scholarly journals Early improvement of executive test performance during antidepressant treatment predicts treatment outcome in patients with Major Depressive Disorder

PLoS ONE ◽  
2018 ◽  
Vol 13 (4) ◽  
pp. e0194574 ◽  
Author(s):  
Stefanie Wagner ◽  
Isabella Helmreich ◽  
Daniel Wollschläger ◽  
Konstantin Meyer ◽  
Sabine Kaaden ◽  
...  
Keyword(s):  
Major Depressive Disorder ◽  
Treatment Outcome ◽  
Depressive Disorder ◽  
Test Performance ◽  
Antidepressant Treatment ◽  
Major Depressive ◽  
Early Improvement

Effectiveness of mirtazapine as add-on to paroxetine v. paroxetine or mirtazapine monotherapy in patients with major depressive disorder with early non-response to paroxetine: a two-phase, multicentre, randomized, double-blind clinical trial

2020 ◽  
pp. 1-9 ◽  
Author(s):  
Le Xiao ◽  
Xuequan Zhu ◽  
Amy Gillespie ◽  
Yuan Feng ◽  
Jingjing Zhou ◽  
...  
Keyword(s):  
Major Depressive Disorder ◽  
Depressive Disorder ◽  
Rating Scale ◽  
Antidepressant Treatment ◽  
Additional Treatment ◽  
Combination Group ◽  
Open Label ◽  
Major Depressive ◽  
Double Blind ◽  
Early Improvement

Abstract Background This study aimed to examine the efficacy of combining paroxetine and mirtazapine v. switching to mirtazapine, for patients with major depressive disorder (MDD) who have had an insufficient response to SSRI monotherapy (paroxetine) after the first 2 weeks of treatment. Methods This double-blind, randomized, placebo-controlled, three-arm study recruited participants from five hospitals in China. Eligible participants were aged 18–60 years with MDD of at least moderate severity. Participants received paroxetine during a 2-week open-label phase and patients who had not achieved early improvement were randomized to paroxetine, mirtazapine or paroxetine combined with mirtazapine for 6 weeks. The primary outcome was improvement on the Hamilton Rating Scale for Depression 17-item (HAMD-17) scores 6 weeks after randomization. Results A total of 204 patients who showed early non-response to paroxetine monotherapy were randomly assigned to receive either mirtazapine and placebo (n = 68), paroxetine and placebo (n = 68) or mirtazapine and paroxetine (n = 68), with 164 patients completing the outcome assessment. At week 8, the least squares (LS) mean change of HAMD-17 scores did not significantly differ among the three groups, (12.98 points) in the mirtazapine group, (12.50 points) in the paroxetine group and (13.27 points) in the mirtazapine plus paroxetine combination group. Participants in the paroxetine monotherapy group were least likely to experience adverse effects. Conclusions After 8 weeks follow-up, paroxetine monotherapy, mirtazapine monotherapy and paroxetine/mirtazapine combination therapy were equally effective in non-improvers at 2 weeks. The results of this trial do not support a recommendation to routinely offer additional treatment or a switch in treatment strategies for MDD patients who do not show early improvement after 2 weeks of antidepressant treatment.

Characterising anxiety in major depressive disorder and its use in predicting antidepressant treatment outcome: An iSPOT-D report

2019 ◽  
Vol 53 (8) ◽  
pp. 782-793 ◽  
Author(s):  
Taylor A Braund ◽  
Donna M Palmer ◽  
Leanne M Williams ◽  
Anthony WF Harris
Keyword(s):  
Major Depressive Disorder ◽  
Treatment Outcome ◽  
Depressive Disorder ◽  
Anxiety Disorders ◽  
Clinical Features ◽  
Antidepressant Treatment ◽  
Anxiety Symptoms ◽  
Poor Agreement ◽  
Major Depressive ◽  
Anxious Depression

Objective: Major depressive disorder commonly co-occurs with one or more anxiety disorders or with clinically significant levels of anxiety symptoms. Although evidence suggests that anxious forms of depression are prognostic of poorer antidepressant outcomes, there is no clear definition of anxious depression, and inferences about clinical outcomes are thus limited. Our objective was to compare and evaluate definitions of anxious depression and anxiety-related scales according to clinical and antidepressant outcome criteria. Method: A total of 1008 adults with a current diagnosis of single-episode or recurrent, nonpsychotic, major depressive disorder were assessed at baseline on clinical features. Participants were then randomised to one of three antidepressants and reassessed at 8 weeks regarding remission and response of the 17-item Hamilton Rating Scale Depression (HRSD17) and the 16-item Quick Inventory of Depressive Symptomatology (QIDS-SR16). Anxious depression was defined as major depressive disorder with one or more anxiety disorders or major depressive disorder with a HRSD17 anxiety/somatisation factor score ⩾7. Anxiety-related scales included the HRSD17 anxiety/somatisation factor and the 42-item Depression Anxiety Stress Scales (DASS42) anxiety and stress subscales. Results: Anxious depression definitions showed poor agreement (κ = 0.15) and the HRSD17 anxiety/somatisation factor was weakly correlated with both DASS42 anxiety ( r = 0.24) and stress subscales ( r = 0.20). Anxious depression definitions were also associated with few impairments on clinical features and did not predict poorer antidepressant treatment outcome. However, higher DASS42 anxiety predicted poorer HRSD17 and QIDS-SR16 remission, and item-level analysis found higher scores on items 9 (situational anxiety) and 23 (somatic anxiety) of the DASS42 predicted poorer treatment outcome, even after adjusting for covariates and multiple comparisons. Conclusion: Common definitions of anxious depression show poor agreement and do not predict poorer treatment outcome. Anxiety symptoms may be better characterised dimensionally using DASS42 when predicting treatment outcome.

Early Improvement in the First 2 Weeks as a Predictor of Treatment Outcome in Patients With Major Depressive Disorder

2009 ◽  
Vol 70 (3) ◽  
pp. 344-353 ◽  
Author(s):  
Armin Szegedi ◽  
Wim T. Jansen ◽  
Arjen P. P. van Willigenburg ◽  
Egbert van der Meulen ◽  
Hans H. Stassen ◽  
...  
Keyword(s):  
Major Depressive Disorder ◽  
Treatment Outcome ◽  
Depressive Disorder ◽  
Major Depressive ◽  
Early Improvement

Optimizing patient expectancy in the pharmacologic treatment of major depressive disorder

2018 ◽  
Vol 49 (14) ◽  
pp. 2414-2420 ◽  
Author(s):  
Sigal Zilcha-Mano ◽  
Patrick J. Brown ◽  
Steven P. Roose ◽  
Kiley Cappetta ◽  
Bret R. Rutherford
Keyword(s):  
Major Depressive Disorder ◽  
Treatment Outcome ◽  
Depressive Symptoms ◽  
Depressive Disorder ◽  
Antidepressant Treatment ◽  
Subsequent Treatment ◽  
Major Depressive ◽  
Treatment Patient ◽  
Treatment Parameter ◽  
Pre Treatment

AbstractBackgroundPatient expectancy is an important source of placebo effects in antidepressant clinical trials, but all prior studies measured expectancy prior to the initiation of medication treatment. Little is known about how expectancy changes during the course of treatment and how such changes influence clinical outcome. Consequently, we undertook the first analysis to date of in-treatment expectancy during antidepressant treatment to identify its clinical and demographic correlates, typical trajectories, and associations with treatment outcome.MethodsData were combined from two randomized controlled trials of antidepressant medication for major depressive disorder in which baseline and in-treatment expectancy assessments were available. Machine learning methods were used to identify pre-treatment clinical and demographic predictors of expectancy. Multilevel models were implemented to test the effects of expectancy on subsequent treatment outcome, disentangling within- and between-patient effects.ResultsRandom forest analyses demonstrated that whereas more severe depressive symptoms predicted lower pre-treatment expectancy, in-treatment expectancy was unrelated to symptom severity. At each measurement point, increased in-treatment patient expectancy significantly predicted decreased depressive symptoms at the following measurement (B = −0.45, t = −3.04, p = 0.003). The greater the gap between expected treatment outcomes and actual depressive severity, the greater the subsequent symptom reductions were (B = 0.49, t = 2.33, p = 0.02).ConclusionsGreater in-treatment patient expectancy is associated with greater subsequent depressive symptom reduction. These findings suggest that clinicians may benefit from monitoring and optimizing patient expectancy during antidepressant treatment. Expectancy may represent another treatment parameter, similar to medication compliance and side effects, to be regularly monitored during antidepressant clinical management.

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