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Argenbright CM, Bertlesman AM, Russell IM, Greer TL, Peng YB, Fuchs PN. The Fibromyalgia Pain Experience: A Scoping Review of the Preclinical Evidence for Replication and Treatment of the Affective and Cognitive Pain Dimensions. Biomedicines 2024; 12:778. [PMID: 38672134 PMCID: PMC11048409 DOI: 10.3390/biomedicines12040778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 03/18/2024] [Accepted: 03/25/2024] [Indexed: 04/28/2024] Open
Abstract
Fibromyalgia is a chronic, widespread pain disorder that is strongly represented across the affective and cognitive dimensions of pain, given that the underlying pathophysiology of the disorder is yet to be identified. These affective and cognitive deficits are crucial to understanding and treating the fibromyalgia pain experience as a whole but replicating this multidimensionality on a preclinical level is challenging. To understand the underlying mechanisms, animal models are used. In this scoping review, we evaluate the current primary animal models of fibromyalgia regarding their translational relevance within the affective and cognitive pain realms, as well as summarize treatments that have been identified preclinically for attenuating these deficits.
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Affiliation(s)
- Cassie M. Argenbright
- Department of Psychology and Biobehavioral Sciences, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA
| | - Alysia M. Bertlesman
- Department of Psychology, The University of Texas at Arlington, Arlington, TX 76019, USA; (A.M.B.); (I.M.R.); (T.L.G.); (Y.B.P.)
| | - Izabella M. Russell
- Department of Psychology, The University of Texas at Arlington, Arlington, TX 76019, USA; (A.M.B.); (I.M.R.); (T.L.G.); (Y.B.P.)
| | - Tracy L. Greer
- Department of Psychology, The University of Texas at Arlington, Arlington, TX 76019, USA; (A.M.B.); (I.M.R.); (T.L.G.); (Y.B.P.)
| | - Yuan B. Peng
- Department of Psychology, The University of Texas at Arlington, Arlington, TX 76019, USA; (A.M.B.); (I.M.R.); (T.L.G.); (Y.B.P.)
| | - Perry N. Fuchs
- Department of Psychological Science, The University of Texas Rio Grande Valley, Edinburg, TX 78539, USA;
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Giles MA, Cooper CM, Jha MK, Chin Fatt CR, Pizzagalli DA, Mayes TL, Webb CA, Greer TL, Etkin A, Trombello JM, Chase HW, Phillips ML, McInnis MG, Carmody T, Adams P, Parsey RV, McGrath PJ, Weissman M, Kurian BT, Fava M, Trivedi MH. Reward Behavior Disengagement, a Neuroeconomic Model-Based Objective Measure of Reward Pathology in Depression: Findings from the EMBARC Trial. Behav Sci (Basel) 2023; 13:619. [PMID: 37622759 PMCID: PMC10451479 DOI: 10.3390/bs13080619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 06/28/2023] [Accepted: 07/21/2023] [Indexed: 08/26/2023] Open
Abstract
The probabilistic reward task (PRT) has identified reward learning impairments in those with major depressive disorder (MDD), as well as anhedonia-specific reward learning impairments. However, attempts to validate the anhedonia-specific impairments have produced inconsistent findings. Thus, we seek to determine whether the Reward Behavior Disengagement (RBD), our proposed economic augmentation of PRT, differs between MDD participants and controls, and whether there is a level at which RBD is high enough for depressed participants to be considered objectively disengaged. Data were gathered as part of the Establishing Moderators and Biosignatures of Antidepressant Response in Clinical Care (EMBARC) study, a double-blind, placebo-controlled clinical trial of antidepressant response. Participants included 195 individuals with moderate to severe MDD (Quick Inventory of Depressive Symptomatology (QIDS-SR) score ≥ 15), not in treatment for depression, and with complete PRT data. Healthy controls (n = 40) had no history of psychiatric illness, a QIDS-SR score < 8, and complete PRT data. Participants with MDD were treated with sertraline or placebo for 8 weeks (stage I of the EMBARC trial). RBD was applied to PRT data using discriminant analysis, and classified MDD participants as reward task engaged (n = 137) or reward task disengaged (n = 58), relative to controls. Reward task engaged/disengaged groups were compared on sociodemographic features, reward-behavior, and sertraline/placebo response (Hamilton Depression Rating Scale scores). Reward task disengaged MDD participants responded only to sertraline, whereas those who were reward task engaged responded to sertraline and placebo (F(1293) = 4.33, p = 0.038). Reward task engaged/disengaged groups did not differ otherwise. RBD was predictive of reward impairment in depressed patients and may have clinical utility in identifying patients who will benefit from antidepressants.
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Affiliation(s)
- Michael A. Giles
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Crystal M. Cooper
- Center for Depression Research and Clinical Care, Peter O’Donnell Jr. Brain Institute and Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA (T.L.G.)
- Jane and John Justin Neurosciences Center, Cook Children’s Health Care System, Fort Worth, TX 76104, USA
| | - Manish K. Jha
- Center for Depression Research and Clinical Care, Peter O’Donnell Jr. Brain Institute and Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA (T.L.G.)
| | - Cherise R. Chin Fatt
- Center for Depression Research and Clinical Care, Peter O’Donnell Jr. Brain Institute and Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA (T.L.G.)
| | - Diego A. Pizzagalli
- Department of Psychiatry, Harvard Medical School, Boston, MA 02215, USA
- McLean Hospital, Belmont, MA 02478, USA
| | - Taryn L. Mayes
- Center for Depression Research and Clinical Care, Peter O’Donnell Jr. Brain Institute and Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA (T.L.G.)
| | - Christian A. Webb
- Department of Psychiatry, Harvard Medical School, Boston, MA 02215, USA
- McLean Hospital, Belmont, MA 02478, USA
| | - Tracy L. Greer
- Center for Depression Research and Clinical Care, Peter O’Donnell Jr. Brain Institute and Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA (T.L.G.)
- Department of Psychology, University of Texas at Arlington, Arlington, TX 76019, USA
| | - Amit Etkin
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94305, USA
| | - Joseph M. Trombello
- Center for Depression Research and Clinical Care, Peter O’Donnell Jr. Brain Institute and Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA (T.L.G.)
| | - Henry W. Chase
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Mary L. Phillips
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Melvin G. McInnis
- Department of Psychiatry, University of Michigan School of Medicine, Ann Arbor, MI 48109, USA
| | - Thomas Carmody
- Peter O’Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Phillip Adams
- Department of Psychiatry, Columbia University, New York, NY 10032, USA
| | - Ramin V. Parsey
- Department of Psychiatry and Behavioral Health, Stony Brook University Renaissance School of Medicine, Stony Brook, NY 11794, USA
| | | | - Myrna Weissman
- Department of Psychiatry, Columbia University, New York, NY 10032, USA
| | - Benji T. Kurian
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Maurizio Fava
- Department of Psychiatry, Harvard Medical School, Boston, MA 02215, USA
- Massachusetts General Hospital, Boston, MA 02114, USA
| | - Madhukar H. Trivedi
- Center for Depression Research and Clinical Care, Peter O’Donnell Jr. Brain Institute and Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA (T.L.G.)
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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.
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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)
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Wang MZ, Jha MK, Minhajuddin A, Pipes R, Levinson S, Mayes TL, Greer TL, Trivedi MH. A primary care first (PCP-first) model to screen and treat depression: A VitalSign 6 report from a second cohort of 32,106 patients. Gen Hosp Psychiatry 2022; 74:1-8. [PMID: 34784574 DOI: 10.1016/j.genhosppsych.2021.11.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 08/16/2021] [Revised: 11/04/2021] [Accepted: 11/05/2021] [Indexed: 11/04/2022]
Abstract
PURPOSE This report from VitalSign6 project describes treatment selection, follow-up rates and remission outcomes by initial depression severity using the PCP-FIRST model. METHODS This retrospective analysis included 32,106 patients aged ≥12 years screened with the Patient Health Questionnaire 2-item (PHQ-2) from November 2016 to July 2019 across 37 primary care clinics. PHQ-2 positive-screen patients (PHQ-2 ≥ 3) received 9-item PHQ (PHQ-9) and 7-item Generalized Anxiety Disorder scales, clinician assessments, and evaluation for pharmacotherapy management with measurement-based care (MBC). RESULTS Of PHQ-2 screened patients, 18.7% (5994/32,106) were positive and received a PHQ-9. Of 5994 patients with PHQ-9, 2571 received a clinical diagnosis of depression of whom, 333 had none-mild depression (PHQ-9 < 10) and 2238 had moderate-severe depression (PHQ-9 ≥ 10). Of the 333 patients with none-mild depression and 2238 patients with moderate-severe depression, 266 and 1929 had at least 18 weeks of data available. Of these, 54.9% (146/266) with none-mild depression and 69.1% (1332/1929) with moderate-severe depression were started on pharmacotherapy. Of the 1478 patients with clinical diagnosis of depression, initiated on pharmacotherapy, 1046 returned for ≥1 follow-up and 616 returned for ≥3 follow-ups over 18 weeks. Of the 1046 patients with ≥1 follow-up visit within 18 weeks, remission rates for patients with mild depression, moderate-severe depression, and overall were 55.6% (66/99), 30% (282/941), and 32.4% (338/1040) respectively. CONCLUSIONS Despite this being a real-world, usual care sample, remission outcomes exceed real world remission rate expectations of 6% in primary care.
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Affiliation(s)
- Margaret Z Wang
- Center for Depression Research and Clinical Care, Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, United States; Peter O'Donnell Jr. Brain Institute, UT Southwestern Medical Center, Dallas, TX, United States.
| | - Manish K Jha
- Center for Depression Research and Clinical Care, Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, United States; Peter O'Donnell Jr. Brain Institute, UT Southwestern Medical Center, Dallas, TX, United States.
| | - Abu Minhajuddin
- Center for Depression Research and Clinical Care, Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, United States; Peter O'Donnell Jr. Brain Institute, UT Southwestern Medical Center, Dallas, TX, United States; Department of Population and Data Sciences, UT Southwestern Medical Center, Dallas, TX, United States.
| | - Ronny Pipes
- Center for Depression Research and Clinical Care, Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, United States; Peter O'Donnell Jr. Brain Institute, UT Southwestern Medical Center, Dallas, TX, United States.
| | - Sara Levinson
- Center for Depression Research and Clinical Care, Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, United States; Peter O'Donnell Jr. Brain Institute, UT Southwestern Medical Center, Dallas, TX, United States.
| | - Taryn L Mayes
- Center for Depression Research and Clinical Care, Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, United States; Peter O'Donnell Jr. Brain Institute, UT Southwestern Medical Center, Dallas, TX, United States.
| | - Tracy L Greer
- Center for Depression Research and Clinical Care, Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, United States; Department of Psychology, University of Texas at Arlington, Arlington, TX, United States.
| | - Madhukar H Trivedi
- Center for Depression Research and Clinical Care, Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, United States; Peter O'Donnell Jr. Brain Institute, UT Southwestern Medical Center, Dallas, TX, United States.
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Greer TL. Circular RNAs as putative biomarkers for depression diagnosis and treatment. EBioMedicine 2021; 68:103362. [PMID: 34049241 PMCID: PMC8167206 DOI: 10.1016/j.ebiom.2021.103362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 04/13/2021] [Indexed: 10/29/2022] Open
Affiliation(s)
- Tracy L Greer
- Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute, The University of Texas Southwestern Medical Center, Dallas, TX 75390-9119, USA.
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Killeen TK, Wolf B, Greer TL, Carmody T, Rethorst CD, Trivedi MH. Gender and racial/ethnic differences in physiologic responses in the Stimulant Reduction Intervention using Dosed Exercise Study. Addict Behav 2020; 110:106546. [PMID: 32688225 PMCID: PMC7416606 DOI: 10.1016/j.addbeh.2020.106546] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 05/31/2020] [Accepted: 07/05/2020] [Indexed: 10/23/2022]
Abstract
Exercise may be beneficial for individuals in substance use disorder (SUD) treatment given the higher rates of both medical and psychiatric comorbidity, namely mood and anxiety disorders, compared to the general population. Gender and/or racial/ethnic differences in health benefits and response to prescribed exercise have been reported and may have implications for designing exercise interventions in SUD programs. METHOD Data are from the National Drug Abuse Treatment Clinical Trials Network (NIDA/CTN) Stimulant Reduction Intervention using Dosed Exercise (STRIDE) trial. Gender differences across racial/ethnic groups in physiological responses and stimulant withdrawal severity across time were analyzed using linear mixed effects models. RESULTS Males completed significantly more exercise sessions than females and were more adherent to the prescribed exercise dose of 12 Kcal/Kg/Week. Controlling for age, race/ethnicity, treatment group and stimulant withdrawal severity, there was a significant gender by time interaction for body mass index (BMI) (p < 0.001), waist circumference (p < 0.001) and heart rate measured prior to exercise sessions (p < 0.01). For females, body mass index (BMI) and waist circumference increased over time while for males BMI and waist circumference stayed unchanged or slightly decreased with time. Heart rate over time significantly increased for females at a higher rate than in males. Stimulant withdrawal severity was similar in males and females at baseline but males exhibited a significant decrease over time while females did not. Although baseline differences were observed, there were no time by race/ethnicity differences in physiologic responses. DISCUSSION Gender differences in response to exercise may have implications for developing gender specific exercise interventions in SUD programs.
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Affiliation(s)
- T K Killeen
- Medical University of South Carolina, Charleston, SC, USA.
| | - B Wolf
- Medical University of South Carolina, Charleston, SC, USA
| | - T L Greer
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - T Carmody
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - C D Rethorst
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - M H Trivedi
- University of Texas Southwestern Medical Center, Dallas, TX, USA
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Greer TL. The Promise of Biomarkers for Psychiatry. Psychiatr Ann 2020. [DOI: 10.3928/00485713-20200505-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Davidov A, Greer TL. Pathology-Congruent Biases as Biomarkers for Psychopathology. Psychiatr Ann 2020. [DOI: 10.3928/00485713-20200504-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Greer TL, Walker R, Rethorst CD, Northrup TF, Warden D, Horigian VE, Silverstein M, Shores-Wilson K, Stotts AL, Trivedi MH. Identifying and responding to trial implementation challenges during multisite clinical trials. J Subst Abuse Treat 2020; 112S:63-72. [PMID: 32220413 PMCID: PMC9746284 DOI: 10.1016/j.jsat.2020.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 01/31/2020] [Accepted: 02/08/2020] [Indexed: 12/16/2022]
Abstract
INTRODUCTION The National Drug Abuse Treatment Clinical Trials Network (CTN) was initiated by the National Institute on Drug Abuse (NIDA) in 2000 with the aim of improving substance use treatment and reducing the time between the discovery of effective treatments and their implementation into clinical practice. While initial trials were conducted almost exclusively in specialty addiction treatment settings, the CTN began evolving strategically in 2010 to conduct research in general medical settings, including healthcare systems, primary care settings, emergency departments, and pharmacies, to broaden impact. The advantages of a research network like the CTN is not only the collective content expertise that investigators contribute to the network, but the collective experience gained by conducting studies in the network and then applying those lessons to future studies. OBJECTIVE To summarize trial implementation challenges encountered, and the process by which solutions were identified and implemented, within one of the last early-phase CTN Stage II behavioral intervention studies conducted in a specialty addiction treatment setting. METHOD AND RESULTS We describe the implementation of the CTN-0037 STimulant Reduction Intervention using Dosed Exercise (STRIDE) trial. Issues encountered during study implementation are categorized into four major areas, described in terms useful to future study teams: 1) study team infrastructure challenges, 2) participant- and site- level challenges, 3) intervention-related challenges, and 4) longitudinal study design challenges. Potential consequences of identified problems and the solutions developed to manage these problems are discussed within the context of these four areas. We propose how to extend these implementation lessons and apply them in other healthcare settings to expand the CTN. CONCLUSIONS Effective study management allows for flexible, collaborative solutions to expected and unexpected obstacles to study success. Implementation strategies derived from the first 15 to 20 years of CTN studies are a result of working with providers and participants, and the ongoing collaboration among CTN investigators and network staff. Timely identification and response to problems during study implementation are critical to the success of a trial, regardless of its design. We believe a collaborative approach to identifying and responding to study implementation challenges will increase the likelihood of successful adoption of relevant, efficacious interventions. As the CTN continues to expand, the wealth of successful trial implementation strategies developed during the first 20 years of the CTN need to be applied and adapted to studies in broader network settings, and considered in conjunction with more formalized implementation science processes that are currently available.
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Affiliation(s)
- Tracy L. Greer
- Center for Depression Research and Clinical Care, Peter O’Donnell Jr. Brain Institute, The University of Texas Southwestern Medical Center, Dallas, Texas, 75390-9119, USA
| | - Robrina Walker
- Center for Depression Research and Clinical Care, Peter O’Donnell Jr. Brain Institute, The University of Texas Southwestern Medical Center, Dallas, Texas, 75390-9119, USA
| | - Chad D. Rethorst
- Center for Depression Research and Clinical Care, Peter O’Donnell Jr. Brain Institute, The University of Texas Southwestern Medical Center, Dallas, Texas, 75390-9119, USA
| | - Thomas F. Northrup
- Department of Family and Community Medicine, University of Texas Medical School at Houston, Houston, Texas, 77030, USA
| | - Diane Warden
- Center for Depression Research and Clinical Care, Peter O’Donnell Jr. Brain Institute, The University of Texas Southwestern Medical Center, Dallas, Texas, 75390-9119, USA
| | - Viviana E. Horigian
- Department of Epidemiology and Public Health, Miller School of Medicine, University of Miami, Miami, Florida, 33136, USA
| | | | - Kathy Shores-Wilson
- Center for Depression Research and Clinical Care, Peter O’Donnell Jr. Brain Institute, The University of Texas Southwestern Medical Center, Dallas, Texas, 75390-9119, USA
| | - Angela L. Stotts
- Department of Family and Community Medicine, University of Texas Medical School at Houston, Houston, Texas, 77030, USA
| | - Madhukar H. Trivedi
- Center for Depression Research and Clinical Care, Peter O’Donnell Jr. Brain Institute, The University of Texas Southwestern Medical Center, Dallas, Texas, 75390-9119, USA
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Chin Fatt CR, Jha MK, Cooper CM, Fonzo G, South C, Grannemann B, Carmody T, Greer TL, Kurian B, Fava M, McGrath PJ, Adams P, McInnis M, Parsey RV, Weissman M, Phillips ML, Etkin A, Trivedi MH. Effect of Intrinsic Patterns of Functional Brain Connectivity in Moderating Antidepressant Treatment Response in Major Depression. Am J Psychiatry 2020; 177:143-154. [PMID: 31537090 DOI: 10.1176/appi.ajp.2019.18070870] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Major depressive disorder is associated with aberrant resting-state functional connectivity across multiple brain networks supporting emotion processing, executive function, and reward processing. The purpose of this study was to determine whether patterns of resting-state connectivity between brain regions predict differential outcome to antidepressant medication (sertraline) compared with placebo. METHODS Participants in the Establishing Moderators and Biosignatures of Antidepressant Response in Clinical Care (EMBARC) study underwent structural and resting-state functional MRI at baseline. Participants were then randomly assigned to receive either sertraline or placebo treatment for 8 weeks (N=279). A region of interest-based approach was utilized to compute functional connectivity between brain regions. Linear mixed-model intent-to-treat analyses were used to identify brain regions that moderated (i.e., differentially predicted) outcomes between the sertraline and placebo arms. RESULTS Prediction of response to sertraline involved several within- and between-network connectivity patterns. In general, higher connectivity within the default mode network predicted better outcomes specifically for sertraline, as did greater between-network connectivity of the default mode and executive control networks. In contrast, both placebo and sertraline outcomes were predicted (in opposite directions) by between-network hippocampal connectivity. CONCLUSIONS This study identified specific functional network-based moderators of treatment outcome involving brain networks known to be affected by major depression. Specifically, functional connectivity patterns of brain regions between and within networks appear to play an important role in identifying a favorable response for a drug treatment for major depressive disorder.
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Affiliation(s)
- Cherise R Chin Fatt
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (Chin Fatt, Jha, Cooper, South, Grannemann, Carmody, Greer, Kurian, Trivedi); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Jha); Department of Psychiatry and Behavioral Sciences and Stanford Neurosciences Institute, Stanford University, Stanford, Calif. (Fonzo, Etkin); Mental Illness Research, Education, and Clinical Center, Veterans Affairs Palo Alto Health Care System, Palo Alto, Calif. (Fonzo, Etkin); Department of Psychiatry, Massachusetts General Hospital, Boston (Fava); New York State Psychiatric Institute and Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York (McGrath, Adams, Weissman); Department of Psychiatry, University of Michigan School of Medicine, Ann Arbor (McInnis); Department of Psychiatry and Behavioral Science and Department of Radiology, Stony Brook University, Stony Brook, N.Y. (Parsey); and Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh (Phillips)
| | - Manish K Jha
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (Chin Fatt, Jha, Cooper, South, Grannemann, Carmody, Greer, Kurian, Trivedi); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Jha); Department of Psychiatry and Behavioral Sciences and Stanford Neurosciences Institute, Stanford University, Stanford, Calif. (Fonzo, Etkin); Mental Illness Research, Education, and Clinical Center, Veterans Affairs Palo Alto Health Care System, Palo Alto, Calif. (Fonzo, Etkin); Department of Psychiatry, Massachusetts General Hospital, Boston (Fava); New York State Psychiatric Institute and Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York (McGrath, Adams, Weissman); Department of Psychiatry, University of Michigan School of Medicine, Ann Arbor (McInnis); Department of Psychiatry and Behavioral Science and Department of Radiology, Stony Brook University, Stony Brook, N.Y. (Parsey); and Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh (Phillips)
| | - Crystal M Cooper
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (Chin Fatt, Jha, Cooper, South, Grannemann, Carmody, Greer, Kurian, Trivedi); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Jha); Department of Psychiatry and Behavioral Sciences and Stanford Neurosciences Institute, Stanford University, Stanford, Calif. (Fonzo, Etkin); Mental Illness Research, Education, and Clinical Center, Veterans Affairs Palo Alto Health Care System, Palo Alto, Calif. (Fonzo, Etkin); Department of Psychiatry, Massachusetts General Hospital, Boston (Fava); New York State Psychiatric Institute and Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York (McGrath, Adams, Weissman); Department of Psychiatry, University of Michigan School of Medicine, Ann Arbor (McInnis); Department of Psychiatry and Behavioral Science and Department of Radiology, Stony Brook University, Stony Brook, N.Y. (Parsey); and Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh (Phillips)
| | - Gregory Fonzo
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (Chin Fatt, Jha, Cooper, South, Grannemann, Carmody, Greer, Kurian, Trivedi); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Jha); Department of Psychiatry and Behavioral Sciences and Stanford Neurosciences Institute, Stanford University, Stanford, Calif. (Fonzo, Etkin); Mental Illness Research, Education, and Clinical Center, Veterans Affairs Palo Alto Health Care System, Palo Alto, Calif. (Fonzo, Etkin); Department of Psychiatry, Massachusetts General Hospital, Boston (Fava); New York State Psychiatric Institute and Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York (McGrath, Adams, Weissman); Department of Psychiatry, University of Michigan School of Medicine, Ann Arbor (McInnis); Department of Psychiatry and Behavioral Science and Department of Radiology, Stony Brook University, Stony Brook, N.Y. (Parsey); and Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh (Phillips)
| | - Charles South
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (Chin Fatt, Jha, Cooper, South, Grannemann, Carmody, Greer, Kurian, Trivedi); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Jha); Department of Psychiatry and Behavioral Sciences and Stanford Neurosciences Institute, Stanford University, Stanford, Calif. (Fonzo, Etkin); Mental Illness Research, Education, and Clinical Center, Veterans Affairs Palo Alto Health Care System, Palo Alto, Calif. (Fonzo, Etkin); Department of Psychiatry, Massachusetts General Hospital, Boston (Fava); New York State Psychiatric Institute and Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York (McGrath, Adams, Weissman); Department of Psychiatry, University of Michigan School of Medicine, Ann Arbor (McInnis); Department of Psychiatry and Behavioral Science and Department of Radiology, Stony Brook University, Stony Brook, N.Y. (Parsey); and Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh (Phillips)
| | - Bruce Grannemann
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (Chin Fatt, Jha, Cooper, South, Grannemann, Carmody, Greer, Kurian, Trivedi); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Jha); Department of Psychiatry and Behavioral Sciences and Stanford Neurosciences Institute, Stanford University, Stanford, Calif. (Fonzo, Etkin); Mental Illness Research, Education, and Clinical Center, Veterans Affairs Palo Alto Health Care System, Palo Alto, Calif. (Fonzo, Etkin); Department of Psychiatry, Massachusetts General Hospital, Boston (Fava); New York State Psychiatric Institute and Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York (McGrath, Adams, Weissman); Department of Psychiatry, University of Michigan School of Medicine, Ann Arbor (McInnis); Department of Psychiatry and Behavioral Science and Department of Radiology, Stony Brook University, Stony Brook, N.Y. (Parsey); and Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh (Phillips)
| | - Thomas Carmody
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (Chin Fatt, Jha, Cooper, South, Grannemann, Carmody, Greer, Kurian, Trivedi); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Jha); Department of Psychiatry and Behavioral Sciences and Stanford Neurosciences Institute, Stanford University, Stanford, Calif. (Fonzo, Etkin); Mental Illness Research, Education, and Clinical Center, Veterans Affairs Palo Alto Health Care System, Palo Alto, Calif. (Fonzo, Etkin); Department of Psychiatry, Massachusetts General Hospital, Boston (Fava); New York State Psychiatric Institute and Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York (McGrath, Adams, Weissman); Department of Psychiatry, University of Michigan School of Medicine, Ann Arbor (McInnis); Department of Psychiatry and Behavioral Science and Department of Radiology, Stony Brook University, Stony Brook, N.Y. (Parsey); and Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh (Phillips)
| | - Tracy L Greer
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (Chin Fatt, Jha, Cooper, South, Grannemann, Carmody, Greer, Kurian, Trivedi); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Jha); Department of Psychiatry and Behavioral Sciences and Stanford Neurosciences Institute, Stanford University, Stanford, Calif. (Fonzo, Etkin); Mental Illness Research, Education, and Clinical Center, Veterans Affairs Palo Alto Health Care System, Palo Alto, Calif. (Fonzo, Etkin); Department of Psychiatry, Massachusetts General Hospital, Boston (Fava); New York State Psychiatric Institute and Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York (McGrath, Adams, Weissman); Department of Psychiatry, University of Michigan School of Medicine, Ann Arbor (McInnis); Department of Psychiatry and Behavioral Science and Department of Radiology, Stony Brook University, Stony Brook, N.Y. (Parsey); and Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh (Phillips)
| | - Benji Kurian
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (Chin Fatt, Jha, Cooper, South, Grannemann, Carmody, Greer, Kurian, Trivedi); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Jha); Department of Psychiatry and Behavioral Sciences and Stanford Neurosciences Institute, Stanford University, Stanford, Calif. (Fonzo, Etkin); Mental Illness Research, Education, and Clinical Center, Veterans Affairs Palo Alto Health Care System, Palo Alto, Calif. (Fonzo, Etkin); Department of Psychiatry, Massachusetts General Hospital, Boston (Fava); New York State Psychiatric Institute and Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York (McGrath, Adams, Weissman); Department of Psychiatry, University of Michigan School of Medicine, Ann Arbor (McInnis); Department of Psychiatry and Behavioral Science and Department of Radiology, Stony Brook University, Stony Brook, N.Y. (Parsey); and Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh (Phillips)
| | - Maurizio Fava
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (Chin Fatt, Jha, Cooper, South, Grannemann, Carmody, Greer, Kurian, Trivedi); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Jha); Department of Psychiatry and Behavioral Sciences and Stanford Neurosciences Institute, Stanford University, Stanford, Calif. (Fonzo, Etkin); Mental Illness Research, Education, and Clinical Center, Veterans Affairs Palo Alto Health Care System, Palo Alto, Calif. (Fonzo, Etkin); Department of Psychiatry, Massachusetts General Hospital, Boston (Fava); New York State Psychiatric Institute and Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York (McGrath, Adams, Weissman); Department of Psychiatry, University of Michigan School of Medicine, Ann Arbor (McInnis); Department of Psychiatry and Behavioral Science and Department of Radiology, Stony Brook University, Stony Brook, N.Y. (Parsey); and Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh (Phillips)
| | - Patrick J McGrath
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (Chin Fatt, Jha, Cooper, South, Grannemann, Carmody, Greer, Kurian, Trivedi); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Jha); Department of Psychiatry and Behavioral Sciences and Stanford Neurosciences Institute, Stanford University, Stanford, Calif. (Fonzo, Etkin); Mental Illness Research, Education, and Clinical Center, Veterans Affairs Palo Alto Health Care System, Palo Alto, Calif. (Fonzo, Etkin); Department of Psychiatry, Massachusetts General Hospital, Boston (Fava); New York State Psychiatric Institute and Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York (McGrath, Adams, Weissman); Department of Psychiatry, University of Michigan School of Medicine, Ann Arbor (McInnis); Department of Psychiatry and Behavioral Science and Department of Radiology, Stony Brook University, Stony Brook, N.Y. (Parsey); and Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh (Phillips)
| | - Phillip Adams
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (Chin Fatt, Jha, Cooper, South, Grannemann, Carmody, Greer, Kurian, Trivedi); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Jha); Department of Psychiatry and Behavioral Sciences and Stanford Neurosciences Institute, Stanford University, Stanford, Calif. (Fonzo, Etkin); Mental Illness Research, Education, and Clinical Center, Veterans Affairs Palo Alto Health Care System, Palo Alto, Calif. (Fonzo, Etkin); Department of Psychiatry, Massachusetts General Hospital, Boston (Fava); New York State Psychiatric Institute and Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York (McGrath, Adams, Weissman); Department of Psychiatry, University of Michigan School of Medicine, Ann Arbor (McInnis); Department of Psychiatry and Behavioral Science and Department of Radiology, Stony Brook University, Stony Brook, N.Y. (Parsey); and Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh (Phillips)
| | - Melvin McInnis
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (Chin Fatt, Jha, Cooper, South, Grannemann, Carmody, Greer, Kurian, Trivedi); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Jha); Department of Psychiatry and Behavioral Sciences and Stanford Neurosciences Institute, Stanford University, Stanford, Calif. (Fonzo, Etkin); Mental Illness Research, Education, and Clinical Center, Veterans Affairs Palo Alto Health Care System, Palo Alto, Calif. (Fonzo, Etkin); Department of Psychiatry, Massachusetts General Hospital, Boston (Fava); New York State Psychiatric Institute and Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York (McGrath, Adams, Weissman); Department of Psychiatry, University of Michigan School of Medicine, Ann Arbor (McInnis); Department of Psychiatry and Behavioral Science and Department of Radiology, Stony Brook University, Stony Brook, N.Y. (Parsey); and Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh (Phillips)
| | - Ramin V Parsey
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (Chin Fatt, Jha, Cooper, South, Grannemann, Carmody, Greer, Kurian, Trivedi); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Jha); Department of Psychiatry and Behavioral Sciences and Stanford Neurosciences Institute, Stanford University, Stanford, Calif. (Fonzo, Etkin); Mental Illness Research, Education, and Clinical Center, Veterans Affairs Palo Alto Health Care System, Palo Alto, Calif. (Fonzo, Etkin); Department of Psychiatry, Massachusetts General Hospital, Boston (Fava); New York State Psychiatric Institute and Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York (McGrath, Adams, Weissman); Department of Psychiatry, University of Michigan School of Medicine, Ann Arbor (McInnis); Department of Psychiatry and Behavioral Science and Department of Radiology, Stony Brook University, Stony Brook, N.Y. (Parsey); and Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh (Phillips)
| | - Myrna Weissman
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (Chin Fatt, Jha, Cooper, South, Grannemann, Carmody, Greer, Kurian, Trivedi); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Jha); Department of Psychiatry and Behavioral Sciences and Stanford Neurosciences Institute, Stanford University, Stanford, Calif. (Fonzo, Etkin); Mental Illness Research, Education, and Clinical Center, Veterans Affairs Palo Alto Health Care System, Palo Alto, Calif. (Fonzo, Etkin); Department of Psychiatry, Massachusetts General Hospital, Boston (Fava); New York State Psychiatric Institute and Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York (McGrath, Adams, Weissman); Department of Psychiatry, University of Michigan School of Medicine, Ann Arbor (McInnis); Department of Psychiatry and Behavioral Science and Department of Radiology, Stony Brook University, Stony Brook, N.Y. (Parsey); and Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh (Phillips)
| | - Mary L Phillips
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (Chin Fatt, Jha, Cooper, South, Grannemann, Carmody, Greer, Kurian, Trivedi); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Jha); Department of Psychiatry and Behavioral Sciences and Stanford Neurosciences Institute, Stanford University, Stanford, Calif. (Fonzo, Etkin); Mental Illness Research, Education, and Clinical Center, Veterans Affairs Palo Alto Health Care System, Palo Alto, Calif. (Fonzo, Etkin); Department of Psychiatry, Massachusetts General Hospital, Boston (Fava); New York State Psychiatric Institute and Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York (McGrath, Adams, Weissman); Department of Psychiatry, University of Michigan School of Medicine, Ann Arbor (McInnis); Department of Psychiatry and Behavioral Science and Department of Radiology, Stony Brook University, Stony Brook, N.Y. (Parsey); and Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh (Phillips)
| | - Amit Etkin
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (Chin Fatt, Jha, Cooper, South, Grannemann, Carmody, Greer, Kurian, Trivedi); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Jha); Department of Psychiatry and Behavioral Sciences and Stanford Neurosciences Institute, Stanford University, Stanford, Calif. (Fonzo, Etkin); Mental Illness Research, Education, and Clinical Center, Veterans Affairs Palo Alto Health Care System, Palo Alto, Calif. (Fonzo, Etkin); Department of Psychiatry, Massachusetts General Hospital, Boston (Fava); New York State Psychiatric Institute and Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York (McGrath, Adams, Weissman); Department of Psychiatry, University of Michigan School of Medicine, Ann Arbor (McInnis); Department of Psychiatry and Behavioral Science and Department of Radiology, Stony Brook University, Stony Brook, N.Y. (Parsey); and Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh (Phillips)
| | - Madhukar H Trivedi
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (Chin Fatt, Jha, Cooper, South, Grannemann, Carmody, Greer, Kurian, Trivedi); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Jha); Department of Psychiatry and Behavioral Sciences and Stanford Neurosciences Institute, Stanford University, Stanford, Calif. (Fonzo, Etkin); Mental Illness Research, Education, and Clinical Center, Veterans Affairs Palo Alto Health Care System, Palo Alto, Calif. (Fonzo, Etkin); Department of Psychiatry, Massachusetts General Hospital, Boston (Fava); New York State Psychiatric Institute and Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York (McGrath, Adams, Weissman); Department of Psychiatry, University of Michigan School of Medicine, Ann Arbor (McInnis); Department of Psychiatry and Behavioral Science and Department of Radiology, Stony Brook University, Stony Brook, N.Y. (Parsey); and Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh (Phillips)
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Jha MK, Cai L, Minhajuddin A, Fatt CC, Furman JL, Gadad BS, Mason BL, Greer TL, Hughes JL, Xiao G, Emslie G, Kennard B, Mayes T, Trivedi MH. Dysfunctional adaptive immune response in adolescents and young adults with suicide behavior. Psychoneuroendocrinology 2020; 111:104487. [PMID: 31756521 DOI: 10.1016/j.psyneuen.2019.104487] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 10/17/2019] [Accepted: 10/18/2019] [Indexed: 01/03/2023]
Abstract
BACKGROUND Immune system dysfunction has been implicated in the pathophysiology of suicide behavior. Here, we conducted an exploratory analysis of immune profile differences of three groups of adolescents and young adults (ages 10-25 years): healthy controls (n = 39), at risk of major depressive disorder (MDD; at-risk, n = 33), and MDD with recent suicide behavior/ ideation (suicide behavior, n = 37). METHODS Plasma samples were assayed for chemokines and cytokines using Bio-Plex Pro Human Chemokine 40-plex assay. Log-transformed cytokine and chemokine levels were compared after controlling for age, gender, body mass index, race, ethnicity, and C-reactive protein (CRP) levels. In post-hoc analyses to understand the effect of dysregulated immune markers identified in this exploratory analysis, their association with autoantibodies was tested in an unrelated sample (n = 166). RESULTS Only levels of interleukin 4 (IL-4) differed significantly among the three groups [false discovery rate (FDR) adjusted p = 0.0007]. Participants with suicide behavior had lower IL-4 [median = 16.8 pg/ml, interquartile range (IQR) = 7.9] levels than healthy controls (median = 29.1 pg/ml, IQR = 16.1, effect size [ES] = 1.30) and those at-risk (median = 24.4 pg/ml, IQR = 16.3, ES = 1.03). IL-4 levels were negatively correlated with depression severity (r= -0.38, p = 0.024). In an unrelated sample of outpatients with MDD, levels of IL-4 were negatively correlated (all FDR p < 0.05) with several autoantibodies [54/117 in total and 12/18 against innate immune markers]. CONCLUSIONS Adolescent and young adult patients with recent suicide behavior exhibit lower IL-4 levels. One biological consequence of reduced IL-4 levels may be increased risk of autoimmunity.
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Affiliation(s)
- Manish K Jha
- Center for Depression Research and Clinical Care, UT Southwestern Medical Center, Dallas, TX, United States; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Ling Cai
- Quantitative Biomedical Research Center, Department of Population and Data Sciences, UT Southwestern Medical Center, Dallas, TX, United States
| | - Abu Minhajuddin
- Center for Depression Research and Clinical Care, UT Southwestern Medical Center, Dallas, TX, United States
| | - Cherise Chin Fatt
- Center for Depression Research and Clinical Care, UT Southwestern Medical Center, Dallas, TX, United States
| | - Jennifer L Furman
- Center for Depression Research and Clinical Care, UT Southwestern Medical Center, Dallas, TX, United States
| | - Bharathi S Gadad
- Center for Depression Research and Clinical Care, UT Southwestern Medical Center, Dallas, TX, United States; Department of Psychiatry, Texas Tech University Health Science Center, El Paso, Texas, United States
| | - Brittany L Mason
- Center for Depression Research and Clinical Care, UT Southwestern Medical Center, Dallas, TX, United States
| | - Tracy L Greer
- Center for Depression Research and Clinical Care, UT Southwestern Medical Center, Dallas, TX, United States
| | - Jennifer L Hughes
- Center for Depression Research and Clinical Care, UT Southwestern Medical Center, Dallas, TX, United States
| | - Guanghua Xiao
- Quantitative Biomedical Research Center, Department of Population and Data Sciences, UT Southwestern Medical Center, Dallas, TX, United States
| | - Graham Emslie
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, United States
| | - Betsy Kennard
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, United States
| | - Taryn Mayes
- Center for Depression Research and Clinical Care, UT Southwestern Medical Center, Dallas, TX, United States
| | - Madhukar H Trivedi
- Center for Depression Research and Clinical Care, UT Southwestern Medical Center, Dallas, TX, United States.
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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.
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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)
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Trombello JM, Killian MO, Liao A, Sanchez K, Greer TL, Walker R, Grannemann B, Rethorst CD, Carmody T, Trivedi MH. Psychometrics of the Self-Report Concise Associated Symptoms Tracking Scale (CAST-SR): Results From the STRIDE (CTN-0037) Study. J Clin Psychiatry 2019; 79:17m11707. [PMID: 29325238 PMCID: PMC5932219 DOI: 10.4088/jcp.17m11707] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 05/17/2017] [Accepted: 12/06/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The self-report Concise Associated Symptoms Tracking Scale (CAST-SR) was developed to track mania, irritability, anxiety, panic, and insomnia symptoms among depressed outpatients receiving antidepressant medication. Given the overlap between these domains, depression, and stimulant use disorders, we reexamined CAST-SR psychometrics in a novel sample: individuals with stimulant use disorder receiving aerobic exercise or health education interventions. METHODS Using the subsample of stimulant-dependent (following DSM-IV criteria) individuals prescribed antidepressants (N = 124) from the multisite Stimulant Reduction Intervention Using Dosed Exercise (CTN-0037) trial (total sample N = 302), conducted July 2010 to February 2013, we analyzed CAST-SR data collected at the first assessment after participant's discharge from residential treatment. We also evaluated the convergent/discriminant validity of the CAST-SR with several self-report questionnaires. RESULTS Confirmatory factor analysis revealed a 12-item measure composed of 4 factors: irritability, anxiety, panic, and insomnia. This factor structure loaded only in participants prescribed antidepressant medication, not in those who were not prescribed antidepressants. These results replicate the original CAST-SR factor structure, except for the mania factor, which failed to load. Internal consistency was high (α = 0.92 for total scale and α = 0.78-0.89 for the 4 factors), and convergent validity was established, especially for the insomnia and irritability factors, alongside the total score with depressive symptoms, insomnia, quality of life, suicide risk, and physical health measures. CONCLUSIONS These results demonstrate the factor structure, reliability, and validity of the CAST-SR in a novel population of only individuals with stimulant use disorders receiving both exercise/health education interventions and antidepressant medication. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01141608.
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Affiliation(s)
- Joseph M Trombello
- Department of Psychiatry, Center for Depression Research and Clinical Care, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Michael O Killian
- School of Social Work, University of Texas at Arlington, Arlington, Texas, USA
| | - Allen Liao
- Department of Psychiatry, Center for Depression Research and Clinical Care, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Current affiliation: Harbor-UCLA Medical Center, Los Angeles, California, USA
| | - Katherine Sanchez
- School of Social Work, University of Texas at Arlington, Arlington, Texas, USA
- Current affiliation: Center for Applied Health Research, Baylor Scott and White Research Institute, Dallas, Texas, USA
| | - Tracy L Greer
- Department of Psychiatry, Center for Depression Research and Clinical Care, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Robrina Walker
- Department of Psychiatry, Center for Depression Research and Clinical Care, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Bruce Grannemann
- Department of Psychiatry, Center for Depression Research and Clinical Care, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Chad D Rethorst
- Department of Psychiatry, Center for Depression Research and Clinical Care, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Thomas Carmody
- Department of Psychiatry, Center for Depression Research and Clinical Care, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Madhukar H Trivedi
- Department of Psychiatry, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-9119.
- Department of Psychiatry, Center for Depression Research and Clinical Care, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Walker R, Northrup TF, Tillitski J, Bernstein I, Greer TL, Trivedi MH. The Stimulant Selective Severity Assessment: A replication and exploratory extension of the Cocaine Selective Severity Assessment. Subst Use Misuse 2019; 54:351-361. [PMID: 30657406 PMCID: PMC6438747 DOI: 10.1080/10826084.2018.1467453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Cocaine and methamphetamine have similar withdrawal symptoms and many individuals concurrently use both substances; however, no measures concurrently assess withdrawal from multiple stimulants. OBJECTIVES This study's aim was to explore the Stimulant Selective Severity Assessment (SSSA), a modified version of the Cocaine Selective Severity Assessment (CSSA), in a sample of stimulant users to determine if it can assess withdrawal symptoms in users of one or more stimulants. METHODS Baseline data were analyzed from the STimulant Reduction Intervention using Dosed Exercise trial, a multisite randomized clinical trial that evaluated exercise versus health education on drug use outcomes in individuals with stimulant use disorders. Data were analyzed for internal consistency, construct validity, and scale dimensionality. RESULTS Internal consistency for the full sample was good (α = 0.81; N = 302), with similar alphas in Cocaine (0.81; n = 177) and Cocaine/Other Stimulant (0.82; n = 92) groups, but with much lower alpha for the group without cocaine use (Other Stimulant, i.e., primarily methamphetamine, α = 0.66; n = 32). Support for construct validity was evidenced by significant positive correlations (r = 0.17 to 0.67) with measures of stimulant craving, depressive symptoms, and pain. Four factors were revealed. Conclusions/Importance: The Stimulant Selective Severity Assessment is a new measure that can be used to assess withdrawal symptoms in users of cocaine or cocaine plus methamphetamine, but it should not be administered to users of methamphetamine only.
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Affiliation(s)
- Robrina Walker
- a Department of Psychiatry , University of Texas Southwestern Medical Center , Dallas , Texas , USA
| | - Thomas F Northrup
- b Department of Family and Community Medicine , The University of Texas Health Science Center at Houston, McGovern Medical School , Houston , Texas , USA
| | - John Tillitski
- a Department of Psychiatry , University of Texas Southwestern Medical Center , Dallas , Texas , USA
| | - Ira Bernstein
- c Department of Clinical Sciences , University of Texas Southwestern Medical Center , Dallas , Texas , USA
| | - Tracy L Greer
- a Department of Psychiatry , University of Texas Southwestern Medical Center , Dallas , Texas , USA
| | - Madhukar H Trivedi
- a Department of Psychiatry , University of Texas Southwestern Medical Center , Dallas , Texas , USA
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Harrison JE, Barry H, Baune BT, Best MW, Bowie CR, Cha DS, Culpepper L, Fossati P, Greer TL, Harmer C, Klag E, Lam RW, Lee Y, Mansur RB, Wittchen H, McIntyre RS. Stability, reliability, and validity of the THINC-it screening tool for cognitive impairment in depression: A psychometric exploration in healthy volunteers. Int J Methods Psychiatr Res 2018; 27:e1736. [PMID: 30088298 PMCID: PMC6174931 DOI: 10.1002/mpr.1736] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 06/15/2018] [Accepted: 06/21/2018] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES There is a need for a brief, reliable, valid, and sensitive assessment tool for screening cognitive deficits in patients with Major Depressive Disorders. This paper examines the psychometric characteristics of THINC-it, a cognitive assessment tool composed of four objective measures of cognition and a self-rated assessment, in subjects without mental disorders. METHODS N = 100 healthy controls with no current or past history of depression were tested on four sequential assessments to examine temporal stability, reliability, and convergent validity of the THINC-it tests. We examined temporal reliability across 1 week and stability via three consecutive assessments. Consistency of assessment by the study rater (intrarater reliability) was calculated using the data from the second and third of these consecutive assessments. RESULTS Test-retest reliability correlations varied between Pearson's r = 0.75 and 0.8. Intrarater reliability between 0.7 and 0.93. Stability for the primary measure for each test yielded within-subject standard deviation values between 5.9 and 11.23 for accuracy measures and 0.735 and 17.3 seconds for latency measures. Convergent validity for three tasks was in the acceptable range, but low for the Symbol Check task. CONCLUSIONS Analysis shows high levels of reliability and stability. Levels of convergent validity were modest but acceptable in the case of all but one test.
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Affiliation(s)
- John E. Harrison
- Alzheimer CenterVU Medical CenterAmsterdamThe Netherlands
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
- Kilmington CommonMetis Cognition LtdWiltshireUK
| | | | | | | | - Christopher R. Bowie
- Department of PsychologyQueen's UniversityKingstonONCanada
- Centre for Addiction and Mental HealthTorontoONCanada
| | - Danielle S. Cha
- Mood Disorders Psychopharmacology UnitUniversity Health NetworkTorontoONCanada
| | - Larry Culpepper
- Department of Family MedicineBoston UniversityBostonMassachusettsUSA
| | - Philippe Fossati
- Sorbonne Universités, UPMC Univ Paris 06, Inserm, CNRS, APHPInstitut du cerveau et de la moelle (ICM)‐Hôpital Pitié SalpétrièreParisFrance
| | - Tracy L. Greer
- Centre for Depression Research and Clinical Care, Department of PsychiatryUniversity of TexasDallasTexasUSA
| | - Catherine Harmer
- Cognitive Neuroscience, Department of PsychiatryOxford UniversityOxfordUK
| | - Esther Klag
- Clinical Psychologist, Rehabilitation Neuropsychologist, PsychotherapistLondonUK
| | - Raymond W. Lam
- BC Leadership Chair in Depression ResearchVancouverBCCanada
- Department of PsychiatryUniversity of British ColumbiaVancouverBCCanada
- Djavad Mowafaghian Centre for Brain HealthMood Disorders CentreVancouverBCCanada
- Canadian Network for Mood and Anxiety Treatments (CANMAT)VancouverBCCanada
| | - Yena Lee
- Mood Disorders Psychopharmacology UnitUniversity Health NetworkTorontoONCanada
- Institute of Medical ScienceUniversity of TorontoTorontoONCanada
| | - Rodrigo B. Mansur
- Mood Disorders Psychopharmacology UnitUniversity Health NetworkTorontoONCanada
- Canadian Network for Mood and Anxiety Treatments (CANMAT)VancouverBCCanada
| | - Hans‐Ulrich Wittchen
- Institute of Clinical Psychology and Psychotherapy and Centre of Clinical Epidemiology and Longitudinal Studies, (CELOS)Technische Universität DresdenDresdenGermany
- Department of Psychiatry and PsychotherapyLudwig‐Maximilians‐University MunichMunichGermany
- Clinical Psychology and Psychotherapy MPCBDresdenGermany
| | - Roger S. McIntyre
- Mood Disorders Psychopharmacology UnitUniversity Health NetworkTorontoONCanada
- Institute of Medical ScienceUniversity of TorontoTorontoONCanada
- Department of PsychiatryUniversity of TorontoTorontoONCanada
- Brain and Cognition Discovery Foundation (BCDF)TorontoONCanada
- Department of PharmacologyUniversity of TorontoTorontoONCanada
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16
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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.
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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
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17
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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.
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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.
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Carmody T, Greer TL, Walker R, Rethorst CD, Trivedi MH. A Complier Average Causal Effect Analysis of the Stimulant Reduction Intervention using Dosed Exercise Study. Contemp Clin Trials Commun 2018; 10:1-8. [PMID: 29682627 PMCID: PMC5898532 DOI: 10.1016/j.conctc.2018.02.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Objective Exercise is a promising treatment for substance use disorders, yet an intention-to-treat analysis of a large, multi-site study found no reduction in stimulant use for exercise versus health education. Exercise adherence was sub-optimal; therefore, secondary post-hoc complier average causal effects (CACE) analysis was conducted to determine the potential effectiveness of adequately dosed exercise. Method The STimulant use Reduction Intervention using Dosed Exercise study was a randomized controlled trial comparing a 12 kcal/kg/week (KKW) exercise dose versus a health education control conducted at nine residential substance use treatment settings across the U.S. that are affiliated with the National Drug Abuse Treatment Clinical Trials Network. Participants were sedentary but medically approved for exercise, used stimulants within 30 days prior to study entry, and received a DSM-IV stimulant abuse or dependence diagnosis within the past year. A CACE analysis adjusted to include only participants with a minimum threshold of adherence (at least 8.3 KKW) and using a negative-binomial hurdle model focused on 218 participants who were 36.2% female, mean age 39.4 years (SD = 11.1), and averaged 13.0 (SD = 9.2) stimulant use days in the 30 days before residential treatment. The outcome was days of stimulant use as assessed by the self-reported TimeLine Follow Back and urine drug screen results. Results The CACE-adjusted analysis found a significantly lower probability of relapse to stimulant use in the exercise group versus the health education group (41.0% vs. 55.7%, p < .01) and significantly lower days of stimulant use among those who relapsed (5.0 days vs. 9.9 days, p < .01). Conclusions The CACE adjustment revealed significant, positive effects for exercise. Further research is warranted to develop strategies for exercise adherence that can ensure achievement of an exercise dose sufficient to produce a significant treatment effect.
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Affiliation(s)
| | | | | | | | - Madhukar H. Trivedi
- Corresponding author. Julie K. Hersh Chair for Depression Research and Clinical Care, 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, USA.
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Rethorst CD, South CC, Rush AJ, Greer TL, Trivedi MH. Prediction of treatment outcomes to exercise in patients with nonremitted major depressive disorder. Depress Anxiety 2017; 34:1116-1122. [PMID: 28672073 PMCID: PMC5718947 DOI: 10.1002/da.22670] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [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: 03/02/2017] [Revised: 04/27/2017] [Accepted: 05/20/2017] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Only one-third of patients with major depressive disorder (MDD) achieve remission with initial treatment. Consequently, current clinical practice relies on a "trial-and-error" approach to identify an effective treatment for each patient. The purpose of this report was to determine whether we could identify a set of clinical and biological parameters with potential clinical utility for prescription of exercise for treatment of MDD in a secondary analysis of the Treatment with Exercise Augmentation in Depression (TREAD) trial. METHODS Participants with nonremitted MDD were randomized to one of two exercise doses for 12 weeks. Participants were categorized as "remitters" (≤12 on the IDS-C), nonresponders (<30% drop in IDS-C), or neither. The least absolute shrinkage and selection operator (LASSO) and random forests were used to evaluate 30 variables as predictors of both remission and nonresponse. Predictors were used to model treatment outcomes using logistic regression. RESULTS Of the 122 participants, 36 were categorized as remitters (29.5%), 56 as nonresponders (45.9%), and 30 as neither (24.6%). Predictors of remission were higher levels of brain-derived neurotrophic factor (BDNF) and IL-1B, greater depressive symptom severity, and higher postexercise positive affect. Predictors of treatment nonresponse were low cardiorespiratory fitness, lower levels of IL-6 and BDNF, and lower postexercise positive affect. Models including these predictors resulted in predictive values greater than 70% (true predicted remitters/all predicted remitters) with specificities greater than 25% (true predicted remitters/all remitters). CONCLUSIONS Results indicate feasibility in identifying patients who will either remit or not respond to exercise as a treatment for MDD utilizing a clinical decision model that incorporates multiple patient characteristics.
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Affiliation(s)
- Chad D. Rethorst
- University of Texas Southwestern Medical Center, Center for Depression Research and Clinical Care, Department of Psychiatry
| | - Charles C. South
- University of Texas Southwestern Medical Center, Center for Depression Research and Clinical Care, Department of Psychiatry
| | | | - Tracy L. Greer
- University of Texas Southwestern Medical Center, Center for Depression Research and Clinical Care, Department of Psychiatry
| | - Madhukar H. Trivedi
- University of Texas Southwestern Medical Center, Center for Depression Research and Clinical Care, Department of Psychiatry
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20
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Greer TL, Furman JL, Trivedi MH. Evaluation of the benefits of exercise on cognition in major depressive disorder. Gen Hosp Psychiatry 2017; 49:19-25. [PMID: 28690019 DOI: 10.1016/j.genhosppsych.2017.06.002] [Citation(s) in RCA: 15] [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: 03/04/2017] [Revised: 06/01/2017] [Accepted: 06/05/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND Cognitive impairment is increasingly recognized as a significant symptom in patients with major depressive disorder (MDD). While exercise is already recommended in many treatment guidelines for patients with MDD and has been shown to improve cognition in other disorders (e.g., Alzheimer's, Parkinson's, schizophrenia), limited research is available evaluating the effect of exercise on cognition in MDD. METHODS We provide a narrative review of existing literature regarding the effect(s) of exercise on cognition across several neurodegenerative and psychiatric diseases, and particularly in MDD, with specific emphasis on study design and methodology that may impair adequate synthesis of the results. We also describe mechanisms by which exercise may improve cognition in depression and other brain disorders. RESULTS Of existing studies with MDD, data are equivocal, as some are supportive of improved cognition, whereas others demonstrate no benefit. Several limitations were noted, including insufficiently-powered designs, variability in interventions examined (e.g., aerobic, anaerobic, mind-body) or control groups, lack of attention to the status of baseline cognitive impairment, and/or heterogeneity across outcome measures and clinical characteristics. CONCLUSIONS While preliminary results suggest the potential for exercise as a beneficial treatment or augmentation strategy for impaired cognition in MDD, the aforementioned limitations necessitate further investigation.
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Affiliation(s)
- Tracy L Greer
- University of Texas, Southwestern Medical Center, Dallas, TX, USA
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Jha MK, Minhajuddin A, Gadad B, Greer TL, Mayes TL, Trivedi MH. Interleukin 17 selectively predicts better outcomes with bupropion-SSRI combination: Novel T cell biomarker for antidepressant medication selection. Brain Behav Immun 2017; 66:103-110. [PMID: 28698115 PMCID: PMC5699207 DOI: 10.1016/j.bbi.2017.07.005] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 06/28/2017] [Accepted: 07/07/2017] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Interleukin 17 (IL-17) is produced by highly inflammatory Th17 cells and has been implicated in pathophysiology of depression. IL-17 putatively disrupts the blood brain barrier and affects dopamine synthesis whereas dopamine has been shown to decrease Th17 cell-mediated immune response. Nevertheless, whether IL-17 can predict differential treatment outcome with antidepressants modulating dopaminergic transmission is unknown. METHODS IL-17 and other T cell and non-T cell markers (Th1, Th2 and non-T cell markers) were measured with the Bioplex Pro™ human cytokine 27-plex kit in the Combining Medications to Enhance Depression Outcomes (CO-MED) trial participants who provided baseline plasma and were treated with either bupropion plus escitalopram (bupropion-SSRI), escitalopram plus placebo (SSRI monotherapy), or venlafaxine plus mirtazapine (n=166). Differential changes in symptom severity and side-effects based on levels of IL-17 and other T and non-T cell markers were tested using a treatment-arm-by-biomarker interaction in separate repeated measures mixed model analyses. Subsequent analyses stratified by treatment arm were conducted for those markers with a significant interaction. RESULTS There was a significant treatment-arm-by-IL-17 interaction for depression severity (p=0.037) but not for side-effects (p=0.28). Higher baseline IL-17 level was associated with greater reduction in depression severity (effect size=0.78, p=0.008) in the bupropion-SSRI but not the other two treatment arms. Other T and non-T cell markers were not associated with differential treatment outcomes. CONCLUSION Higher baseline levels of IL-17 are selectively associated with greater symptomatic reduction in depressed patients treated with bupropion-SSRI combination.
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Affiliation(s)
- Manish K. Jha
- Center for Depression Research and Clinical Care, UT Southwestern Medical Center, Dallas, TX
| | - Abu Minhajuddin
- Department of Clinical Sciences, UT Southwestern Medical Center, Dallas, TX
| | - Bharathi Gadad
- Center for Depression Research and Clinical Care, UT Southwestern Medical Center, Dallas, TX
| | - Tracy L. Greer
- Center for Depression Research and Clinical Care, UT Southwestern Medical Center, Dallas, TX
| | - Taryn L. Mayes
- 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,Corresponding author: Madhukar H. Trivedi, M.D., Professor of Psychiatry, Betty Jo Hay Distinguished Chair in Mental Health, Director, Center for Depression Research and Clinical Care, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-9119, Phone: 214-648-0188, Fax: 214-648-0167,
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McIntyre RS, Best MW, Bowie CR, Carmona NE, Cha DS, Lee Y, Subramaniapillai M, Mansur RB, Barry H, Baune BT, Culpepper L, Fossati P, Greer TL, Harmer C, Klag E, Lam RW, Wittchen HU, Harrison J. The THINC-Integrated Tool (THINC-it) Screening Assessment for Cognitive Dysfunction: Validation in Patients With Major Depressive Disorder. J Clin Psychiatry 2017; 78:873-881. [PMID: 28858441 DOI: 10.4088/jcp.16m11329] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [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: 11/07/2016] [Accepted: 06/09/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To validate the THINC-integrated tool (THINC-it)-a freely available, patient-administered, computerized screening tool integrating subjective and objective measures of cognitive function in adults with major depressive disorder (MDD). METHODS Subjects aged 18 to 65 years (n = 100) with recurrent MDD experiencing a major depressive episode of at least moderate severity were evaluated and compared to age-, sex-, and education-matched healthy controls (n = 100). Between January and June 2016, subjects completed the THINC-it, which includes variants of the Choice Reaction Time Identification Task (IDN), One-Back Test, Digit Symbol Substitution Test, Trail Making Test-Part B, and the Perceived Deficits Questionnaire for Depression-5-item (PDQ-5-D). RESULTS The THINC-it required approximately 10 to 15 minutes for administration and was capable of detecting cognitive deficits in adults with MDD. A total of 44.4% of adults with MDD exhibited cognitive performance at ≥ 1.0 SD below that of healthy controls on standardized mean scores of the THINC-it. Concurrent validity of the overall tool, based on a calculated composite score, was acceptable (r = 0.539, P < .001). Concurrent validity of the component tests ranged from -0.083 (IDN) to 0.929 (PDQ-5-D). Qualitative survey results indicated that there was a high level of satisfaction and perceived value in administering the THINC-it regarding its impact on the appropriateness and quality of care being received. CONCLUSIONS The THINC-it is a valid and sensitive tool for detecting cognitive dysfunction in adults with MDD that is free, easy to use, and rapidly administered. The THINC-it should be incorporated into the assessment and measurement of all patients with MDD, particularly among those with enduring functional impairment. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02508493.
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Affiliation(s)
- Roger S McIntyre
- Department of Psychiatry and Pharmacology, University of Toronto, Mood Disorders Psychopharmacology Unit, University Health Network, Brain and Cognition Discovery Foundation, 399 Bathurst St, Toronto, ON, Canada M5T 2S8. .,Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Canada.,Brain and Cognition Discovery Foundation (BCDF), Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada.,Department of Pharmacology, University of Toronto, Toronto, Canada.,Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Michael W Best
- Department of Psychology, Queen's University, Kingston, Canada
| | - Christopher R Bowie
- Department of Psychology, Queen's University, Kingston, Canada.,Centre for Addiction and Mental Health, Toronto, Canada
| | - Nicole E Carmona
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Canada
| | - Danielle S Cha
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Canada.,Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Yena Lee
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Canada.,Institute of Medical Science, University of Toronto, Toronto, Canada
| | | | - Rodrigo B Mansur
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Canada
| | - Harry Barry
- Stoneylane Clinic Drogheda, Co Louth, Ireland
| | - Bernhard T Baune
- Department of Psychiatry, University of Adelaide, Adelaide, Australia
| | - Larry Culpepper
- Department of Family Medicine, Boston University, Boston, Massachusetts, USA
| | - Philippe Fossati
- Inserm U 1127, CNRS UMR 7225, Sorbonne Universités, UPMC Univ Paris 06, UMR S 1127, Institut du Cerveau et de la Moelle, ICM, Social and Affective Neuroscience (SAN) Team, Paris, France
| | - Tracy L Greer
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Catherine Harmer
- University Department of Psychiatry, Warneford Hospital, Oxford, United Kingdom
| | | | - Raymond W Lam
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Hans-Ulrich Wittchen
- Institute of Clinical Psychology and Psychotherapy and Centre of Clinical Epidemiology and Longitudinal Studies (CELOS), Technische Universität Dresden, Dresden, Germany
| | - John Harrison
- Alzheimer Center, VU Medical Center, Amsterdam, the Netherlands.,Metis Cognition Ltd, Warminster, United Kingdom.,IoPPN, King's College, London, United Kingdom
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23
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Sanchez K, Greer TL, Walker R, Carmody T, Rethorst CD, Trivedi MH. Racial and ethnic differences in treatment outcomes among adults with stimulant use disorders after a dosed exercise intervention. J Ethn Subst Abuse 2017; 16:495-510. [PMID: 28524806 DOI: 10.1080/15332640.2017.1317310] [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] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The current study examined differences in substance abuse treatment outcomes among racial and ethnic groups enrolled in the Stimulant Reduction Intervention using Dosed Exercise (STRIDE) trial, a multisite randomized clinical trial implemented through the National Institute on Drug Abuse's (NIDA's) Clinical Trials Network (CTN). STRIDE aimed to test vigorous exercise as a novel approach to the treatment of stimulant abuse compared to a health education intervention. A hurdle model with a complier average causal effects (CACE) adjustment was used to provide an unbiased estimate of the exercise effect had all participants been adherent to exercise. Among 214 exercise-adherent participants, we found significantly lower probability of use for Blacks (z = -2.45, p = .014) and significantly lower number of days of use for Whites compared to Hispanics (z = -54.87, p = <.001) and for Whites compared to Blacks (z = -28.54, p = <.001), which suggests that vigorous, regular exercise might improve treatment outcomes given adequate levels of adherence.
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Affiliation(s)
- Katherine Sanchez
- a School of Social Work , The University of Texas at Arlington , Arlington , Texas
| | - T L Greer
- b University of Texas Southwestern Medical Center , Dallas , Texas
| | - R Walker
- b University of Texas Southwestern Medical Center , Dallas , Texas
| | - T Carmody
- b University of Texas Southwestern Medical Center , Dallas , Texas
| | - C D Rethorst
- b University of Texas Southwestern Medical Center , Dallas , Texas
| | - M H Trivedi
- b University of Texas Southwestern Medical Center , Dallas , Texas
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24
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Stoutenberg M, Rethorst CD, Vidot DC, Greer TL, Trivedi MH. Cardiorespiratory fitness and body composition of stimulant users: A baseline analysis of the STRIDE cohort. J Subst Abuse Treat 2017; 78:74-79. [PMID: 28554607 DOI: 10.1016/j.jsat.2017.05.005] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 05/05/2017] [Accepted: 05/09/2017] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Relatively little has been reported about the physical characteristics, such as cardiorespiratory fitness (CRF) and body composition, of stimulant users. Identifying risk factors associated with the physical health of stimulant users is an important public health issue as new treatments should better address the entire range of health concerns experienced by this population. METHODS We examined cross-sectional data gathered at baseline from the STimulant Reduction Intervention using Dosed Exercise (STRIDE) study, a multisite randomized clinical trial that examined exercise as an adjunct to treatment as usual for individuals in residential treatment programs (RTPs). Clients were approached after intake to the RTP. Prior to randomization, eligible individuals underwent a comprehensive screening process that included medical screening, where CRF was assessed through a maximal exercise test (time on treadmill), and a series of baseline examinations assessing domains of substance use and mental health. RESULTS Data from 295 individuals with recent stimulant use disorders were analyzed. The mean body mass index (BMI) and waist circumference (WC) and for all participants was 27.8±5.7kg/m2 and 93.5±14.2cm, respectively, while the mean time on treadmill was 13.7±2.9min. Few significant associations were observed between CRF, BMI, or WC and substance use and mental health measures. CONCLUSIONS Stimulant users in this study presented with low CRF levels and would be considered overweight based on their BMI. These individuals would likely benefit from interventions that address both their stimulant use, as well as their physical health.
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Affiliation(s)
- Mark Stoutenberg
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, United States.
| | - Chad D Rethorst
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Denise C Vidot
- School of Nursing & Health Studies, University of Miami, Coral Gables, FL, United States
| | - Tracy L Greer
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Madhukar H Trivedi
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, United States
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25
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Greer TL, Thompson LT. Editorial: Eyeblink Classical Conditioning in Psychiatric Conditions: Novel Uses for a Classic Paradigm. Front Psychiatry 2017; 8:48. [PMID: 28396641 PMCID: PMC5367055 DOI: 10.3389/fpsyt.2017.00048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 03/09/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Tracy L Greer
- Department of Psychiatry, UT Southwestern Medical Center , Dallas, TX , USA
| | - Lucien T Thompson
- Aging & Memory Research, Behavioral and Brain Sciences, University of Texas at Dallas , Richardson, TX , USA
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26
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Northrup TF, Greer TL, Walker R, Rethorst CD, Warden D, Stotts AL, Trivedi MH. An ounce of prevention: A pre-randomization protocol to improve retention in substance use disorder clinical trials. Addict Behav 2017; 64:137-142. [PMID: 27610591 DOI: 10.1016/j.addbeh.2016.08.040] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 05/20/2016] [Revised: 07/26/2016] [Accepted: 08/30/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND Missing data in substance use disorder (SUD) research pose a significant threat to internal validity. Participants terminate involvement or become less likely to attend intervention and research visits for many reasons, which should be addressed prior to becoming problematic. During a 9-month study targeting stimulant abuse, early dropouts and participant reported attendance barriers led to implementing a structured, pre-randomization protocol with participants about retention and solution-focused strategies (the "Fireside Chat"). Our aim is to outline this approach and present data on intervention participation and research visit attendance after implementation. METHODS/DESIGN STimulant Reduction using Dosed Exercise (STRIDE) was a two-arm, multisite randomized clinical trial testing treatment-as-usual for stimulant abuse/dependence augmented by Exercise or Health Education. For both groups, study intervention visits at the site were scheduled 3/week for 12weeks followed by 1/week for 24weeks. During The Chat, research staff thoroughly reviewed participants' expectations, and barriers and solutions to retention. Fifteen participants were randomized (to Exercise or Health Education) prior to and fourteen were randomized after Chat implementation. Intervention and monthly follow-up attendance (before and after implementation) were compared at the site (N=29) that developed and rigorously implemented The Chat. RESULTS Individuals who participated in The Chat (n=14) attended significantly more intervention visits during weeks 1-12 (p<0.001) and weeks 13-36 (p<0.05) and attended more research visits (p<0.001). DISCUSSION Proactive discussion of expectations and barriers prior to randomization was associated with greater study attendance. SUD researchers should consider tailoring this approach to suit their needs. Further investigation is warranted.
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Affiliation(s)
- Thomas F Northrup
- Department of Family and Community Medicine, The University of Texas Health Science Center at Houston (UTHealth), McGovern Medical School, Houston, TX 77030, USA.
| | - Tracy L Greer
- Department of Psychiatry, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-9119, USA
| | - Robrina Walker
- Department of Psychiatry, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-9119, USA
| | - Chad D Rethorst
- Department of Psychiatry, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-9119, USA
| | - Diane Warden
- Department of Psychiatry, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-9119, USA
| | - Angela L Stotts
- Department of Family and Community Medicine, The University of Texas Health Science Center at Houston (UTHealth), McGovern Medical School, Houston, TX 77030, USA; Department of Psychiatry and Behavioral Sciences, UTHealth, McGovern Medical School, Houston, TX 77030, USA
| | - Madhukar H Trivedi
- Department of Psychiatry, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-9119, USA
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27
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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.
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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
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Jha MK, Teer RB, Minhajuddin A, Greer TL, Rush AJ, Trivedi MH. Daily activity level improvement with antidepressant medications predicts long-term clinical outcomes in outpatients with major depressive disorder. Neuropsychiatr Dis Treat 2017; 13:803-813. [PMID: 28352180 PMCID: PMC5359139 DOI: 10.2147/ndt.s128407] [Citation(s) in RCA: 15] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Major depressive disorder (MDD) significantly impacts performance of both work- and nonwork-related routine daily activities. We have shown that work productivity is significantly impaired in employed MDD patients, but the extent of impairments in nonwork-related routine activities and its association with antidepressant treatment outcomes has not been established. MATERIALS AND METHODS Activity impairment was measured using the sixth item of Work Productivity and Activity Impairment Scale in the Combining Medications to Enhance Depression Outcomes (CO-MED) trial (n=665). Published norms were used to define activity impairment levels. The relationship between activity impairment and baseline sociodemographic and clinical characteristics was evaluated along with changes in activity impairment and its relationship with other clinical outcomes such as symptom severity, function, and side effect burden. Remission status at 3 and 7 months was predicted based on week 6 activity impairment level. RESULTS Higher psychosocial and cognitive impairments and greater number of comorbid medical conditions were associated with greater activity impairment at baseline. Proportion of participants with severe activity impairment declined from 47.6% at baseline to 18.7% at 3 months, while mean activity impairment decreased from 57.1 at baseline to 32.8 at 3 months. During course of treatment, levels of activity impairment correlated most strongly with psychosocial function among measures of symptom severity, function, quality of life, and side effect burden. No or minimal activity impairment at week 6 was associated with two to three times higher rates of remission at 3 and 7 months as compared to moderate or severe activity impairment levels even after controlling for remission status at week 6 and select baseline variables. CONCLUSION Depressed patients have high levels of nonwork-related activity impairment at baseline that improves significantly with treatment and independently predicts long-term clinical outcomes. Brief systematic assessment of activity impairment during the course of antidepressant treatment can help inform clinical decision-making.
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Affiliation(s)
- Manish K Jha
- Center for Depression Research and Clinical Care, University of Texas Southwestern Medical Center, Dallas
| | | | - Abu Minhajuddin
- Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Tracy L Greer
- Center for Depression Research and Clinical Care, University of Texas Southwestern Medical Center, Dallas
| | | | - Madhukar H Trivedi
- Center for Depression Research and Clinical Care, University of Texas Southwestern Medical Center, Dallas
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Jha MK, Minhajuddin A, Greer TL, Carmody T, Rush AJ, Trivedi MH. Early Improvement in Psychosocial Function Predicts Longer-Term Symptomatic Remission in Depressed Patients. PLoS One 2016; 11:e0167901. [PMID: 28030546 PMCID: PMC5193346 DOI: 10.1371/journal.pone.0167901] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 11/18/2016] [Indexed: 11/19/2022] Open
Abstract
The goal of this study was to evaluate the relationship between early change in psychosocial function independent of depression severity and longer-term symptomatic remission. Participants of Combining Medications to Enhance Depression Outcomes trial were randomly selected for model selection (n = 334) and validation (n = 331). Changes in psychosocial function (Work and Social Adjustment Scale, WSAS) from baseline to week 6 were assessed and two data-driven sub-groups of WSAS change were identified in the randomly selected model selection half. Results of analyses to predict symptomatic remission at 3 and 7 months were validated for these sub-groups in the second half (validation sample). From baseline to week 6, psychosocial function improved significantly even after adjusting for depression severity at each visit and select baseline variables (age, gender, race, ethnicity, education, income, employment, depression onset before age 18, anxious features, and suicidal ideation), treatment-arm, and WSAS score. The WSAS change patterns identified two (early improvement and gradual change) subgroups. After adjusting for baseline variables and remission status at week 6, participants with early improvement in the second half (validation sample) had greater remission rates than those with gradual change at both 3 (3.3 times) and 7 months (2.3 times) following acute treatment initiation. In conclusion, early improvement in psychosocial function provides a clinically meaningful prediction of longer-term symptomatic remission, independent of depression symptom severity.
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Affiliation(s)
- Manish K. Jha
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, Texas, United States of America
| | - Abu Minhajuddin
- Department of Clinical Sciences, UT Southwestern Medical Center, Dallas, Texas, United States of America
| | - Tracy L. Greer
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, Texas, United States of America
| | - Thomas Carmody
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, Texas, United States of America
| | - Augustus John Rush
- Department of Psychiatry and Behavioral Sciences, Duke-National University of Singapore, Singapore
| | - Madhukar H. Trivedi
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, Texas, United States of America
- * E-mail:
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Jha MK, Minhajuddin A, Greer TL, Carmody T, Rush AJ, Trivedi MH. Early Improvement in Work Productivity Predicts Future Clinical Course in Depressed Outpatients: Findings From the CO-MED Trial. Am J Psychiatry 2016; 173:1196-1204. [PMID: 27523501 PMCID: PMC5895453 DOI: 10.1176/appi.ajp.2016.16020176] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Depression symptom severity, the most commonly studied outcome in antidepressant treatment trials, accounts for only a small portion of burden related to major depression. While lost work productivity is the biggest contributor to depression's economic burden, few studies have systematically evaluated the independent effect of treatment on work productivity and the relationship between changes in work productivity and longer-term clinical course. METHOD Work productivity was measured repeatedly by the Work Productivity and Activity Impairment self-report questionnaire in 331 employed participants with major depression enrolled in the Combining Medications to Enhance Depression Outcomes trial. Trajectories of change in work productivity during the first 6 weeks of treatment were identified and used to predict remission at 3 and 7 months. RESULTS Participants reported reduced absence from work and increased work productivity with antidepressant treatment even after controlling for changes in depression severity. Three distinct trajectories of changes in work productivity were identified: 1) robust early improvement (24%), 2) minimal change (49%), and 3) high-impairment slight reduction (27%). Compared with other participants, those with robust improvement had 3-5 times higher remission rates at 3 months and 2-5 times higher remission rates at 7 months, even after controlling for select baseline variables and remission status at week 6. CONCLUSIONS In this secondary analysis, self-reported work productivity improved in depressed patients with antidepressant treatment even after accounting for depressive symptom reduction. Early improvement in work productivity is associated with much higher remission rates after 3 and 7 months of treatment.
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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.
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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.
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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.
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Affiliation(s)
- Madhukar H Trivedi
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
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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.
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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
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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.
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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
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Dela Cruz AM, Carmody T, Greer TL, Rethorst CD, Warden D, Walker R, Trivedi MH. Baseline medical comorbidities in adults randomized in the STRIDE trial for psychostimulant use disorders. Am J Addict 2016; 25:215-20. [PMID: 26991889 DOI: 10.1111/ajad.12363] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 02/11/2016] [Accepted: 02/29/2016] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Rates of medical illnesses may be higher among individuals with substance use disorders, complicating their care. This study aimed to expand the understanding of other medical conditions in treatment-seeking adults with stimulant use disorder (SUD) using data from Stimulant Reduction Intervention using Dose Exercise (STRIDE), a randomized, multisite trial investigating exercise augmentation of treatment as usual. METHODS Utilizing STRIDE baseline data, we examined demographic and clinical characteristics based on the number of self-reported diagnosed medical conditions among participants meeting eligibility criteria (passing medical screening exam and maximal exercise test, non-opioid dependent, no concomitant beta blocker, or opioid replacement therapy). RESULTS The majority (59%) of study participants (N = 302, mean age all participants = 39 years) did not report any history of other medical problems. Those with two or more conditions were older (mean age 46 years), reported more pain and worse physical functioning, and more psychiatric disorders (average 1.44). Hypertension was more common among participants with cocaine use disorders only (present in 16%) and liver disease was more common in those with cocaine plus other stimulant use disorders (present in 7%). CONCLUSION AND SCIENTIFIC SIGNIFICANCE In this sample, patients with SUD were in surprisingly good health. A subpopulation had an overall higher burden of illness with worsened physical and psychiatric functioning. Provision of coordinated care may optimize treatment outcomes for patients based on medical comorbidity burden as well as type of drug abused, although these conclusions should be considered preliminary as they are based on self-reported data.
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Affiliation(s)
- Adriane M Dela Cruz
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Thomas Carmody
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Tracy L Greer
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Chad D Rethorst
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Diane Warden
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Robrina Walker
- 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
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Northrup TF, Green C, Walker R, Greer TL, Trivedi MH. On the invariance of the Stimulant Craving Questionnaire (STCQ) across cocaine and methamphetamine users. Addict Behav 2015; 42:144-7. [PMID: 25462663 DOI: 10.1016/j.addbeh.2014.11.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 10/01/2014] [Accepted: 11/19/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND The rapid rise in the number of methamphetamine users, relative to cocaine users, has brought the number of each to nearly equal levels, making research on similarities and differences across these groups a needed area of exploration. Craving is postulated to play a significant role in relapse for both user types, yet group differences on observed scale scores have been reported without first assessing the prerequisite measurement equivalence (invariance) of the items, which is essential for meaningful group comparisons. METHODS/DESIGN Baseline data from stimulant users in residential treatment (N=301; n=177 cocaine; n=124 methamphetamine) were used to assess the measurement invariance of the 10-item Stimulant Craving Questionnaire (STCQ), which was adapted from a cocaine-specific measure. RESULTS The unifactorial STCQ demonstrated measurement invariance across cocaine and methamphetamine users for factor loadings (metric), common residual covariances between item pairs, and item intercepts (scalar), as determined by fit indices (RMSEA<0.05; CFI & TLI>0.95; SRMR<0.10). The latent mean, as well as 5 (out of 10) item means and the overall composite scale score, was significantly greater for methamphetamine users compared to cocaine users. DISCUSSION Results indicate the STCQ is an invariant tool for the assessment of stimulant craving across the two most prevalent user types. Methamphetamine users had significantly higher levels of observed and latent craving than cocaine users, demonstrating a potentially meaningful difference in craving between users of these two stimulants. Future research will determine if treatments and statistical models need to account for craving variations across methamphetamine and cocaine users.
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Chartier KG, Sanchez K, Killeen TK, Burrow A, Carmody T, Greer TL, Trivedi MH. Men and women from the STRIDE clinical trial: An assessment of stimulant abstinence symptom severity at residential treatment entry. Am J Addict 2015; 24:336-40. [PMID: 25694201 DOI: 10.1111/ajad.12190] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Revised: 11/20/2014] [Accepted: 12/04/2014] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Gender-specific factors associated with stimulant abstinence severity were examined in a stimulant abusing or dependent residential treatment sample (N = 302). METHOD Bivariate statistics tested gender differences in stimulant abstinence symptoms, measured by participant-reported experiences of early withdrawal. Multivariate linear regression examined gender and other predictors of stimulant abstinence symptom severity. RESULTS Women compared to men reported greater stimulant abstinence symptom severity. Anxiety disorders and individual anxiety-related abstinence symptoms accounted for this difference. African American race/ethnicity was predictive of lower stimulant abstinence severity. DISCUSSION AND CONCLUSIONS Women were more sensitive to anxiety-related stimulant withdrawal symptoms. SCIENTIFIC SIGNIFICANCE Clinics that address anxiety-related abstinence symptoms, which more commonly occur in women, may improve treatment outcome.
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Affiliation(s)
- Karen G Chartier
- Virginia Commonwealth University, School of Social Work and Department of Psychiatry, Richmond, Virginia
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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.
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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
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Sanchez K, Chartier KG, Greer TL, Walker R, Carmody T, Rethorst CD, Ring KM, Dela Cruz AM, Trivedi MH. Comorbidities and race/ethnicity among adults with stimulant use disorders in residential treatment. J Ethn Subst Abuse 2015; 14:79-95. [PMID: 25580933 DOI: 10.1080/15332640.2014.961109] [Citation(s) in RCA: 9] [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] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Comorbid physical and mental health problems are associated with poorer substance abuse treatment outcomes; however, little is known about these conditions among stimulant abusers at treatment entry. This study compared racial and ethnic groups on baseline measures of drug use patterns, comorbid physical and mental health disorders, quality of life, and daily functioning among cocaine and stimulant abusing/dependent patients. Baseline data from a multi-site randomized clinical trial of vigorous exercise as a treatment strategy for a diverse population of stimulant abusers (N=290) were analyzed. Significant differences between groups were found on drug use characteristics, stimulant use disorders, and comorbid mental and physical health conditions. Findings highlight the importance of integrating health and mental health services into substance abuse treatment and could help identify potential areas for intervention to improve treatment outcomes for racial and ethnic minority groups.
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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.
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Affiliation(s)
- Katherine Sanchez
- a School of Social Work , The University of Texas at Arlington , Arlington , Texas , USA
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Rethorst CD, Greer TL, Grannemann B, Ring KM, Marcus BH, Trivedi MH. A Health Education Intervention as the Control Condition in the CTN-0037 STRIDE multi-site exercise trial: Rationale and Description. Ment Health Phys Act 2014; 7:37-41. [PMID: 24729793 PMCID: PMC3979565 DOI: 10.1016/j.mhpa.2013.12.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The selection of a control condition in a randomized controlled trial (RCT) is critical in determining the effect of the experimental treatment. While the use of a placebo pill can be an ideal control in pharmaceutical trials, RCTs of behavioral interventions present unique challenges in the selection and implementation of the appropriate control condition. Investigators must not only consider the control condition's ability to protect against threats to internal validity and its plausibility as a possible intervention, but must also carefully implement the control condition so it does not introduce bias from either the investigators or the participants. The purpose of this paper is to provide the rationale for the use of a health education intervention (HEI) as the control condition in the CTN-0037 Stimulant Reduction Intervention Using Dosed Exercise (STRIDE) trial. In this paper, we will describe the careful design of the HEI to ensure proper implementation and discuss alternative control conditions considered.
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Affiliation(s)
- Chad D. Rethorst
- Department of Psychiatry, University of Texas Southwestern Medical Center
| | - Tracy L. Greer
- Department of Psychiatry, University of Texas Southwestern Medical Center
| | - Bruce Grannemann
- Department of Psychiatry, University of Texas Southwestern Medical Center
| | - Kolette M. Ring
- Department of Psychiatry, University of Texas Southwestern Medical Center
| | - Bess H. Marcus
- Department of Family and Preventive Medicine, University of California San Diego
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Walker R, Morris DW, Greer TL, Trivedi MH. Research staff training in a multisite randomized clinical trial: Methods and recommendations from the Stimulant Reduction Intervention using Dosed Exercise (STRIDE) trial. Addict Res Theory 2014; 22:407-415. [PMID: 25379036 PMCID: PMC4217528 DOI: 10.3109/16066359.2013.868446] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Descriptions of and recommendations for meeting the challenges of training research staff for multisite studies are limited despite the recognized importance of training on trial outcomes. The STRIDE (STimulant Reduction Intervention using Dosed Exercise) study is a multisite randomized clinical trial that was conducted at nine addiction treatment programs across the United States within the National Drug Abuse Treatment Clinical Trials Network (CTN) and evaluated the addition of exercise to addiction treatment as usual (TAU), compared to health education added to TAU, for individuals with stimulant abuse or dependence. Research staff administered a variety of measures that required a range of interviewing, technical, and clinical skills. PURPOSE In order to address the absence of information on how research staff are trained for multisite clinical studies, the current manuscript describes the conceptual process of training and certifying research assistants for STRIDE. METHODS Training was conducted using a three-stage process to allow staff sufficient time for distributive learning, practice, and calibration leading up to implementation of this complex study. RESULTS Training was successfully implemented with staff across nine sites. Staff demonstrated evidence of study and procedural knowledge via quizzes and skill demonstration on six measures requiring certification. Overall, while the majority of staff had little to no experience in the six measures, all research assistants demonstrated ability to correctly and reliably administer the measures throughout the study. CONCLUSIONS Practical recommendations are provided for training research staff and are particularly applicable to the challenges encountered with large, multisite trials.
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Affiliation(s)
- Robrina Walker
- Department of Psychiatry, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, Texas, USA 75390-9119
| | - David W Morris
- Department of Psychiatry, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, Texas, USA 75390-9119
| | - Tracy L Greer
- Department of Psychiatry, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, Texas, USA 75390-9119
| | - Madhukar H Trivedi
- Department of Psychiatry, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, Texas, USA 75390-9119
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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.
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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.
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Affiliation(s)
- C D Rethorst
- University of Texas Southwestern Medical Center, Dallas, TX 75390-9119, USA.
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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.
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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
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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.
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Affiliation(s)
- Madhukar H Trivedi
- Department of Psychiatry, University of Texas Southwestern Medical Center at Dallas, 75390-9119, USA.
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Otto MW, Church TS, Craft LL, Greer TL, Smits JAJ, Trivedi MH. Exercise for mood and anxiety disorders. Prim Care Companion J Clin Psychiatry 2011; 9:287-94. [PMID: 17934553 DOI: 10.4088/pcc.v09n0406] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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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.
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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)
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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
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Affiliation(s)
- Madhukar H Trivedi
- The University of Texas Southwestern Medical Center at Dallas, Dallas, Texas 75390-9119, USA.
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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.
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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.
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