Clinical Characteristics of PMS Co-Morbid with MDD and Effectiveness of SSRIs in its Treatment

AbstractBackground: Data on the clinical characteristics of premenstrual syndrome (PMS) with co-morbid major depressive disorder (MDD) are scarce. Although selective serotonin re-uptake inhibitors (SSRIs) are widely used to treat both PMS and MDD there is little information on their efficacy in PMS in patients with co-morbid MDD.Objective: To describe the clinical picture of PMS co-morbid with current depressive episode (DE) and evaluate its dynamics under a 6-month course of SSRIs treatment.Materials and methods: We present a longitudinal observational study, conducted in out- and inpatient conditions. Thirty-one women eligible to antidepressant treatment for a current DE in the course of MDD were evaluated for PMS and those of them suffering from both conditions were re-evaluated twice during a 6-month medication intake period.Results: The pre-treatment clinical picture of PMS co-morbid with MDD was dominated by moderately to severely expressed mood swings, anxiety, fatigue, breast tenderness, palpitations, abdominal bloating, and headache. After six months of SSRIs intake the syndrome was characterised by nearly the same symptoms (with the addition of irritability and appetite changes) but mildly expressed.Conclusion: Untreated PMS co-morbid with MDD is characterised by mainly moderately severe psychological and around three times less commonly – somatic symptoms. SSRIs treatment alleviate both symptom types at month three and even further, although less pronouncedly at month six.

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Changes in the neural correlates of implicit emotional face processing during antidepressant treatment in major depressive disorder

The International Journal of Neuropsychopharmacology ◽

10.1017/s146114571300062x ◽

2013 ◽

Vol 16 (10) ◽

pp. 2195-2208 ◽

Cited By ~ 29

Author(s):

Teresa A. Victor ◽

Maura L. Furey ◽

Stephen J. Fromm ◽

Arne Öhman ◽

Wayne C. Drevets

Keyword(s):

Major Depressive Disorder ◽

Depressive Disorder ◽

Treatment Condition ◽

Functional Neuroimaging ◽

Antidepressant Treatment ◽

Antidepressant Drugs ◽

Anterior Cingulate ◽

Major Depressive ◽

Pre Treatment ◽

Emotional Face

Abstract An emerging hypothesis regarding the mechanisms underlying antidepressant pharmacotherapy suggests that these agents benefit depressed patients by reversing negative emotional processing biases (Harmer, 2008). Neuropsychological indices and functional neuroimaging measures of the amygdala response show that antidepressant drugs shift implicit and explicit processing biases away from the negative valence and toward the positive valence. However, few studies have explored such biases in regions extensively connected with the amygdala, such as the pregenual anterior cingulate cortex (pgACC) area, where pre-treatment activity consistently has predicted clinical outcome during antidepressant treatment. We used functional magnetic resonance imaging (fMRI) to investigate changes in haemodynamic response patterns to positive vs. negative stimuli in patients with major depressive disorder (MDD) under antidepressant treatment. Participants with MDD (n = 10) underwent fMRI before and after 8 wk sertraline treatment; healthy controls (n = 10) were imaged across an equivalent interval. A backward masking task was used to elicit non-conscious neural responses to sad, happy and neutral face expressions. Haemodynamic responses to emotional face stimuli were compared between conditions and groups in the pgACC. The response to masked-sad vs. masked-happy faces (SN-HN) in pgACC in the depressed subjects was higher in the pre-treatment condition than in the post-treatment condition and this difference was significantly greater than the corresponding change across time in the controls. The treatment-associated difference was attributable to an attenuated response to sad faces and an enhanced response to happy faces. Pre-treatment pgACC responses to SN-HN correlated positively with clinical improvement during treatment. The pgACC participates with the amygdala in processing the salience of emotional stimuli. Treatment-associated functional changes in this limbic network may influence the non-conscious processing of such stimuli by reversing the negative processing bias extant in MDD.

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Optimizing patient expectancy in the pharmacologic treatment of major depressive disorder

Psychological Medicine ◽

10.1017/s0033291718003343 ◽

2018 ◽

Vol 49 (14) ◽

pp. 2414-2420 ◽

Cited By ~ 4

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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Intrinsic connectomes are a predictive biomarker of remission in major depressive disorder

Molecular Psychiatry ◽

10.1038/s41380-019-0574-2 ◽

2019 ◽

Vol 25 (7) ◽

pp. 1537-1549 ◽

Cited By ~ 14

Author(s):

Mayuresh S. Korgaonkar ◽

Andrea N. Goldstein-Piekarski ◽

Alexander Fornito ◽

Leanne M. Williams

Keyword(s):

Major Depressive Disorder ◽

Functional Connectivity ◽

Depressive Disorder ◽

Treatment Response ◽

Antidepressant Treatment ◽

Predictive Biomarker ◽

Major Depressive ◽

Attention Networks ◽

Pre Treatment

Abstract Although major depressive disorder (MDD) is associated with altered functional coupling between disparate neural networks, the degree to which such measures are ameliorated by antidepressant treatment is unclear. It is also unclear whether functional connectivity can be used as a predictive biomarker of treatment response. Here, we used whole-brain functional connectivity analysis to identify neural signatures of remission following antidepressant treatment, and to identify connectomic predictors of treatment response. 163 MDD and 62 healthy individuals underwent functional MRI during pre-treatment baseline and 8-week follow-up sessions. Patients were randomized to escitalopram, sertraline or venlafaxine-XR antidepressants and assessed at follow-up for remission. Baseline measures of intrinsic functional connectivity between each pair of 333 regions were analyzed to identify pre-treatment connectomic features that distinguish remitters from non-remitters. We then interrogated these connectomic differences to determine if they changed post-treatment, distinguished patients from controls, and were modulated by medication type. Irrespective of medication type, remitters were distinguished from non-remitters by greater connectivity within the default mode network (DMN); specifically, between the DMN, fronto-parietal and somatomotor networks, the DMN and visual, limbic, auditory and ventral attention networks, and between the fronto-parietal and somatomotor networks with cingulo-opercular and dorsal attention networks. This baseline hypo-connectivity for non-remitters also distinguished them from controls and increased following treatment. In contrast, connectivity for remitters was higher than controls at baseline and also following remission, suggesting a trait-like connectomic characteristic. Increased functional connectivity within and between large-scale intrinsic brain networks may characterize acute recovery with antidepressants in depression.

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Pre-treatment allostatic load and metabolic dysregulation predict SSRI response in major depressive disorder: a preliminary report

Psychological Medicine ◽

10.1017/s0033291720000896 ◽

2020 ◽

pp. 1-9

Author(s):

Christina M. Hough ◽

F. Saverio Bersani ◽

Synthia H. Mellon ◽

Alexandra E. Morford ◽

Daniel Lindqvist ◽

...

Keyword(s):

Major Depressive Disorder ◽

Depressive Disorder ◽

Treatment Outcomes ◽

Allostatic Load ◽

Antidepressant Treatment ◽

Depression Severity ◽

Major Depressive ◽

Metabolic Dysregulation ◽

Pre Treatment ◽

Ssri Treatment

Abstract Background Major depressive disorder (MDD) is associated with increased allostatic load (AL; a measure of physiological costs of repeated/chronic stress-responding) and metabolic dysregulation (MetD; a measure of metabolic health and precursor to many medical illnesses). Though AL and MetD are associated with poor somatic health outcomes, little is known regarding their relationship with antidepressant-treatment outcomes. Methods We determined pre-treatment AL and MetD in 67 healthy controls and 34 unmedicated, medically healthy MDD subjects. Following this, MDD subjects completed 8-weeks of open-label selective serotonin reuptake inhibitor (SSRI) antidepressant treatment and were categorized as ‘Responders’ (⩾50% improvement in depression severity ratings) or ‘Non-responders’ (<50% improvement). Logistic and linear regressions were performed to determine if pre-treatment AL or MetD scores predicted SSRI-response. Secondary analyses examined cross-sectional differences between MDD and control groups. Results Pre-treatment AL and MetD scores significantly predicted continuous antidepressant response (i.e. absolute decreases in depression severity ratings) (p = 0.012 and 0.014, respectively), as well as post-treatment status as a Responder or Non-responder (p = 0.022 and 0.040, respectively), such that higher pre-treatment AL and MetD were associated with poorer SSRI-treatment outcomes. Pre-treatment AL and MetD of Responders were similar to Controls, while those of Non-responders were significantly higher than both Responders (p = 0.025 and 0.033, respectively) and Controls (p = 0.039 and 0.001, respectively). Conclusions These preliminary findings suggest that indices of metabolic and hypothalamic-pituitary-adrenal-axis dysregulation are associated with poorer SSRI-treatment response. To our knowledge, this is the first study to demonstrate that these markers of medical disease risk also predict poorer antidepressant outcomes.

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Reduced Latency to First Antidepressant Treatment in Italian Patients with a More Recent Onset of Major Depressive Disorder

10.26226/morressier.5885d713d462b8028d891057 ◽

2017 ◽

Author(s):

Benedetta Maria Grancini

Keyword(s):

Major Depressive Disorder ◽

Depressive Disorder ◽

Antidepressant Treatment ◽

Major Depressive ◽

Recent Onset

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Clinical Characteristics of Major Depressive Disorder without Comorbid Psychiatric Diseases Using MMPI-2-RF

10.26226/morressier.5cf632c1af72dec2b0554904 ◽

2019 ◽

Author(s):

Jiyoung Kim

Keyword(s):

Major Depressive Disorder ◽

Depressive Disorder ◽

Clinical Characteristics ◽

Psychiatric Diseases ◽

Major Depressive

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Extension Study of Pimavanserin in Subjects With Major Depressive Disorder and Inadequate Response to Antidepressant Treatment

Case Medical Research ◽

10.31525/ct1-nct04000009 ◽

2019 ◽

Author(s):

Keyword(s):

Major Depressive Disorder ◽

Depressive Disorder ◽

Antidepressant Treatment ◽

Extension Study ◽

Inadequate Response ◽

Major Depressive

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Faculty Opinions recommendation of Early prediction of acute antidepressant treatment response and remission in pediatric major depressive disorder.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1160666.622058 ◽

2009 ◽

Author(s):

Charles Zeanah

Keyword(s):

Major Depressive Disorder ◽

Depressive Disorder ◽

Treatment Response ◽

Antidepressant Treatment ◽

Early Prediction ◽

Major Depressive

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Reduced latency to first antidepressant treatment in Italian patients with a more recent onset of major depressive disorder

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.715 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S529-S529

Author(s):

B. Grancini ◽

B. Dell’Osso ◽

L. Cremaschi ◽

F. De Cagna ◽

B. Benatti ◽

...

Keyword(s):

Major Depressive Disorder ◽

Depressive Disorder ◽

Antidepressant Treatment ◽

Stressful Events ◽

Major Depressive ◽

Recent Onset ◽

Valid Predictor ◽

Before And After ◽

Competing Interest ◽

Year 2000

IntroductionMajor depressive disorder (MDD) is a prevalent burdensome disease, which frequently remains untreated. The duration of untreated illness (DUI) is modifiable parameter and a valid predictor of outcome. Previous investigation in patients with MDD revealed a DUI of different years, while recent reports have documented a reduction of DUI across time, in patients with different psychiatric disorders.Objectives/aimsThe present study was aimed to investigate potential differences in terms of DUI and related variables in patients with MDD across time.MethodsAn overall sample of 188 patients with MDD was divided in two subgroups on the basis of their epoch of onset (onset before and after year 2000). DUI and other onset-related variables were assessed through a specific questionnaire and compared between the two subgroups.ResultsThe whole sample showed a mean DUI of approximately 4.5 years, with a lower value in patients with more recent onset compared to the other subgroup (27.1 ± 42.6 vs. 75.8 ± 105.2 months, P < .05). Moreover, patients with onset after 2000 reported higher rates of onset-related stressful events and lower ones for benzodiazepines prescription (65% vs. 81%; P = 0.02; 47% vs. 30%; P = 0.02).ConclusionsThe comparison of groups with different epochs of onset showed a significant reduction in terms of DUI and benzodiazepines prescription, and a higher rate of onset-related stressful events in patients with a more recent onset. Reported findings are of epidemiologic and clinical relevance in order to evaluate progress and developments in the diagnostic and therapeutic pathways of MDD in Italian and other countries.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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