1
|
Sheehan JJ, LaVallee C, Maughn K, Balakrishnan S, Pesa JA, Joshi K, Nelson C. Real-world assessment of treatment inertia in the management of patients treated for major depressive disorder in the USA. J Comp Eff Res 2024; 13:e230091. [PMID: 37987716 PMCID: PMC10842298 DOI: 10.57264/cer-2023-0091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 10/31/2023] [Indexed: 11/22/2023] Open
Abstract
Aim: Major depressive disorder (MDD) is a debilitating illness in which depressive symptoms may persist after treatment. Treatment inertia is the continued use of the same pharmacotherapy regimen when treatment goals are not met. This study assessed the frequency of treatment inertia among adult patients with MDD treated in a real-world setting. Patients & methods: This was a retrospective, observational study of patients with MDD identified in the Decision Resources Group Real World Evidence US Data Repository from January 2014 to June 2018. Patients (≥18 years) had an elevated Patient Health Questionnaire-9 (PHQ-9) score (≥5) following 8 weeks of stable baseline antidepressant use with/without mental-health outpatient therapy. Treatment inertia, modification and discontinuation were evaluated over a 16-week follow-up period (timeline based on the APA Practice Guidelines). The primary outcome was the proportion of MDD patients experiencing treatment inertia. Results: 2850 patients (median age, 55 years; 74% female) met the study criteria. Of these patients, 834 (29%) had study-defined treatment inertia, 1534 (54%) received treatment modification and 482 (17%) discontinued treatment. Use of mirtazapine (Odd ratio [OR]: 0.63; 95% confidence interval [CI]: 0.50-0.79), selective serotonin reuptake inhibitors (OR: 0.64; 95% CI: 0.54-0.75) or bupropion (OR: 0.71; 95% CI: 0.60-0.84) in the baseline period was associated with an increased likelihood of treatment modification versus not receiving treatment with these medications. Frequency of treatment inertia may differ among those who do not have a documented PHQ-9 score. Conclusion: Effective symptom management is critical for optimal outcomes in MDD. Results demonstrate that treatment inertia is common in MDD despite guidelines recommending treatment modification in patients not reaching remission.
Collapse
Affiliation(s)
- John J Sheehan
- Janssen Scientific Affairs, LLC, Titusville, NJ 08560, USA
| | - Chris LaVallee
- Health Outcomes Research, Decision Resources Group, Boston, MA 02116, USA
| | - Keshia Maughn
- Analytics, Decision Resources Group, Boston, MA 02116, USA
| | | | | | - Kruti Joshi
- Janssen Scientific Affairs, LLC, Titusville, NJ 08560, USA
| | - Craig Nelson
- Department of Psychiatry, University of California San Francisco, San Francisco, CA 94143, USA
| |
Collapse
|
2
|
Christensen MC, McIntyre RS, Adair M, Florea I, Loft H, Fagiolini A. Clinical benefits of vortioxetine 20 mg/day in patients with major depressive disorder. CNS Spectr 2023; 28:693-701. [PMID: 37070529 DOI: 10.1017/s1092852923002249] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Abstract
BACKGROUND Vortioxetine has demonstrated dose-dependent efficacy in patients with major depressive disorder (MDD), with the greatest effect observed with vortioxetine 20 mg/day. This analysis further explored the clinical relevance of the more rapid and greater improvement in depressive symptoms observed with vortioxetine 20 mg/day vs 10 mg/day. METHODS Analysis of pooled data from six short-term (8-week), randomized, placebo-controlled, fixed-dose studies of vortioxetine 20 mg/day in patients with MDD (N = 2620). Symptomatic response (≥50% decrease in Montgomery-Åsberg Depression Rating Scale [MADRS] total score), sustained symptomatic response, and remission (MADRS total score ≤10) were assessed by vortioxetine dosage (20 or 10 mg/day). RESULTS After 8 weeks, 51.4% of patients receiving vortioxetine 20 mg/day had achieved symptomatic response vs 46.0% of those receiving vortioxetine 10 mg/day (P < .05). Significantly more patients achieved symptomatic response vs placebo from week 2 onwards for vortioxetine 20 mg/day and from week 6 onwards for vortioxetine 10 mg/day (both P ≤ .05). Sustained response was achieved from week 4 for 26.0% of patients receiving vortioxetine 20 mg/day vs 19.1% of those receiving vortioxetine 10 mg/day (P < .01), increasing to 36.0% and 29.8%, respectively, over the 8-week treatment period (P < .05). At week 8, 32.0% of patients receiving vortioxetine 20 mg/day were in remission vs 28.2% of those receiving vortioxetine 10 mg/day (P = .09). Rates of adverse events and treatment withdrawal were not increased during the week following vortioxetine dose up-titration to 20 mg/day. CONCLUSION Vortioxetine 20 mg/day provides more rapid and more sustained symptomatic response than vortioxetine 10 mg/day in patients with MDD, without compromising tolerability.
Collapse
Affiliation(s)
| | - Roger S McIntyre
- Mood Disorders Psychopharmacology Unit, University Health Network, University of Toronto, Toronto, ON, Canada
| | | | | | | | - Andrea Fagiolini
- Division of Psychiatry, Department of Molecular and Developmental Medicine, University of Siena School of Medicine, Siena, Italy
| |
Collapse
|
3
|
Arnaud A, Benner J, Suthoff E, Werneburg B, Reinhart M, Sussman M, Kessler RC. The impact of early remission on disease trajectory and patient outcomes in major depression disorder (MDD): A targeted literature review and microsimulation modeling approach based on the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study. J Affect Disord 2023; 325:264-272. [PMID: 36608852 DOI: 10.1016/j.jad.2022.12.147] [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: 12/21/2021] [Revised: 11/30/2022] [Accepted: 12/23/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND While literature has suggested that the duration of a major depressive episode (MDE) may affect both symptomatic and functional outcomes in major depressive disorder (MDD), study designs are limited in their ability to isolate a causal relationship. METHODS A targeted literature review was conducted using the MEDLINE database to assess whether there was an association between (1) shorter duration of an MDE, or (2) increased rapidity of symptom improvement, and MDD outcomes in adult patients. Given findings from the literature, we hypothesized that rapid symptom improvement could be associated with other longer-term clinical outcomes and used a previously-developed microsimulation model to test this hypothesis. The base case of the model replicated step-therapy treatment patterns, for 10,000 simulated patients, based on lines of therapy related to standard of care, observed remission rates, and observed time to relapse from the STAR*D study. In alternative scenario analyses, the step 1 remission rate was varied by +25 % and +50 % from the base case value to simulate the potential impact of improved earlier remission on disease trajectory and patient-level clinical outcomes. RESULTS The literature review (N = 35 studies) suggests a statistically significant relationship between the duration of MDE or early symptom improvement and MDD outcomes. The microsimulation model corroborated these findings and demonstrated that increasing the rate of remission in step 1 results in patients experiencing decreased number of treatment steps, faster time to remission, decreased rate of reaching treatment-resistant depression, and delayed time to relapse. LIMITATIONS Rates of relapse in STAR*D were deemed unreliable due to the high-loss of follow-up; rates of relapse for the MDD DTM were instead derived using parametric extrapolation methods (i.e., exponential, Weibull, log-logistic, Gaussian, log-normal, logistic). Adherence to treatment was assumed to be 100 %; however, non-adherence is expected to result in lower cumulative remission rates. CONCLUSION Findings from the literature, coupled with quantification through a novel microsimulation model, demonstrate the potential impact of increased remission on disease trajectory and patient outcomes in MDD. While additional analyses with the model may be warranted to explore the impact of novel interventions on population health, including long-term outcomes (i.e., 5-year follow-up, lifetime follow-up), efforts by clinicians to increase remission early in the disease trajectory may improve long-term outcomes.
Collapse
|
4
|
Goldberg JF. Perspectives on the success rate of current antidepressant pharmacotherapy. Expert Opin Pharmacother 2022; 23:1781-1791. [PMID: 36259350 DOI: 10.1080/14656566.2022.2138333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION There has been growing debate about the effectiveness of traditional antidepressants for the treatment of depression, and whether the clinical trials literature overstates the value of existing agents. Antidepressant efficacy is limited by suboptimal remission rates, lack of robust efficacy across diverse depressed subgroups, slow onset, and challenges managing tolerability. Clinicians can better navigate uncertainties in this area by recognizing patient-specific clinical and prognostic factors that influence the likelihood of antidepressant drug response. AREAS COVERED The author summarizes pertinent literature regarding drug-placebo differences in antidepressant outcome as well as patient-specific factors that influence antidepressant drug responsivity across subtypes of depressive disorders. EXPERT OPINION Standardized effect sizes for most monoaminergic antidepressants are relatively modest. At least one-third of treatment response derives from nonspecific (yet substantial) placebo effects, limiting the ability to compare antidepressant medication effects to that of "no treatment." Patients with high baseline depressive symptom severity are less likely to respond to placebo but may be more responsive to antidepressant pharmacotherapy than is the case in mild forms of depression. Patient satisfaction with antidepressant response must take into consideration not only efficacy for reducing symptoms but also drug tolerability/acceptability and tangible improvement in functional outcome and quality of life.
Collapse
Affiliation(s)
- Joseph F Goldberg
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY
| |
Collapse
|
5
|
Higuchi M, Nakamura M, Shinohara S, Omiya Y, Takano T, Mizuguchi D, Sonota N, Toda H, Saito T, So M, Takayama E, Terashi H, Mitsuyoshi S, Tokuno S. Detection of Major Depressive Disorder Based on a Combination of Voice Features: An Exploratory Approach. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11397. [PMID: 36141675 PMCID: PMC9517353 DOI: 10.3390/ijerph191811397] [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: 06/23/2022] [Revised: 09/03/2022] [Accepted: 09/07/2022] [Indexed: 06/16/2023]
Abstract
In general, it is common knowledge that people's feelings are reflected in their voice and facial expressions. This research work focuses on developing techniques for diagnosing depression based on acoustic properties of the voice. In this study, we developed a composite index of vocal acoustic properties that can be used for depression detection. Voice recordings were collected from patients undergoing outpatient treatment for major depressive disorder at a hospital or clinic following a physician's diagnosis. Numerous features were extracted from the collected audio data using openSMILE software. Furthermore, qualitatively similar features were combined using principal component analysis. The resulting components were incorporated as parameters in a logistic regression based classifier, which achieved a diagnostic accuracy of ~90% on the training set and ~80% on the test set. Lastly, the proposed metric could serve as a new measure for evaluation of major depressive disorder.
Collapse
Affiliation(s)
- Masakazu Higuchi
- Department of Bioengineering, Graduate School of Engineering, The University of Tokyo, Tokyo 113-8656, Japan or
| | - Mitsuteru Nakamura
- Department of Bioengineering, Graduate School of Engineering, The University of Tokyo, Tokyo 113-8656, Japan or
| | - Shuji Shinohara
- School of Science and Engineering, Tokyo Denki University, Saitama 350-0394, Japan
| | | | | | | | - Noriaki Sonota
- Department of Bioengineering, Graduate School of Engineering, The University of Tokyo, Tokyo 113-8656, Japan or
| | - Hiroyuki Toda
- Department of Psychiatry, School of Medicine, National Defense Medical College, Saitama 359-8513, Japan
| | - Taku Saito
- Department of Psychiatry, School of Medicine, National Defense Medical College, Saitama 359-8513, Japan
| | - Mirai So
- Department of Neuropsychiatry, Tokyo Dental College, Tokyo 101-0061, Japan
| | - Eiji Takayama
- Department of Oral Biochemistry, Asahi University School of Dentistry, Gifu 501-0296, Japan
| | - Hiroo Terashi
- Department of Neurology, Tokyo Medical University, Tokyo 160-8402, Japan
| | - Shunji Mitsuyoshi
- Department of Bioengineering, Graduate School of Engineering, The University of Tokyo, Tokyo 113-8656, Japan or
| | - Shinichi Tokuno
- Department of Bioengineering, Graduate School of Engineering, The University of Tokyo, Tokyo 113-8656, Japan or
- Graduate School of Health Innovation, Kanagawa University of Human Services, Yokosuka 210-0821, Japan
| |
Collapse
|
6
|
Oluboka OJ, Katzman MA, Habert J, Khullar A, Oakander MA, McIntosh D, McIntyre RS, Soares CN, Lam RW, Klassen LJ, Tanguay R. Early Optimized Pharmacological Treatment in Patients With Depression and Chronic Pain. CNS Spectr 2022; 28:1-40. [PMID: 35195060 DOI: 10.1017/s1092852922000128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractMajor depressive disorder (MDD) is the leading cause of disability worldwide. Patients with MDD have high rates of comorbidity with mental and physical conditions, one of which is chronic pain. Chronic pain conditions themselves are also associated with significant disability, and the large number of patients with MDD who have chronic pain drives high levels of disability and compounds healthcare burden. The management of depression in patients who also have chronic pain can be particularly challenging due to underlying mechanisms that are common to both conditions, and because many patients with these conditions are already taking multiple medications. For these reasons, healthcare providers may be reluctant to treat such patients. The Canadian Network for Mood and Anxiety Treatments (CANMAT) guidelines provide evidence-based recommendations for the management of MDD and comorbid psychiatric and medical conditions such as anxiety, substance use disorder, and cardiovascular disease; however, comorbid chronic pain is not addressed. In this article, we provide an overview of the pathophysiological and clinical overlap between depression and chronic pain and review evidence-based pharmacological recommendations in current treatment guidelines for MDD and for chronic pain. Based on clinical experience with MDD patients with comorbid pain, we recommend rapidly and aggressively treating depression according to CANMAT treatment guidelines, using antidepressant medications with analgesic properties, while addressing pain with first-line pharmacotherapy as treatment for depression is optimized. We review options for treating pain symptoms that remain after response to antidepressant treatment is achieved.
Collapse
|
7
|
Paquin V, LeBaron N, Kraus GE, Yung EC, Iskric A, Cervantes P, Kolivakis T, Saint-Laurent M, Gobbi G, Auger N, Low N. Examining the association between duration of untreated illness and clinical outcomes in patients with major depressive and bipolar disorders. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2022. [DOI: 10.1016/j.jadr.2022.100324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
|
8
|
Higuchi M, Sonota N, Nakamura M, Miyazaki K, Shinohara S, Omiya Y, Takano T, Mitsuyoshi S, Tokuno S. Performance Evaluation of a Voice-Based Depression Assessment System Considering the Number and Type of Input Utterances. SENSORS (BASEL, SWITZERLAND) 2021; 22:67. [PMID: 35009610 PMCID: PMC8747535 DOI: 10.3390/s22010067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 12/17/2021] [Accepted: 12/20/2021] [Indexed: 06/14/2023]
Abstract
It is empirically known that mood changes affect facial expressions and voices. In this study, the authors have focused on the voice to develop a method for estimating depression in individuals from their voices. A short input voice is ideal for applying the proposed method to a wide range of applications. Therefore, we evaluated this method using multiple input utterances while assuming a unit utterance input. The experimental results revealed that depressive states could be estimated with sufficient accuracy using the smallest number of utterances when positive utterances were included in three to four input utterances.
Collapse
Affiliation(s)
- Masakazu Higuchi
- Department of Bioengineering, Graduate School of Engineering, The University of Tokyo, Tokyo 113-8656, Japan; (N.S.); (M.N.); (S.S.); (S.M.); or (S.T.)
| | - Noriaki Sonota
- Department of Bioengineering, Graduate School of Engineering, The University of Tokyo, Tokyo 113-8656, Japan; (N.S.); (M.N.); (S.S.); (S.M.); or (S.T.)
| | - Mitsuteru Nakamura
- Department of Bioengineering, Graduate School of Engineering, The University of Tokyo, Tokyo 113-8656, Japan; (N.S.); (M.N.); (S.S.); (S.M.); or (S.T.)
| | - Kenji Miyazaki
- Mitsui Knowledge Industry Co., Ltd., Tokyo 105-6215, Japan;
| | - Shuji Shinohara
- Department of Bioengineering, Graduate School of Engineering, The University of Tokyo, Tokyo 113-8656, Japan; (N.S.); (M.N.); (S.S.); (S.M.); or (S.T.)
| | | | | | - Shunji Mitsuyoshi
- Department of Bioengineering, Graduate School of Engineering, The University of Tokyo, Tokyo 113-8656, Japan; (N.S.); (M.N.); (S.S.); (S.M.); or (S.T.)
| | - Shinichi Tokuno
- Department of Bioengineering, Graduate School of Engineering, The University of Tokyo, Tokyo 113-8656, Japan; (N.S.); (M.N.); (S.S.); (S.M.); or (S.T.)
- Graduate School of Health Innovation, Kanagawa University of Human Services, Kanagawa 210-0821, Japan
| |
Collapse
|
9
|
Perris F, Sampogna G, Giallonardo V, Agnese S, Palummo C, Luciano M, Fabrazzo M, Fiorillo A, Catapano F. Duration of untreated illness predicts 3-year outcome in patients with obsessive-compulsive disorder: A real-world, naturalistic, follow-up study. Psychiatry Res 2021; 299:113872. [PMID: 33770711 DOI: 10.1016/j.psychres.2021.113872] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 03/12/2021] [Indexed: 11/29/2022]
Abstract
Duration of untreated illness (DUI) is a predictor of outcome in psychotic and affective disorders. The few available data on the effect of DUI in obsessive-compulsive disorder (OCD) suggest an association between longer DUI and poorer response to treatments. This is a real-world, naturalistic, follow-up study evaluating the impact of DUI on long-term clinical outcomes. The sample consists of 83 outpatients with OCD with a mean DUI of 7.3 (5.8) years. Patients with symmetry/ordering cluster symptoms were younger at onset of the disease (20.4 ± 7.9 vs. 27.8 ± 10.6; p<.05, d = 0.79), had a longer duration of the illness (10.1 ± 4.6 vs. 6.8 ± 4.6, p<.05; d = 0.53) and a longer DUI (7.9 ± 6.5 vs. 5.4 ± 3.6, p<.05, d = 0.49) compared to patients not presenting with those symptoms. Fifty-nine patients completed the follow-up, and 33.9% (N = 20) met the criteria for partial remission, scoring <15 at the Y-BOCS for at least eight weeks. Patients in partial remission for more than 40% of the follow-up were defined as "good outcome" and they had a significantly shorter DUI compared to patients with "poor outcome". Access to adequate treatments is highly delayed in patients with OCD. DUI is strongly associated with poor treatment outcomes. Therefore, strategies to ensure an early diagnosis and treatment are needed.
Collapse
Affiliation(s)
- Francesco Perris
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy.
| | - Gaia Sampogna
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | | | - Salvatore Agnese
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | - Carmela Palummo
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | - Mario Luciano
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | - Michele Fabrazzo
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | - Andrea Fiorillo
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | - Francesco Catapano
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| |
Collapse
|
10
|
Higuchi M, Nakamura M, Shinohara S, Omiya Y, Takano T, Mitsuyoshi S, Tokuno S. Effectiveness of a Voice-Based Mental Health Evaluation System for Mobile Devices: Prospective Study. JMIR Form Res 2020; 4:e16455. [PMID: 32554367 PMCID: PMC7399964 DOI: 10.2196/16455] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 02/26/2020] [Accepted: 06/15/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND We developed a system for monitoring mental health using voice data from daily phone calls, termed Mind Monitoring System (MIMOSYS), by implementing a method for estimating mental health status from voice data. OBJECTIVE The objective of this study was to evaluate the potential of this system for detecting depressive states and monitoring stress-induced mental changes. METHODS We opened our system to the public in the form of a prospective study in which data were collected over 2 years from a large, unspecified sample of users. We used these data to analyze the relationships between the rate of continued use, the men-to-women ratio, and existing psychological tests for this system over the study duration. Moreover, we analyzed changes in mental data over time under stress from particular life events. RESULTS The system had a high rate of continued use. Voice indicators showed that women have more depressive tendencies than men, matching the rate of depression in Japan. The system's voice indicators and the scores on classical psychological tests were correlated. We confirmed deteriorating mental health for users in areas affected by major earthquakes in Japan around the time of the earthquakes. CONCLUSIONS The results suggest that although this system is insufficient for detecting depression, it may be effective for monitoring changes in mental health due to stress. The greatest feature of our system is mental health monitoring, which is most effectively accomplished by performing long-term time-series analysis of the acquired data considering the user's life events. Such a system can improve the implementation of patient interventions by evaluating objective data along with life events.
Collapse
Affiliation(s)
- Masakazu Higuchi
- Department of Bioengineering, Graduate School of Engineering, The University of Tokyo, Tokyo, Japan
| | - Mitsuteru Nakamura
- Department of Pharmacology, School of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Shuji Shinohara
- Department of Bioengineering, Graduate School of Engineering, The University of Tokyo, Tokyo, Japan
| | - Yasuhiro Omiya
- Research and Product Development Department, PST Inc, Kanagawa, Japan
| | - Takeshi Takano
- Research and Product Development Department, PST Inc, Kanagawa, Japan
| | - Shunji Mitsuyoshi
- Department of Bioengineering, Graduate School of Engineering, The University of Tokyo, Tokyo, Japan
| | - Shinichi Tokuno
- Department of Bioengineering, Graduate School of Engineering, The University of Tokyo, Tokyo, Japan
| |
Collapse
|
11
|
Predictors of functional response and remission with desvenlafaxine 50 mg and 100 mg: a pooled analysis of randomized, placebo-controlled studies in patients with major depressive disorder. CNS Spectr 2020; 25:363-371. [PMID: 31060632 DOI: 10.1017/s1092852919000828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The value of early functional improvement at week 2 for predicting subsequent functional outcomes at week 8 was assessed in a pooled analysis of patients with major depressive disorder (MDD) treated with desvenlafaxine (50 or 100 mg/d) or placebo. METHODS Data were pooled from eight double-blind, placebo-controlled studies of desvenlafaxine 50 mg/d or 100 mg/d for the treatment of MDD. Optimal week-2 improvement thresholds in Sheehan Disability Scale (SDS) score, which best predicted week-8 treatment success, were determined using receiver operating characteristic (ROC) analysis. Four definitions of treatment success were established: (1) functional response, (2) functional/depression response, (3) functional remission, and (4) functional/depression remission. Odds ratios (ORs) of early improvement for prediction (based on thresholds determined in the ROC analysis) of week-8 treatment success were computed using logistic regression models. RESULTS Functional early improvement thresholds of 17%-32% were predictive of week-8 treatment success across treatment groups and definitions of treatment success. Optimal thresholds were higher for more stringent definitions. Negative predictive value exceeded positive predictive value, indicating that failure to achieve early functional improvement was more informative about later treatment success than was the achievement of early functional improvement. Early change in SDS was a highly significant predictor of functional response/remission (ORs, 4.981-8.737; all p < 0.0001); the interaction between treatment and early functional improvement was not significant. CONCLUSION Early improvement in SDS total score was predictive of functional outcomes for patients treated with desvenlafaxine 50 mg, desvenlafaxine 100 mg, or placebo.
Collapse
|
12
|
Vilazodone efficacy in subgroups of patients with major depressive disorder: a post-hoc analysis of four randomized, double-blind, placebo-controlled trials. Int Clin Psychopharmacol 2018; 33:217-223. [PMID: 29608461 PMCID: PMC5991171 DOI: 10.1097/yic.0000000000000217] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The efficacy of antidepressants to treat major depressive disorder (MDD) varies by patient characteristics. This post-hoc analysis evaluated the effects of vilazodone across patient subgroups in adults with MDD. Data were pooled from four trials of vilazodone (NCT00285376, NCT00683592, NCT01473394, and NCT01473381). Mean change from baseline to week 8 in Montgomery-Åsberg Depression Rating Scale (MADRS) total score, MADRS response (≥50% total score improvement), and MADRS remission (total score≤10) were analyzed in the pooled intent-to-treat population (vilazodone=1254, placebo=964) and in subgroups of patients categorized by sex, age, MDD duration, recurrent episodes, baseline MADRS total score, and current episode duration. MADRS total score improvement was significantly greater with vilazodone versus placebo in the intent-to-treat population and in all patient subgroups (P<0.001). MADRS response and remission rates significantly separated from placebo (P<0.05) regardless of age, sex, MDD duration, recurrent MDD, and baseline symptom severity [except remission in patients with very severe baseline symptoms (MADRS score≥35)] and in patients with a shorter current episode duration (≤12 months). Despite the limitations associated with analyzing uncommon outcomes (e.g. MADRS remission) in small subgroups, vilazodone was an effective treatment in multiple patient populations, including those where reduced efficacy has previously been reported: males, older individuals, patients with a longer duration of MDD, and patients with recurrent depression.
Collapse
|
13
|
Scifo E, Pabba M, Kapadia F, Ma T, Lewis DA, Tseng GC, Sibille E. Sustained Molecular Pathology Across Episodes and Remission in Major Depressive Disorder. Biol Psychiatry 2018; 83:81-89. [PMID: 28935211 PMCID: PMC5705452 DOI: 10.1016/j.biopsych.2017.08.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 07/18/2017] [Accepted: 08/08/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND Major depressive disorder (MDD) is a debilitating mental illness and a major cause of lost productivity worldwide. MDD patients often suffer from lifelong recurring episodes of increasing severity, reduced therapeutic response, and shorter remission periods, suggesting the presence of a persistent and potentially progressive pathology. METHODS Subgenual anterior cingulate cortex postmortem samples from four MDD cohorts (single episode, n = 20; single episode in remission, n = 15; recurrent episode, n = 20; and recurrent episode in remission, n = 15), and one control cohort (n = 20) were analyzed by mass spectrometry-based proteomics (n = 3630 proteins) combined with statistical analyses. The data was investigated for trait and state progressive neuropathologies in MDD using both unbiased approaches and tests of a priori hypotheses. RESULTS The data provided weak evidence for proteomic differences as a function of state (depressed/remitted) or number of previous episodes. Instead it suggested the presence of persistent MDD effects, regardless of episodes or remitted state, namely on proteomic measures related to presynaptic neurotransmission, synaptic function, cytoskeletal rearrangements, energy metabolism, phospholipid biosynthesis/metabolism, and calcium ion homeostasis. Selected proteins (dihydropyrimidinase-related protein 1, synaptosomal-associated protein 29, glutamate decarboxylase 1, metabotropic glutamate receptor 1, and excitatory amino acid transporter 3) were validated by Western blot analysis. The findings were independent of technical, demographic (sex or age), or other clinical parameters (death by suicide and drug treatment). CONCLUSIONS Collectively, the results provide evidence for persistent MDD effects across current episodes or remission, in the absence of detectable progressive neuropathology.
Collapse
Affiliation(s)
- Enzo Scifo
- Campbell Family Mental Health Research Institute of CAMH, Department of Psychiatry, and of Pharmacology and Toxicology, University of Toronto, Toronto, M5T1R8, ON, Canada
| | - Mohan Pabba
- Campbell Family Mental Health Research Institute of CAMH, Department of Psychiatry, and of Pharmacology and Toxicology, University of Toronto, Toronto, M5T1R8, ON, Canada
| | - Fenika Kapadia
- Campbell Family Mental Health Research Institute of CAMH, Department of Psychiatry, and of Pharmacology and Toxicology, University of Toronto, Toronto, M5T1R8, ON, Canada
| | - Tianzhou Ma
- Department of Biostatistics, Graduate school of Public Health, University of Pittsburgh, Pittsburgh, PA 15261, USA
| | - David A. Lewis
- Department of Psychiatry, 3811 O’Hara Street, BST W1643, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - George C Tseng
- Department of Biostatistics, Graduate school of Public Health, University of Pittsburgh, Pittsburgh, PA 15261, USA
| | - Etienne Sibille
- Campbell Family Mental Health Research Institute of the Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada.
| |
Collapse
|
14
|
Yoshikawa E, Taniguchi T, Nakamura-Taira N, Ishiguro S, Matsumura H. Factors associated with unwillingness to seek professional help for depression: a web-based survey. BMC Res Notes 2017; 10:673. [PMID: 29202791 PMCID: PMC5716254 DOI: 10.1186/s13104-017-3010-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 11/28/2017] [Indexed: 12/04/2022] Open
Abstract
Objective Depression is a prevalent disorder that has a substantial impact on not only individuals but also society as a whole. Despite many effective depression interventions, delay in initial treatment contact is problematic. The Internet is a possible tool for low-cost dissemination of appropriate information and awareness raising about depressive disorders among the general public. This study aimed to identify factors associated with unwillingness to seek professional help for depression in Internet users. Results This web-based cross-sectional study surveyed 595 participants who scored over the cutoff point for depression on a self-rated mental-health questionnaire for depression, had never been assessed or treated by a mental health professional, and were experiencing depressive symptoms for at least 6 months. Among the 595 participants, 329 (55.3%) reported they were unwilling to seek professional help for depression. Regression analysis indicated that unwillingness to seek professional help for depression was associated with male sex and financial issues as a depression trigger, and that willingness to seek professional help was associated with problems with interpersonal relationships. The Internet warrants further complementary investigation to elucidate factors associated with unwillingness to seek professional help for depression.
Collapse
Affiliation(s)
- Eisho Yoshikawa
- Department of Neuropsychiatry, Nippon Medical School Tama Nagayama Hospital, 1-7-1 Nagayama, Tama City, Tokyo, 206-8512, Japan. .,Department of Neuropsychiatry, Nippon Medical School, 1-1-5 Sendagi, Bunkyo, Tokyo, 113-8602, Japan. .,Ujiie Hospital, 4095 Mukogawara, Sakura-shi, Tochigi, 329-1326, Japan.
| | - Toshiatsu Taniguchi
- Department of Psychology, Fukuyama University, Sanzo, Gakuen-cho, Fukuyama, Hiroshima, 729-0290, Japan.,Tottori Seikyo Hospital, 458 Suehiroonsen-cho, Tottori, Tottori, 680-0841, Japan
| | - Nanako Nakamura-Taira
- Center for Research on Human Development and Clinical Psychology, Hyogo University of Teacher Education, 2-579-15 Shimokume, Kato-shi, Hyogo, 673-1494, Japan
| | - Shin Ishiguro
- Ujiie Hospital, 4095 Mukogawara, Sakura-shi, Tochigi, 329-1326, Japan.,Specified Nonprofit Organization Depression Support Network, 3-20-11 Tamagawa, Setagaya-ku, Tokyo, 158-0094, Japan
| | - Hiromichi Matsumura
- Ujiie Hospital, 4095 Mukogawara, Sakura-shi, Tochigi, 329-1326, Japan.,Specified Nonprofit Organization Depression Support Network, 3-20-11 Tamagawa, Setagaya-ku, Tokyo, 158-0094, Japan
| |
Collapse
|
15
|
Hung CI, Liu CY, Yang CH. Untreated duration predicted the severity of depression at the two-year follow-up point. PLoS One 2017; 12:e0185119. [PMID: 28934289 PMCID: PMC5608308 DOI: 10.1371/journal.pone.0185119] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 09/05/2017] [Indexed: 01/07/2023] Open
Abstract
Background No study has investigated the impact of the duration of untreated depression (DUD) on the severity of depression at the two-year follow-up point in patients with major depressive disorder (MDD) who discontinued pharmacotherapy. This study aimed to investigate this issue. Methods This study enrolled 155 subjects with MDD at baseline, and 101 subjects who had discontinued pharmacotherapy for 17.1 ± 5.8 months were assessed at the two-year follow-up point. DUD was defined as the interval between the onset of the index major depressive episode and the start of pharmacotherapy. The 17-item Hamilton Depression Rating Scale (HAMD) was used to evaluate depression. Multiple linear regressions were used to examine the impacts of DUD on the severity and improvement percentage (IP) of depression at follow-up. Results A longer DUD was significantly associated with a greater severity and a lower IP of depression at follow-up. After controlling for confounding factors, DUD was the most significant factor predicting the severity and IP of depression at follow-up. DUD was more strongly associated with the prognosis of depression at follow-up than depression and anxiety severities at baseline. Conclusions The DUD at baseline independently predicted the severity of depression at the two-year follow-up point. Although the patients had discontinued pharmacotherapy for nearly 1.5 years, the impact of the DUD on the severity of depression persisted at follow-up. The DUD was an important index that predicted the severity of depression at the two-year follow-up point.
Collapse
Affiliation(s)
- Ching-I Hung
- Department of Psychiatry, Chang Gung Memorial Hospital at Linkou and Chang Gung University College of Medicine, Tao-Yuan, Taiwan
- * E-mail:
| | - Chia-Yih Liu
- Department of Psychiatry, Chang Gung Memorial Hospital at Linkou and Chang Gung University College of Medicine, Tao-Yuan, Taiwan
| | - Ching-Hui Yang
- Department of Nursing, Chang Gung University of Science and Technology, Tao-Yuan, Taiwan
| |
Collapse
|
16
|
Oluboka OJ, Katzman MA, Habert J, McIntosh D, MacQueen GM, Milev RV, McIntyre RS, Blier P. Functional Recovery in Major Depressive Disorder: Providing Early Optimal Treatment for the Individual Patient. Int J Neuropsychopharmacol 2017; 21:128-144. [PMID: 29024974 PMCID: PMC5793729 DOI: 10.1093/ijnp/pyx081] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Major depressive disorder is an often chronic and recurring illness. Left untreated, major depressive disorder may result in progressive alterations in brain morphometry and circuit function. Recent findings, however, suggest that pharmacotherapy may halt and possibly reverse those effects. These findings, together with evidence that a delay in treatment is associated with poorer clinical outcomes, underscore the urgency of rapidly treating depression to full recovery. Early optimized treatment, using measurement-based care and customizing treatment to the individual patient, may afford the best possible outcomes for each patient. The aim of this article is to present recommendations for using a patient-centered approach to rapidly provide optimal pharmacological treatment to patients with major depressive disorder. Offering major depressive disorder treatment determined by individual patient characteristics (e.g., predominant symptoms, medical history, comorbidities), patient preferences and expectations, and, critically, their own definition of wellness provides the best opportunity for full functional recovery.
Collapse
Affiliation(s)
- Oloruntoba J Oluboka
- Department of Psychiatry, University of Calgary, Alberta, Canada,Correspondence: Oloruntoba J. Oluboka, MD, Director, PES/PORT, Consultant Psychiatrist, Addiction and Mental Health, South Health Campus, Alberta Health Services, Assistant Clinical Professor of Psychiatry, University of Calgary, Calgary, Canada ()
| | - Martin A Katzman
- START Clinic for Mood and Anxiety Disorders, Toronto, Ontario, Canada
| | - Jeffrey Habert
- Department of Family and Community Medicine, University of Toronto, Ontario, Canada
| | - Diane McIntosh
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Glenda M MacQueen
- Mathison Centre for Mental Health Research and Education, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Roumen V Milev
- Department of Psychiatry, Queen’s University, Kingston, Ontario, Canada
| | - Roger S McIntyre
- Department of Psychiatry and Pharmacology, University of Toronto, Ontario, Canada
| | - Pierre Blier
- Department of Psychiatry, University of Ottawa, Ottawa, Ontario
| |
Collapse
|
17
|
Yahno NN, Fedotova AV. Post-marketing observational program of the effectiveness of fluvoxamine for the treatment of depression in patients with neurological disorders: the FRIENDS study. Neuropsychiatr Dis Treat 2017; 13:2747-2756. [PMID: 29138569 PMCID: PMC5679672 DOI: 10.2147/ndt.s145614] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
In a prospective, non-blinded, uncontrolled, multicenter, post-marketing, observational study (FRIENDS; NCT02043197), fluvoxamine (50-300 mg/day for 90 days) was effective for the treatment of depression in 299 adult patients (age ≥18 years) with neurological disorders at baseline. The therapeutic effect of fluvoxamine was measured by means of changes in the Hospital Anxiety and Depression Scale depression and anxiety scores (HADS-D and HADS-A, respectively), global severity of illness, and clinical condition (measured using the Clinical Global Improvement [CGI] scale). The mean HADS-D subscale score at baseline in the per-protocol cohort (n=296) was 11.7±3.1 points and the corresponding mean HADS-A score was 12.6±3.2. Significant (P<0.0001) improvements in both scores were recorded during fluvoxamine treatment and later follow-up. Most patients (>85%) recorded reductions versus baseline in both indices. In the CGI-based assessment, most evaluated patients (>200) experienced moderate to very substantial clinical improvement, with no or limited side effects. Significant improvements were also recorded in the exploratory outcomes of sleep quality, assessed using the Insomnia Severity Index, and cognitive function, assessed using the Montreal Cognitive Assessment (P<0.0001 vs baseline for both). No death or serious adverse drug reactions were reported during the study. The results of this observational study affirm that fluvoxamine is effective and well tolerated for the treatment of depression in the context of neurological disorders. The effects on the exploratory endpoints of this research merit evaluation in controlled trials.
Collapse
Affiliation(s)
- Nikolay N Yahno
- Neurology Department, I.M. Sechenov First Moscow State Medical University
| | - Anastasia V Fedotova
- Neurology Department, Additional Professional Education Faculty, Pirogov Russian National Research Medical University, Moscow, Russian Federation
| |
Collapse
|
18
|
Slyepchenko A, Maes M, Köhler CA, Anderson G, Quevedo J, Alves GS, Berk M, Fernandes BS, Carvalho AF. T helper 17 cells may drive neuroprogression in major depressive disorder: Proposal of an integrative model. Neurosci Biobehav Rev 2016; 64:83-100. [PMID: 26898639 DOI: 10.1016/j.neubiorev.2016.02.002] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 01/04/2016] [Accepted: 02/02/2016] [Indexed: 02/07/2023]
Abstract
The exact pathophysiology of major depressive disorder (MDD) remains elusive. The monoamine theory, which hypothesizes that MDD emerges as a result of dysfunctional serotonergic, dopaminergic and noradrenergic pathways, has guided the therapy of this illness for several decades. More recently, the involvement of activated immune, oxidative and nitrosative stress pathways and of decreased levels of neurotrophic factors has provided emerging insights regarding the pathophysiology of MDD, leading to integrated theories emphasizing the complex interplay of these mechanisms that could lead to neuroprogression. In this review, we propose an integrative model suggesting that T helper 17 (Th17) cells play a pivotal role in the pathophysiology of MDD through (i) microglial activation, (ii) interactions with oxidative and nitrosative stress, (iii) increases of autoantibody production and the propensity for autoimmunity, (iv) disruption of the blood-brain barrier, and (v) dysregulation of the gut mucosa and microbiota. The clinical and research implications of this model are discussed.
Collapse
Affiliation(s)
- Anastasiya Slyepchenko
- Womens Health Concerns Clinic, St. Joseph's Healthcare Hamilton, MiNDS Program, McMaster University; Hamilton, Ontario, Canada
| | - Michael Maes
- IMPACT Strategic Research Centre, Deakin University, School of Medicine and Barwon Health, Geelong, VIC, Australia
| | - Cristiano A Köhler
- Department of Clinical Medicine and Translational Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil
| | | | - João Quevedo
- Center for Translational Psychiatry, Department of Psychiatry and Behavioral Sciences, The University of Texas Medical School at Houston, Houston, TX, USA; Laboratory of Neurosciences, Graduate Program in Health Sciences, Health Sciences Unit, University of Southern Santa Catarina, Criciúma, SC, Brazil
| | - Gilberto S Alves
- Department of Clinical Medicine and Translational Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil
| | - Michael Berk
- IMPACT Strategic Research Centre, Deakin University, School of Medicine and Barwon Health, Geelong, VIC, Australia; Department of Psychiatry, Florey Institute of Neuroscience and Mental Health, Orygen, The National Centre of Excellence in Youth Mental Health and Orygen Youth Health Research Centre, University of Melbourne, Parkville, VIC, Australia
| | - Brisa S Fernandes
- IMPACT Strategic Research Centre, Deakin University, School of Medicine and Barwon Health, Geelong, VIC, Australia; Laboratory of Calcium Binding Proteins in the Central Nervous System, Department of Biochemistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - André F Carvalho
- Department of Clinical Medicine and Translational Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil.
| |
Collapse
|
19
|
Parker G, McCraw S, Hadzi-Pavlovic D. Unipolar and bipolar patient responses to a new scale measuring the consequences of depression. Psychiatry Res 2015; 230:676-81. [PMID: 26545613 DOI: 10.1016/j.psychres.2015.10.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2015] [Revised: 10/12/2015] [Accepted: 10/20/2015] [Indexed: 10/22/2022]
Abstract
There are generic measures available to assess functional impairment associated with clinical conditions, but no measure has been developed to specifically evaluate consequences of differing mood disorders, our current objective. In this study, 208 participants took part in a research interview which aimed to differentiate clinical depression from non-clinical mood states. The 126 participants who met diagnostic criteria for clinical depression (i.e., bipolar disorder, melancholic depression or non-melancholic depression) were asked to judge whether they had experienced any of 24 consequences of their depressive episodes with the measure focusing on occupational, personal and interpersonal functioning. Such consequences were affirmed by 100% of participants diagnosed with bipolar disorder, 84% of those experiencing melancholic depression and 74% of those who had experienced a non-melancholic depressive episode. Results from a three-factor solution were consistent with the expected domains (i.e. work and relationships; self-care and daily functioning; intimate relationships and coping), and had sound goodness of fit properties. Participants with bipolar disorder were more likely to affirm each item compared to participants with unipolar depression, and participants with melancholic depression affirmed each item at a higher rate than participants who had experienced non-melancholic episodes. The new measure (the Consequences of Depression Scale; CODS) could be utilised in research and clinical activities seeking to identify and quantify the personal and economic burden of mood disorders, and provides an additional perspective for evaluating the impact of mood disorders on interpersonal, personal and occupational functioning.
Collapse
Affiliation(s)
- Gordon Parker
- School of Psychiatry, University of New South Wales, Sydney, Australia and Black Dog Institute, Sydney, Australia.
| | - Stacey McCraw
- School of Psychiatry, University of New South Wales, Sydney, Australia and Black Dog Institute, Sydney, Australia
| | - Dusan Hadzi-Pavlovic
- School of Psychiatry, University of New South Wales, Sydney, Australia and Black Dog Institute, Sydney, Australia
| |
Collapse
|
20
|
Sanglier T, Saragoussi D, Milea D, Tournier M. Depressed older adults may be less cared for than depressed younger ones. Psychiatry Res 2015; 229:905-12. [PMID: 26233825 DOI: 10.1016/j.psychres.2015.07.035] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Revised: 06/16/2015] [Accepted: 07/12/2015] [Indexed: 12/31/2022]
Abstract
The aim of the study was to investigate depression treatment use, either psychotherapy (PT) or antidepressant drugs (ADT) in the older and younger depressed population. Cohorts of 6316 elderly (≥65 year-old) and 25,264 matched non-elderly (25-64 year-old) depressed patients were created from a large national claims database of managed care plans from 2003 to 2006. Factors associated with ADT or PT were assessed using multivariate logistic models. During the 120 days following the depression diagnosis, the elderly persons were less often treated than the younger adults either by ADT (25.6% vs. 33.8%) or by PT (13.0% vs. 34.4%). ADT dispensing occurred later in the elderly group (51 vs. 14 days). ADT was associated with comorbid chronic conditions or polypharmacy in the elderly and younger adults. The selection of treatment (ADT or PT) was associated with the history of treated depression using the same type of treatment, in both groups. Thus, depression goes commonly untreated. Comorbidity was associated with higher ADT dispensing rates. However, although depressed elderly commonly presented with comorbidity, this age group was at higher risk of untreated illness or later treatment.
Collapse
Affiliation(s)
- Thibaut Sanglier
- Université Claude Bernard Lyon I, Villeurbanne, France; Lundbeck SAS, Global Outcomes Research Division, Issy-les-Moulineaux, France
| | - Delphine Saragoussi
- Lundbeck SAS, Global Outcomes Research Division, Issy-les-Moulineaux, France
| | - Dominique Milea
- Lundbeck SAS, Global Outcomes Research Division, Issy-les-Moulineaux, France
| | - Marie Tournier
- Université de Bordeaux, U657, F-33000 Bordeaux, France; INSERM, U657, F-33000 Bordeaux, France; Centre Hospitalier Charles Perrens, F-33000 Bordeaux, France.
| |
Collapse
|
21
|
Cleare A, Pariante CM, Young AH, Anderson IM, Christmas D, Cowen PJ, Dickens C, Ferrier IN, Geddes J, Gilbody S, Haddad PM, Katona C, Lewis G, Malizia A, McAllister-Williams RH, Ramchandani P, Scott J, Taylor D, Uher R. Evidence-based guidelines for treating depressive disorders with antidepressants: A revision of the 2008 British Association for Psychopharmacology guidelines. J Psychopharmacol 2015; 29:459-525. [PMID: 25969470 DOI: 10.1177/0269881115581093] [Citation(s) in RCA: 414] [Impact Index Per Article: 46.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
A revision of the 2008 British Association for Psychopharmacology evidence-based guidelines for treating depressive disorders with antidepressants was undertaken in order to incorporate new evidence and to update the recommendations where appropriate. A consensus meeting involving experts in depressive disorders and their management was held in September 2012. Key areas in treating depression were reviewed and the strength of evidence and clinical implications were considered. The guidelines were then revised after extensive feedback from participants and interested parties. A literature review is provided which identifies the quality of evidence upon which the recommendations are made. These guidelines cover the nature and detection of depressive disorders, acute treatment with antidepressant drugs, choice of drug versus alternative treatment, practical issues in prescribing and management, next-step treatment, relapse prevention, treatment of relapse and stopping treatment. Significant changes since the last guidelines were published in 2008 include the availability of new antidepressant treatment options, improved evidence supporting certain augmentation strategies (drug and non-drug), management of potential long-term side effects, updated guidance for prescribing in elderly and adolescent populations and updated guidance for optimal prescribing. Suggestions for future research priorities are also made.
Collapse
Affiliation(s)
- Anthony Cleare
- Professor of Psychopharmacology & Affective Disorders, King's College London, Institute of Psychiatry, Psychology and Neuroscience, Centre for Affective Disorders, London, UK
| | - C M Pariante
- Professor of Biological Psychiatry, King's College London, Institute of Psychiatry, Psychology and Neuroscience, Centre for Affective Disorders, London, UK
| | - A H Young
- Professor of Psychiatry and Chair of Mood Disorders, King's College London, Institute of Psychiatry, Psychology and Neuroscience, Centre for Affective Disorders, London, UK
| | - I M Anderson
- Professor and Honorary Consultant Psychiatrist, University of Manchester Department of Psychiatry, University of Manchester, Manchester, UK
| | - D Christmas
- Consultant Psychiatrist, Advanced Interventions Service, Ninewells Hospital & Medical School, Dundee, UK
| | - P J Cowen
- Professor of Psychopharmacology, Psychopharmacology Research Unit, Neurosciences Building, University Department of Psychiatry, Warneford Hospital, Oxford, UK
| | - C Dickens
- Professor of Psychological Medicine, University of Exeter Medical School and Devon Partnership Trust, Exeter, UK
| | - I N Ferrier
- Professor of Psychiatry, Honorary Consultant Psychiatrist, School of Neurology, Neurobiology & Psychiatry, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - J Geddes
- Head, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - S Gilbody
- Director of the Mental Health and Addictions Research Group (MHARG), The Hull York Medical School, Department of Health Sciences, University of York, York, UK
| | - P M Haddad
- Consultant Psychiatrist, Cromwell House, Greater Manchester West Mental Health NHS Foundation Trust, Salford, UK
| | - C Katona
- Division of Psychiatry, University College London, London, UK
| | - G Lewis
- Division of Psychiatry, University College London, London, UK
| | - A Malizia
- Consultant in Neuropsychopharmacology and Neuromodulation, North Bristol NHS Trust, Rosa Burden Centre, Southmead Hospital, Bristol, UK
| | - R H McAllister-Williams
- Reader in Clinical Psychopharmacology, Institute of Neuroscience, Newcastle University, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - P Ramchandani
- Reader in Child and Adolescent Psychiatry, Centre for Mental Health, Imperial College London, London, UK
| | - J Scott
- Professor of Psychological Medicine, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - D Taylor
- Professor of Psychopharmacology, King's College London, London, UK
| | - R Uher
- Associate Professor, Canada Research Chair in Early Interventions, Dalhousie University, Department of Psychiatry, Halifax, NS, Canada
| | | |
Collapse
|
22
|
Ghio L, Gotelli S, Cervetti A, Respino M, Natta W, Marcenaro M, Serafini G, Vaggi M, Amore M, Belvederi Murri M. Duration of untreated depression influences clinical outcomes and disability. J Affect Disord 2015; 175:224-8. [PMID: 25658495 DOI: 10.1016/j.jad.2015.01.014] [Citation(s) in RCA: 105] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Revised: 01/12/2015] [Accepted: 01/13/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND The duration of untreated depression (DUD) might have a substantial impact on the clinical outcomes; however, there are important knowledge gaps including the effects on disability and potential differences between first-episode and recurrent episodes of depression. METHODS We recruited 121 outpatients with first episode and recurrent major depression, and conducted prospective clinical assessments over six months. Clinical outcomes included response to antidepressant therapy, remission and changes in disability. RESULTS Patients with a DUD of six months or shorter were more frequently young, unemployed and had higher levels of physical illnesses than those with a longer DUD (all p<0.05). A shorter DUD was associated with significantly higher odds of response at 12 weeks (adjusted odds ratio 2.8; 95% CI: 1.2-6.8) and remission at 24 weeks (4.1; 95% CI: 1.6-10.5) after adjusting for relevant confounders. Changes in disability ratings were analyzed with growth curve analysis and showed steeper declines among those with a shorter DUD. The associations of DUD on clinical outcomes were evident both in patients with first-episode and recurrent depression. LIMITATIONS Naturalistic design. Self-rated assessment of disability. Findings from subgroup analyses should be replicated in larger sample size. CONCLUSIONS A shorter duration of untreated depression is associated with more favorable outcomes for major depression, including depression-related disability. This association seems to work both at the first and recurrent episodes, which might have direct implications for both primary and secondary prevention.
Collapse
Affiliation(s)
- Lucio Ghio
- Department of Neuroscience, Ophthalmology and Genetics, Psychiatry Section, University of Genoa, Italy.
| | | | - Alice Cervetti
- Department of Neuroscience, Ophthalmology and Genetics, Psychiatry Section, University of Genoa, Italy
| | - Matteo Respino
- Department of Neuroscience, Ophthalmology and Genetics, Psychiatry Section, University of Genoa, Italy
| | - Werner Natta
- Department of Neuroscience, Ophthalmology and Genetics, Psychiatry Section, University of Genoa, Italy
| | - Maurizio Marcenaro
- Department of Neuroscience, Ophthalmology and Genetics, Psychiatry Section, University of Genoa, Italy
| | - Gianluca Serafini
- Department of Neuroscience, Ophthalmology and Genetics, Psychiatry Section, University of Genoa, Italy
| | - Marco Vaggi
- Department of Mental Health, ASL3, Genoa, Italy
| | - Mario Amore
- Department of Neuroscience, Ophthalmology and Genetics, Psychiatry Section, University of Genoa, Italy
| | - Martino Belvederi Murri
- Department of Neuroscience, Ophthalmology and Genetics, Psychiatry Section, University of Genoa, Italy
| |
Collapse
|
23
|
Efficacy of levomilnacipran extended-release in major depressive disorder: pooled analysis of 5 double-blind, placebo-controlled trials. CNS Spectr 2015; 20:148-56. [PMID: 24902007 PMCID: PMC4411644 DOI: 10.1017/s1092852914000273] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
INTRODUCTION/OBJECTIVE Post hoc analyses were conducted to evaluate the efficacy of levomilnacipran extended-release (ER) in subgroups of patients with major depressive disorder (MDD). METHODS Data were pooled from 5 completed Phase II/III studies. Patients were categorized by sex, age, MDD duration, recurrence of MDD, current episode duration, number of prior episodes, and baseline Montgomery-Åsberg Depression Rating Scale (MADRS) score. Efficacy was evaluated by MADRS least squares (LS) mean change from baseline, response (MADRS improvement ≥50%), and remission (MADRS ≤10). RESULTS In the pooled population, treatment with levomilnacipran ER versus placebo resulted in greater improvement in MADRS score (-15.8 versus -12.9; LS mean difference, -2.9; P < .001) and higher response rates (44.7% versus 34.5%; P < .001). Comparable treatment effects were found in most subgroups. Remission rates in the overall population were higher for levomilnacipran ER versus placebo (27.7% versus 21.5%; P < .05); notably high remission rates were seen in patients with baseline MADRS score < 30 (48.8% versus 28.9%; P < .001). Discussion Clinically meaningful improvements in depressive symptoms were found across subgroups, including statistically significant outcomes for both response and remission. CONCLUSION Levomilnacipran ER was efficacious across a wide range of MDD patients, including men and women, ages 18-78, with varying histories and symptom severity.
Collapse
|
24
|
Abstract
Cognitive-behavioral therapy (CBT) is an efficacious first-line therapy for patients with major depressive disorder (MDD). Due to the limited accessibility of CBT, long wait lists result in delayed treatment, which may affect treatment outcomes. The goal of this pilot study was to obtain preliminary data from a randomized controlled trial to determine whether delayed CBT reduces the effectiveness of the therapy compared to immediate CBT in patients with MDD receiving pharmacotherapy. Patients were randomized to receive immediate CBT (n=18) or to begin CBT after 6 months (n=20) and received 14 weekly sessions, followed by two additional booster sessions. During the active treatment months, patients in the immediate group demonstrated reductions in scores on the Beck Depression Inventory II (BDI-II) that were similar to those in the delayed CBT group. However, when the analysis was performed using only data from patients in the delayed group who were still in a depressive episode, there was an overall greater decrease in BDI-II scores in the immediate group vs. the delayed group over the active treatment months, but not specifically at the 6-month endpoint. These findings suggest delays in depression treatment, similar to what occurs with real-world wait list times, may not have a significant impact on the effectiveness of CBT in patients who are already receiving treatment as usual. However, such delays may affect the effectiveness of CBT in those patients who remain depressed during the time delay. A larger trial is necessary to confirm these findings. (Journal of Psychiatric Practice 2015;21:107-113).
Collapse
|
25
|
Hung CI, Yu NW, Liu CY, Wu KY, Yang CH. The impact of the duration of an untreated episode on improvement of depression and somatic symptoms. Neuropsychiatr Dis Treat 2015; 11:2245-52. [PMID: 26346571 PMCID: PMC4556250 DOI: 10.2147/ndt.s89498] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
PURPOSE The aim of this study was to investigate the impact of the duration of an untreated episode (DUE) on the improvement of depression and somatic symptoms among patients with major depressive disorder (MDD), after the patients had received 4 weeks of pharmacotherapy. METHODS In this open-label study, there were 155 participants with MDD who were treated daily with 75 mg of venlafaxine for 4 weeks. DUE was defined as the interval between the onset of the index major depressive episode and the start of pharmacotherapy. The Depression and Somatic Symptoms Scale (DSSS), composed of the depression subscale (DS) and the somatic subscale (SS), was used. The SS included the pain subscale (PS) and the nonpain somatic subscale (NPSS). Multiple linear regressions were used to test the impacts of DUE on the improvement percentages (IPs) of depression and somatic symptoms. RESULTS Eighty-five subjects completed the 4-week treatment. The IPs of the DS, SS, and NPSS were significantly negatively correlated with DUE. A shorter DUE was related to higher IPs. DUE was an independent factor, predicting the IPs of the DS, SS, and NPSS. DUE <1 month was the most powerful time-point to predict the IPs of the DS, SS, and NPSS. However, DUE was unable to predict the IP of the PS at all time-points. CONCLUSION A shorter DUE might be one of the factors related to greater improvement of depression and somatic symptoms. DUE should be considered as an important factor when investigating the prognosis of depression and somatic symptoms.
Collapse
Affiliation(s)
- Ching-I Hung
- Department of Psychiatry, Chang Gung Memorial Hospital, Linkou, Taiwan ; Chang Gung University College of Medicine, Tao-Yuan, Taiwan
| | - Nan-Wen Yu
- Department of Psychiatry, Chang Gung Memorial Hospital, Linkou, Taiwan ; Chang Gung University College of Medicine, Tao-Yuan, Taiwan
| | - Chia-Yih Liu
- Department of Psychiatry, Chang Gung Memorial Hospital, Linkou, Taiwan ; Chang Gung University College of Medicine, Tao-Yuan, Taiwan
| | - Kuan-Yi Wu
- Department of Psychiatry, Chang Gung Memorial Hospital, Linkou, Taiwan ; Chang Gung University College of Medicine, Tao-Yuan, Taiwan
| | - Ching-Hui Yang
- Department of Nursing, Chang Gung University of Science and Technology, Tao-Yuan, Taiwan
| |
Collapse
|
26
|
Oguchi Y, Nakagawa A, Sado M, Mitsuda D, Nakagawa Y, Kato N, Takechi S, Hiyama M, Mimura M. Potential predictors of delay in initial treatment contact after the first onset of depression in Japan: a clinical sample study. Int J Ment Health Syst 2014; 8:50. [PMID: 25530800 PMCID: PMC4271502 DOI: 10.1186/1752-4458-8-50] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 11/28/2014] [Indexed: 11/10/2022] Open
Abstract
Background A growing body of evidence shows that reducing the duration of untreated illness (DUI) correlates with improved clinical outcome and course of depression. However, the factors involved in delaying treatment contact after the first onset of lifetime depression are not fully understood. This cross-sectional study aims to identify the characteristics that may predict the delay in initial treatment contact after the first onset of lifetime depression by comparing the socio-demographics and clinical characteristics between those with longer and shorter DUI in a well-characterized Japanese clinical sample. Methods Ninety-five patients with depression with longer (>12 months) and shorter DUI (≤12 months) at three Japanese outpatient clinics were studied. Subjects received a comprehensive evaluation, including semi-structured clinical interviews and assessment battery, and their clinical charts were reviewed. Results Of the total sample, the median of DUI was 4 months (interquartile range (IQR) 25th–75th percentile, 2–13). We found that 72.6% of patients seek treatment contact within the first year of depression onset. Multivariate logistic regression analysis showed that longer DUI in patients was associated with marital status (never married). Further, the DSM-IV melancholic features approached significance. Conclusions Our findings suggest that most Japanese patients with depression are likely to seek treatment within 1 year of onset, and that marital status and melancholia may be potential predictors of the delay in the initial treatment contact after the first onset of lifetime depression.
Collapse
Affiliation(s)
- Yoshiyo Oguchi
- Department of Neuropsychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582 Japan ; Department of Psychiatry, National Hospital Organization, Tokyo Medical Center, Tokyo, Japan
| | - Atsuo Nakagawa
- Department of Neuropsychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582 Japan ; Center for Clinical Research, Keio University School of Medicine, Tokyo, Japan ; Department of Psychiatry, National Hospital Organization, Tokyo Medical Center, Tokyo, Japan
| | - Mitsuhiro Sado
- Department of Neuropsychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582 Japan
| | - Dai Mitsuda
- Department of Neuropsychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582 Japan
| | - Yuko Nakagawa
- Department of Neuropsychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582 Japan
| | - Noriko Kato
- Department of Psychiatry, National Hospital Organization, Tokyo Medical Center, Tokyo, Japan
| | - Sayuri Takechi
- Department of Neuropsychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582 Japan ; Department of Psychiatry, National Hospital Organization, Tokyo Medical Center, Tokyo, Japan
| | - Mitsunori Hiyama
- Department of Psychiatry, National Hospital Organization, Tokyo Medical Center, Tokyo, Japan
| | - Masaru Mimura
- Department of Neuropsychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582 Japan
| |
Collapse
|
27
|
Ki M, Paik JW, Choi KS, Ryu SH, Han C, Lee K, Ham BJ, Chang HS, Won ES, Jun TY, Lee MS. Delays in depression treatment among Korean population. Asia Pac Psychiatry 2014; 6:414-24. [PMID: 25103868 DOI: 10.1111/appy.12140] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2013] [Accepted: 04/24/2014] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Delays in mental health service utilization for patients with depression have been observed globally. To elucidate some aspects of delays, age-related associations with a series of variables representing different stages of mental health service use were studied concurrently. METHODS A total of 1,433 patients with depression participated in a nationwide Korean Depressive Patient Survey through the collaboration of 70 psychiatric clinics and hospitals. Using logistic and Poisson regression, we investigated whether there is variation in the associations by age. RESULTS Patients with depression in South Korea spent 3.4 years on average before starting a first depression treatment after the onset of depression, and 58% of them entered depression treatment in the first year of onset. Early onset appeared to lower the chance of "early depression treatment": e.g., adjusted odds ratio (OR)s for onset age of 40-54, 25-39 and <25 versus ≥55 were 0.65 (95% CI = 0.44, 0.94), 0.36 (95% CI = 0.16, 0.81) and 0.18 (95% CI = 0.06, 0.48), respectively. In contrast, favorable associations of early onset with "self-recognition as depression" and "number of nonpsychiatric clinics attended" before visiting psychiatrist were found. Younger cohorts were associated with more positive attitudes toward all mental health utilization measures. DISCUSSION Delays in depression treatment are lengthy in South Korea. Those with early onset are more likely to have delayed depression treatment but are more willing to seek help from a psychiatrist once they sought for the treatment.
Collapse
Affiliation(s)
- Myung Ki
- School of Medicine, Department of Preventive Medicine, Eulji University, Daejeon, Korea
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
28
|
McCraw S, Parker G, Graham R, Synnott H, Mitchell PB. The duration of undiagnosed bipolar disorder: effect on outcomes and treatment response. J Affect Disord 2014; 168:422-9. [PMID: 25108774 DOI: 10.1016/j.jad.2014.07.025] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Revised: 06/12/2014] [Accepted: 07/11/2014] [Indexed: 11/26/2022]
Abstract
INTRODUCTION There are commonly long delays between the onset of bipolar disorder (BP), seeking of treatment and acquiring a bipolar disorder diagnosis. Whether a longer duration of undiagnosed bipolar disorder (DUBP) leads to an inferior treatment response is unclear in the literature. METHOD We conducted two studies with independent samples of BP patients who had received a first-time diagnosis of BP - first investigating whether DUBP was related to clinical and social outcomes at the time of assessment (n=173) and, second, whether response to mood stabiliser medication was affected by DUBP when assessed three months following assessment and intervention (n=64). RESULTS Participants׳ mean DUBP was 18-20 years (from the onset of mood episodes). After controlling for age, a longer DUBP was associated with employment difficulties, whereas a shorter DUBP was associated with a history of engaging in self-harm behaviours, as well as a reduced likelihood of experiencing social costs as consequence of the mood disorder. The majority of study variables were statistically unrelated to DUBP. In a multivariate analysis, age was the only predictor variable to make a significant contribution to the DUBP (33%). Across the 3-month intervention period, participants improved significantly on all but one outcome measure. The participants׳ likelihood to improve, become worse or experience minimal/no change over the study period was not significantly related to the DUBP. LIMITATIONS Self-reporting poses a risk to measurement precision. Being a naturalistic observation, no specific dose of medication was prescribed. The small sample of BP I patients provided insufficient statistical power to undertake meaningful separate analyses of the BP I and BP II participants. CONCLUSION Early detection and intervention remains important for helping to reduce morbidity and risks associated with untreated BP. However, the variation in DUBP was mostly a function of age and did not substantially affect clinical status at assessment, or lead to an inferior response to mood stabilising medication.
Collapse
Affiliation(s)
- Stacey McCraw
- School of Psychiatry, University of New South Wales, Sydney, Australia; Black Dog Institute, Sydney, Australia.
| | - Gordon Parker
- School of Psychiatry, University of New South Wales, Sydney, Australia; Black Dog Institute, Sydney, Australia
| | - Rebecca Graham
- School of Psychiatry, University of New South Wales, Sydney, Australia; Black Dog Institute, Sydney, Australia
| | | | - P B Mitchell
- School of Psychiatry, University of New South Wales, Sydney, Australia; Black Dog Institute, Sydney, Australia
| |
Collapse
|
29
|
Early improvement in depressive symptoms with desvenlafaxine 50 mg/d as a predictor of treatment success in patients with major depressive disorder. J Clin Psychopharmacol 2014; 34:57-65. [PMID: 24346751 DOI: 10.1097/jcp.0000000000000049] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE This post hoc analysis assessed the predictive value of improvement in depressive scores at early time points for treatment outcomes at week 8 in patients with major depressive disorder treated with desvenlafaxine 50 mg/d or placebo. METHODS Pooled data from 6 double-blind, fixed-dose studies in adult patients with major depressive disorder. Patients were randomly assigned to desvenlafaxine or placebo. Primary end point was change in 17-item Hamilton Rating Scale for Depression (HAM-D17) scores from baseline to week 8 (or last observation carried forward). Optimal thresholds of improvement (percent change from baseline HAM-D17) at weeks 2 and 3 for predicting 4 levels of treatment success (≥ 45%, ≥ 50%, and ≥ 65% decrease from baseline HAM-D17, HAM-D17 ≤ 7) at week 8 (last observation carried forward) were determined using receiver operating characteristic analysis. Odds ratios of the predictability of improvement thresholds were computed from a logistic regression model adjusting for significant baseline predictors. RESULTS Desvenlafaxine 50 mg/d (n = 1207) had significantly greater rates of treatment success for each level of treatment success at 8 weeks compared with placebo (n = 1067). Optimal early improvement thresholds for weeks 2 (20%-30%) and 3 (28%-41%) were highly predictive of all 4 levels of treatment success after adjusting for significant baseline predictors (odds ratios, 0.951-0.960; all P < 0.0001). Negative predictive value of early improvement increased, and positive predictive value decreased, for increasingly stringent definitions of treatment success at week 8. CONCLUSIONS Clinical observations of patients' early response to desvenlafaxine 50 mg/d may have clinical value in predicting treatment success and guiding patient management.
Collapse
|
30
|
Ghio L, Gotelli S, Marcenaro M, Amore M, Natta W. Duration of untreated illness and outcomes in unipolar depression: a systematic review and meta-analysis. J Affect Disord 2014; 152-154:45-51. [PMID: 24183486 DOI: 10.1016/j.jad.2013.10.002] [Citation(s) in RCA: 127] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Revised: 08/30/2013] [Accepted: 10/01/2013] [Indexed: 01/07/2023]
Abstract
BACKGROUND To systematically review evidence of the effects of the duration of untreated depression on the clinical outcomes of patients suffering from Unipolar Major Depression. METHODS A systematic review and meta-analysis of the evidence of duration of untreated depression and the effect it has on clinical outcomes in Unipolar Major Depression. Data used to this purpose were obtained from a literature search of the MEDLINE, Psychoinfo and Embase databases. Comparable data extracted from studies were entered and analysed using Cochrane Collaboration's Review Manager software Version 5.2. RESULTS Ten studies were identified as meeting the inclusion criteria. Only three studies reported comparable data and were consequently used for the meta-analysis. Pooled data indicates the overall positive effect of shorter duration of untreated illness both in a patient's response to treatment (RR 1.70) and remission (RR 1.65). Other studies which were not included in the meta-analysis confirmed the importance of reducing delays in the treatment of depression in order to prevent the risk of worse outcomes and chronicity, in particular in patients presenting with a first episode of depression. Data regarding the association between the duration of untreated episode in recurrent depression and clinical outcomes are less evident. LIMITATIONS The heterogeneity of the selected studies was cause for limitations with regard to the carrying out of adequate meta-analysis. CONCLUSIONS There is evidence highlighting the importance of a reduced no-treatment interval for patients suffering Unipolar Depression. In particular, there is emphasis on the first episode of depression corresponding to the notion of reducing the duration of untreated illness.
Collapse
Affiliation(s)
- Lucio Ghio
- Department of Neuroscience, Ophthalmology and Genetics, Psychiatry Section, University of Genoa, Largo Rosanna Benzi 10, 16100 Genoa, Italy.
| | | | | | | | | |
Collapse
|
31
|
Abstract
BACKGROUND Despite high rates of postcardiac surgery depression, studies of depression treatment in this population have been limited. OBJECTIVE The aim of this study was to evaluate early cognitive behavioral therapy (CBT) in a home environment in patients recovering from cardiac surgery. METHODS : From July 2006 through October 2009, we conducted a randomized controlled trial and enrolled 808 patients who were screened for depressive symptoms using the Beck Depression Inventory (BDI) in the hospital and 1 month later. Patients were interviewed using the Structured Clinical Interview for DSM-IV; those who met criteria for clinical depression (n = 81) were randomized to CBT (n = 45) or usual care (UC; n = 36). After completion of the UC period, 25 individuals were offered later CBT (UC + CBT). RESULTS Main outcomes (depressive symptoms [BDI] and clinical depression [Structured Clinical Interview for DSM-IV]) were evaluated after 8 weeks using intention-to-treat principles and linear mixed models. Compared with the UC group, in the CBT group, there was greater decline in BDI scores (β = 1.41; 95% confidence interval [CI], 0.81-2.02; P = < .001) and greater remission of clinical depression (29 [64%] vs 9 [25%]; number need to treat, 2.5; 95% CI, 1.7-4.9; P < .001). Compared with the early CBT group (median time from surgery to CBT, 45.5 days) the later UC + CBT group (median time from surgery to CBT, 122 days) also experienced a reduction in BDI scores, but the group × time effect was smaller (β = 0.79; 95% CI, 0.10-1.47; P = .03) and remission rates between the 2 groups did not differ. CONCLUSIONS Early home CBT is effective in depressed postcardiac surgery patients. Early treatment is associated with greater symptom reduction than similar therapy given later after surgery.
Collapse
|
32
|
Hoyer C, Sartorius A, Lecourtier L, Kiening KL, Meyer-Lindenberg A, Gass P. One ring to rule them all?--Temporospatial specificity of deep brain stimulation for treatment-resistant depression. Med Hypotheses 2013; 81:611-8. [PMID: 23910557 DOI: 10.1016/j.mehy.2013.07.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Revised: 07/01/2013] [Accepted: 07/05/2013] [Indexed: 01/30/2023]
Abstract
Deep brain stimulation (DBS) for intractable cases of depression has emerged as a valuable therapeutic option during the last decade. While several locations have been intensely investigated in recent years, the literature is lacking an all-encompassing perspective thereupon asking if and how these stimulation sites relate to each other and what this may imply for the underlying mechanisms of action of this treatment modality. We aim at proposing a model of DBS mechanism of action with particular focus on several puzzling aspects regarding an apparent temporo-spatial specificity of antidepressant action, i.e. the discrepancy between protracted response after initiation of stimulation and rapid relapse upon discontinuation, as well as differential effects on psychopathology. We suggest that the pre-treatment depressive state is determined by the interaction of individual traits with dysfunctional adaptive processes as responses to stress, resulting in a disease-associated, overtly dysfunctional, equilibrium. The antidepressant action of DBS is thought to modify and re-set this equilibrium in a temporospatially distinct manner by influencing the activity states of two different brain circuitries. The idea of sequential and temporospatially distinct mechanisms of action bears implications for the assessment of psychopathology and behavior in clinical and preclinical studies as well as investigations into brain circuit activity states.
Collapse
Affiliation(s)
- Carolin Hoyer
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, J5, 68159 Mannheim, Germany.
| | | | | | | | | | | |
Collapse
|
33
|
Moylan S, Maes M, Wray NR, Berk M. The neuroprogressive nature of major depressive disorder: pathways to disease evolution and resistance, and therapeutic implications. Mol Psychiatry 2013; 18:595-606. [PMID: 22525486 DOI: 10.1038/mp.2012.33] [Citation(s) in RCA: 353] [Impact Index Per Article: 32.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
In some patients with major depressive disorder (MDD), individual illness characteristics appear consistent with those of a neuroprogressive illness. Features of neuroprogression include poorer symptomatic, treatment and functional outcomes in patients with earlier disease onset and increased number and length of depressive episodes. In such patients, longer and more frequent depressive episodes appear to increase vulnerability for further episodes, precipitating an accelerating and progressive illness course leading to functional decline. Evidence from clinical, biochemical and neuroimaging studies appear to support this model and are informing novel therapeutic approaches. This paper reviews current knowledge of the neuroprogressive processes that may occur in MDD, including structural brain consequences and potential molecular mechanisms including the role of neurotransmitter systems, inflammatory, oxidative and nitrosative stress pathways, neurotrophins and regulation of neurogenesis, cortisol and the hypothalamic-pituitary-adrenal axis modulation, mitochondrial dysfunction and epigenetic and dietary influences. Evidence-based novel treatments informed by this knowledge are discussed.
Collapse
Affiliation(s)
- S Moylan
- School of Medicine, Deakin University, Geelong, VIC, Australia.
| | | | | | | |
Collapse
|
34
|
Bukh JD, Bock C, Vinberg M, Kessing LV. The effect of prolonged duration of untreated depression on antidepressant treatment outcome. J Affect Disord 2013; 145:42-8. [PMID: 22854096 DOI: 10.1016/j.jad.2012.07.008] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2012] [Revised: 07/06/2012] [Accepted: 07/06/2012] [Indexed: 12/01/2022]
Abstract
BACKGROUND The duration of untreated illness has been considered a likely predictor of the course of psychotic disorders. However, there is only sparse data concerning the influence of treatment delay on the outcome of mood disorders. The present study aimed to assess the effect of prolonged untreated depression on the outcome of antidepressant treatment. METHOD Patients aged 18-70 years with recent onset of the first lifetime depressive episode were systematically recruited by the Danish Psychiatric Central Research Register during a 2-year period. A total number of 399 individuals out of 1006 potential participants in the Register were interviewed, and 270 fulfilled the inclusion criteria. The validity of the diagnosis, duration of untreated illness, remission on first-line antidepressant treatment and a number of covariates, including psychiatric co-morbidity, personality disorders and traits, stressful life events prior to onset, and family history of psychiatric illness, were assessed by structured interviews. RESULTS The remission rate was significantly decreased among patients with six months or more of untreated depression as compared to patients who were treated with antidepressant medication earlier after onset (21.1% versus 33.7%, OR=0.5, 95% CI 0.3 to 0.9, p=0.03). The negative influence of a prolonged DUI on the outcome did not seem confounded by any of a wide range of demographic and clinical variables. LIMITATIONS The outcome was evaluated retrospectively. The findings cannot be generalized to patients outside hospital settings. CONCLUSION Initiation of antidepressant treatment more than six months after onset of first episode depression reduces the chance of obtaining remission. The results emphasize the importance of early recognition and treatment of patients suffering from depression.
Collapse
Affiliation(s)
- Jens Drachmann Bukh
- Department 6233, Blegdamsvej 9, Psychiatric Center Copenhagen, Rigshospitalet, University Hospital of Copenhagen, DK-2100 Copenhagen, Denmark.
| | | | | | | |
Collapse
|
35
|
Dell'Osso B, Glick ID, Baldwin DS, Altamura AC. Can long-term outcomes be improved by shortening the duration of untreated illness in psychiatric disorders? A conceptual framework. Psychopathology 2013; 46:14-21. [PMID: 22890286 DOI: 10.1159/000338608] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2011] [Accepted: 03/18/2012] [Indexed: 01/22/2023]
Abstract
The duration of untreated illness (DUI), meaning the latency to the pharmacological treatment, has been increasingly investigated in the last decade as a predictor of outcome across different psychiatric conditions, particularly in psychotic disorders. DUI is essentially computed by subtracting the age of onset of a specific disorder from the age at which the first adequate pharmacological treatment is administered. Assessment of the latency to treatment represents one of the first steps in planning early interventions. This review examines the role of the DUI in psychotic and affective disorders, focusing on neuropathological, epidemiologic, clinical and prognostic factors related to a longer latency to treatment. Through a Medline and Cochrane Library search, relevant studies up to June 2011 and other pertinent articles including meta-analyses, randomized controlled trials, naturalistic studies and clinical reviews were identified. Converging evidence indicates that a prolonged DUI negatively influences the outcome of first-episode psychosis and schizophrenia in different ways, and increasing data point toward a similar conclusion in affective disorders. Even though methodological limitations related to investigation of the DUI need to be considered, research and interventions aimed to reduce latency to treatments are object of increasing implementation worldwide. The assessment of the DUI represents one of the most important parameters to consider in this perspective, in order to quantify different latency to treatment in specific disorders and to plan related, targeted interventions.
Collapse
Affiliation(s)
- Bernardo Dell'Osso
- Department of Neurological Sciences, Università degli Studi di Milano, Milano, Italy.
| | | | | | | |
Collapse
|
36
|
Pathway to psychiatric care in a tertiary mental health facility in Jaipur, India. Asian J Psychiatr 2012; 5:303-8. [PMID: 23174437 DOI: 10.1016/j.ajp.2012.04.003] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2011] [Revised: 04/01/2012] [Accepted: 04/13/2012] [Indexed: 11/20/2022]
Abstract
PURPOSE This study was planned to evaluate the pathway to care of mentally ill patients attending a tertiary mental health facility in Jaipur to highlight the difficulties of mentally ill and their relatives in accessing appropriate care. METHODS Seventy-six patients, who attended the Out Patient Department of Psychiatry of a tertiary care hospital in Jaipur, India for the first time, were enrolled in this study. The family members of the patients were interviewed to evaluate the pathway to care using the Encounter form developed by the WHO. RESULTS The patients were predominantly young adults, male, from rural, agrarian but educated background and a majority of them presented with psychotic illnesses. It was seen that there were five major gateways to care of the mentally ill in the region, Faith healers being the most popular portal of care. The median duration of untreated illness (DUI) was 6 months, and subjects had already visited, 2 carers before visiting any mental health professional. The median monetary cost of the pathway was Rs. 3565. Patients suffering from psychotic illnesses presented earlier. Those who used psychiatric services as first portal of care had different socio-demographic variables as compared to clients who used other services. CONCLUSION This pathway to psychiatric care study in Jaipur, India demonstrated that referral pathway heavily relies on faith healers. The study indicates possible fields and gives indications, underlining the importance of improving awareness campaigns that will facilitate the recognition of psychiatric disorders.
Collapse
|
37
|
Thomas AC, Staiger PK. Introducing mental health and substance use screening into a community-based health service in Australia: usefulness and implications for service change. HEALTH & SOCIAL CARE IN THE COMMUNITY 2012; 20:635-644. [PMID: 22747792 DOI: 10.1111/j.1365-2524.2012.01079.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Mental health issues such as depression or anxiety and alcohol or other drug (AOD) problems often remain undiagnosed and untreated despite their prevalence in the community. This paper reports on the implementation and evaluation of an AOD and depression/anxiety screening programme within two Community Health Services (CHS) in Australia. Study 1 examined results from 5 weeks of screening (March-April 2008) using the Patient Health Questionnaire (two- and nine-item, Kroenke et al. 2001, 2003), the Conjoint Screen for Alcohol and other Drug Problems (Brown et al. 2001) and the Alcohol, Smoking and Substance Involvement Screening Test (Humeniuk & Ali 2006). Of the 55 clients screened, 33% were at risk of depression or anxiety, 22% reporting moderate-severe depression. Thirteen per cent were at risk of substance use disorders. A substantial proportion of at-risk clients were not currently accessing help for these issues from the CHS and therefore screening can facilitate identification and treatment referral. However, the majority of eligible clients were not screened, limiting screening reach. A second study evaluated the screening implementation from a process perspective via thematic analysis of focus group data from six managers and 14 intake/assessment workers (April 2008). This showed that when screening occurred, it facilitated opportunities for education and intervention with at-risk clients, although cultural mores, privacy concerns and shame/stigma could affect accuracy of screen scores at times. Importantly, the evaluation revealed that most decisions not to screen were made by workers, not by clients. Reasons for non-screening related to worker discomfort in asking sensitive questions and/or managing client distress, and a reluctance to spend long periods of time screening in time-pressured environments. The evaluation suggested that these problems could be resolved by splitting screening responsibilities, enhancing worker training and expanding follow-up screening. Findings will inform any community-based health system considering introducing screening.
Collapse
Affiliation(s)
- Anna C Thomas
- Faculty of Life and Social Sciences, Brain and Psychological Sciences Research Centres, Swinburne University of Technology, Melbourne, Australia.
| | | |
Collapse
|
38
|
McCann TV, Lubman DI. Young people with depression and their experience accessing an enhanced primary care service for youth with emerging mental health problems: a qualitative study. BMC Psychiatry 2012; 12:96. [PMID: 22853550 PMCID: PMC3441774 DOI: 10.1186/1471-244x-12-96] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2011] [Accepted: 07/27/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite the emergence of mental health problems during adolescence and early adulthood, many young people encounter difficulties accessing appropriate services. In response to this gap, the Australian Government recently established new enhanced primary care services (headspace) that target young people with emerging mental health problems. In this study, we examine the experience of young people with depression accessing one of these services, with a focus on understanding how they access the service and the difficulties they encounter in the process. METHOD Individual, in-depth, audio-recorded interviews were used to collect data. Twenty-six young people with depression were recruited from a headspace site in Melbourne, Australia. Interpretative phenomenological analysis was used to analyse the data. RESULTS Four overlapping themes were identified in the data. First, school counsellors as access mediators, highlights the prominent role school counsellors have in facilitating student access to the service. Second, location as an access facilitator and inhibitor. Although the service is accessible by public transport, it is less so to those who do not live near public transport. Third, encountering barriers accessing the service initially. Two main service access barriers were experienced: unfamiliarity with the service, and delays in obtaining initial appointments for ongoing therapy. Finally, the service's funding model acts as an access facilitator and barrier. While the model provides a low or no cost services initially, it limits the number of funded sessions, and this can be problematic. CONCLUSIONS Young people have contrasting experiences accessing the service. School counsellors have an influential role in facilitating access, and its close proximity to public transport enhances access. The service needs to become more prominent in young people's consciousness, while the appointment system would benefit from providing more timely appointments with therapists. The service's funding model is important in enabling access initially to young people from low socioeconomic backgrounds, but the government needs to reassess the model for those who require additional support.
Collapse
Affiliation(s)
- Terence V McCann
- School of Nursing and Midwifery, Victoria University, PO Box 14428, Melbourne, 8001, VIC, Australia.
| | - Dan I Lubman
- Turning Point Alcohol and Drug Centre, Eastern Health and Monash University, 54-62 Gertrude Street, Fitzroy, 3065, VIC, Australia
| |
Collapse
|
39
|
Adachi Y, Aleksic B, Nobata R, Suzuki T, Yoshida K, Ono Y, Ozaki N. Combination use of Beck Depression Inventory and two-question case-finding instrument as a screening tool for depression in the workplace. BMJ Open 2012; 2:bmjopen-2011-000596. [PMID: 22566608 PMCID: PMC3353128 DOI: 10.1136/bmjopen-2011-000596] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVES The present study aimed to validate screening tools that could be used to identify depression among workers. DESIGN Diagnostic test study. SETTINGS Workers from three Japanese companies agreed to participate. PARTICIPANTS Recruitment for the group 1 occurred between January 2001 and February 2004, and 89 participants (81 men and 8 women with a mean age of 38.4±6.6 years) (98.8%) took part in the study. Recruitment for the group 2 occurred between July 2000 and February 2004, and 1500 participants (1408 men and 92 women with a mean age of 40.9±7.2 years) (94.2%) took part in the study. Demographic data are shown in supplementary table 1. PRIMARY AND SECONDARY OUTCOME MEASURES the Beck Depression Inventory (BDI) and a two-question case-finding instrument (TQI) were administered to 89 workers and Mini-International Neuropsychiatric Interview was conducted to verify the diagnosis of depression. A second group of 1500 workers completed the BDI and TQI to detect possible sample bias for the distribution of depression. Specificity, sensitivity and positive predictive value were calculated in order to obtain the optimal cut-off scores for BDI and TQI and receiver operating characteristic curves, and Youden Index were applied to further refine the optimal cut-off scores. RESULTS When paired together, BDI score ≥10 and TQI score of 2 adequately identified workers who had major depressive disorder and those who had other psychiatric disorders that are frequently comorbid with major depressive disorder. CONCLUSIONS The combination of BDI score ≥10 and TQI score of 2 can adequately screen for current and potential cases of depression among workers. Furthermore, BDI and TQI offer the advantage of being relatively easy to administer to a large number of workers. Early detection of depression could improve treatment outcomes and decrease economic burden. TRIAL REGISTRATION [corrected]
Collapse
Affiliation(s)
- Yasunori Adachi
- Department of Psychiatry, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Branko Aleksic
- Department of Psychiatry, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Ryoko Nobata
- Department of Psychiatry, Toyota Memorial Hospital, Toyota, Japan
| | - Tatsuyo Suzuki
- Department of Psychiatry, Seishinkai Okehazama Hospital, Toyoake, Japan
| | - Keizo Yoshida
- Health Care Promotion Division, DENSO Corporation, Kariya, Japan
| | - Yuichiro Ono
- Department of Public Health, Fujita Health University, Toyoake, Japan
| | - Norio Ozaki
- Department of Psychiatry, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| |
Collapse
|
40
|
Abstract
INTRODUCTION OR BACKGROUND Depressive disorder is a long term, relapsing condition associated with high levels of disability and mortality. It has a neurobiological basis and is associated with functional and structural brain abnormalities. SOURCES OF DATA The data discussed have been obtained mainly from meta-analyses, randomized controlled clinical trials and key review papers as well as animal studies. AREAS OF AGREEMENT Genetic vulnerability and stress are key factors in its aetiopathogenesis. Dysregulation of the hypothalamo-pituitary-adrenal (HPA) axis reduces hippocampal volumes and prefrontal cortex (PFC) activity in depressed patients and disrupts homeostasis within the neurocircuit of depression. Antidepressant drugs increase brain-derived neurotrophin, restoring neuronal growth and activity and modulate interactions between the neurocircuit anatomical structures. AREAS OF CONTROVERSY It remains to be confirmed whether structural changes in the brain are purely abnormalities in neuroplasticity and are fully reversible, whether they predate depression and whether they increase in the long term. GROWING POINTS Investigation of the molecular mechanisms mediating gene and environment interaction is a growing and potentially fruitful area of research in the neurobiology of depression. Further elucidation of the neuroanatomical and physiological connections between the limbic structures and PFC may help identify key areas to target in treatment. The role of the dysregulation of the HPA axis and identifiable stressors in the recent or remote past which are not always present in depression need further study. AREAS TIMELY FOR DEVELOPING RESEARCH Prospective studies examining the interaction between changes in brain function and structure in relation to stress and identified relevant genes and how these may be influenced by antidepressant drug treatment and the long-term course of depression would help clarify their role in the pathophysiology of this disorder.
Collapse
Affiliation(s)
- Eleni Palazidou
- East London Foundation Trust, Tower Hamlets Centre for Mental Health, Mile End Hospital, London, UK.
| |
Collapse
|
41
|
Rubio JM, Markowitz JC, Alegría A, Pérez-Fuentes G, Liu SM, Lin KH, Blanco C. Epidemiology of chronic and nonchronic major depressive disorder: results from the national epidemiologic survey on alcohol and related conditions. Depress Anxiety 2011; 28:622-31. [PMID: 21796739 PMCID: PMC3212845 DOI: 10.1002/da.20864] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Burden related to major depressive disorder (MDD) derives mostly from long-term occurrence of symptoms. This study aims to examine the prevalence, sociodemographic correlates, patterns of 12-month and lifetime psychiatric comorbidity, lifetime risk factors, psychosocial functioning, and mental health service utilization of chronic major depressive disorder (CMDD) compared to nonchronic major depressive disorder. METHODS Face-to-face interviews were conducted in the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (n = 43,093). RESULTS The 12-month and lifetime prevalence of CMDD within the population meeting criteria for MDD was 26.5% and 24.0%, respectively. Individuals reporting a chronic course of MDD were socioeconomically and educationally disadvantaged, tended to be older, report loss of spouse or history of divorce, live in rural areas, have public assistance, low self-esteem, worse overall health and more likely to report comorbidities, most importantly dysthymia, generalized anxiety disorder, avoidant, and dependant personality disorder. Individuals with chronic MDD were more likely to report familial but not childhood onset risk factors for MDD. Those suffering CMDD were more likely to seek and receive mental health care than other forms of MDD, even though it took longer to start treatment. CONCLUSION Chronic course of MDD is related to still worse socioeconomic conditions, educational achievement, more comorbidities, and family risk factors, although other courses of MDD carried greater risk of unmet treatment.
Collapse
Affiliation(s)
- Jose M. Rubio
- Department of Psychiatry, and College of Physicians and Surgeons, Columbia University, New York, NY 10032,New York State Psychiatric Institute, New York, NY 10032
| | - John C. Markowitz
- Department of Psychiatry, and College of Physicians and Surgeons, Columbia University, New York, NY 10032,New York State Psychiatric Institute, New York, NY 10032,Weill Medical College of Cornell University New York, NY 10065
| | - Analucía Alegría
- Department of Psychiatry, and College of Physicians and Surgeons, Columbia University, New York, NY 10032,New York State Psychiatric Institute, New York, NY 10032
| | - Gabriela Pérez-Fuentes
- Department of Psychiatry, and College of Physicians and Surgeons, Columbia University, New York, NY 10032,New York State Psychiatric Institute, New York, NY 10032
| | - Shang-Min Liu
- Department of Psychiatry, and College of Physicians and Surgeons, Columbia University, New York, NY 10032,New York State Psychiatric Institute, New York, NY 10032
| | - Keng-Han Lin
- Department of Psychiatry, and College of Physicians and Surgeons, Columbia University, New York, NY 10032,New York State Psychiatric Institute, New York, NY 10032
| | - Carlos Blanco
- Department of Psychiatry, and College of Physicians and Surgeons, Columbia University, New York, NY 10032,New York State Psychiatric Institute, New York, NY 10032
| |
Collapse
|
42
|
Hidalgo MPL, Caumo W, Dantas G, Franco DG, Torres ILDS, Pezzi J, Elisabetsky E, Detanico BC, Piato Â, Markus RP. 6‐Sulfatoxymelatonin as a predictor of clinical outcome in depressive patients. Hum Psychopharmacol 2011; 26:252-7. [PMID: 21681816 DOI: 10.1002/hup.1204] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES This study established the value of the 6‐sulfatoxymelatonin (aMT6s) urine concentration as a predictor of the therapeutic response to noradrenaline reuptake inhibitors in depressive patients. METHODS Twenty-two women aged 18-60 years were selected. Depressive symptoms were assessed by using the Hamilton Depression Scale. Urine samples were collected at 0600-1200 h, 1200-1800 h, 1800-2400 h, and 2400-0600 h intervals, 1 day before and 1 day after starting on the nortriptyline treatment. Urine aMT6s concentration was analyzed by a one-way analysis of variance/Bonferroni test. Spearman's rank correlation coefficient was used to analyze the correlation between depressive symptoms after 2 weeks of antidepressant treatment and the increase in aMT6s urine concentration. RESULTS Higher and lower size effect groups were compared by independent Student's t-tests. At baseline, the 2400‐ to 0600‐h interval differed from all other intervals presenting a significantly higher aMT6s urine concentration. A significant difference in aMT6s urine concentrations was found 1 day after treatment in all four intervals. Higher size effect group had lower levels of depressive symptoms 2 weeks after the treatment. A positive correlation between depressive symptoms and the delta of aMT6s in the 2400-0600 h interval was observed. CONCLUSION Our results reinforce the hypothesis that aMT6s excretion is a predictor of clinical outcome in depression, especially in regard to noradrenaline reuptake inhibitors.
Collapse
Affiliation(s)
- Maria Paz Loayza Hidalgo
- Department of Psychiatry and Forensic Medicine, Faculty of Medicine, Federal University of Rio Grande do Sul and Laboratory of Chronobiology of Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Altamura AC, Buoli M, Serati M. Duration of illness and duration of untreated illness in relation to drug response in psychiatric disorders. ACTA ACUST UNITED AC 2011. [DOI: 10.2217/npy.10.2] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|