First-Line and Combination Therapeutics for Major Depressive Disorder

Depression ◽  
2019 ◽  
pp. 183-196
Author(s):  
Manish K. Jha
Keyword(s):  
Major Depressive Disorder ◽  
Depressive Disorder ◽  
Symptom Severity ◽  
Severe Depression ◽  
Severity Of Illness ◽  
Treatment Modalities ◽  
First Line ◽  
Major Depressive ◽  
Ongoing Research ◽  
Selection Of

Major depressive disorder (MDD) affects one in five adults during their lifetime. Patients with MDD and their clinicians have a multitude of options to select for management of this chronic and/or recurrent condition. Selection of treatment modalities may be guided by the severity of illness. Nonpharmacologic treatments such as psychotherapy or exercise may be considered for those with mild symptom severity, with pharmacologic treatment reserved for those with moderate or higher symptom severity. Severe or very severe depression may warrant the combination of both pharmacologic and psychotherapeutic treatments. In patients who fail to improve adequately with one or more first-line treatments, augmentation with second-generation antipsychotics should be considered. There currently are no objective markers to guide the selection of one first-line treatment over other. Exciting ongoing research in the field of depression may inform new methods to personalize treatment selection and potentially lead to the development of mechanistically novel antidepressants.

scholarly journals Predictors of Suicidal Ideation and Attempt among Patients with Major Depressive Disorder at a Tertiary Care Hospital, Puducherry

2021 ◽  
Vol 12 (01) ◽  
pp. 122-128
Author(s):  
Ralte Lalthankimi ◽  
Padmavathi Nagarajan ◽  
Vikas Menon ◽  
Jeby Jose Olickal
Keyword(s):  
Major Depressive Disorder ◽  
Suicidal Ideation ◽  
Depressive Disorder ◽  
Rating Scale ◽  
Tertiary Care ◽  
Severe Depression ◽  
Care Hospital ◽  
Suicidal Behaviors ◽  
Major Depressive ◽  
Severity Of Depression

Abstract Objectives Mental disorders have a large impact on death by suicide. Hence, this study aims to determine the prevalence of suicidal behaviors among major depressive disorder (MDD) patients and the associated factors. Materials and Methods This cross-sectional analytical study was conducted among individuals aged 18 to 65 years, diagnosed with MDD in the Psychiatry Outpatient Department of a Tertiary Care Center, Puducherry during March to October 2019. Severity of depression was assessed using Hamilton Depression Rating Scale and Columbia-Suicide Severity Rating Scale was used to find the suicidal behaviors. Results For 166 participants in the study, mean (standard deviation) age was 40 (11) years and majority were females (76%). More than one-third (37%) had severe or very severe depression, and the prevalence of suicidal ideation, plan, and attempts were 83, 24, and 35%, respectively. After adjusting the covariates, the severity of depression and unemployment were significantly associated with suicidal attempts (adjusted prevalence ratios [aPR] = 11.4 and 1.9), and very severe depression was associated with suicidal ideation (aPR = 1.6). Among 140 individuals with suicidal ideation, 45 (32%) had an ideation frequency of 2 to 3 times/week, 69 (50%) had ideation for 1 hour, 36 (26%) could control ideation with little difficulty, and 12% had suicidal ideation mostly to end or stop their pain. Conclusion Suicidal ideation and attempts were significantly high in MDD patients, and the severity of depression was significantly associated with it. Early identification of high-risk suicidal behavior and implementation of effective preventive interventions are necessary to reduce death by suicide in these groups.

scholarly journals Cognition and Its Association with Psychosocial and Occupational Functioning during Treatment with Escitalopram in Patients with Major Depressive Disorder: A CAN-BIND-1 Report: La Cognition Et Son Association Avec Le Fonctionnement Psychosocial Et Professionnel Durant Le Traitement Par Escitalopram Chez Des Patients Souffrant De Trouble Dépressif Majeur: Une Étude Can-Bind-1

2020 ◽  
pp. 070674372097482
Author(s):  
Shane J. McInerney ◽  
Trisha Chakrabarty ◽  
Malgorzata Maciukiewicz ◽  
Benicio N. Frey ◽  
Glenda M. MacQueen ◽  
...  
Keyword(s):  
Major Depressive Disorder ◽  
Depressive Disorder ◽  
Cognitive Functioning ◽  
Symptom Severity ◽  
Cognitive Change ◽  
Cognitive Domain ◽  
Depression Symptom ◽  
Major Depressive ◽  
Occupational Functioning ◽  
The Impact

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.

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

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

THE PATTERN OF IRRATIONAL BELIEFS ASSOCIATED WITH MAJOR DEPRESSIVE DISORDER

1992 ◽  
Vol 20 (3) ◽  
pp. 199-212 ◽  
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.

Barbiturate Anticonvulsants as a Cause of Severe Depression

PEDIATRICS ◽  
1988 ◽  
Vol 82 (2) ◽  
pp. 284-284
Author(s):  
GABOR BARABAS ◽  
WENDY S. MATTHEWS
Keyword(s):  
Major Depressive Disorder ◽  
Suicidal Ideation ◽  
Depressive Disorder ◽  
Severe Depression ◽  
Recent Issue ◽  
Major Depressive ◽  
Seizure Disorders ◽  
Emotional Factors ◽  
Psychiatric Disturbances ◽  
Epileptic Children

To the Editor.— In a recent issue, Brent et al1 compared patients treated with phenobarbital with those treated with carbamazepine for seizure disorders. They noted that there was a much higher prevalence of major depressive disorder and suicidal ideation among those taking phenobarbital. They emphasized that the incidence of psychiatric disturbances is higher among epileptic children as compared with controls and that on occasion this may be due to iatrogenic effects of anticonvulsants and not only to factors intrinsic to epilepsy or secondary emotional factors.

Escitalopram Versus SNRI Antidepressants in the Acute Treatment of Major Depressive Disorder: Integrative Analysis of Four Double-Blind, Randomized Clinical Trials

CNS Spectrums ◽  
2009 ◽  
Vol 14 (6) ◽  
pp. 326-333 ◽  
Author(s):  
Susan G. Kornstein ◽  
Dayong Li ◽  
Yongcai Mao ◽  
Sara Larsson ◽  
Henning F. Andersen ◽  
...  
Keyword(s):  
Major Depressive Disorder ◽  
Depressive Disorder ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Randomized Clinical Trials ◽  
Rating Scale ◽  
Severe Depression ◽  
Major Depressive ◽  
Double Blind ◽  
Madrs Score ◽  
Treatment Difference

AbstractIntroduction: Recent data suggest that escitalopram may be more effective in severe depression than other selective serotonin reuptake inhibitors.Methods: Individual patient data from four randomized, double-blind comparative trials of escitalopram versus a serotonin/norepinephrine reuptake inhibitor (SNRI) (two trials with duloxetine and two with venlafaxine extended release) in outpatients (18–85 years of age) with moderate-to-severe major depressive disorder were pooled. The primary efficacy parameter in all four trials was mean change in the Montgomery-Asberg Depression Rating Scale (MADRS) score.Results: Significantly fewer escitalopram (82/524) than SNRI (114/527) patients prematurely withdrew from treatment due to all causes (15.6% vs. 21.6%, Fisher Exact: P=.014) and adverse events (5.3% vs. 12.0%, Fisher Exact: P <.0001). Mean reduction in MADRS score from baseline to Week 8 was significantly greater for the escitalopram group versus the SNRI group using the last observation carried forward (LOCF) approach [mean treatment difference at Week 8 of 1.7 points (P <.01)]. Similar results were observed in the severely depressed (baseline MADRS score ≥30) patient subset (mean treatment difference at Week 8 of 2.9 points [P <.001, LOCF]). Observed cases analyses yielded no significant differences in efficacy parameters.Conclusion: This pooled analysis indicates that escitalopram is at least as effective as the SNRIs (venlafaxine XR and duloxetine), even in severe depression, and escitalopram treatment was better tolerated.

Cognitive Therapy versus Medication in the Treatment of Moderate to Severe Depression

2018 ◽  
Author(s):  
Daniel Barron ◽  
Robert Ostroff
Keyword(s):  
Major Depressive Disorder ◽  
Depressive Disorder ◽  
Cognitive Therapy ◽  
Study Design ◽  
Clinical Case ◽  
Severe Depression ◽  
Major Depressive ◽  
Study Intervention ◽  
Landmark Study

This chapter provides a summary of a landmark study on major depressive disorder. Is paroxetine or cognitive therapy more effective in treating patients with moderate to severe major depressive disorder? Starting with that question, it describes the basics of the study, including funding, study location, who was studied, how many patients, study design, study intervention, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and information, discusses implications, and concludes with a relevant clinical case.

Rostral Anterior Cingulate Glutamine/Glutamate Disbalance in Major Depressive Disorder Depends on Symptom Severity

2019 ◽  
Vol 4 (12) ◽  
pp. 1049-1058 ◽  
Author(s):  
Lejla Colic ◽  
Felicia von Düring ◽  
Dominik Denzel ◽  
Liliana Ramona Demenescu ◽  
Anton R. Lord ◽  
...  
Keyword(s):  
Major Depressive Disorder ◽  
Depressive Disorder ◽  
Symptom Severity ◽  
Anterior Cingulate ◽  
Major Depressive

A Placebo-Controlled Study Evaluating the Efficacy and Safety of Flexible-Dose Desvenlafaxine Treatment in Outpatients with Major Depressive Disorder

CNS Spectrums ◽  
2009 ◽  
Vol 14 (1) ◽  
pp. 41-50 ◽  
Author(s):  
Alan D. Feiger ◽  
Karen A. Tourian ◽  
Gregory R. Rosas ◽  
S. Krishna Padmanabhan
Keyword(s):  
Major Depressive Disorder ◽  
Depressive Disorder ◽  
Dose Range ◽  
Severity Of Illness ◽  
Final Evaluation ◽  
Analysis Of Covariance ◽  
Controlled Study ◽  
Double Blind Study ◽  
Efficacy And Safety ◽  
Major Depressive

ABSTRACTIntroduction: This research compares the efficacy and safety of desvenlafaxine (administered as desvenlafaxine succinate) versus placebo in treating major depressive disorder.Methods: In this randomized, double-blind study, outpatients with major depressive disorder ≥18 years of age received desvenlafaxine 200–400 mg/day or placebo for 8 weeks. Efficacy endpoints included (primary) change in 17-item Hamilton Rating Scale for Depression score at the final evaluation (last observation carried forward, analysis of covariance) and (secondary) Clinical Global Impressions—Improvement and—Severity of Illness scales.Results: The difference between desvenlafaxine (n=117) and placebo (n=118) on the primary endpoint was not significant (−9.1 vs −7.5, P=.078). Week 8 observed cases (desvenlafaxine, n=80; placebo, n=94) results were significant (−10.7 vs −7.9, P=.008). Differences at the final evaluation (last observation carried forward) were significant for Clinical Global Impressions—Improvement (2.9 vs 2.5, P=.037) and Clinical Global Impressions—Severity of Illness (−1.9 vs −1.2, P=.041). Discontinuation rates due to adverse events (AEs) were 12% and 3% for desvenlafaxine and placebo, respectively (P=.008). The most frequently reported AE associated with desvenlafaxine was nausea (36% vs 9% [placebo]).Conclusion: In this study, the primary analysis did not show significant differences between desvenlafaxine and placebo; discontinuations due to AEs associated with the desvenlafaxine dose range may have contributed to the lack of statistical separation.

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