems to be more efficacious in the treatment of females. Both drugs were more efficacious in patients who suffered a shorter episode of illness. Our results could represent an interesting point of view in the perspective of choosing the most suitable therapy based on clinical and social features for each patient. Metaregression is a retrospective analysis, based on the cumulative results of previous studies, so the lack of original data could represent the main limitation in this report and in the interpretation of the results obtained.
Collapse
|
21
|
Murphy E, Hou L, Maher BS, Woldehawariat G, Kassem L, Akula N, Laje G, McMahon FJ. Race, genetic ancestry and response to antidepressant treatment for major depression. Neuropsychopharmacology 2013; 38:2598-606. [PMID: 23827886 PMCID: PMC3828530 DOI: 10.1038/npp.2013.166] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Revised: 06/22/2013] [Accepted: 06/25/2013] [Indexed: 11/09/2022]
Abstract
The Sequenced Treatment Alternatives to Relieve Depression (STAR*D) Study revealed poorer antidepressant treatment response among black compared with white participants. This racial disparity persisted even after socioeconomic and baseline clinical factors were taken into account. Some studies have suggested genetic contributions to this disparity, but none have attempted to disentangle race and genetic ancestry. Here we used genome-wide single-nucleotide polymorphism (SNP) data to examine independent contributions of race and genetic ancestry to citalopram response. Secondary data analyses included 1877 STAR*D participants who completed an average of 10 weeks of citalopram treatment and provided DNA samples. Participants reported their race as White (n=1464), black (n=299) or other/mixed (n=114). Genetic ancestry was estimated by multidimensional scaling (MDS) analyses of about 500 000 SNPs. Ancestry proportions were estimated by STRUCTURE. Structural equation modeling was used to examine the direct and indirect effects of observed and latent predictors of response, defined as change in the Quick Inventory of Depressive Symptomatology (QIDS) score from baseline to exit. Socioeconomic and baseline clinical factors, race, and anxiety significantly predicted response, as previously reported. However, direct effects of race disappeared in all models that included genetic ancestry. Genetic African ancestry predicted lower treatment response in all models. Although socioeconomic and baseline clinical factors drive racial differences in antidepressant response, genetic ancestry, rather than self-reported race, explains a significant fraction of the residual differences. Larger samples would be needed to identify the specific genetic mechanisms that may be involved, but these findings underscore the importance of including more African-American patients in drug trials.
Collapse
Affiliation(s)
- Eleanor Murphy
- Human Genetics Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, US Department of Health and Human Services, Bethesda, MD, USA
| | - Liping Hou
- Human Genetics Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, US Department of Health and Human Services, Bethesda, MD, USA
| | - Brion S Maher
- Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Girma Woldehawariat
- Human Genetics Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, US Department of Health and Human Services, Bethesda, MD, USA
| | - Layla Kassem
- Human Genetics Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, US Department of Health and Human Services, Bethesda, MD, USA
| | - Nirmala Akula
- Human Genetics Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, US Department of Health and Human Services, Bethesda, MD, USA
| | - Gonzalo Laje
- Human Genetics Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, US Department of Health and Human Services, Bethesda, MD, USA
| | - Francis J McMahon
- Human Genetics Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, US Department of Health and Human Services, Bethesda, MD, USA
| |
Collapse
|
22
|
Murphy EJ, Kassem L, Chemerinski A, Rush AJ, Laje G, McMahon FJ. Retention and attrition among African Americans in the STAR*D study: what causes research volunteers to stay or stray? Depress Anxiety 2013; 30:1137-44. [PMID: 23723044 PMCID: PMC3818393 DOI: 10.1002/da.22134] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Revised: 04/02/2013] [Accepted: 05/04/2013] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND High attrition rates among African-Americans (AA) volunteers are a persistent problem that makes clinical trials less representative and complicates estimation of treatment outcomes. Many studies contrast AA with other ethnic/racial groups, but few compare the AA volunteers who remain in treatment with those who leave. Here, in addition to comparing patterns of attrition between African Americans and Whites, we identify predictors of overall and early attrition among African Americans. METHOD Sample comprised non-Hispanic African-American (n = 673) and White (n = 2,549) participants in the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study. Chi-square tests were used to examine racial group differences in reasons for exit. Multivariate logistic regression was used to examine predictors of overall attrition, early attrition (by level 2) and top reasons cited for attrition among African Americans. RESULTS Both African-American and White dropouts most commonly cited noncompliance reasons for attrition during the earlier phases of the study, while citing reasons related to efficacy and medication side effects later in the study. Satisfaction with treatment strongly predicted overall attrition among African Americans independent of socioeconomic, clinical, medical or psychosocial factors. Early attrition among African American dropouts was associated with less psychiatric comorbidity, and higher perceived physical functioning but greater severity of clinician-rated depression. CONCLUSIONS Compliance, efficacy, and side effects are important factors that vary in relative importance during the course of a clinical trial. For African Americans in such trials, retention strategies should be broadened to emphasize patient engagement and satisfaction during the critical periods immediately following enrollment and treatment initiation.
Collapse
Affiliation(s)
- Eleanor J Murphy
- Human Genetics Branch, Intramural Research Program, National Institute of Mental Health, NIH, USDHHS,Corresponding Author, 35 Convent Drive, Building 35, Porter Bldg, RM 1A-209, Bethesda, MD, 20892. Tel: (301) 451-3813; Fax (301) 402-7094;
| | - Layla Kassem
- Human Genetics Branch, Intramural Research Program, National Institute of Mental Health, NIH, USDHHS
| | - Anat Chemerinski
- Human Genetics Branch, Intramural Research Program, National Institute of Mental Health, NIH, USDHHS
| | - A. John Rush
- Duke-National University of Singapore, Singapore
| | - Gonzalo Laje
- Human Genetics Branch, Intramural Research Program, National Institute of Mental Health, NIH, USDHHS
| | - Francis J. McMahon
- Human Genetics Branch, Intramural Research Program, National Institute of Mental Health, NIH, USDHHS
| |
Collapse
|
23
|
Abstract
Pharmacogenetics brought the promise of matching individuals with treatments that would be efficacious while minimizing adverse events. This has been long needed in psychiatry, where treatment options have been empirical and treatment choices have been made largely based on clinical judgment. The efficacy and tolerability of antidepressants, the most common drugs used in mood disorders, have been widely studied in pharmacogenetics. Genetic association studies have been reported for pharmacokinetic genes such as the CYP450 isoenzymes or MDR1, and pharmacodynamic genes such as the serotonin transporter (SLC6A4) or the serotonin 2A receptor (HTR2A). However, despite the large number of reports, clinically useful predictors are still scarce for antidepressant monotherapy. Pharmacogenetic predictors of efficacy for mood stabilizers such as lithium and anticonvulsants have not had a dissimilar fate, and clinically meaningful markers are yet to emerge. The lack of consistent results may be in part due to small samples of heterogeneous populations and lack of consensus on phenotype definitions. Current pharmacogenetic recommendations include testing for HLA-B*1502 when using carbamazepine in Asian ancestry populations to prevent Stevens–Johnson syndrome, CYP2D6 genotypes when using pimozide, and CYP2D6 in polypharmacy to minimize drug interactions. This review, which is aimed at clinicians, lays the basis for understanding strengths and weaknesses of pharmacogenetic studies and outlines current clinical uses of these biomarkers.
Collapse
|
24
|
Cassano P, Chang T, Trinh NH, Baer L, Fava M, Mischoulon D. Differential impact of isolated psychotic symptoms on treatment outcome of major depressive disorder in the STAR*D cohort of Whites, Blacks and Latinos. J Affect Disord 2013; 150:578-84. [PMID: 23489398 PMCID: PMC3749257 DOI: 10.1016/j.jad.2013.02.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2012] [Accepted: 02/01/2013] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To determine whether isolated psychotic symptoms are more likely to be endorsed by depressed Latinos as opposed to other ethnic-racial groups; whether these symptoms affect Latinos similarly to other ethnic-racial groups in terms of treatment response; and whether they are more likely to be associated with anxiety disorders in depressed Latinos. METHODS We analyzed data from STAR*D subjects who self identified as White, Black, or Latino. Rates of isolated psychotic symptoms were assessed by the self-rated Psychiatric Diagnostic Screening Questionnaire (PDSQ) and compared between ethnic-racial groups. Depressive remission outcomes were compared within each ethnic-racial group between subjects who endorsed psychotic symptoms versus no psychotic symptoms. Associations between isolated psychotic symptoms and anxiety disorders were also examined. RESULTS Among 2597 eligible subjects with at least one post-baseline assessment and available PDSQ data excluding first-rank symptoms, the prevalence of auditory-visual hallucination was 2.5% in Whites (n=49/1928), 11.3% in Blacks (n=45/398) 6.3% in Latinos (n=17/270) (χ(2)=64.9; df=2; p<0.001). Prevalence of paranoid ideation was 15.5% in Whites (n=299/1927), 31.5% in Blacks (n=126/400), and 21.1% in Latinos (n=57/270) (χ(2)=57.3; df=2; p<0.001). Among Whites and Blacks but not Latinos, depressive remission rates were worse in subjects with auditory-visual hallucinations compared to those without them. Paranoid ideation had a significant negative impact on remission in Whites only. In all ethnic-racial groups, a significant association was found between auditory-visual hallucinations and PTSD and panic disorder. LIMITATIONS The STAR*D study did not include any structured clinician-based assessment of psychotic symptoms. CONCLUSION Latinos do not appear to have worse outcomes when treated for MDD with auditory-visual hallucinations, differently from Whites and Blacks.
Collapse
Affiliation(s)
- Paolo Cassano
- Depression Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, United States.
| | | | | | | | | | | |
Collapse
|
25
|
Thompson-Brenner H, Franko DL, Thompson DR, Grilo CM, Boisseau CL, Roehrig JP, Richards LK, Bryson SW, Bulik CM, Crow SJ, Devlin MJ, Gorin AA, Kristeller JL, Masheb R, Mitchell JE, Peterson CB, Safer DL, Striegel RH, Wilfley DE, Wilson GT. Race/ethnicity, education, and treatment parameters as moderators and predictors of outcome in binge eating disorder. J Consult Clin Psychol 2013; 81:710-21. [PMID: 23647283 DOI: 10.1037/a0032946] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Binge eating disorder (BED) is prevalent among individuals from minority racial/ethnic groups and among individuals with lower levels of education, yet the efficacy of psychosocial treatments for these groups has not been examined in adequately powered analyses. This study investigated the relative variance in treatment retention and posttreatment symptom levels accounted for by demographic, clinical, and treatment variables as moderators and predictors of outcome. METHOD Data were aggregated from 11 randomized, controlled trials of psychosocial treatments for BED conducted at treatment sites across the United States. Participants were N = 1,073 individuals meeting criteria for BED including n = 946 Caucasian, n = 79 African American, and n = 48 Hispanic/Latino participants. Approximately 86% had some higher education; 85% were female. Multilevel regression analyses examined moderators and predictors of treatment retention, Eating Disorder Examination (EDE) global score, frequency of objective bulimic episodes (OBEs), and OBE remission. RESULTS Moderator analyses of race/ethnicity and education were nonsignificant. Predictor analyses revealed African Americans were more likely to drop out of treatment than Caucasians, and lower level of education predicted greater posttreatment OBEs. African Americans showed a small but significantly greater reduction in EDE global score relative to Caucasians. Self-help treatment administered in a group showed negative outcomes relative to other treatment types, and longer treatment was associated with better outcome. CONCLUSIONS Observed lower treatment retention among African Americans and lesser treatment effects for individuals with lower levels of educational attainment are serious issues requiring attention. Reduced benefit was observed for shorter treatment length and self-help administered in groups.
Collapse
|
26
|
Lam YF, Fukui N, Sugai T, Watanabe J, Watanabe Y, Suzuki Y, Someya T. Pharmacogenomics in Psychiatric Disorders. Pharmacogenomics 2013. [DOI: 10.1016/b978-0-12-391918-2.00006-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
|
27
|
Carter GC, Cantrell RA, Victoria Zarotsky, Haynes VS, Phillips G, Alatorre CI, Goetz I, Paczkowski R, Marangell LB. Comprehensive review of factors implicated in the heterogeneity of response in depression. Depress Anxiety 2012; 29:340-54. [PMID: 22511365 DOI: 10.1002/da.21918] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Heterogeneity in overall response and outcomes to pharmacological treatment has been reported in several depression studies but with few sources that integrate these results. The goal of this study was to review the literature and attempt to identify nongenetic factors potentially predictive of overall response to depression treatments. METHODS A comprehensive review of the literature from the last 10 years was performed using three key databases (PubMed, EMBASE, and Cochrane). All relevant studies that met the inclusion criteria were selected and scored for their levels of evidence using the NICE scoring method. A subjective assessment of the strength of evidence for each factor was performed using predefined criteria. RESULTS Our broad search yielded 76 articles relevant to treatment heterogeneity. Sociodemographic factors, disease characteristics, and comorbidities were the most heavily researched areas. Some of the factors associated with more favorable overall response include being married, other social support, and low levels of baseline depressive symptoms. Evidence relating to baseline disease severity as a factor predictive of antidepressant response was particularly convincing among the factors reviewed. The presence of comorbid anxiety and pain contributed to worse antidepressant treatment outcomes. CONCLUSIONS Several factors either predictive of or associated with overall response to antidepressant treatment have been identified. Inclusion of factors predictive of response in the design of future trials may help tailor treatments to depression patients presenting to the average clinical practice, resulting in improved outcomes.
Collapse
Affiliation(s)
- Gebra Cuyún Carter
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, Indiana, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Hankerson SH, Fenton MC, Geier TJ, Keyes KM, Weissman MM, Hasin DS. Racial differences in symptoms, comorbidity, and treatment for major depressive disorder among black and white adults. J Natl Med Assoc 2011; 103:576-84. [PMID: 21999032 PMCID: PMC3866690 DOI: 10.1016/s0027-9684(15)30383-7] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Racial differences in the clinical nature of major depressive disorder (MDD) could contribute to treatment disparities, but national data with large samples are limited. Our objective was to examine black-white differences in clinical characteristics and treatment for MDD from one of the largest, national community samples of US adults. METHODS Non-Hispanic black and white adults (n=32752) from the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions produced data on 1866 respondents who met criteria for MDD based on the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) in the preceding 12 months. Outcome measures were depressive symptoms, comorbid psychiatric and medical disorders, disability, and treatment. RESULTS Blacks with MDD had significantly higher odds of initial insomnia, early-morning awakening, and restlessness than whites. Odds of hypertension (odds ratio [OR), 2.16; 95% confidence interval [CI], 1.48-3.14), obesity (OR, 1.98; 95% CI, 1.45-2.69), and liver disease (OR, 3.68; 95% CI, 1.20-11.30) were higher among blacks than whites. In unadjusted models, blacks had greater impairment than whites in social and physical functioning. However, adjusting for sociodemographic characteristics eliminated these differences. Blacks were less likely than whites to receive outpatient services (OR, 0.51; 95% CI, 0.36-0.72) and be prescribed medications for MDD, but were more likely to receive emergency room and inpatient treatment. CONCLUSIONS We found few racial differences in depressive symptoms, psychiatric comorbidity, and disability after adjusting for sociodemographic factors. Blacks' lower utilization of ambulatory treatment for MDD and greater medical comorbidity, emergency department use, and hospitalization suggests that management of MDD among blacks should be emphasized in primary care or other settings where treatment is more accessible.
Collapse
Affiliation(s)
- Sidney H Hankerson
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | | | | | | | | | | |
Collapse
|
29
|
Examining the role of race and ethnicity in relapse rates of major depressive disorder. Compr Psychiatry 2011; 52:151-5. [PMID: 21295221 PMCID: PMC3052934 DOI: 10.1016/j.comppsych.2010.05.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2010] [Revised: 05/01/2010] [Accepted: 05/04/2010] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE We test the hypothesis that racial or ethnic differences exist in relapse rates to fluoxetine discontinuation in major depressive disorder (MDD). METHOD Data are from a prospective study examining the relapse rates secondary to fluoxetine discontinuation in MDD. Subjects in the discontinuation phase consisted of 255 adults aged 18 to 65: 214 subjects who self-identified as white, 22 as African American, 13 as Latino American, and 6 as Asian American. RESULTS In both the fluoxetine and placebo groups, no statistically significant differences emerged when comparing time to relapse for minority groups as compared to the white population. Adjusting for statistically significant predictors of relapse (symptom severity, neurovegetative symptom pattern, sex) and for educational level did not change the outcome of the survival analyses. CONCLUSIONS Although the size of minority groups in this sample was modest, in a randomized, controlled trial setting, minority and white patients may have similar rates of relapse in MDD. This finding reinforces the importance of maintenance treatment in relapse for both minority as well as white patients with MDD. Given the self-selecting nature of clinical trials, future studies are needed to further examine the potential influence of underlying cultural factors on clinical outcomes in minority populations.
Collapse
|
30
|
Joseph NT, Myers HF, Schettino JR, Olmos NT, Bingham-Mira C, Lesser IM, Poland RE. Support and Undermining in Interpersonal Relationships are Associated with Symptom Improvement in a Trial of Antidepressant Medication. Psychiatry 2011; 74:240-54. [PMID: 21916630 PMCID: PMC3374597 DOI: 10.1521/psyc.2011.74.3.240] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The purpose of this study was to investigate the relationships of chronic stress, social undermining, and social support with symptom reduction and remission in depressed patients treated with antidepressant medication (citalopram), and to determine whether these relationships were moderated by ethnicity. A sample of 301 treatment-seeking adult patients with non-psychotic depression, including 169 African American and 132 Caucasian men and women, were enrolled in an eight week, dose-escalation clinical trial. Intent-to-treat analyses indicated that, consistent with expectations, more baseline social support was associated with greater symptom reduction and higher likelihood of remission, especially at higher levels of social undermining. Additionally, increases in social support from baseline to last visit were associated with more symptom reduction and higher likelihood of remission. However, contrary to expectations, higher levels of baseline social undermining were associated with more symptom reduction in Caucasians, but not in African Americans. Results supported the treatment-enhancing effect of available social support at the beginning of treatment and over the course of treatment. Efforts to enhance social support for patients on antidepressants should be considered as part of comprehensive treatment.
Collapse
Affiliation(s)
- Nataria T. Joseph
- Department of Psychology, University of California at Los Angeles,Please address correspondence to Nataria T. Joseph, C. Phil., Department of Psychology, University of California at Los Angeles, 1285 Franz Hall, Los Angeles, CA 90095-1563; (310) 295-8882;
| | - Hector F. Myers
- Department of Psychology, University of California at Los Angeles,Charles R. Drew University of Medicine & Science
| | | | - Natasha T. Olmos
- Department of Psychology, University of California at Los Angeles
| | | | - Ira M. Lesser
- Harbor-UCLA Medical Center and the Los Angeles Biomedical Research Institute
| | | |
Collapse
|
31
|
Kroenke K, Theobald D, Wu J, Norton K, Morrison G, Carpenter J, Tu W. Effect of telecare management on pain and depression in patients with cancer: a randomized trial. JAMA 2010; 304:163-71. [PMID: 20628129 PMCID: PMC3010214 DOI: 10.1001/jama.2010.944] [Citation(s) in RCA: 239] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
CONTEXT Pain and depression are 2 of the most prevalent and treatable cancer-related symptoms, yet they frequently go unrecognized, undertreated, or both. OBJECTIVE To determine whether centralized telephone-based care management coupled with automated symptom monitoring can improve depression and pain in patients with cancer. DESIGN, SETTING, AND PATIENTS Randomized controlled trial conducted in 16 community-based urban and rural oncology practices involved in the Indiana Cancer Pain and Depression (INCPAD) trial. Recruitment occurred from March 2006 through August 2008 and follow-up concluded in August 2009. The participating patients had depression (Patient Health Questionnaire-9 score > or = 10), cancer-related pain (Brief Pain Inventory [BPI] worst pain score > or = 6), or both. INTERVENTION The 202 patients randomly assigned to receive the intervention and 203 to receive usual care were stratified by symptom type. Patients in the intervention group received centralized telecare management by a nurse-physician specialist team coupled with automated home-based symptom monitoring by interactive voice recording or Internet. MAIN OUTCOME MEASURES Blinded assessment at baseline and at months 1, 3, 6, and 12 for depression (20-item Hopkins Symptom Checklist [HSCL-20]) and pain (BPI) severity. RESULTS Of the 405 participants enrolled in the study, 131 had depression only, 96 had pain only, and 178 had both depression and pain. Of the 274 patients with pain, 137 patients in the intervention group had greater improvements in BPI pain severity over the 12 months of the trial whether measured as a continuous severity score or as a categorical pain responder (> or = 30% decrease in BPI) than the 137 patients in the usual-care group (P < .001 for both). Similarly, of the 309 patients with depression, the 154 patients in the intervention group had greater improvements in HSCL-20 depression severity over the 12 months of the trial whether measured as a continuous severity score or as a categorical depression responder (> or = 50% decrease in HSCL) than the 155 patients in the usual care group (P < .001 for both). The standardized effect size for between-group differences at 3 and 12 months was 0.67 (95% confidence interval [CI], 0.33-1.02) and 0.39 (95% CI, 0.01-0.77) for pain, and 0.42 (95% CI, 0.16-0.69) and 0.41 (95% CI, 0.08-0.72) for depression. CONCLUSION Centralized telecare management coupled with automated symptom monitoring resulted in improved pain and depression outcomes in cancer patients receiving care in geographically dispersed urban and rural oncology practices. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00313573.
Collapse
Affiliation(s)
- Kurt Kroenke
- Center for Implementing Evidence-Based Practice, Richard Roudebush VA Medical Center, Indianapolis, IN, USA.
| | | | | | | | | | | | | |
Collapse
|
32
|
Abstract
PURPOSE OF REVIEW Although there has been an increase in research on postpartum depression (PPD), an inadequate focus has been placed on immigrant women. This is a significant limitation given the rapidly changing demographics in North America. RECENT FINDINGS Immigrants face unique and multiple layers of challenges that may compromise their mental health and prevent them from receiving adequate and equitable care. For immigrant women, many of these stressors are especially compounded in the vulnerable postpartum period, resulting in PPD. Cultural values and practices may be protective in some instances, whereas in other instances they exacerbate PPD. There is a significant gap in existing literature regarding the complex psychosocial, cultural, and spiritual factors that may moderate the effects of the depression. Furthermore, the measurement of PPD is hampered by cross-cultural methodological challenges. SUMMARY Given the complexity of the psychosocial issues facing immigrant women, there is a need to develop a comprehensive response toward addressing the multifaceted challenges, ensuring equitable immigration and related policies; adequate community resources and social services to address social determinants of health; inclusiveness in public health and prevention strategies; equitable access to a culturally competent healthcare system; capacity building of marginalized communities; and culturally competent interventions at the individual level. Additional research using the bidimensional model of acculturation is needed.
Collapse
|
33
|
Leuchter AF, Cook IA, Hunter AM, Korb AS. A new paradigm for the prediction of antidepressant treatment response. DIALOGUES IN CLINICAL NEUROSCIENCE 2010. [PMID: 20135901 PMCID: PMC3181929 DOI: 10.31887/dcns.2009.11.4/afleuchter] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Current treatment of Major Depressive Disorder utilizes a trial-and-error sequential treatment strategy that results in delays in achieving response and remission for a majority of patients. Protracted ineffective treatment prolongs patient suffering and increases health care costs. In addition, long and unsuccessful antidepressant trials may diminish patient expectations, reinforce negative cognitions, and condition patients not to respond during subsequent antidepressant trials, thus contributing to further treatment resistance. For these reasons, it is critical to identify reliable predictors of antidepressant treatment response that can be used to shorten or eliminate lengthy and ineffective trials. Research on possible endophenotypic as well as genomic predictors has not yet yielded reliable predictors. The most reliable predictors identified thus far are symptomatic and physiologic characteristics of patients that emerge early in the course of treatment. We propose here the term “response endophenotypes” (REs) to describe this class of predictors, defined as latent measurable symptomatic or neurobiologie responses of individual patients that emerge early in the course of treatment, and which carry strong predictive power for individual patient outcomes. Use of REs constitutes a new paradigm in which medication treatment trials that are likely to be ineffective could be stopped within 1 to 2 weeks and other medication more likely to be effective could be started. Data presented here suggest that early changes in symptoms, quantitative electroencephalography, and gene expression could be used to construct effective REs. We posit that this new paradigm could lead to earlier recovery from depressive illness and ultimately produce profound health and economic benefits.
Collapse
Affiliation(s)
- Andrew F Leuchter
- Laboratory of Brain Behavior, and Pharmacology, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA 90024, USA.
| | | | | | | |
Collapse
|
34
|
Lesser IM, Myers HF, Lin KM, Bingham Mira C, Joseph NT, Olmos NT, Schettino J, Poland RE. Ethnic differences in antidepressant response: a prospective multi-site clinical trial. Depress Anxiety 2010; 27:56-62. [PMID: 19960492 PMCID: PMC3113513 DOI: 10.1002/da.20619] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Although depression is a highly prevalent condition that occurs in all ethnic groups, the influence of ethnicity on treatment response still remains unclear. METHODS A prospective 8-week, open-label clinical trial comparing the efficacy and side effects of citalopram (CIT) with dose escalation (20-60 mg/day) was performed in African-Americans and Caucasians with nonpsychotic major depression. The intent-to-treat sample consisted of 301 participants (169 African-Americans and 132 Caucasians). RESULTS Although African-Americans were more socially disadvantaged and had a more severe depression, outcomes between the groups were similar. Remission rates were approximately 50% in both groups and about 2/3 of participants met response criteria. Retention was greater than 75% in both groups, with no differences in dropout rate. There were no differences in the number of completers, number of visits made, final dose of CIT, or in side effect profiles. CONCLUSIONS These results confirm the growing body of evidence, including recent studies using measurement-based care, that patients from minority groups have outcomes that are similar to those of Caucasians. The provision of measurement-based care and encouragement of patient participation can reduce ethnic differences in response to treatment for depression.
Collapse
Affiliation(s)
- Ira M Lesser
- Department of Psychiatry, Harbor-UCLA Medical Center and the Los Angeles Biomedical Research Institute, Torrance, California, USA.
| | | | | | | | | | | | | | | |
Collapse
|
35
|
Rush AJ, Warden D, Wisniewski SR, Fava M, Trivedi MH, Gaynes BN, Nierenberg AA. STAR*D: revising conventional wisdom. CNS Drugs 2009; 23:627-47. [PMID: 19594193 DOI: 10.2165/00023210-200923080-00001] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The STAR*D (Sequenced Treatment Alternatives to Relieve Depression) study used a series of sequenced, randomized treatment trials following a first and, if needed, subsequent treatment steps to define the tolerability and effectiveness of various options in both acute and longer term treatment. Adult outpatients (n=4041) with nonpsychotic major depressive disorder, substantial chronic and recurrent depression, and co-morbid psychiatric and general medical conditions were enrolled in 41 representative primary and specialty care settings. About one-third of participants remitted in first step treatment with citalopram, 50% of these within 6 weeks. Poorer outcomes were associated with minority status, socioeconomic disadvantage, more axis I and III co-morbid disorders, lower function and quality of life, and anxious and melancholic features. In step 2 medication switch, there were no significant differences in remission among within-class, out-of-class or dual-action agents: sertraline (27%), bupropion-sustained release (26%) and venlafaxine-extended release (25%). In step 2 medication augmentation of citalopram, there was no significant difference in remission between bupropion-sustained release (39%) and buspirone (33%), although participants using bupropion-sustained release had greater symptom reduction and better tolerability. There were no significant differences in remission in step 2 between cognitive therapy and medication treatment in either the switch (31% vs 27%) or augmentation (31% vs 33%) strategies, although participants in cognitive therapy augmentation had a longer time to remission than those in medication augmentation (55 vs 40 days). In step 3, there were no differences in remission between a switch to mirtazapine (8%) or nortriptyline (12%), or between augmentation with lithium (13%) or T(3) (triiodothyronine, liothyronine) [25%], although more participants discontinued lithium due to adverse effects than discontinued T(3). In the fourth step, there was no difference in remission between tranylcypromine (14%) or venlafaxine-extended release plus mirtazapine (16%), although the combination treatment had fewer adverse effects and had the advantages of not requiring a washout period or diet restrictions. Participants requiring more than two well delivered treatments may be characterized as treatment resistant given the substantially lower remission rates after that point. Treatment resistance was associated with more concurrent axis I or III co-morbid conditions, socioeconomic disadvantage, chronicity and melancholic or anxious features. However, if participants remained in treatment for up to four steps, about 67% reached remission. Times to remission were not substantially longer for later treatment steps. The importance of reaching remission is highlighted by the lower relapse rates in naturalistic follow-up for participants entering in remission compared with those entering with response but not remission (step 1: 34% vs 59%; step 2: 47% vs 68%; step 3: 42% vs 76%; step 4: 50% vs 83%). Clinical decision making based on the itemized measurement of symptoms and adverse effects at each treatment visit was feasible in STAR*D's real world settings and resulted in adequate dosages and durations of treatment that generally exceeded those typically found in practice settings. Although switch and augmentation strategies could not be directly compared due to the equipoise stratified randomized design, the higher remission rates at step 2 with medication augmentation are intriguing and merit further study.
Collapse
Affiliation(s)
- A John Rush
- Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
| | | | | | | | | | | | | |
Collapse
|
36
|
Uebelacker LA, Strong D, Weinstock LM, Miller IW. Use of item response theory to understand differential functioning of DSM-IV major depression symptoms by race, ethnicity and gender. Psychol Med 2009; 39:591-601. [PMID: 18588740 DOI: 10.1017/s0033291708003875] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Psychological literature and clinical lore suggest that there may be systematic differences in how various demographic groups experience depressive symptoms, particularly somatic symptoms. The aim of the current study was to use methods based on item response theory (IRT) to examine whether, when equating for levels of depression symptom severity, there are demographic differences in the likelihood of reporting DSM-IV depression symptoms. METHOD We conducted a secondary analysis of a subset (n=13 753) of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) dataset, which includes a large epidemiological sample of English-speaking Americans. We compared data from women and men, Hispanics and non-Hispanic Whites, African Americans and Whites, Asian Americans and Whites, and American Indians and Whites. RESULTS There were few differences overall, although the differences that we did find were primarily limited to somatic symptoms, and particularly appetite and weight disturbance. CONCLUSIONS For the most part, individuals responded similarly to the criteria used to diagnose major depression across gender and across English-speaking racial and ethnic groups in the USA.
Collapse
Affiliation(s)
- L A Uebelacker
- Warren Alpert Medical School of Brown University and Butler Hospital, Providence, RI 02906, USA.
| | | | | | | |
Collapse
|
37
|
Lekman M, Paddock S, McMahon FJ. Pharmacogenetics of major depression: insights from level 1 of the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial. Mol Diagn Ther 2008; 12:321-30. [PMID: 18803430 PMCID: PMC2839187 DOI: 10.1007/bf03256297] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Major depression is a serious mental illness frequently associated with devastating consequences for those affected. Suicide rates are significantly elevated, creating a sense of urgency to identify effective yet safe treatment options. A plethora of antidepressants are available on the market today, designed to act on different neurotransmitter systems in the brain, providing the clinician with several treatment strategies. There is, however, very little guidance as to which antidepressant may be most successful in a certain individual. Biomarkers that can predict treatment outcome would thus be of great value, shortening the time until remission and reducing costs for the healthcare system by reducing unsuccessful treatment attempts. The proven contribution of heredity to major depression risk suggests that genetic markers may be good biomarkers for treatment outcome.The Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study and a large ancillary pharmacogenetic study in 1953 STAR*D participants constitute the largest effort to date to identify genetic predictors of antidepressant treatment outcome. In this review, the results of candidate gene studies carried out so far are summarized and discussed, and some future directions are proposed.
Collapse
Affiliation(s)
- Magnus Lekman
- Department of Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Silvia Paddock
- Department of Neuroscience, Karolinska Institute, Stockholm, Sweden
- Genetic Basis of Mood & Anxiety disorders, Mood & Anxiety program, National Institute of Mental Health (NIMH), National Institutes of Health (NIH), Dept. of Health & Human Services (DHHS), Bethesda, MD, USA
| | - Francis J. McMahon
- Genetic Basis of Mood & Anxiety disorders, Mood & Anxiety program, National Institute of Mental Health (NIMH), National Institutes of Health (NIH), Dept. of Health & Human Services (DHHS), Bethesda, MD, USA
| |
Collapse
|