What is the role of conventional antidepressants in the treatment of major depressive episodes with Mixed Features Specifier?

CNS Spectrums ◽  
2016 ◽  
Vol 22 (2) ◽  
pp. 120-125 ◽  
Author(s):  
Gianni L. Faedda ◽  
Ciro Marangoni
Keyword(s):  
Clinical Trials ◽  
Unipolar Depression ◽  
Preliminary Evidence ◽  
Major Depressive ◽  
Pharmacological Management ◽  
Diagnostic And Statistical Manual ◽  
Mixed Features ◽  
Effective Use ◽  
Major Depressive Episodes ◽  
Depressive Episodes

The newly introduced Mixed Features Specifier of Major Depressive Episode and Disorder (MDE/MDD) is especially challenging in terms of pharmacological management. Prior to the publication of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, the symptoms of the mixed features specifier were intradepressive hypomanic symptoms, always and only associated with bipolar disorder (BD).Intradepressive hypomanic symptoms, mostly referred to as depressive mixed states (DMX), have been poorly characterized, and their treatment offers significant challenges. To understand the diagnostic context of DMX, we trace the nosological changes and collocation of intradepressive hypomanic symptoms, and examine diagnostic and prognostic implications of such mixed features.One of the reasons so little is known about the treatment of DMX is that depressed patients with rapid cycling, substance abuse disorder, and suicidal ideation/attempts are routinely excluded from clinical trials of antidepressants. The exclusion of DMX patients from clinical trials has prevented an assessment of the safety and tolerability of short- and long-term use of antidepressants. Therefore, the generalization of data obtained in clinical trials for unipolar depression to patients with intradepressive hypomanic features is inappropriate and methodologically flawed.A selective review of the literature shows that antidepressants alone have limited efficacy in DMX, but they have the potential to induce, maintain, or worsen mixed features during depressive episodes in BD. On the other hand, preliminary evidence supports the effective use of some atypical antipsychotics in the treatment of DMX.

Stahl's Essential Psychopharmacology

2021 ◽  
Author(s):  
Stephen M. Stahl
Keyword(s):  
Mental Health Professionals ◽  
Health Professionals ◽  
Visual Language ◽  
New Drugs ◽  
Major Depressive ◽  
Mixed Features ◽  
Color Scheme ◽  
Major Depressive Episodes ◽  
Depressive Episodes ◽  
Source Of Information

Long established as the preeminent source in its field, the eagerly anticipated fifth edition of Dr Stahl's essential textbook of psychopharmacology is here! With its use of icons and figures that form Dr Stahl's unique 'visual language', the book is the single most readable source of information on disease and drug mechanisms for all students and mental health professionals seeking to understand and utilize current therapeutics, and to anticipate the future for novel medications. Every aspect of the book has been updated, with the clarity of explanation that only Dr Stahl can bring. The new edition includes over 500 new or refreshed figures, an intuitive color scheme, fourteen new uses for older drugs and eighteen brand new drugs, coverage of Parkinson's Disease Psychosis, behavioural symptoms of dementia, and mixed features in major depressive episodes, and expanded information on the medical uses of cannabis and hallucinogen assisted psychotherapy.

Sensitivity and specificity of the Italian version of the bipolar spectrum diagnostic scale. Different scores in distinct populations with unipolar depression

2017 ◽  
Vol 41 (S1) ◽  
pp. S333-S333
Author(s):  
D. Piacentino ◽  
P. Girardi ◽  
K.G.D. Md ◽  
L. Sanna ◽  
I. Pacchiarotti ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Unipolar Depression ◽  
Type I ◽  
Bipolar Spectrum ◽  
Italian Version ◽  
Major Depressive ◽  
Specificity And Sensitivity ◽  
Competing Interest ◽  
Major Depressive Episodes ◽  
Depressive Episodes

IntroductionTo date, the proposition of recurrence as a subclinical bipolar disorder feature has not received adequate testing.Objectives/AimsWe used the Italian version of the bipolar spectrum diagnostic scale (BSDS), a self-rated questionnaire of bipolar risk, in a sample of patients with mood disorders to test its specificity and sensitivity in identifying cases and discriminating between high risk for bipolar disorder major depressive patients (HRU) and low risk (LRU) adopting as a high recurrence cut-off five or more lifetime major depressive episodes.MethodsWe included 115 patients with DSM-5 bipolar disorder (69 type I, 41 type II, and 5 NOS) and 58 with major depressive disorder (29 HRU and 29 LRU, based on the recurrence criterion). Patients filled-out the Italian version of the BSDS, which is currently undergoing a validation process.ResultsThe BSDS, adopting a threshold of 14, had 84% sensitivity and 76% specificity. HRU, as predicted, scored on the BSDS intermediate between LRU and bipolar disorder. Clinical characteristics of HRU were more similar to bipolar disorder than to LRU; HRU, like bipolar disorder patients, had more lifetime hospitalizations, higher suicidal ideation and attempt numbers, and higher rates of family history of suicide.ConclusionsThe BSDS showed satisfactory sensitivity and sensitivity. Splitting the unipolar sample into HRU and LRU, on the basis of the at least 5 lifetime major depressive episodes criterion, yielded distinct unipolar subpopulations that differ on outcome measures and BSDS scores.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Comparative efficacy and acceptability of non-surgical brain stimulation for the acute treatment of adult major depressive episodes: A systematic review and network meta-analysis of 113 randomised clinical trials

2018 ◽  
Author(s):  
Julian Mutz ◽  
Vijeinika Vipulananthan ◽  
Ben Carter ◽  
Rene Hurlemann ◽  
Cynthia H Y Fu ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Brain Stimulation ◽  
Acute Treatment ◽  
Meta Analysis ◽  
High Dose ◽  
Major Depressive ◽  
Treatment Protocols ◽  
Severity Scores ◽  
Major Depressive Episodes ◽  
Depressive Episodes

Background: Non-surgical brain stimulation techniques have been applied as tertiary treatments in major depression. However, the relative efficacy and acceptability of individual protocols is uncertain. Our aim was to estimate the comparative clinical efficacy and acceptability of non-surgical brain stimulation for the acute treatment of major depressive episodes in adults. Methods: Embase, PubMed/MEDLINE and PsycINFO were searched up until May 8, 2018, supplemented by manual searches of bibliographies of recent reviews and included trials. We included clinical trials with random allocation to electroconvulsive therapy (ECT), repetitive transcranial magnetic stimulation (rTMS), accelerated TMS (aTMS), priming TMS (pTMS), deep TMS (dTMS), theta burst stimulation (TBS), synchronised TMS (sTMS), magnetic seizure therapy (MST) or transcranial direct current stimulation (tDCS) protocols or sham. Data were extracted from published reports and outcomes were synthesised using pairwise and network random-effects meta-analysis. Primary outcomes were response (efficacy) and all-cause discontinuation (acceptability). We computed odds ratios (OR) with 95% confidence intervals (CI). Remission and continuous post-treatment depression severity scores were also examined. Results: 113 trials (262 treatment arms) randomising 6,750 patients (mean age = 47.9 years; 59% female) with major depressive disorder or bipolar depression met our inclusion criteria. In terms of efficacy, 10 out of 18 treatment protocols were associated with higher response relative to sham in network meta-analysis: bitemporal ECT (OR=8.91, 95%CI 2.57-30.91), high-dose right-unilateral ECT (OR=7.27, 1.90-27.78), pTMS (OR=6.02, 2.21-16.38), MST (OR=5.55, 1.06-28.99), bilateral rTMS (OR=4.92, 2.93-8.25), bilateral TBS (OR=4.44, 1.47-13.41), low-frequency right rTMS (OR=3.65, 2.13-6.24), intermittent TBS (OR=3.20, 1.45-7.08), high-frequency left rTMS (OR=3.17, 2.29-4.37) and tDCS (OR=2.65, 1.55-4.55). Comparing active treatments, bitemporal ECT and high-dose right-unilateral ECT were associated with increased response. All treatment protocols were at least as acceptable as sham treatment. Conclusion: We found that non-surgical brain stimulation techniques constitute viable alternative or add-on treatments for adult patients with major depressive episodes. Our findings also highlight the need to consider other patient and treatment-related factors in addition to antidepressant efficacy and acceptability when making clinical decisions; and emphasize important research priorities in the field of brain stimulation.

scholarly journals Reduced visual contrast suppression during major depressive episodes

2021 ◽  
Vol 46 (2) ◽  
Author(s):  
Viljami Salmela ◽  
Lumikukka Socada ◽  
John Söderholm ◽  
Roope Heikkilä ◽  
Jari Lahti ◽  
...  
Keyword(s):  
Bayes Factor ◽  
Unipolar Depression ◽  
Cortical Processing ◽  
Major Depressive ◽  
Visual Contrast ◽  
Contrast Information ◽  
Behavioural Tests ◽  
Contrast Perception ◽  
Major Depressive Episodes ◽  
Depressive Episodes

Background: Previous studies have suggested that processing of visual contrast information could be altered in major depressive disorder. To clarify the changes at different levels of the visual hierarchy, we behaviourally measured contrast perception in 2 centre-surround conditions, assessing retinal and cortical processing. Methods: As part of a prospective cohort study, our sample consisted of controls (n = 29; 21 female) and patients with unipolar depression, bipolar disorder and borderline personality disorder who had baseline major depressive episodes (n = 111; 74 female). In a brightness induction test that assessed retinal processing, participants compared the perceived luminance of uniform patches (presented on a computer screen) as the luminance of the backgrounds was varied. In a contrast suppression test that assessed cortical processing, participants compared the perceived contrast of gratings, which were presented with collinearly or orthogonally oriented backgrounds. Results: Brightness induction was similar for patients with major depressive episodes and controls (p = 0.60, d = 0.115, Bayes factor = 3.9), but contrast suppression was significantly lower for patients than for controls (p < 0.006, d = 0.663, Bayes factor = 35.2). We observed no statistically significant associations between contrast suppression and age, sex, or medication or diagnostic subgroup. At follow-up (n = 74), we observed some normalization of contrast perception. Limitations: We assessed contrast perception using behavioural tests instead of electrophysiology. Conclusion: The reduced contrast suppression we observed may have been caused by decreased retinal feedforward or cortical feedback signals. Because we observed intact brightness induction, our results suggest normal retinal but altered cortical processing of visual contrast during a major depressive episode. This alteration is likely to be present in multiple types of depression and to partially normalize upon remission.

The treatment of bipolar mixed states

2017 ◽  
Author(s):  
Sarah Kittel-Schneider
Keyword(s):  
Mixed States ◽  
Major Depressive ◽  
Randomized Controlled Clinical Trials ◽  
Diagnostic And Statistical Manual ◽  
Dsm 5 ◽  
Bipolar Ii ◽  
Definition Of ◽  
Bipolar Patients ◽  
Major Depressive Episodes ◽  
Depressive Episodes

Definition of mixed episodes has changed in the Diagnostic and Statistical Manual of Mental Disorders (5th edition) (DSM-5). A mixed feature specifier can be added not only to major depressive episodes and manic episodes in bipolar patients but also to hypomanic episodes in bipolar II patients and major depressive episode in major depressive disorder. Atypical antipsychotics seem to be effective in acute treatment as well as valproate and carbamazepine. Regarding prophylaxis of mixed states, monotherapy with valproate, olanzapine and quetiapine seems to prevent mixed episodes. Adjunctive therapy with valproate or lithium to quetiapine has also proven to be effective in prophylaxis of mixed episodes. In patients who suffer from pharmacotherapy-resistant mixed episodes electroconvulsive therapy can lead to response/remission. There is a lack of randomized controlled clinical trials investigating pharmacological and non-pharmacological treatments with focus on mixed states of bipolar patients, especially according to the DSM-5 definition.

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