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Schneider C, Breilmann J, Reuter B, Becker T, Kösters M. Systematic evaluation of the 'efficacy-effectiveness gap' in the treatment of depression with venlafaxine and duloxetine. Acta Psychiatr Scand 2021; 144:113-124. [PMID: 33661520 DOI: 10.1111/acps.13293] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 02/17/2021] [Accepted: 02/23/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Evidence of larger drug effects in highly standardized studies (efficacy) compared to clinical routine (effectiveness) is discussed as efficacy-effectiveness gap. This study aimed to quantify effect size differences of RCTs and non-RCTs in the treatment of depression with venlafaxine and duloxetine and to identify effect modifying predictors. METHODS A comprehensive systematic review and meta-analysis was conducted, including all prospective trials, which evaluated the treatment effects of duloxetine or venlafaxine in patients with depression. The primary outcome was the pre-post effect size after acute therapy, which were compared between RCTs and non-RCTs. Moreover, an exploratory analysis of predictors in a mixed meta-regression model within an information-theoretic approach was performed. RESULTS 171 RCTs and 74 non-RCTs were included. The pre-post effect size differed significantly between RCTs and non-RCTs (-3.04 vs. -2.62, Δ = 0.41, p = 0.012, high heterogeneity). Study characteristics were very similar between RCTs and non-RCTs. Most important variables to predict effect sizes were 'depression severity', 'dose' and 'number of participants'. CONCLUSION Despite differences in effect sizes between RCTs and non-RCTs, study design is not clearly an important predictor for the effect sizes. Our results question the common assumption that non-RCTs are generally better suited to describe a drug's effectiveness in clinical practice than RCTs. Future studies and their reporting should put more emphasis on the description of external validity, in order to allow better assessments of clinical relevance.
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Affiliation(s)
- Carolin Schneider
- Department of Psychiatry II, Ulm University, Bezirkskrankenhaus Günzburg, Germany.,Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Johanna Breilmann
- Department of Psychiatry II, Ulm University, Bezirkskrankenhaus Günzburg, Germany
| | - Benedikt Reuter
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Thomas Becker
- Department of Psychiatry II, Ulm University, Bezirkskrankenhaus Günzburg, Germany
| | - Markus Kösters
- Department of Psychiatry II, Ulm University, Bezirkskrankenhaus Günzburg, Germany
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Hung CI, Liu CY, Yang CH, Wang SJ. Migraine with active headache was associated with other painful physical symptoms at two-year follow-up among patients with major depressive disorder. PLoS One 2019; 14:e0216108. [PMID: 31039196 PMCID: PMC6490935 DOI: 10.1371/journal.pone.0216108] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 04/15/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Few studies have investigated the associations of comorbid migraine with other painful physical symptoms (PPS) in patients with major depressive disorder (MDD) at the two-year follow-up point. This study aimed to investigate this issue. METHODS At baseline, 155 outpatients with MDD were enrolled. Migraine was diagnosed at baseline according to the International Classification of Headache Disorders. At follow-up, data of 101 subjects were analyzed. The average intensities of head, bone and/or joints, back, chest, abdomen, neck and/or shoulder, general muscle, and limb pain in the past week were evaluated using a visual analog scale (VAS). At follow-up, active headache was defined as a score on the VAS > 3. Multiple linear regressions were used to investigate the associations of migraine at baseline with other PPS at follow-up. RESULTS Compared with the migraine with inactive headache group and the non-migraine group, patients with migraine with active headache had significantly higher intensities of other PPS and a lower remission rate of depression. There were no significant differences in the pain intensities of the other seven PPS between the migraine with inactive headache group and the non-migraine group. Headache intensity was significantly correlated with the intensities of other PPS at baseline and follow-up. Migraine with active headache independently predicted other PPS after controlling for depression and anxiety at baseline. CONCLUSIONS Migraine with active headache among MDD patients could predict other PPS. Prevention and treatment of headache might help to decrease other PPS and improve the prognosis of depression. Integration of treatment for depression and headache is indicated.
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Affiliation(s)
- Ching-I Hung
- Department of Psychiatry, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan
- School of Medicine, Chang Gung University, Tao-Yuan, Taiwan
| | - Chia-Yih Liu
- Department of Psychiatry, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan
- School of Medicine, Chang Gung University, Tao-Yuan, Taiwan
| | - Ching-Hui Yang
- Department of Nursing, Mackay Medical College, New Taipei, Taiwan
| | - Shuu-Jiun Wang
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Brain Research Center, National Yang-Ming University, Taipei, Taiwan
- Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- * E-mail:
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Hung CI, Liu CY, Yang CH, Wang SJ. Migraine and greater pain symptoms at 10-year follow-up among patients with major depressive disorder. J Headache Pain 2018; 19:56. [PMID: 30019214 PMCID: PMC6049843 DOI: 10.1186/s10194-018-0884-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 07/02/2018] [Indexed: 12/16/2022] Open
Abstract
Background No study has investigated the associations of migraine with pain symptoms over a ten-year period among outpatients with major depressive disorder (MDD). This study aimed to investigate this issue. Methods At baseline, the study enrolled 290 outpatients with MDD and followed-up the patients at six-month, two-year, and ten-year time points. MDD and anxiety comorbidities were diagnosed using the Structured Clinical Interview for DSM-IV-text revision. Migraine was diagnosed based on the International Classification of Headache Disorders. The bodily pain subscale of the Short Form 36 (SF-BP) and the pain subscale (PS) of the Depression and Somatic Symptoms scale were also used. Generalized Estimating Equation models were employed to investigate the longitudinal impacts of migraine on pain symptoms. Results MDD patients with migraine had lower SF-BP and higher PS scores than those without. Depression, anxiety, and headache indices were significantly correlated with SF-BP and PS scores. The higher the frequency of migraine, the more often patients suffered from pain symptoms. Patients with migraine at all investigated time points suffered from pain symptoms most of the time (ranging from 60.0% to 73.7%) over the 10 years. After controlling for depression and anxiety, migraine was independently associated with a decreased SF-BP score (by 8.93 points) and an increased PS score (by 1.33 points). Conclusion Migraine was an important comorbidity associated with greater severities of pain symptoms during long-term follow-up. Migraine treatment should be integrated into the treatment of depression to improve pain symptoms and quality of life in the pain dimension.
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Affiliation(s)
- Ching-I Hung
- Department of Psychiatry, Chang-Gung Memorial Hospital at Linkou and Chang-Gung University College of Medicine, Tao-Yuan, Taiwan
| | - 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
| | - Shuu-Jiun Wang
- Faculty of Medicine and Brain Research Center, National Yang-Ming University and Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan. .,Department of Neurology, Taipei Veterans General Hospital, No. 201 Shi-Pai Road, Section 2, Taipei, 112, Taiwan.
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Hung CI, Liu CY, Yang CH, Wang SJ. Headache: an important factor associated with muscle soreness/pain at the two-year follow-up point among patients with major depressive disorder. J Headache Pain 2016; 17:57. [PMID: 27233897 PMCID: PMC4883023 DOI: 10.1186/s10194-016-0648-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Accepted: 05/21/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND No study has compared the associations of headache, anxiety, and depression at baseline with muscle soreness or pain (MS/P) at baseline and at the two-year follow-up point among outpatients with major depressive disorder (MDD). This study aimed to investigate the above issue. METHODS This study enrolled 155 outpatients with MDD at baseline, and 131 attended a two-year follow-up appointment. At baseline, migraine was diagnosed based on the International Classification of Headache Disorders, 2(nd) edition. MDD and anxiety disorders were diagnosed using the Structured Clinical Interview for DSM-IV-TR. The visual analog scale was used to evaluate the intensities of headache and MS/P in the neck, shoulder, back, upper limbs, and lower limbs. Depression and anxiety were evaluated using the Hospital Anxiety and Depression Scale. Multiple linear regressions were used to compare the associations of these factors with MS/P. RESULTS Compared with anxiety disorders, migraine was more strongly associated with MS/P in all areas at baseline and in the upper and lower limbs at follow-up. Headache intensity at baseline was the factor most strongly associated with MS/P in all areas at baseline and follow-up after controlling for depression and anxiety. Headache intensity at baseline predicted MS/P at baseline and follow-up. CONCLUSIONS Migraine and headache intensity are important factors related to MS/P at baseline and follow-up among patients with MDD. Integrating depression and headache treatment might be indicated to improve MS/P.
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Affiliation(s)
- Ching-I Hung
- 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
| | - Ching-Hui Yang
- Department of Nursing, Chang Gung University of Science and Technology, Tao-Yuan, Taiwan
| | - Shuu-Jiun Wang
- Faculty of Medicine, National Yang-Ming University School of Medicine and Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan. .,Department of Neurology, Taipei Veterans General Hospital, No. 201 Shi-Pai Road, Section 2, Taipei, 112, Taiwan.
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Florea I, Danchenko N, Brignone M, Loft H, Rive B, Abetz-Webb L. The Effect of Vortioxetine on Health-related Quality of Life in Patients With Major Depressive Disorder. Clin Ther 2015; 37:2309-2323.e6. [DOI: 10.1016/j.clinthera.2015.08.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 07/31/2015] [Accepted: 08/04/2015] [Indexed: 10/23/2022]
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Hung CI, Liu CY, Yang CH, Wang SJ. The Impacts of Migraine among Outpatients with Major Depressive Disorder at a Two-Year Follow-Up. PLoS One 2015; 10:e0128087. [PMID: 26000962 PMCID: PMC4441375 DOI: 10.1371/journal.pone.0128087] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 03/29/2015] [Indexed: 11/28/2022] Open
Abstract
Background No study has investigated the impacts of migraine on depression, anxiety, and somatic symptoms and remission at the two-year follow-up point among patients with major depressive disorder (MDD). This study aimed to investigate the above issues. Methods Psychiatric outpatients with MDD recruited at baseline were investigated at a two-year follow-up (N = 106). The Hamilton Depression Rating Scale, Hospital Anxiety and Depression Scale, and Depression and Somatic Symptoms Scale were used. Migraine was diagnosed according to the International Classification of Headache Disorders, 2nd edition. The patients were divided into no migraine, inactive migraine, and active migraine subgroups. Multiple logistic regressions were used to investigate the significant factors related to full remission of depression. Results Among patients without pharmacotherapy at the follow-up, patients with active migraine had significantly greater severities of anxiety and somatic symptoms as compared with patients without migraine; moreover, patients with active migraine had the lowest improvement percentage and full remission rate. There were no significant differences in depression, anxiety, and somatic symptoms between patients with inactive migraine and those without migraine. Active headache at follow-up was a significant factor related to a lower full remission rate. Conclusions Active headache at follow-up was associated with a lower rate of full remission and more residual anxiety and somatic symptoms at follow-up among patients with migraine. Physicians should integrate a treatment plan for depression and migraine for the treatment of patients with MDD.
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Affiliation(s)
- Ching-I Hung
- Department of Psychiatry, Chang Gung Memorial Hospital at Linkou and Chang Gung University School of Medicine, Tao-Yuan, Taiwan
| | - Chia-Yih Liu
- Department of Psychiatry, Chang Gung Memorial Hospital at Linkou and Chang Gung University School of Medicine, Tao-Yuan, Taiwan
| | - Ching-Hui Yang
- Department of Nursing, Chang Gung University of Science and Technology, Tao-Yuan, Taiwan
| | - Shuu-Jiun Wang
- Faculty of Medicine, National Yang-Ming University School of Medicine and Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- * E-mail:
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Hung CI, Liu CY, Chen CY, Yang CH, Wang SJ. The impacts of migraine and anxiety disorders on painful physical symptoms among patients with major depressive disorder. J Headache Pain 2014; 15:73. [PMID: 25382691 PMCID: PMC4236854 DOI: 10.1186/1129-2377-15-73] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 11/03/2014] [Indexed: 01/03/2023] Open
Abstract
Background No study has simultaneously investigated the impacts of migraine and anxiety disorders on painful physical symptoms (PPS) among patients with major depressive disorder (MDD). The study aimed to investigate this issue. Methods This open-label study enrolled 155 outpatients with MDD, who were then treated with venlafaxine 75 mg per day for four weeks. Eighty-five participants with good compliance completed the treatment. Migraine was diagnosed according to the International Classification of Headache Disorders. MDD and anxiety disorders were diagnosed using the Structured Clinical Interview for DSM-IV-TR. The visual analog scale (VAS) was used to evaluate the severity of eight PPS. Multiple linear and logistic regressions were used to investigate the impacts of migraine and anxiety disorders on PPS. Results Compared with patients without migraine, patients with migraine had a greater severity of PPS at baseline and post-treatment. After controlling for demographic variables and depressive severity, migraine independently predicted the intensities of eight PPS at baseline and four PPS post-treatment. Moreover, migraine independently predicted poorer treatment responses of chest pain and full remission of pains in the head, chest, neck and/or shoulder. Anxiety disorders predicted less full remission of pains in the abdomen and limbs. Conclusion Migraine and anxiety disorders have negative impacts on PPS among patients with MDD. Integrating the treatment of migraine and anxiety disorders into the management of depression might help to improve PPS and the prognosis of MDD.
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Affiliation(s)
| | | | | | | | - Shuu-Jiun Wang
- Department of Neurology, National Yang-Ming University School of Medicine and Taipei Veterans General Hospital, No, 201 Shi-Pai Road, Section 2, Taipei 112, Taiwan.
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