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Lam RW, Kennedy SH, Adams C, Bahji A, Beaulieu S, Bhat V, Blier P, Blumberger DM, Brietzke E, Chakrabarty T, Do A, Frey BN, Giacobbe P, Gratzer D, Grigoriadis S, Habert J, Ishrat Husain M, Ismail Z, McGirr A, McIntyre RS, Michalak EE, Müller DJ, Parikh SV, Quilty LS, Ravindran AV, Ravindran N, Renaud J, Rosenblat JD, Samaan Z, Saraf G, Schade K, Schaffer A, Sinyor M, Soares CN, Swainson J, Taylor VH, Tourjman SV, Uher R, van Ameringen M, Vazquez G, Vigod S, Voineskos D, Yatham LN, Milev RV. Canadian Network for Mood and Anxiety Treatments (CANMAT) 2023 Update on Clinical Guidelines for Management of Major Depressive Disorder in Adults: Réseau canadien pour les traitements de l'humeur et de l'anxiété (CANMAT) 2023 : Mise à jour des lignes directrices cliniques pour la prise en charge du trouble dépressif majeur chez les adultes. Can J Psychiatry 2024:7067437241245384. [PMID: 38711351 DOI: 10.1177/07067437241245384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
BACKGROUND The Canadian Network for Mood and Anxiety Treatments (CANMAT) last published clinical guidelines for the management of major depressive disorder (MDD) in 2016. Owing to advances in the field, an update was needed to incorporate new evidence and provide new and revised recommendations for the assessment and management of MDD in adults. METHODS CANMAT convened a guidelines editorial group comprised of academic clinicians and patient partners. A systematic literature review was conducted, focusing on systematic reviews and meta-analyses published since the 2016 guidelines. Recommendations were organized by lines of treatment, which were informed by CANMAT-defined levels of evidence and supplemented by clinical support (consisting of expert consensus on safety, tolerability, and feasibility). Drafts were revised based on review by patient partners, expert peer review, and a defined expert consensus process. RESULTS The updated guidelines comprise eight primary topics, in a question-and-answer format, that map a patient care journey from assessment to selection of evidence-based treatments, prevention of recurrence, and strategies for inadequate response. The guidelines adopt a personalized care approach that emphasizes shared decision-making that reflects the values, preferences, and treatment history of the patient with MDD. Tables provide new and updated recommendations for psychological, pharmacological, lifestyle, complementary and alternative medicine, digital health, and neuromodulation treatments. Caveats and limitations of the evidence are highlighted. CONCLUSIONS The CANMAT 2023 updated guidelines provide evidence-informed recommendations for the management of MDD, in a clinician-friendly format. These updated guidelines emphasize a collaborative, personalized, and systematic management approach that will help optimize outcomes for adults with MDD.
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Affiliation(s)
- Raymond W Lam
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Sidney H Kennedy
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Camelia Adams
- Department of Psychiatry, University of Saskatchewan, Saskatoon, SK, Canada
| | - Anees Bahji
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Serge Beaulieu
- Department of Psychiatry, McGill University, Montréal, QC, Canada
| | - Venkat Bhat
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Pierre Blier
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada
| | | | - Elisa Brietzke
- Department of Psychiatry, Queen's University, Kingston, ON, Canada
| | - Trisha Chakrabarty
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - André Do
- Department of Psychiatry, Université de Montréal, Montréal, QC, Canada
| | - Benicio N Frey
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Peter Giacobbe
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - David Gratzer
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | | | - Jeffrey Habert
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - M Ishrat Husain
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Zahinoor Ismail
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Alexander McGirr
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Roger S McIntyre
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Erin E Michalak
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Daniel J Müller
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Sagar V Parikh
- Department of Psychiatry, University of Michigan, Ann Arbour, MI, USA
| | - Lena S Quilty
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Arun V Ravindran
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Nisha Ravindran
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Johanne Renaud
- Department of Psychiatry, McGill University, Montréal, QC, Canada
| | | | - Zainab Samaan
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Gayatri Saraf
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada
| | - Kathryn Schade
- Office of Research Services, Huron University, London, ON, Canada
| | - Ayal Schaffer
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Mark Sinyor
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Claudio N Soares
- Department of Psychiatry, Queen's University, Kingston, ON, Canada
| | - Jennifer Swainson
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
| | - Valerie H Taylor
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Smadar V Tourjman
- Department of Psychiatry, Université de Montréal, Montréal, QC, Canada
| | - Rudolf Uher
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Michael van Ameringen
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Gustavo Vazquez
- Department of Psychiatry, Queen's University, Kingston, ON, Canada
| | - Simone Vigod
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Daphne Voineskos
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Lakshmi N Yatham
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Roumen V Milev
- Department of Psychiatry, Queen's University, Kingston, ON, Canada
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Vaccarino SR, Wang S, Rizvi SJ, Lou W, Hassel S, MacQueen GM, Ho K, Frey BN, Lam RW, Milev RV, Rotzinger S, Ravindran AV, Strother SC, Kennedy SH. Functional neuroimaging biomarkers of anhedonia response to escitalopram plus adjunct aripiprazole treatment for major depressive disorder. BJPsych Open 2024; 10:e18. [PMID: 38179598 PMCID: PMC10790221 DOI: 10.1192/bjo.2023.588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 08/21/2023] [Accepted: 09/19/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Identifying neuroimaging biomarkers of antidepressant response may help guide treatment decisions and advance precision medicine. AIMS To examine the relationship between anhedonia and functional neurocircuitry in key reward processing brain regions in people with major depressive disorder receiving aripiprazole adjunct therapy with escitalopram. METHOD Data were collected as part of the CAN-BIND-1 study. Participants experiencing a current major depressive episode received escitalopram for 8 weeks; escitalopram non-responders received adjunct aripiprazole for an additional 8 weeks. Functional magnetic resonance imaging (on weeks 0 and 8) and clinical assessment of anhedonia (on weeks 0, 8 and 16) were completed. Seed-based correlational analysis was employed to examine the relationship between baseline resting-state functional connectivity (rsFC), using the nucleus accumbens (NAc) and anterior cingulate cortex (ACC) as key regions of interest, and change in anhedonia severity after adjunct aripiprazole. RESULTS Anhedonia severity significantly improved after treatment with adjunct aripiprazole.There was a positive correlation between anhedonia improvement and rsFC between the ACC and posterior cingulate cortex, ACC and posterior praecuneus, and NAc and posterior praecuneus. There was a negative correlation between anhedonia improvement and rsFC between the ACC and anterior praecuneus and NAc and anterior praecuneus. CONCLUSIONS Eight weeks of aripiprazole, adjunct to escitalopram, was associated with improved anhedonia symptoms. Changes in functional connectivity between key reward regions were associated with anhedonia improvement, suggesting aripiprazole may be an effective treatment for individuals experiencing reward-related deficits. Future studies are required to replicate our findings and explore their generalisability, using other agents with partial dopamine (D2) agonism and/or serotonin (5-HT2A) antagonism.
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Affiliation(s)
- Sophie R. Vaccarino
- Institute of Medical Science, University of Toronto, Canada; Centre for Depression and Suicide Studies, Unity Health Toronto, Canada; and Cumming School of Medicine, University of Calgary, Canada
| | - Shijing Wang
- Institute of Medical Science, University of Toronto, Canada; and Centre for Depression and Suicide Studies, Unity Health Toronto, Canada
| | - Sakina J. Rizvi
- Institute of Medical Science, University of Toronto, Canada; Centre for Depression and Suicide Studies, Unity Health Toronto, Canada; Department of Psychiatry, University of Toronto, Canada; Department of Psychiatry, Unity Health Toronto, Canada; and Li Ka Shing Knowledge Institute, Unity Health Toronto, Canada
| | - Wendy Lou
- Dalla Lana School of Public Health, University of Toronto, Canada; and Department of Biostatistics, University of Toronto, Canada
| | - Stefanie Hassel
- Cumming School of Medicine, University of Calgary, Canada; and Department of Psychiatry, University of Calgary, Canada
| | - Glenda M. MacQueen
- Cumming School of Medicine, University of Calgary, Canada; and Department of Psychiatry, University of Calgary, Canada
| | - Keith Ho
- Centre for Depression and Suicide Studies, Unity Health Toronto, Canada; Department of Psychiatry, Unity Health Toronto, Canada; and Li Ka Shing Knowledge Institute, Unity Health Toronto, Canada
| | - Benicio N. Frey
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Canada
| | - Raymond W. Lam
- Department of Psychiatry, University of British Columbia, Canada
| | - Roumen V. Milev
- Department of Psychiatry, Providence Care, Queen's University, Canada
| | - Susan Rotzinger
- Centre for Depression and Suicide Studies, Unity Health Toronto, Canada
| | | | - Stephen C. Strother
- Institute of Medical Science, University of Toronto, Canada; Rotman Research Institute, Baycrest Centre, Canada; and Department of Medical Biophysics, University of Toronto, Canada
| | - Sidney H. Kennedy
- Institute of Medical Science, University of Toronto, Canada; Centre for Depression and Suicide Studies, Unity Health Toronto, Canada; Department of Psychiatry, University of Toronto, Canada; Department of Psychiatry, Unity Health Toronto, Canada; Li Ka Shing Knowledge Institute, Unity Health Toronto, Canada; and Krembil Research Institute, University Health Network, Toronto, Canada
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3
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Mu J, Ravindran AV, Cuijpers P, Shen Y, Yang W, Li Q, Zhou X, Xie P. Stroke depression: a concept with clinical applicability. Stroke Vasc Neurol 2023:svn-2022-002146. [PMID: 37793901 DOI: 10.1136/svn-2022-002146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 09/06/2023] [Indexed: 10/06/2023] Open
Abstract
Stroke is a common neurological condition and among the leading causes of death and disability worldwide. Depression is both a risk factor for and complication of stroke, and the two conditions may have a complex reciprocal relationship over time. However, the secondary effects of depression on stroke are often overlooked, resulting in increased morbidity and mortality. In the previous concept of 'poststroke depression', stroke and depression were considered as two independent diseases. It often delays the diagnosis and treatment of patients. The concept 'stroke depression' proposed in this article will emphasise more the necessity of aggressive treatment of depression in the overall management of stroke, thus to reduce the incidence of stroke and in the meantime, improve the prognosis of stroke. Hopefully, it will lead us into a new era of acute stroke intervention.
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Affiliation(s)
- Jun Mu
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Arun V Ravindran
- Campbell Family Mental Health Research Centre, Centre for Addiction and Mental Health; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Yiqing Shen
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- NHC Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wensong Yang
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qi Li
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xinyu Zhou
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Peng Xie
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- NHC Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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4
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Su S, Zhao Y, Zeng N, Liu X, Zheng Y, Sun J, Zhong Y, Wu S, Ni S, Gong Y, Zhang Z, Gao N, Yuan K, Yan W, Shi L, Ravindran AV, Kosten T, Shi J, Bao Y, Lu L. Epidemiology, clinical presentation, pathophysiology, and management of long COVID: an update. Mol Psychiatry 2023; 28:4056-4069. [PMID: 37491461 DOI: 10.1038/s41380-023-02171-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 06/20/2023] [Accepted: 06/27/2023] [Indexed: 07/27/2023]
Abstract
The increasing number of coronavirus disease 2019 (COVID-19) infections have highlighted the long-term consequences of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection called long COVID. Although the concept and definition of long COVID are described differently across countries and institutions, there is general agreement that it affects multiple systems, including the immune, respiratory, cardiovascular, gastrointestinal, neuropsychological, musculoskeletal, and other systems. This review aims to provide a synthesis of published epidemiology, symptoms, and risk factors of long COVID. We also summarize potential pathophysiological mechanisms and biomarkers for precise prevention, early diagnosis, and accurate treatment of long COVID. Furthermore, we suggest evidence-based guidelines for the comprehensive evaluation and management of long COVID, involving treatment, health systems, health finance, public attitudes, and international cooperation, which is proposed to improve the treatment strategies, preventive measures, and public health policy making of long COVID.
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Affiliation(s)
- Sizhen Su
- 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
| | - Yimiao Zhao
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China
- Scholl of Public Health, Peking University, Beijing, China
| | - Na Zeng
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China
- Scholl of Public Health, Peking University, Beijing, China
| | - Xiaoxing Liu
- 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
| | - Yongbo Zheng
- Peking-Tsinghua Center for Life Sciences and PKU-IDG/McGovern Institute for Brain Research, Peking University, Beijing, China
| | - Jie Sun
- Pain Medicine Center, Peking University Third Hospital, Beijing, China
| | - Yi Zhong
- 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
| | - Shuilin Wu
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China
- Scholl of Public Health, Peking University, Beijing, China
| | - Shuyu Ni
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China
- Scholl of Public Health, Peking University, Beijing, China
| | - Yimiao Gong
- 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
- Peking-Tsinghua Center for Life Sciences and PKU-IDG/McGovern Institute for Brain Research, Peking University, Beijing, China
| | - Zhibo 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
| | - Nan Gao
- The First Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan, China
| | - Kai Yuan
- 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
| | - Wei Yan
- 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
| | - Le Shi
- 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
| | - Arun V Ravindran
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Thomas Kosten
- Department of Psychiatry, Baylor College of Medicine, Houston, TX, USA
| | - Jie Shi
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China
| | - Yanping Bao
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China.
- Scholl of Public Health, Peking University, Beijing, China.
| | - Lin Lu
- 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.
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China.
- Peking-Tsinghua Center for Life Sciences and PKU-IDG/McGovern Institute for Brain Research, Peking University, Beijing, China.
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5
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Dama M, Wu M, Tassone VK, Demchenko I, Frey BN, Milev RV, Ravindran AV, Parikh SV, Rotzinger S, Lou W, Lam RW, Kennedy SH, Bhat V. The course of insomnia symptoms during the acute treatment of major depressive disorder: A CAN-BIND-1 report. Psychiatry Res 2023; 325:115222. [PMID: 37163883 DOI: 10.1016/j.psychres.2023.115222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 04/17/2023] [Accepted: 04/23/2023] [Indexed: 05/12/2023]
Abstract
Despite considerable efforts to study the relationship between insomnia and depression, there is minimal research investigating whether insomnia symptoms change over time during a course of antidepressant pharmacotherapy. This study investigated the course of insomnia symptoms during the acute treatment of major depressive disorder (MDD) using a secondary analysis of data from MDD patients (N = 180) who were treated with open-label escitalopram (10-20 mg/day) for 8-weeks. Montgomery-Asberg Depression Rating Scale without sleep item (modified-MADRS) assessed depression and Self-reported Quick Inventory Depressive Scale (QIDS-SR) measured subjective sleep-onset, mid-nocturnal, and early-morning insomnia throughout 8-weeks of treatment. Pittsburgh Sleep Quality Index (PSQI) was used to assess subjective sleep quality, duration, onset latency, and efficiency throughout 8-weeks of treatment. Remission of depression was defined as modified-MADRS ≤10 at week-8. Mixed model repeated measures (MMRMs) were conducted with remission status as an independent variable and each sleep variable as a dependent variable. MMRMs demonstrated that remitters had significantly lower QIDS-SR sleep-onset and mid-nocturnal insomnia scores as well as a significantly lower PSQI sleep quality score than non-remitters throughout 8-weeks of treatment. Monitoring subjective sleep-onset and mid-nocturnal insomnia during the course of treatment with serotonergic antidepressants may be useful for predicting acute remission of depression.
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Affiliation(s)
- Manish Dama
- School of Medicine, Trinity College Dublin, The University of Dublin, Dublin, Ireland; Interventional Psychiatry Program and Centre for Depression & Suicide Studies, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Michelle Wu
- Interventional Psychiatry Program and Centre for Depression & Suicide Studies, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Vanessa K Tassone
- Interventional Psychiatry Program and Centre for Depression & Suicide Studies, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Ilya Demchenko
- Interventional Psychiatry Program and Centre for Depression & Suicide Studies, St. Michael's Hospital, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Benicio N Frey
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada; Mood Disorders Program, St. Joseph's Healthcare Hamilton, Ontario, Canada
| | - Roumen V Milev
- Department of Psychiatry, Queen's University, Kingston, Ontario, Canada
| | - Arun V Ravindran
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Sagar V Parikh
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, United States
| | - Susan Rotzinger
- Interventional Psychiatry Program and Centre for Depression & Suicide Studies, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Wendy Lou
- Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | - Raymond W Lam
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sidney H Kennedy
- Interventional Psychiatry Program and Centre for Depression & Suicide Studies, St. Michael's Hospital, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute & Krembil Research Institute, Toronto, Ontario, Canada
| | - Venkat Bhat
- Interventional Psychiatry Program and Centre for Depression & Suicide Studies, St. Michael's Hospital, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute & Krembil Research Institute, Toronto, Ontario, Canada.
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6
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Rosenblat JD, Husain MI, Lee Y, McIntyre RS, Mansur RB, Castle D, Offman H, Parikh SV, Frey BN, Schaffer A, Greenway KT, Garel N, Beaulieu S, Kennedy SH, Lam RW, Milev R, Ravindran AV, Tourjman V, Ameringen MV, Yatham LN, Taylor V. The Canadian Network for Mood and Anxiety Treatments (CANMAT) Task Force Report: Serotonergic Psychedelic Treatments for Major Depressive Disorder. Can J Psychiatry 2023; 68:5-21. [PMID: 35975555 PMCID: PMC9720483 DOI: 10.1177/07067437221111371] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Serotonergic psychedelics are re-emerging as potential novel treatments for several psychiatric disorders including major depressive disorder. The Canadian Network for Mood and Anxiety Treatments (CANMAT) convened a task force to review the evidence and provide a consensus recommendation for the clinical use of psychedelic treatments for major depressive disorder. METHODS A systematic review was conducted to identify contemporary clinical trials of serotonergic psychedelics for the treatment of major depressive disorder and cancer-related depression. Studies published between January 1990 and July 2021 were identified using combinations of search terms, inspection of bibliographies and review of other psychedelic reviews and consensus statements. The levels of evidence for efficacy were graded according to the Canadian Network for Mood and Anxiety Treatments criteria. RESULTS Only psilocybin and ayahuasca have contemporary clinical trials evaluating antidepressant effects. Two pilot studies showed preliminary positive effects of single-dose ayahuasca for treatment-resistant depression (Level 3 evidence). Small randomized controlled trials of psilocybin combined with psychotherapy showed superiority to waitlist controls and comparable efficacy and safety to an active comparator (escitalopram with supportive psychotherapy) in major depressive disorder, with additional randomized controlled trials showing efficacy specifically in cancer-related depression (Level 3 evidence). There was only one open-label trial of psilocybin in treatment-resistant unipolar depression (Level 4 evidence). Small sample sizes and functional unblinding were major limitations in all studies. Adverse events associated with psychedelics, including psychological (e.g., psychotomimetic effects) and physical (e.g., nausea, emesis and headaches) effects, were generally transient. CONCLUSIONS There is currently only low-level evidence to support the efficacy and safety of psychedelics for major depressive disorder. In Canada, as of 2022, psilocybin remains an experimental option that is only available through clinical trials or the special access program. As such, Canadian Network for Mood and Anxiety Treatments considers psilocybin an experimental treatment and recommends its use primarily within clinical trials, or, less commonly, through the special access program in rare, special circumstances.
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Affiliation(s)
- Joshua D Rosenblat
- Department of Psychiatry, 7938University of Toronto, Toronto, Ontario, Canada.,7978Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Ontario, Canada
| | - M Ishrat Husain
- Department of Psychiatry, 7938University of Toronto, Toronto, Ontario, Canada.,Centre for Addiction and Mental Health, Campbell Family Mental Health Research Institute Toronto, Ontario, Canada
| | - Yena Lee
- 7978Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Ontario, Canada
| | - Roger S McIntyre
- Department of Psychiatry, 7938University of Toronto, Toronto, Ontario, Canada.,7978Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Ontario, Canada
| | - Rodrigo B Mansur
- Department of Psychiatry, 7938University of Toronto, Toronto, Ontario, Canada.,7978Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Ontario, Canada
| | - David Castle
- Department of Psychiatry, 7938University of Toronto, Toronto, Ontario, Canada.,Centre for Addiction and Mental Health, Campbell Family Mental Health Research Institute Toronto, Ontario, Canada
| | - Hilary Offman
- Department of Psychiatry, 7938University of Toronto, Toronto, Ontario, Canada
| | - Sagar V Parikh
- Department of Psychiatry, 7938University of Toronto, Toronto, Ontario, Canada.,Depression Program, Michigan Medicine, University of Michigan, Ann Arbor, USA
| | - Benicio N Frey
- Mood Disorders Program, St. Joseph's Healthcare Hamilton, McMaster University, Psychiatry & Behavioural Neurosciences, Hamilton, Ontario, Canada
| | - Ayal Schaffer
- Department of Psychiatry, 7938University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | | | - Nicolas Garel
- McGill University, Psychiatry, Montreal, Quebec, Canada
| | | | - Sidney H Kennedy
- Department of Psychiatry, 7938University of Toronto, Toronto, Ontario, Canada.,7978Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Ontario, Canada
| | - Raymond W Lam
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Roumen Milev
- Department of Psychiatry, Providence Care, Queen's University, Kingston, ON, Canada
| | - Arun V Ravindran
- Department of Psychiatry, 7938University of Toronto, Toronto, Ontario, Canada.,Centre for Addiction and Mental Health, Campbell Family Mental Health Research Institute Toronto, Ontario, Canada
| | - Valerie Tourjman
- Institut universitaire en santé mentale de Montréal, Psychiatry, Montreal, Quebec, Canada
| | - Michael Van Ameringen
- McMaster University Medical Centre, Anxiety Disorders Clinic, Hamilton, Ontario, Canada
| | - Lakshmi N Yatham
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Valerie Taylor
- Department of Psychiatry, 7938University of Toronto, Toronto, Ontario, Canada.,7978Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Ontario, Canada
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Pipe A, Ravindran N, Paric A, Patterson B, Van Ameringen M, Ravindran AV. Treatments for child and adolescent attention deficit hyperactivity disorder in low and middle-income countries: A narrative review. Asian J Psychiatr 2022; 76:103232. [PMID: 35987096 DOI: 10.1016/j.ajp.2022.103232] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 07/18/2022] [Accepted: 08/08/2022] [Indexed: 11/02/2022]
Abstract
BACKGROUND Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder that affects approximately 2-7 % of children globally and is associated with a myriad of difficulties that have long-term consequences. Most children and adolescents live in low- and middle-income countries (LMICs), but there are few reports and no consolidation of findings on ADHD treatment outcomes in this population. We conducted a review of ADHD treatment literature for children and adolescents living in LMICs. METHODS Studies were identified using databases (PsychoINFO, Pubmed, MEDLINER, EMBASE, Global Health, Academic Search Complete, Google Scholar). The initial search produced 139 articles. These were filtered for language, title, abstract, and full-text keyword identification to yield a final 20 articles to be included in this review. RESULTS Reports on outcomes of both psychological and pharmacological treatment were relatively sparse, particularly the former, which mostly referred to parent training and multimodal programs in pre-school children. Most evidence exists for the benefit of methylphenidate-IR with a few reports on other agents, including clonidine, atomoxetine, and lisdexamfetamine. Methylphenidate is the most common agent to treat ADHD in youth in LMICs. Younger age, combined subtype, and comorbid oppositional defiant disorder were associated with poorer treatment outcome. CONCLUSION Access to treatment for ADHD is overall limited in LMICs and varied among individual countries. Pharmacological treatments were generally more available than psychological interventions. Several barriers including stigma, cost, and lack of resources were reported to impact treatment acceptance. More research in LMICs is needed to improve and expand mental health services in these regions.
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Affiliation(s)
- Amy Pipe
- Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario N6A 5C1, Canada.
| | - Nisha Ravindran
- Centre for Addiction and Mental Health, 100 Stokes Street, Toronto, Ontario, M6J 1H4 Canada; Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario, M5T 1R8 Canada.
| | - Angela Paric
- Centre for Addiction and Mental Health, 100 Stokes Street, Toronto, Ontario, M6J 1H4 Canada.
| | - Beth Patterson
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, 100 West 5th Street, Hamilton, Ontario, L8N 3K7 Canada; MacAnxiety Research Centre, McMaster University, 1057 Main Street West, Hamilton, Ontario, L8S 1B8 Canada.
| | - Michael Van Ameringen
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, 100 West 5th Street, Hamilton, Ontario, L8N 3K7 Canada.
| | - Arun V Ravindran
- Centre for Addiction and Mental Health, 100 Stokes Street, Toronto, Ontario, M6J 1H4 Canada; Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario, M5T 1R8 Canada.
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8
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Espinola CW, Khoo Y, Parmar R, Demchenko I, Frey BN, Milev RV, Ravindran AV, Parikh SV, Ho K, Rotzinger S, Lou W, Lam RW, Kennedy SH, Bhat V. Pretreatment anxious depression as a predictor of side effect frequency and severity in escitalopram and aripiprazole adjunctive therapy. Brain Behav 2022; 12:e2555. [PMID: 35333448 PMCID: PMC9120722 DOI: 10.1002/brb3.2555] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 01/02/2022] [Accepted: 03/01/2022] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVE To report side effect frequency and severity in patients with major depressive disorder (MDD) receiving escitalopram and aripiprazole adjunctive therapy and to examine whether pretreatment anxious depression is associated with the number and presence of specific side effects. METHODS 188 of the 211 trial participants provided information on side effects during treatment with escitalopram (10-20 mg) for 8 weeks, and nonresponders received further augmentation on aripiprazole (2-10 mg) adjunctive therapy for another 8 weeks, whereas responders remained on escitalopram. Participants completed the Toronto Side Effects Scale at weeks 2, 4, 10, and 12. Covariate-adjusted negative binomial regression and Wilcoxon tests examined the association between anxious depression (GAD-7 ≥ 10) and number of side effects. Covariate-adjusted logistic regression and chi-square tests explored the association between anxious depression and specific side effects. RESULTS For both therapies, the most frequent side effects were also the most severe. They mostly related to the central nervous system (CNS) (i.e., drowsiness and nervousness). Between baseline and week 2, the number of side effects participants experienced (incidence rate ratio [IRR] = 1.38, p = .010) or had trouble with (IRR = 1.34, p = .026) was significantly higher among those with anxious depression for escitalopram but not adjunctive aripiprazole. Further, odds of experiencing and having trouble with nervousness and agitation were also significantly higher in anxious depression for escitalopram only (p < .05). CONCLUSION Patients on escitalopram and aripiprazole adjunctive therapy may experience and have trouble with CNS side effects. Pretreatment anxious depression may predispose escitalopram recipients with MDD to developing side effects, especially those related to anxiety.
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Affiliation(s)
- Caroline W Espinola
- Interventional Psychiatry Program, St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Yuelee Khoo
- Interventional Psychiatry Program, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Roohie Parmar
- Interventional Psychiatry Program, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Ilya Demchenko
- Interventional Psychiatry Program, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Benicio N Frey
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada.,Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare, Hamilton, Ontario, Canada
| | - Roumen V Milev
- Departments of Psychiatry and Psychology, Queen's University, Providence Care, Kingston, Ontario, Canada
| | - Arun V Ravindran
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Sagar V Parikh
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Keith Ho
- Interventional Psychiatry Program, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Susan Rotzinger
- Interventional Psychiatry Program, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Wendy Lou
- Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Raymond W Lam
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sidney H Kennedy
- Interventional Psychiatry Program, St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital & Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Venkat Bhat
- Interventional Psychiatry Program, St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital & Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
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- Interventional Psychiatry Program, St. Michael's Hospital, Toronto, Ontario, Canada
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9
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Dama M, Khoo Y, Frey BN, Milev RV, Ravindran AV, Parikh SV, Rotzinger S, Lou W, Lam RW, Kennedy SH, Bhat V. Rhythmicity of sleep and clinical outcomes in major depressive disorder: A CAN-BIND-1 Report. Journal of Affective Disorders Reports 2022. [DOI: 10.1016/j.jadr.2022.100370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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10
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Espinola CW, Khoo Y, Parmar R, Demchenko I, Frey BN, Milev RV, Ravindran AV, Parikh SV, Ho K, Rotzinger S, Lou W, Lam RW, Kennedy SH, Bhat V. Males and females differ in reported sexual functioning with escitalopram treatment for major depressive disorder: A CAN-BIND-1 study report. J Psychopharmacol 2022; 36:604-613. [PMID: 35546043 DOI: 10.1177/02698811221095832] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Antidepressant use for major depressive disorder (MDD) is frequently associated with sexual dysfunction. AIMS Cross-sectional and longitudinal relationships between antidepressant treatment outcomes and sexual functioning (SF) were evaluated separately for males and females receiving escitalopram. We further assessed the association between pre- and posttreatment SF. METHODS In all, 208 of the 211 CAN-BIND-1 trial participants (77 males and 131 females) with MDD and detectable drug blood levels were eligible for the analyses. All received escitalopram (10-20 mg) for 8 weeks. At baseline and Week 8, participants completed the Montgomery-Åsberg Depression Rating Scale (MADRS) and the SexFx scale, which measures sexual satisfaction and SF frequency. Mixed-model repeated measures assessed baseline to Week 8 SF changes among participants with different response/remission statuses. Multiple linear regression analyses examined SF differences between treatment outcomes at Week 8 as well as associations between pretreatment and eventual SF. RESULTS For both sexes, overall sexual satisfaction improved among responders but not among nonresponders (p < 0.05). For females, overall SF frequency did not change significantly over time regardless of response status. For males, overall SF decreased significantly among nonresponders; orgasm decreased significantly among nonresponders and, to a lesser extent, among responders (p < 0.05). For both sexes, pretreatment SF was significantly associated with SF at Week 8 across all domains (p < 0.05). CONCLUSION For both sexes, sexual satisfaction improves with response to escitalopram. For females, the response does not correspond to improvements in SF frequency. For males, SF frequency, particularly that of orgasm, declines regardless of response/nonresponse.ClinicalTrials.gov identifier: NCT01655706.
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Affiliation(s)
- Caroline W Espinola
- Interventional Psychiatry Program, Centre for Depression & Suicide Studies, St. Michael's Hospital, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Yuelee Khoo
- Interventional Psychiatry Program, Centre for Depression & Suicide Studies, St. Michael's Hospital, Toronto, ON, Canada
| | - Roohie Parmar
- Interventional Psychiatry Program, Centre for Depression & Suicide Studies, St. Michael's Hospital, Toronto, ON, Canada
| | - Ilya Demchenko
- Interventional Psychiatry Program, Centre for Depression & Suicide Studies, St. Michael's Hospital, Toronto, ON, Canada
| | - Benicio N Frey
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.,Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare, Hamilton, ON, Canada
| | - Roumen V Milev
- Departments of Psychiatry and Psychology, Queen's University, Providence Care Hospital, Kingston, ON, Canada
| | - Arun V Ravindran
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Sagar V Parikh
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Keith Ho
- Interventional Psychiatry Program, Centre for Depression & Suicide Studies, St. Michael's Hospital, Toronto, ON, Canada
| | - Susan Rotzinger
- Interventional Psychiatry Program, Centre for Depression & Suicide Studies, St. Michael's Hospital, Toronto, ON, Canada
| | - Wendy Lou
- Dalla Lana School of Public Health, University of Toronto, ON, Canada
| | - Raymond W Lam
- Department of Psychiatry, The University of British Columbia, Vancouver, BC, Canada
| | - Sidney H Kennedy
- Interventional Psychiatry Program, Centre for Depression & Suicide Studies, St. Michael's Hospital, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada.,Li Ka Shing Knowledge Institute & Krembil Research Institute, Toronto, ON, Canada
| | - Venkat Bhat
- Interventional Psychiatry Program, Centre for Depression & Suicide Studies, St. Michael's Hospital, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada.,Li Ka Shing Knowledge Institute & Krembil Research Institute, Toronto, ON, Canada
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11
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Ravindran N, McKay M, Paric A, Johnson S, Chandrasena R, Abraham G, Ravindran AV. Randomized, Placebo-Controlled Effectiveness Study of Quetiapine XR in Comorbid Depressive and Anxiety Disorders. J Clin Psychiatry 2022; 83. [PMID: 35324094 DOI: 10.4088/jcp.21m14096] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Objective: Quetiapine is approved as an adjunctive treatment for major depressive disorder (MDD) and as monotherapy for bipolar depression. It is often used off-label for treating anxiety conditions and as an augmentation agent for treatment-resistant depression. However, its benefit in depression with comorbid anxiety disorders has not been systematically evaluated. The current study evaluated the benefit and tolerability of quetiapine as augmentation to first-line antidepressants for MDD comorbid with anxiety disorders. Methods: In this multicenter trial (June 2008-June 2013), 76 adults (aged 18-65 years) with a primary diagnosis of unipolar depression comorbid with at least 1 anxiety disorder (per DSM-IV-TR criteria) received flexible-dose quetiapine extended-release (XR) 50-300 mg/d or placebo as add-on for 12 weeks in a 2:1 ratio. Depression, anxiety, life satisfaction, and adverse events were assessed. Results: Depression, anxiety, and function improved significantly in both groups. On primary outcome measures, quetiapine was superior to placebo in improving depression (17-item Hamilton Depression Rating Scale score: mean difference = -3.64; 95% CI, -7.01 to -0.27) and anxiety symptoms (Hamilton Anxiety Rating Scale score: mean difference = -4.02; 95% CI, -7.41 to -0.64), as well as Clinical Global Impressions-Severity of Illness scale score (mean difference = -0.64; 95% CI, -1.13 to -0.15). On secondary measures including the Montgomery-Asberg Depression Rating Scale, Beck Depression Inventory, Penn State Worry Questionnaire, and Quality of Life Satisfaction and Enjoyment Questionnaire, quetiapine produced a greater degree of improvement compared to placebo, but group differences were not statistically significant. Quetiapine was well tolerated, with mostly minor and no serious adverse effects. Conclusions: Quetiapine augmentation may be a useful intervention for MDD with comorbid anxiety. Trial Registration: ClinicalTrials.gov Identifier: NCT00688818.
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Affiliation(s)
- Nisha Ravindran
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Martha McKay
- University Health Network, Toronto, Ontario, Canada
| | - Angela Paric
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Sunny Johnson
- Department of Psychiatry, Credit Valley Hospital, Mississauga, Ontario, Canada
| | | | - Gaby Abraham
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Arun V Ravindran
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Corresponding author: Arun V. Ravindran, MD, 100 Stokes St, Toronto, ON M6J 1H4 Canada
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12
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Khoo Y, Demchenko I, Frey BN, Milev RV, Ravindran AV, Parikh SV, Ho K, Rotzinger S, Lou W, Lam RW, Kennedy SH, Bhat V. Baseline anxiety, and early anxiety/depression improvement in anxious depression predicts treatment outcomes with escitalopram: A CAN-BIND-1 study report. J Affect Disord 2022; 300:50-58. [PMID: 34921820 DOI: 10.1016/j.jad.2021.12.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 11/09/2021] [Accepted: 12/12/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Although anxiety symptoms frequently co-occur with major depressive disorder, few studies examined the prediction of treatment outcomes among participants with anxious depression receiving antidepressants. We investigated whether baseline anxiety, and early improvements in anxiety and depression symptoms predict eventual treatment outcomes. METHODS 111 participants with anxious depression, defined using ≥ 10 on GAD-7, received escitalopram (10-20 mg) for 8 weeks. Covariate-adjusted logistic regression was conducted to examine the impact of baseline anxiety, and to assess the extent week 2 anxiety (GAD-7) and depression (QIDS-SR) percentage improvement associates with week 8 anxiety (GAD-7) and depression (MADRS) response/remission. Optimum improvement thresholds were identified using receiving-operating-curve analysis and their predictive values assessed. RESULTS Greater percentage improvement in anxiety and depression after the first 2 weeks of treatment significantly increased odds of achieving week 8 anxiety and depression response/remission (OR:1.01-1.04, p<0.05). Early anxiety (68.4%/87.2%) and depression (52.2%/83.0%) improvement thresholds around 30 and 40% provided moderate to high positive predictive value (PPV) for predicting week 8 anxiety response/remission, as well as moderate to high negative predictive value (NPV) for predicting week 8 depression response/remission (anxiety:70.8%/91.7%; depression:72.2%/90.1%). Baseline anxiety severity predicted anxiety outcomes at weeks 2 and 8. LIMITATIONS Trial lacked placebo group. CONCLUSION In anxious depression, early improvement in anxiety may be better than depression in predicting anxiety outcomes, with similar or higher PPVs. Both improvement types perform similarly in predicting depression outcomes, with the lack of improvement predictive of non-response and non-remission. Finally, baseline anxiety predicts eventual anxiety but not depression outcomes.
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Affiliation(s)
- Yuelee Khoo
- Interventional Psychiatry Program, Centre for Depression & Suicide Studies, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Ilya Demchenko
- Interventional Psychiatry Program, Centre for Depression & Suicide Studies, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Benicio N Frey
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada; Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare, Hamilton, Ontario, Canada
| | - Roumen V Milev
- Departments of Psychiatry and Psychology, Queen's University, Providence Care, Kingston, Ontario, Canada
| | - Arun V Ravindran
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Sagar V Parikh
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, United States
| | - Keith Ho
- Interventional Psychiatry Program, Centre for Depression & Suicide Studies, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Susan Rotzinger
- Interventional Psychiatry Program, Centre for Depression & Suicide Studies, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Wendy Lou
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Raymond W Lam
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sidney H Kennedy
- Interventional Psychiatry Program, Centre for Depression & Suicide Studies, St. Michael's Hospital, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute & Krembil Research Institute, Toronto, Ontario, Canada
| | - Venkat Bhat
- Interventional Psychiatry Program, Centre for Depression & Suicide Studies, St. Michael's Hospital, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute & Krembil Research Institute, Toronto, Ontario, Canada.
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13
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Rnic K, Jung YE, Torres I, Chakrabarty T, LeMoult J, Vaccarino AL, Morton E, Bhat V, Giacobbe P, McInerney S, Frey BN, Milev RV, Müller D, Ravindran AV, Rotzinger S, Kennedy SH, Lam RW. Association between discrepancy in objective and subjective cognitive abilities and treatment response in patients with major depressive disorder: A CAN-BIND-1 study report. J Affect Disord 2021; 295:1095-1101. [PMID: 34706420 DOI: 10.1016/j.jad.2021.09.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 08/31/2021] [Accepted: 09/02/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND Major Depressive Disorder (MDD) is characterized by objective and subjective cognitive deficits. Discrepancies between objective and subjective cognitive performance can reflect under- to over-estimations of cognitive abilities, and these discrepancies are referred to as cognitive self-appraisals. Despite evidence that low self-appraisals are associated with depression, the modifiability of self-appraisals and their association with treatment outcome remains unclear. The current study examined whether self-appraisals change following antidepressant treatment. Furthermore, we investigated the association of self-appraisals with treatment outcome. METHODS As part of the CAN-BIND-1 clinical trial, 154 patients with MDD completed measures of objective and subjective cognitive abilities, depressive symptoms, and functional outcomes (work productivity, psychosocial functioning, and quality of life) at baseline and post-escitalopram treatment. Self-appraisals were calculated based on discrepancies between objective and subjective cognitive abilities, with higher scores indicating overestimation of cognitive abilities. RESULTS Baseline self-appraisals were not predictive of treatment outcomes. However, self-appraisals increased from pre- to post-treatment. Moreover, pre-post treatment increases in self-appraisals were associated with positive treatment response and remission, decreases in depressive symptoms, and improvements in work productivity, psychosocial functioning, and quality of life. LIMITATIONS The pre-post intervention design precluded examining the temporal precedence of change in self-appraisals versus depressive symptoms and functional outcomes. CONCLUSIONS Findings are the first to demonstrate that self-appraisals are treatment-sensitive and are associated with treatment outcomes and recovery from MDD. Cognitive self-appraisals may represent a key marker of treatment response and a valuable target for assessment and intervention, as well as a potential mechanism underlying risk and recovery.
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Affiliation(s)
- Katerina Rnic
- Department of Psychology, University of British Columbia, Vancouver, British Columbia V6T 1Z4, Canada,.
| | - Young-Eun Jung
- Department of Psychiatry, College of Medicine, Jeju National University, Jeju 63241, Korea
| | - Ivan Torres
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia V6T 1Z4, Canada
| | - Trisha Chakrabarty
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia V6T 1Z4, Canada
| | - Joelle LeMoult
- Department of Psychology, University of British Columbia, Vancouver, British Columbia V6T 1Z4, Canada
| | | | - Emma Morton
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia V6T 1Z4, Canada
| | - Venkat Bhat
- Department of Psychiatry, University of Toronto, Toronto, Ontario M5T 1R8, Canada
| | - Peter Giacobbe
- Department of Psychiatry, University of Toronto, Toronto, Ontario M5T 1R8, Canada
| | - Shane McInerney
- Department of Psychiatry, National University of Ireland, Galway H91 Tk33, Ireland
| | - Benicio N Frey
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario L8N 3K7, Canada
| | - Roumen V Milev
- Departments of Psychiatry and Psychology, Queen's University, Kingston, Ontario K7L 3N6, Canada
| | - Daniel Müller
- Department of Psychiatry, University of Toronto, Toronto, Ontario M5T 1R8, Canada
| | - Arun V Ravindran
- Department of Psychiatry, University of Toronto, Toronto, Ontario M5T 1R8, Canada
| | - Susan Rotzinger
- Department of Psychiatry, University of Toronto, Toronto, Ontario M5T 1R8, Canada
| | - Sidney H Kennedy
- Department of Psychiatry, University of Toronto, Toronto, Ontario M5T 1R8, Canada
| | - Raymond W Lam
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia V6T 1Z4, Canada
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14
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Yatham LN, Chakrabarty T, Bond DJ, Schaffer A, Beaulieu S, Parikh SV, McIntyre RS, Milev RV, Alda M, Vazquez G, Ravindran AV, Frey BN, Sharma V, Goldstein BI, Rej S, O'Donovan C, Tourjman V, Kozicky JM, Kauer-Sant'Anna M, Malhi G, Suppes T, Vieta E, Kapczinski F, Kanba S, Lam RW, Kennedy SH, Calabrese J, Berk M, Post R. Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) recommendations for the management of patients with bipolar disorder with mixed presentations. Bipolar Disord 2021; 23:767-788. [PMID: 34599629 DOI: 10.1111/bdi.13135] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVES The 2018 Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) guidelines provided clinicians with pragmatic treatment recommendations for bipolar disorder (BD). While these guidelines included commentary on how mixed features may direct treatment selection, specific recommendations were not provided-a critical gap which the current update aims to address. METHOD Overview of research regarding mixed presentations in BD, with treatment recommendations developed using a modified CANMAT/ISBD rating methodology. Limitations are discussed, including the dearth of high-quality data and reliance on expert opinion. RESULTS No agents met threshold for first-line treatment of DSM-5 manic or depressive episodes with mixed features. For mania + mixed features second-line treatment options include asenapine, cariprazine, divalproex, and aripiprazole. In depression + mixed features, cariprazine and lurasidone are recommended as second-line options. For DSM-IV defined mixed episodes, with a longer history of research, asenapine and aripiprazole are first-line, and olanzapine (monotherapy or combination), carbamazepine, and divalproex are second-line. Research on maintenance treatments following a DSM-5 mixed presentation is extremely limited, with third-line recommendations based on expert opinion. For maintenance treatment following a DSM-IV mixed episode, quetiapine (monotherapy or combination) is first-line, and lithium and olanzapine identified as second-line options. CONCLUSION The CANMAT and ISBD groups hope these guidelines provide valuable support for clinicians providing care to patients experiencing mixed presentations, as well as further influence investment in research to improve diagnosis and treatment of this common and complex clinical state.
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Affiliation(s)
- Lakshmi N Yatham
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Trisha Chakrabarty
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - David J Bond
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Ayal Schaffer
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Serge Beaulieu
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Sagar V Parikh
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Roger S McIntyre
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Roumen V Milev
- Department of Psychiatry, Queens University, Kingston, Ontario, Canada
| | - Martin Alda
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Gustavo Vazquez
- Department of Psychiatry, Queens University, Kingston, Ontario, Canada
| | - Arun V Ravindran
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Benicio N Frey
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, and St. Joseph's Healthcare, Hamilton, Ontario, Canada
| | - Verinder Sharma
- Departments of Psychiatry and Obstetrics & Gynaecology, Western University, London, Ontario, Canada
| | | | - Soham Rej
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Claire O'Donovan
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Valerie Tourjman
- Department of Psychiatry and addiction, University of Montreal, Montreal, QC, Canada
| | | | - Marcia Kauer-Sant'Anna
- Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Gin Malhi
- Department of Psychiatry, University of Sydney, Sydney, Australia
| | - Trisha Suppes
- Department of Psychiatry and Behavioural Sciences, Stanford School of Medicine and VA Palo Alto Health Care System, Palo Alto, California, USA
| | - Eduard Vieta
- Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Flavio Kapczinski
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, and St. Joseph's Healthcare, Hamilton, Ontario, Canada
| | - Shigenobu Kanba
- Department of Neuropsychiatry, Kyushu University, Fukuoka, Japan
| | - Raymond W Lam
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sidney H Kennedy
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Joseph Calabrese
- Department of Psychiatry, Western Reserve University, Cleveland, Ohio, USA
| | - Michael Berk
- IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, Geelong, Australia
| | - Robert Post
- Department of Psychiatry, George Washington University, Washington, District of Columbia, USA
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15
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Xiang Y, Cipriani A, Teng T, Del Giovane C, Zhang Y, Weisz JR, Li X, Cuijpers P, Liu X, Barth J, Jiang Y, Cohen D, Fan L, Gillies D, Du K, Ravindran AV, Zhou X, Xie P. Comparative efficacy and acceptability of psychotherapies for post-traumatic stress disorder in children and adolescents: a systematic review and network meta-analysis. Evid Based Ment Health 2021; 24:153-160. [PMID: 34599050 PMCID: PMC8543231 DOI: 10.1136/ebmental-2021-300346] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 09/20/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Available evidence on the comparative efficacy and acceptability of psychotherapies for post-traumatic stress disorder (PTSD) in children and adolescents remains uncertain. OBJECTIVE We aimed to compare and rank the different types and formats of psychotherapies for PTSD in children and adolescents. METHODS We searched eight databases and other international registers up to 31 December 2020. The pairwise meta-analyses and frequentist network meta-analyses estimated pooled standardised mean differences (SMDs) and ORs with random-effects model. Efficacy at post-treatment and follow-up, acceptability, depressive and anxiety symptoms were measured. FINDINGS We included 56 randomised controlled trials with 5327 patients comparing 14 different types of psychotherapies and 3 control conditions. For efficacy, cognitive processing therapy (CPT), behavioural therapy (BT), individual trauma-focused cognitive-behavioural therapy (TF-CBT), eye movement desensitisation and reprocessing, and group TF-CBT were significantly superior to all control conditions at post-treatment and follow-up (SMDs between -2.42 and -0.25). Moreover, CPT, BT and individual TF-CBT were more effective than supportive therapy (SMDs between -1.92 and -0.49). Results for depressive and anxiety symptoms were similar to the findings for the primary outcome. Most of the results were rated as 'moderate' to 'very low' in terms of confidence of evidence. CONCLUSIONS CPT, BT and individual TF-CBT appear to be the best choices of psychotherapy for PTSD in young patients. Other types and different ways of delivering psychological treatment can be alternative options. Clinicians should consider the importance of each outcome and the patients' preferences in real clinical practice.
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Affiliation(s)
- Yajie Xiang
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- NHC Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Neurobiology, Chongqing, China
| | - Andrea Cipriani
- Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Teng Teng
- NHC Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Neurobiology, Chongqing, China
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | | | - Yuqing Zhang
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - John R Weisz
- Department of Psychology, Harvard University, Cambridge, Massachusetts, USA
| | - Xuemei Li
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- NHC Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Neurobiology, Chongqing, China
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Xueer Liu
- NHC Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Neurobiology, Chongqing, China
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jürgen Barth
- Institute for Complementary and Integrative Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Yuanliang Jiang
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- NHC Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Neurobiology, Chongqing, China
| | - David Cohen
- Department of Child and Adolescent Psychiatry, Hôpital Pitié-Salpétrière, Institut des Systèmes Intelligents et Robotiques, Université Pierre et Marie Curie, Paris, France
| | - Li Fan
- NHC Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Neurobiology, Chongqing, China
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Donna Gillies
- University of Sydney, Sydney, New South Wales, Australia
| | - Kang Du
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- NHC Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Neurobiology, Chongqing, China
| | - Arun V Ravindran
- Campbell Family Mental Health Research Centre, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Xinyu Zhou
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- NHC Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Neurobiology, Chongqing, China
| | - Peng Xie
- NHC Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Neurobiology, Chongqing, China
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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16
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Liu L, Ni SY, Yan W, Lu QD, Zhao YM, Xu YY, Mei H, Shi L, Yuan K, Han Y, Deng JH, Sun YK, Meng SQ, Jiang ZD, Zeng N, Que JY, Zheng YB, Yang BN, Gong YM, Ravindran AV, Kosten T, Wing YK, Tang XD, Yuan JL, Wu P, Shi J, Bao YP, Lu L. Mental and neurological disorders and risk of COVID-19 susceptibility, illness severity and mortality: A systematic review, meta-analysis and call for action. EClinicalMedicine 2021; 40:101111. [PMID: 34514362 PMCID: PMC8424080 DOI: 10.1016/j.eclinm.2021.101111] [Citation(s) in RCA: 79] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 08/12/2021] [Accepted: 08/13/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) has evolved into a worldwide pandemic, and has been found to be closely associated with mental and neurological disorders. We aimed to comprehensively quantify the association between mental and neurological disorders, both pre-existing and subsequent, and the risk of susceptibility, severity and mortality of COVID-19. METHODS In this systematic review and meta-analysis, we searched PubMed, Web of Science, Embase, PsycINFO, and Cochrane library databases for studies published from the inception up to January 16, 2021 and updated at July 7, 2021. Observational studies including cohort and case-control, cross-sectional studies and case series that reported risk estimates of the association between mental or neurological disorders and COVID-19 susceptibility, illness severity and mortality were included. Two researchers independently extracted data and conducted the quality assessment. Based on I2 heterogeneity, we used a random effects model to calculate pooled odds ratios (OR) and 95% confidence intervals (95% CI). Subgroup analyses and meta-regression analysis were also performed. This study was registered on PROSPERO (registration number: CRD 42021230832). FINDING A total of 149 studies (227,351,954 participants, 89,235,737 COVID-19 patients) were included in this analysis, in which 27 reported morbidity (132,727,798), 56 reported illness severity (83,097,968) and 115 reported mortality (88,878,662). Overall, mental and neurological disorders were associated with a significant high risk of infection (pre-existing mental: OR 1·67, 95% CI 1·12-2·49; and pre-existing neurological: 2·05, 1·58-2·67), illness severity (mental: pre-existing, 1·40, 1·25-1·57; sequelae, 4·85, 2·53-9·32; neurological: pre-existing, 1·43, 1·09-1·88; sequelae, 2·17, 1·45-3·24), and mortality (mental: pre-existing, 1·47, 1·26-1·72; neurological: pre-existing, 2·08, 1·61-2·69; sequelae, 2·03, 1·66-2·49) from COVID-19. Subgroup analysis revealed that association with illness severity was stronger among younger COVID-19 patients, and those with subsequent mental disorders, living in low- and middle-income regions. Younger patients with mental and neurological disorders were associated with higher mortality than elders. For type-specific mental disorders, susceptibility to contracting COVID-19 was associated with pre-existing mood disorders, anxiety, and attention-deficit hyperactivity disorder (ADHD); illness severity was associated with both pre-existing and subsequent mood disorders as well as sleep disturbance; and mortality was associated with pre-existing schizophrenia. For neurological disorders, susceptibility was associated with pre-existing dementia; both severity and mortality were associated with subsequent delirium and altered mental status; besides, mortality was associated with pre-existing and subsequent dementia and multiple specific neurological diseases. Heterogeneities were substantial across studies in most analysis. INTERPRETATION The findings show an important role of mental and neurological disorders in the context of COVID-19 and provide clues and directions for identifying and protecting vulnerable populations in the pandemic. Early detection and intervention for neurological and mental disorders are urgently needed to control morbidity and mortality induced by the COVID-19 pandemic. However, there was substantial heterogeneity among the included studies, and the results should be interpreted with caution. More studies are needed to explore long-term mental and neurological sequela, as well as the underlying brain mechanisms for the sake of elucidating the causal pathways for these associations. FUNDING This study is supported by grants from the National Key Research and Development Program of China, the National Natural Science Foundation of China, Special Research Fund of PKUHSC for Prevention and Control of COVID-19, and the Fundamental Research Funds for the Central Universities.
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Affiliation(s)
- Lin Liu
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China
- School of Public Health, Peking University, Beijing, China
| | - Shu-Yu Ni
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China
- School of Public Health, Peking University, Beijing, China
| | - Wei Yan
- 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), Chinese Academy of Medical Sciences Research Unit (No. 2018RU006), Peking University, Beijing 100191, China
| | - Qing-Dong Lu
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China
- School of Public Health, Peking University, Beijing, China
| | - Yi-Miao Zhao
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China
- School of Public Health, Peking University, Beijing, China
| | - Ying-Ying Xu
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China
- School of Public Health, Peking University, Beijing, China
| | - Huan Mei
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China
- School of Public Health, Peking University, Beijing, China
| | - Le Shi
- 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), Chinese Academy of Medical Sciences Research Unit (No. 2018RU006), Peking University, Beijing 100191, China
| | - Kai Yuan
- 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), Chinese Academy of Medical Sciences Research Unit (No. 2018RU006), Peking University, Beijing 100191, China
| | - Ying Han
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China
| | - Jia-Hui Deng
- 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), Chinese Academy of Medical Sciences Research Unit (No. 2018RU006), Peking University, Beijing 100191, China
| | - Yan-Kun Sun
- 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), Chinese Academy of Medical Sciences Research Unit (No. 2018RU006), Peking University, Beijing 100191, China
| | - Shi-Qiu Meng
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China
| | - Zheng-Dong Jiang
- Wuhan Wuchang Hospital, Wuhan University of Science and Technology, Wuhan, China
| | - Na Zeng
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China
- School of Public Health, Peking University, Beijing, China
- Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Jian-Yu Que
- 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), Chinese Academy of Medical Sciences Research Unit (No. 2018RU006), Peking University, Beijing 100191, China
| | - Yong-Bo Zheng
- 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), Chinese Academy of Medical Sciences Research Unit (No. 2018RU006), Peking University, Beijing 100191, China
| | - Bei-Ni Yang
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China
- School of Public Health, Peking University, Beijing, China
| | - Yi-Miao Gong
- 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), Chinese Academy of Medical Sciences Research Unit (No. 2018RU006), Peking University, Beijing 100191, China
| | | | - Thomas Kosten
- Department of Psychiatry, Baylor College of Medicine, Houston, TX, United States
| | - Yun Kwok Wing
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Xiang-Dong Tang
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Mental Health Center and Translational Neuroscience Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Jun-Liang Yuan
- 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), Chinese Academy of Medical Sciences Research Unit (No. 2018RU006), Peking University, Beijing 100191, China
| | - Ping Wu
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China
| | - Jie Shi
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China
| | - Yan-Ping Bao
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China
- School of Public Health, Peking University, Beijing, China
| | - Lin Lu
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China
- 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), Chinese Academy of Medical Sciences Research Unit (No. 2018RU006), Peking University, Beijing 100191, China
- Peking-Tsinghua Centre for Life Sciences and PKU-IDG/McGovern Institute for Brain Research, Peking University, Beijing, China
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17
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McInerney SJ, Chakrabarty T, Maciukiewicz M, Frey BN, MacQueen GM, Milev RV, Ravindran AV, Rotzinger S, Kennedy SH, Lam RW. Cognition and Its Association with Psychosocial and Occupational Functioning during Treatment with Escitalopram in Patients with Major Depressive Disorder: A CAN-BIND-1 Report: La Cognition Et Son Association Avec Le Fonctionnement Psychosocial Et Professionnel Durant Le Traitement Par Escitalopram Chez Des Patients Souffrant De Trouble Dépressif Majeur: Une Étude Can-Bind-1. Can J Psychiatry 2021; 66:798-806. [PMID: 33353384 PMCID: PMC8504285 DOI: 10.1177/0706743720974823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Major depressive disorder (MDD) is associated with impairments in both cognition and functioning. However, whether cognitive deficits significantly contribute to impaired psychosocial and occupational functioning, independent of other depressive symptoms, is not well established. We examined the relationship between cognitive performance and functioning in depressed patients before and after antidepressant treatment using secondary data from the first Canadian Biomarker Integration Network in Depression-1 study. METHODS Cognition was assessed at baseline in unmedicated, depressed participants with MDD (n = 207) using the Central Nervous System Vital Signs computerized battery, psychosocial functioning with the Sheehan Disability Scale (SDS), and occupational functioning with the Lam Employment Absence and Productivity Scale (LEAPS). Cognition (n = 181), SDS (n = 175), and LEAPS (n = 118) were reassessed after participants received 8 weeks of open-label escitalopram monotherapy. A series of linear regressions were conducted to determine (1) whether cognitive functioning was associated with psychosocial and occupational functioning prior to treatment, after adjusting for overall depressive symptom severity and (2) whether changes in cognitive functioning after an 8-week treatment phase were associated with changes in psychosocial and occupational functioning, after adjusting for changes in overall symptom severity. RESULTS Baseline global cognitive functioning, after adjusting for depression symptom severity and demographic variables, was associated with the SDS work/study subscale (β = -0.17; P = 0.03) and LEAPS productivity subscale (β = -0.17; P = 0.05), but not SDS total (β = 0.19; P = 0.12) or LEAPS total (β = 0.41; P = 0.17) scores. Although LEAPS and SDS scores showed significant improvements after 8 weeks of treatment (P < 0.001), there were no significant associations between changes in cognitive domain scores and functional improvements. CONCLUSION Cognition was associated with occupational functioning at baseline, but changes in cognition were not associated with psychosocial or occupational functional improvements following escitalopram treatment. We recommend the use of more comprehensive functional assessments to determine the impact of cognitive change on functional outcomes in future research.
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Affiliation(s)
- Shane J McInerney
- Department of Psychiatry, University of Toronto, Ontario, Canada.,Department of Psychiatry, University Hospital Galway, Ireland
| | - Trisha Chakrabarty
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Malgorzata Maciukiewicz
- Centre for Addiction and Mental Health, Campbell Family Mental Health Research Institute, Toronto, Ontario, Canada.,Department of Rheumatology, Center of Experimental Rheumatology, University Hospital Zurich, Switzerland
| | - Benicio N Frey
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Glenda M MacQueen
- Deceased, formerly Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Roumen V Milev
- Department of Psychiatry, Queen's University, Kingston, Ontario, Canada.,Department of Psychology, Queen's University, Kingston, Ontario, Canada
| | - Arun V Ravindran
- Department of Psychiatry, University of Toronto, Ontario, Canada
| | - Susan Rotzinger
- Department of Psychiatry, University of Toronto, Ontario, Canada
| | - Sidney H Kennedy
- Department of Psychiatry, University of Toronto, Ontario, Canada
| | - Raymond W Lam
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
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18
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Walker ZJ, Xue S, Jones MP, Ravindran AV. Depression, Anxiety, and Other Mental Disorders in Patients With Cancer in Low- and Lower-Middle-Income Countries: A Systematic Review and Meta-Analysis. JCO Glob Oncol 2021; 7:1233-1250. [PMID: 34343029 PMCID: PMC8457869 DOI: 10.1200/go.21.00056] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Cancer is a growing public health issue in low- and lower-middle–income countries (LLMICs), but the mental health consequences in this setting have not been well-characterized. We aimed to systematically evaluate the available literature on the prevalence, associates, and treatment of mental disorders in patients with cancer in LLMICs.
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Affiliation(s)
- Zoe J Walker
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Royal Hobart Hospital, Hobart, Australia
| | - Siqi Xue
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Michael P Jones
- Royal Hobart Hospital, Hobart, Australia.,Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada.,Princess Margaret Cancer Centre, Toronto, Toronto, Ontario, Canada
| | - Arun V Ravindran
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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19
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Xu Y, Su S, Jiang Z, Guo S, Lu Q, Liu L, Zhao Y, Wu P, Que J, Shi L, Deng J, Meng S, Yan W, Sun Y, Yuan K, Lin X, Sun S, Ravindran AV, Chen S, Wing YK, Tang X, Ran M, Lu Y, Shi J, Huang G, Bao Y, Lu L. Prevalence and Risk Factors of Mental Health Symptoms and Suicidal Behavior Among University Students in Wuhan, China During the COVID-19 Pandemic. Front Psychiatry 2021; 12:695017. [PMID: 34326787 PMCID: PMC8313758 DOI: 10.3389/fpsyt.2021.695017] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 06/17/2021] [Indexed: 02/05/2023] Open
Abstract
Background: University students who are exposed to coronavirus disease 2019 (COVID-19) could be mentally distressed. We aimed to evaluate the pattern and risk factors of mental health and suicidal behavior among students who experienced long-term school closure due to the COVID-19 pandemic. Methods: This large-sample, cross-sectional, online survey was conducted from June 29, 2020, to July 18, 2020. Eleven thousand two hundred fifty four participants were recruited from 30 universities located in Wuhan, Hubei Province, China. The prevalence of symptoms of depression, anxiety, insomnia, and posttraumatic stress disorder (PTSD) and suicidal behavior was evaluated using the Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, Insomnia Severity Index, Posttraumatic Stress Disorder Checklist for DSM-5, and questions about suicidal ideation and attempts, respectively. Logistic regression was used to explore risk factors for mental health problems and suicidal behavior. Results: The prevalence of mental health problems was 41.5% for depressive symptoms, 32.6% for anxiety symptoms, 35.0% for insomnia symptoms, 8.5% for PTSD symptoms, and 2.0% for suicidal behavior. Participants with high stress during the pandemic were at higher risk of symptoms of depression [adjusted odds ratio (OR) = 1.67, 95% confidence interval (CI) = 1.43-1.95, p < 0.01), anxiety (adjusted OR = 1.90, 95% CI = 1.63-2.23, p < 0.01), insomnia (adjusted OR = 1.64, 95% CI = 1.44-1.87, p < 0.01), PTSD (adjusted OR = 1.71, 95% CI = 1.38-2.11, p < 0.01) and suicidal behavior (adjusted OR = 3.51, 95% CI = 2.28-5.40, p < 0.01). Distant relationship with parents, changes in lifestyle and alcohol use during the pandemic were associated with higher risk of mental health symptoms and suicidal behavior, whereas regular physical exercise reduced the risk of mental health problems. Conclusions: The psychological symptoms and suicidal behavior were relatively high among students who attended university in Wuhan, China after 6 months of the COVID-19 outbreak in China. Comprehensive mental health services and suicide prevention strategies are essential for university students during the COVID-19 pandemic.
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Affiliation(s)
- Yingying Xu
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China
- School of Public Health, Peking University, Beijing, China
| | - Sizhen Su
- 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
| | - Zhendong Jiang
- Wuhan Wuchang Hospital, Wuhan University of Science and Technology, Wuhan, China
| | - Suihuai Guo
- Wuhan Wuchang Hospital, Wuhan University of Science and Technology, Wuhan, China
| | - Qingdong Lu
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China
- School of Public Health, Peking University, Beijing, China
| | - Lin Liu
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China
- School of Public Health, Peking University, Beijing, China
| | - Yimiao Zhao
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China
- School of Public Health, Peking University, Beijing, China
| | - Ping Wu
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China
| | - Jianyu Que
- 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
| | - Le Shi
- 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
| | - Jiahui Deng
- 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
| | - Shiqiu Meng
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China
| | - Wei Yan
- 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
| | - Yankun Sun
- 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
| | - Kai Yuan
- 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
| | - Xiao Lin
- 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
| | - Siwei Sun
- 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
| | - Arun V. Ravindran
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Sijing Chen
- Department of Psychiatry, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yun Kwok Wing
- Department of Psychiatry, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Xiangdong Tang
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Mental Health Center and Translational Neuroscience Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Maosheng Ran
- Department of Social Work and Social Administration, University of Hong Kong, Hong Kong, China
| | - Yu Lu
- Wuhan Wuchang Hospital, Wuhan University of Science and Technology, Wuhan, China
| | - Jie Shi
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China
| | - Guofu Huang
- Wuhan Wuchang Hospital, Wuhan University of Science and Technology, Wuhan, China
| | - Yanping Bao
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China
- School of Public Health, Peking University, Beijing, China
| | - Lin Lu
- 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
- Peking-Tsinghua Center for Life Sciences and PKU-IDG/McGovern Institute for Brain Research, Peking University, Beijing, China
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20
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Lee Y, Mansur RB, Brietzke E, Kapogiannis D, Delgado-Peraza F, Boutilier JJ, Chan TC, Carmona NE, Rosenblat JD, Lee J, Maletic V, Vinberg M, Suppes T, Goldstein BI, Ravindran AV, Taylor VH, Chawla S, Nogueras-Ortiz C, Cosgrove VE, Kramer NE, Ho R, Raison CA, McIntyre RS. Peripheral inflammatory biomarkers define biotypes of bipolar depression. Mol Psychiatry 2021; 26:3395-3406. [PMID: 33658605 PMCID: PMC8413393 DOI: 10.1038/s41380-021-01051-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 01/25/2021] [Accepted: 02/12/2021] [Indexed: 12/27/2022]
Abstract
We identified biologically relevant moderators of response to tumor necrosis factor (TNF)-α inhibitor, infliximab, among 60 individuals with bipolar depression. Data were derived from a 12-week, randomized, placebo-controlled clinical trial secondarily evaluating the efficacy of infliximab on a measure of anhedonia (i.e., Snaith-Hamilton Pleasure Scale). Three inflammatory biotypes were derived from peripheral cytokine measurements using an iterative, machine learning-based approach. Infliximab-randomized participants classified as biotype 3 exhibited lower baseline concentrations of pro- and anti-inflammatory cytokines and soluble TNF receptor-1 and reported greater pro-hedonic improvements, relative to those classified as biotype 1 or 2. Pretreatment biotypes also moderated changes in neuroinflammatory substrates relevant to infliximab's hypothesized mechanism of action. Neuronal origin-enriched extracellular vesicle (NEV) protein concentrations were reduced to two factors using principal axis factoring: phosphorylated nuclear factorκB (p-NFκB), Fas-associated death domain (p-FADD), and IκB kinase (p-IKKα/β) and TNF receptor-1 (TNFR1) comprised factor "NEV1," whereas phosphorylated insulin receptor substrate-1 (p-IRS1), p38 mitogen-activated protein kinase (p-p38), and c-Jun N-terminal kinase (p-JNK) constituted "NEV2". Among infliximab-randomized subjects classified as biotype 3, NEV1 scores were decreased at weeks 2 and 6 and increased at week 12, relative to baseline, and NEV2 scores increased over time. Decreases in NEV1 scores and increases in NEV2 scores were associated with greater reductions in anhedonic symptoms in our classification and regression tree model (r2 = 0.22, RMSE = 0.08). Our findings provide preliminary evidence supporting the hypothesis that the pro-hedonic effects of infliximab require modulation of multiple TNF-α signaling pathways, including NF-κB, IRS1, and MAPK.
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Affiliation(s)
- Yena Lee
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada. .,Institute of Medical Science, University of Toronto, Toronto, ON, Canada.
| | - Rodrigo B. Mansur
- Mood Disorders Psychopharmacology Unit, University Health Network, 399 Bathurst Street, MP 9-325, Toronto, ON, M5T 2S8, Canada,Department of Psychiatry, University of Toronto, Toronto, ON, M5S 1A8, Canada
| | - Elisa Brietzke
- Department of Psychiatry, Queen’s University School of Medicine; Centre for Neuroscience Studies, Queen’s University, Kingston, ON, K7L 3N6, Canada
| | - Dimitrios Kapogiannis
- Laboratory of Clinical Investigation, Intramural Research Program, National Institute on Aging, National Institutes of Health (NIA/NIH), Baltimore, MD, 20814, USA
| | - Francheska Delgado-Peraza
- Laboratory of Clinical Investigation, Intramural Research Program, National Institute on Aging, National Institutes of Health (NIA/NIH), Baltimore, MD, 20814, USA
| | - Justin J. Boutilier
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, 53706, USA
| | - Timothy C.Y. Chan
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, ON, M5S 3G8, Canada
| | - Nicole E. Carmona
- Department of Psychology, Ryerson University, Toronto, ON, M5B 2K3, Canada
| | - Joshua D. Rosenblat
- Mood Disorders Psychopharmacology Unit, University Health Network, 399 Bathurst Street, MP 9-325, Toronto, ON, M5T 2S8, Canada,Department of Psychiatry, University of Toronto, Toronto, ON, M5S 1A8, Canada
| | - JungGoo Lee
- Department of Psychiatry, College of Medicine, Haeundae Paik Hospital; Paik Institute for Clinical Research; Department of Health Science and Technology, Graduate School, Inje University, Busan, 47392, Republic of Korea
| | - Vladimir Maletic
- Department of Neuropsychiatry and Behavioral Sciences, University of South Carolina School of Medicine, Greer, SC, 29203, USA
| | - Maj Vinberg
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Psychiatric Research Unit, Psychiatric Centre North Zealand, Dyrehavevej 48, 3400 Hillerød, Denmark
| | - Trisha Suppes
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, 94305, USA,VA Palo Alto Health Care System, 3801 Miranda Ave. (151T), Palo Alto, CA, 94304, USA
| | - Benjamin I. Goldstein
- Institute of Medical Science, University of Toronto, Toronto, ON, M5S 1A8, Canada,Department of Psychiatry, University of Toronto, Toronto, ON, M5S 1A8, Canada,Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, ON, M5T 1R7, Canada,Department of Pharmacology, University of Toronto, Toronto, ON, M5S 1A8, Canada
| | - Arun V. Ravindran
- Institute of Medical Science, University of Toronto, Toronto, ON, M5S 1A8, Canada,Department of Psychiatry, University of Toronto, Toronto, ON, M5S 1A8, Canada
| | - Valerie H. Taylor
- Institute of Medical Science, University of Toronto, Toronto, ON, M5S 1A8, Canada,Department of Psychiatry, University of Toronto, Toronto, ON, M5S 1A8, Canada,Department of Psychiatry, Foothills Medical Centre, University of Calgary, AB, T2N 2T9, Canada
| | - Sahil Chawla
- Laboratory of Clinical Investigation, Intramural Research Program, National Institute on Aging, National Institutes of Health (NIA/NIH), Baltimore, MD, 20814, USA
| | - Carlos Nogueras-Ortiz
- Laboratory of Clinical Investigation, Intramural Research Program, National Institute on Aging, National Institutes of Health (NIA/NIH), Baltimore, MD, 20814, USA
| | - Victoria E. Cosgrove
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Nicole E. Kramer
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Roger Ho
- Department of Psychological Medicine, National University of Singapore, Singapore, 119228, Singapore
| | - Charles A. Raison
- School of Human Ecology, University of Wisconsin-Madison, Madison, WI, 53706, USA
| | - Roger S. McIntyre
- Mood Disorders Psychopharmacology Unit, University Health Network, 399 Bathurst Street, MP 9-325, Toronto, ON, M5T 2S8, Canada,Institute of Medical Science, University of Toronto, Toronto, ON, M5S 1A8, Canada,Department of Psychiatry, University of Toronto, Toronto, ON, M5S 1A8, Canada,Department of Pharmacology, University of Toronto, Toronto, ON, M5S 1A8, Canada,Brain and Cognition Discovery Foundation, Toronto, ON, L5C 4E7, Canada
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21
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Shi L, Que JY, Lu ZA, Gong YM, Liu L, Wang YH, Ran MS, Ravindran N, Ravindran AV, Fazel S, Bao YP, Shi J, Lu L. Prevalence and correlates of suicidal ideation among the general population in China during the COVID-19 pandemic. Eur Psychiatry 2021; 64:e18. [PMID: 33686933 PMCID: PMC7943957 DOI: 10.1192/j.eurpsy.2021.5] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic is a major threat to the public. However, the comprehensive profile of suicidal ideation among the general population has not been systematically investigated in a large sample in the age of COVID-19. METHODS A national online cross-sectional survey was conducted between February 28, 2020 and March 11, 2020 in a representative sample of Chinese adults aged 18 years and older. Suicidal ideation was assessed using item 9 of the Patient Health Questionnaire-9. The prevalence of suicidal ideation and its risk factors was evaluated. RESULTS A total of 56,679 participants (27,149 males and 29,530 females) were included. The overall prevalence of suicidal ideation was 16.4%, including 10.9% seldom, 4.1% often, and 1.4% always suicidal ideation. The prevalence of suicidal ideation was higher in males (19.1%) and individuals aged 18-24 years (24.7%) than in females (14.0%) and those aged 45 years and older (11.9%). Suicidal ideation was more prevalent in individuals with suspected or confirmed infection (63.0%), frontline workers (19.2%), and people with pre-existing mental disorders (41.6%). Experience of quarantine, unemployed, and increased psychological stress during the pandemic were associated with an increased risk of suicidal ideation and its severity. However, paying more attention to and gaining a better understanding of COVID-19-related knowledge, especially information about psychological interventions, could reduce the risk. CONCLUSIONS The estimated prevalence of suicidal ideation among the general population in China during COVID-19 was significant. The findings will be important for improving suicide prevention strategies during COVID-19.
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Affiliation(s)
- Le Shi
- 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), Peking University, Beijing, China
| | - Jian-Yu Que
- 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), Peking University, Beijing, China
| | - Zheng-An Lu
- 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), Peking University, Beijing, China
| | - Yi-Miao Gong
- Peking-Tsinghua Center for Life Sciences and PKU-IDG/McGovern Institute for Brain Research, Peking University, Beijing, China
| | - Lin Liu
- National Institute on Drug Dependence and Beijing Key Laboratory on Drug Dependence Research, Peking University, Beijing, China
| | - Yun-He Wang
- National Institute on Drug Dependence and Beijing Key Laboratory on Drug Dependence Research, Peking University, Beijing, China
| | - Mao-Sheng Ran
- Department of Social Work and Social Administration, University of Hong Kong, Hong Kong, China
| | - Nisha Ravindran
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Arun V Ravindran
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Seena Fazel
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Yan-Ping Bao
- National Institute on Drug Dependence and Beijing Key Laboratory on Drug Dependence Research, Peking University, Beijing, China
| | - Jie Shi
- National Institute on Drug Dependence and Beijing Key Laboratory on Drug Dependence Research, Peking University, Beijing, China
| | - Lin Lu
- 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), Peking University, Beijing, China.,Peking-Tsinghua Center for Life Sciences and PKU-IDG/McGovern Institute for Brain Research, Peking University, Beijing, China.,National Institute on Drug Dependence and Beijing Key Laboratory on Drug Dependence Research, Peking University, Beijing, China
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22
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Xue S, Husain MI, Zhao H, Ravindran AV. Cannabis Use and Prospective Long-Term Association with Anxiety: A Systematic Review and Meta-Analysis of Longitudinal Studies: Usage du cannabis et association prospective à long terme avec l'anxiété: une revue systématique et une méta-analyse d'études longitudinales. Can J Psychiatry 2021; 66:126-138. [PMID: 32909828 PMCID: PMC7918873 DOI: 10.1177/0706743720952251] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Cannabis use is proposed as a risk factor for psychosis and is associated with depressive disorders. However, the relationship between recreational cannabis use and its longitudinal implications on anxiety conditions is less studied. The aim of this investigation is to systematically evaluate published literature and perform a meta-analysis of the data. METHODS A systematic search was performed of MEDLINE, Embase, and PsychINFO from inception to May 31, 2020, in addition to a hand search. Longitudinal studies that evaluated the relationship of cannabis use and development of anxiety were included. Where applicable, adjusted odds ratios (ORs) were extracted, pooled, and evaluated using random-effects meta-analysis. RESULTS After screening of unique abstracts (n = 6835), the final evaluation included 24 studies, of which 10 reported ORs that were analyzed quantitatively. Cannabis use was significantly associated with increased odds of developing any anxiety conditions (OR = 1.25; 95% CI, 1.01 to 1.54). Cannabis use was not significantly associated with developing generalized anxiety disorder, panic disorder, or social anxiety disorder. Review of studies not reporting OR revealed mixed results but are suggestive of a link between cannabis use and increased rates/severity of anxiety. CONCLUSIONS Published evidence suggests that cannabis use is likely associated with increased risk of anxiety in the long term but variability of study designs precludes declaration of a causal relationship. Awareness of this association is of relevance for both clinical practice and mental health policy implementation.
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Affiliation(s)
- Siqi Xue
- Department of Psychiatry, 7938University of Toronto, Ontario, Canada
| | - M Ishrat Husain
- Department of Psychiatry, 7938University of Toronto, Ontario, Canada.,7978Centre for Addictions and Mental Health (CAMH), Toronto, Ontario, Canada
| | - Haoyu Zhao
- 7978Centre for Addictions and Mental Health (CAMH), Toronto, Ontario, Canada
| | - Arun V Ravindran
- Department of Psychiatry, 7938University of Toronto, Ontario, Canada.,7978Centre for Addictions and Mental Health (CAMH), Toronto, Ontario, Canada
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23
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Swainson J, McGirr A, Blier P, Brietzke E, Richard-Devantoy S, Ravindran N, Blier J, Beaulieu S, Frey BN, Kennedy SH, McIntyre RS, Milev RV, Parikh SV, Schaffer A, Taylor VH, Tourjman V, van Ameringen M, Yatham LN, Ravindran AV, Lam RW. The Canadian Network for Mood and Anxiety Treatments (CANMAT) Task Force Recommendations for the Use of Racemic Ketamine in Adults with Major Depressive Disorder: Recommandations Du Groupe De Travail Du Réseau Canadien Pour Les Traitements De L'humeur Et De L'anxiété (Canmat) Concernant L'utilisation De La Kétamine Racémique Chez Les Adultes Souffrant De Trouble Dépressif Majeur. Can J Psychiatry 2021; 66:113-125. [PMID: 33174760 PMCID: PMC7918868 DOI: 10.1177/0706743720970860] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Patients with major depressive disorder often have limited response to first-line and second-line medications; hence, novel pharmacological treatments are needed for treatment-resistant depression (TRD). Ketamine, an N-methyl-d-aspartate (NMDA) receptor antagonist, has demonstrated rapid antidepressant effects in patients with TRD. The Canadian Network for Mood and Anxiety Treatments (CANMAT) convened a task force to review the evidence for efficacy and safety of racemic ketamine and to provide recommendations for its use in clinical practice. METHODS A systematic review was conducted with computerized search of electronic databases up to January 31, 2020 using combinations of search terms, inspection of bibliographies, and review of other ketamine guidelines and consensus statements. The level of evidence and lines of treatment were assigned according to CANMAT criteria. Recommendations were given in question-answer format. RESULTS Intravenous (IV) racemic ketamine given as a single infusion has Level 1 evidence for efficacy in adults with TRD. The evidence for multiple infusions, given as an acute series or as ongoing maintenance treatment, is limited to Level 3. Adverse events associated with ketamine infusions include behavioral (e.g., dissociative symptoms) and physiological (e.g., hypertension) events. There is only Level 3 or 4 evidence for non-IV formulations of racemic ketamine. Consensus recommendations are given for clinical administration of IV ketamine including patient selection, facility and personnel issues, monitoring, and maintaining response. CONCLUSIONS Single-dose IV racemic ketamine is a third-line recommendation for adults with TRD. The need for repeated and maintenance ketamine infusions should be carefully assessed on a case-by-case basis with consideration of potential risks and benefits. Because of limited evidence for efficacy and risk for misuse and diversion, the use of oral and other formulations of racemic ketamine should be limited to specialists with ketamine-prescribing expertise and affiliations with tertiary or specialized centers.
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Affiliation(s)
- Jennifer Swainson
- Department of Psychiatry, 12357University of Alberta, Edmonton, Alberta, Canada
| | - Alexander McGirr
- Department of Psychiatry, 70401University of Calgary, Alberta, Canada
| | - Pierre Blier
- Department of Psychiatry, 12365University of Ottawa, Ontario, Canada
| | - Elisa Brietzke
- Department of Psychiatry, 104820Queen's University, Kingston, Ontario, Canada
| | | | - Nisha Ravindran
- Department of Psychiatry, 12366University of Toronto, Ontario, Canada
| | - Jean Blier
- Department of Anesthesiology and Pain Medicine, 12365University of Ottawa, Ontario, Canada
| | - Serge Beaulieu
- Department of Psychiatry, 12367McGill University, Montreal, Quebec, Canada
| | - Benicio N Frey
- Department of Psychiatry and Behavioural Neurosciences, 62703McMaster University, Hamilton, Ontario, Canada
| | - Sidney H Kennedy
- Department of Psychiatry, 12366University of Toronto, Ontario, Canada
| | - Roger S McIntyre
- Department of Psychiatry, 12366University of Toronto, Ontario, Canada
| | - Roumen V Milev
- Department of Psychiatry, 104820Queen's University, Kingston, Ontario, Canada
| | - Sagar V Parikh
- Department of Psychiatry, 12266University of Michigan, Ann Arbor, Michigan, USA
| | - Ayal Schaffer
- Department of Psychiatry, 12366University of Toronto, Ontario, Canada
| | - Valerie H Taylor
- Department of Psychiatry, 70401University of Calgary, Alberta, Canada
| | - Valérie Tourjman
- Department of Psychiatry, 12368Université de Montréal, Québec, Canada
| | - Michael van Ameringen
- Department of Psychiatry and Behavioural Neurosciences, 62703McMaster University, Hamilton, Ontario, Canada
| | - Lakshmi N Yatham
- Department of Psychiatry, 8166University of British Columbia, Vancouver, British Columbia, Canada
| | - Arun V Ravindran
- Department of Psychiatry, 12366University of Toronto, Ontario, Canada
| | - Raymond W Lam
- Department of Psychiatry, 8166University of British Columbia, Vancouver, British Columbia, Canada
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24
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Ravindran AV, McKay MS, Silva TD, Tindall C, Garfinkel T, Paric A, Ravindran L. Breathing-focused Yoga as Augmentation for Unipolar and Bipolar Depression: A Randomized Controlled Trial: Le yoga axé sur la respiration comme traitement d'appoint pour la dépression unipolaire et bipolaire: Un essai randomisé contrôlé. Can J Psychiatry 2021; 66:159-169. [PMID: 32677851 PMCID: PMC7918867 DOI: 10.1177/0706743720940535] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Patients with depression frequently experience persistent residual symptoms even with optimal interventions. These patients often use complementary treatments, including yoga, as a preferred alternative or adjunctive treatment. There is evidence for the benefit of yoga for depression, but this has not been rigorously evaluated, particularly in bipolar depression. We aimed to determine the feasibility and benefit of manualized breathing-focused yoga in comparison to psychoeducation as augmentation to pharmacotherapy for improving residual symptoms of depression in unipolar and bipolar patients. METHODS Using a randomized single-blind crossover design, 72 outpatients with unipolar or bipolar depression were augmented with the two 8-week interventions at separate times, as add-ons to current first-line antidepressants and mood stabilizers. The primary outcome measure was the Montgomery-Åsberg Depression Rating Scale (MADRS). Due to the high dropout of participants after crossover at Week 8, analysis focused on between-group comparisons of yoga and psychoeducation during the initial 8 weeks of the study. RESULTS There was a significant decline in depressive symptoms, as measured by the MADRS, following 8 weeks of yoga. However, there was no significant difference in MADRS ratings between intervention groups. Similar improvements in self-rated depressive symptoms and well-being were also observed across time. CONCLUSIONS Both yoga and psychoeducation may improve residual symptoms of unipolar and bipolar depression as add-on to medications. In-class group sessions and long study durations may reduce feasibility for this population. Larger trials with parallel group design and shorter duration may be more feasible.
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Affiliation(s)
- Arun V Ravindran
- 7978Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Ontario, Canada
| | - Martha S McKay
- 7978Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Ontario, Canada
| | - Tricia da Silva
- Institute of Medical Science, University of Toronto, Ontario, Canada
| | - Claudia Tindall
- 7978Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | | | - Angela Paric
- 7978Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Lakshmi Ravindran
- 7978Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Ontario, Canada
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25
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Yue JL, Yan W, Sun YK, Yuan K, Su SZ, Han Y, Ravindran AV, Kosten T, Everall I, Davey CG, Bullmore E, Kawakami N, Barbui C, Thornicroft G, Lund C, Lin X, Liu L, Shi L, Shi J, Ran MS, Bao YP, Lu L. Mental health services for infectious disease outbreaks including COVID-19: a rapid systematic review. Psychol Med 2020; 50:2498-2513. [PMID: 33148347 PMCID: PMC7642960 DOI: 10.1017/s0033291720003888] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 09/05/2020] [Accepted: 09/28/2020] [Indexed: 12/27/2022]
Abstract
The upsurge in the number of people affected by the COVID-19 is likely to lead to increased rates of emotional trauma and mental illnesses. This article systematically reviewed the available data on the benefits of interventions to reduce adverse mental health sequelae of infectious disease outbreaks, and to offer guidance for mental health service responses to infectious disease pandemic. PubMed, Web of Science, Embase, PsycINFO, WHO Global Research Database on infectious disease, and the preprint server medRxiv were searched. Of 4278 reports identified, 32 were included in this review. Most articles of psychological interventions were implemented to address the impact of COVID-19 pandemic, followed by Ebola, SARS, and MERS for multiple vulnerable populations. Increasing mental health literacy of the public is vital to prevent the mental health crisis under the COVID-19 pandemic. Group-based cognitive behavioral therapy, psychological first aid, community-based psychosocial arts program, and other culturally adapted interventions were reported as being effective against the mental health impacts of COVID-19, Ebola, and SARS. Culturally-adapted, cost-effective, and accessible strategies integrated into the public health emergency response and established medical systems at the local and national levels are likely to be an effective option to enhance mental health response capacity for the current and for future infectious disease outbreaks. Tele-mental healthcare services were key central components of stepped care for both infectious disease outbreak management and routine support; however, the usefulness and limitations of remote health delivery should also be recognized.
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Affiliation(s)
- Jing-Li Yue
- 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
| | - Wei Yan
- 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
| | - Yan-Kun Sun
- 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
| | - Kai Yuan
- 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
| | - Si-Zhen Su
- 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
| | - Ying Han
- National Institute on Drug Dependence, Peking University, Beijing, China
| | | | - Thomas Kosten
- Division of Alcohol and Addiction Psychiatry, Baylor College of Medicine, Houston, Texas, USA
| | - Ian Everall
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Christopher G Davey
- Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia
| | - Edward Bullmore
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Department of Research and Development, Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Norito Kawakami
- Department of Mental Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Corrado Barbui
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
- Cochrane Global Mental Health, University of Verona, Verona, Italy
| | - Graham Thornicroft
- Centre for Global Mental Health and Centre for Implementation Science, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Crick Lund
- Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Xiao Lin
- Peking-Tsinghua Centre for Life Sciences and PKU-IDG/McGovern Institute for Brain Research, Peking University, Beijing, China
| | - Lin Liu
- 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
| | - Le Shi
- 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
| | - Jie Shi
- National Institute on Drug Dependence, Peking University, Beijing, China
| | - Mao-Sheng Ran
- Department of Social Work and Social Administration, University of Hong Kong, Hong Kong, China
| | - Yan-Ping Bao
- National Institute on Drug Dependence, Peking University, Beijing, China
| | - Lin Lu
- 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
- Peking-Tsinghua Centre for Life Sciences and PKU-IDG/McGovern Institute for Brain Research, Peking University, Beijing, China
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26
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Lee Y, Brietzke E, Cao B, Chen Y, Linnaranta O, Mansur RB, Cortes P, Kösters M, Majeed A, Tamura JK, Lui LMW, Vinberg M, Keinänen J, Kisely S, Naveed S, Barbui C, Parker G, Owolabi M, Nishi D, Lee J, Srisurapanont M, Gill H, Guo L, Balanzá-Martínez V, Partonen T, Nolen WA, Lee JH, Kim JH, Chavannes NH, Ewais T, Atienza-Carbonell B, Silven AV, Yasuma N, Gil A, Novikov A, Lacey C, Versluis A, von Malortie S, Chan LF, Waqas A, Purgato M, Aardoom JJ, Ly-Uson JT, Sim K, Tuineag M, van der Kleij RMJJ, van Luenen S, Suttajit S, Hajek T, Lee YW, Porter RJ, Alsuwaidan M, Rosenblat JD, Ravindran AV, Lam RW, McIntyre RS. Development and implementation of guidelines for the management of depression: a systematic review. Bull World Health Organ 2020; 98:683-697H. [PMID: 33177758 PMCID: PMC7652558 DOI: 10.2471/blt.20.251405] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 07/09/2020] [Accepted: 07/10/2020] [Indexed: 12/12/2022] Open
Abstract
Objective To evaluate the development and implementation of clinical practice guidelines for the management of depression globally. Methods We conducted a systematic review of existing guidelines for the management of depression in adults with major depressive or bipolar disorder. For each identified guideline, we assessed compliance with measures of guideline development quality (such as transparency in guideline development processes and funding, multidisciplinary author group composition, systematic review of comparative efficacy research) and implementation (such as quality indicators). We compared guidelines from low- and middle-income countries with those from high-income countries. Findings We identified 82 national and 13 international clinical practice guidelines from 83 countries in 27 languages. Guideline development processes and funding sources were explicitly specified in a smaller proportion of guidelines from low- and middle-income countries (8/29; 28%) relative to high-income countries (35/58; 60%). Fewer guidelines (2/29; 7%) from low- and middle-income countries, relative to high-income countries (22/58; 38%), were authored by a multidisciplinary development group. A systematic review of comparative effectiveness was conducted in 31% (9/29) of low- and middle-income country guidelines versus 71% (41/58) of high-income country guidelines. Only 10% (3/29) of low- and middle-income country and 19% (11/58) of high-income country guidelines described plans to assess quality indicators or recommendation adherence. Conclusion Globally, guideline implementation is inadequately planned, reported and measured. Narrowing disparities in the development and implementation of guidelines in low- and middle-income countries is a priority. Future guidelines should present strategies to implement recommendations and measure feasibility, cost–effectiveness and impact on health outcomes.
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Affiliation(s)
- Yena Lee
- Mood Disorders Psychopharmacology Unit, Toronto Western Hospital, University Health Network, 399 Bathurst St 9MP-325, Toronto, Ontario, Canada
| | - Elisa Brietzke
- Department of Psychiatry, Queen's University School of Medicine, Kingston, Canada
| | - Bing Cao
- School of Psychology and Key Laboratory of Cognition and Personality, Southwest University, Chongqing, China
| | - Yan Chen
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Outi Linnaranta
- Bipolar Disorders Clinic, Douglas Mental Health University Institute, Montréal, Canada
| | - Rodrigo B Mansur
- Mood Disorders Psychopharmacology Unit, Toronto Western Hospital, University Health Network, 399 Bathurst St 9MP-325, Toronto, Ontario, Canada
| | - Paulina Cortes
- Pontificia Universidad Católica de Chile, Santiago, Región Metropolitana, Chile
| | - Markus Kösters
- Department of Psychiatry II, Ulm University, Ulm, Germany
| | - Amna Majeed
- Mood Disorders Psychopharmacology Unit, Toronto Western Hospital, University Health Network, 399 Bathurst St 9MP-325, Toronto, Ontario, Canada
| | - Jocelyn K Tamura
- Mood Disorders Psychopharmacology Unit, Toronto Western Hospital, University Health Network, 399 Bathurst St 9MP-325, Toronto, Ontario, Canada
| | - Leanna M W Lui
- Mood Disorders Psychopharmacology Unit, Toronto Western Hospital, University Health Network, 399 Bathurst St 9MP-325, Toronto, Ontario, Canada
| | - Maj Vinberg
- Psychiatric Research Unit, Psychiatric Centre North Zealand, Hilleroed, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Jaakko Keinänen
- Department of Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland
| | - Steve Kisely
- School of Clinical Medicine, The University of Queensland, Brisbane, Australia
| | - Sadiq Naveed
- Department of Psychiatry and Behavioral Sciences, University of Kansas Medical Center, Kansas, USA
| | - Corrado Barbui
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Biomedicine and Movement Sciences, Verona, Italy
| | - Gary Parker
- Global Alliance for Chronic Diseases, Wellcome Trust, London, England
| | - Mayowa Owolabi
- Center for Genomics and Precision Medicine, University of Ibadan, Ibadan, Nigeria
| | - Daisuke Nishi
- Department of Mental Health, The University of Tokyo, Tokyo, Japan
| | - JungGoo Lee
- Paik Institute for Clinical Research, Inje University, Busan, Republic of Korea
| | | | - Hartej Gill
- Mood Disorders Psychopharmacology Unit, Toronto Western Hospital, University Health Network, 399 Bathurst St 9MP-325, Toronto, Ontario, Canada
| | - Lan Guo
- School of Public Health, Sun Yat-sen University, Guangdong, China
| | - Vicent Balanzá-Martínez
- Teaching Unit of Psychiatry and Psychological Medicine, University of Valencia, Valencia, CIBERSAM, Spain
| | - Timo Partonen
- Department of Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland
| | - Willem A Nolen
- Department of Psychiatry, University of Groningen, Groningen, Netherlands
| | - Jae-Hon Lee
- Department of Psychiatry, Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Ji Hwan Kim
- Paik Institute for Clinical Research, Inje University, Busan, Republic of Korea
| | - Niels H Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
| | - Tatjana Ewais
- School of Clinical Medicine, The University of Queensland, Brisbane, Australia
| | | | - Anna V Silven
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
| | - Naonori Yasuma
- Department of Mental Health, The University of Tokyo, Tokyo, Japan
| | - Artyom Gil
- WHO European Office for the Prevention and Control of Noncommunicable Diseases, Division of Country Health Programme, Moscow, Russian Federation
| | - Andrey Novikov
- Psychiatric and Neurological Hospital, Surgut, Russian Federation
| | - Cameron Lacey
- Maori Indigenous Health Institute, University of Otago, Christchurch, New Zealand
| | - Anke Versluis
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
| | | | - Lai Fong Chan
- Mood Disorders Psychopharmacology Unit, Toronto Western Hospital, University Health Network, 399 Bathurst St 9MP-325, Toronto, Ontario, Canada.,Department of Psychiatry, Queen's University School of Medicine, Kingston, Canada
| | - Ahmed Waqas
- Mood Disorders Psychopharmacology Unit, Toronto Western Hospital, University Health Network, 399 Bathurst St 9MP-325, Toronto, Ontario, Canada.,School of Psychology and Key Laboratory of Cognition and Personality, Southwest University, Chongqing, China
| | - Marianna Purgato
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Biomedicine and Movement Sciences, Verona, Italy
| | - Jiska Joëlle Aardoom
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
| | - Josefina T Ly-Uson
- Mood Disorders Psychopharmacology Unit, Toronto Western Hospital, University Health Network, 399 Bathurst St 9MP-325, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Kang Sim
- Mood Disorders Psychopharmacology Unit, Toronto Western Hospital, University Health Network, 399 Bathurst St 9MP-325, Toronto, Ontario, Canada.,Bipolar Disorders Clinic, Douglas Mental Health University Institute, Montréal, Canada
| | - Maria Tuineag
- Mood Disorders Psychopharmacology Unit, Toronto Western Hospital, University Health Network, 399 Bathurst St 9MP-325, Toronto, Ontario, Canada.,Pontificia Universidad Católica de Chile, Santiago, Región Metropolitana, Chile
| | | | - Sanne van Luenen
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
| | - Sirijit Suttajit
- Department of Psychiatry, Chiang Mai University, Chiang Mai, Thailand
| | - Tomas Hajek
- Mood Disorders Psychopharmacology Unit, Toronto Western Hospital, University Health Network, 399 Bathurst St 9MP-325, Toronto, Ontario, Canada.,Department of Psychiatry II, Ulm University, Ulm, Germany
| | - Yu Wei Lee
- Mood Disorders Psychopharmacology Unit, Toronto Western Hospital, University Health Network, 399 Bathurst St 9MP-325, Toronto, Ontario, Canada.,Bipolar Disorders Clinic, Douglas Mental Health University Institute, Montréal, Canada
| | - Richard J Porter
- Mood Disorders Psychopharmacology Unit, Toronto Western Hospital, University Health Network, 399 Bathurst St 9MP-325, Toronto, Ontario, Canada.,Psychiatric Research Unit, Psychiatric Centre North Zealand, Hilleroed, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Mohammad Alsuwaidan
- Mood Disorders Psychopharmacology Unit, Toronto Western Hospital, University Health Network, 399 Bathurst St 9MP-325, Toronto, Ontario, Canada.,Department of Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland
| | - Joshua D Rosenblat
- Mood Disorders Psychopharmacology Unit, Toronto Western Hospital, University Health Network, 399 Bathurst St 9MP-325, Toronto, Ontario, Canada.,School of Clinical Medicine, The University of Queensland, Brisbane, Australia
| | - Arun V Ravindran
- Mood Disorders Psychopharmacology Unit, Toronto Western Hospital, University Health Network, 399 Bathurst St 9MP-325, Toronto, Ontario, Canada.,School of Clinical Medicine, The University of Queensland, Brisbane, Australia
| | - Raymond W Lam
- Mood Disorders Psychopharmacology Unit, Toronto Western Hospital, University Health Network, 399 Bathurst St 9MP-325, Toronto, Ontario, Canada.,Department of Psychiatry and Behavioral Sciences, University of Kansas Medical Center, Kansas, USA
| | - Roger S McIntyre
- Mood Disorders Psychopharmacology Unit, Toronto Western Hospital, University Health Network, 399 Bathurst St 9MP-325, Toronto, Ontario, Canada
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27
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Zhou X, Teng T, Zhang Y, Del Giovane C, Furukawa TA, Weisz JR, Li X, Cuijpers P, Coghill D, Xiang Y, Hetrick SE, Leucht S, Qin M, Barth J, Ravindran AV, Yang L, Curry J, Fan L, Silva SG, Cipriani A, Xie P. Comparative efficacy and acceptability of antidepressants, psychotherapies, and their combination for acute treatment of children and adolescents with depressive disorder: a systematic review and network meta-analysis. Lancet Psychiatry 2020; 7:581-601. [PMID: 32563306 PMCID: PMC7303954 DOI: 10.1016/s2215-0366(20)30137-1] [Citation(s) in RCA: 149] [Impact Index Per Article: 37.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 03/24/2020] [Accepted: 03/24/2020] [Indexed: 01/28/2023]
Abstract
BACKGROUND Depressive disorders are common in children and adolescents. Antidepressants, psychotherapies, and their combination are often used in routine clinical practice; however, available evidence on the comparative efficacy and safety of these interventions is inconclusive. Therefore, we sought to compare and rank all available treatment interventions for the acute treatment of depressive disorders in children and adolescents. METHODS We did a systematic review and network meta-analysis. We searched PubMed, Embase, the Cochrane Central Register of Controlled Trials, Web of Science, PsycINFO, ProQuest, CINAHL, LiLACS, international trial registries, and the websites of regulatory agencies for published and unpublished randomised controlled trials from database inception until Jan 1, 2019. We included placebo-controlled and head-to-head trials of 16 antidepressants, seven psychotherapies, and five combinations of antidepressant and psychotherapy that are used for the acute treatment of children and adolescents (≤18 years old and of both sexes) with depressive disorder diagnosed according to standard operationalised criteria. Trials recruiting participants with treatment-resistant depression, bipolar disorder, psychotic depression, treatment duration of less than 4 weeks, or an overall sample size of fewer than ten patients were excluded. We extracted data following a predefined hierarchy of outcome measures, and assessed risk of bias and certainty of evidence using validated methods. Primary outcomes were efficacy (change in depressive symptoms) and acceptability (treatment discontinuation due to any cause). We estimated summary standardised mean differences (SMDs) or odds ratios (ORs) with credible intervals (CrIs) using network meta-analysis with random effects. This study was registered with PROSPERO, number CRD42015020841. FINDINGS From 20 366 publications, we included 71 trials (9510 participants). Depressive disorders in most studies were moderate to severe. In terms of efficacy, fluoxetine plus cognitive behavioural therapy (CBT) was more effective than CBT alone (-0·78, 95% CrI -1·55 to -0·01) and psychodynamic therapy (-1·14, -2·20 to -0·08), but not more effective than fluoxetine alone (-0·22, -0·86 to 0·42). No pharmacotherapy alone was more effective than psychotherapy alone. Only fluoxetine plus CBT and fluoxetine were significantly more effective than pill placebo or psychological controls (SMDs ranged from -1·73 to -0·51); and only interpersonal therapy was more effective than all psychological controls (-1·37 to -0·66). Nortriptyline (SMDs ranged from 1·04 to 2·22) and waiting list (SMDs ranged from 0·67 to 2·08) were less effective than most active interventions. In terms of acceptability, nefazodone and fluoxetine were associated with fewer dropouts than sertraline, imipramine, and desipramine (ORs ranged from 0·17 to 0·50); imipramine was associated with more dropouts than pill placebo, desvenlafaxine, fluoxetine plus CBT, and vilazodone (2·51 to 5·06). Most of the results were rated as "low" to "very low" in terms of confidence of evidence according to Confidence In Network Meta-Analysis. INTERPRETATION Despite the scarcity of high-quality evidence, fluoxetine (alone or in combination with CBT) seems to be the best choice for the acute treatment of moderate-to-severe depressive disorder in children and adolescents. However, the effects of these interventions might vary between individuals, so patients, carers, and clinicians should carefully balance the risk-benefit profile of efficacy, acceptability, and suicide risk of all active interventions in young patients with depression on a case-by-case basis. FUNDING National Key Research and Development Program of China.
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Affiliation(s)
- Xinyu Zhou
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Teng Teng
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yuqing Zhang
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | | | - Toshi A Furukawa
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine and School of Public Health, Kyoto, Japan
| | - John R Weisz
- Department of Psychology, Harvard University, Cambridge, MA, USA
| | - Xuemei Li
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - David Coghill
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - Yajie Xiang
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Sarah E Hetrick
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | - Stefan Leucht
- Department of Psychiatry and Psychotherapy, School of Medicine, Technische Universität München, Munich, Germany
| | - Mengchang Qin
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jürgen Barth
- Institute for Complementary and Integrative Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Arun V Ravindran
- Department of Psychiatry, University of Toronto and Division of Mood and Anxiety Disorders, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Lining Yang
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - John Curry
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Li Fan
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | | | - Andrea Cipriani
- Department of Psychiatry, University of Oxford, Oxford, UK; Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Peng Xie
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
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28
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Uher R, Frey BN, Quilty LC, Rotzinger S, Blier P, Foster JA, Müller DJ, Ravindran AV, Soares CN, Turecki G, Parikh SV, Milev R, MacQueen G, Lam RW, Kennedy SH. Symptom Dimension of Interest-Activity Indicates Need for Aripiprazole Augmentation of Escitalopram in Major Depressive Disorder: A CAN-BIND-1 Report. J Clin Psychiatry 2020; 81. [PMID: 32558407 DOI: 10.4088/jcp.20m13229] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Accepted: 04/27/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Differential predictors of response to alternative treatment options are needed to improve the outcomes in major depressive disorder. The symptom dimension comprising loss of interest and reduced activity has been reported as a predictor of poor outcome of treatment with antidepressants. We hypothesized that augmentation with partial dopamine agonist aripiprazole will be effective for individuals with pronounced interest-activity symptoms. METHODS We tested the hypothesis in the 2-phase Canadian Biomarker Integration Network in Depression trial 1 (CAN-BIND-1). All participants had a primary diagnosis of major depressive disorder confirmed with the Mini-International Neuropsychiatric Interview. In phase 1, 188 individuals received escitalopram monotherapy 10-20 mg daily for 8 weeks. In phase 2, nonresponders received augmentation with aripiprazole 2-10 mg daily while responders continued escitalopram monotherapy for another 8 weeks. Outcomes were measured with the Montgomery-Åsberg Depression Rating Scale (MADRS) every 2 weeks. Effects of baseline interest-activity symptoms on outcomes were tested in repeated-measures mixed-effects models. RESULTS Higher baseline interest-activity score (indicative of more severe loss of interest and reduction in activity) predicted worse outcome of escitalopram monotherapy in phase 1 (b = 1.75; 95% CI, 0.45 to 3.05; P = .009), but the association disappeared with the augmentation option in phase 2 (b = -0.19; 95% CI, -1.30 to 0.92; P = .739). A significant interaction between the baseline interest-activity score and aripiprazole reflected the opposite direction of the relationship between baseline interest-activity score and degree of improvement with escitalopram monotherapy versus aripiprazole augmentation (b = -1.60; 95% CI, -2.35 to -0.84; P < .001). CONCLUSIONS Individuals with prominent loss of interest and reduction in activity benefit less from escitalopram monotherapy and more from aripiprazole augmentation. Future trials may test the benefits of early prodopaminergic augmentation guided by interest-activity symptoms. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01655706.
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Affiliation(s)
- Rudolf Uher
- Dalhousie University, 5909 Veterans Memorial Lane, Halifax, NS, B3H 2E2, NS, Canada. .,Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada.,Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Benicio N Frey
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada.,St Joseph's Healthcare, Hamilton, Ontario, Canada
| | - Lena C Quilty
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Susan Rotzinger
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Pierre Blier
- Royal's Institute of Mental Health Research, University of Ottawa, Ottawa, Ontario, Canada
| | - Jane A Foster
- Department of Psychiatry & Behavioural Neurosciences, St Joseph's Healthcare, Hamilton, Ontario, Canada
| | - Daniel J Müller
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Arun V Ravindran
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Claudio N Soares
- Departments of Psychiatry and Psychology, Queen's University, Providence Care Hospital, Kingston, Ontario, Canada
| | - Gustavo Turecki
- Douglas Institute, Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Sagar V Parikh
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Roumen Milev
- Departments of Psychiatry and Psychology, Queen's University, Providence Care Hospital, Kingston, Ontario, Canada
| | - Glenda MacQueen
- University of Calgary, Hotchkiss Brain Institute, Calgary, Alberta, Canada
| | - Raymond W Lam
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sidney H Kennedy
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, University Health Network, Toronto, Ontario, Canada.,Krembil Research Centre, University Health Network, University of Toronto, Canada
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- Members of the CAN-BIND Investigator Team are listed at www.canbind.ca/about-can-bind/our-team/
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29
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Gajaria A, Ravindran AV, Castrillo ME, Herrera Rodríguez A, Zaheer J. Mental health of transitional aged youth in Nicaragua: Perceptions and experiences of educators. Glob Public Health 2019; 15:151-160. [PMID: 31392925 DOI: 10.1080/17441692.2019.1648535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Mental illnesses contribute to a large proportion of the disease burden in children and adolescents in low and middle-income countries (LMICs). There is limited research completed in LMICs about paediatric mental health, particularly related to youth. School is a place where many adolescents first seek mental health support. This study examined how educators in Nicaragua view youth mental health and how mental health can be supported in LMIC schools. Focus groups were completed with teachers serving youth from a variety of socioeconomic settings within León, Nicaragua. The study was completed from an Interpretivist theoretical paradigm and coding of qualitative data was completed consistent with Constructivist Grounded Theory. Educators described their roles in as detecting mental health problems and liasing with other supports; they noted barriers as cross-sector integration and social challenges. Educators felt that youth would be better served by improving integration of care, addressing structural factors, and providing more teacher supports. A model for addressing youth mental health in LMICs could include a stepped-care approach with schools providing preventative programming as well as developing within school referral strategies for youth with higher needs. There may be a role for the use of community health promoters.
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Affiliation(s)
- Amy Gajaria
- Centre for Addiction and Mental Health, University of Toronto, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Arun V Ravindran
- Centre for Addiction and Mental Health, University of Toronto, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
| | | | - Andrés Herrera Rodríguez
- Centro de Investigación en Demografía y Salud, León, Nicaragua.,Faculty of Medicine, UNAN-León, León, Nicaragua
| | - Juveria Zaheer
- Department of Psychiatry, University of Toronto, Toronto, Canada.,Institute for Mental Health Policy Research, Toronto, Canada
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30
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Kennedy SH, Lam RW, Rotzinger S, Milev RV, Blier P, Downar J, Evans KR, Farzan F, Foster JA, Frey BN, Giacobbe P, Hall GB, Harkness KL, Hassel S, Ismail Z, Leri F, McInerney S, MacQueen GM, Minuzzi L, Müller DJ, Parikh SV, Placenza FM, Quilty LC, Ravindran AV, Sassi RB, Soares CN, Strother SC, Turecki G, Vaccarino AL, Vila-Rodriguez F, Yu J, Uher R. Symptomatic and Functional Outcomes and Early Prediction of Response to Escitalopram Monotherapy and Sequential Adjunctive Aripiprazole Therapy in Patients With Major Depressive Disorder: A CAN-BIND-1 Report. J Clin Psychiatry 2019; 80. [PMID: 30840787 DOI: 10.4088/jcp.18m12202] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 08/15/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To report the symptomatic and functional outcomes in patients with major depressive disorder (MDD) during a 2-phase treatment trial and to estimate the value of early improvement after 2 weeks in predicting clinical response to escitalopram and subsequently to adjunctive treatment with aripiprazole. METHODS Participants with MDD (N = 211) identified with the Montgomery-Asberg Depression Rating Scale (MADRS) and confirmed with the Mini-International Neuropsychiatric Interview were recruited from 6 outpatient centers across Canada (August 2013 through December 2016) and treated with open-label escitalopram (10-20 mg) for 8 weeks (Phase 1). Clinical and functional outcomes were evaluated using the MADRS, Quick Inventory of Depressive Symptomatology-Self-Rated (QIDS-SR), Sheehan Disability Scale (SDS), and Lam Employment Absence and Productivity Scale (LEAPS). Participants were evaluated at 8 and 16 weeks for clinical and functional response and remission. Phase 1 responders continued escitalopram while nonresponders received adjunctive aripiprazole (2-10 mg) for a further 8 weeks (Phase 2). RESULTS After Phase 1, MADRS response (≥ 50% decrease from baseline) and remission (score ≤ 10) were, respectively, 47% and 31%, and SDS response (score ≤ 12) and remission (score ≤ 6) were, respectively, 53% and 24%. Response to escitalopram was maintained in 91% of participants at week 16, while 61% of the adjunctive aripiprazole group achieved MADRS response during Phase 2. Response and remission rates with the QIDS-SR were lower than with the MADRS. The LEAPS demonstrated significant occupational improvement (P < .05). Early symptomatic improvement predicted outcomes with modest accuracy. CONCLUSIONS This study demonstrates comparable symptomatic and functional outcomes to those of other large practical-design studies. There was a high response rate with the adjunctive use of aripiprazole in escitalopram nonresponders. Given the limited value of early clinical improvement to predict outcome, integration of clinical and biological markers deserves further exploration. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01655706.
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Affiliation(s)
- Sidney H Kennedy
- St Michael's Hospital, 193 Yonge St, Ste 6-001A, Toronto, ON M5B1M4, Canada. .,Department of Psychiatry, Krembil Research Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
| | - Raymond W Lam
- University of British Columbia and Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada
| | - Susan Rotzinger
- Department of Psychiatry, Krembil Research Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Roumen V Milev
- Department of Psychiatry, Queen's University and Providence Care Hospital, Kingston, Ontario, Canada.,Department of Psychology, Queen's University, Kingston, Ontario, Canada
| | - Pierre Blier
- University of Ottawa Institute of Mental Health Research, Ottawa, Ontario, Canada
| | - Jonathan Downar
- Department of Psychiatry, Krembil Research Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Kenneth R Evans
- Indoc Research, Toronto, Ontario, Canada.,Department of Pathology and Molecular Medicine, Queen's University, Kingston, Ontario, Canada
| | - Faranak Farzan
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Jane A Foster
- Department of Psychiatry, Krembil Research Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, and St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Benicio N Frey
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, and St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Peter Giacobbe
- Department of Psychiatry, Krembil Research Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Geoffrey B Hall
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, and St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Kate L Harkness
- Department of Psychology, Queen's University, Kingston, Ontario, Canada
| | - Stefanie Hassel
- University of Calgary, Hotchkiss Brain Institute, Calgary, Alberta, Canada
| | - Zahinoor Ismail
- University of Calgary, Hotchkiss Brain Institute, Calgary, Alberta, Canada
| | | | - Shane McInerney
- Department of Psychiatry, Krembil Research Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Glenda M MacQueen
- University of Calgary, Hotchkiss Brain Institute, Calgary, Alberta, Canada
| | - Luciano Minuzzi
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, and St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Daniel J Müller
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | | | - Franca M Placenza
- Department of Psychiatry, Krembil Research Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Lena C Quilty
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Arun V Ravindran
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Roberto B Sassi
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, and St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Claudio N Soares
- Department of Psychiatry, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, Queen's University and Providence Care Hospital, Kingston, Ontario, Canada
| | | | - Gustavo Turecki
- McGill University, Montréal, Quebec, Canada.,Douglas Mental Health University Institute Frank B. Common (FBC), Montréal, Quebec, Canada
| | | | - Fidel Vila-Rodriguez
- University of British Columbia and Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada
| | - Joanna Yu
- Department of Psychiatry, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Rudolf Uher
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
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- Members of the CAN-BIND Investigator Team are listed at www.canbind.ca/our-team/
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Yatham S, Sivathasan S, Yoon R, da Silva TL, Ravindran AV. Depression, anxiety, and post-traumatic stress disorder among youth in low and middle income countries: A review of prevalence and treatment interventions. Asian J Psychiatr 2018; 38:78-91. [PMID: 29117922 DOI: 10.1016/j.ajp.2017.10.029] [Citation(s) in RCA: 84] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 10/27/2017] [Accepted: 10/30/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Low and middle income countries (LMICs) not only have the majority of the world's population but also the largest proportion of youth. Poverty, civil conflict and environmental stressors tend to be endemic in these countries and contribute to significant psychiatric morbidity, including depression, anxiety and post-traumatic stress disorder (PTSD). However, mental health data from LMICs is scarce, particularly data on youth. Evaluation of such information is crucial for planning services and reducing the burden of disability. This paper reviews the published data on the prevalence and randomized trials of interventions for depression, anxiety and PTSD in youth in LMICs. METHODS PubMed and Google Scholar were searched for articles published in English up to January 2017, using the keywords: Low/middle income country, depression, anxiety, post-traumatic stress disorder, child, youth, adolescent, prevalence, treatment, intervention, and outcomes. RESULTS The few prevalence studies in LMICs reported rates of up to 28% for significant symptoms of depression or anxiety among youth, and up to 87% for symptoms of PTSD among youth exposed to traumatic experienences, though these rates varied widely depending on several factors, including the assessments tools used. Most rigorous interventions employed some form or variation of CBT, with mixed results. Studies using other forms of psychosocial interventions appear to be heterogeneous and less rigorous. CONCLUSIONS The mental health burden due to depression and anxiety disorders in youth is substantial in LMICs, with high needs but inadequate services. Youth specific services for early detection and cost-effective interventions are needed.
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Affiliation(s)
- Swetha Yatham
- University of British Columbia, Canada (Currently St. George's Medical School, University of London, United Kingdom)
| | | | - Rosalia Yoon
- University of Toronto and Centre for Addiction and Mental Health, Canada
| | - Tricia L da Silva
- University of Toronto and Centre for Addiction and Mental Health, Canada
| | - Arun V Ravindran
- University of Toronto and Centre for Addiction and Mental Health, Canada.
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Gajaria A, Ravindran AV. Interventions for perinatal depression in low and middle-income countries: A systematic review. Asian J Psychiatr 2018; 37:112-120. [PMID: 30173015 DOI: 10.1016/j.ajp.2018.08.014] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 07/11/2018] [Accepted: 08/16/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Perinatal depression has been associated with infant low birth weight and with multiple health indicators affecting childhood morbidity and mortality. The condition is twice as prevalent in low and middle-income countries (LMICs) compared to high-income countries but poorly studied. AIM To conduct a review of published literature on interventions for perinatal depression in LMICs. METHODS A search of the literature was performed for articles published up to October 2017. The key inclusion criteria were peer-reviewed studies focusing on interventions for perinatal depression during pregnancy and/or up to one-year postpartum. RESULTS 1088 citations were retrieved, of which 18 studies with representation from countries in Africa, Asia, North America (Mexico) and South America were included. The majority of interventions were conducted in lower-income settings. Most were psychosocial in nature and often provided by lay health workers and in the community. Interventions integrated as part of general health programs and employing psychotherapeutic approaches were more effective and were also preferred. Only one study incorporated the use of psychiatric medications. CONCLUSION Despite the limited publications, there is reasonable evidence for the benefit of psychological interventions in perinatal depression in LMICs. More research is needed to verify and extend these results and, in particular, to evaluate the benefit of adjunctive medications when treating moderate to severe depression and whether interventions can increase social supports.
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Affiliation(s)
- Amy Gajaria
- University of Toronto, Department of Psychiatry, Canada; Division of Child and Youth Psychiatry, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Arun V Ravindran
- University of Toronto, Department of Psychiatry, Canada; Campbell Family Mental Health Research Centre, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
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Ravindran AV, Balneaves LG, Faulkner G, Ortiz A, McIntosh D, Morehouse RL, Ravindran L, Yatham LN, Kennedy SH, Lam RW, MacQueen GM, Milev RV, Parikh SV. Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder: Section 5. Complementary and Alternative Medicine Treatments. Focus (Am Psychiatr Publ) 2018; 16:85-94. [PMID: 32015703 DOI: 10.1176/appi.focus.16106] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
(Reprinted by permission of SAGE Publications, Inc., from The Canadian Journal of Psychiatry 2016; 61:576-587. Copyright © 2016 by the Authors [https://doi.org/10.1177/0706743716660290]).
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Walker ZJ, Jones MP, Ravindran AV. Psychiatric disorders among people with cancer in low- and lower-middle-income countries: study protocol for a systematic review and meta-analysis. BMJ Open 2017; 7:e017043. [PMID: 28801432 PMCID: PMC5724159 DOI: 10.1136/bmjopen-2017-017043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 06/16/2017] [Accepted: 07/03/2017] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Cancer is a rapidly growing public health problem in low- and lower-middle-income countries (LLMICs). There is evidence from upper-income countries that comorbid mental illness is common and can adversely impact cancer outcomes. Little is known about this burden in LLMICs. This systematic review has two aims. The first is to review the prevalence and patterns of psychiatric comorbidity in adults with cancer in LLMICs. The second is to review psychiatric treatment outcomes in this population. METHODS AND ANALYSIS The review will be reported according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. A systematic search of electronic databases (MEDLINE, PsycInfo, Embase and CINAHL) will be conducted. Studies will be included if they report the prevalence of psychiatric comorbidity, or if they evaluate psychiatric treatment outcomes, in adults with cancer living in LLMICs. The search will be limited to studies published in peer-reviewed journals between March 2002 and March 2017. The reference lists of included studies will be hand searched. Critical appraisal will be performed using Quality Assessment Tools from the National Institute of Health. Pooled prevalence meta-analysis is planned. ETHICS AND DISSEMINATION Ethics approval is not required as no primary data will be collected. The results will be presented at conferences and published in a peer-reviewed journal. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42017057103.
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Affiliation(s)
- Zoe J Walker
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Michael P Jones
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Arun V Ravindran
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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35
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Zhou X, Cipriani A, Zhang Y, Cuijpers P, Hetrick SE, Weisz JR, Pu J, Giovane CD, Furukawa TA, Barth J, Coghill D, Leucht S, Yang L, Ravindran AV, Xie P. Comparative efficacy and acceptability of antidepressants, psychological interventions, and their combination for depressive disorder in children and adolescents: protocol for a network meta-analysis. BMJ Open 2017; 7:e016608. [PMID: 28801423 PMCID: PMC5629731 DOI: 10.1136/bmjopen-2017-016608] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Depressive disorder is common in children and adolescents, with important consequences and serious impairments in terms of personal and social functioning. While both pharmacological and psychological interventions have been shown to be effective, there is still uncertainty about the balance between these and what treatment strategy should be preferred in clinical practice. Therefore, we aim to compare and rank in a network meta-analysis (NMA) the commonly used psychological, pharmacological and combined interventions for depressive disorder in children and adolescents. METHODS AND ANALYSIS We will update the literature search of two previous NMAs for the identification of trials of antidepressant and psychotherapy alone for depressive disorder in children and adolescents. For identification of trials of combination interventions, seven databases (PubMed, EMBASE, CENTRAL (Cochrane Central Register of Controlled Trials), Web of Science, PsycINFO, CINAHL, LiLACS) will be searched from date of inception. We will also search ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform and check relevant reports on the US Food and Drug Administration website for unpublished data. Building on our previous findings in the field, we will include any commonly prescribed oral antidepressants and any manualised or structured psychotherapies, as well as their combinations. Randomised controlled trials assessing any active intervention against active comparator or pill placebo/psychological controls in acute treatment for depressive disorder in children and adolescents will be included. The primary outcomes will be efficacy (mean change in depressive symptoms), and acceptability of treatment (dropout rate due to any cause). The secondary outcomes will be remission rate, tolerability of treatment (dropouts for adverse events), as well as suicide-related outcomes (suicidal behaviour or ideation). We will perform Bayesian NMAs for all relative outcome measures. Subgroup analyses and sensitivity analyses will be conducted to assess the robustness of the findings. DISSEMINATION This NMA will provide the most up to date and clinically useful information about the comparative efficacy and acceptability of antidepressants, psychological intervention and their combination in the acute treatment of children and adolescents with depressive disorder. This is the newest NMA and therefore these results are very important in terms of evidence-based medicine. The results will be disseminated through peer-reviewed publication. PROTOCOL REGISTRATION PROSPERO CRD42015020841.
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Affiliation(s)
- Xinyu Zhou
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Andrea Cipriani
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Yuqing Zhang
- Department of Neurology, Institute of Neuroscience and the Collaborative Innovation Centre for Brain Science,The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Sarah E Hetrick
- Orygen, The National Centre of Excellence in Youth Mental Health, and the Centre of Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - John R Weisz
- Department of Psychology, Harvard University, Cambridge, USA
| | - Juncai Pu
- Department of Neurology, Institute of Neuroscience and the Collaborative Innovation Centre for Brain Science,The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Cinzia Del Giovane
- Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Toshiaki A Furukawa
- Department of Health Promotion and Human Behaviour, Kyoto University Graduate School of Medicine and School of Public Health, Kyoto, Japan
| | - Jürgen Barth
- Institute for Complementary and Integrative Medicine,UniversityHospital and University of Zurich, Zurich, Switzerland
| | - David Coghill
- Departments of Paediatrics and Psychiatry, University of Melbourne, Melbourne, Australia
| | - Stefan Leucht
- Department of Psychiatry and Psychotherapy, Technische Universität München, Munich, Germany
| | - Lining Yang
- Department of Neurology, Institute of Neuroscience and the Collaborative Innovation Centre for Brain Science,The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Arun V Ravindran
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Peng Xie
- Department of Neurology, Institute of Neuroscience and the Collaborative Innovation Centre for Brain Science,The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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36
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Lam RW, Ismail Z, MacQueen GM, Milev RV, Parikh SV, Ravindran AV, Kennedy SH. Response to Letter Regarding CANMAT Recommendations for the Pharmacological Treatment of Late-life Depression. Can J Psychiatry 2017; 62:353-354. [PMID: 28525728 PMCID: PMC5459233 DOI: 10.1177/0706743717700878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Raymond W Lam
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Glenda M MacQueen
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Roumen V Milev
- Department of Psychiatry, Queen's University, Kingston, Ontario, Canada
| | - Sagar V Parikh
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | | | - Sidney H Kennedy
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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37
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Bhikram TP, Farb NAS, Ravindran LN, Papadopoulos YG, Conn DK, Pollock BG, Ravindran AV. The Effect of Intravenous Citalopram on the Neural Substrates of Obsessive-Compulsive Disorder. J Neuropsychiatry Clin Neurosci 2017; 28:243-7. [PMID: 27019066 DOI: 10.1176/appi.neuropsych.15090213] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This study investigated the effect of an intravenous serotonin reuptake inhibitor on the neural substrates of obsessive-compulsive disorder (OCD), as intravenous agents may be more effective in treating OCD than conventional oral pharmacotherapy. Eight OCD subjects and eight control subjects received alternate infusions of citalopram and placebo during functional magnetic resonance imaging, in a randomized, symptom-provocation, crossover design. Compared with baseline, OCD subjects displayed significant changes in prefrontal neural activity after the citalopram infusion relative to placebo, and these changes correlated with reductions in subjective anxiety.
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Affiliation(s)
- Tracy P Bhikram
- From the University of Toronto, Toronto, Canada (TPB, NASF, LNR, DKC, BGP, AVR); the Centre for Addiction and Mental Health, Toronto (TPB, LNR, YGP); the Campbell Research Institute, Toronto (BGP, AVR); the Rotman Research Institute, Toronto (NASF); and the Baycrest Centre for Geriatric Care, Toronto (DKC)
| | - Norman A S Farb
- From the University of Toronto, Toronto, Canada (TPB, NASF, LNR, DKC, BGP, AVR); the Centre for Addiction and Mental Health, Toronto (TPB, LNR, YGP); the Campbell Research Institute, Toronto (BGP, AVR); the Rotman Research Institute, Toronto (NASF); and the Baycrest Centre for Geriatric Care, Toronto (DKC)
| | - Lakshmi N Ravindran
- From the University of Toronto, Toronto, Canada (TPB, NASF, LNR, DKC, BGP, AVR); the Centre for Addiction and Mental Health, Toronto (TPB, LNR, YGP); the Campbell Research Institute, Toronto (BGP, AVR); the Rotman Research Institute, Toronto (NASF); and the Baycrest Centre for Geriatric Care, Toronto (DKC)
| | - Yousef G Papadopoulos
- From the University of Toronto, Toronto, Canada (TPB, NASF, LNR, DKC, BGP, AVR); the Centre for Addiction and Mental Health, Toronto (TPB, LNR, YGP); the Campbell Research Institute, Toronto (BGP, AVR); the Rotman Research Institute, Toronto (NASF); and the Baycrest Centre for Geriatric Care, Toronto (DKC)
| | - David K Conn
- From the University of Toronto, Toronto, Canada (TPB, NASF, LNR, DKC, BGP, AVR); the Centre for Addiction and Mental Health, Toronto (TPB, LNR, YGP); the Campbell Research Institute, Toronto (BGP, AVR); the Rotman Research Institute, Toronto (NASF); and the Baycrest Centre for Geriatric Care, Toronto (DKC)
| | - Bruce G Pollock
- From the University of Toronto, Toronto, Canada (TPB, NASF, LNR, DKC, BGP, AVR); the Centre for Addiction and Mental Health, Toronto (TPB, LNR, YGP); the Campbell Research Institute, Toronto (BGP, AVR); the Rotman Research Institute, Toronto (NASF); and the Baycrest Centre for Geriatric Care, Toronto (DKC)
| | - Arun V Ravindran
- From the University of Toronto, Toronto, Canada (TPB, NASF, LNR, DKC, BGP, AVR); the Centre for Addiction and Mental Health, Toronto (TPB, LNR, YGP); the Campbell Research Institute, Toronto (BGP, AVR); the Rotman Research Institute, Toronto (NASF); and the Baycrest Centre for Geriatric Care, Toronto (DKC)
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Parikh SV, Quilty L, Ravitz P, Rosenbluth M, Pavlova B, Grigoriadis S, Velyvis V, Uher R, Kennedy SH, Lam RW, MacQueen GM, Milev R, Ravindran AV. Rating Short-Term Psychodynamic Therapy for the Canadian Network for Mood and Anxiety Treatments Depression Guidelines. Can J Psychiatry 2017; 62:77-78. [PMID: 28055254 PMCID: PMC5302116 DOI: 10.1177/0706743716676754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Sagar V Parikh
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA.,Department of Psychiatry, University of Toronto, Toronto, Ontario
| | | | | | | | - Barbara Pavlova
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia
| | | | | | - Rudolf Uher
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia
| | - Sidney H Kennedy
- Department of Psychiatry, University of Toronto, Toronto, Ontario
| | - Raymond W Lam
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia
| | | | - Roumen Milev
- Departments of Psychiatry and Psychology, Queen's University, Kingston, Ontario
| | - Arun V Ravindran
- Department of Psychiatry, University of Toronto, Toronto, Ontario
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Ahmad KF, Senanayake M, de Silva V, da Silva TL, Ravindran AV. Trajectory of Illness and Treatment Outcomes among First-Episode Psychosis Patients in Sri Lanka. International Journal of Mental Health 2016. [DOI: 10.1080/00207411.2016.1222566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Kennedy SH, Lam RW, McIntyre RS, Tourjman SV, Bhat V, Blier P, Hasnain M, Jollant F, Levitt AJ, MacQueen GM, McInerney SJ, McIntosh D, Milev RV, Müller DJ, Parikh SV, Pearson NL, Ravindran AV, Uher R. Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder: Section 3. Pharmacological Treatments. Can J Psychiatry 2016; 61:540-60. [PMID: 27486148 PMCID: PMC4994790 DOI: 10.1177/0706743716659417] [Citation(s) in RCA: 646] [Impact Index Per Article: 80.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND The Canadian Network for Mood and Anxiety Treatments (CANMAT) conducted a revision of the 2009 guidelines by updating the evidence and recommendations. The scope of the 2016 guidelines remains the management of major depressive disorder (MDD) in adults, with a target audience of psychiatrists and other mental health professionals. METHODS Using the question-answer format, we conducted a systematic literature search focusing on systematic reviews and meta-analyses. Evidence was graded using CANMAT-defined criteria for level of evidence. Recommendations for lines of treatment were based on the quality of evidence and clinical expert consensus. "Pharmacological Treatments" is the third of six sections of the 2016 guidelines. With little new information on older medications, treatment recommendations focus on second-generation antidepressants. RESULTS Evidence-informed responses are given for 21 questions under 4 broad categories: 1) principles of pharmacological management, including individualized assessment of patient and medication factors for antidepressant selection, regular and frequent monitoring, and assessing clinical and functional outcomes with measurement-based care; 2) comparative aspects of antidepressant medications based on efficacy, tolerability, and safety, including summaries of newly approved drugs since 2009; 3) practical approaches to pharmacological management, including drug-drug interactions and maintenance recommendations; and 4) managing inadequate response and treatment resistance, with a focus on switching antidepressants, applying adjunctive treatments, and new and emerging agents. CONCLUSIONS Evidence-based pharmacological treatments are available for first-line treatment of MDD and for management of inadequate response. However, given the limitations of the evidence base, pharmacological management of MDD still depends on tailoring treatments to the patient.
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Affiliation(s)
- Sidney H Kennedy
- Department of Psychiatry, University of Toronto, Toronto, Ontario *Co-first authors.
| | - Raymond W Lam
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia *Co-first authors
| | - Roger S McIntyre
- Department of Psychiatry, University of Toronto, Toronto, Ontario
| | | | - Venkat Bhat
- Department of Psychiatry, McGill University, Montréal, Quebec
| | - Pierre Blier
- Department of Psychiatry, University of Ottawa, Ottawa, Ontario
| | - Mehrul Hasnain
- Department of Psychiatry, Memorial University, St. John's, Newfoundland
| | - Fabrice Jollant
- Department of Psychiatry, McGill University, Montréal, Quebec
| | - Anthony J Levitt
- Department of Psychiatry, University of Toronto, Toronto, Ontario
| | | | | | - Diane McIntosh
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia
| | - Roumen V Milev
- Department of Psychiatry, Queen's University, Kingston, Ontario
| | - Daniel J Müller
- Department of Psychiatry, University of Toronto, Toronto, Ontario
| | - Sagar V Parikh
- Department of Psychiatry, University of Toronto, Toronto, Ontario Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
| | | | - Arun V Ravindran
- Department of Psychiatry, University of Toronto, Toronto, Ontario
| | - Rudolf Uher
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia
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Lam RW, McIntosh D, Wang J, Enns MW, Kolivakis T, Michalak EE, Sareen J, Song WY, Kennedy SH, MacQueen GM, Milev RV, Parikh SV, Ravindran AV. Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder: Section 1. Disease Burden and Principles of Care. Can J Psychiatry 2016; 61:510-23. [PMID: 27486151 PMCID: PMC4994789 DOI: 10.1177/0706743716659416] [Citation(s) in RCA: 171] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND The Canadian Network for Mood and Anxiety Treatments (CANMAT) conducted a revision of the 2009 guidelines by updating the evidence and recommendations. The scope of the 2016 guidelines remains the management of major depressive disorder (MDD) in adults, with a target audience of psychiatrists and other mental health professionals. METHODS Using the question-answer format, we conducted a systematic literature search focusing on systematic reviews and meta-analyses. Evidence was graded using CANMAT-defined criteria for level of evidence. Recommendations for lines of treatment were based on the quality of evidence and clinical expert consensus. This section is the first of six guidelines articles. RESULTS In Canada, the annual and lifetime prevalence of MDD was 4.7% and 11.3%, respectively. MDD represents the second leading cause of global disability, with high occupational and economic impact mainly attributable to indirect costs. DSM-5 criteria for depressive disorders remain relatively unchanged, but other clinical dimensions (sleep, cognition, physical symptoms) may have implications for depression management. e-Mental health is increasingly used to support clinical and self-management of MDD. In the 2-phase (acute and maintenance) treatment model, specific goals address symptom remission, functional recovery, improved quality of life, and prevention of recurrence. CONCLUSIONS The burden attributed to MDD remains high, whether from individual distress, functional and relationship impairment, reduced quality of life, or societal economic cost. Applying core principles of care, including comprehensive assessment, therapeutic alliance, support of self-management, evidence-informed treatment, and measurement-based care, will optimize clinical, quality of life, and functional outcomes in MDD.
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Affiliation(s)
- Raymond W Lam
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia
| | - Diane McIntosh
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia
| | - JianLi Wang
- Department of Psychiatry, University of Calgary, Calgary, Alberta
| | - Murray W Enns
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba
| | - Theo Kolivakis
- Department of Psychiatry, McGill University, Montréal, Quebec
| | - Erin E Michalak
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia
| | - Jitender Sareen
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba
| | - Wei-Yi Song
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia
| | - Sidney H Kennedy
- Department of Psychiatry, University of Toronto, Toronto, Ontario
| | | | - Roumen V Milev
- Department of Psychiatry, Queen's University, Kingston, Ontario
| | - Sagar V Parikh
- Department of Psychiatry, University of Toronto, Toronto, Ontario Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
| | - Arun V Ravindran
- Department of Psychiatry, University of Toronto, Toronto, Ontario
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Vaccarino AL, Evans KR, Kalali AH, Kennedy SH, Engelhardt N, Frey BN, Greist JH, Kobak KA, Lam RW, MacQueen G, Milev R, Placenza FM, Ravindran AV, Sheehan DV, Sills T, Williams JBW. The Depression Inventory Development Workgroup: A Collaborative, Empirically Driven Initiative to Develop a New Assessment Tool for Major Depressive Disorder. Innov Clin Neurosci 2016; 13:20-31. [PMID: 27974997 PMCID: PMC5141593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The Depression Inventory Development project is an initiative of the International Society for CNS Drug Development whose goal is to develop a comprehensive and psychometrically sound measurement tool to be utilized as a primary endpoint in clinical trials for major depressive disorder. Using an iterative process between field testing and psychometric analysis and drawing upon expertise of international researchers in depression, the Depression Inventory Development team has established an empirically driven and collaborative protocol for the creation of items to assess symptoms in major depressive disorder. Depression-relevant symptom clusters were identified based on expert clinical and patient input. In addition, as an aid for symptom identification and item construction, the psychometric properties of existing clinical scales (assessing depression and related indications) were evaluated using blinded datasets from pharmaceutical antidepressant drug trials. A series of field tests in patients with major depressive disorder provided the team with data to inform the iterative process of scale development. We report here an overview of the Depression Inventory Development initiative, including results of the third iteration of items assessing symptoms related to anhedonia, cognition, fatigue, general malaise, motivation, anxiety, negative thinking, pain and appetite. The strategies adopted from the Depression Inventory Development program, as an empirically driven and collaborative process for scale development, have provided the foundation to develop and validate measurement tools in other therapeutic areas as well.
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Affiliation(s)
- Anthony L Vaccarino
- Dr. Vaccarino is with Indoc Research, Toronto, Ontario, Canada; Dr. Evans is with Indoc Research, Toronto, Ontario, Canada, and Department of Pathology and Molecular Medicine, Queen's University, Kingston, Ontario, Canada; Dr. Kalali is with Quintiles Inc, San Diego, California, USA, and Department of Psychiatry, University of California, San Diego, California, USA; Drs. Kennedy and Placenza are with University Health Network, Toronto, Ontario, Canada; Dr. Engelhardt is with Cronos Clinical Consulting Services, Lambertville, New Jersey, USA; Dr. Frey is with Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada, and Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare, Hamilton, Ontario, Canada; Dr. Greist is with Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA; Dr. Kobak is with Center for Telepsychology, Madison, Wisconsin, USA; Dr. Lam is with Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada; Dr. MacQueen is with Mathison Centre for Mental Health Research and Education, Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada; Dr. Milev is with Department of Psychiatry, Queen's University, Kingston, Ontario, Canada; Dr. Ravindran is with Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada, and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Dr. Sheehan is with Department of Psychiatry and Behavioral Health, University of South Florida College of Medicine, Tampa, Florida, USA; Dr. Sills was with OCBN, Toronto, Ontario, Canada; Dr. Williams is with Columbia University, New York, New York, USA, and Medavante Inc., Trenton, New Jersey, USA
| | - Kenneth R Evans
- Dr. Vaccarino is with Indoc Research, Toronto, Ontario, Canada; Dr. Evans is with Indoc Research, Toronto, Ontario, Canada, and Department of Pathology and Molecular Medicine, Queen's University, Kingston, Ontario, Canada; Dr. Kalali is with Quintiles Inc, San Diego, California, USA, and Department of Psychiatry, University of California, San Diego, California, USA; Drs. Kennedy and Placenza are with University Health Network, Toronto, Ontario, Canada; Dr. Engelhardt is with Cronos Clinical Consulting Services, Lambertville, New Jersey, USA; Dr. Frey is with Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada, and Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare, Hamilton, Ontario, Canada; Dr. Greist is with Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA; Dr. Kobak is with Center for Telepsychology, Madison, Wisconsin, USA; Dr. Lam is with Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada; Dr. MacQueen is with Mathison Centre for Mental Health Research and Education, Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada; Dr. Milev is with Department of Psychiatry, Queen's University, Kingston, Ontario, Canada; Dr. Ravindran is with Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada, and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Dr. Sheehan is with Department of Psychiatry and Behavioral Health, University of South Florida College of Medicine, Tampa, Florida, USA; Dr. Sills was with OCBN, Toronto, Ontario, Canada; Dr. Williams is with Columbia University, New York, New York, USA, and Medavante Inc., Trenton, New Jersey, USA
| | - Amir H Kalali
- Dr. Vaccarino is with Indoc Research, Toronto, Ontario, Canada; Dr. Evans is with Indoc Research, Toronto, Ontario, Canada, and Department of Pathology and Molecular Medicine, Queen's University, Kingston, Ontario, Canada; Dr. Kalali is with Quintiles Inc, San Diego, California, USA, and Department of Psychiatry, University of California, San Diego, California, USA; Drs. Kennedy and Placenza are with University Health Network, Toronto, Ontario, Canada; Dr. Engelhardt is with Cronos Clinical Consulting Services, Lambertville, New Jersey, USA; Dr. Frey is with Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada, and Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare, Hamilton, Ontario, Canada; Dr. Greist is with Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA; Dr. Kobak is with Center for Telepsychology, Madison, Wisconsin, USA; Dr. Lam is with Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada; Dr. MacQueen is with Mathison Centre for Mental Health Research and Education, Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada; Dr. Milev is with Department of Psychiatry, Queen's University, Kingston, Ontario, Canada; Dr. Ravindran is with Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada, and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Dr. Sheehan is with Department of Psychiatry and Behavioral Health, University of South Florida College of Medicine, Tampa, Florida, USA; Dr. Sills was with OCBN, Toronto, Ontario, Canada; Dr. Williams is with Columbia University, New York, New York, USA, and Medavante Inc., Trenton, New Jersey, USA
| | - Sidney H Kennedy
- Dr. Vaccarino is with Indoc Research, Toronto, Ontario, Canada; Dr. Evans is with Indoc Research, Toronto, Ontario, Canada, and Department of Pathology and Molecular Medicine, Queen's University, Kingston, Ontario, Canada; Dr. Kalali is with Quintiles Inc, San Diego, California, USA, and Department of Psychiatry, University of California, San Diego, California, USA; Drs. Kennedy and Placenza are with University Health Network, Toronto, Ontario, Canada; Dr. Engelhardt is with Cronos Clinical Consulting Services, Lambertville, New Jersey, USA; Dr. Frey is with Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada, and Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare, Hamilton, Ontario, Canada; Dr. Greist is with Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA; Dr. Kobak is with Center for Telepsychology, Madison, Wisconsin, USA; Dr. Lam is with Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada; Dr. MacQueen is with Mathison Centre for Mental Health Research and Education, Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada; Dr. Milev is with Department of Psychiatry, Queen's University, Kingston, Ontario, Canada; Dr. Ravindran is with Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada, and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Dr. Sheehan is with Department of Psychiatry and Behavioral Health, University of South Florida College of Medicine, Tampa, Florida, USA; Dr. Sills was with OCBN, Toronto, Ontario, Canada; Dr. Williams is with Columbia University, New York, New York, USA, and Medavante Inc., Trenton, New Jersey, USA
| | - Nina Engelhardt
- Dr. Vaccarino is with Indoc Research, Toronto, Ontario, Canada; Dr. Evans is with Indoc Research, Toronto, Ontario, Canada, and Department of Pathology and Molecular Medicine, Queen's University, Kingston, Ontario, Canada; Dr. Kalali is with Quintiles Inc, San Diego, California, USA, and Department of Psychiatry, University of California, San Diego, California, USA; Drs. Kennedy and Placenza are with University Health Network, Toronto, Ontario, Canada; Dr. Engelhardt is with Cronos Clinical Consulting Services, Lambertville, New Jersey, USA; Dr. Frey is with Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada, and Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare, Hamilton, Ontario, Canada; Dr. Greist is with Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA; Dr. Kobak is with Center for Telepsychology, Madison, Wisconsin, USA; Dr. Lam is with Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada; Dr. MacQueen is with Mathison Centre for Mental Health Research and Education, Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada; Dr. Milev is with Department of Psychiatry, Queen's University, Kingston, Ontario, Canada; Dr. Ravindran is with Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada, and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Dr. Sheehan is with Department of Psychiatry and Behavioral Health, University of South Florida College of Medicine, Tampa, Florida, USA; Dr. Sills was with OCBN, Toronto, Ontario, Canada; Dr. Williams is with Columbia University, New York, New York, USA, and Medavante Inc., Trenton, New Jersey, USA
| | - Benicio N Frey
- Dr. Vaccarino is with Indoc Research, Toronto, Ontario, Canada; Dr. Evans is with Indoc Research, Toronto, Ontario, Canada, and Department of Pathology and Molecular Medicine, Queen's University, Kingston, Ontario, Canada; Dr. Kalali is with Quintiles Inc, San Diego, California, USA, and Department of Psychiatry, University of California, San Diego, California, USA; Drs. Kennedy and Placenza are with University Health Network, Toronto, Ontario, Canada; Dr. Engelhardt is with Cronos Clinical Consulting Services, Lambertville, New Jersey, USA; Dr. Frey is with Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada, and Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare, Hamilton, Ontario, Canada; Dr. Greist is with Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA; Dr. Kobak is with Center for Telepsychology, Madison, Wisconsin, USA; Dr. Lam is with Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada; Dr. MacQueen is with Mathison Centre for Mental Health Research and Education, Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada; Dr. Milev is with Department of Psychiatry, Queen's University, Kingston, Ontario, Canada; Dr. Ravindran is with Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada, and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Dr. Sheehan is with Department of Psychiatry and Behavioral Health, University of South Florida College of Medicine, Tampa, Florida, USA; Dr. Sills was with OCBN, Toronto, Ontario, Canada; Dr. Williams is with Columbia University, New York, New York, USA, and Medavante Inc., Trenton, New Jersey, USA
| | - John H Greist
- Dr. Vaccarino is with Indoc Research, Toronto, Ontario, Canada; Dr. Evans is with Indoc Research, Toronto, Ontario, Canada, and Department of Pathology and Molecular Medicine, Queen's University, Kingston, Ontario, Canada; Dr. Kalali is with Quintiles Inc, San Diego, California, USA, and Department of Psychiatry, University of California, San Diego, California, USA; Drs. Kennedy and Placenza are with University Health Network, Toronto, Ontario, Canada; Dr. Engelhardt is with Cronos Clinical Consulting Services, Lambertville, New Jersey, USA; Dr. Frey is with Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada, and Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare, Hamilton, Ontario, Canada; Dr. Greist is with Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA; Dr. Kobak is with Center for Telepsychology, Madison, Wisconsin, USA; Dr. Lam is with Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada; Dr. MacQueen is with Mathison Centre for Mental Health Research and Education, Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada; Dr. Milev is with Department of Psychiatry, Queen's University, Kingston, Ontario, Canada; Dr. Ravindran is with Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada, and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Dr. Sheehan is with Department of Psychiatry and Behavioral Health, University of South Florida College of Medicine, Tampa, Florida, USA; Dr. Sills was with OCBN, Toronto, Ontario, Canada; Dr. Williams is with Columbia University, New York, New York, USA, and Medavante Inc., Trenton, New Jersey, USA
| | - Kenneth A Kobak
- Dr. Vaccarino is with Indoc Research, Toronto, Ontario, Canada; Dr. Evans is with Indoc Research, Toronto, Ontario, Canada, and Department of Pathology and Molecular Medicine, Queen's University, Kingston, Ontario, Canada; Dr. Kalali is with Quintiles Inc, San Diego, California, USA, and Department of Psychiatry, University of California, San Diego, California, USA; Drs. Kennedy and Placenza are with University Health Network, Toronto, Ontario, Canada; Dr. Engelhardt is with Cronos Clinical Consulting Services, Lambertville, New Jersey, USA; Dr. Frey is with Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada, and Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare, Hamilton, Ontario, Canada; Dr. Greist is with Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA; Dr. Kobak is with Center for Telepsychology, Madison, Wisconsin, USA; Dr. Lam is with Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada; Dr. MacQueen is with Mathison Centre for Mental Health Research and Education, Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada; Dr. Milev is with Department of Psychiatry, Queen's University, Kingston, Ontario, Canada; Dr. Ravindran is with Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada, and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Dr. Sheehan is with Department of Psychiatry and Behavioral Health, University of South Florida College of Medicine, Tampa, Florida, USA; Dr. Sills was with OCBN, Toronto, Ontario, Canada; Dr. Williams is with Columbia University, New York, New York, USA, and Medavante Inc., Trenton, New Jersey, USA
| | - Raymond W Lam
- Dr. Vaccarino is with Indoc Research, Toronto, Ontario, Canada; Dr. Evans is with Indoc Research, Toronto, Ontario, Canada, and Department of Pathology and Molecular Medicine, Queen's University, Kingston, Ontario, Canada; Dr. Kalali is with Quintiles Inc, San Diego, California, USA, and Department of Psychiatry, University of California, San Diego, California, USA; Drs. Kennedy and Placenza are with University Health Network, Toronto, Ontario, Canada; Dr. Engelhardt is with Cronos Clinical Consulting Services, Lambertville, New Jersey, USA; Dr. Frey is with Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada, and Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare, Hamilton, Ontario, Canada; Dr. Greist is with Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA; Dr. Kobak is with Center for Telepsychology, Madison, Wisconsin, USA; Dr. Lam is with Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada; Dr. MacQueen is with Mathison Centre for Mental Health Research and Education, Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada; Dr. Milev is with Department of Psychiatry, Queen's University, Kingston, Ontario, Canada; Dr. Ravindran is with Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada, and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Dr. Sheehan is with Department of Psychiatry and Behavioral Health, University of South Florida College of Medicine, Tampa, Florida, USA; Dr. Sills was with OCBN, Toronto, Ontario, Canada; Dr. Williams is with Columbia University, New York, New York, USA, and Medavante Inc., Trenton, New Jersey, USA
| | - Glenda MacQueen
- Dr. Vaccarino is with Indoc Research, Toronto, Ontario, Canada; Dr. Evans is with Indoc Research, Toronto, Ontario, Canada, and Department of Pathology and Molecular Medicine, Queen's University, Kingston, Ontario, Canada; Dr. Kalali is with Quintiles Inc, San Diego, California, USA, and Department of Psychiatry, University of California, San Diego, California, USA; Drs. Kennedy and Placenza are with University Health Network, Toronto, Ontario, Canada; Dr. Engelhardt is with Cronos Clinical Consulting Services, Lambertville, New Jersey, USA; Dr. Frey is with Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada, and Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare, Hamilton, Ontario, Canada; Dr. Greist is with Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA; Dr. Kobak is with Center for Telepsychology, Madison, Wisconsin, USA; Dr. Lam is with Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada; Dr. MacQueen is with Mathison Centre for Mental Health Research and Education, Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada; Dr. Milev is with Department of Psychiatry, Queen's University, Kingston, Ontario, Canada; Dr. Ravindran is with Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada, and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Dr. Sheehan is with Department of Psychiatry and Behavioral Health, University of South Florida College of Medicine, Tampa, Florida, USA; Dr. Sills was with OCBN, Toronto, Ontario, Canada; Dr. Williams is with Columbia University, New York, New York, USA, and Medavante Inc., Trenton, New Jersey, USA
| | - Roumen Milev
- Dr. Vaccarino is with Indoc Research, Toronto, Ontario, Canada; Dr. Evans is with Indoc Research, Toronto, Ontario, Canada, and Department of Pathology and Molecular Medicine, Queen's University, Kingston, Ontario, Canada; Dr. Kalali is with Quintiles Inc, San Diego, California, USA, and Department of Psychiatry, University of California, San Diego, California, USA; Drs. Kennedy and Placenza are with University Health Network, Toronto, Ontario, Canada; Dr. Engelhardt is with Cronos Clinical Consulting Services, Lambertville, New Jersey, USA; Dr. Frey is with Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada, and Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare, Hamilton, Ontario, Canada; Dr. Greist is with Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA; Dr. Kobak is with Center for Telepsychology, Madison, Wisconsin, USA; Dr. Lam is with Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada; Dr. MacQueen is with Mathison Centre for Mental Health Research and Education, Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada; Dr. Milev is with Department of Psychiatry, Queen's University, Kingston, Ontario, Canada; Dr. Ravindran is with Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada, and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Dr. Sheehan is with Department of Psychiatry and Behavioral Health, University of South Florida College of Medicine, Tampa, Florida, USA; Dr. Sills was with OCBN, Toronto, Ontario, Canada; Dr. Williams is with Columbia University, New York, New York, USA, and Medavante Inc., Trenton, New Jersey, USA
| | - Franca M Placenza
- Dr. Vaccarino is with Indoc Research, Toronto, Ontario, Canada; Dr. Evans is with Indoc Research, Toronto, Ontario, Canada, and Department of Pathology and Molecular Medicine, Queen's University, Kingston, Ontario, Canada; Dr. Kalali is with Quintiles Inc, San Diego, California, USA, and Department of Psychiatry, University of California, San Diego, California, USA; Drs. Kennedy and Placenza are with University Health Network, Toronto, Ontario, Canada; Dr. Engelhardt is with Cronos Clinical Consulting Services, Lambertville, New Jersey, USA; Dr. Frey is with Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada, and Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare, Hamilton, Ontario, Canada; Dr. Greist is with Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA; Dr. Kobak is with Center for Telepsychology, Madison, Wisconsin, USA; Dr. Lam is with Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada; Dr. MacQueen is with Mathison Centre for Mental Health Research and Education, Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada; Dr. Milev is with Department of Psychiatry, Queen's University, Kingston, Ontario, Canada; Dr. Ravindran is with Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada, and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Dr. Sheehan is with Department of Psychiatry and Behavioral Health, University of South Florida College of Medicine, Tampa, Florida, USA; Dr. Sills was with OCBN, Toronto, Ontario, Canada; Dr. Williams is with Columbia University, New York, New York, USA, and Medavante Inc., Trenton, New Jersey, USA
| | - Arun V Ravindran
- Dr. Vaccarino is with Indoc Research, Toronto, Ontario, Canada; Dr. Evans is with Indoc Research, Toronto, Ontario, Canada, and Department of Pathology and Molecular Medicine, Queen's University, Kingston, Ontario, Canada; Dr. Kalali is with Quintiles Inc, San Diego, California, USA, and Department of Psychiatry, University of California, San Diego, California, USA; Drs. Kennedy and Placenza are with University Health Network, Toronto, Ontario, Canada; Dr. Engelhardt is with Cronos Clinical Consulting Services, Lambertville, New Jersey, USA; Dr. Frey is with Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada, and Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare, Hamilton, Ontario, Canada; Dr. Greist is with Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA; Dr. Kobak is with Center for Telepsychology, Madison, Wisconsin, USA; Dr. Lam is with Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada; Dr. MacQueen is with Mathison Centre for Mental Health Research and Education, Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada; Dr. Milev is with Department of Psychiatry, Queen's University, Kingston, Ontario, Canada; Dr. Ravindran is with Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada, and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Dr. Sheehan is with Department of Psychiatry and Behavioral Health, University of South Florida College of Medicine, Tampa, Florida, USA; Dr. Sills was with OCBN, Toronto, Ontario, Canada; Dr. Williams is with Columbia University, New York, New York, USA, and Medavante Inc., Trenton, New Jersey, USA
| | - David V Sheehan
- Dr. Vaccarino is with Indoc Research, Toronto, Ontario, Canada; Dr. Evans is with Indoc Research, Toronto, Ontario, Canada, and Department of Pathology and Molecular Medicine, Queen's University, Kingston, Ontario, Canada; Dr. Kalali is with Quintiles Inc, San Diego, California, USA, and Department of Psychiatry, University of California, San Diego, California, USA; Drs. Kennedy and Placenza are with University Health Network, Toronto, Ontario, Canada; Dr. Engelhardt is with Cronos Clinical Consulting Services, Lambertville, New Jersey, USA; Dr. Frey is with Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada, and Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare, Hamilton, Ontario, Canada; Dr. Greist is with Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA; Dr. Kobak is with Center for Telepsychology, Madison, Wisconsin, USA; Dr. Lam is with Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada; Dr. MacQueen is with Mathison Centre for Mental Health Research and Education, Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada; Dr. Milev is with Department of Psychiatry, Queen's University, Kingston, Ontario, Canada; Dr. Ravindran is with Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada, and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Dr. Sheehan is with Department of Psychiatry and Behavioral Health, University of South Florida College of Medicine, Tampa, Florida, USA; Dr. Sills was with OCBN, Toronto, Ontario, Canada; Dr. Williams is with Columbia University, New York, New York, USA, and Medavante Inc., Trenton, New Jersey, USA
| | - Terrence Sills
- Dr. Vaccarino is with Indoc Research, Toronto, Ontario, Canada; Dr. Evans is with Indoc Research, Toronto, Ontario, Canada, and Department of Pathology and Molecular Medicine, Queen's University, Kingston, Ontario, Canada; Dr. Kalali is with Quintiles Inc, San Diego, California, USA, and Department of Psychiatry, University of California, San Diego, California, USA; Drs. Kennedy and Placenza are with University Health Network, Toronto, Ontario, Canada; Dr. Engelhardt is with Cronos Clinical Consulting Services, Lambertville, New Jersey, USA; Dr. Frey is with Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada, and Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare, Hamilton, Ontario, Canada; Dr. Greist is with Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA; Dr. Kobak is with Center for Telepsychology, Madison, Wisconsin, USA; Dr. Lam is with Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada; Dr. MacQueen is with Mathison Centre for Mental Health Research and Education, Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada; Dr. Milev is with Department of Psychiatry, Queen's University, Kingston, Ontario, Canada; Dr. Ravindran is with Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada, and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Dr. Sheehan is with Department of Psychiatry and Behavioral Health, University of South Florida College of Medicine, Tampa, Florida, USA; Dr. Sills was with OCBN, Toronto, Ontario, Canada; Dr. Williams is with Columbia University, New York, New York, USA, and Medavante Inc., Trenton, New Jersey, USA
| | - Janet B W Williams
- Dr. Vaccarino is with Indoc Research, Toronto, Ontario, Canada; Dr. Evans is with Indoc Research, Toronto, Ontario, Canada, and Department of Pathology and Molecular Medicine, Queen's University, Kingston, Ontario, Canada; Dr. Kalali is with Quintiles Inc, San Diego, California, USA, and Department of Psychiatry, University of California, San Diego, California, USA; Drs. Kennedy and Placenza are with University Health Network, Toronto, Ontario, Canada; Dr. Engelhardt is with Cronos Clinical Consulting Services, Lambertville, New Jersey, USA; Dr. Frey is with Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada, and Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare, Hamilton, Ontario, Canada; Dr. Greist is with Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA; Dr. Kobak is with Center for Telepsychology, Madison, Wisconsin, USA; Dr. Lam is with Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada; Dr. MacQueen is with Mathison Centre for Mental Health Research and Education, Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada; Dr. Milev is with Department of Psychiatry, Queen's University, Kingston, Ontario, Canada; Dr. Ravindran is with Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada, and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Dr. Sheehan is with Department of Psychiatry and Behavioral Health, University of South Florida College of Medicine, Tampa, Florida, USA; Dr. Sills was with OCBN, Toronto, Ontario, Canada; Dr. Williams is with Columbia University, New York, New York, USA, and Medavante Inc., Trenton, New Jersey, USA
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MacQueen GM, Frey BN, Ismail Z, Jaworska N, Steiner M, Lieshout RJV, Kennedy SH, Lam RW, Milev RV, Parikh SV, Ravindran AV. Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder: Section 6. Special Populations: Youth, Women, and the Elderly. Can J Psychiatry 2016; 61:588-603. [PMID: 27486149 PMCID: PMC4994788 DOI: 10.1177/0706743716659276] [Citation(s) in RCA: 137] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND The Canadian Network for Mood and Anxiety Treatments (CANMAT) conducted a revision of the 2009 guidelines by updating the evidence and recommendations. The scope of the 2016 guidelines remains the management of major depressive disorder (MDD) in adults, with a target audience of psychiatrists and other mental health professionals. METHODS Using the question-answer format, we conducted a systematic literature search focusing on systematic reviews and meta-analyses. Evidence was graded using CANMAT-defined criteria for level of evidence. Recommendations for lines of treatment were based on the quality of evidence and clinical expert consensus. This section on "Special Populations" is the sixth of six guidelines articles. RESULTS Recent studies inform the treatment of MDD in children and adolescents, pregnant and breastfeeding women, women in perimenopause or menopause, and the elderly. Evidence for efficacy of treatments in these populations is more limited than for the general adult population, however, and risks of treatment in these groups are often poorly studied and reported. CONCLUSIONS Despite the limited evidence base, extant data and clinical experience suggest that each of these special populations can benefit from the systematic application of treatment guidelines for treatment of MDD.
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Affiliation(s)
| | - Benicio N Frey
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario
| | - Zahinoor Ismail
- Department of Psychiatry, University of Calgary, Calgary, Alberta
| | | | - Meir Steiner
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario
| | - Ryan J Van Lieshout
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario
| | - Sidney H Kennedy
- Department of Psychiatry, University of Toronto, Toronto, Ontario
| | - Raymond W Lam
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia
| | - Roumen V Milev
- Department of Psychiatry, Queen's University, Kingston, Ontario
| | - Sagar V Parikh
- Department of Psychiatry, University of Toronto, Toronto, Ontario Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
| | - Arun V Ravindran
- Department of Psychiatry, University of Toronto, Toronto, Ontario
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Parikh SV, Quilty LC, Ravitz P, Rosenbluth M, Pavlova B, Grigoriadis S, Velyvis V, Kennedy SH, Lam RW, MacQueen GM, Milev RV, Ravindran AV, Uher R. Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder: Section 2. Psychological Treatments. Can J Psychiatry 2016; 61:524-39. [PMID: 27486150 PMCID: PMC4994791 DOI: 10.1177/0706743716659418] [Citation(s) in RCA: 196] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND The Canadian Network for Mood and Anxiety Treatments (CANMAT) has revised its 2009 guidelines for the management of major depressive disorder (MDD) in adults by updating the evidence and recommendations. The target audiences for these 2016 guidelines are psychiatrists and other mental health professionals. METHODS Using the question-answer format, we conducted a systematic literature search focusing on systematic reviews and meta-analyses. Evidence was graded using CANMAT-defined criteria for level of evidence. Recommendations for lines of treatment were based on the quality of evidence and clinical expert consensus. "Psychological Treatments" is the second of six sections of the 2016 guidelines. RESULTS Evidence-informed responses were developed for 25 questions under 5 broad categories: 1) patient characteristics relevant to using psychological interventions; 2) therapist and health system characteristics associated with optimizing outcomes; 3) descriptions of major psychotherapies and their efficacy; 4) additional psychological interventions, such as peer interventions and computer- and technology-delivered interventions; and 5) combining and/or sequencing psychological and pharmacological interventions. CONCLUSIONS First-line psychological treatment recommendations for acute MDD include cognitive-behavioural therapy (CBT), interpersonal therapy (IPT), and behavioural activation (BA). Second-line recommendations include computer-based and telephone-delivered psychotherapy. Where feasible, combining psychological treatment (CBT or IPT) with antidepressant treatment is recommended because combined treatment is superior to either treatment alone. First-line psychological treatments for maintenance include CBT and mindfulness-based cognitive therapy (MBCT). Patient preference, in combination with evidence-based treatments and clinician/system capacity, will yield the optimal treatment strategies for improving individual outcomes in MDD.
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Affiliation(s)
- Sagar V Parikh
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan Department of Psychiatry, University of Toronto, Toronto, Ontario
| | - Lena C Quilty
- Department of Psychiatry, University of Toronto, Toronto, Ontario
| | - Paula Ravitz
- Department of Psychiatry, University of Toronto, Toronto, Ontario
| | | | - Barbara Pavlova
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia
| | | | | | - Sidney H Kennedy
- Department of Psychiatry, University of Toronto, Toronto, Ontario
| | - Raymond W Lam
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia
| | | | - Roumen V Milev
- Department of Psychiatry, Queen's University, Kingston, Ontario
| | - Arun V Ravindran
- Department of Psychiatry, University of Toronto, Toronto, Ontario
| | - Rudolf Uher
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia
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Milev RV, Giacobbe P, Kennedy SH, Blumberger DM, Daskalakis ZJ, Downar J, Modirrousta M, Patry S, Vila-Rodriguez F, Lam RW, MacQueen GM, Parikh SV, Ravindran AV. Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder: Section 4. Neurostimulation Treatments. Can J Psychiatry 2016; 61:561-75. [PMID: 27486154 PMCID: PMC4994792 DOI: 10.1177/0706743716660033] [Citation(s) in RCA: 336] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND The Canadian Network for Mood and Anxiety Treatments (CANMAT) conducted a revision of the 2009 guidelines by updating the evidence and recommendations. The scope of the 2016 guidelines remains the management of major depressive disorder (MDD) in adults, with a target audience of psychiatrists and other mental health professionals. METHODS Using the question-answer format, we conducted a systematic literature search focusing on systematic reviews and meta-analyses. Evidence was graded using CANMAT-defined criteria for level of evidence. Recommendations for lines of treatment were based on the quality of evidence and clinical expert consensus. "Neurostimulation Treatments" is the fourth of six sections of the 2016 guidelines. RESULTS Evidence-informed responses were developed for 31 questions for 6 neurostimulation modalities: 1) transcranial direct current stimulation (tDCS), 2) repetitive transcranial magnetic stimulation (rTMS), 3) electroconvulsive therapy (ECT), 4) magnetic seizure therapy (MST), 5) vagus nerve stimulation (VNS), and 6) deep brain stimulation (DBS). Most of the neurostimulation treatments have been investigated in patients with varying degrees of treatment resistance. CONCLUSIONS There is increasing evidence for efficacy, tolerability, and safety of neurostimulation treatments. rTMS is now a first-line recommendation for patients with MDD who have failed at least 1 antidepressant. ECT remains a second-line treatment for patients with treatment-resistant depression, although in some situations, it may be considered first line. Third-line recommendations include tDCS and VNS. MST and DBS are still considered investigational treatments.
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Affiliation(s)
- Roumen V Milev
- Department of Psychiatry, Queen's University, Kingston, Ontario
| | - Peter Giacobbe
- Department of Psychiatry, University of Toronto, Toronto, Ontario
| | - Sidney H Kennedy
- Department of Psychiatry, University of Toronto, Toronto, Ontario
| | | | | | - Jonathan Downar
- Department of Psychiatry, University of Toronto, Toronto, Ontario
| | | | - Simon Patry
- Department of Psychiatry, L'Université Laval, Québec City, Québec
| | - Fidel Vila-Rodriguez
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia
| | - Raymond W Lam
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia
| | | | - Sagar V Parikh
- Department of Psychiatry, University of Toronto, Toronto, Ontario Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
| | - Arun V Ravindran
- Department of Psychiatry, University of Toronto, Toronto, Ontario
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Ravindran AV, Balneaves LG, Faulkner G, Ortiz A, McIntosh D, Morehouse RL, Ravindran L, Yatham LN, Kennedy SH, Lam RW, MacQueen GM, Milev RV, Parikh SV. Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder: Section 5. Complementary and Alternative Medicine Treatments. Can J Psychiatry 2016; 61:576-87. [PMID: 27486153 PMCID: PMC4994794 DOI: 10.1177/0706743716660290] [Citation(s) in RCA: 164] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND The Canadian Network for Mood and Anxiety Treatments (CANMAT) conducted a revision of the 2009 guidelines by updating the evidence and recommendations. The scope of the 2016 guidelines remains the management of major depressive disorder (MDD) in adults, with a target audience of psychiatrists and other mental health professionals. METHODS Using the question-answer format, we conducted a systematic literature search focusing on systematic reviews and meta-analyses. Evidence was graded using CANMAT-defined criteria for level of evidence. Recommendations for lines of treatment were based on the quality of evidence and clinical expert consensus. "Complementary and Alternative Medicine Treatments" is the fifth of six sections of the 2016 guidelines. RESULTS Evidence-informed responses were developed for 12 questions for 2 broad categories of complementary and alternative medicine (CAM) interventions: 1) physical and meditative treatments (light therapy, sleep deprivation, exercise, yoga, and acupuncture) and 2) natural health products (St. John's wort, omega-3 fatty acids; S-adenosyl-L-methionine [SAM-e], dehydroepiandrosterone, folate, Crocus sativus, and others). Recommendations were based on available data on efficacy, tolerability, and safety. CONCLUSIONS For MDD of mild to moderate severity, exercise, light therapy, St. John's wort, omega-3 fatty acids, SAM-e, and yoga are recommended as first- or second-line treatments. Adjunctive exercise and adjunctive St. John's wort are second-line recommendations for moderate to severe MDD. Other physical treatments and natural health products have less evidence but may be considered as third-line treatments. CAM treatments are generally well tolerated. Caveats include methodological limitations of studies and paucity of data on long-term outcomes and drug interactions.
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Affiliation(s)
- Arun V Ravindran
- Department of Psychiatry, University of Toronto, Toronto, Ontario
| | | | - Guy Faulkner
- School of Kinesiology, University of British Columbia, Vancouver, British Columbia
| | - Abigail Ortiz
- Department of Psychiatry, University of Ottawa, Ottawa, Ontario
| | - Diane McIntosh
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia
| | | | | | - Lakshmi N Yatham
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia
| | - Sidney H Kennedy
- Department of Psychiatry, University of Toronto, Toronto, Ontario
| | - Raymond W Lam
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia
| | | | - Roumen V Milev
- Department of Psychiatry, Queen's University, Kingston, Ontario
| | - Sagar V Parikh
- Department of Psychiatry, University of Toronto, Toronto, Ontario Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
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Lam RW, Kennedy SH, Parikh SV, MacQueen GM, Milev RV, Ravindran AV. Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder: Introduction and Methods. Can J Psychiatry 2016; 61:506-9. [PMID: 27486152 PMCID: PMC4994787 DOI: 10.1177/0706743716659061] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Raymond W Lam
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia * Co-first authors.
| | - Sidney H Kennedy
- Department of Psychiatry, University of Toronto, Toronto, Ontario * Co-first authors
| | - Sagar V Parikh
- Department of Psychiatry, University of Toronto, Toronto, Ontario Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
| | | | - Roumen V Milev
- Department of Psychiatry, Queen's University, Kingston, Ontario
| | - Arun V Ravindran
- Department of Psychiatry, University of Toronto, Toronto, Ontario
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Cipriani A, Zhou X, Del Giovane C, Hetrick SE, Qin B, Whittington C, Coghill D, Zhang Y, Hazell P, Leucht S, Cuijpers P, Pu J, Cohen D, Ravindran AV, Liu Y, Michael KD, Yang L, Liu L, Xie P. Comparative efficacy and tolerability of antidepressants for major depressive disorder in children and adolescents: a network meta-analysis. Lancet 2016; 388:881-90. [PMID: 27289172 DOI: 10.1016/s0140-6736(16)30385-3] [Citation(s) in RCA: 388] [Impact Index Per Article: 48.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Major depressive disorder is one of the most common mental disorders in children and adolescents. However, whether to use pharmacological interventions in this population and which drug should be preferred are still matters of controversy. Consequently, we aimed to compare and rank antidepressants and placebo for major depressive disorder in young people. METHODS We did a network meta-analysis to identify both direct and indirect evidence from relevant trials. We searched PubMed, the Cochrane Library, Web of Science, Embase, CINAHL, PsycINFO, LiLACS, regulatory agencies' websites, and international registers for published and unpublished, double-blind randomised controlled trials up to May 31, 2015, for the acute treatment of major depressive disorder in children and adolescents. We included trials of amitriptyline, citalopram, clomipramine, desipramine, duloxetine, escitalopram, fluoxetine, imipramine, mirtazapine, nefazodone, nortriptyline, paroxetine, sertraline, and venlafaxine. Trials recruiting participants with treatment-resistant depression, treatment duration of less than 4 weeks, or an overall sample size of less than ten patients were excluded. We extracted the relevant information from the published reports with a predefined data extraction sheet, and assessed the risk of bias with the Cochrane risk of bias tool. The primary outcomes were efficacy (change in depressive symptoms) and tolerability (discontinuations due to adverse events). We did pair-wise meta-analyses using the random-effects model and then did a random-effects network meta-analysis within a Bayesian framework. We assessed the quality of evidence contributing to each network estimate using the GRADE framework. This study is registered with PROSPERO, number CRD42015016023. FINDINGS We deemed 34 trials eligible, including 5260 participants and 14 antidepressant treatments. The quality of evidence was rated as very low in most comparisons. For efficacy, only fluoxetine was statistically significantly more effective than placebo (standardised mean difference -0·51, 95% credible interval [CrI] -0·99 to -0·03). In terms of tolerability, fluoxetine was also better than duloxetine (odds ratio [OR] 0·31, 95% CrI 0·13 to 0·95) and imipramine (0·23, 0·04 to 0·78). Patients given imipramine, venlafaxine, and duloxetine had more discontinuations due to adverse events than did those given placebo (5·49, 1·96 to 20·86; 3·19, 1·01 to 18·70; and 2·80, 1·20 to 9·42, respectively). In terms of heterogeneity, the global I(2) values were 33·21% for efficacy and 0% for tolerability. INTERPRETATION When considering the risk-benefit profile of antidepressants in the acute treatment of major depressive disorder, these drugs do not seem to offer a clear advantage for children and adolescents. Fluoxetine is probably the best option to consider when a pharmacological treatment is indicated. FUNDING National Basic Research Program of China (973 Program).
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Affiliation(s)
| | - Xinyu Zhou
- Department of Neurology and Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China; Institute of Neuroscience and the Collaborative Innovation Center for Brain Science, Chongqing Medical University, Chongqing, China
| | - Cinzia Del Giovane
- Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Sarah E Hetrick
- Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Bin Qin
- Department of Neurology and Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China; Institute of Neuroscience and the Collaborative Innovation Center for Brain Science, Chongqing Medical University, Chongqing, China
| | | | - David Coghill
- Division of Neuroscience, School of Medicine, University of Dundee, Dundee, UK; Department of Paediatrics, and Department of Psychiatry, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Yuqing Zhang
- Department of Neurology and Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China; Institute of Neuroscience and the Collaborative Innovation Center for Brain Science, Chongqing Medical University, Chongqing, China
| | - Philip Hazell
- Discipline of Psychiatry, Sydney Medical School, Concord West, NSW, Australia
| | - Stefan Leucht
- Department of Psychiatry and Psychotherapy, Technische Universität München, Munich, Germany
| | - Pim Cuijpers
- Department of Clinical, Neuro- and Developmental Psychology, VU University Amsterdam, Amsterdam, Netherlands
| | - Juncai Pu
- Department of Neurology and Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China; Institute of Neuroscience and the Collaborative Innovation Center for Brain Science, Chongqing Medical University, Chongqing, China
| | - David Cohen
- Department of Child and Adolescent Psychiatry, Hôpital Pitié-Salpétrière, Institut des Systèmes Intelligents et Robotiques, Université Pierre et Marie Curie, Paris, France
| | - Arun V Ravindran
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Yiyun Liu
- Department of Neurology and Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China; Institute of Neuroscience and the Collaborative Innovation Center for Brain Science, Chongqing Medical University, Chongqing, China
| | - Kurt D Michael
- Department of Psychology, Appalachian State University, Boone, NC, USA
| | - Lining Yang
- Department of Neurology and Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China; Institute of Neuroscience and the Collaborative Innovation Center for Brain Science, Chongqing Medical University, Chongqing, China
| | - Lanxiang Liu
- Department of Neurology and Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China; Institute of Neuroscience and the Collaborative Innovation Center for Brain Science, Chongqing Medical University, Chongqing, China
| | - Peng Xie
- Department of Neurology and Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China; Institute of Neuroscience and the Collaborative Innovation Center for Brain Science, Chongqing Medical University, Chongqing, China; South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.
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Ravindran AV, Herrera A, Kutcher S, Henderson J, Herrera A, Kutcher S, Henderson J, Castrillo M, Ramirez J, Da Silva TL. Improving youth well-being in Nicaragua through mental health education:
A pilot project. Ann Glob Health 2016. [DOI: 10.1016/j.aogh.2016.04.566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Lam RW, Milev R, Rotzinger S, Andreazza AC, Blier P, Brenner C, Daskalakis ZJ, Dharsee M, Downar J, Evans KR, Farzan F, Foster JA, Frey BN, Geraci J, Giacobbe P, Feilotter HE, Hall GB, Harkness KL, Hassel S, Ismail Z, Leri F, Liotti M, MacQueen GM, McAndrews MP, Minuzzi L, Müller DJ, Parikh SV, Placenza FM, Quilty LC, Ravindran AV, Salomons TV, Soares CN, Strother SC, Turecki G, Vaccarino AL, Vila-Rodriguez F, Kennedy SH. Discovering biomarkers for antidepressant response: protocol from the Canadian biomarker integration network in depression (CAN-BIND) and clinical characteristics of the first patient cohort. BMC Psychiatry 2016; 16:105. [PMID: 27084692 PMCID: PMC4833905 DOI: 10.1186/s12888-016-0785-x] [Citation(s) in RCA: 98] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 03/18/2016] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Major Depressive Disorder (MDD) is among the most prevalent and disabling medical conditions worldwide. Identification of clinical and biological markers ("biomarkers") of treatment response could personalize clinical decisions and lead to better outcomes. This paper describes the aims, design, and methods of a discovery study of biomarkers in antidepressant treatment response, conducted by the Canadian Biomarker Integration Network in Depression (CAN-BIND). The CAN-BIND research program investigates and identifies biomarkers that help to predict outcomes in patients with MDD treated with antidepressant medication. The primary objective of this initial study (known as CAN-BIND-1) is to identify individual and integrated neuroimaging, electrophysiological, molecular, and clinical predictors of response to sequential antidepressant monotherapy and adjunctive therapy in MDD. METHODS CAN-BIND-1 is a multisite initiative involving 6 academic health centres working collaboratively with other universities and research centres. In the 16-week protocol, patients with MDD are treated with a first-line antidepressant (escitalopram 10-20 mg/d) that, if clinically warranted after eight weeks, is augmented with an evidence-based, add-on medication (aripiprazole 2-10 mg/d). Comprehensive datasets are obtained using clinical rating scales; behavioural, dimensional, and functioning/quality of life measures; neurocognitive testing; genomic, genetic, and proteomic profiling from blood samples; combined structural and functional magnetic resonance imaging; and electroencephalography. De-identified data from all sites are aggregated within a secure neuroinformatics platform for data integration, management, storage, and analyses. Statistical analyses will include multivariate and machine-learning techniques to identify predictors, moderators, and mediators of treatment response. DISCUSSION From June 2013 to February 2015, a cohort of 134 participants (85 outpatients with MDD and 49 healthy participants) has been evaluated at baseline. The clinical characteristics of this cohort are similar to other studies of MDD. Recruitment at all sites is ongoing to a target sample of 290 participants. CAN-BIND will identify biomarkers of treatment response in MDD through extensive clinical, molecular, and imaging assessments, in order to improve treatment practice and clinical outcomes. It will also create an innovative, robust platform and database for future research. TRIAL REGISTRATION ClinicalTrials.gov identifier NCT01655706 . Registered July 27, 2012.
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Affiliation(s)
- Raymond W Lam
- University of British Columbia and Vancouver Coastal Health Authority, 2255 Wesbrook Mall, Vancouver, BC, V6T 2A1, Canada
| | - Roumen Milev
- Queen's University, Providence Care, Mental Health Services 752 King Street West, Postal Bag 603, Kingston, ON, K7L 7X3, Canada
| | - Susan Rotzinger
- University Health Network, 399 Bathurst Street, Toronto, ON, M5T 2S8, Canada.,Department of Psychiatry, University of Toronto, 250 College Street, 8th floor, Toronto, ON, M5T 1R8, Canada
| | - Ana C Andreazza
- Department of Psychiatry, University of Toronto, 250 College Street, 8th floor, Toronto, ON, M5T 1R8, Canada.,Centre for Addiction and Mental Health, 1001 Queen St. W, Toronto, ON, M6J 1A8, Canada
| | - Pierre Blier
- University of Ottawa Institute of Mental Health Research, 1145 Carling Avenue, Ottawa, ON, K1Z 7K4, Canada
| | - Colleen Brenner
- Loma Linda University, 24851 Circle Dr, Loma Linda, CA, 92354, USA
| | - Zafiris J Daskalakis
- Department of Psychiatry, University of Toronto, 250 College Street, 8th floor, Toronto, ON, M5T 1R8, Canada.,Centre for Addiction and Mental Health, 1001 Queen St. W, Toronto, ON, M6J 1A8, Canada
| | - Moyez Dharsee
- Indoc Research, 258 Adelaide St. East, Suite 200, Toronto, ON, M5A 1N1, Canada
| | - Jonathan Downar
- University Health Network, 399 Bathurst Street, Toronto, ON, M5T 2S8, Canada.,Department of Psychiatry, University of Toronto, 250 College Street, 8th floor, Toronto, ON, M5T 1R8, Canada
| | - Kenneth R Evans
- Indoc Research, 258 Adelaide St. East, Suite 200, Toronto, ON, M5A 1N1, Canada.,Department of Pathology and Molecular Medicine, Queen's University, 88 Stuart Street, Kingston, ON, K7L 3N6, Canada
| | - Faranak Farzan
- Department of Psychiatry, University of Toronto, 250 College Street, 8th floor, Toronto, ON, M5T 1R8, Canada.,Centre for Addiction and Mental Health, 1001 Queen St. W, Toronto, ON, M6J 1A8, Canada
| | - Jane A Foster
- University Health Network, 399 Bathurst Street, Toronto, ON, M5T 2S8, Canada.,McMaster University, and St. Joseph's Healthcare Hamilton, 1280 Main Street West, Hamilton, ON, L8S4L8, Canada
| | - Benicio N Frey
- McMaster University, and St. Joseph's Healthcare Hamilton, 1280 Main Street West, Hamilton, ON, L8S4L8, Canada
| | - Joseph Geraci
- University Health Network, 399 Bathurst Street, Toronto, ON, M5T 2S8, Canada
| | - Peter Giacobbe
- University Health Network, 399 Bathurst Street, Toronto, ON, M5T 2S8, Canada.,Department of Psychiatry, University of Toronto, 250 College Street, 8th floor, Toronto, ON, M5T 1R8, Canada
| | - Harriet E Feilotter
- Indoc Research, 258 Adelaide St. East, Suite 200, Toronto, ON, M5A 1N1, Canada.,Department of Pathology and Molecular Medicine, Queen's University, 88 Stuart Street, Kingston, ON, K7L 3N6, Canada
| | - Geoffrey B Hall
- McMaster University, and St. Joseph's Healthcare Hamilton, 1280 Main Street West, Hamilton, ON, L8S4L8, Canada
| | - Kate L Harkness
- Department of Psychology, Queen's University, Kingston, ON, K7L 3N6, Canada
| | - Stefanie Hassel
- Aston University, Aston Triangle, Birmingham, West Midlands, B4 7ET, UK
| | - Zahinoor Ismail
- University of Calgary Hotchkiss Brain Institute, 2500 University Dr NW, Calgary, AB, T2N 1N4, Canada
| | - Francesco Leri
- University of Guelph, 50 Stone Rd E, Guelph, ON, N1G 2W1, Canada
| | - Mario Liotti
- Simon Fraser University, 8888 University Dr, Burnaby, BC, V5A 1S6, Canada
| | - Glenda M MacQueen
- University of Calgary Hotchkiss Brain Institute, 2500 University Dr NW, Calgary, AB, T2N 1N4, Canada
| | - Mary Pat McAndrews
- University Health Network, 399 Bathurst Street, Toronto, ON, M5T 2S8, Canada
| | - Luciano Minuzzi
- McMaster University, and St. Joseph's Healthcare Hamilton, 1280 Main Street West, Hamilton, ON, L8S4L8, Canada
| | - Daniel J Müller
- Department of Psychiatry, University of Toronto, 250 College Street, 8th floor, Toronto, ON, M5T 1R8, Canada.,Centre for Addiction and Mental Health, 1001 Queen St. W, Toronto, ON, M6J 1A8, Canada
| | - Sagar V Parikh
- Universisty of Michigan, 500S State St, Ann Arbor, MI, 48109, USA
| | - Franca M Placenza
- University Health Network, 399 Bathurst Street, Toronto, ON, M5T 2S8, Canada
| | - Lena C Quilty
- Department of Psychiatry, University of Toronto, 250 College Street, 8th floor, Toronto, ON, M5T 1R8, Canada.,Centre for Addiction and Mental Health, 1001 Queen St. W, Toronto, ON, M6J 1A8, Canada
| | - Arun V Ravindran
- Department of Psychiatry, University of Toronto, 250 College Street, 8th floor, Toronto, ON, M5T 1R8, Canada.,Centre for Addiction and Mental Health, 1001 Queen St. W, Toronto, ON, M6J 1A8, Canada
| | - Tim V Salomons
- University of Reading, Earley Gate, Whiteknights, Reading, RG6 6AL, UK
| | - Claudio N Soares
- St. Michael's Hospital, 193 Yonge St, Toronto, ON, M5B 1M4, Canada
| | - Stephen C Strother
- Rotman Research Institute at Baycrest Centre, 3560 Bathurst Street, Toronto, ON, M6A 2E1, Canada
| | - Gustavo Turecki
- McGill University , 845 Rue Sherbrooke O, Montréal, QC, H3A 0G4, Canada.,Douglas Mental Health University Institute Frank B. Common (FBC) F-3145, 6875 LaSalle Boulevard, Montréal, QC, H4H 1R3, Canada
| | - Anthony L Vaccarino
- Indoc Research, 258 Adelaide St. East, Suite 200, Toronto, ON, M5A 1N1, Canada
| | - Fidel Vila-Rodriguez
- University of British Columbia and Vancouver Coastal Health Authority, 2255 Wesbrook Mall, Vancouver, BC, V6T 2A1, Canada
| | - Sidney H Kennedy
- University Health Network, 399 Bathurst Street, Toronto, ON, M5T 2S8, Canada. .,Department of Psychiatry, University of Toronto, 250 College Street, 8th floor, Toronto, ON, M5T 1R8, Canada. .,St. Michael's Hospital, 193 Yonge St, Toronto, ON, M5B 1M4, Canada.
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