Has the symptom severity inclusion requirement narrowed the definition of major depressive disorder in antidepressant efficacy trials?

Objectives: Major depressive disorder (MDD) is associated with impairments in both cognition and functioning. However, whether cognitive deficits significantly contribute to impaired psychosocial and occupational functioning, independent of other depressive symptoms, is not well established. We examined the relationship between cognitive performance and functioning in depressed patients before and after antidepressant treatment using secondary data from the first Canadian Biomarker Integration Network in Depression-1 study. Methods: Cognition was assessed at baseline in unmedicated, depressed participants with MDD ( n = 207) using the Central Nervous System Vital Signs computerized battery, psychosocial functioning with the Sheehan Disability Scale (SDS), and occupational functioning with the Lam Employment Absence and Productivity Scale (LEAPS). Cognition ( n = 181), SDS ( n = 175), and LEAPS ( n = 118) were reassessed after participants received 8 weeks of open-label escitalopram monotherapy. A series of linear regressions were conducted to determine (1) whether cognitive functioning was associated with psychosocial and occupational functioning prior to treatment, after adjusting for overall depressive symptom severity and (2) whether changes in cognitive functioning after an 8-week treatment phase were associated with changes in psychosocial and occupational functioning, after adjusting for changes in overall symptom severity. Results: Baseline global cognitive functioning, after adjusting for depression symptom severity and demographic variables, was associated with the SDS work/study subscale (β = −0.17; P = 0.03) and LEAPS productivity subscale (β = −0.17; P = 0.05), but not SDS total (β = 0.19; P = 0.12) or LEAPS total (β = 0.41; P = 0.17) scores. Although LEAPS and SDS scores showed significant improvements after 8 weeks of treatment ( P < 0.001), there were no significant associations between changes in cognitive domain scores and functional improvements. Conclusion: Cognition was associated with occupational functioning at baseline, but changes in cognition were not associated with psychosocial or occupational functional improvements following escitalopram treatment. We recommend the use of more comprehensive functional assessments to determine the impact of cognitive change on functional outcomes in future research.

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High-frequency cognitive and mood assessment in major depressive disorder with wearable technology (Preprint)

10.2196/preprints.12814 ◽

2018 ◽

Author(s):

Francesca Cormack ◽

Maggie McCue ◽

Nick Taptiklis ◽

Caroline Skirrow ◽

Emilie Glazer ◽

...

Keyword(s):

Major Depressive Disorder ◽

Cognitive Function ◽

Depressive Disorder ◽

Symptom Severity ◽

High Frequency ◽

Depression Symptom ◽

Cognitive Assessments ◽

Major Depressive ◽

Good Correspondence ◽

Adequate Treatment

BACKGROUND Cognitive symptoms are common in major depressive disorder, and may help to identify patients that need treatment or who are not experiencing adequate treatment response. Digital tools to provide real time data assessing cognitive function could help to support patients treatment and remediation of cognitive and mood symptoms. OBJECTIVE This study examined adherence, feasibility, and validity of a wearable high-frequency cognitive and mood assessment app over 6 weeks, corresponding to when antidepressant pharmacotherapy begins to show efficacy. METHODS Thirty patients (aged 19−63; 19 women) with mild-moderate depression participated. The new Cognition Kit application was delivered via the Apple Watch, providing a high-resolution touch screen display for task presentation and logging responses. Cognition was assessed by the n-back task up to 3 times daily and depressed mood by 3 short questions once daily. Selected tests sensitive to depression from the Cambridge Neuropsychological Test Automated Battery and validated questionnaires of depression symptom severity were administered on 4 occasions (baseline, weeks 1, 3, and 6). Adherence was defined as participants completing at least one assessment daily. RESULTS Adherence was excellent for mood and cognitive assessments (95% and 96%, respectively), did not deteriorate over time, and was not influenced by depression symptom severity or cognitive function at study onset. Daily mood assessments showed good correspondence with validated depression questionnaires (correlations range from .45 to .69 for total daily mood score) and daily cognitive assessments showed good correspondence with cognitive tests sensitive to depression (correlations ranged from .37 to .50 for mean n-back). CONCLUSIONS The study supports the feasibility and validity of high-frequency assessment of cognitive function and mood function using wearable devices over an extended period in patients with major depressive disorder. CLINICALTRIAL clinicaltrials.gov NCT03067506

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THE PATTERN OF IRRATIONAL BELIEFS ASSOCIATED WITH MAJOR DEPRESSIVE DISORDER

Social Behavior and Personality An International Journal ◽

10.2224/sbp.1992.20.3.199 ◽

1992 ◽

Vol 20 (3) ◽

pp. 199-212 ◽

Cited By ~ 6

Author(s):

Lyne Prud'homme ◽

Pierre Barron

Keyword(s):

Major Depressive Disorder ◽

Discriminant Analysis ◽

Depressive Disorder ◽

Symptom Severity ◽

Irrational Beliefs ◽

Irrational Belief ◽

Normal Control Group ◽

Control Group ◽

Major Depressive ◽

Normal Controls

In light of Rational-Emotive Theory, this study was undertaken to determine the pattern of irrational beliefs underlying Major Depressive Disorder (MDD). A total of 126 subjects (50 males, 76 females) volunteered to participate. Patients clinically diagnosed with MDD (unipolar type) and a control group of non-depressed patients were solicited from the inpatient and outpatient facilities of several Ottawa and Montreal hospitals; the normal control group comprised students and civil servants. The subjects completed questionnaires to measure irrational belief endorsement (IBT, RBI) and symptom severity (STAI, BDI) and to verify the depression diganosis (IDD). Multivariate statistics were used to determine the pattern of beliefs which best discriminates between the MDD group, the psychiatric control group, and the normal controls. Discriminant analysis of the IBT revealed a pattern of four irrational beliefs generally known as demand for approval, frustration reactivity, anxious overconcern, and helplessness over past. The implications of such findings for RET theory are discussed.

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Antidepressant efficacy of olanzapine as monotherapy in major depressive disorder, without psychosis: A pilot study

Psychiatry Research Neuroimaging ◽

10.1016/j.pscychresns.2005.08.003 ◽

2006 ◽

Vol 146 (2) ◽

pp. 149-155 ◽

Cited By ~ 10

Author(s):

Jose Mathews ◽

Keith S. Garcia ◽

Mark A. Mintun ◽

Yvette I. Sheline

Keyword(s):

Major Depressive Disorder ◽

Pilot Study ◽

Depressive Disorder ◽

Major Depressive ◽

Antidepressant Efficacy

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A simpler definition of major depressive disorder

Psychological Medicine ◽

10.1017/s0033291709990572 ◽

2009 ◽

Vol 40 (3) ◽

pp. 451-457 ◽

Cited By ~ 26

Author(s):

M. Zimmerman ◽

J. N. Galione ◽

I. Chelminski ◽

J. B. McGlinchey ◽

D. Young ◽

...

Keyword(s):

Major Depressive Disorder ◽

Depressive Disorder ◽

Somatic Symptoms ◽

Structured Interview ◽

Major Depressive ◽

Medically Ill ◽

Treatment Providers ◽

Dsm Iv ◽

Definition Of ◽

High Level

BackgroundThe DSM-IV symptom criteria for major depressive disorder (MDD) are somewhat lengthy, with many studies showing that treatment providers have difficulty recalling all nine symptoms. Moreover, the criteria include somatic symptoms that are difficult to apply in patients with medical illnesses. In a previous report, we developed a briefer definition of MDD that was composed of the mood and cognitive symptoms of the DSM-IV criteria, and found high levels of agreement between the simplified and full DSM-IV definitions. The goal of the present study was to replicate these findings in another large sample of psychiatric out-patients and to extend the findings to other patient samples.MethodWe interviewed 1100 psychiatric out-patients and 210 pathological gamblers presenting for treatment and 1200 candidates for bariatric surgery. All patients were interviewed by a diagnostic rater who administered a semi-structured interview. We inquired about all symptoms of depression for all patients.ResultsIn all three samples high levels of agreement were found between the DSM-IV and the simpler definition of MDD. Summing across all 2510 patients, the level of agreement between the two definitions was 95.5% and the κ coefficient was 0.87.ConclusionsAfter eliminating the four somatic criteria from the DSM-IV definition of MDD, a high level of concordance was found between this simpler definition and the original DSM-IV classification. This new definition offers two advantages over the current DSM-IV definition – it is briefer and it is easier to apply with medically ill patients because it is free of somatic symptoms.

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