Mixed-up about how to diagnose and treat mixed features in major depressive episodes

The classical point of view—that major depressive episodes (MDEs), no matter what additional symptoms are present, should be treated first line with antidepressants—is now giving way to new a notion. The idea is that MDEs mixed with a few symptoms of mania/hypomania should be viewed very differently in terms of their natural history, clinical outcome, and treatment, and perhaps certain antipsychotics should be given as first-line treatment rather than antidepressant monotherapy.

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Diagnosing and Treating Major Depressive Episodes that Lie Along the Mood Disorders Spectrum: Focus on Depression with Mixed Features

CNS Spectrums ◽

10.1017/s1092852921000262 ◽

2021 ◽

pp. 1-25

Author(s):

Susan L. McElroy ◽

Anna I. Guerdjikova ◽

Francisco Romo-Nava

Keyword(s):

Mood Disorders ◽

Major Depressive ◽

Mixed Features ◽

Major Depressive Episodes ◽

Depressive Episodes

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

CNS Spectrums ◽

10.1017/s1092852916000493 ◽

2016 ◽

Vol 22 (2) ◽

pp. 120-125 ◽

Cited By ~ 7

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.

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Stahl's Essential Psychopharmacology

10.1017/9781108975292 ◽

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.

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A cost-effectiveness model of escitalopram, citalopram,and venlafaxine as first-line treatment for major depressive disorder in Belgium

Clinical Therapeutics ◽

10.1016/j.clinthera.2005.01.001 ◽

2005 ◽

Vol 27 (1) ◽

pp. 111-124 ◽

Cited By ~ 30

Author(s):

Koen Demyttenaere ◽

Michiel E.H. Hemels ◽

Joumana Hudry ◽

Lieven Annemans

Keyword(s):

Major Depressive Disorder ◽

Cost Effectiveness ◽

Depressive Disorder ◽

Line Treatment ◽

First Line ◽

Major Depressive ◽

Effectiveness Model ◽

First Line Treatment

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Leishmanicidal Activity of Withanolides from Aureliana Fasciculata var. Fasciculata

Molecules ◽

10.3390/molecules23123160 ◽

2018 ◽

Vol 23 (12) ◽

pp. 3160 ◽

Cited By ~ 1

Author(s):

Simone Lima ◽

Juliana Pacheco ◽

André Marques ◽

Eduardo Veltri ◽

Rita Almeida-Lafetá ◽

...

Keyword(s):

Point Of View ◽

Neglected Diseases ◽

Line Treatment ◽

Oral Drugs ◽

First Line ◽

Reference Drug ◽

Important Form ◽

Genus Leishmania ◽

Intracellular Amastigote ◽

First Line Treatment

Leishmaniasis is the generic denomination to the neglected diseases caused by more than 20 species of protozoa belonging to the genus Leishmania. The toxic and parenteral-delivered pentavalent antimonials remain to be the first-line treatment. However, all the current used drugs have restrictions. The species Aureliana fasciculata (Vell.) Sendtner var. fasciculata is a native Brazilian species parsimoniously studied on a chemical point of view. In this study, the antileishmanial activity of A. fasciculata was evaluated. Among the evaluated samples of the leaves, the dichloromethane partition (AFfDi) showed the more pronounced activity, with IC50 1.85 µg/ml against promastigotes of L. amazonensis. From AFfDi, two active withanolides were isolated, the Aurelianolides A and B, with IC50 7.61 μM and 7.94 μM, respectively. The withanolides also proved to be active against the clinically important form, the intracellular amastigote, with IC50 2.25 μM and 6.43 μM for Aurelianolides A and B, respectively. Furthermore, withanolides showed results for in silico parameters of absorption, distribution, metabolism, excretion, and toxicity (ADMET) similar to miltefosine, the reference drug, and were predicted as good oral drugs, with the advantage of not being hepatotoxic. These results suggest that these compounds can be useful as scaffolds for planning drug design.

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Clinical outcome of patients who reduced sunitinib or pazopanib during first-line treatment for advanced kidney cancer

Urologic Oncology Seminars and Original Investigations ◽

10.1016/j.urolonc.2017.05.007 ◽

2017 ◽

Vol 35 (9) ◽

pp. 541.e7-541.e13 ◽

Cited By ~ 8

Author(s):

Roberto Iacovelli ◽

Maria Cossu Rocca ◽

Luca Galli ◽

Ugo De Giorgi ◽

Roberto Sabbatini ◽

...

Keyword(s):

Clinical Outcome ◽

Kidney Cancer ◽

Line Treatment ◽

First Line ◽

First Line Treatment

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First-Line Efficacy of Anti-HER2 Treatments in Previously Treated HER2-Positive Metastatic Breast Cancer Patients: A Retrospective Observational Study Investigating the Efficacy of Re-Exposure to Anti-HER2 Therapy for HER2-Positive Metastatic Breast Cancer Patients in Comparison with Naïve Patients

Breast Care ◽

10.1159/000516936 ◽

2021 ◽

pp. 1-7

Author(s):

Barliz Waissengrin ◽

Roni Levin ◽

Ido Wolf ◽

Eliya Shachar ◽

Amir Sonnenblick

Keyword(s):

Breast Cancer ◽

Metastatic Breast Cancer ◽

Clinical Outcome ◽

Metastatic Breast ◽

Line Treatment ◽

Previous Exposure ◽

Breast Cancer Patients ◽

First Line ◽

Her2 Positive ◽

First Line Treatment

Background: Most patients with HER2-positive metastatic breast cancer (MBC) receive first-line treatment with anti-HER2 agents and have already received anti-HER2 therapy as adjuvant or neoadjuvant therapy in the local setting of their disease presentation. Despite that, they constitute only a minority among clinical trials, and their response to reintroduction to anti-HER2 treatments is inconclusive based upon conflicting studies. We aimed to examine if previous exposure influences the clinical outcome of patients treated with anti-HER2 treatments compared to patients who were naïve to anti-HER2 agents. Methods: We conducted a retrospective observational study of HER2-positive MBC patients who were treated with trastuzumab and pertuzumab from 2014 to 2018. We collected and analyzed data including patients’ demographic characteristic as well as extracted data of previous treatment regimens and the efficiency of the anti-HER2 therapy measured by response rate (RR), time to tumor progression (TTP), and overall survival (OS). Results: Eighty patients met the inclusion criteria, 26 (32.5%) of them were previously exposed to anti-HER2 treatments and 54 (67.5%) were not previously exposed to anti-HER2 therapy. No significant differences were detected in RR after 3 months of treatment (p = 0.684). TTP was significantly better among patients with no previous exposure in comparison with patients with previous exposure to anti-HER2 therapy (21 vs. 14 months, p = 0.044) and we noted a trend in better OS (p = 0.056). Conclusion: Our analysis suggests that previous exposure to anti-HER2 agents might influence the clinical outcome of first-line treatment in metastatic HER2 patients. These findings justify further exploration of the benefit of reintroduction of anti-HER2 treatment enabling the optimal treatment for patients with previous anti-HER2 therapy exposure.

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