1
|
Trombello JM, Cooper CM, Fatt CC, Grannemann BD, Carmody TJ, Jha MK, Mayes TL, Greer TL, Yezhuvath U, Aslan S, Pizzagalli DA, Weissman MM, Webb CA, Dillon DG, McGrath PJ, Fava M, Parsey RV, McInnis MG, Etkin A, Trivedi MH. Neural substrates of emotional conflict with anxiety in major depressive disorder: Findings from the Establishing Moderators and biosignatures of Antidepressant Response in Clinical Care (EMBARC) randomized controlled trial. J Psychiatr Res 2022; 149:243-251. [PMID: 35290819 PMCID: PMC9746288 DOI: 10.1016/j.jpsychires.2022.03.015] [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] [Received: 11/05/2021] [Revised: 02/16/2022] [Accepted: 03/07/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND The brain circuitry of depression and anxiety/fear is well-established, involving regions such as the limbic system and prefrontal cortex. We expand prior literature by examining the extent to which four discrete factors of anxiety (immediate state anxiety, physiological/panic, neuroticism/worry, and agitation/restlessness) among depressed outpatients are associated with differential responses during reactivity to and regulation of emotional conflict. METHODS A total of 172 subjects diagnosed with major depressive disorder underwent functional magnetic resonance imaging while performing an Emotional Stroop Task. Two main contrasts were examined using whole brain voxel wise analyses: emotional reactivity and emotion regulation. We also evaluated the association of these contrasts with the four aforementioned anxiety factors. RESULTS During emotional reactivity, participants with higher immediate state anxiety showed potentiated activation in the rolandic operculum and insula, while individuals with higher levels of physiological/panic demonstrated decreased activation in the posterior cingulate. No significant results emerged for any of the four factors on emotion regulation. When re-analyzing these statistically-significant brain regions through analyses of a subsample with (n = 92) and without (n = 80) a current anxiety disorder, no significant associations occurred among those without an anxiety disorder. Among those with an anxiety disorder, results were similar to the full sample, except the posterior cingulate was associated with the neuroticism/worry factor. CONCLUSIONS Divergent patterns of task-related brain activation across four discrete anxiety factors could be used to inform treatment decisions and target specific aspects of anxiety that involve intrinsic processing to attenuate overactive responses to emotional stimuli.
Collapse
Affiliation(s)
- Joseph M. Trombello
- Department of Psychiatry, Center for Depression Research and Clinical Care, University of Texas Southwestern Medical Center, Dallas, TX, USA,Janssen Research & Development, LLC, Titusville, NJ, USA
| | - Crystal M. Cooper
- Department of Psychiatry, Center for Depression Research and Clinical Care, University of Texas Southwestern Medical Center, Dallas, TX, USA,Neuroscience Research, Cook Children’s Medical Center, Fort Worth, TX, USA
| | - Cherise Chin Fatt
- Department of Psychiatry, Center for Depression Research and Clinical Care, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Bruce D. Grannemann
- Department of Psychiatry, Center for Depression Research and Clinical Care, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Thomas J. Carmody
- Department of Psychiatry, Center for Depression Research and Clinical Care, University of Texas Southwestern Medical Center, Dallas, TX, USA,Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Manish K. Jha
- Department of Psychiatry, Center for Depression Research and Clinical Care, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Taryn L. Mayes
- Department of Psychiatry, Center for Depression Research and Clinical Care, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Tracy L. Greer
- Department of Psychiatry, Center for Depression Research and Clinical Care, University of Texas Southwestern Medical Center, Dallas, TX, USA,Department of Psychology, The University of Texas at Arlington, Arlington, TX, USA
| | | | - Sina Aslan
- Department of Psychiatry, Center for Depression Research and Clinical Care, University of Texas Southwestern Medical Center, Dallas, TX, USA,Advance MRI LLC, Frisco, TX, USA
| | - Diego A. Pizzagalli
- Harvard Medical School, McLean Hospital, Department of Psychiatry, Boston, MA, USA
| | - Myrna M. Weissman
- Columbia University, Department of Psychiatry, New York, NY, USA,New York State Psychiatric Institute and Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY, USA
| | - Christian A. Webb
- Harvard Medical School, McLean Hospital, Department of Psychiatry, Boston, MA, USA
| | - Daniel G. Dillon
- Harvard Medical School, McLean Hospital, Department of Psychiatry, Boston, MA, USA
| | - Patrick J. McGrath
- Columbia University, Department of Psychiatry, New York, NY, USA,New York State Psychiatric Institute and Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY, USA
| | - Maurizio Fava
- Massachusetts General Hospital, Department of Psychiatry, Boston, MA, USA
| | - Ramin V. Parsey
- Stony Brook University, Department of Psychiatry, Stony Brook, NY, USA
| | - Melvin G. McInnis
- University of Michigan, Department of Psychiatry, Ann Arbor, MI, USA
| | - Amit Etkin
- Stanford University School of Medicine, Department of Psychiatry, Palo Alto, CA, USA
| | - Madhukar H. Trivedi
- Department of Psychiatry, Center for Depression Research and Clinical Care, University of Texas Southwestern Medical Center, Dallas, TX, USA,Corresponding author. Center for Depression Research and Clinical Care, Peter O’Donnell Jr. Brain Institute, University of Texas Southwestern Medical Center, USA. (M.H. Trivedi)
| |
Collapse
|
2
|
Hughes JL, Grannemann BD, Trombello JM, Martin WB, Fuller AK, Trivedi MH. Psychometric properties of the Generalized Anxiety Disorder 7-item scale in youth: Screening in a primary care sample. Ann Clin Psychiatry 2021; 33:241-250. [PMID: 34672926 DOI: 10.12788/acp.0047] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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] [Indexed: 11/20/2022]
Abstract
BACKGROUND Anxiety disorders in youth are frequently underdiagnosed and untreated, partly due to a lack of screening in primary care. The Generalized Anxiety Disorder 7-item (GAD-7) scale is a brief self-report measure designed to screen for anxiety in primary care settings. However, little is known about the psychometrics of this scale with adolescents. METHODS Participants included 579 youth age 11 to 17 years who received screening for depression in a primary care setting through a web-based application, VitalSign6, over a 4-year period. Psychometric analyses were completed based on classical test theory (CTT) and item response theory (IRT). RESULTS Using CTT and IRT methods, the GAD-7 has a unidimensional structure with good psychometric properties. In addition, the IRT analysis demonstrates that items 1 and 2 are strongly associated with the total score, and thus are good choices as a 2-item screening tool. Convergent validity was demonstrated, with high correlations between the GAD-7 and other measures of anxiety, and discriminant validity was also demonstrated, with low correlations to measures of other psychological states. CONCLUSIONS This psychometric evaluation of the GAD-7 provides support for the utility of this measure with adolescents. The GAD-2 is a good estimate of GAD-7 total score.
Collapse
Affiliation(s)
- Jennifer L Hughes
- Center for Depression Research and Clinical Care, Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Bruce D Grannemann
- Center for Depression Research and Clinical Care, Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Joseph M Trombello
- Center for Depression Research and Clinical Care, Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - W Blake Martin
- Center for Depression Research and Clinical Care, Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Anne K Fuller
- Center for Depression Research and Clinical Care, Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Madhukar H Trivedi
- Center for Depression Research and Clinical Care, Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| |
Collapse
|
3
|
Cooper CM, Chin Fatt CR, Liu P, Grannemann BD, Carmody T, Almeida JRC, Deckersbach T, Fava M, Kurian BT, Malchow AL, McGrath PJ, McInnis M, Oquendo MA, Parsey RV, Bartlett E, Weissman M, Phillips ML, Lu H, Trivedi MH. Discovery and replication of cerebral blood flow differences in major depressive disorder. Mol Psychiatry 2020; 25:1500-1510. [PMID: 31388104 DOI: 10.1038/s41380-019-0464-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [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: 10/16/2017] [Revised: 03/06/2019] [Accepted: 03/26/2019] [Indexed: 01/08/2023]
Abstract
Major depressive disorder (MDD) is a serious, heterogeneous disorder accompanied by brain-related changes, many of which are still to be discovered or refined. Arterial spin labeling (ASL) is a neuroimaging technique used to measure cerebral blood flow (CBF; perfusion) to understand brain function and detect differences among groups. CBF differences have been detected in MDD, and may reveal biosignatures of disease-state. The current work aimed to discover and replicate differences in CBF between MDD participants and healthy controls (HC) as part of the EMBARC study. Participants underwent neuroimaging at baseline, prior to starting study medication, to investigate biosignatures in MDD. Relative CBF (rCBF) was calculated and compared between 106 MDD and 36 HC EMBARC participants (whole-brain Discovery); and 58 MDD EMBARC participants and 58 HC from the DLBS study (region-of-interest Replication). Both analyses revealed reduced rCBF in the right parahippocampus, thalamus, fusiform and middle temporal gyri, as well as the left and right insula, for those with MDD relative to HC. Both samples also revealed increased rCBF in MDD relative to HC in both the left and right inferior parietal lobule, including the supramarginal and angular gyri. Cingulate and prefrontal regions did not fully replicate. Lastly, significant associations were detected between rCBF in replicated regions and clinical measures of MDD chronicity. These results (1) provide reliable evidence for ASL in detecting differences in perfusion for multiple brain regions thought to be important in MDD, and (2) highlight the potential role of using perfusion as a biosignature of MDD.
Collapse
Affiliation(s)
- Crystal M Cooper
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Cherise R Chin Fatt
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Peiying Liu
- Department of Radiology, Johns Hopkins University, Baltimore, MD, USA
| | - Bruce D Grannemann
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Thomas Carmody
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jorge R C Almeida
- Department of Psychiatry, Dell Medical School, University of Texas Austin, Austin, TX, USA
| | - Thilo Deckersbach
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Maurizio Fava
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Benji T Kurian
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Ashley L Malchow
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Patrick J McGrath
- Department of Psychiatry, Columbia University, New York State Psychiatric Institute, New York, NY, USA
| | - Melvin McInnis
- Department of Psychiatry, University of Michigan School of Medicine, Ann Arbor, MI, USA
| | - Maria A Oquendo
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ramin V Parsey
- Department of Psychiatry, Stony Brook University, Stony Brook, NY, USA
| | - Elizabeth Bartlett
- Department of Psychiatry, Columbia University, New York State Psychiatric Institute, New York, NY, USA
| | - Myrna Weissman
- Department of Psychiatry, Columbia University, New York State Psychiatric Institute, New York, NY, USA
| | - Mary L Phillips
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Hanzhang Lu
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Department of Radiology, Johns Hopkins University, Baltimore, MD, USA
| | - Madhukar H Trivedi
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA.
| |
Collapse
|
4
|
Jha MK, Grannemann BD, Trombello JM, Clark EW, Eidelman SL, Lawson T, Greer TL, Rush AJ, Trivedi MH. A Structured Approach to Detecting and Treating Depression in Primary Care: VitalSign6 Project. Ann Fam Med 2019; 17:326-335. [PMID: 31285210 PMCID: PMC6827639 DOI: 10.1370/afm.2418] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [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: 07/18/2018] [Revised: 02/15/2019] [Accepted: 03/12/2019] [Indexed: 12/21/2022] Open
Abstract
PURPOSE This report describes outcomes of an ongoing quality-improvement project (VitalSign6) in a large US metropolitan area to improve recognition, treatment, and outcomes of depressed patients in 16 primary care clinics (6 charity clinics, 6 federally qualified health care centers, 2 private clinics serving low-income populations, and 2 private clinics serving patients with either Medicare or private insurance). METHODS Inclusion in this retrospective analysis was restricted to the first 25,000 patients (aged ≥12 years) screened with the 2-item Patient Health Questionnaire (PHQ-2) in the aforementioned quality-improvement project. Further evaluations with self-reports and clinician assessments were recorded for those with positive screen (PHQ-2 >2). Data collected from August 2014 though November 2016 were available at 3 levels: (1) initial PHQ-2 (n = 25,000), (2) positive screen (n = 4,325), and (3) clinician-diagnosed depressive disorder with 18 or more weeks of enrollment (n = 2,160). RESULTS Overall, 17.3% (4,325/25,000) of patients screened positive for depression. Of positive screens, 56.1% (2,426/4,325) had clinician-diagnosed depressive disorder. Of those enrolled for 18 or more weeks, 64.8% were started on measurement-based pharmacotherapy and 8.9% referred externally. Of the 1,400 patients started on pharmacotherapy, 45.5%, 30.2%, 12.6%, and 11.6% had 0, 1, 2, and 3 or more follow-up visits, respectively. Remission rates were 20.3% (86/423), 31.6% (56/177), and 41.7% (68/163) for those with 1, 2, and 3 or more follow-up visits, respectively. Baseline characteristics associated with higher attrition were: non-white, positive drug-abuse screen, lower depression/anxiety symptom severity, and younger age. CONCLUSION Although remission rates are high in those with 3 or more follow-up visits after routine screening and treatment of depression, attrition from care is a significant issue adversely affecting outcomes.
Collapse
Affiliation(s)
- Manish K Jha
- Center for Depression Research and Clinical Care, UT Southwestern Medical Center, Dallas, Texas (Jha, Granneman, Trombello, Clark, Eidelman, Greer, Trivedi); Departments of Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, New York (Jha); Duke-National University of Singapore, Singapore (Rush); Department of Psychiatry, Duke Medical School, Durham, North Carolina (Rush); Texas Tech University-Health Sciences Center, Permian Basin, Texas (Rush)
| | - Bruce D Grannemann
- Center for Depression Research and Clinical Care, UT Southwestern Medical Center, Dallas, Texas (Jha, Granneman, Trombello, Clark, Eidelman, Greer, Trivedi); Departments of Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, New York (Jha); Duke-National University of Singapore, Singapore (Rush); Department of Psychiatry, Duke Medical School, Durham, North Carolina (Rush); Texas Tech University-Health Sciences Center, Permian Basin, Texas (Rush)
| | - Joseph M Trombello
- Center for Depression Research and Clinical Care, UT Southwestern Medical Center, Dallas, Texas (Jha, Granneman, Trombello, Clark, Eidelman, Greer, Trivedi); Departments of Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, New York (Jha); Duke-National University of Singapore, Singapore (Rush); Department of Psychiatry, Duke Medical School, Durham, North Carolina (Rush); Texas Tech University-Health Sciences Center, Permian Basin, Texas (Rush)
| | - E Will Clark
- Center for Depression Research and Clinical Care, UT Southwestern Medical Center, Dallas, Texas (Jha, Granneman, Trombello, Clark, Eidelman, Greer, Trivedi); Departments of Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, New York (Jha); Duke-National University of Singapore, Singapore (Rush); Department of Psychiatry, Duke Medical School, Durham, North Carolina (Rush); Texas Tech University-Health Sciences Center, Permian Basin, Texas (Rush)
| | - Sara Levinson Eidelman
- Center for Depression Research and Clinical Care, UT Southwestern Medical Center, Dallas, Texas (Jha, Granneman, Trombello, Clark, Eidelman, Greer, Trivedi); Departments of Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, New York (Jha); Duke-National University of Singapore, Singapore (Rush); Department of Psychiatry, Duke Medical School, Durham, North Carolina (Rush); Texas Tech University-Health Sciences Center, Permian Basin, Texas (Rush)
| | - Tiffany Lawson
- Center for Depression Research and Clinical Care, UT Southwestern Medical Center, Dallas, Texas (Jha, Granneman, Trombello, Clark, Eidelman, Greer, Trivedi); Departments of Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, New York (Jha); Duke-National University of Singapore, Singapore (Rush); Department of Psychiatry, Duke Medical School, Durham, North Carolina (Rush); Texas Tech University-Health Sciences Center, Permian Basin, Texas (Rush)
| | - Tracy L Greer
- Center for Depression Research and Clinical Care, UT Southwestern Medical Center, Dallas, Texas (Jha, Granneman, Trombello, Clark, Eidelman, Greer, Trivedi); Departments of Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, New York (Jha); Duke-National University of Singapore, Singapore (Rush); Department of Psychiatry, Duke Medical School, Durham, North Carolina (Rush); Texas Tech University-Health Sciences Center, Permian Basin, Texas (Rush)
| | - A John Rush
- Center for Depression Research and Clinical Care, UT Southwestern Medical Center, Dallas, Texas (Jha, Granneman, Trombello, Clark, Eidelman, Greer, Trivedi); Departments of Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, New York (Jha); Duke-National University of Singapore, Singapore (Rush); Department of Psychiatry, Duke Medical School, Durham, North Carolina (Rush); Texas Tech University-Health Sciences Center, Permian Basin, Texas (Rush)
| | - Madhukar H Trivedi
- Center for Depression Research and Clinical Care, UT Southwestern Medical Center, Dallas, Texas (Jha, Granneman, Trombello, Clark, Eidelman, Greer, Trivedi); Departments of Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, New York (Jha); Duke-National University of Singapore, Singapore (Rush); Department of Psychiatry, Duke Medical School, Durham, North Carolina (Rush); Texas Tech University-Health Sciences Center, Permian Basin, Texas (Rush)
| |
Collapse
|
5
|
Cooper CM, Chin Fatt CR, Jha M, Fonzo GA, Grannemann BD, Carmody T, Ali A, Aslan S, Almeida JR, Deckersbach T, Fava M, Kurian BT, McGrath PJ, McInnis M, Parsey RV, Weissman M, Phillips ML, Lu H, Etkin A, Trivedi MH. Cerebral Blood Perfusion Predicts Response to Sertraline versus Placebo for Major Depressive Disorder in the EMBARC Trial. EClinicalMedicine 2019; 10:32-41. [PMID: 31193824 PMCID: PMC6543260 DOI: 10.1016/j.eclinm.2019.04.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 04/10/2019] [Accepted: 04/11/2019] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Major Depressive Disorder (MDD) has been associated with brain-related changes. However, biomarkers have yet to be defined that could "accurately" identify antidepressant-responsive patterns and reduce the trial-and-error process in treatment selection. Cerebral blood perfusion, as measured by Arterial Spin Labelling (ASL), has been used to understand resting-state brain function, detect abnormalities in MDD, and could serve as a marker for treatment selection. As part of a larger trial to identify predictors of treatment outcome, the current investigation aimed to identify perfusion predictors of treatment response in MDD. METHODS For this secondary analysis, participants include 231 individuals with MDD from the EMBARC study, a randomised, placebo-controlled trial investigating clinical, behavioural, and biological predictors of antidepressant response. Participants received sertraline (n = 114) or placebo (n = 117) and response was monitored for 8 weeks. Pre-treatment neuroimaging was completed, including ASL. A whole-brain, voxel-wise linear mixed-effects model was conducted to identify brain regions in which perfusion levels differentially predict (moderate) treatment response. Clinical effectiveness of perfusion moderators was investigated by composite moderator analysis and remission rates. Composite moderator analysis combined the effect of individual perfusion moderators and identified which contribute to sertraline or placebo as the "preferred" treatment. Remission rates were calculated for participants "accurately" treated based on the composite moderator (lucky) versus "inaccurately" treated (unlucky). FINDINGS Perfusion levels in multiple brain regions differentially predicted improvement with sertraline over placebo. Of these regions, perfusion in the putamen and anterior insula, inferior temporal gyrus, fusiform, parahippocampus, inferior parietal lobule, and orbital frontal gyrus contributed to sertraline response. Remission rates increased from 37% for all those who received sertraline to 53% for those who were lucky to have received it and sertraline was their perfusion-preferred treatment. INTERPRETATION This large study showed that perfusion patterns in brain regions involved with reward, salience, affective, and default mode processing moderate treatment response favouring sertraline over placebo. Accurately matching patients with defined perfusion patterns could significantly increase remission rates. FUNDING National Institute of Mental Health, the Hersh Foundation, and the Center for Depression Research and Clinical Care, Peter O'Donnell Brain Institute at UT Southwestern Medical Center.Trial Registration.Establishing Moderators and Biosignatures of Antidepressant Response for Clinical Care for Depression (EMARC) Registration Number: NCT01407094 (https://clinicaltrials.gov/ct2/show/NCT01407094).
Collapse
Affiliation(s)
- Crystal M. Cooper
- Department of Psychiatry, University of Texas Southwestern Medical Center, United States of America
| | - Cherise R. Chin Fatt
- Department of Psychiatry, University of Texas Southwestern Medical Center, United States of America
| | - Manish Jha
- Department of Psychiatry, University of Texas Southwestern Medical Center, United States of America
| | - Gregory A. Fonzo
- Department of Psychiatry and behavioural Sciences, Stanford University School of Medicine, United States of America
- Stanford Neurosciences Institute, Stanford University, United States of America
- Sierra Pacific Mental Illness, Research, Education, and Clinical Center (MIRECC), Veterans Affairs Palo Alto Healthcare System, United States of America
| | - Bruce D. Grannemann
- Department of Psychiatry, University of Texas Southwestern Medical Center, United States of America
| | - Thomas Carmody
- Department of Psychiatry, University of Texas Southwestern Medical Center, United States of America
| | - Aasia Ali
- Department of Psychiatry, University of Texas Southwestern Medical Center, United States of America
| | - Sina Aslan
- Department of Psychiatry, University of Texas Southwestern Medical Center, United States of America
- Advance MRI, LLC, United States of America
| | - Jorge R.C. Almeida
- Department of Psychiatry, University of Texas Austin, United States of America
| | - Thilo Deckersbach
- Department of Psychiatry, Massachusetts General Hospital, United States of America
| | - Maurizio Fava
- Department of Psychiatry, Massachusetts General Hospital, United States of America
| | - Benji T. Kurian
- Department of Psychiatry, University of Texas Southwestern Medical Center, United States of America
| | - Patrick J. McGrath
- Department of Psychiatry, Columbia University, New York State Psychiatric Institute, United States of America
| | - Melvin McInnis
- Department of Psychiatry, University of Michigan School of Medicine, United States of America
| | - Ramin V. Parsey
- Departments of Psychiatry, Stony Brook University, United States of America
| | - Myrna Weissman
- Department of Psychiatry, Columbia University, New York State Psychiatric Institute, United States of America
| | - Mary L. Phillips
- Department of Psychiatry, University of Pittsburgh School of Medicine, United States of America
| | - Hanzhang Lu
- Department of Psychiatry, University of Texas Southwestern Medical Center, United States of America
- Department of Radiology, Johns Hopkins University, United States of America
| | - Amit Etkin
- Department of Psychiatry and behavioural Sciences, Stanford University School of Medicine, United States of America
- Stanford Neurosciences Institute, Stanford University, United States of America
- Sierra Pacific Mental Illness, Research, Education, and Clinical Center (MIRECC), Veterans Affairs Palo Alto Healthcare System, United States of America
| | - Madhukar H. Trivedi
- Department of Psychiatry, University of Texas Southwestern Medical Center, United States of America
| |
Collapse
|
6
|
De La Garza N, Rush AJ, Killian MO, Grannemann BD, Carmody TJ, Trivedi MH. The Concise Health Risk Tracking Self-Report (CHRT-SR) assessment of suicidality in depressed outpatients: A psychometric evaluation. Depress Anxiety 2019; 36:313-320. [PMID: 30370613 DOI: 10.1002/da.22855] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 07/09/2018] [Revised: 08/22/2018] [Accepted: 09/22/2018] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND The 12-item Concise Health Risk Tracking Self-Report (CHRT-SR12 ) is a brief, self-report measure that systematically assesses both suicidal thinking and associated thoughts that may indicate the propensity for suicidal acts. It can be used as a tool to both assess risk and guide treatment interventions targeting associated cognitions. METHODS This report used acute treatment data from a clinically representative sample of outpatients with nonpsychotic major depressive disorder (N = 665) participating in the Combining Medications to Enhance Depression Outcomes trial, who received up to 12 weeks of escitalopram, escitalopram plus bupropion SR, or venlafaxine XR plus mirtazapine. Outcome assessors and patients were masked to treatment. RESULTS Factor analysis of CHRT-SR12 confirmed that the 12 items have higher order structure with two subscales (Propensity, Suicidal Thoughts) and a total score. Internal consistencies were acceptable for both subscales and total score. All three scales were modestly correlated with overall depression severity (r = 0.54 to r = 0.21) and highly discriminating among patients grouped by suicide item ratings on three different depressive symptom ratings. The three scales also distinguished change over the acute phase treatment for those with different levels of baseline suicidal ideation (measured by 30-item Inventory of Depressive Symptomatology (item 18) and for those with change in suicidal ideation (baseline to last visit). CONCLUSIONS The CHRT-SR12 has good to excellent psychometric properties and is sensitive to change in suicidal thinking and propensity toward suicidal behavior in outpatients with major depressive disorder. It allows for the monitoring of thoughts and feelings associated with increased suicidal risk as well as levels of thoughts about suicide.
Collapse
Affiliation(s)
- Nancy De La Garza
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas
| | - A John Rush
- Department of Psychiatry, Duke Medical School, Durham, North Carolina.,Department of Psychiatry, Texas Tech University Health Sciences Center, Lubbbock, Texas.,Department of Psychiatry, Duke National University of Singapore, Singapore
| | - Michael O Killian
- Department of Social Work, Florida State University, Tallahassee, Florida
| | - Bruce D Grannemann
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Thomas J Carmody
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Madhukar H Trivedi
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas
| |
Collapse
|
7
|
Liao A, Walker R, Carmody TJ, Cooper C, Shaw MA, Grannemann BD, Adams P, Bruder GE, McInnis MG, Webb CA, Dillon DG, Pizzagalli DA, Phillips ML, Kurian BT, Fava M, Parsey RV, McGrath PJ, Weissman MM, Trivedi MH. Anxiety and anhedonia in depression: Associations with neuroticism and cognitive control. J Affect Disord 2019; 245:1070-1078. [PMID: 30699849 PMCID: PMC9667857 DOI: 10.1016/j.jad.2018.11.072] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 03/28/2018] [Revised: 10/10/2018] [Accepted: 11/10/2018] [Indexed: 01/02/2023]
Abstract
BACKGROUND Despite the fact that higher levels of anxiety and anhedonia in Major Depressive Disorder (MDD) are linked to poorer treatment outcomes, mechanisms contributing to these clinical presentations remain unclear. Neuroticism, impaired cognitive control, and blunted reward learning may be critical processes involved in MDD and may help to explain symptoms of anxiety and anhedonia. METHODS Using baseline data from patients with early-onset MDD (N = 296) in the Establishing Moderators and Biosignatures of Antidepressant Response in Clinical Care (EMBARC) trial, we conducted a path analysis to model relationships between neuroticism, cognitive control, and reward learning to levels of anxiety and anhedonia. RESULTS Neuroticism was positively associated with both anhedonia (standardized coefficient = 0.26, p < .001) and anxiety (standardized coefficient = 0.40, p < .001). Cognitive control was negatively associated with anxiety (standardized coefficient = -0.18, p < .05). Reward learning was not significantly associated with either anxiety or anhedonia. LIMITATIONS Extraneous variables not included in the model may have even more influence in explaining symptoms of anxiety and anhedonia. Restricted range in these variables may have attenuated some of the hypothesized relationships. Most important, because this was a cross-sectional analysis in a currently depressed sample, we cannot draw any causal conclusions without experimental and longitudinal data. CONCLUSIONS These cross-sectional findings suggest that neuroticism may contribute to anxiety and anhedonia in patients with early onset and either chronic or recurrent MDD, while enhanced cognitive control may protect against anxiety.
Collapse
Affiliation(s)
- Allen Liao
- Department of Psychiatry, University of Texas Southwestern Medical Center
| | - Robrina Walker
- Department of Psychiatry, University of Texas Southwestern Medical Center
| | - Thomas J. Carmody
- Department of Psychiatry, University of Texas Southwestern Medical Center
| | - Crystal Cooper
- Department of Psychiatry, University of Texas Southwestern Medical Center
| | | | | | - Phil Adams
- Department of Psychiatry, Columbia University
| | | | | | | | | | | | | | - Benji T. Kurian
- Department of Psychiatry, University of Texas Southwestern Medical Center
| | | | - Ramin V. Parsey
- Department of Psychiatry, Stonybrook University School of Medicine
| | | | | | | |
Collapse
|
8
|
Trombello JM, Killian MO, Grannemann BD, Rush AJ, Mayes TL, Parsey RV, McInnis M, Jha MK, Ali A, McGrath PJ, Adams P, Oquendo MA, Weissman MM, Carmody TJ, Trivedi MH. The Concise Health Risk Tracking-Self Report: Psychometrics within a placebo-controlled antidepressant trial among depressed outpatients. J Psychopharmacol 2019; 33:185-193. [PMID: 30652941 PMCID: PMC6379122 DOI: 10.1177/0269881118817156] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 12/12/2022]
Abstract
BACKGROUND/AIMS While substantial prior research has evaluated the psychometric properties of the 12-item Concise Health Risk Tracking-Self Report (CHRT-SR12), a measure of suicide propensity and suicidal thoughts, no prior research has investigated its factor structure, sensitivity to change over time, and other psychometric properties in a placebo-controlled trial of antidepressant medication, nor determined whether symptoms change throughout treatment. METHODS Participants in the multi-site Establishing Moderators and Biosignatures of Antidepressant Response in Clinical Care (EMBARC) study ( n=278) provided data to evaluate the factor structure and sensitivity to change over time of the CHRT-SR12 through eight weeks of a clinical trial in which participants received either placebo or antidepressant medication (sertraline). RESULTS/OUTCOMES Factor analysis confirmed two factors: propensity (comprised of first-order factors including pessimism, helplessness, social support, and despair) and suicidal thoughts. Internal consistency (α's ranged from 0.69-0.92) and external validity were both acceptable, with the total score and propensity factor scores significantly correlated with total scores and single-item suicidal-thoughts scores on the self-report Quick Inventory of Depressive Symptoms and the clinician-rated 17-item Hamilton Rating Scale for Depression. Through analyzing CHRT-SR12 changes over eight treatment weeks, the total score and both the factors decreased regardless of baseline suicidal thoughts. Change in clinician-rated suicidal thoughts was reflected by change in both the total score and propensity factor score. CONCLUSIONS/INTERPRETATION These results confirm the reliability, validity, and applicability of the CHRT-SR12 to a placebo-controlled clinical trial of depressed outpatients receiving antidepressant medication.
Collapse
Affiliation(s)
- Joseph M Trombello
- 1 Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Michael O Killian
- 2 College of Social Work, Florida State University, Tallahassee, FL, USA
| | - Bruce D Grannemann
- 1 Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Augustus John Rush
- 3 Department of Psychiatry, Duke Medical School, Durham, NC, USA.,5 Duke-National University of Singapore, Singapore
| | - Taryn L Mayes
- 1 Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Ramin V Parsey
- 6 Department of Psychiatry, Stony Brook University, Stony Brook, NY USA
| | - Melvin McInnis
- 7 Department of Psychiatry, University of Michigan, Ann Arbor, MI USA
| | - Manish K Jha
- 1 Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Aasia Ali
- 1 Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Patrick J McGrath
- 8 Department of Psychiatry, Columbia University, New York, NY USA.,9 New York State Psychiatric Institute and Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY USA
| | - Phil Adams
- 9 New York State Psychiatric Institute and Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY USA
| | - Maria A Oquendo
- 10 Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - Myrna M Weissman
- 8 Department of Psychiatry, Columbia University, New York, NY USA.,9 New York State Psychiatric Institute and Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY USA
| | - Thomas J Carmody
- 1 Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Madhukar H Trivedi
- 1 Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| |
Collapse
|
9
|
Rush AJ, South CC, Jha MK, Grannemann BD, Trivedi MH. Toward a very brief quality of life enjoyment and Satisfaction Questionnaire. J Affect Disord 2019; 242:87-95. [PMID: 30173063 DOI: 10.1016/j.jad.2018.08.052] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 07/23/2018] [Accepted: 08/12/2018] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To develop and evaluate a new brief self-report measure of satisfaction/quality of life in depressed outpatients. METHODS Using the Quality of Life Enjoyment and Satisfaction Questionnaire Short-Form (Q-LES-Q-SF) self-report from Step-1 (n = 2181) of the STAR*D trial, items were selected based on their magnitude of change with treatment and correlation with 16-item Quick Inventory of Depressive Symptomatology Self-Report (QIDS-SR16). Psychometric analyses were conducted. Replication of scale performance was assessed with STAR*D Step-2 data (n = 250). RESULTS The 7 items selected ("Mini-Q-LES-Q") rated satisfaction with work, household activities, social and family relations, leisure time activities, daily function and sense of well-being in the past week. This uni-dimensional scale captured 83-94% variance in Q-LES-Q-SF and had acceptable Item Response and Classical Test Theory characteristics. Baseline to exit percent changes in the Mini-Q-LES-Q and the QIDS-SR16 were significantly, modestly related (r = -0.552) (Step-1) and replicated (r = -0.562) (Step-2). The Mini-Q-LES-Q detected the expected improvement in satisfaction/quality of life in acute treatment, yet also identified residual deficits expected in many at acute-phase exit. LIMITATIONS Population norms are yet undefined. Concurrent validity with detailed, well-validated scales that assess the seven Quality of Life domains incorporated in the Mini-Q-LES-Q remains unestablished. Sensitivity to symptom changes induced by psychotherapy or somatic therapies or sensitive to the effects of therapies aimed at enhancing quality of life enjoyment and function is unknown. CONCLUSION The 7-item Mini-Q-LES-Q self-report measure satisfaction/quality of life has acceptable psychometric properties, reflects change with depressive symptom reduction, and detects residual deficits in this key clinical outcome.
Collapse
Affiliation(s)
- A John Rush
- Department of Psychiatry, Duke Medical School, Durham, NC, USA; Department of Psychiatry, Texas Tech University Health Sciences Center, Permian Basin, TX, USA; Duke-National University of Singapore, Singapore
| | - Charles C South
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Manish K Jha
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Bruce D Grannemann
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Madhukar H Trivedi
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA.
| |
Collapse
|
10
|
Jha MK, Malchow AL, Grannemann BD, Rush AJ, Trivedi MH. Do baseline sub-threshold hypomanic symptoms affect acute-phase antidepressant outcome in outpatients with major depressive disorder? Preliminary findings from the randomized CO-MED trial. Neuropsychopharmacology 2018; 43:2197-2203. [PMID: 30135556 PMCID: PMC6135801 DOI: 10.1038/s41386-018-0180-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 07/03/2018] [Accepted: 07/26/2018] [Indexed: 11/09/2022]
Abstract
Sub-threshold hypomanic symptoms are common in major depressive disorder. This study evaluated the prevalence, the clinical and sociodemographic correlates, and the overall and differential effects of the presence/absence of sub-threshold hypomanic symptoms at baseline on acute-phase treatment outcomes with bupropion-plus-escitalopram combination, escitalopram monotherapy, and venlafaxine-plus-mirtazapine combination. Combining medications to enhance depression outcomes (CO-MED) trial participants (n = 665) were designated as sub-threshold hypomanic symptoms present (Altman Self-Rating Mania Scale score (ASRM) ≥ 1) or absent (ASRM = 0) and compared on clinical and sociodemographic features and remission rates. Participants with sub-threshold hypomanic symptoms (n = 335/665, 50.4%) were more likely to be black and non-Hispanic, have comorbid medical and psychiatric disorders, experience longer index episodes, and report lower depression severity and psychosocial impairment. Intent-to-treat remission rates were lower overall (absent = 42.7%, present = 34.0%, p = 0.02), with escitalopram monotherapy (absent = 45.8%, present = 31.6%, p = 0.03), and with venlafaxine-XR-plus-mirtazapine combination (absent = 44.4%, present = 30.1%, p = 0.03) but not with bupropion-plus-escitalopram combination (absent = 37.7%, present = 40.0%, p = 0.73). Participants without sub-threshold hypomanic symptoms were more likely to remit than those with such symptoms overall [odds ratio (OR) = 1.49], with escitalopram monotherapy (OR = 1.71), and with venlafaxine-plus-mirtazapine combination (OR = 1.97) but not with bupropion-plus-escitalopram combination (OR = 0.96), even after controlling for baseline depression severity, psychosocial impairment, and number of comorbid psychiatric disorders. Sub-threshold hypomanic symptoms (found in about 50% of patients in this report) were associated with lower remission rates with escitalopram monotherapy and with venlafaxine-plus-mirtazapine combination but not with the bupropion-plus-escitalopram combination.
Collapse
Affiliation(s)
- Manish K Jha
- Center for Depression Research and Clinical Care, UT Southwestern Medical Center, Dallas, TX, USA
| | - Ashley L Malchow
- Center for Depression Research and Clinical Care, UT Southwestern Medical Center, Dallas, TX, USA
| | - Bruce D Grannemann
- Center for Depression Research and Clinical Care, UT Southwestern Medical Center, Dallas, TX, USA
| | - A John Rush
- Duke-National University of Singapore, Singapore, Singapore
- Department of Psychiatry, Duke Medical School, Durham, NC, USA
- Texas Tech University-Health Sciences Center, Permian Basin, TX, USA
| | - Madhukar H Trivedi
- Center for Depression Research and Clinical Care, UT Southwestern Medical Center, Dallas, TX, USA.
| |
Collapse
|
11
|
Mayes TL, Kennard BD, Killian M, Carmody T, Grannemann BD, Rush AJ, Jha MK, Hughes J, Emslie GJ, Trivedi MH. Psychometric properties of the concise health risk tracking (CHRT) in adolescents with suicidality. J Affect Disord 2018; 235:45-51. [PMID: 29649710 DOI: 10.1016/j.jad.2018.03.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [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: 10/04/2017] [Revised: 03/01/2018] [Accepted: 03/10/2018] [Indexed: 01/15/2023]
Abstract
BACKGROUND Several self-report rating scales have been developed to assess suicidal ideation, yet few examine other factors related to increased suicidal risk, and even fewer have been validated in both adolescents and adults. We evaluate the 14-item Concise Health Risk Tracking - Self Report (CHRT-SR), a measure previously validated in adults, in a sample of adolescents at risk for suicide. METHOD Data are from a retrospective chart review of adolescents treated in an intensive outpatient program for youth with severe suicidality. Teens completed the CHRT-SR and Quick Inventory of Depressive Symptomatology - Adolescents (QIDS-A) at baseline and discharge. The CHRT-SR was evaluated to determine the factor validity, internal consistency, construct validity, and sensitivity to change. RESULTS Adolescents (n = 271) completed the CHRT-SR prior to treatment, and 231 completed the CHRT-SR at discharge. Three factors were identified with excellent model fit: Propensity, Impulsivity, and Suicidal Thoughts. Internal consistency reliability coefficients were good-to-excellent for the total score and all three factors at baseline (a = 0.774-0.915) and exit (a = 0.849-0.941). The total score and all three factors significantly correlated with overall depression severity and suicidal ideation as rated by teens and parent (p = .704-0.756, all p < .001). The CHRT-SR was sensitive to change, with moderate to large effect sizes (Cohen's d = 0.599-1.062). LIMITATIONS Study limitations include generalizability, lack of a control group, and retrospective data from a sample of opportunity. CONCLUSIONS The CHRT-SR is a reliable and valid measure for examining severity of suicidal thoughts and associated risk factors, and is sensitive to change following an intervention in adolescents.
Collapse
Affiliation(s)
- Taryn L Mayes
- Department of Psychiatry at UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9119, United States. taryn.mayes.@utsouthwestern.edu
| | - Betsy D Kennard
- UT Southwestern Medical Center and the Department of Psychiatry at Children's Health Systems of Texas, Children's Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9119, United States.
| | - Michael Killian
- School of Social Work at UT Arlington, 211 S. Cooper St., #201b, Arlington, TX, 76019, United States.
| | - Thomas Carmody
- Department of Clinical Sciences at UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9119, United States.
| | - Bruce D Grannemann
- Department of Psychiatry at UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9119, United States.
| | - A John Rush
- Professor emeritus, Duke-NUS, 7 Avenida Vista Grande, #112, Santa Fe, NM, 87508, United States.
| | - Manish K Jha
- Department of Psychiatry at UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9119, United States.
| | - Jennifer Hughes
- Department of Psychiatry at UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9119, United States.
| | - Graham J Emslie
- Department of Psychiatry at UT Southwestern Medical Center, 6300 Harry Hines Blvd. Suite 1200, Dallas, TX 75235, United States.
| | - Madhukar H Trivedi
- Department of Psychiatry at UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9119, United States.
| |
Collapse
|
12
|
Trombello JM, Pizzagalli DA, Weissman MM, Grannemann BD, Cooper CM, Greer TL, Malchow AL, Jha M, Carmody TJ, Kurian BT, Webb CA, Dillon DG, McGrath PJ, Bruder G, Fava M, Parsey RV, McInnis MG, Adams P, Trivedi MH. Characterizing anxiety subtypes and the relationship to behavioral phenotyping in major depression: Results from the EMBARC study. J Psychiatr Res 2018; 102:207-215. [PMID: 29689518 PMCID: PMC6097520 DOI: 10.1016/j.jpsychires.2018.04.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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] [Received: 10/05/2017] [Revised: 03/29/2018] [Accepted: 04/05/2018] [Indexed: 01/05/2023]
Abstract
The current study aimed to characterize the multifaceted nature of anxiety in patients with major depression by evaluating distinct anxiety factors. We then related these derived anxiety factors to performance on a Flanker Task of cognitive control, in order to further validate these factors. Data were collected from 195 patients with nonpsychotic chronic or recurrent major depression or dysthymic disorder. At baseline, participants completed self-report measures of anxiety, depression, and other related symptoms (mania, suicidality) and clinicians administered a structured diagnostic interview and the Hamilton Rating Scale for Depression, including anxiety/somatization items. Four discrete factors (State Anxiety, Panic, Neuroticism/Worry, and Restlessness/Agitation) emerged, with high degrees of internal consistency. Discriminant and convergent validity analyses also yielded findings in the expected direction. Furthermore, the neuroticism/worry factor was associated with Flanker Task interference, such that individuals higher on neuroticism/worry responded more incorrectly (yet faster) to incongruent vs. congruent trials whereas individuals higher on the fear/panic factor responded more slowly, with no accuracy effect, to the Flanker Task stimuli. These results parse anxiety into four distinct factors that encompass physiological, psychological, and cognitive components of anxiety. While state anxiety, panic and neuroticism/worry are related to existing measures of anxiety, the Restlessness/Agitation factor appears to be a unique measure of general anxious arousal. Furthermore, two factors were independently validated through the Flanker Task. These results suggest that these anxiety domains have distinct behavioral profiles and could have differential responses to distinct treatments.
Collapse
Affiliation(s)
- Joseph M. Trombello
- The University of Texas Southwestern Medical Center, Department of Psychiatry, Center for Depression Research and Clinical Care, Department of Psychiatry, Dallas, TX, USA
| | - Diego A. Pizzagalli
- Harvard Medical School – McLean Hospital, Department of Psychiatry, Boston, MA, USA
| | - Myrna M. Weissman
- Columbia University, Department of Psychiatry, New York, NY, USA, New York State Psychiatric Institute and Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY, USA
| | - Bruce D. Grannemann
- The University of Texas Southwestern Medical Center, Department of Psychiatry, Center for Depression Research and Clinical Care, Department of Psychiatry, Dallas, TX, USA
| | - Crystal M. Cooper
- The University of Texas Southwestern Medical Center, Department of Psychiatry, Center for Depression Research and Clinical Care, Department of Psychiatry, Dallas, TX, USA
| | - Tracy L. Greer
- The University of Texas Southwestern Medical Center, Department of Psychiatry, Center for Depression Research and Clinical Care, Department of Psychiatry, Dallas, TX, USA
| | - Ashley L. Malchow
- The University of Texas Southwestern Medical Center, Department of Psychiatry, Center for Depression Research and Clinical Care, Department of Psychiatry, Dallas, TX, USA
| | - Manish Jha
- The University of Texas Southwestern Medical Center, Department of Psychiatry, Center for Depression Research and Clinical Care, Department of Psychiatry, Dallas, TX, USA
| | - Thomas J. Carmody
- The University of Texas Southwestern Medical Center, Department of Psychiatry, Center for Depression Research and Clinical Care, Department of Psychiatry, Dallas, TX, USA
| | - Benji T. Kurian
- The University of Texas Southwestern Medical Center, Department of Psychiatry, Center for Depression Research and Clinical Care, Department of Psychiatry, Dallas, TX, USA
| | - Christian A. Webb
- Harvard Medical School – McLean Hospital, Department of Psychiatry, Boston, MA, USA
| | - Daniel G. Dillon
- Harvard Medical School – McLean Hospital, Department of Psychiatry, Boston, MA, USA
| | - Patrick J. McGrath
- Columbia University, Department of Psychiatry, New York, NY, USA, New York State Psychiatric Institute and Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY, USA
| | - Gerard Bruder
- Columbia University, Department of Psychiatry, New York, NY, USA, New York State Psychiatric Institute and Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY, USA
| | - Maurizio Fava
- Massachusetts General Hospital, Department of Psychiatry, Boston, MA, USA
| | - Ramin V. Parsey
- Stony Brook University, Department of Psychiatry, Stony Brook, NY, USA
| | - Melvin G. McInnis
- University of Michigan, Department of Psychiatry, Ann Arbor, MI, USA
| | - Phil Adams
- New York State Psychiatric Institute and Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY, USA
| | - Madhukar H. Trivedi
- The University of Texas Southwestern Medical Center, Department of Psychiatry, Center for Depression Research and Clinical Care, Department of Psychiatry, Dallas, TX, USA
| |
Collapse
|
13
|
Sanchez K, Killian MO, Mayes TL, Greer TL, Trombello JM, Lindblad R, Grannemann BD, Carmody TJ, Rush AJ, Walker R, Trivedi MH. A psychometric evaluation of the Concise Health Risk Tracking Self-Report (CHRT-SR)- a measure of suicidality-in patients with stimulant use disorder. J Psychiatr Res 2018; 102:65-71. [PMID: 29626753 PMCID: PMC7505104 DOI: 10.1016/j.jpsychires.2018.03.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 03/25/2018] [Indexed: 12/14/2022]
Abstract
Stimulant use disorders are both common and associated with suicidal ideation and attempts. The psychometric properties of the 12-item Concise Health Risk Tracking Scale Self-Report (CHRT-SR), a measure that was created to assess suicidal thinking and several factors associated with a propensity to act, has been established in persons with mood disorders. This is a secondary analysis to assess the CHRT-SR in 302 stimulant abusing patients that had participated in a clinical trial. A confirmatory factor analysis (CFA) was conducted to assess the factor validity of the 12-item CHRT-SR model with a second-order Propensity factor. The CHRT-SR total score and 2 factor scores (Propensity and Suicidal Thoughts) demonstrated acceptable internal consistency and test-retest reliabilities. These two subscales and the total score were modestly but significantly associated with measures of depression and life satisfaction, demonstrating construct validity. Two additional items assessing Impulsivity were also analyzed, and demonstrated acceptable internal consistency, test-retest reliability, and construct validity. The CHRT-SR appears to be a reliable and valid tool to assess suicidality in persons with stimulant use disorder.
Collapse
Affiliation(s)
- Katherine Sanchez
- Center for Applied Health Research, Baylor Scott and White Research Institute, Dallas, TX, USA; Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Michael O Killian
- Center for Applied Health Research, Baylor Scott and White Research Institute, Dallas, TX, USA
| | - Taryn L Mayes
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Tracy L Greer
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Joseph M Trombello
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Bruce D Grannemann
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Thomas J Carmody
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - A John Rush
- Dept Psychiatry, Duke Medical School, Durham, NC, USA; Texas Tech University-Health Sciences Center, Permian Basin, TX, USA; Duke-National University of Singapore, Singapore
| | - Robrina Walker
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Madhukar H Trivedi
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA.
| |
Collapse
|
14
|
Trivedi MH, South C, Jha MK, Rush AJ, Cao J, Kurian B, Phillips M, Pizzagalli DA, Trombello JM, Oquendo MA, Cooper C, Dillon DG, Webb C, Grannemann BD, Bruder G, McGrath PJ, Parsey R, Weissman M, Fava M. A Novel Strategy to Identify Placebo Responders: Prediction Index of Clinical and Biological Markers in the EMBARC Trial. Psychother Psychosom 2018; 87:285-295. [PMID: 30110685 PMCID: PMC9764260 DOI: 10.1159/000491093] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 06/15/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND One in three clinical trial patients with major depressive disorder report symptomatic improvement with placebo. Strategies to mitigate the effect of placebo responses have focused on modifying study design with variable success. Identifying and excluding or controlling for individuals with a high likelihood of responding to placebo may improve clinical trial efficiency and avoid unnecessary medication trials. METHODS Participants included those assigned to the placebo arm (n = 141) of the Establishing Moderators and Biosignatures for Antidepressant Response in Clinical Care (EMBARC) trial. The elastic net was used to evaluate 283 baseline clinical, behavioral, imaging, and electrophysiological variables to identify the most robust yet parsimonious features that predicted depression severity at the end of the double-blind 8-week trial. Variables retained in at least 50% of the 100 imputed data sets were used in a Bayesian multiple linear regression model to simultaneously predict the probabilities of response and remission. RESULTS Lower baseline depression severity, younger age, absence of melancholic features or history of physical abuse, less anxious arousal, less anhedonia, less neuroticism, and higher average theta current density in the rostral anterior cingulate predicted a higher likelihood of improvement with placebo. The Bayesian model predicted remission and response with an actionable degree of accuracy (both AUC > 0.73). An interactive calculator was developed predicting the likelihood of placebo response at the individual level. CONCLUSION Easy-to-measure clinical, behavioral, and electrophysiological assessments can be used to identify placebo responders with a high degree of accuracy. Development of this calculator based on these findings can be used to identify potential placebo responders.
Collapse
Affiliation(s)
- Madhukar H. Trivedi
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Charles South
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Manish K. Jha
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - A. John Rush
- Duke-National University of Singapore, Singapore, Singapore;,Duke Medical School, Durham, NC, USA;,Texas Tech University Health Sciences Center, Permian Basin, TX, USA
| | - Jing Cao
- Department of Statistical Science, Southern Methodist University, Dallas, TX, USA
| | - Benji Kurian
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Mary Phillips
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA;,Columbia University, New York, NY, USA
| | - Diego A. Pizzagalli
- Center for Depression, Anxiety and Stress Research, Mclean Hospital, Belmont, MA, USA
| | - Joseph M. Trombello
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Maria A. Oquendo
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Crystal Cooper
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Daniel G. Dillon
- Center for Depression, Anxiety and Stress Research, Mclean Hospital, Belmont, MA, USA
| | - Christian Webb
- Center for Depression, Anxiety and Stress Research, Mclean Hospital, Belmont, MA, USA
| | - Bruce D. Grannemann
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Gerard Bruder
- New York State Psychiatric Institute and Department of Psychiatry, College of Physicians and Surgeons, New York, NY, USA
| | - Patrick J. McGrath
- New York State Psychiatric Institute and Department of Psychiatry, College of Physicians and Surgeons, New York, NY, USA
| | - Ramin Parsey
- Stony Brook University School of Medicine, Stony Brook, NY, USA
| | - Myrna Weissman
- New York State Psychiatric Institute and Department of Psychiatry, College of Physicians and Surgeons, New York, NY, USA
| | - Maurizio Fava
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| |
Collapse
|
15
|
Gadad BS, Jha MK, Grannemann BD, Mayes TL, Trivedi MH. Proteomics profiling reveals inflammatory biomarkers of antidepressant treatment response: Findings from the CO-MED trial. J Psychiatr Res 2017; 94. [PMID: 28628884 PMCID: PMC5804347 DOI: 10.1016/j.jpsychires.2017.05.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [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: 11/16/2022]
Abstract
Animal and human studies suggest an association between depression and aberrant immune response. Further, common inflammatory markers may change during the course of antidepressant treatment in patients. The objective of this study was to evaluate changes in inflammatory markers and clinical outcomes from subjects enrolled in the Combining Medications to Enhance Depression Outcome (CO-MED) trial. At baseline and week 12 (treatment completion), plasma samples of 102 participants were analyzed via a multiplex assay comprised of inflammatory markers using a 27-plex standard assay panel plus a 4-plex human acute phase xMAP technology based platform. We carried out analyses in two steps. First, t-tests were used to identify inflammatory marker levels that changed between baseline and week 12. For markers that were altered, logistic regression models were then conducted to look for associated changes in remission at week 12. Among the 31 inflammatory markers analyzed, several cytokines (IL-5, IFN-γ, IL-13), two chemokines (Eotaxin-1/CCL11, RANTES) and an acute-phase reactant (serum amyloid P component) showed change from baseline to week 12. However, only two indicated differential remission responses. Interestingly, increased levels of Eotaxin-1/CCL11 correlated with remission at week 12, whereas decreased levels of IFN-γ correlated with non-remission at week 12. Results suggest that these inflammatory proteins may serve as predictors of treatment response.
Collapse
Affiliation(s)
- Bharathi S. Gadad
- UT Southwestern Medical Center, Center for Depression Research and Clinical Care, Department of Psychiatry, Dallas, TX, USA
| | - Manish K. Jha
- UT Southwestern Medical Center, Center for Depression Research and Clinical Care, Department of Psychiatry, Dallas, TX, USA
| | - Bruce D. Grannemann
- UT Southwestern Medical Center, Center for Depression Research and Clinical Care, Department of Psychiatry, Dallas, TX, USA
| | - Taryn L. Mayes
- UT Southwestern Medical Center, Center for Depression Research and Clinical Care, Department of Psychiatry, Dallas, TX, USA
| | - Madhukar H. Trivedi
- UT Southwestern Medical Center, Center for Depression Research and Clinical Care, Department of Psychiatry, Dallas, TX, USA,Correspondence may be addressed to: Madhukar H. Trivedi, M.D., Professor of Psychiatry, Betty Jo Hay Distinguished Chair in Mental Health, Julie K. Hersh Chair for Depression Research and Clinical Care, Director, Center for Depression Research and Clinical Care, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-9119, Phone: 214-648-0188, Fax: 214-648-0167,
| |
Collapse
|
16
|
La Garza ND, Rush AJ, Grannemann BD, Trivedi MH. Toward a very brief self-report to assess the core symptoms of depression (VQIDS-SR 5 ). Acta Psychiatr Scand 2017; 135:548-553. [PMID: 28316080 PMCID: PMC6130195 DOI: 10.1111/acps.12720] [Citation(s) in RCA: 7] [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] [Accepted: 02/21/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To develop a short, 5-item measure of the core symptoms of depression based on the 16-item Quick Inventory of Depressive Symptomatology - Self-Report (QIDS-SR16 ) and to evaluate psychometric properties of this new measure (Very Quick Inventory of Depressive Symptomatology - Self-Report: VQIDS-SR5 ). METHOD Using data from a convenience sample of the Combining Medications to Enhance Depression Outcomes (CO-MED) trial, we evaluated the psychometric properties of the VQIDS-SR5 , its sensitivity to change, and its comparability to the QIDS-SR16 and clinician-rated scales (QIDS-C16 and VQIDS-C5 ). RESULTS The VQIDS-SR5 has a single-factor structure with an acceptable internal consistency (Cronbach's alpha: 0.67-0.81). The VQIDS-SR5 was as sensitive to change as its parent scale, then QIDS-SR16 and, detected change at an earlier time frame. Additionally, the VQIDS-SR5 was comparable to the QIDS-SR16 , QIDS-C16 , and VQIDS-C5 . CONCLUSION The VQIDS-SR5 can effectively evaluate the core symptoms of depression during the course of treatment.
Collapse
Affiliation(s)
- Nancy De La Garza
- Center for Depression Research and Clinical Care, UT Southwestern Medical Center, Dallas, TX
| | - A. John Rush
- Professor Emeritus, Duke-National University of Singapore, Singapore
| | - Bruce D. Grannemann
- Center for Depression Research and Clinical Care, UT Southwestern Medical Center, Dallas, TX
| | - Madhukar H. Trivedi
- Center for Depression Research and Clinical Care, UT Southwestern Medical Center, Dallas, TX
| |
Collapse
|
17
|
Petkova E, Ogden RT, Tarpey T, Ciarleglio A, Jiang B, Su Z, Carmody T, Adams P, Kraemer HC, Grannemann BD, Oquendo MA, Parsey R, Weissman M, McGrath PJ, Fava M, Trivedi MH. Statistical Analysis Plan for Stage 1 EMBARC (Establishing Moderators and Biosignatures of Antidepressant Response for Clinical Care) Study. Contemp Clin Trials Commun 2017; 6:22-30. [PMID: 28670629 PMCID: PMC5485858 DOI: 10.1016/j.conctc.2017.02.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 02/08/2017] [Accepted: 02/13/2017] [Indexed: 12/28/2022] Open
Abstract
Antidepressant medications are commonly used to treat depression, but only about 30% of patients reach remission with any single first-step antidepressant. If the first-step treatment fails, response and remission rates at subsequent steps are even more limited. The literature on biomarkers for treatment response is largely based on secondary analyses of studies designed to answer primary questions of efficacy, rather than on a planned systematic evaluation of biomarkers for treatment decision. The lack of evidence-based knowledge to guide treatment decisions for patients with depression has lead to the recognition that specially designed studies with the primary objective being to discover biosignatures for optimizing treatment decisions are necessary. Establishing Moderators and Biosignatures of Antidepressant Response in Clinical Care (EMBARC) is one such discovery study. Stage 1 of EMBARC is a randomized placebo controlled clinical trial of 8 week duration. A wide array of patient characteristics is collected at baseline, including assessments of brain structure, function and connectivity along with electrophysiological, biological, behavioral and clinical features. This paper reports on the data analytic strategy for discovering biosignatures for treatment response based on Stage 1 of EMBARC.
Collapse
Affiliation(s)
- Eva Petkova
- New York University, New York, NY, USA
- Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, USA
| | | | - Thaddeus Tarpey
- New York University, New York, NY, USA
- Wright State University, Dayton, OH, USA
| | - Adam Ciarleglio
- New York University, New York, NY, USA
- Columbia University, New York, NY, USA
| | - Bei Jiang
- University of Alberta, Edmonton, Alberta, Canada
| | - Zhe Su
- New York University, New York, NY, USA
| | - Thomas Carmody
- University of Texas, Southwestern Medical Center, Dallas, TX, USA
| | - Philip Adams
- New York State Psychiatric Institute, New York, NY, USA
- Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY, USA
| | | | | | - Maria A. Oquendo
- New York State Psychiatric Institute, New York, NY, USA
- Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY, USA
| | | | - Myrna Weissman
- New York State Psychiatric Institute, New York, NY, USA
- Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY, USA
| | - Patrick J. McGrath
- New York State Psychiatric Institute, New York, NY, USA
- Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY, USA
| | | | | |
Collapse
|
18
|
Trivedi MH, Greer TL, Rethorst CD, Carmody T, Grannemann BD, Walker R, Warden D, Wilson KS, Stoutenberg M, Oden N, Silverstein M, Hodgkins C, Love L, Seamans C, Stotts A, Causey T, Szucs-Reed RP, Rinaldi P, Myrick H, Straus M, Liu D, Lindblad R, Church T, Blair SN, Nunes EV. Randomized Controlled Trial Comparing Exercise to Health Education for Stimulant Use Disorder: Results From the CTN-0037 STimulant Reduction Intervention Using Dosed Exercise (STRIDE) Study. J Clin Psychiatry 2017; 78:1075-1082. [PMID: 28199070 PMCID: PMC5683711 DOI: 10.4088/jcp.15m10591] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [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: 12/11/2015] [Accepted: 04/29/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To evaluate exercise as a treatment for stimulant use disorders. METHODS The STimulant Reduction Intervention using Dosed Exercise (STRIDE) study was a randomized clinical trial conducted in 9 residential addiction treatment programs across the United States from July 2010 to February 2013. Of 497 adults referred to the study, 302 met all eligibility criteria, including DSM-IV criteria for stimulant abuse and/or dependence, and were randomized to either a dosed exercise intervention (Exercise) or a health education intervention (Health Education) control, both augmenting treatment as usual and conducted thrice weekly for 12 weeks. The primary outcome of percent stimulant abstinent days during study weeks 4 to 12 was estimated using a novel algorithm adjustment incorporating self-reported Timeline Followback (TLFB) stimulant use and urine drug screen (UDS) data. RESULTS Mean percent of abstinent days based on TLFB was 90.8% (SD = 16.4%) for Exercise and 91.6% (SD = 14.7%) for Health Education participants. Percent of abstinent days using the eliminate contradiction (ELCON) algorithm was 75.6% (SD = 27.4%) for Exercise and 77.3% (SD = 25.1%) for Health Education. The primary intent-to-treat analysis, using a mixed model controlling for site and the ELCON algorithm, produced no treatment effect (P = .60). In post hoc analyses controlling for treatment adherence and baseline stimulant use, Exercise participants had a 4.8% higher abstinence rate (78.7%) compared to Health Education participants (73.9%) (P = .03, number needed to treat = 7.2). CONCLUSIONS The primary analysis indicated no significant difference between exercise and health education. Adjustment for intervention adherence showed modestly but significantly higher percent of abstinent days in the exercise group, suggesting that exercise may improve outcomes for stimulant users who have better adherence to an exercise dose. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01141608.
Collapse
Affiliation(s)
- Madhukar H. Trivedi
- University of Texas Southwestern Medical Center, Dallas, TX,Address Correspondence to: Madhukar H. Trivedi, M.D. Professor of Psychiatry, Betty Jo Hay Distinguished Chair in Mental Health, Director, Center for Depression Research and Clinical Care UT Southwestern Medical Center, 5323 Harry Hines Blvd. Dallas, TX 75390-9119, Ph: 214-648-0188,
| | - Tracy L. Greer
- University of Texas Southwestern Medical Center, Dallas, TX
| | | | - Thomas Carmody
- University of Texas Southwestern Medical Center, Dallas, TX
| | | | - Robrina Walker
- University of Texas Southwestern Medical Center, Dallas, TX
| | - Diane Warden
- University of Texas Southwestern Medical Center, Dallas, TX
| | | | | | - Neal Oden
- The EMMES Corporation, Rockville, MD
| | | | | | - Lee Love
- Gibson Recovery Center, Cape Girardeau, MO
| | | | - Angela Stotts
- University of Texas Health Science Center at Houston, Houston, TX
| | - Trey Causey
- Morris Village Alcohol and Drug Addiction Treatment Center, Columbia, SC
| | | | | | - Hugh Myrick
- Ralph H. Johnson VA Medical Center, Charleston, SC
| | - Michele Straus
- National Institutes of Health, National Institute on Drug Abuse, Bethesda, MD
| | - David Liu
- National Institutes of Health, National Institute on Drug Abuse, Bethesda, MD
| | | | | | | | | |
Collapse
|
19
|
Jha MK, Greer TL, Grannemann BD, Carmody T, Rush AJ, Trivedi MH. Early normalization of Quality of Life predicts later remission in depression: Findings from the CO-MED trial. J Affect Disord 2016; 206:17-22. [PMID: 27455354 DOI: 10.1016/j.jad.2016.07.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [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: 04/11/2016] [Accepted: 07/03/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND Although normal Quality of Life (QoL) is the outcome desired by patients, it is unclear if QoL changes early in course of antidepressant treatments are independent of depression severity, and can predict subsequent remission. METHODS The Quality of Life Inventory was obtained repeatedly in the Combining Medications to Enhance Depression Outcomes trial. Mixed model analyses assessed QoL change. Using population-based norms, participants were grouped as very low, low, or normal QoL at week 4, and association with remission was evaluated. RESULTS Overall baseline to week 4 QoL improved significantly (p=0.0015) even after controlling for change in depression severity and baseline variables (gender, age, education, race, ethnicity, income, employment status, anxious features, depression onset before age 18, suicidal ideations, and treatment-arm). At week 4, participants with low and normal QoL had higher unadjusted odds ratio (OR) for remission at 3 months (low QoL OR=2.36, 95% confidence interval (CI)=1.25,4.44; normal QoL OR=2.59, 95% CI=1.53,4.39) and 7 months (low QoL OR=2.07, 95% CI=1.00,4.31; normal QoL OR=3.98, 95% CI=2.06,7.69) compared to those with very low QoL. Remission rates, adjusted for baseline variables, were higher only for participants with normal QoL (3 months OR=2.83, 95% CI=1.42,5.68; 7 months OR=6.10, 95% CI=2.40,15.63). LIMITATIONS Secondary analysis, short period of assessment for QoL change, remission instead of functional recovery as long-term outcome. CONCLUSION Quality of life improves early, independent of depression severity. Normal QoL at week 4 is associated with 2-6 times higher remission rates. Findings support QoL beyond symptomatic change as a potential mediator of remission.
Collapse
Affiliation(s)
- Manish K Jha
- Department of Psychiatry, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-9119, USA
| | - Tracy L Greer
- Department of Psychiatry, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-9119, USA
| | - Bruce D Grannemann
- Department of Psychiatry, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-9119, USA
| | - Thomas Carmody
- Department of Psychiatry, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-9119, USA
| | - A John Rush
- Duke-National University of Singapore, Singapore
| | - Madhukar H Trivedi
- Department of Psychiatry, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-9119, USA.
| |
Collapse
|
20
|
Trivedi MH, Greer TL, Grannemann BD, Church TS, Galper DI, Sunderajan P, Wisniewski SR, Chambliss HO, Jordan AN, Finley C, Carmody TI. TREAD: TReatment with Exercise Augmentation for Depression: study rationale and design. Clin Trials 2016; 3:291-305. [PMID: 16895046 DOI: 10.1191/1740774506cn151oa] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background Despite recent advancements in the pharmacological treatment of major depressive disorder (MDD), over half of patients who receive treatment with antidepressant medication do not achieve full remission of symptoms. There is evidence that exercise can reduce depressive symptomatology when used as a treatment for MDD. However, no randomized controlled trials have evaluated exercise as an augmentation strategy for patients with carefully diagnosed MDD who remain symptomatic following an adequate acute phase trial of antidepressant therapy. Purpose TReatment with Exercise Augmentation for Depression (TREAD) is an NIMH-funded, randomized, controlled trial designed to assess the relative efficacy of two doses of aerobic exercise to augment selective serotonin reuptake inhibitor (SSRI) treatment of MDD. Methods The TREAD study includes 12 weeks of acute phase treatment with a 12-week post-treatment follow-up. In addition to looking at change in depressive symptoms as a primary outcome, it also includes comprehensive assessment of psychosocial function and treatment adherence. Results This paper reviews the rationale and design of TREAD and illustrates how we address several key issues in contemporary patient-oriented research on MDD: 1) the use of augmentation strategies in the treatment of depressive disorders in general, 2) the use of non-pharmacological strategies in the treatment of depressive disorders, 3) the considerations of designing a well-controlled trial using two active treatment groups, and 4) the implementation of an adherence program for the use of exercise as a treatment strategy. Conclusions The TREAD study is uniquely designed to overcome sources of potential bias and threats to internal and external validity that have limited prior research on the mental health effects of exercise. The study is facilitated by the development of a multidisciplinary research team that includes experts in both depression treatment and exercise physiology, as well as other related fields.
Collapse
Affiliation(s)
- Madhukar H Trivedi
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Greer TL, Trombello JM, Rethorst CD, Carmody TJ, Jha MK, Liao A, Grannemann BD, Chambliss HO, Church TS, Trivedi MH. IMPROVEMENTS IN PSYCHOSOCIAL FUNCTIONING AND HEALTH-RELATED QUALITY OF LIFE FOLLOWING EXERCISE AUGMENTATION IN PATIENTS WITH TREATMENT RESPONSE BUT NONREMITTED MAJOR DEPRESSIVE DISORDER: RESULTS FROM THE TREAD STUDY. Depress Anxiety 2016; 33:870-81. [PMID: 27164293 PMCID: PMC5662022 DOI: 10.1002/da.22521] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [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: 11/10/2015] [Revised: 04/18/2016] [Accepted: 04/20/2016] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Functional impairments often remain despite symptomatic improvement with antidepressant treatment, supporting the need for novel treatment approaches. The present study examined the extent to which exercise augmentation improved several domains of psychosocial functioning and quality of life (QoL) among depressed participants. METHODS Data were collected from 122 partial responders to antidepressant medication. Participants were randomized to either high- (16 kcal/kg of weight/week [KKW]) or low-dose (4-KKW) exercise. Participants completed a combination of supervised and home-based exercise for 12 weeks. The Short-Form Health Survey, Work and Social Adjustment Scale, Social Adjustment Scale, Quality of Life Enjoyment and Satisfaction Questionnaire, and Satisfaction with Life Scale were collected at 6 and 12 weeks. Participants with data for at least one of the two follow-up time points (n = 106) were analyzed using a linear mixed model to assess change from baseline within groups and the difference between groups for each psychosocial outcome measure. All analyses controlled for covariates, including baseline depressive symptomatology. RESULTS Participants experienced significant improvements in functioning across tested domains, and generally fell within a healthy range of functioning on all measures at Weeks 6 and 12. Although no differences were found between exercise groups, improvements were observed across a variety of psychosocial and QoL domains, even in the low-dose exercise group. CONCLUSIONS These findings support exercise augmentation of antidepressant treatment as a viable intervention for treatment-resistant depression to improve function in addition to symptoms.
Collapse
Affiliation(s)
- Tracy L. Greer
- The University of Texas Southwestern Medical Center, Division of Mood Disorders, Department of Psychiatry, Dallas, TX, USA,Address Correspondence to: Tracy L. Greer, Ph.D. Associate Professor, Department of Psychiatry, Center for Depression Research and Clinical Care, 5323 Harry Hines Blvd., Dallas, TX 75390-9119, Phone: 214-648-0156, Fax: 214-648-0167,
| | - Joseph M. Trombello
- The University of Texas Southwestern Medical Center, Division of Mood Disorders, Department of Psychiatry, Dallas, TX, USA
| | - Chad D. Rethorst
- The University of Texas Southwestern Medical Center, Division of Mood Disorders, Department of Psychiatry, Dallas, TX, USA
| | - Thomas J. Carmody
- The University of Texas Southwestern Medical Center, Division of Mood Disorders, Department of Psychiatry, Dallas, TX, USA,The University of Texas Southwestern Medical Center, Department of Clinical Sciences, Dallas, TX USA
| | - Manish K. Jha
- The University of Texas Southwestern Medical Center, Division of Mood Disorders, Department of Psychiatry, Dallas, TX, USA
| | - Allen Liao
- The University of Texas Southwestern Medical Center, Division of Mood Disorders, Department of Psychiatry, Dallas, TX, USA
| | - Bruce D. Grannemann
- The University of Texas Southwestern Medical Center, Division of Mood Disorders, Department of Psychiatry, Dallas, TX, USA
| | | | - Timothy S. Church
- Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, LA, USA
| | - Madhukar H. Trivedi
- The University of Texas Southwestern Medical Center, Division of Mood Disorders, Department of Psychiatry, Dallas, TX, USA
| |
Collapse
|
22
|
Suterwala AM, Rethorst CD, Carmody TJ, Greer TL, Grannemann BD, Jha M, Trivedi MH. Affect Following First Exercise Session as a Predictor of Treatment Response in Depression. J Clin Psychiatry 2016; 77:1036-42. [PMID: 27561137 PMCID: PMC5673095 DOI: 10.4088/jcp.15m10104] [Citation(s) in RCA: 12] [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: 05/13/2015] [Accepted: 10/06/2015] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Remission rates are low with first-step or even second-step antidepressant treatments. Furthermore, despite extensive investments from National Institutes of Health and from industry, novel treatments are not yet available in clinical care for depression. Predictors of treatment response very early in the course of treatment can avoid unnecessarily lengthy trials with ineffective treatments and reduce the trial and error process. This article examines the expression of positive affect immediately following an acute exercise session at the end of the first exercise session as a predictor of treatment response in the National Institute of Mental Health-funded TREAD (Treatment with Exercise Augmentation for Depression) study, which was conducted from April 2003 to August 2007. METHODS 122 subjects with DSM-IV-diagnosed major depressive disorder were randomized to public health dose (16 kcal/kg/wk) or low dose (4 kcal/kg/wk) of exercise for 12 weeks. Affect following the first exercise session was assessed using the Positive and Negative Affect Scale (PANAS), and depressive symptoms were assessed weekly using the Inventory of Depressive Symptomatology, Clinician Rating (IDS-C) (primary outcome measure). RESULTS The PANAS composite affect score (positive-negative total) predicted change in IDS-C score (P < .05), as well as treatment response (P < .02) and remission (P < .03) for those in the high-dose group but not in the low-dose group. CONCLUSIONS These findings suggest that the composite positive affect following the first exercise session has clinical utility to predict treatment response to exercise in depression and match the "right patient" with the "right" treatment. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT00076258.
Collapse
Affiliation(s)
| | | | | | - Tracy L. Greer
- University of Texas Southwestern Medical Center, Dallas, TX
| | | | - Manish Jha
- University of Texas Southwestern Medical Center, Dallas, TX
| | - Madhukar H Trivedi
- Comprehensive Center for Depression, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-9119. .,University of Texas Southwestern Medical Center, Dallas, Texas, USA
| |
Collapse
|
23
|
Abstract
According to some, it is increasingly common for defendants to admit they committed an offense but to argue that they shouldn't be held legally responsible because they have an excuse. The present study was conducted to investigate views of excuse defenses. Forty-three participants rated 15 different excuse defenses (e.g., steroid use) on a number of characteristics (e.g., persuasiveness of defense). Participants also indicated whether they would be willing to change an assigned sentence (increase or decrease sentence, recommend treatment or probation) in the presence of each excuse defense. Ratings revealed that excuses vary in persuasiveness, with the persuasiveness of an excuse associated with the defendant's perceived amount of responsibility for the act and control over the criminal act and excusing condition. Defendants providing excuses seen as more persuasive tended to receive shorter sentences and more treatment recommendations. Possible factors influencing judgments are discussed.
Collapse
|
24
|
Trivedi MH, McGrath PJ, Fava M, Parsey RV, Kurian BT, Phillips ML, Oquendo MA, Bruder G, Pizzagalli D, Toups M, Cooper C, Adams P, Weyandt S, Morris DW, Grannemann BD, Ogden RT, Buckner R, McInnis M, Kraemer HC, Petkova E, Carmody TJ, Weissman MM. Establishing moderators and biosignatures of antidepressant response in clinical care (EMBARC): Rationale and design. J Psychiatr Res 2016; 78:11-23. [PMID: 27038550 PMCID: PMC6100771 DOI: 10.1016/j.jpsychires.2016.03.001] [Citation(s) in RCA: 180] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 03/02/2016] [Accepted: 03/03/2016] [Indexed: 12/28/2022]
Abstract
UNLABELLED Remission rates for Major Depressive Disorder (MDD) are low and unpredictable for any given antidepressant. No biological or clinical marker has demonstrated sufficient ability to match individuals to efficacious treatment. Biosignatures developed from the systematic exploration of multiple biological markers, which optimize treatment selection for individuals (moderators) and provide early indication of ultimate treatment response (mediators) are needed. The rationale and design of a multi-site, placebo-controlled randomized clinical trial of sertraline examining moderators and mediators of treatment response is described. The target sample is 300 participants with early onset (≤30 years) recurrent MDD. Non-responders to an 8-week trial are switched double blind to either bupropion (for sertraline non-responders) or sertraline (for placebo non-responders) for an additional 8 weeks. Clinical moderators include anxious depression, early trauma, gender, melancholic and atypical depression, anger attacks, Axis II disorder, hypersomnia/fatigue, and chronicity of depression. Biological moderator and mediators include cerebral cortical thickness, task-based fMRI (reward and emotion conflict), resting connectivity, diffusion tensor imaging (DTI), arterial spin labeling (ASL), electroencephalograpy (EEG), cortical evoked potentials, and behavioral/cognitive tasks evaluated at baseline and week 1, except DTI, assessed only at baseline. The study is designed to standardize assessment of biomarkers across multiple sites as well as institute replicable quality control methods, and to use advanced data analytic methods to integrate these markers. A Differential Depression Treatment Response Index (DTRI) will be developed. The data, including biological samples (DNA, RNA, and plasma collected before and during treatment), will become available in a public scientific repository. CLINICAL TRIAL REGISTRATION Establishing Moderators and Biosignatures of Antidepressant Response for Clinical Care for Depression (EMBARC). Identifier: NCT01407094. URL: http://clinicaltrials.gov/show/NCT01407094.
Collapse
Affiliation(s)
| | - Patrick J McGrath
- New York State Psychiatric Institute & Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY, USA
| | | | | | - Benji T Kurian
- University of Texas, Southwestern Medical Center, Dallas, TX, USA
| | | | - Maria A Oquendo
- New York State Psychiatric Institute & Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY, USA
| | - Gerard Bruder
- New York State Psychiatric Institute & Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY, USA
| | | | - Marisa Toups
- University of Texas, Southwestern Medical Center, Dallas, TX, USA
| | - Crystal Cooper
- University of Texas, Southwestern Medical Center, Dallas, TX, USA
| | - Phil Adams
- New York State Psychiatric Institute & Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY, USA
| | - Sarah Weyandt
- University of Texas, Southwestern Medical Center, Dallas, TX, USA
| | - David W Morris
- University of Texas, Southwestern Medical Center, Dallas, TX, USA
| | | | | | | | | | | | | | - Thomas J Carmody
- University of Texas, Southwestern Medical Center, Dallas, TX, USA
| | - Myrna M Weissman
- New York State Psychiatric Institute & Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY, USA
| |
Collapse
|
25
|
Greer TL, Grannemann BD, Chansard M, Karim AI, Trivedi MH. Dose-dependent changes in cognitive function with exercise augmentation for major depression: results from the TREAD study. Eur Neuropsychopharmacol 2015; 25:248-56. [PMID: 25453481 DOI: 10.1016/j.euroneuro.2014.10.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [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: 07/22/2014] [Revised: 09/16/2014] [Accepted: 10/11/2014] [Indexed: 11/17/2022]
Abstract
Cognitive dysfunction has been repeatedly observed in major depressive disorder (MDD), particularly in areas of attention, verbal and nonverbal learning and memory, and executive functioning. Exercise has been shown to improve cognitive outcomes in other populations, including age-associated cognitive decline, but has not to our knowledge been investigated as an augmentation strategy in depression. This study evaluated the effectiveness of exercise augmentation on cognitive performance in persons with MDD and residual symptoms that included cognitive complaints following initial treatment with a selective serotonin reuptake inhibitor (SSRI). Participants enrolled in the Treatment with Exercise Augmentation for Depression (TREAD) study were randomized to receive either a low or high dose exercise regimen. TREAD participants who provided informed consent for the current study completed Cambridge Neuropsychological Test Automated Battery measures assessing Attention, Visual Memory, Executive Function/Set-shifting and Working Memory, and Executive Function/Spatial Planning domains. Data were analyzed for 39 participants completing both baseline and Week 12 cognitive testing. Overall tests indicated a significant task × group × time interaction for the Executive Function/Set-shifting and Working Memory domain. Post-hoc tests indicated improvements in high dose exercisers' spatial working memory, but decreases in spatial working memory and set-shifting outcomes in low dose exercisers. Both groups improved on measures of psychomotor speed, attention, visual memory and spatial planning. This study suggests a dose-response effect of exercise in specific executive function and working memory tasks among depressed persons with a partial response to SSRI and cognitive complaints, with some cognitive functions improving regardless of exercise dose.
Collapse
Affiliation(s)
- Tracy L Greer
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX 75390-9119, USA.
| | - Bruce D Grannemann
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX 75390-9119, USA
| | - Matthieu Chansard
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX 75390-9119, USA
| | - Alyzae I Karim
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX 75390-9119, USA
| | - Madhukar H Trivedi
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX 75390-9119, USA
| |
Collapse
|
26
|
Sanchez K, Walker R, Campbell ANC, Greer TL, Hu MC, Grannemann BD, Nunes EV, Trivedi MH. Depressive Symptoms and Associated Clinical Characteristics in Outpatients Seeking Community-Based Treatment for Alcohol and Drug Problems. Subst Abus 2014; 36:297-303. [PMID: 25084694 DOI: 10.1080/08897077.2014.937845] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [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: 12/13/2022]
Abstract
BACKGROUND Comorbid psychiatric and substance use disorders are common and associated with poorer treatment engagement, retention, and outcomes. This study examines the presence of depressive symptoms and the demographic and clinical correlates in a diverse sample of substance abuse treatment seekers to better characterize patients with co-occurring depressive symptoms and substance use disorders and understand potential treatment needs. METHODS Baseline data from a randomized clinical effectiveness trial of a computer-assisted, Web-delivered psychosocial intervention were analyzed. Participants (N = 507) were recruited from 10 geographically diverse outpatient drug treatment programs. Assessments included the self-report Patient Health Questionnaire, and measures of coping strategies, social functioning, physical health status, and substance use. RESULTS One fifth (21%; n = 106) of the sample screened positive for depression; those screening positive for depression were significantly more likely to screen positive for anxiety (66.9%) and posttraumatic stress disorder (PTSD; 42.9%). After controlling for anxiety and PTSD symptoms, presence of depressive symptoms remained significantly associated with fewer coping strategies (P = .001), greater impairment in social adjustment (P < .001), and poorer health status (P < .001), but not to days of drug use in the last 90 days (P = .14). CONCLUSIONS Depression is a clinically significant problem among substance abusers, and, in this study, patients who screened positive for depression were more likely to have co-occurring symptoms of anxiety and PTSD. Additionally, the presence of depressive symptoms was associated with fewer coping strategies and poorer social adjustment. Coping skills are a significant predictor of addiction outcomes, and it may be especially important to screen for and enhance coping among depressed patients. Evidence-based interventions that target coping skills and global functioning among substance abusers with depressive symptoms may be important adjuncts to usual treatment.
Collapse
Affiliation(s)
- Katherine Sanchez
- a School of Social Work , The University of Texas at Arlington , Arlington , Texas , USA
| | | | | | | | | | | | | | | |
Collapse
|
27
|
Heath WP, Grannemann BD. How video image size interacts with evidence strength, defendant emotion, and the defendant-victim relationship to alter perceptions of the defendant. Behav Sci Law 2014; 32:496-507. [PMID: 24715347 DOI: 10.1002/bsl.2120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Revised: 02/22/2014] [Accepted: 02/24/2014] [Indexed: 06/03/2023]
Abstract
Courtroom video presentations can range from images on small screens installed in the jury box to images on courtroom video monitors or projection screens. Does video image size affect jurors' perceptions of information presented during trials? To investigate this we manipulated video image size as well as defendant emotion level presented during testimony (low, moderate), the defendant-victim relationship (spouses, strangers), and the strength of the evidence (weak, strong). Participants (N=263) read a case and trial summary, watched video of defendant testimony, and then answered a questionnaire. Larger screens generally accentuated what was presented (e.g., made stronger evidence seem stronger and weaker evidence seem weaker), acting mainly upon trial outcome variables (e.g., verdict). Non-trial outcomes (e.g., defendant credibility) were generally affected by defendant emotion level and the defendant-victim relationship. Researchers and attorneys presenting video images need to recognize that respondents may evaluate videotaped trial evidence differently as a function of how video evidence is presented.
Collapse
Affiliation(s)
- Wendy P Heath
- University of Texas-Southwestern Medical Center, Department of Psychiatry
| | | |
Collapse
|
28
|
Myers AK, Grannemann BD, Lingvay I, Trivedi MH. Brief report: depression and history of suicide attempts in adults with new-onset Type 2 Diabetes. Psychoneuroendocrinology 2013; 38:2810-4. [PMID: 23978666 DOI: 10.1016/j.psyneuen.2013.06.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [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: 08/13/2012] [Revised: 06/07/2013] [Accepted: 06/07/2013] [Indexed: 11/24/2022]
Abstract
AIM To assess past suicide attempts in a cohort of adults with Type 2 Diabetes diagnosed within the prior 24 months. METHODS Outpatients were recruited from diabetes education classes or diabetes shared medical appointment. Participants aged 18 or over with a self-reported diagnosis of Type 2 Diabetes (T2DM) in the prior 24 months completed questionnaires about medical (including diabetes), psychiatric, and social history. Participants also completed two screening questionnaires for depression: Patient Health Questionnaire 9 and the Questionnaire Inventory for Depressive Symptoms-Self Report. Those who screened positive for depression had confirmatory testing with a clinician administered Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) checklist. RESULTS In this convenience sample of 145 patients with Type 2 Diabetes, 9.7% of patients had history of a suicide attempt and 38.2% met diagnosis for major depressive disorder (MDD). Patients with MDD were more likely to have a history of suicide attempts than those without MDD (p=0.0002). Of the patients with prior suicide attempts, 50% screened positive for MDD at the time of the survey. CONCLUSION In patients with newly-diagnosed Type 2 Diabetes the rate of past suicide attempts was nearly 10%, which is twice the rate seen in the general population. The rate of past suicide attempts in currently depressed patients with diabetes is 21.8%. These findings suggest the need for monitoring patients with diabetes and depression for future suicide risk.
Collapse
Affiliation(s)
- Alyson K Myers
- Department of Psychiatry, University of Texas at Southwestern Medical Center, Dallas, TX, United States; Division of Endocrinology, University of Texas at Southwestern Medical Center, Dallas, TX, United States.
| | | | | | | |
Collapse
|
29
|
Rethorst CD, Toups MS, Greer TL, Nakonezny PA, Carmody TJ, Grannemann BD, Huebinger RM, Barber RC, Trivedi MH. Pro-inflammatory cytokines as predictors of antidepressant effects of exercise in major depressive disorder. Mol Psychiatry 2013; 18:1119-24. [PMID: 22925832 PMCID: PMC3511631 DOI: 10.1038/mp.2012.125] [Citation(s) in RCA: 135] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Revised: 06/27/2012] [Accepted: 07/05/2012] [Indexed: 12/24/2022]
Abstract
Exercise is an efficacious treatment for major depressive disorder (MDD) and has independently been shown to have anti-inflammatory effects in non-depressed subjects. Patients with MDD have elevated inflammatory cytokines but it is not known if exercise affects inflammation in MDD patients and whether these changes are clinically relevant. In the TReatment with Exercise Augmentation for Depression (TREAD) study, participants who were partial responders to a selective serotonin reuptake inhibitor were randomized to receive one of two doses of exercise: 16 kilocalories per kilogram of body weight per week (KKW), or 4 KKW for 12 weeks. Blood samples were collected before initiation and again at the end of the 12-week exercise intervention. Serum was analyzed using a multiplexed ELISA for interferon-γ (IFN-γ), interleukin-1β (IL-1β), interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α). Higher baseline levels of TNF-α were associated with greater decrease in depression symptoms over the 12-week exercise period (P<0.0001). In addition, a significant positive correlation between change in IL-1β and change in depression symptom scores was observed (P=0.04). There were no significant changes in mean level of any cytokine following the 12-week intervention, and no significant relationship between exercise dose and change in mean cytokine level. Results suggest that high TNF-α may differentially predict better outcomes with exercise treatment as opposed to antidepressant medications for which high TNF-α is linked to poor response. Our results also confirm findings from studies of antidepressant medications that tie decreasing IL-1β to positive depression treatment outcomes.
Collapse
|
30
|
Rethorst CD, Sunderajan P, Greer TL, Grannemann BD, Nakonezny PA, Carmody TJ, Trivedi MH. Does exercise improve self-reported sleep quality in non-remitted major depressive disorder? Psychol Med 2013; 43:699-709. [PMID: 23171815 DOI: 10.1017/s0033291712001675] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Sleep disturbances are persistent residual symptoms following remission of major depressive disorder (MDD) and are associated with an increased risk of MDD recurrence. The purpose of the current study was to examine the effect of exercise augmentation on self-reported sleep quality in participants with non-remitted MDD. Method Participants were randomized to receive selective serotonin reuptake inhibitor (SSRI) augmentation with one of two doses of exercise: 16 kilocalories per kilogram of body weight per week (KKW) or 4 KKW for 12 weeks. Depressive symptoms were assessed using the clinician-rated Inventory of Depressive Symptomatology (IDS-C). The four sleep-related items on the IDS-C (Sleep Onset Insomnia, Mid-Nocturnal Insomnia, Early Morning Insomnia, and Hypersomnia) were used to assess self-reported sleep quality. RESULTS Significant decreases in total insomnia (p < 0.0001) were observed, along with decreases in sleep onset, mid-nocturnal and early-morning insomnia (p's <0.002). Hypersomnia did not change significantly (p = 0.38). Changes in total, mid-nocturnal and early-morning insomnia were independent of changes in depressive symptoms. Higher baseline hypersomnia predicted a greater decrease in depression severity following exercise treatment (p = 0.0057). No significant moderating effect of any baseline sleep on change in depression severity was observed. There were no significant differences between exercise treatment groups on total insomnia or any individual sleep item. CONCLUSIONS Exercise augmentation resulted in improvements in self-reported sleep quality in patients with non-remitted MDD. Given the prevalence of insomnia as a residual symptom following MDD treatment and the associated risk of MDD recurrence, exercise augmentation may have an important role in the treatment of MDD.
Collapse
Affiliation(s)
- C D Rethorst
- University of Texas Southwestern Medical Center, Dallas, TX 75390-9119, USA.
| | | | | | | | | | | | | |
Collapse
|
31
|
Greer TL, Ring KM, Warden D, Grannemann BD, Church TS, Somoza E, Blair SN, Szapocznik J, Stoutenberg M, Rethorst C, Walker R, Morris DW, Kosinski AS, Kyle T, Marcus B, Crowell B, Oden N, Nunes E, Trivedi MH. Rationale for Using Exercise in the Treatment of Stimulant Use Disorders. J Glob Drug Policy Pract 2012; 6:http://ctndisseminationlibrary.org/display/825.htm. [PMID: 25364477 PMCID: PMC4214380] [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] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Novel approaches to the treatment of stimulant abuse and dependence are needed. Clinical data examining the use of exercise as a treatment for the abuse of nicotine, alcohol, and other substances suggest that exercise may be a beneficial treatment for stimulant abuse. In addition, exercise has been associated with improvements in many other health-related areas that may be adversely affected by stimulant use or its treatment, such as sleep disturbance, cognitive function, mood, weight, quality of life, and anhedonia. Neurobiological evidence provides plausible mechanisms by which exercise could positively affect treatment outcomes in stimulant abuse. The National Institute on Drug Abuse (NIDA) Clinical Trials Network (CTN) CTN-0037 Stimulant Reduction Intervention using Dosed Exercise (STRIDE) study is a multisite randomized clinical trial that compares exercise to health education as potential treatments for stimulant abuse or dependence. If effective, exercise may provide an additional approach to the treatment of stimulant use disorders.
Collapse
Affiliation(s)
- Tracy L Greer
- The University of Texas Southwestern Medical Center at Dallas
| | - Kolette M Ring
- The University of Texas Southwestern Medical Center at Dallas
| | - Diane Warden
- The University of Texas Southwestern Medical Center at Dallas
| | | | - Timothy S Church
- Preventive Medicine Laboratory, Pennington Biomedical Research Center
| | - Eugene Somoza
- Cincinnati Addictions Research Center (CinARC); Department of Psychiatry, University of Cincinnati College of Medicine
| | - Steven N Blair
- Department of Exercise Science, University of South Carolina ; Department of Epidemiology and Biostatistics, University of South Carolina
| | - Jose Szapocznik
- Department of Epidemiology and Public Health, University of Miami, Miller School of Medicine
| | - Mark Stoutenberg
- Department of Epidemiology and Public Health, University of Miami, Miller School of Medicine
| | - Chad Rethorst
- The University of Texas Southwestern Medical Center at Dallas
| | - Robrina Walker
- The University of Texas Southwestern Medical Center at Dallas
| | - David W Morris
- The University of Texas Southwestern Medical Center at Dallas
| | - Andrzej S Kosinski
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Duke Clinical Research Institute
| | | | - Bess Marcus
- Department of Family and Preventive Medicine, The University of California, San Diego
| | | | | | - Edward Nunes
- New York State Psychiatric Institute/Department of Psychiatry, College of Physicians and Surgeons of Columbia University
| | | |
Collapse
|
32
|
Trivedi MH, Greer TL, Potter JS, Grannemann BD, Nunes EV, Rethorst C, Warden D, Ring KM, Somoza E. Determining the primary endpoint for a stimulant abuse trial: lessons learned from STRIDE (CTN 0037). Am J Drug Alcohol Abuse 2011; 37:339-49. [PMID: 21854276 DOI: 10.3109/00952990.2011.598589] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND No consensus is available for identifying the best primary outcome for substance use disorder trials, making interpretation across trials difficult. Abstinence is the most desirable treatment outcome although a wide variety of other endpoints have been used. OBJECTIVES This report provides a framework for determining an optimal primary endpoint and the relevant measurement approach for substance use disorder treatment trials. The framework was developed based on a trial for stimulant abuse using exercise as an augmentation treatment, delivered within the NIDA Clinical Trials Network. The use of a common endpoint across trials will facilitate comparisons of treatment efficacy. METHODS Primary endpoint options in existing substance abuse studies were evaluated. This evaluation included surveys of the literature for endpoints and measurement approaches, followed by assessment of endpoint choices against study design issues, population characteristics, tests of sensitivity, and tests of clinical meaningfulness. CONCLUSION We concluded that the best current choice for a primary endpoint is percent days abstinent, as measured by the Time Line Follow Back interview conducted three times a week with recall aided by a take-home Substance Use Diary. To improve the accuracy of the self-reported drug use, the results of qualitative urine drug screens will be used in conjunction with the Time Line Follow Back results. SCIENTIFIC SIGNIFICANCE There is a need for a standardized endpoint in this field to allow for comparison across treatment studies, and we suggest that the recommended candidate endpoint be considered. However, the study design and goals ultimately must guide the final decision.
Collapse
Affiliation(s)
- Madhukar H Trivedi
- Department of Psychiatry, University of Texas Southwestern Medical Center at Dallas, 75390-9119, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Toups MS, Greer TL, Kurian BT, Grannemann BD, Carmody TJ, Huebinger R, Rethorst C, Trivedi MH. Effects of serum Brain Derived Neurotrophic Factor on exercise augmentation treatment of depression. J Psychiatr Res 2011; 45:1301-6. [PMID: 21641002 PMCID: PMC9900870 DOI: 10.1016/j.jpsychires.2011.05.002] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2011] [Revised: 05/03/2011] [Accepted: 05/06/2011] [Indexed: 02/08/2023]
Abstract
BACKGROUND Brain Derived Neurotrophic Factor (BDNF) has potential as a biomarker of depression treatment because serum BDNF in depressed human subjects is decreased and normalizes with treatment. The relationship between serum BDNF and exercise treatment of depression is not known. The Treatment with Exercise Augmentation for Depression (TREAD) study examined dosed exercise augmentation treatment of partial responders to antidepressants. Serum BDNF in TREAD subjects was analyzed to understand its relationship with exercise training. METHODS Subjects were randomized to high (16 kcal/kg/week or KKW) or low (4 KKW) energy expenditure exercise over 12 weeks. Actual kcal/week expended and IDS-C scores were collected weekly. One hundred four subjects in TREAD provided baseline blood samples; a subset of 70 subjects also provided week 12 samples. Serum BDNF was determined using ELISA. Correlations were examined between change in BDNF and 1) mean kcal/week expended, and 2) change in IDS-C score. Mixed-effects ANOVA examined the effect of baseline BDNF on outcome. RESULTS Resting serum BDNF was stable and did not correlate with energy expenditure (p = 0.15) or IDS-C improvement (p = 0.89). Subjects entering the study with higher BDNF improved more rapidly on the IDS-C (p = 0.003). LIMITATIONS Serum may not be the most sensitive blood fraction in which to measure BDNF change. Pre-treatment with medication may mask exercise effect on BDNF. CONCLUSIONS These results suggest that change in serum BDNF does not reflect efficacy of exercise augmentation treatment of MDD. Instead BDNF may function as an augmentation moderator. Pre-treatments that raise BDNF may improve the efficacy of exercise treatment of MDD.
Collapse
Affiliation(s)
- Marisa S.P. Toups
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX 75235, USA
| | - Tracy L. Greer
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX 75235, USA
| | - Benji T. Kurian
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX 75235, USA
| | - Bruce D. Grannemann
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX 75235, USA
| | - Thomas J. Carmody
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX 75235, USA
- Department of Clinical Sciences, UT Southwestern Medical Center, Dallas, TX 75235, USA
| | - Ryan Huebinger
- Department of Surgery, UT Southwestern Medical Center, Dallas, TX 75235, USA
| | - Chad Rethorst
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX 75235, USA
| | - Madhukar H. Trivedi
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX 75235, USA
- Corresponding author: (M.H. Trivedi)
| |
Collapse
|
34
|
Trivedi MH, Greer TL, Grannemann BD, Church TS, Somoza E, Blair SN, Szapocznik J, Stoutenberg M, Rethorst C, Warden D, Ring KM, Walker R, Morris DW, Kosinski AS, Kyle T, Marcus B, Crowell B, Oden N, Nunes E. Stimulant reduction intervention using dosed exercise (STRIDE) - CTN 0037: study protocol for a randomized controlled trial. Trials 2011; 12:206. [PMID: 21929768 PMCID: PMC3191354 DOI: 10.1186/1745-6215-12-206] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [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: 07/29/2011] [Accepted: 09/19/2011] [Indexed: 11/20/2022] Open
Abstract
Background There is a need for novel approaches to the treatment of stimulant abuse and dependence. Clinical data examining the use of exercise as a treatment for the abuse of nicotine, alcohol, and other substances suggest that exercise may be a beneficial treatment for stimulant abuse, with direct effects on decreased use and craving. In addition, exercise has the potential to improve other health domains that may be adversely affected by stimulant use or its treatment, such as sleep disturbance, cognitive function, mood, weight gain, quality of life, and anhedonia, since it has been shown to improve many of these domains in a number of other clinical disorders. Furthermore, neurobiological evidence provides plausible mechanisms by which exercise could positively affect treatment outcomes. The current manuscript presents the rationale, design considerations, and study design of the National Institute on Drug Abuse (NIDA) Clinical Trials Network (CTN) CTN-0037 Stimulant Reduction Intervention using Dosed Exercise (STRIDE) study. Methods/Design STRIDE is a multisite randomized clinical trial that compares exercise to health education as potential treatments for stimulant abuse or dependence. This study will evaluate individuals diagnosed with stimulant abuse or dependence who are receiving treatment in a residential setting. Three hundred and thirty eligible and interested participants who provide informed consent will be randomized to one of two treatment arms: Vigorous Intensity High Dose Exercise Augmentation (DEI) or Health Education Intervention Augmentation (HEI). Both groups will receive TAU (i.e., usual care). The treatment arms are structured such that the quantity of visits is similar to allow for equivalent contact between groups. In both arms, participants will begin with supervised sessions 3 times per week during the 12-week acute phase of the study. Supervised sessions will be conducted as one-on-one (i.e., individual) sessions, although other participants may be exercising at the same time. Following the 12-week acute phase, participants will begin a 6-month continuation phase during which time they will attend one weekly supervised DEI or HEI session. Clinical Trials Registry ClinicalTrials.gov, NCT01141608 http://clinicaltrials.gov/ct2/show/NCT01141608?term=Stimulant+Reduction+Intervention+using+Dosed+Exercise&rank=1
Collapse
Affiliation(s)
- Madhukar H Trivedi
- The University of Texas Southwestern Medical Center at Dallas, Dallas, Texas 75390-9119, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
35
|
Warden D, Trivedi MH, Greer TL, Nunes E, Grannemann BD, Horigian VE, Somoza E, Ring K, Kyle T, Szapocznik J. Rationale and methods for site selection for a trial using a novel intervention to treat stimulant abuse. Contemp Clin Trials 2011; 33:29-37. [PMID: 21946515 DOI: 10.1016/j.cct.2011.08.011] [Citation(s) in RCA: 13] [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] [Subscribe] [Scholar Register] [Received: 05/05/2011] [Revised: 08/24/2011] [Accepted: 08/30/2011] [Indexed: 10/17/2022]
Abstract
Although the selection of appropriate clinical sites has a significant impact on the successful conduct of clinical trials, no generally accepted model is available for site selection. Use of an appropriate site selection process is even more pertinent when conducting large scale, practical clinical trials in practice settings. This report provides a rationale for selecting sites by identifying both a set of basic site selection criteria important to most trials as well as criteria specific to the features of a particular study's design. In this two-tier system, although all these criteria must be met, some criteria are firm and viewed as essential for a site to conduct the trial. Other criteria, such as those that support study recruitment or participant retention, are flexible. These flexible criteria may be addressed through several alternative solutions that meet the original intent of the criterion. We illustrate how the study specific features and requirements of Stimulant Reduction Intervention using Dosed Exercise (STRIDE), a multisite clinical trial evaluating the efficacy of exercise or health education, added to treatment as usual for stimulant abuse are linked to firm and flexible site selection criteria. We also present an iterative, multi-step approach to site selection including building awareness about the study and screening and evaluating sites using these criteria. This simple model could maximize the chance that selected sites will implement a study successfully and achieve trial aims. It may be helpful to researchers who are developing criteria and methods for site selection for specific clinical trials.
Collapse
Affiliation(s)
- Diane Warden
- Department of Psychiatry, The University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Blvd., Dallas, TX 75390-9119, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Kurian BT, Trivedi MH, Grannemann BD, Claassen CA, Daly EJ, Sunderajan P. A computerized decision support system for depression in primary care. Prim Care Companion J Clin Psychiatry 2011; 11:140-6. [PMID: 19750065 DOI: 10.4088/pcc.08m00687] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2008] [Accepted: 09/11/2008] [Indexed: 02/08/2023]
Abstract
OBJECTIVE In 2004, results from The Texas Medication Algorithm Project (TMAP) showed better clinical outcomes for patients whose physicians adhered to a paper-and-pencil algorithm compared to patients who received standard clinical treatment for major depressive disorder (MDD). However, implementation of and fidelity to the treatment algorithm among various providers was observed to be inadequate. A computerized decision support system (CDSS) for the implementation of the TMAP algorithm for depression has since been developed to improve fidelity and adherence to the algorithm. METHOD This was a 2-group, parallel design, clinical trial (one patient group receiving MDD treatment from physicians using the CDSS and the other patient group receiving usual care) conducted at 2 separate primary care clinics in Texas from March 2005 through June 2006. Fifty-five patients with MDD (DSM-IV criteria) with no significant difference in disease characteristics were enrolled, 32 of whom were treated by physicians using CDSS and 23 were treated by physicians using usual care. The study's objective was to evaluate the feasibility and efficacy of implementing a CDSS to assist physicians acutely treating patients with MDD compared to usual care in primary care. Primary efficacy outcomes for depression symptom severity were based on the 17-item Hamilton Depression Rating Scale (HDRS(17)) evaluated by an independent rater. RESULTS Patients treated by physicians employing CDSS had significantly greater symptom reduction, based on the HDRS(17), than patients treated with usual care (P < .001). CONCLUSIONS The CDSS algorithm, utilizing measurement-based care, was superior to usual care for patients with MDD in primary care settings. Larger randomized controlled trials are needed to confirm these findings. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00551083.
Collapse
Affiliation(s)
- Benji T Kurian
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas
| | | | | | | | | | | |
Collapse
|
37
|
Trivedi MH, Greer TL, Church TS, Carmody TJ, Grannemann BD, Galper DI, Dunn AL, Earnest CP, Sunderajan P, Henley SS, Blair SN. Exercise as an augmentation treatment for nonremitted major depressive disorder: a randomized, parallel dose comparison. J Clin Psychiatry 2011; 72:677-84. [PMID: 21658349 PMCID: PMC9900872 DOI: 10.4088/jcp.10m06743] [Citation(s) in RCA: 147] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2010] [Accepted: 02/23/2011] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Most patients with major depressive disorder (MDD) require second-step treatments to achieve remission. The Treatment with Exercise Augmentation for Depression (TREAD) study was designed to test the efficacy of aerobic exercise as an augmentation treatment for MDD patients who had not remitted with antidepressant treatment. METHOD Eligible participants in this randomized controlled trial were sedentary individuals (men and women aged 18-70 years) diagnosed with DSM-IV nonpsychotic MDD who had not remitted with selective serotonin reuptake inhibitor (SSRI) treatment. Participants were recruited through physician referrals and advertisements. A total of 126 participants were randomized to augmentation treatment with either 16 kcal per kg per week (KKW) or 4 KKW of exercise expenditure for 12 weeks while SSRI treatment was held constant. Supervised sessions were conducted at The Cooper Institute, Dallas, Texas, with additional home-based sessions as needed to fulfill the weekly exercise prescription. The primary outcome was remission (as determined by a score ≤ 12 on the Inventory of Depressive Symptomatology, Clinician-Rated). The study took place between August 2003 and August 2007. RESULTS There were significant improvements over time for both groups combined (F₁,₁₂₁ = 39.9, P < .0001), without differential group effect (group effect: F₁,₁₃₄ = 3.2, P = .07; group-by-time effect: F₁,₁₁₉ = 3.8, P = .06). Adjusted remission rates at week 12 were 28.3% versus 15.5% for the 16-KKW and 4-KKW groups, respectively, leading to a number needed to treat (NNT) of 7.8 for 16 KKW versus 4 KKW. Men, regardless of family history of mental illness, and women without a family history of mental illness had higher remission rates by week 12 with higher-dose (women, 39.0%; men, 85.4%) than with lower-dose exercise (women, 5.6%; men, 0.1%) (women: t₉₅ = 2.1, P = .04; men: t₈₈ = 5.4, P < .0001) (NNT: women, 3.0; men, 1.2). CONCLUSIONS There was a trend for higher remission rates in the higher-dose exercise group (P < .06), with a clinically meaningful NNT of 7.8 in favor of the high exercise dose. Significant differences between groups were found when the moderating effects of gender and family history of mental illness were taken into account and suggest that higher-dose exercise may be better for all men and for women without a family history of mental illness. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00076258.
Collapse
|
38
|
Kern JK, Fletcher CL, Garver CR, Mehta JA, Grannemann BD, Knox KR, Richardson TA, Trivedi MH. Prospective trial of equine-assisted activities in autism spectrum disorder. Altern Ther Health Med 2011; 17:14-20. [PMID: 22164808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Anecdotal reports and some studies suggest that equine-assisted activities may be beneficial in autism spectrum disorders (ASD). OBJECTIVE To examine the effects ofequine-assisted activities on overall severity of autism symptoms using the Childhood Autism Rating Scale (CARS) and the quality ofparent-child interactions using the Timberlawn Parent-Child Interaction Scale. In addition, this study examined changes in sensory processing, quality of life, and parental treatment satisfaction. DESIGN AND PARTICIPANTS Children with ASD were evaluated at four time points: (1) before beginning a 3-to-6 month waiting period, (2) before starting the riding treatment, and (3) after 3 months and (4) 6 months of riding. Twenty-four participants completed the waiting list period and began the riding program, and 20 participants completed the entire 6 months of riding. Pretreatment was compared to posttreatment with each child acting as his or her own control. RESULTS A reduction in the severity of autism symptoms occurred with the therapeutic riding treatment. There was no change in CARS scores during the pretreatment baseline period; however, there was a significant decrease after treatment at 3 months and 6 months of riding. The Timberlawn Parent-Child Interaction Scale showed a significant improvement in Mood and Tone at 3 months and 6 months of riding and a marginal improvement in the reduction of Negative Regard at 6 months of riding. The parent-rated quality of life measure showed improvement, including the pretreatment waiting period. All of the ratings in the Treatment Satisfaction Survey were between good and very good. CONCLUSION These results suggest that children with ASD benefit from equine-assisted activities.
Collapse
Affiliation(s)
- Janet K Kern
- Research Department, Autism Treatment Center, Dallas, Texas, USA.
| | | | | | | | | | | | | | | |
Collapse
|
39
|
Abstract
BACKGROUND Recent studies suggest that children diagnosed with an autism spectrum disorder (ASD) have significantly increased levels of urinary porphyrins associated with mercury (Hg) toxicity, including pentacarboxyporphyrin (5cxP), precoproporphyrin (prcP), and coproporphyrin (cP), compared to typically developing controls. However, these initial studies were criticized because the controls were not age- and gender-matched to the children diagnosed with an ASD. METHODS Urinary porphyrin biomarkers in a group of children (2-13 years of age) diagnosed with an ASD (n= 20) were compared to matched (age, gender, race, location, and year tested) group of typically developing controls (n= 20). RESULTS Participants diagnosed with an ASD had significantly increased levels of 5cxP, prcP, and cP in comparison to controls. No significant differences were found in non-Hg associated urinary porphyrins (uroporphyrins, hexacarboxyporphyrin, and heptacarboxyporphyrin). There was a significantly increased odds ratio for an ASD diagnosis relative to controls among study participants with precoproporphyrin (odds ratio = 15.5, P < 0.01) and coproporphyrin (odds ratio = 15.5, P < 0.01) levels in the second through fourth quartiles in comparison to the first quartile. CONCLUSION These results suggest that the levels of Hg-toxicity-associated porphyrins are higher in children with an ASD diagnosis than controls. Although the pattern seen (increased 5cxP, prcP, and cP) is characteristic of Hg toxicity, the influence of other factors, such as genetics and other metals cannot be completely ruled out.
Collapse
Affiliation(s)
- Janet K Kern
- Research Department, Genetics Consultants of Dallas/ASD Centers, LLC., 408 N. Allen Dr, Allen, TX 75013, USA.
| | | | | | | | | | | |
Collapse
|
40
|
East C, Willis BL, Barlow CE, Grannemann BD, FitzGerald SJ, DeFina LF, Trivedi MH. Depressive symptoms and metabolic syndrome in preventive healthcare: the Cooper Center longitudinal study. Metab Syndr Relat Disord 2011; 8:451-7. [PMID: 20854094 DOI: 10.1089/met.2010.0017] [Citation(s) in RCA: 20] [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] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Depression, metabolic syndrome, and reduced cardiorespiratory fitness (CRF) are known to increase the risk of developing diabetes and cardiovascular disease. The association among these factors in a generally healthy, active population with access to health care is not well defined. METHODS This was a cross-sectional analysis of data collected on 5,125 women and men during preventive care examinations at the Cooper Clinic from 2000 to 2008. The main outcome measures were depressive symptoms as assessed by the Centers for Epidemiologic Studies Depression Scale short form (CES-D-10) questionnaire, presence or absence of metabolic syndrome, and CRF as measured by a maximal exercise treadmill test. RESULTS Women and men who exhibited depressive symptoms had a statistically higher prevalence of metabolic syndrome compared to those who did not (for women, 15.4% versus 7.2%, P < 0.0001; for men, 31.6% versus 22.8%, P < 0.0001). Individuals with depressive symptoms had an increased frequency of higher waist circumference, higher triglycerides, and lower high-density lipoprotein. Women with depressive symptoms also had marginally higher fasting blood glucose levels. After adjusting for age and smoking status, the odds of metabolic syndrome in women with depressive symptoms was 2.81 [95% confidence interval (CI), 2.01-3.93] times the odds of metabolic syndrome in those without depressive symptoms, and in men with depressive symptoms, the odds were 1.69 (95% CI, 1.42-2.00) times the odds of metabolic syndrome in men without. When controlled for CRF level, the presence or absence of depressive symptoms on the presence of metabolic syndrome is attenuated but remains statistically significant in women. CONCLUSION Even in a generally healthy population with access to health care, the presence of depressive symptoms was associated with increased metabolic syndrome.
Collapse
Affiliation(s)
- Cara East
- Soltero Cardiovascular Research Center, Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, Texas, USA
| | | | | | | | | | | | | |
Collapse
|
41
|
Trivedi MH, Daly EJ, Kern JK, Grannemann BD, Sunderajan P, Claassen CA. Barriers to implementation of a computerized decision support system for depression: an observational report on lessons learned in "real world" clinical settings. BMC Med Inform Decis Mak 2009; 9:6. [PMID: 19159458 PMCID: PMC2639574 DOI: 10.1186/1472-6947-9-6] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2008] [Accepted: 01/21/2009] [Indexed: 11/29/2022] Open
Abstract
Background Despite wide promotion, clinical practice guidelines have had limited effect in changing physician behavior. Effective implementation strategies to date have included: multifaceted interventions involving audit and feedback, local consensus processes, marketing; reminder systems, either manual or computerized; and interactive educational meetings. In addition, there is now growing evidence that contextual factors affecting implementation must be addressed such as organizational support (leadership procedures and resources) for the change and strategies to implement and maintain new systems. Methods To examine the feasibility and effectiveness of implementation of a computerized decision support system for depression (CDSS-D) in routine public mental health care in Texas, fifteen study clinicians (thirteen physicians and two advanced nurse practitioners) participated across five sites, accruing over 300 outpatient visits on 168 patients. Results Issues regarding computer literacy and hardware/software requirements were identified as initial barriers. Clinicians also reported concerns about negative impact on workflow and the potential need for duplication during the transition from paper to electronic systems of medical record keeping. Conclusion The following narrative report based on observations obtained during the initial testing and use of a CDSS-D in clinical settings further emphasizes the importance of taking into account organizational factors when planning implementation of evidence-based guidelines or decision support within a system.
Collapse
Affiliation(s)
- Madhukar H Trivedi
- Mood Disorders Research Program & Clinic, Department of Psychiatry, University of Texas Southwestern Medical Center at Dallas, TX, USA.
| | | | | | | | | | | |
Collapse
|
42
|
Claassen C, Kurian B, Trivedi MH, Grannemann BD, Tuli E, Pipes R, Preston AM, Flood A. Telephone-based assessments to minimize missing data in longitudinal depression trials: a project IMPACTS study report. Contemp Clin Trials 2009; 30:13-9. [PMID: 18761427 PMCID: PMC3268227 DOI: 10.1016/j.cct.2008.08.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2007] [Revised: 08/05/2008] [Accepted: 08/07/2008] [Indexed: 11/26/2022]
Abstract
PURPOSE Missing data in clinical efficacy and effectiveness trials continue to be a major threat to the validity of study findings. The purpose of this report is to describe methods developed to ensure completion of outcome assessments with public mental health sector subjects participating in a longitudinal, repeated measures study for the treatment of major depressive disorder. We developed longitudinal assessment procedures that included telephone-based clinician interviews in order to minimize missing data commonly encountered with face-to-face assessment procedures. METHODS A pre-planned, multi-step strategy was developed to ensure completeness of data collection. The procedure included obtaining multiple pieces of patient contact information at baseline, careful education of both staff and patients concerning the purpose of assessments, establishing good patient rapport, and finally being flexible and persistent with phone appointments to ensure the completion of telephone-based follow-up assessments. A well-developed administrative and organizational structure was also put in place prior to study implementation. RESULTS The assessment completion rate for the primary outcome for 310 of 504 subjects who enrolled and completed 52 weeks (at the time of manuscript) of telephone-based follow-up assessments was 96.8%. CONCLUSION By utilizing telephone-based follow-up procedures and adapting our easy-to-use pre-defined multi-step approach, researchers can maximize patient data retention in longitudinal studies.
Collapse
Affiliation(s)
- Cindy Claassen
- University of Texas Southwestern Medical Center, Dallas, Texas 75390-9119, USA
| | | | | | | | | | | | | | | |
Collapse
|
43
|
Higgins PL, Heath WP, Grannemann BD. How Type of Excuse Defense, Mock Juror Age, and Defendant Age Affect Mock Jurors' Decisions. The Journal of Social Psychology 2007; 147:371-92. [DOI: 10.3200/socp.147.4.371-392] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
44
|
Abstract
This study examined the relationship between auditory, visual, touch, and oral sensory dysfunction in autism and their relationship to multisensory dysfunction and severity of autism. The Sensory Profile was completed on 104 persons with a diagnosis of autism, 3 to 56 years of age. Analysis showed a significant correlation between the different processing modalities using total scores. Analysis also showed a significant correlation between processing modalities for both high and low thresholds, with the exception that auditory high threshold processing did not correlate with oral low threshold or touch low threshold processing. Examination of the different age groups suggests that sensory disturbance correlates with severity of autism in children, but not in adolescents and adults. Evidence from this study suggests that: all the main modalities and multisensory processing appear to be affected; sensory processing dysfunction in autism is global in nature; and sensory processing problems need to be considered part of the disorder.
Collapse
Affiliation(s)
- Janet K Kern
- University of Texas, Southwestern Medical Center, Dallas, TX 75390, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Abstract
This study examined the difference between sulfhydryl-reactive metals (mercury, lead, arsenic, and cadmium) in the hair of 45 children with autism (1-6 yr of age) as compared to 45 gender-, age-, and race-matched typical children. Hair samples were measured with inductively coupled mass spectrometry. Some studies, such as Holmes et al. (2003), suggested that children with autism may be poor detoxifiers relative to normally developing children. Metals that are not eliminated sequester in the brain. Our study found that arsenic, cadmium, and lead were significantly lower in the hair of children with autism than in matched controls. Mercury was in the same direction (lower in autism) following the same pattern, but did not achieve statistical significance. The evidence from our study supports the notion that children with autism may have trouble excreting these metals, resulting in a higher body burden that may contribute to symptoms of autism.
Collapse
Affiliation(s)
- Janet K Kern
- Department of Psychiatry, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas 75390-9119, USA.
| | | | | | | |
Collapse
|
46
|
Kern JK, Trivedi MH, Garver CR, Grannemann BD, Andrews AA, Savla JS, Johnson DG, Mehta JA, Schroeder JL. The pattern of sensory processing abnormalities in autism. Autism 2007; 10:480-94. [PMID: 16940314 DOI: 10.1177/1362361306066564] [Citation(s) in RCA: 303] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The study was undertaken to evaluate the nature of sensory dysfunction in persons with autism. The cross-sectional study examined auditory, visual, oral, and touch sensory processing, as measured by the Sensory Profile, in 104 persons with a diagnosis of autism, 3-56 years of age, gender-and age-matched to community controls. Persons with autism had abnormal auditory, visual, touch, and oral sensory processing that was significantly different from controls. This finding was also apparent when the high and low thresholds of these modalities were examined separately. At later ages for the group with autism, lower levels of abnormal sensory processing were found, except for low threshold touch, which did not improve significantly. There was a significant interaction in low threshold auditory and low threshold visual, suggesting that the two groups change differently over time on these variables. These results suggest that sensory abnormalities in autism are global in nature (involving several modalities) but have the potential to improve with age.
Collapse
Affiliation(s)
- Janet K Kern
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas 75390-9119, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
47
|
Trivedi MH, Claassen CA, Grannemann BD, Kashner TM, Carmody TJ, Daly E, Kern JK. Assessing physicians' use of treatment algorithms: Project IMPACTS study design and rationale. Contemp Clin Trials 2006; 28:192-212. [PMID: 16997636 PMCID: PMC2793279 DOI: 10.1016/j.cct.2006.08.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2005] [Revised: 07/17/2006] [Accepted: 08/01/2006] [Indexed: 11/16/2022]
Abstract
Effective treatments for major depressive disorder have been available for 35 years, yet inadequate pharmacotherapy continues to be widespread leading to suboptimal outcomes. Evidence-based medication algorithms have the potential to bring much-needed improvement in effectiveness of antidepressant treatment in "real-world" clinical settings. Project IMPACTS (Implementation of Algorithms using Computerized Treatment Systems) addresses the critical question of how best to facilitate integration of depression treatment algorithms into routine care. It tests an algorithm implemented through a computerized decision support system using a measurement-based care approach for depression against a paper-and-pencil version of the same algorithm and non-algorithm-based, specialist-delivered usual care. This paper reviews issues related to the Project IMPACTS study rationale, design, and procedures. Patient outcomes include symptom severity, social and work function, and quality of life. The economic impact of treatment is assessed in terms of health care utilization and cost. Data collected on physician behavior include degree of adherence to guidelines and physician attitudes about the perceived utility, ease of use, and self-reported effect of the use of algorithms on workload. Novel features of the design include a two-tiered study enrollment procedure, which initially enroll physicians as subjects, and then following recruitment of physicians, enrollment of subjects takes place based initially on an independent assessment by study staff to determine study eligibility. The study utilizes brief, easy-to-use symptom severity measures that facilitate physician decision making, and it employs a validated, phone-based, follow-up assessment protocol in order to minimize missing data, a problem common in public sector and longitudinal mental health studies. IMPACTS will assess the success of algorithm implementation and subsequent physician adherence using study-developed criteria and related statistical approaches. These new procedures and data points will also allow a more refined assessment of algorithm-driven treatment in the future.
Collapse
Affiliation(s)
- Madhukar H Trivedi
- Department of Psychiatry, The University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-9119, USA.
| | | | | | | | | | | | | |
Collapse
|
48
|
Abstract
The use of augmentation strategies among patients with major depression is increasing because rates of complete remission with standard antidepressant monotherapy are quite low. Clinical and neurobiological data suggest that exercise may be a good candidate for use as an augmentation treatment for depression. This pilot study examined the use of exercise to augment antidepressant medication in patients with major depression. Seventeen patients with incomplete remission of depressive symptoms began a 12-week exercise program while continuing their antidepressant medication (unchanged in type or dose). Individual exercise prescriptions were calculated based on an exercise dose consistent with currently recommended public health guidelines. The exercise consisted of both supervised and home-based sessions. The 17-item Hamilton Rating Scale for Depression (HRSD17) and the Inventory of Depressive Symptomatology-Self-Report (IDS-SR30) were used to assess symptoms of depression on a weekly basis. Intent-to-treat analyses yielded significant decreases on both the HRSD17 (5.8 points, p < 0.008) and IDS-SR30 (13.9 points, p < 0.002). For patients who completed the study (n = 8), HRSD17 scores decreased by 10.4 points and IDS-SR30 scores decreased by 18.8 points. This study provides preliminary evidence for exercise as an effective augmentation treatment for antidepressant medication. This is a lower-cost augmentation strategy that has numerous health benefits and may further reduce depressive symptoms in partial responders to antidepressant treatment. Practical tips on how practitioners can use exercise to enhance antidepressant treatment are discussed. Longer-term use of exercise is also likely to confer additional health benefits for this population.
Collapse
Affiliation(s)
- Madhukar H Trivedi
- University of Texas Southwestern Medical Center at Dallas, Mood Disorders Research Program and Clinic, 6363 Forest Park, Dallas, TX 75235, USA.
| | | | | | | | | |
Collapse
|
49
|
Chambliss HO, Greer TL, Grannemann BD, Jordan AN, Galper DI, Church TS, Trivedi MH, Blair SN. Baseline Physical Activity Characteristics of Individuals Seeking Exercise as an Adjuvant Treatment for Depression. Med Sci Sports Exerc 2006. [DOI: 10.1249/00005768-200605001-01336] [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] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
50
|
Abstract
OBJECTIVE While there is some indication from studies in the acute phase of antidepressant treatment that there are differences in the timing of improvement in symptoms, relatively little work has explored the patterns of change for specific symptom clusters and the predictability of these changes to signal eventual response during the acute phase of treatment. This article investigates the use of clusters of symptoms on the 17-item Hamilton Rating Scale for Depression (HAM-D-17) to define the pattern of late response versus nonresponse to antidepressant medication. METHOD Using principal component analysis, the HAM-D-17 was divided into 4 symptom clusters (mood, sleep/psychic anxiety, appetite, and somatic anxiety/weight). Data for 996 patients with major depressive disorder (DSM-III-R criteria), who participated in a 12-week acute phase study with nefazodone, were subjected to a post hoc analysis of changes in symptom cluster scores. Patients were divided into 3 groups: early responders (< 4 weeks), late responders (4-12 weeks), and nonresponders (> 12 weeks) as defined by < 50% reduction in HAM-D-17 scores from baseline. The late-responder and nonresponder groups were subjected to the principal component analysis. Data were collected from October 1992 to November 1994. RESULTS There were significant differences in the pattern of symptom change on the mood cluster (weeks 3-4) (p < .0001), the sleep/psychic anxiety cluster (weeks 3-4) (p < .003), and the somatic anxiety/weight cluster (weeks 3-4) (p < .01) for the late responders compared to the nonresponders. Using change scores, a discriminant function analysis correctly assigned 127 of the 182 late responders and 85 of the 133 nonresponders, or 70% of the late responders and 64% of the nonresponders, to their final response groups. CONCLUSION Monitoring changes in symptom clusters from the HAM-D-17 during this crucial early stage (first 4 weeks) can be used to distinguish late responders (after week 4) from nonresponders. Successful identification of nonresponders based on symptom cluster change in the first 4 weeks would facilitate a shortening of an ineffective treatment trial and allow for necessary changes in treatment strategy, helping physicians more closely follow treatment guidelines.
Collapse
Affiliation(s)
- Madhukar H Trivedi
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas 75390-9119, USA.
| | | | | | | |
Collapse
|