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Maciaszek J, Pawłowski T, Hadryś T, Misiak B. Baseline depressive symptoms as predictors of efficacy and tolerability of the treatment with duloxetine: a network analysis approach. Front Psychiatry 2023; 14:1210289. [PMID: 37398593 PMCID: PMC10312095 DOI: 10.3389/fpsyt.2023.1210289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 06/02/2023] [Indexed: 07/04/2023] Open
Abstract
Introduction Depression is considered one of the most prevalent and burdensome mental disorders. Only 50-60% of patients respond to first-line treatment. Individuals with depression might benefit from personalized treatment, tailored to the individual needs of the patient. In this study, we aimed to explore the baseline characteristics of depressive symptoms associated with a good response to duloxetine treatment using a network analysis. Additionally, the relationship between baseline psychopathological symptoms and treatment tolerability was assessed. Methods The sample of 88 drug-free patients with active depressive episode, who started monotherapy with increasing doses of duloxetine were evaluated. The Hamilton Depression Rating Scale (HAM-D) was used to assess depression severity and the UKU side effect rating scale to monitor adverse drug reactions (ADRs). A network analysis that explored interactions of specific baseline depression symptoms, treatment efficacy and tolerability was performed. Results The node representing duloxetine treatment efficacy was directly connected to the nodes representing the first HAM-D item ("depressed mood") (edge weight = 0.191) and duloxetine dose (edge weight = 0.144). The node representing ADRs was directly connected to only one node representing the baseline score of the HAM-D anxiety (psychic) item (edge weight = 0.263). Discussion Our findings indicate that individuals with depression presenting greater levels of depressed mood and lower levels of anxiety symptoms might better respond to the treatment with duloxetine in terms of efficacy and tolerability.
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Tao Y, Hou W, Niu H, Ma Z, Zheng Z, Wang S, Liu X, Zhang L. Comparing the centrality symptoms of major depressive disorder samples across junior high school students, senior high school students, college students and elderly adults during city lockdown of COVID-19 pandemic-A network analysis. J Affect Disord 2023; 324:190-198. [PMID: 36586620 PMCID: PMC9797224 DOI: 10.1016/j.jad.2022.12.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 09/11/2022] [Accepted: 12/23/2022] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Recently, in the view of network analysis, depression has been conceptualized as a complex and dynamic network model combining individual symptoms. To date, no studies have systematically examined and compared depressive symptom networks across different populations. METHODS A total of 36,105 participants were recruited and asked to complete the Patient Health Questionnaire-9 among junior high school students, senior high school students, college students, and elderly adults who were more susceptible to depression during the COVID-19 lockdown in China. In the analysis, we applied the optimal cutoff score ≥ 8 for students and a score ≥ 6 for elderly adults to identify 5830 participants who were likely to be depressed. The index of "strength" was used to identify central symptoms in the network structure. RESULTS The results showed that Sad Mood was the most central symptom among junior high school students, senior high school students, and college students, but the most central symptom in the elderly was Guilt. Among the top three central symptoms, Suicide Ideation was unique to senior high school students, while Anhedonia was most prevalent among college students. Guilt - Suicide Ideation, Anhedonia - Energy, Anhedonia - Sad Mood, and Sleep - Energy showed the strongest association among junior and senior high school students, college students, and elderly adults, respectively. NCT (i.e., Network Comparison Test) suggested that the network's global connectivity was ultimately inconsistent, but the network structure remained roughly intact. CONCLUSION In treatment, targeting central symptoms may be critical to alleviating depression.
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Affiliation(s)
- Yanqiang Tao
- Faculty of Psychology, Beijing Normal University, Beijing 100875, China; Beijing Key Laboratory of Applied Experimental Psychology, National Demonstration Center for Experimental Psychology Education, Beijing 100875, China
| | - Wenxin Hou
- Faculty of Psychology, Beijing Normal University, Beijing 100875, China; Beijing Key Laboratory of Applied Experimental Psychology, National Demonstration Center for Experimental Psychology Education, Beijing 100875, China
| | - Haiqun Niu
- School of Psychology, Nanjing Normal University, Nanjing 210097, China
| | - Zijuan Ma
- School of Psychology, South China Normal University, Guangzhou 510631, China.
| | - Zeqing Zheng
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing 100875, China.
| | - Shujian Wang
- Faculty of Psychology, Beijing Normal University, Beijing 100875, China; Beijing Key Laboratory of Applied Experimental Psychology, National Demonstration Center for Experimental Psychology Education, Beijing 100875, China.
| | - Xiangping Liu
- Faculty of Psychology, Beijing Normal University, Beijing 100875, China; Beijing Key Laboratory of Applied Experimental Psychology, National Demonstration Center for Experimental Psychology Education, Beijing 100875, China.
| | - Liang Zhang
- College Students' Mental Health Education Center, Northeast Agricultural University, Harbin 150030, China; College of Education for the Future, Beijing Normal University AT ZHUHAI, Zhuhai 519087, China.
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Chen IP, Huang CC, Huang HC, Yang FPG, Ko KT, Lee YT, Sun FJ, Liu SI. Adjunctive Bright Light Therapy for Non-Seasonal Major Depressive Disorder: A Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12430. [PMID: 36231728 PMCID: PMC9566126 DOI: 10.3390/ijerph191912430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/25/2022] [Accepted: 09/27/2022] [Indexed: 06/16/2023]
Abstract
This double-blind, randomized controlled trial assessed bright light therapy (BLT) augmentation efficacy compared with placebo light in treating non-seasonal major depressive disorder. The study participants belonged to a subtropical area (24.5°-25.5°N) with extensive daylight and included outpatients who had received stable dosages and various regimens of antidepressive agents for 4 weeks before enrollment. The outcomes were the 17-item Hamilton Depression Rating Scale, Montgomery-Asberg Depression Rating Scale, and Patient Health Questionnaire-9, which were assessed at weeks 1, 2, and 4. A total of 43 participants (mean age 45 years, ranging from 22-81) were randomized into the BLT [n = 22] and placebo light groups [n = 21]. After a 4-week administration of morning light therapy (30 min/day), depressive symptoms did not reduce significantly, which might be due to the small sample size. Nonetheless, this study had some strengths because it was conducted in warmer climates, unlike other studies, and examined diverse Asians with depression. Our findings suggest that several factors, such as poor drug response, different antidepressive regimens, duration of BLT, and daylength variability (i.e., natural daylight in the environment) may influence the utility of add-on BLT. Researchers may consider these important factors for future non-seasonal depression studies in subtropical environments.
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Affiliation(s)
- I-Peng Chen
- Department of Psychiatry, MacKay Memorial Hospital, Taipei 104217, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei City 252005, Taiwan
| | - Chun-Chao Huang
- Department of Medicine, MacKay Medical College, New Taipei City 252005, Taiwan
- Department of Radiology, MacKay Memorial Hospital, Taipei 104217, Taiwan
- MacKay Junior College of Medicine, Nursing and Management, Taipei 112021, Taiwan
| | - Hui-Chun Huang
- MacKay Junior College of Medicine, Nursing and Management, Taipei 112021, Taiwan
- Department of Medical Research, MacKay Memorial Hospital, Taipei 104217, Taiwan
| | - Fan-Pei Gloria Yang
- Department of Foreign Languages and Literature, National Tsing Hua University, Hsinchu 300044, Taiwan
- Center for Cognition and Mind Sciences, National Tsing Hua University, Hsinchu 300044, Taiwan
- Department of Radiology, Graduate School of Dentistry, Osaka University, Osaka 565-0871, Japan
| | - Kai-Ting Ko
- Department of Psychiatry, MacKay Memorial Hospital, Taipei 104217, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei City 252005, Taiwan
| | - Yun-Tse Lee
- Department of Psychiatry, MacKay Memorial Hospital, Taipei 104217, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei City 252005, Taiwan
| | - Fang-Ju Sun
- MacKay Junior College of Medicine, Nursing and Management, Taipei 112021, Taiwan
- Department of Medical Research, MacKay Memorial Hospital, Taipei 104217, Taiwan
- Institute of Biomedical Informatics, National Yang Ming Chiao Tung University, Hsinchu 300093, Taiwan
| | - Shen-Ing Liu
- Department of Psychiatry, MacKay Memorial Hospital, Taipei 104217, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei City 252005, Taiwan
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Cheung T, Jin Y, Lam S, Su Z, Hall BJ, Xiang YT. Network analysis of depressive symptoms in Hong Kong residents during the COVID-19 pandemic. Transl Psychiatry 2021; 11:460. [PMID: 34489416 PMCID: PMC8419676 DOI: 10.1038/s41398-021-01543-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 07/12/2021] [Accepted: 07/26/2021] [Indexed: 02/08/2023] Open
Abstract
In network theory depression is conceptualized as a complex network of individual symptoms that influence each other, and central symptoms in the network have the greatest impact on other symptoms. Clinical features of depression are largely determined by sociocultural context. No previous study examined the network structure of depressive symptoms in Hong Kong residents. The aim of this study was to characterize the depressive symptom network structure in a community adult sample in Hong Kong during the COVID-19 pandemic. A total of 11,072 participants were recruited between 24 March and 20 April 2020. Depressive symptoms were measured using the Patient Health Questionnaire-9. The network structure of depressive symptoms was characterized, and indices of "strength", "betweenness", and "closeness" were used to identify symptoms central to the network. Network stability was examined using a case-dropping bootstrap procedure. Guilt, Sad Mood, and Energy symptoms had the highest centrality values. In contrast, Concentration, Suicide, and Sleep had lower centrality values. There were no significant differences in network global strength (p = 0.259), distribution of edge weights (p = 0.73) and individual edge weights (all p values > 0.05 after Holm-Bonferroni corrections) between males and females. Guilt, Sad Mood, and Energy symptoms were central in the depressive symptom network. These central symptoms may be targets for focused treatments and future psychological and neurobiological research to gain novel insight into depression.
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Affiliation(s)
- Teris Cheung
- School of Nursing, Hong Kong Polytechnic University, Hong Kong SAR, China.
| | - Yu Jin
- College of Education for the Future, Beijing Normal University, Beijing, China
| | - Simon Lam
- School of Nursing, Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Zhaohui Su
- Center on Smart and Connected Health Technologies, Mays Cancer Center, School of Nursing, UT Health San Antonio, San Antonio, TX, USA
| | - Brian J Hall
- Global and Community Mental Health Research Group, New York University (Shanghai), Shanghai, China
- School of Global Public Health, New York University, New York, NY, USA
| | - Yu-Tao Xiang
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao SAR, China.
- Centre for Cognitive and Brain Sciences, University of Macau, Macao SAR, China.
- Institute of Advanced Studies in Humanities and Social Sciences, University of Macau, Macao SAR, China.
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Lam RW, Wajsbrot DB, Meier E, Pappadopulos E, Mackell JA, Boucher M. Effect of desvenlafaxine 50 mg and 100 mg on energy and lassitude in patients with major depressive disorder: A pooled analysis. J Psychopharmacol 2017; 31:1204-1214. [PMID: 28718346 DOI: 10.1177/0269881117719261] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Nine randomized, double-blind, placebo-controlled studies of major depressive disorder were pooled to evaluate the effects of desvenlafaxine 50- and 100-mg/d on energy and lassitude in adults with major depressive disorder ( n=4279). Changes from baseline to endpoint in 17-item Hamilton Rating Scale for Depression (HAM-D17) Work and Activities, Retardation, and Somatic Symptoms General items, HAM-D17 psychomotor retardation factor, and Montgomery-Åsberg Depression Rating Scale Lassitude item were analyzed with a mixed model for repeated measures analysis of variance. Associations between residual energy measures and functional impairment, based on the Sheehan Disability Scale, were modeled using stepwise multiple linear regression. Improvement from baseline was significantly greater for both desvenlafaxine doses versus placebo on all energy symptom outcomes at week 8 (all p⩽0.005). Both early improvement in HAM-D17 psychomotor retardation at week 2 and residual energy symptoms at week 8 were associated with Sheehan Disability Scale total score at week 8 (all p⩽0.001). Among Sheehan Disability Scale remitters and responders, the HAM-D17 psychomotor retardation score at week 8 was significantly lower with desvenlafaxine (both doses) than placebo. Desvenlafaxine 50 and 100 mg/d significantly improved energy and lassitude symptoms in patients with major depressive disorder. Both early improvement in energy and fewer residual energy symptoms were associated with functional improvement.
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Tokuoka H, Nishihara M, Fujikoshi S, Yoshikawa A, Kuga A. Predicting treatment outcomes of major depressive disorder by early improvement in painful physical symptoms: a pooled analysis of double-blind, placebo-controlled trials of duloxetine. Neuropsychiatr Dis Treat 2017; 13:2457-2467. [PMID: 29026309 PMCID: PMC5626379 DOI: 10.2147/ndt.s143093] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE We determined if early improvement in painful physical symptoms (PPS) can be a predictor of remission in the treatment of major depressive disorder (MDD). METHODS We included randomized, double-blind, parallel-group clinical trials of duloxetine (40-60 mg/day) versus placebo for the acute treatment of MDD with associated PPS. Only those studies using the Montgomery-Åsberg Depression Rating Scale (MADRS) and the Brief Pain Inventory - Short Form (BPI-SF) were included. Three studies met all criteria and included male or female outpatients aged ≥18 years who met the diagnostic criteria for MDD, had a MADRS total score ≥20, and had at least moderate pain (BPI-SF average pain score ≥3). Positive predictive values (PPVs) and negative predictive values (NPVs) of early improvement in PPS for remission were analyzed. PPVs were the proportion of patients with remission (MADRS total score ≤10) at week 8 out of patients who experienced early improvement in BPI-SF average pain score (≥30% decrease from baseline at week 1, 2, or 4). NPVs were the proportion of patients without remission (MADRS total score >10) at week 8 out of patients who did not experience early improvement in PPS. RESULTS Data from 1,320 patients were analyzed (duloxetine N=641 and placebo N=679). The overall remission (MADRS total score ≤10 at week 8) rate for the duloxetine group was significantly higher than the placebo group (38.5% vs 21.8%; P<0.0001). For both treatment groups, PPVs of early improvement in BPI-SF (30% improvement from baseline) were higher than the overall remission rate for all weeks examined (weeks 1, 2, and 4); in general, NPVs of early improvement in BPI-SF for nonremission were higher than the overall nonremission rate. CONCLUSION Early improvement in PPS can be a useful clinical indicator of subsequent treatment outcome for MDD patients with associated PPS.
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Affiliation(s)
- Hirofumi Tokuoka
- Bio-Medicine, Medicines Development Unit Japan, Eli Lilly Japan K.K., Kobe
| | - Makoto Nishihara
- Multidisciplinary Pain Center, Aichi Medical University, Nagakute, Aichi
| | | | - Aki Yoshikawa
- Scientific Communications, Medicines Development Unit Japan, Eli Lilly Japan K.K., Kobe, Japan
| | - Atsushi Kuga
- Bio-Medicine, Medicines Development Unit Japan, Eli Lilly Japan K.K., Kobe
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