Antidepressant Medication Treatment Failure Does Not Predict Lower Remission With ECT for Major Depressive Disorder

During the past two decades, a number of studies have found that depressed patients frequently have manic symptoms intermixed with depressive symptoms. While the frequency of mixed syndromes are more common in bipolar than in unipolar depressives, mixed states are also common in patients with major depressive disorder. The admixture of symptoms may be evident when depressed patients present for treatment, or they may emerge during ongoing treatment. In some patients, treatment with antidepressant medication might precipitate the emergence of mixed states. It would therefore be useful to systematically inquire into the presence of manic/hypomanic symptoms in depressed patients. We can anticipate that increased attention will likely be given to mixed depression because of changes in the DSM–5. In the present article, I review instruments that have been utilized to assess the presence and severity of manic symptoms and therefore could be potentially used to identify the DSM–5 mixed-features specifier in depressed patients and to evaluate the course and outcome of treatment. In choosing which measure to use, clinicians and researchers should consider whether the measure assesses both depression and mania/hypomania, assesses all or only some of the DSM–5 criteria for the mixed-features specifier, or assesses manic/hypomanic symptoms that are not part of the DSM–5 definition. Feasibility, more so than reliability and validity, will likely determine whether these measures are incorporated into routine clinical practice.

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Efficacy and Safety of Mirtazapine in Major Depressive Disorder Patients After SSRI Treatment Failure

The Journal of Clinical Psychiatry ◽

10.4088/jcp.v62n0603 ◽

2001 ◽

Vol 62 (6) ◽

pp. 413-420 ◽

Cited By ~ 61

Author(s):

Maurizio Fava ◽

David L. Dunner ◽

John H. Greist ◽

Sheldon H. Preskorn ◽

Madhukar H. Trivedi ◽

...

Keyword(s):

Major Depressive Disorder ◽

Depressive Disorder ◽

Treatment Failure ◽

Efficacy And Safety ◽

Major Depressive ◽

Ssri Treatment

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Cognitive Therapy for Major Depressive Disorder in Primary Care

The British Journal of Psychiatry ◽

10.1192/bjp.144.4.400 ◽

1984 ◽

Vol 144 (4) ◽

pp. 400-406 ◽

Cited By ~ 159

Author(s):

John D. Teasdale ◽

Melanie J. V. Fennell ◽

George A. Hibbert ◽

Peter L Amies

Keyword(s):

Major Depressive Disorder ◽

Depressive Disorder ◽

Cognitive Therapy ◽

Comparison Group ◽

Psychological Treatment ◽

Antidepressant Medication ◽

Self Report ◽

Major Depressive ◽

Treatment As Usual ◽

Severity Of Depression

SummaryCognitive therapy for depression is a psychological treatment designed to train patients to identify and correct the negative depressive thinking which, it has been hypothesised, contributes to the maintenance of depression. General practice patients meeting Research Diagnostic Criteria for primary major depressive disorder were randomly allocated either to continue with the treatment they would normally receive (which in the majority of cases included antidepressant medication) or to receive, in addition, sessions of cognitive therapy. At completion of treatment, patients receiving cognitive therapy were significantly less depressed than the comparison group, both on blind ratings of symptom severity made by psychiatric assessors and on a self-report measure of severity of depression. At three-month follow-up cognitive therapy patients no longer differed from patients receiving treatment-as-usual, but this was mainly as a result of continuing improvement in the comparison group.

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Suicidal ideation and other persisting symptoms after CBT or antidepressant medication treatment for major depressive disorder

Psychological Medicine ◽

10.1017/s0033291718002568 ◽

2018 ◽

Vol 49 (11) ◽

pp. 1869-1878 ◽

Cited By ~ 3

Author(s):

Boadie W. Dunlop ◽

Philip E. Polychroniou ◽

Jeffrey J. Rakofsky ◽

Charles B. Nemeroff ◽

W. Edward Craighead ◽

...

Keyword(s):

Major Depressive Disorder ◽

Suicidal Ideation ◽

Depressive Disorder ◽

Rating Scale ◽

Antidepressant Medication ◽

Major Depressive ◽

Residual Symptom ◽

Residual Symptoms ◽

Antidepressant Medications ◽

Item Scores

AbstractBackgroundPersisting symptoms after treatment for major depressive disorder (MDD) contribute to ongoing impairment and relapse risk. Whether cognitive behavior therapy (CBT) or antidepressant medications result in different profiles of residual symptoms after treatment is largely unknown.MethodsThree hundred fifteen adults with MDD randomized to treatment with either CBT or antidepressant medication in the Predictors of Remission in Depression to Individual and Combined Treatments (PReDICT) study were analyzed for the frequency of residual symptoms using the Montgomery Asberg Depression Rating Scale (MADRS) item scores at the end of the 12-week treatment period. Separate comparisons were made for treatment responders and non-responders.ResultsAmong treatment completers (n= 250) who responded to CBT or antidepressant medication, there were no significant differences in the persistence of residual MADRS symptoms. However, non-responders treated with medication were significantly less likely to endorse suicidal ideation (SI) at week 12 compared with those treated with CBT (non-responders to medication: 0/54, 0%, non-responders to CBT: 8/30, 26.7%;p= .001). Among patients who terminated the trial early (n= 65), residual MADRS item scores did not significantly differ between the CBT- and medication-treated groups.ConclusionsDepressed adults who respond to CBT or antidepressant medication have similar residual symptom profiles. Antidepressant medications reduce SI, even among patients for whom the medication provides little overall benefit.

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Changes in Psychological Need Fulfillment Over the Course of Treatment for Major Depressive Disorder

Journal of Social and Clinical Psychology ◽

10.1521/jscp.2018.37.5.381 ◽

2018 ◽

Vol 37 (5) ◽

pp. 381-404 ◽

Cited By ~ 2

Author(s):

Matthew N. Quitasol ◽

Marc A. Fournier ◽

Stefano I. Di Domenico ◽

R. Michael Bagby ◽

Lena C. Quilty

Keyword(s):

Major Depressive Disorder ◽

Depressive Disorder ◽

Clinical Sample ◽

Antidepressant Medication ◽

Psychological Needs ◽

Dysfunctional Attitudes ◽

Cognitive Errors ◽

Need Fulfillment ◽

Major Depressive ◽

Psychological Need

Self-determination theory (Ryan & Deci, 2017) maintains that the psychological needs for autonomy, competence, and relatedness are essential qualities of experience that individuals require to thrive. The present research examined the role of psychological need fulfillment in a clinical sample undergoing treatment for major depressive disorder. Fifty-one patients with a SCID-IV diagnosis for major depressive disorder were randomly assigned to 16 weeks of cognitive behavioral therapy or antidepressant medication. Depressive symptoms, cognitive errors, dysfunctional attitudes, and psychological need fulfillment were assessed at four time points (pre-treatment, week 4, week 8, and week 16). Psychological need fulfillment increased over the course of treatment and did not differ significantly between treatment conditions. Furthermore, increases in psychological need fulfillment were associated with decreases in depression severity over and above the effects of time, cognitive errors, and dysfunctional attitudes. Given the incremental predictive validity of need fulfillment, a better understanding of its role in the treatment for depression may prove beneficial to mental health researchers and practitioners.

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Higher dose weekly fluoxetine in hemodialysis patients: A case series report

The International Journal of Psychiatry in Medicine ◽

10.1177/0091217420913399 ◽

2020 ◽

Vol 56 (1) ◽

pp. 3-13

Author(s):

Kelley M Kauffman ◽

Jacqueline Dolata ◽

Maria Figueroa ◽

Douglas Gunzler ◽

Anne Huml ◽

...

Keyword(s):

Major Depressive Disorder ◽

Side Effects ◽

Depressive Disorder ◽

Case Series ◽

Antidepressant Medication ◽

Hemodialysis Patients ◽

Future Research ◽

Major Depressive ◽

Patient Health ◽

Case Series Report

Objective The antidepressant medication fluoxetine at 90 mg dosed weekly is as effective and safe as standard formulation fluoxetine 20 mg dosed daily in patients with major depressive disorder. Weekly fluoxetine has not been well studied in hemodialysis patients, and doses beyond 90 mg/week have not been described in this population. This case series, derived from a larger study on depression in hemodialysis patients, describes the use of weekly fluoxetine at dosages beyond 90 mg/week. Method Hemodialysis patients with depressive symptom severity scored ≥10 on the 9-item Patient Health Questionnaire and major depressive disorder confirmed with Mini International Neuropsychiatric Interview were initially prescribed daily fluoxetine for two weeks and then transitioned to weekly fluoxetine. Dosage titration was made at the discretion of the prescribing clinician. Fluoxetine was continued for a total of 12 weeks. Results Four women, aged 24 to 65 years, on hemodialysis for 1 to 18 years, were started on weekly fluoxetine that was increased over several weeks up to 180 mg. Side effects included restlessness, dry mouth, sedation, and lightheadedness. Two patients ultimately had their weekly fluoxetine decreased back to 90 mg. However, all four continued weekly fluoxetine as part of poststudy aftercare and no longer met diagnostic criteria for major depressive disorder, current episode. Conclusions Weekly fluoxetine at doses of 180 mg may be a reasonable treatment consideration for hemodialysis patients who have partial or insufficient antidepressant response. Side effects may limit tolerance of the 180 mg dose in some individuals. Future research should investigate longer term health outcomes of weekly fluoxetine in this population.

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