A practical approach to the early identification of antidepressant medication non-responders

2011 ◽  
Vol 42 (2) ◽  
pp. 309-316 ◽  
Author(s):  
J. Li ◽  
A. Y. C. Kuk ◽  
A. J. Rush
Keyword(s):  
Clinical Features ◽  
Depressive Symptomatology ◽  
Antidepressant Medication ◽  
Self Report ◽  
Symptom Change ◽  
Clinical Value ◽  
Treatment Of Depression ◽  
Outcomes Study ◽  
Symptom Changes ◽  
Time Point

BackgroundThe aim of the present study was to determine whether a combination of baseline features and early post-baseline depressive symptom changes have clinical value in predicting out-patient non-response in depressed out-patients after 8 weeks of medication treatment.MethodWe analysed data from the Combining Medications to Enhance Depression Outcomes study for 447 participants with complete 16-item Quick Inventory of Depressive Symptomatology – Self-Report (QIDS-SR16) ratings at baseline and at treatment weeks 2, 4 and 8. We used a multi-time point, recursive subsetting approach that included baseline features and changes in QIDS-SR16 scores from baseline to weeks 2 and 4, to identify non-responders (<50% reduction in QIDS-SR16) at week 8 with a pre-specified accuracy level.ResultsPretreatment clinical features alone were not clinically useful predictors of non-response after 8 weeks of treatment. Baseline to week 2 symptom change identified 48 non-responders (of which 36 were true non-responders). This approach gave a clinically meaningful negative predictive value of 0.75. Symptom change from baseline to week 4 identified 79 non-responders (of which 60 were true non-responders), achieving the same accuracy. Symptom change at both weeks 2 and 4 identified 87 participants (almost 20% of the sample) as non-responders with the same accuracy. More participants with chronic than non-chronic index episodes could be accurately identified by week 4.ConclusionsSpecific baseline clinical features combined with symptom changes by weeks 2–4 can provide clinically actionable results, enhancing the efficiency of care by personalizing the treatment of depression.

scholarly journals PAX-D: study protocol for a randomised placebo-controlled trial evaluating the efficacy and mechanism of pramipexole as add-on treatment for people with treatment resistant depression

2021 ◽  
pp. ebmental-2021-300282
Author(s):  
Sheena Kristine Au-Yeung ◽  
James Griffiths ◽  
Sophie Roberts ◽  
Chloe Edwards ◽  
Ly-Mee Yu ◽  
...  
Keyword(s):  
Decision Making ◽  
Depressive Symptomatology ◽  
Bipolar Depression ◽  
Antidepressant Medication ◽  
Well Being ◽  
Reward Processing ◽  
Self Report ◽  
Treatment Resistant Depression ◽  
Treatment Resistant ◽  
Resistant Depression

IntroductionClinical depression is usually treated in primary care with psychological therapies and antidepressant medication. However, when patients do not respond to at least two or more antidepressants within a depressive episode, they are considered to have treatment resistant depression (TRD). Previous small randomised controlled trials suggested that pramipexole, a dopamine D2/3 receptor agonist, may be effective for treating patients with unipolar and bipolar depression as it is known to influence motivational drive and reward processing. PAX-D will compare the effects of pramipexole vs placebo when added to current antidepressant medication for people with TRD. Additionally, PAX-D will investigate the mechanistic effect of pramipexole on reward sensitivity using a probabilistic decision-making task.Methods and analysisPAX-D will assess effectiveness in the short- term (during the first 12 weeks) and in the longer-term (48 weeks) in patients with TRD from the UK. The primary outcome will be change in self-reported depressive symptoms from baseline to week 12 post-randomisation measured using the Quick Inventory of Depressive Symptomatology Self-Report (QIDS-SR16). Performance on the decision-making task will be measured at week 0, week 2 and week 12. Secondary outcomes include anhedonia, anxiety and health economic measures including quality of life, capability, well-being and costs. PAX-D will also assess the adverse effects of pramipexole including impulse control difficulties.DiscussionPramipexole is a promising augmentation agent for TRD and may be a useful addition to existing treatment regimes. PAX-D will assess its effectiveness and test for a potential mechanism of action in patients with TRD.Trial registration numberISRCTN84666271

Characterization of depressed bipolar patients with current suicidal ideation

2020 ◽  
pp. 000486742096374
Author(s):  
Bénédicte Nobile ◽  
Jonathan Dubois ◽  
Bruno Aouizerate ◽  
Valerie Aubin ◽  
Joséphine Loftus ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Suicidal Ideation ◽  
Clinical Features ◽  
Rating Scale ◽  
Depressive Symptomatology ◽  
Self Report ◽  
Depressed Patients ◽  
Scale Total Score ◽  
Suicidal Patients

Objective: Bipolar disorder is one of the most frequent psychiatric disorders among suicidal patients. A large part of patients with bipolar disorder (30–50%) will attempt suicide. Suicidal ideation being a major risk factor of suicidal act, it is crucial to better characterize patients with suicidal bipolar depression (i.e. depression with current suicidal ideation). The aim of this study was to characterize suicidal bipolar depressed patients in comparison with non-suicidal depressed patients in terms of clinical characteristics, evolution of depression and suicidal ideation course over time, and risk of suicide attempt during follow-up. Methods: Among patients with bipolar disorder recruited from the network of FondaMental expert centres for bipolar disorder between 2009 and 2017, we selected patients with at least mild depression (Montgomery–Åsberg Depression Rating Scale total score >11) and without current manic symptomatology (Young Mania Rating Scale total score <7) at baseline ( N = 938). Suicidal depression was defined by a baseline score ⩾2 for item 12 of the Quick Inventory of Depressive Symptomatology–Self Report ( N = 271, 28.9%). Non-suicidal depression was defined by a baseline item 12 of the Quick Inventory of Depressive Symptomatology–Self Report score <2 ( N = 667, 71.1%). A subsample of about 300 patients (with or without suicidal ideation at baseline) was followed up for 2 years. Results: Baseline clinical features (e.g. depression severity, childhood trauma, global functioning) were more severe in patients with than without suicidal depression. Suicidal patients tended to remain more suicidal throughout the follow-up than patients without suicidal ideation at baseline (3.4-fold higher risk of persistent suicidal ideation at the 2-year visit despite an improvement in depressive symptomatology). Conclusions: Depressed bipolar disorder patients reporting suicidal ideation had more severe clinical features at baseline and were more prone to report persistent suicidal ideation during the follow-up, independently of thymic state. Clinicians should closely monitor this subgroup of patients.

Ketamine Treatment in Depression: A Systematic Review of Clinical Characteristics Predicting Symptom Improvement

2020 ◽  
Vol 20 (15) ◽  
pp. 1398-1414 ◽  
Author(s):  
Darby J.E. Lowe ◽  
Daniel J. Müller ◽  
Tony P. George
Keyword(s):  
Clinical Features ◽  
Clinical Characteristics ◽  
Bipolar Depression ◽  
Antidepressant Effect ◽  
Future Research ◽  
Symptom Improvement ◽  
Randomized Controlled ◽  
Treatment Of Depression ◽  
Future Direction

Ketamine has been shown to be efficacious for the treatment of depression, specifically among individuals who do not respond to first-line treatments. There is still, however, a lack of clarity surrounding the clinical features and response periods across samples that respond to ketamine. This paper systematically reviews published randomized controlled trials that investigate ketamine as an antidepressant intervention in both unipolar and bipolar depression to determine the specific clinical features of the samples across different efficacy periods. Moreover, similarities and differences in clinical characteristics associated with acute versus longer-term drug response are discussed. Similarities across all samples suggest that the population that responds to ketamine’s antidepressant effect has experienced chronic, long-term depression, approaching ketamine treatment as a “last resort”. Moreover, differences between these groups suggest future research to investigate the potential of stronger efficacy towards depression in the context of bipolar disorder compared to major depression, and in participants who undergo antidepressant washout before ketamine administration. From these findings, suggestions for the future direction of ketamine research for depression are formed.

scholarly journals ReCAP: Would Women With Breast Cancer Prefer to Receive an Antidepressant for Anxiety or Depression From Their Oncologist?

2016 ◽  
Vol 12 (2) ◽  
pp. 172-174 ◽  
Author(s):  
Daniel C. McFarland ◽  
Megan Johnson Shen ◽  
Kirk Harris ◽  
John Mandeli ◽  
Amy Tiersten ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Mental Health ◽  
Health Professional ◽  
Mental Health Professional ◽  
Antidepressant Medication ◽  
Self Report ◽  
Mental Health Provider ◽  
Anxiety And Depression ◽  
Pharmacologic Treatment ◽  
Mental Health Referral

QUESTIONS ASKED: Preferences of patients with breast cancer for provider-specific pharmacologic management of anxiety and depression are unknown. Use of patient-guided treatment preferences for the treatment of depression and anxiety are known to improve adherence and treatment outcomes in primary care settings, but these preferences are not known in women with breast cancer. This may be especially true shortly after the patient receives a diagnosis of cancer and is most psychologically symptomatic, yet committed to following through with her oncologic care. Do breast cancer patients have preferences regarding having their anxiety and depression assessed and treated by their oncologists versus being cared for by a psychiatrist or mental health provider? SUMMARY ANSWER: The majority of patients accepted antidepressant prescribing by their oncologist; only a minority preferred treatment by a mental health professional. These findings are consistent with previous data from medically ill patients that demonstrated a preference for medical providers to address and treat their depression or anxiety. Twenty percent of participants would not want any treatment. Patients who met depression criteria were less likely to prefer a mental health referral. Patients who were already taking an antidepressant or demonstrated higher levels of chronic stress were more likely to prefer a mental health referral. METHODS: Patients with breast cancer (stages 0-IV) were asked two questions: (1) “Would you be willing to have your oncologist treat your depression or anxiety with an antidepressant medication if you were to become depressed or anxious at any point during your treatment?” and (2) “Would you prefer to be treated by a psychiatrist or mental health professional for problems with either anxiety or depression?” In addition, the Distress Thermometer and Problem List, Hospital Anxiety and Depression Scale, Risky Families Questionnaire, and demographic information were assessed. BIAS, CONFOUNDING FACTORS, DRAWBACKS: This was a survey of only women who were asked to self-report hypothetical preferences. Although minimal differences were noted for the 16.8% of participants who were already taking an antidepressant medication, it is not clear how they might have interpreted the questions in a more realistic setting. REAL-LIFE IMPLICATIONS: These findings suggest a benefit for promoting education of oncologists to assess psychological symptoms and manage anxiety and depression as a routine part of an outpatient visit. It highlights a fertile opportunity for oncologists to integrate mental health treatment for their patients by beginning pharmacologic treatment, discussing their anxiety or depressive symptoms, and initiating or comanaging pharmacologic treatment of anxiety or depression. Early recognition and management of distress, anxiety, and depression would limit the delay in obtaining appropriate treatment, especially during the first year after a cancer diagnosis when patients are most symptomatic and have many difficult treatment decisions to make. The oncologist’s use of antidepressant medications to treat anxiety and depression may benefit patients most by following guidelines. A collaborative care model offers one potential solution that could establish ownership, expand resources, disseminate knowledge, and provide a system of integration for mental health and oncology providers. [Table: see text]

Psychogenic Seizures and Loss

1983 ◽  
Vol 12 (2) ◽  
pp. 121-128 ◽  
Author(s):  
David L. Gardner ◽  
Richard L. Goldberg
Keyword(s):  
Literature Review ◽  
Crisis Intervention ◽  
Depressive Symptomatology ◽  
Case Reports ◽  
Symptom Relief ◽  
Antidepressant Medication ◽  
Treatment Approaches ◽  
Psychogenic Seizures

A review of the diagnostic and treatment approaches to psychogenic seizures has been offered. Two case reports of psychogenic seizures precipitated by loss and associated with depressive symptomatology have been presented. A literature review of cases seems to substantiate the frequency for the association between the development of psychogenic seizures and loss/depressive symptomatology. Symptom relief can be achieved with the utilization of a crisis intervention style psychotherapy. Antidepressant medication may also have a useful role in the treatment of some psychogenic seizures.

scholarly journals Mood and Global Symptom Changes among Psychotherapy Clients with Depressive Personality

2012 ◽  
Vol 2012 ◽  
pp. 1-12
Author(s):  
Rachel E. Maddux ◽  
Lars-Gunnar Lundh
Keyword(s):  
Repeated Measures ◽  
Mixed Model ◽  
Psychological Symptoms ◽  
Self Report ◽  
Treatment Results ◽  
Repeated Measures Analysis ◽  
Depressive Personality ◽  
Symptom Changes ◽  
Psychotherapy Clients ◽  
Over Time

The present study assessed the rate of depressive personality (DP), as measured by the self-report instrument depressive personality disorder inventory (DPDI), among 159 clients entering psychotherapy at an outpatient university clinic. The presenting clinical profile was evaluated for those with and without DP, including levels of depressed mood, other psychological symptoms, and global severity of psychopathology. Clients were followed naturalistically over the course of therapy, up to 40 weeks, and reassessed on these variables again after treatment. Results indicated that 44 percent of the sample qualified for DP prior to treatment, and these individuals had a comparatively more severe and complex presenting disposition than those without DP. Mixed-model repeated-measures analysis of variance was used to examine between-groups changes on mood and global severity over time, with those with DP demonstrating larger reductions on both outcome variables, although still showing more symptoms after treatment, than those without DP. Only eleven percent of the sample continued to endorse DP following treatment. These findings suggest that in routine clinical situations, psychotherapy may benefit individuals with DP.

Intropunitiveness and Parasuicide: Prediction of Interview Response

1988 ◽  
Vol 153 (6) ◽  
pp. 801-804 ◽  
Author(s):  
J. Goldberg ◽  
I. Sakinofsky
Keyword(s):  
Cognitive Interview ◽  
Theoretical Models ◽  
Cognitive Intervention ◽  
Self Report ◽  
Symptom Change ◽  
Depressive State ◽  
Change Measure ◽  
State Changes ◽  
Interview Group ◽  
Depressive States

A recently proposed relationship between intropunitiveness and depressive states was examined in interview intervention with parasuicidal in-patients. To test the prediction that highly intropunitive parasuicidal individuals would be most responsive to cognitive intervention, a sample of 48 parasuicidal in-patients were administered a battery of individual difference measures, including the Hostility Questionnaire. Subjects were randomly assigned to one of three interview procedures, namely a cognitive interview, an affective interview or a waiting period (control). Highly intropunitive individuals in the cognitive interview group showed the most improvements on a self-report depressive symptom change measure. In addition to supporting theoretical models of depressive state changes, the study has important clinical implications because of the need to identify parasuicidal individuals who are most likely to benefit from brief interventions.

Parents' and Teachers' Sensitivity to Unhappiness Reported by Undercontrolled Children

1989 ◽  
Vol 14 (3) ◽  
pp. 166-174 ◽  
Author(s):  
Betty C. Epanchin ◽  
Mary Sue Rennells
Keyword(s):  
Depressive Symptoms ◽  
Behavior Problems ◽  
Child Behavior ◽  
Child Behavior Checklist ◽  
Depressive Symptomatology ◽  
Self Report ◽  
Teacher Report ◽  
Behavioral Ratings ◽  
Self Reports ◽  
Teacher Report Form

The primary purpose of this study was to investigate parents' and teachers' sensitivity to the unhappiness and depression of 110 elementary-aged undercontrolled children being treated in an inpatient program. Sensitivity was operationally defined as congruence between the child's responses on two self-report measures (Children's Depression Inventory and Hopelessness Scale for Children) and the adults' behavioral ratings of the children on behavior checklists (Child Behavior Checklist and Teacher Report Form). The first hypothesis that children's self-reports of depressive symptoms would not be significantly correlated with parents' and teachers' ratings of depressive symptomatology was supported. Secondly, it was hypothesized that there would be no differences in the level of self-reported depressive symptoms when children who were rated as depressed by their parents and teachers were compared with children rated as not depressed by their parents and teachers. This was also supported. Finally, it was hypothesized that children who reported significant levels of depressive symptomatology would be rated by their parents and teachers as having more behavior problems than children who did not report significant levels of depressed symptomatology. This was partially supported. The implications of these results in relation to identification and treatment are discussed.

Depression impact on the sexual desire

2011 ◽  
Vol 26 (S2) ◽  
pp. 1549-1549
Author(s):  
M. Lourenço ◽  
L.P. Azevedo ◽  
J.L. Gouveia
Keyword(s):  
Sexual Desire ◽  
Depressive Symptomatology ◽  
Psychiatric Patients ◽  
Severe Depression ◽  
List Type ◽  
Sexual Performance ◽  
Average Value ◽  
Treatment Of Depression ◽  
The One ◽  
The Relationship

IntroductionDepression as a pathology and the side effects of pharmacology therapy have been pointed proven to be as responsible for the lack of sexual desire. Among the drugs used in the treatment of depression, anti-depressives are the ones mostly connected to sexual dysfunction.Aims /objectivesTo study the relationship between depression and its impact on the sexual desire in psychiatric patients.MethodsThe chosen sample is composed of 89 subjects, 73 females and 16 males, with ages ranging from 21 to 70 years, who present with depressive symptomatology (mild to moderate symptomatology (MMS) and severe symptomatology (SS).To each patient 3 instruments were applied: 1)Questionnaire used to collect demographic and clinical data from the sample;2)Instrument of estimation of the depression degree (BDI - Beck Depression Inventory);3)Instrument of valuation of the sexual desire (SDS - Sexual Desire Scale).ResultsDepression average value obtained with BDI was 25.58 (SD = 11.86). The majority was satisfied with their marital relationship (72.7% and 52.9%, respectively), and the group with most sexual damaged (actual sexual performance regarding sexual desire) being the one with severe depression (54.5% versus 82.4%, respectively). Regarding total SDS value, the group with MMD present with higher levels of sexual desire (M = 54.93; DP = 14.56) than the group with SD (M = 41.82; DP = 11.86).ConclusionsThis study presents an exploratory character and the obtained results revealed that depressive symptomatology severity is directly related with sexual desire, by saying the higher the depression's severity is the lower sexual desire will be.

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