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Jeong HS, Kim HMS, Kim KM. Network Structure and Clustering Analysis Relating to Individual Symptoms of Problematic Internet Use in a Community Adolescent Population. Eur Addict Res 2024; 30:181-193. [PMID: 38615663 DOI: 10.1159/000535677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 12/01/2023] [Indexed: 04/16/2024]
Abstract
INTRODUCTION Problematic internet use (PIU) is a psychopathology that includes multiple symptoms and psychological constructs. Because no studies have considered both network structures and clusters among individual symptoms in the context of PIU in a Korean adolescent population, this study aimed to investigate network structures and clustering in relation to PIU symptoms in adolescents. METHODS Overall, 73,238 adolescents were included. PIU severity was assessed using a self-rating scale comprising 20 items and 6 subscales, namely, the Internet Addiction Proneness Scale for Youth-Short Form; KS scale. Network structures and clusters among symptoms were analyzed using a Gaussian graphical model and exploratory graph analysis, respectively. Centrality of strength, closeness, and betweenness scores was also calculated. RESULTS Our study identified four clusters: disturbance in adaptive functioning, virtual interpersonal relationships, withdrawal, and tolerance. The symptom of confidence served as a node bridging the cluster of virtual interpersonal relationships and other clusters of withdrawal and disturbances of adaptive function. The symptom of craving served as a bridge between the clusters of withdrawal and tolerance with high betweenness centrality. CONCLUSION This study identified network structures and clustering among PIU symptoms in adolescents and revealed that positive experiences derived from online interpersonal relationships were an important mechanism underlying PIU. These are novel insights concerning the interconnection among multiple symptoms and related clustering for the mechanism of adolescent PIU in terms of KS-scale PIU assessment.
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Affiliation(s)
- Hyu Seok Jeong
- Department of Psychiatry, Dankook University Hospital, Cheonan, Republic of Korea
- Department of Psychiatry, College of Medicine, Dankook University, Cheonan, Republic of Korea
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hillary Mi-Sung Kim
- Department of Child Psychology and Education, Sungkyunkwan Univeristy, Seoul, Republic of Korea
| | - Kyoung Min Kim
- Department of Psychiatry, Dankook University Hospital, Cheonan, Republic of Korea
- Department of Psychiatry, College of Medicine, Dankook University, Cheonan, Republic of Korea
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Kim KM, Lee KH, Kim H, Kim O, Kim JW. Symptom clusters in adolescent depression and differential responses of clusters to pharmacologic treatment. J Psychiatr Res 2024; 172:59-65. [PMID: 38364553 DOI: 10.1016/j.jpsychires.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 11/20/2023] [Accepted: 02/01/2024] [Indexed: 02/18/2024]
Abstract
OBJECTIVE Symptoms of depression in adolescents are widely variable, but they are often interactive and clustered. The analysis of interactions and clusters among individual symptoms may help predict treatment outcomes. We aimed to determine clusters of individual symptoms in adolescent depression and their changes in the response to pharmacological treatment. METHOD A total of 95 adolescents, aged 12-17 years, with major depressive disorder were included. Participants were treated with escitalopram, and depressive symptoms were assessed at baseline (V1) and 1, 2, 4, 6, and 8 weeks (V6). The severity of depression was assessed using the Children's Depression Rating Scale-Revised. To construct network and clustering structures among symptoms, the Gaussian graphical model and Exploratory Graph Analysis with the tuning parameter to minimize the extended Bayesian information criterion were adopted. RESULTS Exploratory Graph Analysis revealed that symptoms of depression comprised four clusters: impaired activity, somatic concerns, subjective mood, and observed affect. The main effect of visit with decreased symptom severity was significant in all four clusters; however, the degree of symptom improvement differed among the four clusters. The effect size of score differences from V1 to V6 was the highest in the subjective mood (Cohen's d = 1.075), and lowest in impaired activity (d = 0.501) clusters. CONCLUSION The present study identified four symptom clusters associated with adolescent depression and their differential changes related to antidepressant treatment. This finding suggests that escitalopram was the most effective at improving subjective mood among different clusters. However, other therapeutic modalities may be needed to improve other clusters of symptoms, consequently leading to increased overall improvement of depression in adolescents.
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Affiliation(s)
- Kyoung Min Kim
- Department of Psychiatry, College of Medicine, Dankook University, Cheonan, Republic of Korea; Department of Psychiatry, Dankook University Hospital, Cheonan, Republic of Korea
| | - Kyung Hwa Lee
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Seoul National University Hospital, Seoul, Republic of Korea
| | - Haebin Kim
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ok Kim
- Department of Psychology, Graduate School of Dankook University, Cheonan, Republic of Korea
| | - Jae-Won Kim
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Seoul National University Hospital, Seoul, Republic of Korea; Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea.
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Sampogna G, Caraci F, Carmassi C, Dell'Osso B, Ferrari S, Martinotti G, Sani G, Serafini G, Signorelli MS, Fiorillo A. Efficacy and tolerability of desvenlafaxine in the real-world treatment of patients with major depression: a narrative review and an expert opinion paper. Expert Opin Pharmacother 2023; 24:1511-1525. [PMID: 37450377 DOI: 10.1080/14656566.2023.2237410] [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: 05/21/2023] [Revised: 07/11/2023] [Accepted: 07/13/2023] [Indexed: 07/18/2023]
Abstract
INTRODUCTION Major depressive disorder (MDD) is a common severe mental disorder, requiring a tailored and integrated treatment. Several approaches are available including different classes of antidepressants various psychotherapeutic approaches, and psychosocial interventions. The treatment plan for each patient with MDD should be differentiated on the basis of several clinical, personal, and contextual factors. AREAS COVERED Desvenlafaxine - a serotonine-noradrenergic reuptake inhibitor (SNRI) antidepressant - has been approved in the United States in 2008 for the treatment of MDD in adults, and has been recently rediscovered by clinicians due to its good side-effect profile and its clinical effectiveness. A narrative review on efficacy, tolerability and use of desvenlafaxine in clinical practice was carried out. The keywords: 'major depression', 'depression,' 'desvenlafaxine,' 'efficacy,' 'clinical efficacy,' 'side effects', 'tolerability,' 'elderly patients', 'consultation-liaison', 'menopausal', 'young people', 'adolescent' were entered in PubMed, ISI Web of Knowledge, Scopus and Medline. No time limit was fixed, the search strategy was implemented on May 10, 2023. EXPERT OPINION Desvenlafaxine should be listed among the optimal treatment strategies for managing people with MDD, whose main strengths are: 1) ease of dosing; 2) favorable safety and tolerability profile, 3) absence of sexual dysfunctions, weight gain and low rate of discontinuation symptoms; 4) low risk of drug-drug interactions.
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Affiliation(s)
- Gaia Sampogna
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | - Filippo Caraci
- Department of Drug and Health Sciences, University of Catania, Catania, Italy
- Unit of Neuropharmacology and Translational Neurosciences, Oasi Research Institute-IRCCS, Troina, Italy
| | | | - Bernardo Dell'Osso
- Neuroscience Research Center, Department of Biomedical and Clinical Sciences and Aldo Ravelli Center for Neurotechnology and Brain Therapeutic, University of Milan, Milano, Italy
- Department of Psychiatry and Behavioural Sciences, Stanford University, Stanford, USA
| | - Silvia Ferrari
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Dipartimento Ad attività Integrata di Salute Mentale E Dipendenze Patologiche, Azienda USL-IRCCS Reggio Emilia, Reggio Emilia, Italy
| | - Giovanni Martinotti
- Department of Neuroscience, Imaging and Clinical Sciences, University "G. D'Annunzio" of Chieti-Pescara, Chieti, Italy
| | - Gabriele Sani
- Institute of Psychiatry, Department of Neuroscience, Catholic University of the Sacred Hearth, Rome, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health, Psychiatry Section, University of Genoa, IRCCS, San Martino, Genoa, Italy
| | - Gianluca Serafini
- Department of Psychiatry, Department of Neuroscience Head, Neck and Thorax, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Maria Salvina Signorelli
- Department of Clinical and Experimental Medicine, AOU Policlinico Hospital, University of Catania, Catania, Italy
| | - Andrea Fiorillo
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
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Mi W, Di X, Wang Y, Li H, Xu X, Li L, Wang H, Wang G, Zhang K, Tian F, Luo J, Yang C, Zhou Y, Xie S, Zhong H, Wu B, Yang D, Chen Z, Li Y, Chen J, Lv S, Yi Q, Jiang Z, Tian J, Zhang H. A phase 3, multicenter, double-blind, randomized, placebo-controlled clinical trial to verify the efficacy and safety of ansofaxine (LY03005) for major depressive disorder. Transl Psychiatry 2023; 13:163. [PMID: 37164957 PMCID: PMC10171157 DOI: 10.1038/s41398-023-02435-0] [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] [Received: 10/18/2022] [Revised: 03/31/2023] [Accepted: 04/18/2023] [Indexed: 05/12/2023] Open
Abstract
Major depressive disorder (MDD) is the most prevalent form of depression and is becoming a great challenge for public health and medical practice. Although first-line antidepressants offer therapeutic benefits, about 35% of depressed patients are not adequately treated, creating a substantial unmet medical need. A multicenter, double-blind, randomized, placebo-controlled phase 3 clinical trial was conducted in patients with MDD in China to assess the efficacy and safety of ansofaxine (LY03005), a potential triple reuptake inhibitor of serotonin, norepinephrine, and dopamine. Eligible 588 MDD patients were included and randomly assigned (1:1:1) to 8-week treatment with ansofaxine 80 mg/day(n = 187), ansofaxine 160 mg/day(n = 186), or placebo(n = 185). The primary efficacy endpoint was the Montgomery-Åsberg Depression Rating Scale (MADRS) total score change from baseline to the end of the study. Safety indexes included adverse events, vital signs, physical examination, laboratory tests, 12-lead electrocardiogram (ECG), and evaluation of suicide tendency and sexual function. Significant differences were found in mean changes in MADRS total score at week 8 in the two ansofaxine groups (80 mg, -20.0; 160 mg, -19.9) vs. placebo (-14.6; p < 0.0001). All doses of ansofaxine were generally well-tolerated. Treatment-emergent adverse events (TEAEs) were reported by 137 (74.46%) patients in ansofaxine 80 mg group, 144 (78.26%) patients in ansofaxine 160 mg and 125 (67.93%) patients in the placebo group. The incidence of treatment-related adverse events (TRAEs) was 59.2% (109 patients), 65.22% (120 patients) in the 80, 160 mg ansofaxine groups, and 45.11% (83 patients) in the placebo group. The initial results of this trial indicate that ansofaxine at both the 80 mg/day and 160 mg/day was effective and safe in adult patients with MDD. ClinicalTrials.gov Identifier: NCT04853407.
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Affiliation(s)
- Weifeng Mi
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Xiaolan Di
- Beijing Huilongguan Hospital, Beijing, China
| | - Yiming Wang
- The Affiliated Hospital of Guizhou Medical University, Guizhou, China
| | - Huafang Li
- Shanghai Mental Health Center, Shanghai, China
| | - Xiufeng Xu
- First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Lehua Li
- Second Xiangya Hospital of Central South University, Changsha, China
| | - Huaning Wang
- First Affiliated Hospital of the Fourth Military Medical University of Chinese People's Liberation Army, Xi'an, China
| | | | - Kerang Zhang
- First Hospital of Shanxi Medical University, Taiyuan, China
| | - Feng Tian
- Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Jiong Luo
- Beijing Anding Hospital of Capital Medical University, Beijing, China
| | - Chanjuan Yang
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | | | | | - Hua Zhong
- Huzhou Third Municipal Hospital, Huzhou, China
| | - Bin Wu
- Xi 'an Mental Health Center, Xi'an, China
| | - Dong Yang
- Hunan Brain Hospital, Changsha, China
| | - Zhenhua Chen
- Renmin Hospital of Wuhan University, Wuhan, China
| | - Yi Li
- Wuhan Mental Health Center, Wuhan, China
| | | | - Shuyun Lv
- The Fourth People Hospital of Urumqi, Urumqi, China
| | - Qizhong Yi
- The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Zhiwei Jiang
- Beijing KeyTech Statistical Technology Co., Ltd, Beijing, China
| | | | - Hongyan Zhang
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China.
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Efficacy of adjunctive brexpiprazole on symptom clusters of major depressive disorder: A post hoc analysis of four clinical studies. J Affect Disord 2022; 316:201-208. [PMID: 35970327 DOI: 10.1016/j.jad.2022.08.021] [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: 04/08/2022] [Revised: 07/04/2022] [Accepted: 08/10/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND Major depressive disorder (MDD) is a clinically heterogenous condition and its treatment should be individualized according to the presence of particular symptom clusters. The aim of this pooled analysis was to investigate the effects of adjunctive brexpiprazole on different symptom clusters in MDD. METHODS Data were included from four similarly designed, short-term, randomized, double-blind, placebo-controlled studies of adjunctive brexpiprazole in adults with MDD and inadequate response to 2-4 antidepressant treatments (ADTs), including 1 administered by investigators. Mean changes from baseline and Cohen's d effect sizes (ES) versus placebo were determined for the following Montgomery-Åsberg Depression Rating Scale symptom clusters: core, anhedonia, dysphoria, retardation, vegetative, loss of interest, and lassitude. RESULTS Over 6 weeks, ADT + brexpiprazole 2 mg (n = 486) showed greater improvement than ADT + placebo (n = 585) for all symptom clusters: core (ES = 0.36; p < 0.0001), anhedonia (ES = 0.43; p < 0.0001), dysphoria (ES = 0.27; p < 0.0001), retardation (ES = 0.32; p < 0.0001), vegetative (ES = 0.29; p < 0.0001), loss of interest (ES = 0.30; p < 0.0001), and lassitude (ES = 0.33; p < 0.0001). Improvements of similar magnitude were observed for ADT + brexpiprazole 2-3 mg (n = 770) versus ADT + placebo (n = 788) (ES = 0.24-0.38; all clusters p < 0.0001). In most cases, improvement over ADT + placebo was observed from Week 1 onwards. LIMITATIONS Post hoc analysis with no adjunctive active comparator. CONCLUSIONS Patients receiving adjunctive brexpiprazole versus adjunctive placebo showed improvements across a range of MDD symptom clusters. Improvements appeared early (generally from Week 1) and were maintained over 6 weeks. These data indicate that adjunctive brexpiprazole may benefit multiple subtypes of patient with MDD and inadequate response to ADTs.
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Anxiolytic Effect of Carvedilol in Chronic Unpredictable Stress Model. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2022; 2022:6906722. [PMID: 36035219 PMCID: PMC9417788 DOI: 10.1155/2022/6906722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 07/13/2022] [Accepted: 07/25/2022] [Indexed: 11/18/2022]
Abstract
Anxiety disorders are the most prevalent psychiatric disorders being also a comorbid state of other diseases. We aimed to evaluate the anxiolytic-like effects of carvedilol (CVD), a drug used to treat high blood pressure and heart failure with potent antioxidant effects, in animals exposed to chronic unpredictable stress (CUS). To do this, female Swiss mice were exposed to different stressors for 21 days. Between days 15 and 21, the animals received oral CVD (5 or 10 mg/kg) or the antidepressant desvenlafaxine (DVS 10 mg/kg). On the 22nd day, behavioral tests were conducted to evaluate locomotor activity (open field) and anxiety-like alterations (elevated plus-maze—EPM and hole board—HB tests). After behavioral determinations, the animals were euthanized, and the adrenal gland, blood and brain areas, prefrontal cortex (PFC), and hippocampus were removed for biochemical analysis. CUS reduced the crossings while increased rearing and grooming, an effect reversed by both doses of CVD and DVS. CUS decreased the number of entries and permanence time in the open arms of the EPM, while all treatments reversed this effect. CUS reduced the number of head dips in the HB, an effect reversed by CVD. The CUS reduced weight gain, while only CVD5 reversed this effect. A reduction in the cortical layer size of the adrenal gland was observed in stressed animals, which CVD reversed. Increased myeloperoxidase activity (MPO) and interferon-γ (IFN-γ), as well as reduction of interleukin-4 (IL-4) induced by CUS, were reversed by CVD. DVS and CVD increased IL-6 in both brain areas. In the hippocampus, DVS caused an increase in IFN-γ. Our data show that CVD presents an anxiolytic effect partially associated with immune-inflammatory mechanism regulation.
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Kim KM, Kim H, Kim D, Kim JW. The analysis of network structure among the depressive symptoms in a clinical sample of children and adolescents. Asian J Psychiatr 2021; 62:102748. [PMID: 34243062 DOI: 10.1016/j.ajp.2021.102748] [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: 05/11/2021] [Revised: 06/24/2021] [Accepted: 06/25/2021] [Indexed: 10/20/2022]
Abstract
The symptoms of depressive disorder in children and adolescents vary widely and have complex interconnections with each other. This study aimed to identify the network structures among individual depressive symptoms in clinically referred children and adolescents. A total of 464 children and adolescents who visited the outpatient psychiatry clinic in South Korea were enrolled. The Children's Depression Inventory (CDI) was used to assess depressive symptoms. To construct the network structure and estimate the centrality indices among individual symptoms, the Gaussian graphical model was utilized with the tuning parameter to minimize the extended Bayesian information criterion. Among all symptoms, self-hatred had the highest strength centrality, followed by crying and self-deprecation. Among 191 valid edges constituting the CDI symptom network, sadness-crying, school work difficulty-school performance decrement, disobedience-fights, misbehavior-low self-esteem, self-deprecation-self-blame, school dislike-lack of friendship, self-hatred-negative body image, anhedonia-social withdrawal, self-hatred-suicidal ideation, crying-irritability, and sadness-loneliness showed significantly higher weights than the other edges. The present study identified the network structure among depressive symptoms in children and adolescents. Future studies including more symptoms of depression are warranted to provide insights into the underlying mechanisms of child and adolescent depression.
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Affiliation(s)
- Kyoung Min Kim
- Department of Psychiatry, College of Medicine, Dankook University, Cheonan, Republic of Korea; Department of Psychiatry, Dankook University Hospital, Cheonan, Republic of Korea
| | - Haebin Kim
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea; Workplace Mental Health Institute, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Dohyun Kim
- Department of Psychiatry, College of Medicine, Dankook University, Cheonan, Republic of Korea; Department of Psychiatry, Dankook University Hospital, Cheonan, Republic of Korea
| | - Jae-Won Kim
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea; Division of Child and Adolescent Psychiatry, Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea.
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Norman TR, Olver JS. Desvenlafaxine in the treatment of major depression: an updated overview. Expert Opin Pharmacother 2021; 22:1087-1097. [PMID: 33706624 DOI: 10.1080/14656566.2021.1900826] [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: 10/21/2022]
Abstract
Introduction: Major depressive disorder (MDD) remains one of the most prevalent mental health conditions. It is a chronic, relapsing condition and despite multiple treatment options, many patients fail to achieve remission of symptoms. Inadequacy of treatment has stimulated the search for agents with significant therapeutic advantages.Areas covered: This review examines literature concerning the use of desvenlafaxine in the treatment of MDD published since a previous analysis in this journal in 2014. Published papers were identified via a PubMed and Web of Science search and excluded congress presentations. Results from clinical trials in MDD, systematic reviews, and post hoc analyses in patient subgroups, are reviewed.Expert opinion: Desvenlafaxine was an effective antidepressant with favorable safety and tolerability in adults. Efficacy was demonstrated in the subgroup of peri- and post-menopausal women with MDD but not in children and adolescents. There is a relatively low potential for drug-drug interactions due to its metabolic profile. Hepatic impairment does not significantly alter dose requirements, whereas severe renal disease requires some adjustments of dose. Desvenlafaxine maybe suitable in patients with comorbid physical illnesses. Desvenlafaxine can be a first line consideration for the treatment of cases of MDD uncomplicated by medical comorbidities.
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Affiliation(s)
- Trevor R Norman
- Department of Psychiatry, Austin Hospital, University of Melbourne, Heidelberg, Victoria, AUSTRALIA
| | - James S Olver
- Department of Psychiatry, Austin Hospital, University of Melbourne, Heidelberg, Victoria, AUSTRALIA
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Trajectories of Function and Symptom Change in Desvenlafaxine Clinical Trials: Toward Personalized Treatment for Depression. J Clin Psychopharmacol 2021; 41:579-584. [PMID: 34183490 PMCID: PMC8407446 DOI: 10.1097/jcp.0000000000001435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE/BACKGROUND Heterogeneity has been documented in trajectories of symptom change during antidepressant treatment for major depressive disorder (MDD). It is unclear whether distinct trajectories of change exist for functioning during antidepressant treatment. METHODS/PROCEDURES This analysis explored distinct trajectories of functioning in MDD and tested whether they corresponded to trajectories of symptom change. Data were from 4317 patients and were pooled from 9 randomized placebo-controlled trials. Growth mixture modeling was used to identify trajectories of Hamilton Rating Scale for Depression (HRSD) and Sheehan Disability Scale (SDS) for placebo- and desvenlafaxine-treated patients. FINDINGS/RESULTS Three trajectories were identified for symptoms (HRSD) in patients receiving placebo (mean reduction baseline to week 8, -18.4 [most favorable] to -2.6 points [least favorable]). Four HRSD trajectories were identified for patients receiving desvenlafaxine (mean reduction from baseline to week 8, -17.2 [most favorable] to -2.6 points [least favorable]). Four trajectories were identified for functioning (SDS) in patients receiving placebo (mean reduction baseline to week 8, -13.6 [most favorable] to -0.8 points [least favorable]), and 3 for desvenlafaxine (-12.8 to -1.4 points, respectively). Percentages of agreement between most favorable HRSD and SDS trajectories were 75% (placebo) and 85% (desvenlafaxine), and for least favorable trajectories were 88% (placebo) and 80% (desvenlafaxine). IMPLICATIONS/CONCLUSIONS Distinct trajectories of change based on symptoms and functioning were identified among patients with MDD receiving desvenlafaxine and among patients with MDD receiving placebo. Differentiating subpopulations of patients has the potential to provide a more personalized treatment of patients with MDD.ClinicalTrials.govIdentifiers: NCT00072774; NCT00277823; NCT00300378; NCT00384033; NCT00798707; NCT00863798; NCT01121484; NCT00824291; NCT01432457.
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Kato M, Asami Y, Wajsbrot DB, Wang X, Boucher M, Prieto R, Pappadopulos E. Clustering patients by depression symptoms to predict venlafaxine ER antidepressant efficacy: Individual patient data analysis. J Psychiatr Res 2020; 129:160-167. [PMID: 32912597 DOI: 10.1016/j.jpsychires.2020.06.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 05/19/2020] [Accepted: 06/10/2020] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To identify clusters of patients with major depressive disorder (MDD) based on the baseline 17-item Hamilton Rating Scale for Depression (HAM-D17) items and to evaluate the efficacy of venlafaxine extended release (VEN) vs placebo, and the potential effect of dose on efficacy, in each cluster. METHODS Cluster analysis was performed to identify clusters based on standardized HAM-D17 item scores of individual patient data at baseline from 9 double-blind, placebo-controlled studies of VEN for MDD. Change from baseline in HAM-D17 total score was analyzed using a mixed-effects model for repeated measures for each cluster; response and remission rates at week 8 were analyzed using logistic regression. Discontinuation rates were also evaluated in each cluster. RESULTS In 2599 patients, 3 patient clusters were identified, characterized as High modified Core (mCore) Symptoms/High Anxiety (cluster 1), High mCore Symptoms/Medium Anxiety (cluster 2), and Medium mCore Symptoms/Medium Anxiety (cluster 3). Significant effects of VEN vs placebo were observed on change from baseline in HAM-D17 total score at week 8 for both clusters 1 and 2 (both P < 0.001), but not for cluster 3. In cluster 3, a significant treatment effect of VEN was observed at week 8 in the lower-dose subgroup but not in the higher-dose subgroup. All-cause discontinuation rates were significantly higher in placebo than VEN in each cluster. CONCLUSIONS Three unique clusters of patients were identified differing in baseline mCore symptoms and anxiety. Cluster membership may predict efficacy outcomes and contribute to dose effects in patients treated with VEN. CLINICAL TRIALS REGISTRATION NCT01441440; other studies included in this analysis were conducted before the requirement to register clinical studies took effect.
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Affiliation(s)
- Masaki Kato
- Department of Neuropsychiatry, Kansai Medical University, Osaka, Japan.
| | - Yuko Asami
- Upjohn Medical Affairs, Pfizer Japan Inc., Tokyo, Japan
| | | | | | - Matthieu Boucher
- Pfizer Canada Inc, Kirkland, Canada; McGill University, Montréal, QC, Canada
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