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Wang T, Yang J, Zhu Y, Niu N, Ding B, Wang P, Zhao H, Li N, Chao Y, Gao S, Dong X, Wang Z. Evaluation of metabolomics-based urinary biomarker models for recognizing major depression disorder and bipolar disorder. J Affect Disord 2024; 356:1-12. [PMID: 38548210 DOI: 10.1016/j.jad.2024.03.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 03/01/2024] [Accepted: 03/23/2024] [Indexed: 04/12/2024]
Abstract
BACKGROUND Major depressive disorder (MDD) and bipolar disorder (BD) are psychiatric disorders with overlapping symptoms, leading to high rates of misdiagnosis due to the lack of biomarkers for differentiation. This study aimed to identify metabolic biomarkers in urine samples for diagnosing MDD and BD, as well as to establish unbiased differential diagnostic models. METHODS We utilized a metabolomics approach employing ultra-high performance liquid chromatography-mass spectrometry (UHPLC-MS) to analyze the metabolic profiles of urine samples from individuals with MDD (n = 50), BD (n = 12), and healthy controls (n = 50). The identification of urine metabolites was verified using MS data analysis tools and online metabolite databases. RESULTS Two diagnostic panels consisting of a combination of metabolites and clinical indicators were identified-one for MDD and another for BD. The discriminative capacity of these panels was assessed using the area under the receiver operating characteristic (ROC) curve, yielding an area under the curve (AUC) of 0.9084 for MDD and an AUC value of 0.9017 for BD. CONCLUSIONS High-resolution mass spectrometry-based assays show promise in identifying urinary biomarkers for depressive disorders. The combination of urine metabolites and clinical indicators is effective in differentiating healthy controls from individuals with MDD and BD. The metabolic pathway indicating oxidative stress is seen to significantly contribute to depressive disorders.
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Affiliation(s)
- Tianjiao Wang
- School of Medicine, Shanghai University, Shanghai 200444, China; Clinical Research Center for Mental Health, School of Medicine, Shanghai University, Shanghai 200083, China
| | - Jingzhi Yang
- Institute of Translational Medicine, Shanghai University, Shanghai 200444, China
| | - Yuncheng Zhu
- Clinical Research Center for Mental Health, School of Medicine, Shanghai University, Shanghai 200083, China; Division of Mood Disorders, Shanghai Hongkou Mental Health Center, Shanghai 200083, China
| | - Na Niu
- Division of Mood Disorders, Shanghai Hongkou Mental Health Center, Shanghai 200083, China
| | - Binbin Ding
- Division of Mood Disorders, Shanghai Hongkou Mental Health Center, Shanghai 200083, China
| | - Ping Wang
- Division of Mood Disorders, Shanghai Hongkou Mental Health Center, Shanghai 200083, China
| | - Hongxia Zhao
- Zhanjiang Institute of Clinical Medicine, Central People's Hospital of Zhanjiang, Zhanjiang 524045, China
| | - Na Li
- School of Medicine, Shanghai University, Shanghai 200444, China
| | - Yufan Chao
- School of Medicine, Shanghai University, Shanghai 200444, China
| | - Songyan Gao
- Institute of Translational Medicine, Shanghai University, Shanghai 200444, China
| | - Xin Dong
- School of Medicine, Shanghai University, Shanghai 200444, China; Clinical Research Center for Mental Health, School of Medicine, Shanghai University, Shanghai 200083, China.
| | - Zuowei Wang
- Clinical Research Center for Mental Health, School of Medicine, Shanghai University, Shanghai 200083, China; Division of Mood Disorders, Shanghai Hongkou Mental Health Center, Shanghai 200083, China.
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2
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Liao Y, Han X, Guo L, Wang W, Wang H, Li L, Shen M, Song W, Zhu D, Jiang Y, Teopiz KM, Lu C, McIntyre RS. Evaluation of a novel instrument for detecting bipolar disorders in China: The Rapid Mood Screener (RMS). J Affect Disord 2024; 348:54-61. [PMID: 38110155 DOI: 10.1016/j.jad.2023.12.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 12/01/2023] [Accepted: 12/13/2023] [Indexed: 12/20/2023]
Abstract
OBJECTIVE Bipolar disorder is easily misdiagnosed with major depressive disorder (MDD). The Rapid Mood Screener (RMS) was developed to address this unmet clinical need. This study aims to translate and evaluated the reliability and validity of the RMS in Chinese adults with bipolar I/II disorder (BD-I/II). METHODS Brislin's translation and Delphi method were conducted to formulate the RMS-Chinses version (RMS-C). Patients with MDD (N = 99), BD-I (N = 77) and BD-II (N = 78) were included to assess the validity and reliability of RMS-C. The area under the curve (AUC) was computed to ascertain the ability of the Mood Disorder Questionnaire (MDQ) and RMS-C to distinguish BD-I and BD-II from MDD. The optimal cut-off scores for classification were also calculated by the maximum sensitivity and specificity. RESULTS The intraclass correlation coefficient of the RMS-C was 0.82 (95%CI, 0.71-0.89). The content validity index by six items were 0.71, 0.86, 1.00, 0.86, 1.00, and 1.00 in turn, and by scales was 0.90. The AUCs of the RMS-C in both BD-I/II, BD-I alone and BD-II alone were 0.83 (95 % CI, 0.78-0.89), 0.82 (95 % CI, 0.75-0.89) and 0.85 (95 % CI, 0.79-0.91), respectively, and were comparably to the MDQ. The optimal RMS-C values of the presence of BD-I and BD-II were >4 and 3, respectively. CONCLUSION The RMS-C is a valid, simple self-administer screening tool to help identify BD-I or BD-II in persons experiencing a depressive episode. Validating the impact of screening with the RMS-C on health outcomes and health economics is warranted.
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Affiliation(s)
- Yuhua Liao
- Department of Psychiatry, Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, People's Republic of China; Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Xue Han
- Department of Psychiatry, Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, People's Republic of China
| | - Lan Guo
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Wanxin Wang
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Hongqiong Wang
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Lingjiang Li
- Mental Health Institute of the Second Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Manjun Shen
- Department of Psychiatry, Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, People's Republic of China
| | - Weidong Song
- Department of Psychiatry, Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, People's Republic of China
| | - Dongjian Zhu
- Department of Psychiatry, Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, People's Republic of China
| | - Yunbin Jiang
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Kayla M Teopiz
- Brain and Cognition Discovery Foundation, Toronto, ON, Canada
| | - Ciyong Lu
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China.
| | - Roger S McIntyre
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada; Department of Pharmacology, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Canadian Rapid Treatment Center of Excellence, Mississauga, ON, Canada; Brain and Cognition Discovery Foundation, Toronto, ON, Canada
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3
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Wang Y, Lu Z, Xun G. Effect of aripiprazole on promoting cognitive function and enhancing clinical efficacy in patients with first-episode depression on escitalopram: A randomized controlled trial. J Affect Disord 2024; 344:159-168. [PMID: 37827257 DOI: 10.1016/j.jad.2023.10.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 09/24/2023] [Accepted: 10/08/2023] [Indexed: 10/14/2023]
Abstract
OBJECTIVES To explore the effect of escitalopram combined with aripiprazole on cognitive function in patients with major depressive disorder (MDD), and to evaluate the clinical efficacy of the combination therapy. METHOD A total of 70 patients with first-episode MDD were randomly divided into the study group or the control group, receiving escitalopram combined with aripiprazole (5 mg/day) or escitalopram monotherapy respectively for 8 weeks. The severity of illness was assessed by using the Hamilton Rating Scale for Depression (HAMD) at baseline, at the end of 4th and 8th week, and cognitive function was assessed by using the THINC integrated tool (THINC-it), the Wisconsin Card Sorting Test (WCST), and the Continuous Performance Test (CPT). Rating Scale for Extrapyramidal Side Effects (RSESE) was applied to assess adverse reactions. RESULTS The average HAMD-17 and HAMA scores decreased over time in both the control and the study groups, but the reductions were not statistically different between two groups with the passage of time. In WCST, total number of response (TR) of the study group decreased relative to the baseline at the end of the eighth week, but the control group did not significantly change during whole eight weeks. Perseverative errors (PE) in the control group eventually decreased at the end of Week 8 compared to that at Week 4, but in the study group, it was a continuous trend of decrease. In CPT, the decrease of leakage responses (LR) in the study group was higher than that of the control group in 2-digit number, and LR of the control group was higher than that of the study group at the end of Week 8 in 4-digit number. The downtrend of LR in 4-digit number kept for the whole period in study group, while in the control group, the LR did not decrease significantly until the end of Week 8 compared to that at baseline. CONCLUSION Escitalopram combined with a low-dose of aripiprazole, and escitalopram monotherapy could both enhance cognitive function of MDD patients, while the improvements of combination therapy might happen relatively earlier. The combined use of escitalopram and aripiprazole might be more beneficial to the domains of executive function (EF) and continuous attention compared to escitalopram monotherapy. There was no significant differences between two treatment options in alleviating depressive and anxiety symptoms.
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Affiliation(s)
- Yingtan Wang
- The National Clinical Research Center for Mental Disorders and Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China; Department of Mental Health, Jining Medical University, Jining, China
| | - Zhe Lu
- Peking University Sixth Hospital, Peking University Institute of Mental Health, Beijing, China
| | - Guanglei Xun
- Shandong Mental Health Center, Shandong University, Jinan, China.
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Hsu JW, Chen LC, Tsai SJ, Huang KL, Bai YM, Su TP, Chen TJ, Chen MH. Disease progression to bipolar disorder among adolescents and young adults with antidepressant-resistant and antidepressant-responsive depression: Does antidepressant class matter? Eur Neuropsychopharmacol 2023; 74:22-29. [PMID: 37247462 DOI: 10.1016/j.euroneuro.2023.04.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 04/20/2023] [Accepted: 04/24/2023] [Indexed: 05/31/2023]
Abstract
Studies have demonstrated a positive relationship between antidepressant resistance and the progression of bipolar disorder. However, the influence of antidepressant classes such as selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs) in this context has yet to be investigated. A total of 5,285 adolescents and young adults with antidepressant-resistant depression and 21,140 with antidepressant-responsive depression were recruited in the present study. The antidepressant-resistant depression group was divided into two subgroups: only resistant to SSRIs (n = 2,242, 42.4%) and additionally resistant to non-SSRIs (n = 3,043, 57.6%) groups. The status of bipolar disorder progression was monitored from the date of depression diagnosis to the end of 2011. Patients with antidepressant-resistant depression were more likely to develop bipolar disorder during the follow-up (hazard ratio [HR]: 2.88, 95% confidence interval [CI]: 2.67-3.09) than those with antidepressant-responsive depression. Furthermore, the group that was additionally resistant to non-SSRIs were at the highest risk of bipolar disorder (HR: 3.02, 95% CI: 2.76-3.29), followed by the group that was only resistant to SSRIs (2.70, 2.44-2.98). Adolescents and young adults with antidepressant-resistant depression, especially those who responded poorly to both SSRIs and SNRIs, were at increased risk of subsequent bipolar disorder compared with those with antidepressant-responsive depression. Further studies are warranted to elucidate the molecular pathomechanisms underlying the resistance to SSRIs and SNRIs and subsequent bipolar disorder.
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Affiliation(s)
- Ju-Wei Hsu
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Psychiatry, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Li-Chi Chen
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Psychiatry, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Psychiatry, General Cheng Hsin Hospital, Taipei, Taiwan
| | - Shih-Jen Tsai
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Psychiatry, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Kai-Lin Huang
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Psychiatry, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ya-Mei Bai
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Psychiatry, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Tung-Ping Su
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Psychiatry, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Psychiatry, General Cheng Hsin Hospital, Taipei, Taiwan
| | - Tzeng-Ji Chen
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Family Medicine, Taipei Veterans General Hospital, Hsinchu Branch, Hsinchu, Taiwan
| | - Mu-Hong Chen
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Psychiatry, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
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Huang Y, Sun P, Wu Z, Guo X, Wu X, Chen J, Yang L, Wu X, Fang Y. Comparison on the clinical features in patients with or without treatment-resistant depression: A National Survey on Symptomatology of Depression report. Psychiatry Res 2023; 319:114972. [PMID: 36434937 DOI: 10.1016/j.psychres.2022.114972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 11/17/2022] [Accepted: 11/19/2022] [Indexed: 11/22/2022]
Abstract
Patients with treatment-resistant depression (TRD) have fewer treatment options and worse prognoses than those without TRD. Although the etiology or pathophysiology of TRD remains unclear, certain clinical variables have been found to be related to its severity and prognosis. Therefore, 1151 patients with recurrent depression were recruited from the National Survey on Symptomatology of Depression (NSSD) and their depressive symptoms were assessed by using the doctor-rating assessment questionnaire. Then, the differences between patients with or without TRD were compared by parametric or nonparametric tests and the risk factors for TRD were explored by logistic regression. The results showed there were differences in clinical variables between patients with and without TRD. Additionally, we found depression with more somatic symptoms had a higher risk for TRD. Further analysis by stepwise logistic regression showed that age, gender, religious belief, drinking habit, the total course of depression, the number of hospitalizations, characteristics of seasonal episode remission, depressed mood, hypersexuality, emotionally incoherent psychotic symptoms, psychomotor agitation, respiratory system symptoms and history of suicide attempts were strongly associated with TRD. So, it is crucial for clinicians to identify these clinical features and adjust treatments timely.
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Affiliation(s)
- Yingying Huang
- Department of Psychiatry and Mental Health, Jining Medical University, Shandong 272002, China; Department 2 of the Elderly, Qingdao Mental Health Center, Shandong 266034, China
| | - Ping Sun
- Department 2 of the Elderly, Qingdao Mental Health Center, Shandong 266034, China; Clinical Research Center & Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
| | - Zhiguo Wu
- Department of Psychiatry, Shanghai Yangpu District Mental Health Center, Shanghai 200093, China; Clinical Research Centre in Mental Health, Shanghai University of Medicine & Health Sciences, Shanghai 200030, China
| | - Xiaoyun Guo
- Clinical Research Center & Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
| | - Xiaohui Wu
- Clinical Research Center & Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
| | - Jun Chen
- Clinical Research Center & Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China; CAS Center for Excellence in Brain Science and Intelligence Technology, Shanghai 200031, China; Shanghai Key Laboratory of Psychotic Disorders, Shanghai 201108, China
| | - Lu Yang
- Clinical Research Center & Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
| | - Xiao Wu
- Department of Bacteriology and Immunology, Beijing Key Laboratory on Drug-Resistant Tuberculosis Research, Beijing Tuberculosis and Thoracic Tumor Research Institute/Beijing Chest Hospital, Capital Medical University, Beijing 101125, China
| | - Yiru Fang
- Clinical Research Center & Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China; CAS Center for Excellence in Brain Science and Intelligence Technology, Shanghai 200031, China; Shanghai Key Laboratory of Psychotic Disorders, Shanghai 201108, China.
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Jiménez-Fernández S, Gurpegui M, Garrote-Rojas D, Gutiérrez-Rojas L, Carretero MD, Correll CU. Oxidative stress parameters and antioxidants in adults with unipolar or bipolar depression versus healthy controls: Systematic review and meta-analysis. J Affect Disord 2022; 314:211-221. [PMID: 35868596 DOI: 10.1016/j.jad.2022.07.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 07/06/2022] [Accepted: 07/09/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND To study differences in oxidative stress markers and antioxidants among patients with bipolar depression (BPD) and unipolar depression (UPD). METHODS Data sources. Electronic MEDLINE/PubMed/Cochrane Library/Scopus/TripDatabase database search until 30/06/2021. STUDY SELECTION Included were articles comparing antioxidant or oxidative stress markers between adults with BPD or UPD and healthy controls (HCs). DATA EXTRACTION Two authors extracted data independently. Random effects meta-analysis, calculating standardized mean differences for results from ≥3 studies. RESULTS Oxidative stress markers reported in 40 studies -1 published repeatedly- (UPD, studies = 30 n = 3072; their HCs, n = 2856; BPD, studies = 11 n = 393; their HCs, n = 540; with 1 study reporting on both UPD and BPD) included thiobarbituric acid reactive substances (TBARS), antioxidant uric acid and antioxidant-enhancing enzymes superoxide dismutase (SOD), catalase (CAT) and glutathione-peroxidase (GPX). Compared with HCs, UPD and BPD were associated with significantly higher levels of TBARS, without differences between UPD and BPD (P = 0.11). Compared with HCs, UPD and BPD did not differ regarding the activity of the CAT (P = 0.28), SOD (P = 0.87) and GPX (P = 0.25) enzymes. However, uric acid levels were significantly higher vs HCs in BPD than in UPD among adult patients (P = 0.004). Results were heterogenous, which, for some parameters, decreased after stratification by the blood source (serum, plasma red blood cells, whole blood). LIMITATIONS The main limitations are the small number of studies/participants in the BPD subgroup, and heterogeneity of the results. SUMMATIONS Both BPD and UPD may be associated with an impaired oxidative stress balance, with significantly higher uric acid levels vs. HCs in UPD than in BPD.
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Affiliation(s)
- Sara Jiménez-Fernández
- Department of Psychiatry and CTS-549 Research Group, Institute of Neurosciences, University of Granada, Granada, Spain; Child and Adolescent Mental Health Unit, Jaén University Hospital, Jaén, Spain.
| | - Manuel Gurpegui
- Department of Psychiatry and CTS-549 Research Group, Institute of Neurosciences, University of Granada, Granada, Spain
| | | | - Luis Gutiérrez-Rojas
- Department of Psychiatry and CTS-549 Research Group, Institute of Neurosciences, University of Granada, Granada, Spain; Psychiatry Service, San Cecilio University Hospital, Granada, Spain
| | - María D Carretero
- Department of Psychiatry and CTS-549 Research Group, Institute of Neurosciences, University of Granada, Granada, Spain
| | - Christoph U Correll
- Department of Psychiatry Research, Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA; Department of Psychiatry and Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA; Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Manhasset, NY, USA; Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin Berlin, Berlin, Germany
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A piece of the puzzle: Does bipolarity partly explain the high prevalence of treatment resistance in depression? Psychiatry Res 2022; 307:114275. [PMID: 34847512 DOI: 10.1016/j.psychres.2021.114275] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 11/01/2021] [Accepted: 11/06/2021] [Indexed: 12/28/2022]
Abstract
In this cross-sectional study we examined whether the prevalence of treatment resistant depression (TRD) can be partly attributed to level of bipolarity. We included data of 201 patients with either episodic depression or TRD, who received treatment for their depression at either an outpatient or 2nd opinion/daytime setting, within a specialised mental healthcare department in the Netherlands. Whether level of TRD, assessed by the 'Dutch Measure for quantification of Treatment Resistance in Depression', can be partly explained by level of bipolarity, assessed by 'the Bipolarity Index', was examined using linear regression. We found no direct association between level of TRD and level of bipolarity, nor did comorbid anxiety disorders obscure an existing association. In this study we found no evidence for overlooked bipolarity contributing to the high prevalence of TRD. If replicated, we could state that additional screening on bipolarity with an instrument such as the 'Bipolarity Index' in the specialised mental health care is unnecessary.
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Rybak YE, Lai KSP, Ramasubbu R, Vila‐Rodriguez F, Blumberger DM, Chan P, Delva N, Giacobbe P, Gosselin C, Kennedy SH, Iskandar H, McInerney S, Ravitz P, Sharma V, Zaretsky A, Burhan AM. Treatment-resistant major depressive disorder: Canadian expert consensus on definition and assessment. Depress Anxiety 2021; 38:456-467. [PMID: 33528865 PMCID: PMC8049072 DOI: 10.1002/da.23135] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 12/14/2020] [Accepted: 12/23/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Treatment-resistant depression (TRD) is a debilitating chronic mental illness that confers increased morbidity and mortality, decreases the quality of life, impairs occupational, social, and offspring development, and translates into increased costs on the healthcare system. The goal of this study is to reach an agreement on the concept, definition, staging model, and assessment of TRD. METHODS This study involved a review of the literature and a modified Delphi process for consensus agreement. The Appraisal of Guidelines for Research & Evaluation II guidelines were followed for the literature appraisal. Literature was assessed for quality and strength of evidence using the grading, assessment, development, and evaluations system. Canadian national experts in depression were invited for the modified Delphi process based on their prior clinical and research expertize. Survey items were considered to have reached a consensus if 80% or more of the experts supported the statement. RESULTS Fourteen Canadian experts were recruited for three rounds of surveys to reach a consensus on a total of 27 items. Experts agreed that a dimensional definition for treatment resistance was a useful concept to describe the heterogeneity of this illness. The use of staging models and clinical scales was recommended in evaluating depression. Risk factors and comorbidities were identified as potential predictors for treatment resistance. CONCLUSIONS TRD is a meaningful concept both for clinical practice and research. An operational definition for TRD will allow for opportunities to improve the validity of predictors and therapeutic options for these patients.
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Affiliation(s)
- Yuri E. Rybak
- Department of PsychiatryWestern UniversityLondonOntarioCanada
| | - Ka S. P. Lai
- Department of PsychiatryWestern UniversityLondonOntarioCanada
| | | | - Fidel Vila‐Rodriguez
- Department of PsychiatryUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | | | - Peter Chan
- Department of PsychiatryUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Nicholas Delva
- Department of PsychiatryQueen's UniversityKingstonOntarioCanada
| | - Peter Giacobbe
- Department of PsychiatryUniversity of TorontoTorontoOntarioCanada
| | - Caroline Gosselin
- Department of PsychiatryUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | | | - Hani Iskandar
- Department of PsychiatryMcGill UniversityMontrealQuebecCanada
| | - Shane McInerney
- Department of PsychiatryUniversity of TorontoTorontoOntarioCanada
| | - Paula Ravitz
- Department of PsychiatryUniversity of TorontoTorontoOntarioCanada
| | - Verinder Sharma
- Department of PsychiatryWestern UniversityLondonOntarioCanada
| | - Ari Zaretsky
- Department of PsychiatryUniversity of TorontoTorontoOntarioCanada
| | - Amer M. Burhan
- Ontario Shores Centre for Mental Health SciencesWhitbyOntarioCanada,Department of PsychiatryUniversity of Toronto Temerty Faculty of MedicineTorontoOntarioCanada
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Does a Positive Response to Lithium Augmentation in Resistant Major Depression Indicate a Bipolar Disorder?: A Long-Term Follow-up Study. J Clin Psychopharmacol 2021; 41:202-204. [PMID: 33587395 DOI: 10.1097/jcp.0000000000001359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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10
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Hu YH, Chen K, Chang IC, Shen CC. Critical Predictors for the Early Detection of Conversion From Unipolar Major Depressive Disorder to Bipolar Disorder: Nationwide Population-Based Retrospective Cohort Study. JMIR Med Inform 2020; 8:e14278. [PMID: 32242821 PMCID: PMC7165312 DOI: 10.2196/14278] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 12/26/2019] [Accepted: 02/09/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Unipolar major depressive disorder (MDD) and bipolar disorder are two major mood disorders. The two disorders have different treatment strategies and prognoses. However, bipolar disorder may begin with depression and could be diagnosed as MDD in the initial stage, which may later contribute to treatment failure. Previous studies indicated that a high proportion of patients diagnosed with MDD will develop bipolar disorder over time. This kind of hidden bipolar disorder may contribute to the treatment resistance observed in patients with MDD. OBJECTIVE In this population-based study, our aim was to investigate the rate and risk factors of a diagnostic change from unipolar MDD to bipolar disorder during a 10-year follow-up. Furthermore, a risk stratification model was developed for MDD-to-bipolar disorder conversion. METHODS We conducted a retrospective cohort study involving patients who were newly diagnosed with MDD between January 1, 2000, and December 31, 2004, by using the Taiwan National Health Insurance Research Database. All patients with depression were observed until (1) diagnosis of bipolar disorder by a psychiatrist, (2) death, or (3) December 31, 2013. All patients with depression were divided into the following two groups, according to whether bipolar disorder was diagnosed during the follow-up period: converted group and nonconverted group. Six groups of variables within the first 6 months of enrollment, including personal characteristics, physical comorbidities, psychiatric comorbidities, health care usage behaviors, disorder severity, and psychotropic use, were extracted and were included in a classification and regression tree (CART) analysis to generate a risk stratification model for MDD-to-bipolar disorder conversion. RESULTS Our study enrolled 2820 patients with MDD. During the follow-up period, 536 patients were diagnosed with bipolar disorder (conversion rate=19.0%). The CART method identified five variables (kinds of antipsychotics used within the first 6 months of enrollment, kinds of antidepressants used within the first 6 months of enrollment, total psychiatric outpatient visits, kinds of benzodiazepines used within one visit, and use of mood stabilizers) as significant predictors of the risk of bipolar disorder conversion. This risk CART was able to stratify patients into high-, medium-, and low-risk groups with regard to bipolar disorder conversion. In the high-risk group, 61.5%-100% of patients with depression eventually developed bipolar disorder. On the other hand, in the low-risk group, only 6.4%-14.3% of patients with depression developed bipolar disorder. CONCLUSIONS The CART method identified five variables as significant predictors of bipolar disorder conversion. In a simple two- to four-step process, these variables permit the identification of patients with low, intermediate, or high risk of bipolar disorder conversion. The developed model can be applied to routine clinical practice for the early diagnosis of bipolar disorder.
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Affiliation(s)
- Ya-Han Hu
- Center for Innovative Research on Aging Society, National Chung Cheng University, Chiayi County, Taiwan.,MOST AI Biomedical Research Center, National Cheng Kung University, Tainan City, Taiwan.,Department of Information Management, National Central University, Taoyuan City, Taiwan
| | - Kuanchin Chen
- Department of Business Information Systems, Western Michigan University, Kalamazoo, MI, United States
| | - I-Chiu Chang
- Department of Information Management and Institute of Healthcare Information Management, National Chung Cheng University, Chiayi County, Taiwan
| | - Cheng-Che Shen
- Department of Information Management and Institute of Healthcare Information Management, National Chung Cheng University, Chiayi County, Taiwan.,Department of Psychiatry, Chiayi Branch, Taichung Veterans General Hospital, Chiayi City, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
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11
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Affiliation(s)
- Verinder Sharma
- Department of Psychiatry, University of Western Ontario & Parkwood Institute, London, Canada
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12
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Hede V, Favre S, Aubry JM, Richard-Lepouriel H. Bipolar spectrum disorder: What evidence for pharmacological treatment? A systematic review. Psychiatry Res 2019; 282:112627. [PMID: 31677696 DOI: 10.1016/j.psychres.2019.112627] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 10/17/2019] [Accepted: 10/19/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND OBJECTIVES Bipolar spectrum disorder (BSD) is an extended concept of bipolar disorder (BD) that includes conditions that do not fulfill the criteria. There is no recommendation today about its treatment. We reviewed relevant literature focusing on pharmacological treatments, looking for high-strength evidence leading to guidelines. METHODOLOGY A literature search was conducted using MedLine / PubMed database and Google Scholar up to September 2018. Search words were related to BSD and pharmacological treatment. RESULTS The literature search yielded 621 articles. Out of these, 35 articles met our selection criteria. There was limited high quality data. Only one randomized control trial (RCT) and one randomized open label trial were found. Most studies used different definition of BSD. CONCLUSIONS There is a considerable lack of data and no evidence supporting efficacy of pharmacological treatment for BSD. There is a need for a consensus on the definition of BSD and more evidence studies to evaluate drug's effectiveness in this condition.
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Affiliation(s)
- Vincent Hede
- Mood disorder unit, Psychiatric specialties service, Geneva University Hospital, Rue de Lausanne 20, CH-1201 Geneva, Switzerland.
| | - Sophie Favre
- Mood disorder unit, Psychiatric specialties service, Geneva University Hospital, Rue de Lausanne 20, CH-1201 Geneva, Switzerland.
| | - Jean-Michel Aubry
- Mood disorder unit, Psychiatric specialties service, Geneva University Hospital, Rue de Lausanne 20, CH-1201 Geneva, Switzerland; Department of Psychiatry, University of Geneva, Geneva, Switzerland.
| | - Hélène Richard-Lepouriel
- Mood disorder unit, Psychiatric specialties service, Geneva University Hospital, Rue de Lausanne 20, CH-1201 Geneva, Switzerland.
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13
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Maalouf F, Bakhti R, Tamim H, Shehab S, Brent D. Neurocognitive Predictors of Clinical Improvement in Selective Serotonin Reuptake Inhibitor-Treated Adolescents with Major Depressive Disorder. J Child Adolesc Psychopharmacol 2019; 28:387-394. [PMID: 29652529 DOI: 10.1089/cap.2017.0105] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Numerous studies have suggested cognitive deficits as consistently associated with adolescent depression. No study to date, however, has assessed neurocognitive predictors of selective serotonin reuptake inhibitor (SSRI) treatment response in adolescents with depression. This study examined neurocognitive tasks at baseline as predictors of clinical improvement with SSRI treatment (fluoxetine) at week 6 and 12 in an adolescent population. METHODS Adolescents with depression were recruited from a child and adolescent psychiatry outpatient clinic at a university medical center. Twenty-four adolescents (mean age 14.8 years) with Major Depressive Disorder completed tasks of the Cambridge Neuropsychological Test Automated Battery, including visual memory, executive functioning, sustained attention, and impulsivity. Depression severity, measured by the Children's Depression Rating Scale-Revised (CDRS-R), was assessed at week 6 and 12 and clinical improvement was defined as percentage (%) change in CDRS-R from baseline. RESULTS Clinical improvement is noted at both week 6 (mean % change in CDRS-R [M] = 46.8, standard deviation [SD] = 51.9) and week 12 (M = 87.9, SD = 57.2). Results reveal that less difficulty in sustained attention (p = 0.02), lower impulsivity (p = 0.00), and better planning (p = 0.04) at baseline were predictors of greater clinical improvement at week 6. Lower impulsivity at baseline remained significantly predictive of clinical improvement at week 12 (p = 0.01). CONCLUSION Neurocognitive assessments could potentially help identify a subset of depressed adolescents who may not respond to conventional SSRI treatment and who may be better candidates for alternative or augmentation treatments.
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Affiliation(s)
- Fadi Maalouf
- 1 Department of Psychiatry, Faculty of Medicine, American University of Beirut , Beirut, Lebanon
| | - Rinad Bakhti
- 1 Department of Psychiatry, Faculty of Medicine, American University of Beirut , Beirut, Lebanon
| | - Hani Tamim
- 2 Department of Internal Medicine, American University of Beirut Medical Center , Beirut, Lebanon
| | - Safa Shehab
- 1 Department of Psychiatry, Faculty of Medicine, American University of Beirut , Beirut, Lebanon
| | - David Brent
- 3 Western Psychiatric Institute and Clinic, University of Pittsburgh , Pittsburgh, Pennsylvania
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14
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Zimmerman M, Chelminski I, Dalrymple K, Martin J. Screening for Bipolar Disorder and Finding Borderline Personality Disorder: A Replication and Extension. J Pers Disord 2019; 33:533-543. [PMID: 30036171 DOI: 10.1521/pedi_2018_32_357] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The authors' group previously reported that patients who screened positive on the Mood Disorders Questionnaire (MDQ), the most frequently studied screening scale for bipolar disorder, were as likely to be diagnosed with borderline personality disorder (BPD) as with bipolar disorder. A limitation of that study was that the authors examined the performance of the MDQ in patients presenting for various psychiatric disorders, including depression. The recognition of bipolar disorder and its differential diagnosis with BPD is of greatest clinical relevance in depressed patients. In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project, the authors attempted to replicate their initial findings in a new sample of psychiatric outpatients, and they also examined the performance of the MDQ in depressed patients. The results of the present study were consistent with the original report, thereby indicating that the MDQ is not effective in helping distinguish bipolar disorder from BPD.
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Affiliation(s)
| | | | | | - Jacob Martin
- Department of Psychiatry and Human Behavior, Brown Medical School, and the Department of Psychiatry, Rhode Island Hospital, Providence, Rhode Island
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15
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Dvorak J, Hilke M, Trettin M, Wenzler S, Hagen M, Ghirmai N, Müller M, Kraft D, Reif A, Oertel V. Aberrant brain network topology in fronto-limbic circuitry differentiates euthymic bipolar disorder from recurrent major depressive disorder. Brain Behav 2019; 9:e01257. [PMID: 31066228 PMCID: PMC6576154 DOI: 10.1002/brb3.1257] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 01/19/2019] [Accepted: 02/10/2019] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Previous studies have established graph theoretical analysis of functional network connectivity (FNC) as a potential tool to detect neurobiological underpinnings of psychiatric disorders. Despite the promising outcomes in studies that examined FNC aberrancies in bipolar disorder (BD) and major depressive disorder (MDD), there is still a lack of research comparing both mood disorders, especially in a nondepressed state. In this study, we used graph theoretical network analysis to compare brain network properties of euthymic BD, euthymic MDD and healthy controls (HC) to evaluate whether these groups showed distinct features in FNC. METHODS We collected resting-state functional magnetic resonance imaging (fMRI) data from 20 BD patients, 15 patients with recurrent MDD as well as 30 age- and gender-matched HC. Graph theoretical analyses were then applied to investigate functional brain networks on a global and regional network level. RESULTS Global network analysis revealed a significantly higher mean global clustering coefficient in BD compared to HC. We further detected frontal, temporal and subcortical nodes in emotion regulation areas such as the limbic system and associated regions exhibiting significant differences in network integration and segregation in BD compared to MDD patients and HC. Participants with MDD and HC only differed in frontal and insular network centrality. CONCLUSION In conclusion, our findings indicate that a significantly altered brain network topology in the limbic system might be a trait marker specific to BD. Brain network analysis in these regions may therefore be used to differentiate euthymic BD not only from HC but also from patients with MDD.
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Affiliation(s)
- Jannis Dvorak
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe University Frankfurt, Frankfurt, Germany
| | - Marietheres Hilke
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe University Frankfurt, Frankfurt, Germany.,Brain Imaging Center (BIC), Goethe University Frankfurt, Frankfurt, Germany
| | - Marco Trettin
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe University Frankfurt, Frankfurt, Germany
| | - Sofia Wenzler
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe University Frankfurt, Frankfurt, Germany
| | - Marleen Hagen
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe University Frankfurt, Frankfurt, Germany
| | - Naddy Ghirmai
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe University Frankfurt, Frankfurt, Germany
| | - Maximilian Müller
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe University Frankfurt, Frankfurt, Germany.,Brain Imaging Center (BIC), Goethe University Frankfurt, Frankfurt, Germany
| | - Dominik Kraft
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe University Frankfurt, Frankfurt, Germany.,Brain Imaging Center (BIC), Goethe University Frankfurt, Frankfurt, Germany
| | - Andreas Reif
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe University Frankfurt, Frankfurt, Germany
| | - Viola Oertel
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe University Frankfurt, Frankfurt, Germany
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16
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Rhee TG, Rosenheck RA. Psychotropic polypharmacy reconsidered: Between-class polypharmacy in the context of multimorbidity in the treatment of depressive disorders. J Affect Disord 2019; 252:450-457. [PMID: 31004825 PMCID: PMC6520147 DOI: 10.1016/j.jad.2019.04.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 02/26/2019] [Accepted: 04/07/2019] [Indexed: 01/22/2023]
Abstract
OBJECTIVES Both psychiatric polypharmacy and multimorbidity are common in depressed adults. We examine recent patterns of psychotropic polypharmacy with attention to concurrent multimorbidity in the treatment of depressive disorders in outpatient psychiatric care. METHODS Data from the 2006-2015 National Ambulatory Medical Care Survey offer nationally representative samples of office-based psychiatric care in adults with depressive disorders (ICD-9-CM codes 296.20-296.26, 296.30-296.36, 300.4, 311, and 301.10-301.13) (n = 6,685 unweighted). These data allowed estimation of the prevalence of polypharmacy (within-class, between-class, and both) involving four major psychotropic classes: antidepressants, antipsychotics, mood-stabilizers, and sedative-hypnotics. We further evaluated the proportion of within-class and between-class psychotropic prescription combinations that were potentially justifiable, taking FDA-approved indications and multimorbidity into consideration. RESULTS Prescribing two or more psychotropic medications for depressed adults remained substantial and stable ranging from 59.0% in 2006-2007 to 58.0% in 2014-2015. The most common within-class polypharmacy types were: antidepressants (22.7%) and sedative-hypnotics (14.8%). The most common between-class polypharmacy types were: an antidepressant and a sedative-hypnotic (30.7%), an antidepressant and an antipsychotic (16.4%), and an antipsychotic and a sedative-hypnotic (9.0%). In visits in which between-class psychotropics were prescribed, 53.9% were potentially justified by FDA-approved augmentation and/or adjunctive treatment strategies or by psychiatric multimorbidities. CONCLUSION Psychotropic polypharmacy affects more than half of depressed adults. Between-class polypharmacy is the most common pattern and in over 50% of instances may be justified by augmentation strategies or considerations of psychiatric multimorbidity. Future research is needed to address effectiveness, safety, and cost-effectiveness of polypharmaceutical care for depression, especially those occurring with psychiatric co-morbididities.
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Affiliation(s)
- Taeho Greg Rhee
- Department of Community Medicine and Health Care, School of Medicine, University of Connecticut, 263 Farmington Avenue, Farmington, CT 06030, United States; Department of Psychiatry, School of Medicine, Yale University, New Haven, CT, United States; Veterans Affairs (VA) New England Mental Illness Research, Education and Clinical Centers (MIRECC), West Haven, CT, United States; Veterans Affairs (VA) Connecticut Healthcare System, West Haven, CT, United States.
| | - Robert A. Rosenheck
- Veterans Affairs (VA) New England Mental Illness Research, Education and Clinical Centers (MIRECC), West Haven, CT,Veterans Affairs (VA) Connecticut Healthcare System, West Haven, CT
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17
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A systematic review on neuropsychological function in bipolar disorders type I and II and subthreshold bipolar disorders-something to think about. CNS Spectr 2019; 24:127-143. [PMID: 30859934 DOI: 10.1017/s1092852918001463] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Neuropsychological dysfunction is a well-established finding in individuals with bipolar disorder type I (BP-I), even during euthymic periods; however, it is less clear whether this also pertains to bipolar disorder type II (BP-II) or those with subthreshold states (SBP; subthreshold bipolar disorder), such as bipolar not otherwise specified (BP-NOS). Herein, we compare the literature regarding neuropsychological performance in BP-II vs BP-I to determine the extent of relative impairment, and we present and review all related studies on cognition in SBP. After systematically searching PubMed, Medline, PsycINFO, and The Cochrane Library, we found 17 papers that comprise all the published studies relevant for this review. The areas that are consistently found to be impaired in BP are executive function, verbal memory, visual spatial working memory, and attention. More studies than not show no significant difference between BP-I and BP-II, particularly in euthymic samples. Preliminary evidence suggests that patients experiencing major depressive episodes who also meet criteria for SBP show similar profiles to BP-II; however, these results pertain only to a depressed sample. SBP were found to perform significantly better than both MDD and healthy controls in a euthymic sample. A consensus on mood state, patient selection, and neuropsychological testing needs to be agreed on for future research. Furthermore, no studies have used the most recent DSM-5 criteria for SBP; future studies should address this. Finally, the underlying bases of cognitive dysfunction in these diagnostic groups need to be further investigated. We suggest recommendations on all of the above current research challenges.
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18
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Bipolar features in major depressive disorder: Results from the Iranian mental health survey (IranMHS). J Affect Disord 2018; 241:319-324. [PMID: 30142591 DOI: 10.1016/j.jad.2018.08.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 07/11/2018] [Accepted: 08/07/2018] [Indexed: 01/26/2023]
Abstract
BACKGROUND Past research suggests that individuals suffering from depressive disorders with bipolar features might have different clinical outcomes resembling bipolar disorders. The objectives of this study are to determine the prevalence of bipolar features among individuals meeting the criteria for 12-month major depressive disorder (MDD) in the Iranian population and to examine the demographic and clinical characteristics associated with these features. METHODS Data were drawn from the Iranian Mental Health Survey (IranMHS), a representative household survey of the Iranian population aged 15-64 years. The study sample consisted of all individuals with a 12-month MDD (n = 1014) ascertained by the Composite International Diagnostic Interview (CIDI 2.1) without a lifetime history of bipolar I or II disorders. Mood Disorder Questionnaire (MDQ) was used to screen for the lifetime history of bipolar features among participants with MDD. RESULTS Among participants meeting the 12-month MDD criteria, 22.1% (95% CI: 19.6-24.7) had a lifetime history of bipolar features. Compared with those without these features, participants with bipolar features had higher odds of endorsing suicidal ideations and suicide attempts, comorbid anxiety and substance use disorders, severe impairment, history of psychotic symptoms, some features of atypical depression and fewer depressive symptoms. Associations with comorbid anxiety disorders [Odds Ratio (OR) = 1.43; 95% confidence interval (CI): 1.00-2.03] and history of psychotic symptoms (OR = 2.63 95% CI: 1.81-3.81) persisted in multivariable models. LIMITATION Relying on self-reports of lifetime bipolar symptoms which is open to recall bias, and cross-sectional study design which limits interpretation of outcome and course of MDD are two major limitations of this study. CONCLUSION The presence of bipolar features is associated with a distinct demographic and clinical profile in MDD. Identifying these cases would enhance the homogeneity of the depressive disorder phenotype in general population surveys. Identifying MDD patients with these features has potential clinical implications.
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19
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Haroon E, Daguanno AW, Woolwine BJ, Goldsmith DR, Baer WM, Wommack EC, Felger JC, Miller AH. Antidepressant treatment resistance is associated with increased inflammatory markers in patients with major depressive disorder. Psychoneuroendocrinology 2018; 95:43-49. [PMID: 29800779 PMCID: PMC6427066 DOI: 10.1016/j.psyneuen.2018.05.026] [Citation(s) in RCA: 157] [Impact Index Per Article: 26.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 05/08/2018] [Accepted: 05/18/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND One third of patients with major depressive disorder (MDD) fail to respond to currently available antidepressant medications. Inflammation may contribute to treatment non-response through effects on neurotransmitter systems relevant to antidepressant efficacy. In post-hoc analyses, increased concentrations of inflammatory markers prior to treatment predict poor antidepressant response. However, limited data exists on whether depressed patients with multiple failed treatment trials in their current episode of depression exhibit increased inflammation. METHODS Plasma concentrations of inflammatory markers were measured in unmedicated, medically stable patients with MDD (n = 98) and varying numbers of adequate antidepressant treatment trials in the current depressive episode as measured by the Massachusetts General Hospital Antidepressant Treatment Response Questionnaire. Covariates including age, sex, race, education, body mass index (BMI) and severity of depression were included in statistical models where indicated. RESULTS A significant relationship was found between number of failed treatment trials and tumor necrosis factor (TNF), soluble TNF receptor 2 (sTNF-R2) and interleukin (IL)-6 (all p < 0.05 in multivariate analyses). Post hoc pairwise comparisons with correction for multiple testing revealed that patients with 3 or more failed trials in the current episode had significantly higher plasma TNF, sTNF-R2 and IL-6 compared to individuals with 0 or 1 trial (all p < 0.05). High sensitivity c-reactive protein was also associated with a greater number of treatment failures, but only in models with BMI excluded. CONCLUSIONS Measuring inflammatory markers and targeting inflammation or its downstream mediators may be relevant for depressed patients with multiple failed antidepressant treatment trials in their current depressive episode.
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Affiliation(s)
| | | | | | | | | | | | | | - Andrew H. Miller
- Corresponding author at: Emory Clinic Building B, Suite B5100, 1365-B Clifton Rd., Atlanta, GA, 30322 United States. (A.H. Miller)
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20
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Savitz JB, Teague TK, Misaki M, Macaluso M, Wurfel BE, Meyer M, Drevets D, Yates W, Gleason O, Drevets WC, Preskorn SH. Treatment of bipolar depression with minocycline and/or aspirin: an adaptive, 2×2 double-blind, randomized, placebo-controlled, phase IIA clinical trial. Transl Psychiatry 2018; 8:27. [PMID: 29362444 PMCID: PMC5802452 DOI: 10.1038/s41398-017-0073-7] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Accepted: 11/01/2017] [Indexed: 12/27/2022] Open
Abstract
Given evidence of chronic inflammation in bipolar disorder (BD), we tested the efficacy of aspirin and minocycline as augmentation therapy for bipolar depression. Ninety-nine depressed outpatients with BD were enrolled in a 6 week, double-blind, placebo-controlled trial, and randomized to one of four groups: active minocycline (100 mg b.i.d.) + active aspirin (81 mg b.i.d.) (M + A); active minocycline + placebo aspirin (M + P); placebo-minocycline + active aspirin (A + P); and placebo-minocycline + placebo aspirin (P + P). A blinded interim analysis mid-way through the study led to the dropping of the M + P and A + P arms from further enrollment giving numbers per group who were included in the final analysis of: 30 (M + A), 18 (M + P), 19 (A + P), and 28 (P + P). When the study started, there were three primary outcome measures. Based on the results of the interim analysis, the primary outcome variable, response to treatment as defined by >50% decrease in Montgomery-Äsberg Depression Rating Scale (MADRS) score was maintained. The other two (i.e., the change in mean MADRS score from baseline to end of study and the remission rate, with remission being defined as a score of <11 on the MADRS) were reduced to exploratory outcome measures because the interim analysis indicated that the study was adequately powered to test differences in response rate but not the mean change in MADRS scores or remission rates. CRP and IL-6 were assayed to measure inflammation. Urinary thromboxane B2 (11-D-TXB2) concentrations, which were significantly increased at baseline in the combined BD sample (n = 90) vs. a healthy control group (n = 27), served as an indirect marker of cyclooxygenase (COX) activity. In a two-group analysis, the M + A group showed a greater response rate than the P + P group (p(one-tailed) = 0.034, OR = 2.93, NNT = 4.7). When all four arms were included in the analysis, there was a main effect of aspirin on treatment response that was driven by both the M + A and the A + P groups (p(two-tailed) = 0.019, OR = 3.67, NNT = 4.0). Additionally, there was a significant 3-way interaction between aspirin, minocycline, and IL-6, indicating that response to minocycline was significantly greater in participants in the M + P group with higher IL-6 concentrations. Further, participants in the M + P group who responded to treatment had significantly greater decreases in IL-6 levels between baseline and visit 7 vs. non-responders. Regarding the exploratory outcomes, there was a main effect for aspirin on the remission rate (χ12 = 4.14, p(2t) = 0.04, OR = 2.52, NNT = 8.0). There was no significant main effect of aspirin or minocycline on the mean change in MADRS score across visits. Aspirin and minocycline may be efficacious adjunctive treatments for bipolar depression. Given their potential import, additional studies to confirm and extend these findings are warranted.
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Affiliation(s)
- Jonathan B. Savitz
- 0000 0004 0512 8863grid.417423.7Laureate Institute for Brain Research, Tulsa, OK USA ,0000 0001 2160 264Xgrid.267360.6Faculty of Community Medicine, University of Tulsa, Tulsa, OK USA
| | - T. Kent Teague
- 0000 0004 0447 0018grid.266900.bDepartment of Surgery, University of Oklahoma College of Medicine, Tulsa, OK USA ,0000 0004 0447 0018grid.266900.bDepartment of Psychiatry, University of Oklahoma College of Medicine, Tulsa, OK USA ,0000 0004 0447 0018grid.266900.bDepartment of Pharmaceutical Sciences, University of Oklahoma College of Pharmacy, Tulsa, OK USA ,0000 0004 0542 825Xgrid.261367.7Department of Biochemistry and Microbiology, Oklahoma State University Center for Health Sciences, Tulsa, OK USA
| | - Masaya Misaki
- 0000 0004 0512 8863grid.417423.7Laureate Institute for Brain Research, Tulsa, OK USA
| | - Matt Macaluso
- 0000 0001 2106 0692grid.266515.3Department of Psychiatry and Clinical Trials Unit, University of Kansas School of Medicine, Wichita, Kansas USA
| | - Brent E. Wurfel
- 0000 0004 0512 8863grid.417423.7Laureate Institute for Brain Research, Tulsa, OK USA
| | - Matt Meyer
- 0000 0004 0512 8863grid.417423.7Laureate Institute for Brain Research, Tulsa, OK USA
| | - Douglas Drevets
- 0000 0001 2179 3618grid.266902.9Department of Medicine, Oklahoma University Health Sciences Center, and Oklahoma City VAMC, Oklahoma City, Oklahoma USA
| | - William Yates
- 0000 0004 0512 8863grid.417423.7Laureate Institute for Brain Research, Tulsa, OK USA
| | - Ondria Gleason
- 0000 0004 0447 0018grid.266900.bDepartment of Psychiatry, University of Oklahoma College of Medicine, Tulsa, OK USA
| | - Wayne C. Drevets
- 0000 0004 0512 8863grid.417423.7Laureate Institute for Brain Research, Tulsa, OK USA ,grid.417429.dJanssen Research and Development, LLC of Johnson and Johnson, Inc., Titusville, NJ USA
| | - Sheldon H. Preskorn
- 0000 0004 0512 8863grid.417423.7Laureate Institute for Brain Research, Tulsa, OK USA ,0000 0001 2106 0692grid.266515.3Department of Psychiatry and Clinical Trials Unit, University of Kansas School of Medicine, Wichita, Kansas USA
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21
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Dinsdale NL, Crespi BJ. Revisiting the wandering womb: Oxytocin in endometriosis and bipolar disorder. Horm Behav 2017; 96:69-83. [PMID: 28919554 DOI: 10.1016/j.yhbeh.2017.09.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 09/07/2017] [Accepted: 09/09/2017] [Indexed: 12/23/2022]
Abstract
Hippocrates attributed women's high emotionality - hysteria - to a 'wandering womb'. Although hysteria diagnoses were abandoned along with the notion that displaced wombs cause emotional disturbance, recent research suggests that elevated levels of oxytocin occur in both bipolar disorder and endometriosis, a gynecological condition involving migration of endometrial tissue beyond the uterus. We propose and evaluate the hypothesis that elevated oxytocinergic system activity jointly contributes to bipolar disorder and endometriosis. First, we provide relevant background on endometriosis and bipolar disorder, and then we examine evidence for comorbidity between these conditions. We next: (1) review oxytocin's associations with personality traits, especially extraversion and openness, and how they overlap with bipolar spectrum traits; (2) describe evidence for higher oxytocinergic activity in both endometriosis and bipolar disorder; (3) examine altered hypothalamic-pituitary-gonadal axis functioning in both conditions; (4) describe data showing that medications that treat one condition can improve symptoms of the other; (5) discuss fitness-related impacts of endometriosis and bipolar disorder; and (6) review a pair of conditions, polycystic ovary syndrome and autism, that show evidence of involving reduced oxytocinergic activity, in direct contrast to endometriosis and bipolar disorder. Considered together, the bipolar spectrum and endometriosis appear to involve dysregulated high extremes of normally adaptive pleiotropy in the female oxytocin system, whereby elevated levels of oxytocinergic activity coordinate outgoing sociality with heightened fertility, apparently characterizing, overall, a faster life history. These findings should prompt a re-examination of how mind-body interactions, and the pleiotropic endocrine systems that underlie them, contribute to health and disease.
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Affiliation(s)
- Natalie L Dinsdale
- Department of Biological Sciences, Simon Fraser University, 8888 University Drive, Burnaby V5A 1S6, BC, Canada; Department of Psychology, 9 Campus Drive, 154 Arts, University of Saskatchewan, Saskatoon S7N 5A5, SK, Canada.
| | - Bernard J Crespi
- Department of Biological Sciences, Simon Fraser University, 8888 University Drive, Burnaby V5A 1S6, BC, Canada.
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Singh S, Scouller P, Smith DJ. Evaluation of the 13-item Hypomania Checklist and a brief 3-item manic features questionnaire in primary care. BJPsych Bull 2017; 41:187-191. [PMID: 28811911 PMCID: PMC5537571 DOI: 10.1192/pb.bp.116.054577] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Aims and method The mean delay for bipolar disorder diagnosis is 10 years. Identification of patients with previous hypomania is challenging, sometimes resulting in misdiagnosis. The aims of this study were: (a) to estimate the proportion of primary care patients with depression currently taking antidepressants who have undiagnosed bipolar disorder and (b) to compare a brief 3-item manic features questionnaire with the Hypomania Checklist (HCL-13). The sample comprised patients with a recorded diagnosis of depression, either on long-term antidepressant therapy or with previous multiple courses of antidepressants. Results Of 149 participants assessed, 24 (16.1%) satisfied criteria for bipolar disorder. Areas under the curve (AUC) for the 3-item questionnaire and the HCL-13 were similar (0.79 and 0.72, respectively) but positive predictive values (PPV) were low. Clinical implications Bipolar disorder may be underdiagnosed in primary care. A 3-item questionnaire could be used by general practitioners to screen for bipolar disorder in their patients with depression.
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Affiliation(s)
- Sukhmeet Singh
- University of Glasgow, Glasgow, UK.,NHS Greater Glasgow and Clyde, UK
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23
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Yrondi A, Bennabi D, Haffen E, Garnier M, Bellivier F, Bourgerol T, Camus V, D'Amato T, Doumy O, Haesebaert F, Holtzmann J, Lançon C, Vignaud P, Moliere F, Nieto I, Richieri RM, Domenech P, Rabu C, Mallet L, Yon L, Schmitt L, Stephan F, Vaiva G, Walter M, Llorca PM, Courtet P, Leboyer M, El-Hage W, Aouizerate B. Significant Need for a French Network of Expert Centers Enabling a Better Characterization and Management of Treatment-Resistant Depression (Fondation FondaMental). Front Psychiatry 2017; 8:244. [PMID: 29225582 PMCID: PMC5706526 DOI: 10.3389/fpsyt.2017.00244] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 11/06/2017] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Major depression is characterized by (i) a high lifetime prevalence of 16-17% in the general population; (ii) a high frequency of treatment resistance in around 20-30% of cases; (iii) a recurrent or chronic course; (iv) a negative impact on the general functioning and quality of life; and (v) a high level of comorbidity with various psychiatric and non-psychiatric disorders, high occurrence of completed suicide, significant burden along with the personal, societal, and economic costs. In this context, there is an important need for the development of a network of expert centers for treatment-resistant depression (TRD), as performed under the leadership of the Fondation FondaMental. METHODS The principal mission of this national network is to establish a genuine prevention, screening, and diagnosis policy for TRD to offer a systematic, comprehensive, longitudinal, and multidimensional evaluation of cases. A shared electronic medical file is used referring to a common exhaustive and standardized set of assessment tools exploring psychiatric, non-psychiatric, metabolic, biological, and cognitive dimensions of TRD. This is paralleled by a medico-economic evaluation to examine the global economic burden of the disease and related health-care resource utilization. In addition, an integrated biobank has been built by the collection of serum and DNA samples for the measurement of several biomarkers that could further be associated with the treatment resistance in the recruited depressed patients. A French observational long-term follow-up cohort study is currently in progress enabling the extensive assessment of resistant depressed patients. In those unresponsive cases, each expert center proposes relevant therapeutic options that are classically aligned to the international guidelines referring to recognized scientific societies. DISCUSSION This approach is expected to improve the overall clinical assessments and to provide evidence-based information to those clinicians most closely involved in the management of TRD thereby facilitating treatment decisions and choice in everyday clinical practice. This could contribute to significantly improve the poor prognosis, the relapsing course, daily functioning and heavy burden of TRD. Moreover, the newly created French network of expert centers for TRD will be particularly helpful for a better characterization of sociodemographic, clinical, neuropsychological, and biological markers of treatment resistance required for the further development of personalized therapeutic strategies in TRD.
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Affiliation(s)
- Antoine Yrondi
- Service de Psychiatrie et de Psychologie Médicale de l'adulte, Centre Expert Dépression Résistante FondaMental, CHRU de Toulouse, Hôpital Purpan, Toulouse, France
| | - Djamila Bennabi
- Service de Psychiatrie clinique, Centre Expert Dépression Résistante FondaMental, EA 481 Neurosciences, Université de Bourgogne Franche Comté, Besançon, France
| | - Emmanuel Haffen
- Service de Psychiatrie clinique, Centre Expert Dépression Résistante FondaMental, Centre Investigation Clinique 1431-INSERM, EA 481 Neurosciences, Université de Bourgogne Franche Comté, Besançon, France
| | - Marion Garnier
- Service de Psychiatrie de l'adulte B, Centre Expert Dépression Résistante FondaMental, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - Frank Bellivier
- Service de Psychiatrie adulte, Centre Expert Dépression Résistante FondaMental, Hôpital Fernand-Widal, Paris, France
| | - Thierry Bourgerol
- Service de Psychiatrie de l'adulte, CS 10217, Centre Expert Dépression Résistante FondaMental, CHU de Grenoble, Hôpital Nord, Grenoble, France
| | - Vincent Camus
- Clinique Psychiatrique Universitaire, Centre Expert Dépression Résistante FondaMental, Inserm U1253 imaging and Brain:iBrain, CHRU de Tours, Tours, France
| | - Thierry D'Amato
- Service Universitaire de Psychiatrie adulte, Centre Expert Dépression Résistante FondaMental, Centre Hospitalier Le Vinatier, Bron cedex, France
| | - Olivier Doumy
- Pôle de Psychiatrie Générale et Universitaire, Centre Expert Dépression Résistante FondaMental, CH Charles Perrens, Bordeaux, France
| | - Frédéric Haesebaert
- Service Universitaire de Psychiatrie adulte, Centre Expert Dépression Résistante FondaMental, Centre Hospitalier Le Vinatier, Bron cedex, France
| | - Jérôme Holtzmann
- Service de Psychiatrie de l'adulte, CS 10217, Centre Expert Dépression Résistante FondaMental, CHU de Grenoble, Hôpital Nord, Grenoble, France
| | - Christophe Lançon
- Pôle Psychiatrie, Centre Expert Dépression Résistante FondaMental, CHU La Conception, Marseille, France
| | - Philippe Vignaud
- Service Universitaire de Psychiatrie adulte, Centre Expert Dépression Résistante FondaMental, Centre Hospitalier Le Vinatier, Bron cedex, France
| | - Fanny Moliere
- Département des Urgences et Post-Urgences Psychiatriques, Centre Expert Dépression Résistante FondaMental, CHRU Lapeyronie, Montpellier, France
| | - Isabel Nieto
- Service de Psychiatrie adulte, Centre Expert Dépression Résistante FondaMental, Hôpital Fernand-Widal, Paris, France
| | - Raphaëlle Marie Richieri
- Pôle Psychiatrie, Centre Expert Dépression Résistante FondaMental, CHU La Conception, Marseille, France
| | - Philippe Domenech
- Pôle de Psychiatrie des Hôpitaux Universitaires, Centre Expert Dépression Résistante FondaMental, Hôpital Henri Mondor, Créteil, France
| | - Corentin Rabu
- Pôle de Psychiatrie des Hôpitaux Universitaires, Centre Expert Dépression Résistante FondaMental, Hôpital Henri Mondor, Créteil, France
| | - Luc Mallet
- Pôle de Psychiatrie des Hôpitaux Universitaires, Centre Expert Dépression Résistante FondaMental, Hôpital Henri Mondor, Créteil, France
| | - Liova Yon
- Pôle de Psychiatrie des Hôpitaux Universitaires, Centre Expert Dépression Résistante FondaMental, Hôpital Henri Mondor, Créteil, France
| | - Laurent Schmitt
- Service de Psychiatrie et de Psychologie Médicale de l'adulte, Centre Expert Dépression Résistante FondaMental, CHRU de Toulouse, Hôpital Purpan, Toulouse, France
| | - Florian Stephan
- Service de Psychiatrie de l'adulte, Centre Expert Dépression Résistante FondaMental, CHU de Brest, Hôpital de Bohars, Bohars, France
| | - Guillaume Vaiva
- Service de Psychiatrie adulte, Centre Expert Dépression Résistante FondaMental, CHRU de Lille, Hôpital Fontan 1, Lille, France
| | - Michel Walter
- Service de Psychiatrie de l'adulte, Centre Expert Dépression Résistante FondaMental, CHU de Brest, Hôpital de Bohars, Bohars, France
| | - Pierre-Michel Llorca
- Service de Psychiatrie de l'adulte B, Centre Expert Dépression Résistante FondaMental, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - Philippe Courtet
- Département des Urgences et Post-Urgences Psychiatriques, Centre Expert Dépression Résistante FondaMental, CHRU Lapeyronie, Montpellier, France
| | - Marion Leboyer
- Pôle de Psychiatrie des Hôpitaux Universitaires, Centre Expert Dépression Résistante FondaMental, Hôpital Henri Mondor, Créteil, France
| | - Wissam El-Hage
- Clinique Psychiatrique Universitaire, Centre Expert Dépression Résistante FondaMental, Inserm U1253 imaging and Brain:iBrain, CHRU de Tours, Tours, France
| | - Bruno Aouizerate
- Pôle de Psychiatrie Générale et Universitaire, Centre Expert Dépression Résistante FondaMental, CH Charles Perrens, Bordeaux, France
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Oldani L, Altamura AC, Abdelghani M, Young AH. Brain stimulation treatments in bipolar disorder: A review of the current literature. World J Biol Psychiatry 2016; 17:482-94. [PMID: 25471324 DOI: 10.3109/15622975.2014.984630] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Brain stimulation techniques are non-pharmacologic strategies which offer additional therapeutic options for treatment-resistant depression (TRD). The purpose of this paper is to review the current literature regarding the use of brain stimulation in resistant bipolar disorder (BD), with particular reference to hypomanic/manic symptoms. METHODS Keywords pertaining to the brain simulation techniques used in the treatment of depression (either unipolar or bipolar) along with their role in regard to hypomanic/manic symptoms were used to conduct an electronic search of the literature. Pertinent findings were identified by the authors and reviewed. RESULTS Brain stimulation techniques represent a valid therapeutic option in TRD. They have been extensively studied in unipolar depression and, to a minor extent, in the depressive phase of BD, showing encouraging but often limited results. With exception of electroconvulsive therapy, the efficacy of brain stimulation in the treatment of manic symptoms of bipolar patients is still uncertain and needs to be fully evaluated. CONCLUSIONS Brain stimulation in BD is derived from its use in unipolar depression. However, there are many important differences between these two disorders and more studies with a systematic approach need to be conducted on larger samples of bipolar patients with treatment-resistant characteristics.
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Affiliation(s)
- Lucio Oldani
- a Department of Psychiatry , University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico , Milan , Italy
| | - A Carlo Altamura
- a Department of Psychiatry , University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico , Milan , Italy
| | - Mohamed Abdelghani
- b Complex Depression, Anxiety and Trauma Service (CDAT) and Neurodevelopmental Service (Adult ADHD and Adult ASD), Camden and Islington NHS Foundation Trust, St Pancras Hospital , London , UK
| | - Allan H Young
- c Centre for Affective Disorders, Institute of Psychiatry, King's College London , Denmark Hill, London , UK
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25
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[Differences in Subjective Experience Between Unipolar and Bipolar Depression]. ACTA ACUST UNITED AC 2016; 45:162-9. [PMID: 27569010 DOI: 10.1016/j.rcp.2015.09.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2015] [Revised: 08/09/2015] [Accepted: 09/25/2015] [Indexed: 11/22/2022]
Abstract
INTRODUCTION It is important to make distinction between bipolar and unipolar depression because treatment and prognosis are different. Since the diagnosis of the two conditions is purely clinical, find symptomatic differences is useful. OBJECTIVES Find differences in subjective experience (first person) between unipolar and bipolar depression. METHODS Phenomenological-oriented qualitative exploratory study of 12 patients (7 with bipolar depression and 5 with unipolar depression, 3 men and 9 women). We used a semi-structured interview based on Examination of Anomalous Self-Experience (EASE). RESULTS The predominant mood in bipolar depression is emotional dampening, in unipolar is sadness. The bodily experience in bipolar is of a heavy, tired body; an element that inserts between the desires of acting and performing actions and becomes an obstacle to the movement. In unipolar is of a body that feels more comfortable with the stillness than activity, like laziness of everyday life. Cognition and the stream of consciousness: in bipolar depression, compared with unipolar, thinking is slower, as if to overcome obstacles in their course. There are more difficult to understand what is heard or read. Future perspective: in bipolar depression, hopelessness is stronger and broader than in unipolar, as if the very possibility of hope was lost. CONCLUSIONS Qualitative differences in predominant mood, bodily experience, cognition and future perspective were found between bipolar and unipolar depression.
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Leung CM, Yim CL, Yan CTY, Chan CC, Xiang YT, Mak ADP, Fok MLY, Ungvari GS. The Bipolar II Depression Questionnaire: A Self-Report Tool for Detecting Bipolar II Depression. PLoS One 2016; 11:e0149752. [PMID: 26963908 PMCID: PMC4786156 DOI: 10.1371/journal.pone.0149752] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 02/04/2016] [Indexed: 01/26/2023] Open
Abstract
Bipolar II (BP-II) depression is often misdiagnosed as unipolar (UP) depression, resulting in suboptimal treatment. Tools for differentiating between these two types of depression are lacking. This study aimed to develop a simple, self-report screening instrument to help distinguish BP-II depression from UP depressive disorder. A prototype BP-II depression questionnaire (BPIIDQ-P) was constructed following a literature review, panel discussions and a field trial. Consecutively assessed patients with a diagnosis of depressive disorder or BP with depressive episodes completed the BPIIDQ-P at a psychiatric outpatient clinic in Hong Kong between October and December 2013. Data were analyzed using discriminant analysis and logistic regression. Of the 298 subjects recruited, 65 (21.8%) were males and 233 (78.2%) females. There were 112 (37.6%) subjects with BP depression [BP-I = 42 (14.1%), BP-II = 70 (23.5%)] and 182 (62.4%) with UP depression. Based on family history, age at onset, postpartum depression, episodic course, attacks of anxiety, hypersomnia, social phobia and agoraphobia, the 8-item BPIIDQ-8 was constructed. The BPIIDQ-8 differentiated subjects with BP-II from those with UP depression with a sensitivity/specificity of 0.75/0.63 for the whole sample and 0.77/0.72 for a female subgroup with a history of childbirth. The BPIIDQ-8 can differentiate BP-II from UP depression at the secondary care level with satisfactory to good reliability and validity. It has good potential as a screening tool for BP-II depression in primary care settings. Recall bias, the relatively small sample size, and the high proportion of females in the BP-II sample limit the generalization of the results.
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Affiliation(s)
- Chi Ming Leung
- Department of Psychiatry, Shatin Hospital, Hong Kong SAR, China
- * E-mail: (CML); (YTX)
| | - Chi Lap Yim
- Department of Psychiatry, Shatin Hospital, Hong Kong SAR, China
| | | | - Cheuk Chi Chan
- Department of Psychiatry, Shatin Hospital, Hong Kong SAR, China
| | - Yu-Tao Xiang
- Unit of Psychiatry, Faculty of Health Sciences, University of Macau, Macao SAR, China
- * E-mail: (CML); (YTX)
| | - Arthur D. P. Mak
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Marcella Lei-Yee Fok
- King's College London, King's Health Partners, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
| | - Gabor S. Ungvari
- School of Psychiatry and Clinical Neurosciences, University of Western Australia, Perth, Australia
- The University of Notre Dame Australia/Marian Centre, Perth, Australia
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Evaluating antidepressant treatment prior to adding second-line therapies among patients with treatment-resistant depression. Int J Clin Pharm 2016; 38:429-37. [PMID: 26935957 DOI: 10.1007/s11096-016-0272-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 02/25/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Patients with depression can be mistakenly labeled as treatment-resistant if they fail to receive an adequate first-line antidepressant trial. Adding second-line agents to the treatment regimens can create an additional burden on both the patients and the healthcare system. OBJECTIVES To determine if depressed patients receive an adequate antidepressant trial prior to starting second-line therapy and to investigate the association between the type of second-line treatment and severity of illness or depression among unipolar versus bipolar patients. SETTING Oklahoma Medicaid claims data between 2006 and 2011. METHODS Subjects were depression-diagnosed adult patients with at least two prescriptions of antidepressants followed by a second-line agent. Patients were categorized into one of three groups: an atypical antipsychotic, other augmentation agents (lithium, buspirone, and triiodothyronine), or adding antidepressants, based on the type of second-line therapy. An adequate trial was defined per the American Psychiatric Association guidelines. Factors associated with the type of treatment were tested using multinomial logistic regression models stratified by type of depression (unipolar vs. bipolar patients). MAIN OUTCOME MEASURE Variables used to measure receiving an adequate antidepressant trial included: trial duration, adherence, dose adequacy, and number of distinct antidepressant trials. RESULTS A total of 3910 patients were included in the analysis. Most subjects reached the recommended antidepressant dose. However, 28 % of patients had an antidepressant trial duration <4 weeks and only 60 % tried at least two antidepressant regimens prior to adding second-line therapy. Approximately 50 % of the subjects were non-adherent across all groups. Severity of illness and receipt of an adequate antidepressant trial were not predictors of the type of second-line treatment. CONCLUSION Many patients do not receive an adequate antidepressant trial before starting a second-line agent. The type of second-line treatment was independent of severity of depression. These findings support policies that require reviewing the recommended dose and duration of the first-line antidepressant before adding second-line agents. Healthcare providers need to review the patient's history and reconsider the evidence for prescribing second-line agents.
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Hepgul N, King S, Amarasinghe M, Breen G, Grant N, Grey N, Hotopf M, Moran P, Pariante CM, Tylee A, Wingrove J, Young AH, Cleare AJ. Clinical characteristics of patients assessed within an Improving Access to Psychological Therapies (IAPT) service: results from a naturalistic cohort study (Predicting Outcome Following Psychological Therapy; PROMPT). BMC Psychiatry 2016; 16:52. [PMID: 26920578 PMCID: PMC4769576 DOI: 10.1186/s12888-016-0736-6] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 02/04/2016] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND A substantial number of patients do not benefit from first line psychological therapies for the treatment of depression and anxiety. Currently, there are no clear predictors of treatment outcomes for these patients. The PROMPT project aims to establish an infrastructure platform for the identification of factors that predict outcomes following psychological treatment for depression and anxiety. Here we report on the first year of recruitment and describe the characteristics of our sample to date. METHODS One hundred and forty-seven patients awaiting treatment within an Improving Access to Psychological Therapies (IAPT) service were recruited between February 2014 and February 2015 (representing 48 % of those eligible). Baseline assessments were conducted to collect information on a variety of clinical, psychological and social variables including a diagnostic interview using the Mini International Neuropsychiatric Interview (MINI). RESULTS Our initial findings showed that over a third of our sample were not presenting to IAPT services for the first time, and 63 % had been allocated to receive higher intensity IAPT treatments. Approximately half (46 %) were taking prescribed psychotropic medication (most frequently antidepressants). Co-morbidity was common: 72 % of the sample met criteria for 2 or more current MINI diagnoses. Our initial data also indicated that 16 % met criteria for borderline personality disorder and 69 % were at high risk of personality disorder. Sixty-one percent scored above the screening threshold for bipolarity. Over half of participants (55 %) reported experiencing at least one stressful life event in the previous 12 months, whilst 67 % reported experiencing at least one form of childhood trauma. CONCLUSIONS Our results to date highlight the complex nature of patients seen within an urban IAPT service, with high rates of psychiatric comorbidity, personality disorder, bipolarity and childhood trauma. Whilst there are significant challenges associated with researching IAPT populations, we have also confirmed the feasibility of undertaking such research.
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Affiliation(s)
- Nilay Hepgul
- Department of Psychological Medicine & Centre for Affective Disorders, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK. .,Department of Palliative Care and Rehabilitation, King's College London, Cicely Saunders Institute, London, UK.
| | - Sinead King
- Department of Psychological Medicine & Centre for Affective Disorders, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK.
| | - Myanthi Amarasinghe
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, MRC Social, Genetic, and Developmental Psychiatry Centre, London, UK.
| | - Gerome Breen
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, MRC Social, Genetic, and Developmental Psychiatry Centre, London, UK.
| | - Nina Grant
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK.
| | - Nick Grey
- South London & Maudsley NHS Foundation Trust, Centre for Anxiety Disorders and Trauma, London, UK.
| | - Matthew Hotopf
- Department of Psychological Medicine & Centre for Affective Disorders, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK.
| | - Paul Moran
- Department of Health Services and Population Research, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK.
| | - Carmine M. Pariante
- Department of Psychological Medicine & Centre for Affective Disorders, King’s College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - André Tylee
- Department of Health Services and Population Research, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK.
| | - Janet Wingrove
- South London & Maudsley NHS Foundation Trust, Southwark Psychological Therapies Service, London, UK.
| | - Allan H. Young
- Department of Psychological Medicine & Centre for Affective Disorders, King’s College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Anthony J. Cleare
- Department of Psychological Medicine & Centre for Affective Disorders, King’s College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
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Park YM, Lee BH. Treatment response in relation to subthreshold bipolarity in patients with major depressive disorder receiving antidepressant monotherapy: a post hoc data analysis (KOMDD study). Neuropsychiatr Dis Treat 2016; 12:1221-7. [PMID: 27274258 PMCID: PMC4876090 DOI: 10.2147/ndt.s104188] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The aim of this observational study was to determine whether subthreshold bipolarity affects treatment response and remission in patients with major depressive disorder receiving antidepressant (AD) monotherapy over a 6-month follow-up period. METHODS Seventy-eight patients with major depressive disorder were stratified into two subgroups according to the presence of subthreshold bipolarity, identified using the Korean version of the Mood Disorder Questionnaire (K-MDQ), which classifies patients as positive for a screening of bipolarity based on the cutoff for the total K-MDQ score (ie, 7 points). They received AD monotherapy such as escitalopram, sertraline, paroxetine, or tianeptine for 6 months. The Beck Depression Inventory (BDI), Hamilton Depression Rating Scale (HAMD), Hamilton Anxiety Scale, and Beck Scale for Suicide Ideation were applied at baseline, 1 week, 3 weeks, 2 months, 3 months, and 6 months. RESULTS The mean HAMD, BDI, and Beck Scale for Suicide Ideation scores were higher in the bipolarity group than in the nonbipolarity group at 3 weeks. The mean BDI score was also higher in the bipolarity group than in the nonbipolarity group at 6 months. Evaluation of the ratio of improvement for each scale revealed different patterns of percentage changes between the two groups over the 6-month follow-up period. Furthermore, the response and remission rates (as assessed using BDI and HAMD scores) were higher in the nonbipolarity group than in the bipolarity group, with the exception of HAMD scores at the 3-week follow-up time point. CONCLUSION The findings of this study showed that depressed patients with bipolarity had a worse response to AD monotherapy than did those without bipolarity.
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Affiliation(s)
- Young-Min Park
- Department of Psychiatry, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Republic of Korea
| | - Bun-Hee Lee
- Department of Psychiatry, Seoul Eunpyeong Hospital, Seoul, Republic of Korea
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Sugawara H, Sakamoto K, Harada T, Shimizu S, Ishigooka J. A retrospective study of predictive factors for effective aripiprazole augmentation of antidepressant therapy in treatment-resistant depression. Neuropsychiatr Dis Treat 2016; 12:1151-6. [PMID: 27274249 PMCID: PMC4869788 DOI: 10.2147/ndt.s104115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Several studies have evaluated the efficacy and tolerability of aripiprazole for augmentation of antidepressant therapy for treatment-resistant depression (TRD). Here, we investigated the efficacy of aripiprazole augmentation for TRD including both major depressive disorder and bipolar disorder and the clinical predictors of treatment efficacy in a Japanese population. METHODS Eighty-five depressed Japanese patients who underwent aripiprazole augmentation therapy after failing to respond satisfactorily to antidepressant monotherapy were included in the study. Treatment responses were evaluated based on Clinical Global Impression Improvement scores assessed 8 weeks after initiation of aripiprazole administration. We compared demographic and diagnostic variables, psychiatric medication variables, and clinical variables between remission and nonremission groups. RESULTS The aripiprazole augmentation remission rate was 36.5%. Multiple logistic regression analysis indicated that aripiprazole augmentation was significantly more effective for bipolar depression than for major depressive disorder, and both absence of comorbid anxiety disorders and current episode duration >3 months were significantly associated with the efficacy of aripiprazole augmentation. CONCLUSION Polarity of depression, comorbidity of anxiety disorders, and current episode duration may predict the efficacy of aripiprazole augmentation for TRD including both major depressive disorder and bipolar disorder. Among them, comorbidity of anxiety disorders was significantly related to the efficacy for TRD including only major depressive disorder. Additional studies are needed to examine the association between the efficacy of aripiprazole augmentation and bipolarity, and these findings should be validated further in a prospective study.
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Affiliation(s)
- Hiroko Sugawara
- Department of Psychiatry, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan; Support Center for Women Health Care Professionals and Researchers, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
| | - Kaoru Sakamoto
- Department of Psychiatry, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
| | - Tsuyoto Harada
- Department of Psychiatry, Tokyo Women's Medical University Medical Center East, Arakawa-ku, Tokyo, Japan
| | - Satoru Shimizu
- Department of Research, Medical Research Institute, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
| | - Jun Ishigooka
- Department of Psychiatry, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
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Kimura A, Hashimoto T, Niitsu T, Iyo M. Presence of psychological distress symptoms associated with onset-related life events in patients with treatment-refractory depression. J Affect Disord 2015; 175:303-9. [PMID: 25661396 DOI: 10.1016/j.jad.2015.01.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 01/15/2015] [Indexed: 10/24/2022]
Abstract
BACKGROUND Previous studies have reported that various non-life-threatening life events could cause psychological distress symptoms like posttraumatic stress disorder in adults and adolescents. We examined whether patients with treatment-refractory depression (TRD) perceive their experiences of life events, of which they think as triggering the onset of depression, as more serious psychological distress symptoms than remitted or mildly symptomatic patients with major depressive disorder (MDD). METHODS This study employed a cross-sectional design. We recruited 78 outpatients consisting of 31 TRD patients, 31 remitted MDD patients, and 16 mildly symptomatic MDD patients. We adopted the Impact of Event Scale-Revised (IES-R) to assess the severity of psychological distress symptoms associated with the events that patients thought as triggering the onset of depression. We also evaluated clinical features and variables including the Hamilton Depression Rating Scale (HDRS). RESULTS The mean [±SD] score of the IES-R in patients with TRD (46.7 [15.1]) was significantly higher than in remitted (10.3 [9.9], p<0.001) or mildly symptomatic (31.3 [7.7], p<0.001) patients with MDD. The HDRS scores showed significant correlations with those of the IES-R among all patients (r=0.811). LIMITATIONS This study was not able to exclude the possibility that the severity of psychological distress symptoms associated with onset-related events could influence the difficult therapeutic course in patients with TRD due to the cross-sectional design. CONCLUSIONS This study demonstrated that patients with TRD perceive their onset-related life events as serious psychological distress symptoms. This result contributes to understanding the pathophysiology of TRD.
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Affiliation(s)
- Atsushi Kimura
- Department of Psychiatry, Chiba University Graduate School of Medicine, Chiba, Japan; Department of Psychiatry, Chiba University Hospital, Chiba, Japan
| | - Tasuku Hashimoto
- Department of Psychiatry, Chiba University Graduate School of Medicine, Chiba, Japan; Department of Psychiatry, Chiba University Hospital, Chiba, Japan.
| | - Tomihisa Niitsu
- Department of Psychiatry, Chiba University Graduate School of Medicine, Chiba, Japan; Department of Psychiatry, Chiba University Hospital, Chiba, Japan
| | - Masaomi Iyo
- Department of Psychiatry, Chiba University Graduate School of Medicine, Chiba, Japan; Department of Psychiatry, Chiba University Hospital, Chiba, Japan
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Zorumski CF, Nagele P, Mennerick S, Conway CR. Treatment-Resistant Major Depression: Rationale for NMDA Receptors as Targets and Nitrous Oxide as Therapy. Front Psychiatry 2015; 6:172. [PMID: 26696909 PMCID: PMC4673867 DOI: 10.3389/fpsyt.2015.00172] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 11/23/2015] [Indexed: 11/13/2022] Open
Abstract
Major depressive disorder (MDD) remains a huge personal and societal encumbrance. Particularly burdensome is a virulent subtype of MDD, treatment resistant major depression (TMRD), which afflicts 15-30% of MDD patients. There has been recent interest in N-methyl-d-aspartate receptors (NMDARs) as targets for treatment of MDD and perhaps TMRD. To date, most pre-clinical and clinical studies have focused on ketamine, although psychotomimetic and other side effects may limit ketamine's utility. These considerations prompted a recent promising pilot clinical trial of nitrous oxide, an NMDAR antagonist that acts through a mechanism distinct from that of ketamine, in patients with severe TRMD. In this paper, we review the clinical picture of TRMD as a subtype of MDD, the evolution of ketamine as a fast-acting antidepressant, and clinical and basic science studies supporting the possible use of nitrous oxide as a rapid antidepressant.
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Affiliation(s)
- Charles F Zorumski
- Department of Psychiatry, Washington University School of Medicine , St. Louis, MO , USA ; Taylor Family Institute for Innovative Psychiatric Research, Washington University School of Medicine , St. Louis, MO , USA
| | - Peter Nagele
- Taylor Family Institute for Innovative Psychiatric Research, Washington University School of Medicine , St. Louis, MO , USA ; Department of Anesthesiology, Washington University School of Medicine , St. Louis, MO , USA
| | - Steven Mennerick
- Department of Psychiatry, Washington University School of Medicine , St. Louis, MO , USA ; Taylor Family Institute for Innovative Psychiatric Research, Washington University School of Medicine , St. Louis, MO , USA
| | - Charles R Conway
- Department of Psychiatry, Washington University School of Medicine , St. Louis, MO , USA ; Taylor Family Institute for Innovative Psychiatric Research, Washington University School of Medicine , St. Louis, MO , USA
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Kutzelnigg A, Kopeinig M, Chen CK, Fábián A, Pujol-Luna MG, Shin YC, Treuer T, D'yachkova Y, Deix C, Kasper S, Doby D. Compliance as a stable function in the treatment course of bipolar disorder in patients stabilized on olanzapine: results from a 24-month observational study. Int J Bipolar Disord 2014; 2:13. [PMID: 25360398 PMCID: PMC4206769 DOI: 10.1186/s40345-014-0013-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Accepted: 10/01/2014] [Indexed: 12/16/2022] Open
Abstract
Compliance is a key factor in the maintenance treatment of bipolar disorder. This noninterventional study was conducted to explore factors associated with higher levels of compliance in bipolar patients, all treated in routine clinical settings. Bipolar outpatients (Clinical Global Impression of Severity score ≤3) who had been stabilized with olanzapine mono- or combination therapy for ≥4 weeks were enrolled in the study. Compliance to medication was assessed at baseline and after 3, 6, 9, 12, 18, and 24 months by a physician-rated, 4-point categorical scale using the following classification: noncompliant (patients being compliant to treatment schedule less than 20% of the time) and low (20% to 59% of the time), moderate (60% to 79% of the time), and high (≥80% of the time) levels of compliance. Both baseline and post-baseline factors were used in a generalized estimating equations (GEE) model to predict the likelihood of high compliance. Of 891 eligible patients, 657 patients completed the 24-month observation period. High levels of compliance (≥80%) were observed in 67% of patients at baseline, increasing to 80% in study completers. High compliance at baseline was identified as a strong predictor of compliance during study participation (odds ratio (OR) = 6.9, 95% confidence interval (CI) = 5.0 to 9.5, p < 0.001). Factors associated with high compliance during the study (GEE model) included greater life satisfaction (p = 0.002), better insight into illness (p < 0.001), less work impairment (p = 0.007), and fewer days of inpatient care (p = 0.002). Compliance ratings varied by country (p < 0.001) and duration of post-baseline treatment (p = 0.014). In conclusion, a number of clinical, functional, and social factors were identified as predictors of compliance in patients with bipolar disorder. As compliance is crucial for the long-term management of these patients, more attention should be directed towards compliance itself and factors associated with compliance levels in everyday treatment settings.
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Affiliation(s)
- Alexandra Kutzelnigg
- Department of Psychiatry and Psychotherapy, Division of Biological Psychiatry, Medical University Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Martin Kopeinig
- Psychosoziale Dienste in Wien (PSD), Mariahilfer Strasse 77-79, 1060 Vienna, Austria
| | - Chih-Ken Chen
- Chang Gung Memorial Hospital, Keelung, Chang Gung University School of Medicine, No.200 Lane 208, Ji-Jin 1st Road, Anle District, Keelung City, 204 Taoyuan, Taiwan
| | - Agnes Fábián
- Réthy Pál Kórház-Rendelőintézet, Békéscsaba, Hungary
| | | | | | - Tamás Treuer
- Eli Lilly, Madách u. 13-14. (VII. emelet), 1075 Budapest, Hungary
| | | | - Claudia Deix
- Eli Lilly, Kölblgasse 8-10, 1030 Vienna, Austria
| | - Siegfried Kasper
- Department of Psychiatry and Psychotherapy, Division of Biological Psychiatry, Medical University Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Dagmar Doby
- Eli Lilly, Kölblgasse 8-10, 1030 Vienna, Austria
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Abstract
OBJECTIVE Mixed-depressive features imply an occult bipolarity and might be linked to resistance to antidepressant therapy and a higher risk of suicide. Currently, there is no consensus about or any clinical guidelines available for this ill-defined clinical entity. The aim of this study was to assess the effectiveness, safety, and tolerability of mood stabilizers, such as valproate, for adjuvant therapy in patients suspected of having mixed-depressive features. METHODS This retrospective observational study reviewed medical records of psychiatric outpatients attended by the author from 2008 to 2013. Patients who presented with inadequately treated, long-lasting atypical depressive- and/or anxiety-spectrum symptoms, and who started adjuvant valproate therapy for the first time in their course of treatment, were identified. Patient demographics, clinical profiles, treatment responses, and treatment-emergent adverse events (AEs) were examined in detail. RESULTS A total of 22 patients (7 men and 15 women) ranging in age between 25 and 78 years were treated with valproate 100-1250 mg/day and observed for 3-60 months. The majority exhibited much or moderate improvement, and only four showed a limited response. During follow up, 12 continued adjuvant valproate, 3 were intermittent users, and 3 quit after no apparent response; 4 experienced an aggravation of symptoms after discontinuation but were stabilized soon after reinstitution. AEs were reported by 12 patients and 4 stopped valproate for intolerability despite improvement. CONCLUSION Adjuvant valproate therapy seems to be a promising approach to treating patients who manifest atypical neurotic or mood disorders with subthreshold bipolarity at a dosage around the lower end of that used to treat full-syndromal bipolar disorders.
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Affiliation(s)
- Chen-Chung Liu
- Department of Psychiatry, National Taiwan University Hospital, No. 7 Chung-Shan South Road, Taipei, 10002, Taiwan
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Rizvi SJ, Grima E, Tan M, Rotzinger S, Lin P, Mcintyre RS, Kennedy SH. Treatment-resistant depression in primary care across Canada. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2014; 59:349-57. [PMID: 25007419 PMCID: PMC4086317 DOI: 10.1177/070674371405900702] [Citation(s) in RCA: 103] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2013] [Accepted: 01/01/2014] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Treatment-resistant depression (TRD) represents a considerable global health concern. The goal of the InSight study was to investigate the prevalence of TRD and to evaluate its clinical characterization and management, compared with nonresistant depression, in primary care centres. METHODS Physicians completed a case report on a consecutive series of patients with major depressive disorder (n = 1212), which captured patient demographics and comorbidity, as well as current and past medication. RESULTS Using failure to respond to at least 2 antidepressants (ADs) from different classes as the definition of TRD, the overall prevalence was 21.7%. There were no differences in prevalence between men and women or among ethnicities. Patients with TRD had longer episode duration, were more likely to receive polypharmacy (for example, psychotropic, lipid-lowering, and antiinflammatory agents), and reported more AD related side effects. Higher rates of disability and comorbidity (axes I to III) were associated with treatment resistance. Obesity and being overweight were also associated with treatment resistance. While the selection and sequencing of pharmacotherapy by family physicians in this sample was in line with recommendations from evidence-based treatment guidelines, the wait time to make a change in treatment was 6 to 8 weeks in both groups, which exceeds guideline recommendations. CONCLUSIONS These real-world data demonstrate the high prevalence of TRD in primary care settings, and underscore the substantial burden of illness associated with TRD.
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Affiliation(s)
- Sakina J Rizvi
- Student, Departments of Pharmaceutical Sciences and Neuroscience, University of Toronto, Toronto, Ontario; Clinical Research Coordinator, Department of Psychiatry, University Health Network, Toronto, Ontario
| | - Etienne Grima
- Chief Operating Officer and Chief Financial Officer, Canadian Heart Research Centre, Toronto, Ontario
| | - Mary Tan
- Statistician, Canadian Heart Research Centre, Toronto, Ontario
| | - Susan Rotzinger
- Project Manager, Department of Psychiatry, University Health Network, Toronto, Ontario
| | - Peter Lin
- Director of Primary Care Initiatives, Canadian Heart Research Centre, Toronto, Ontario
| | - Roger S Mcintyre
- Psychiatrist, Department of Psychiatry, University Health Network, Toronto, Ontario; Professor, Department of Psychiatry, University of Toronto, Toronto, Ontario; Professsor, Department of Pharmacology, University of Toronto, Toronto, Ontario
| | - Sidney H Kennedy
- Psychiatrist, Department of Psychiatry, University Health Network, Toronto, Ontario; Professor, Department of Psychiatry, University of Toronto, Toronto, Ontario; Professor, Institute of Medical Sciences, University of Toronto, toronto, Ontario
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Coplan JD, Gopinath S, Abdallah CG, Berry BR. A neurobiological hypothesis of treatment-resistant depression - mechanisms for selective serotonin reuptake inhibitor non-efficacy. Front Behav Neurosci 2014; 8:189. [PMID: 24904340 PMCID: PMC4033019 DOI: 10.3389/fnbeh.2014.00189] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Accepted: 05/07/2014] [Indexed: 12/20/2022] Open
Abstract
First-line treatment of major depression includes administration of a selective serotonin reuptake inhibitor (SSRI), yet studies suggest that remission rates following two trials of an SSRI are <50%. The authors examine the putative biological substrates underlying "treatment resistant depression (TRD)" with the goal of elucidating novel rationales to treat TRD. We look at relevant articles from the preclinical and clinical literature combined with clinical exposure to TRD patients. A major focus was to outline pathophysiological mechanisms whereby the serotonin system becomes impervious to the desired enhancement of serotonin neurotransmission by SSRIs. A complementary focus was to dissect neurotransmitter systems, which serve to inhibit the dorsal raphe. We propose, based on a body of translational studies, TRD may not represent a simple serotonin deficit state but rather an excess of midbrain peri-raphe serotonin and subsequent deficit at key fronto-limbic projection sites, with ultimate compromise in serotonin-mediated neuroplasticity. Glutamate, serotonin, noradrenaline, and histamine are activated by stress and exert an inhibitory effect on serotonin outflow, in part by "flooding" 5-HT1A autoreceptors by serotonin itself. Certain factors putatively exacerbate this scenario - presence of the short arm of the serotonin transporter gene, early-life adversity and comorbid bipolar disorder - each of which has been associated with SSRI-treatment resistance. By utilizing an incremental approach, we provide a system for treating the TRD patient based on a strategy of rescuing serotonin neurotransmission from a state of SSRI-induced dorsal raphe stasis. This calls for "stacked" interventions, with an SSRI base, targeting, if necessary, the glutamatergic, serotonergic, noradrenergic, and histaminergic systems, thereby successively eliminating the inhibitory effects each are capable of exerting on serotonin neurons. Future studies are recommended to test this biologically based approach for treatment of TRD.
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Affiliation(s)
- Jeremy D Coplan
- Division of Neuropsychopharmacology, Department of Psychiatry and Behavioral Science, State University of New York Downstate Medical Center , Brooklyn, NY , USA
| | - Srinath Gopinath
- Division of Neuropsychopharmacology, Department of Psychiatry and Behavioral Science, State University of New York Downstate Medical Center , Brooklyn, NY , USA
| | - Chadi G Abdallah
- Department of Psychiatry, Yale School of Medicine , New Haven, CT , USA ; Clinical Neuroscience Division, National Center for PTSD , West Haven, CT , USA
| | - Benjamin R Berry
- State University of New York Downstate College of Medicine , Brooklyn, NY , USA
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Keizer I, Piguet C, Favre S, Aubry JM, Dayer A, Gervasoni N, Gex-Fabry M, Bertschy G. Subjective experience of thought overactivation in mood disorders: beyond racing and crowded thoughts. Psychopathology 2014; 47:174-84. [PMID: 24107841 DOI: 10.1159/000354781] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Accepted: 08/04/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND Racing thoughts, crowded thoughts and flight of ideas are frequent symptoms in mood disorders, but the underlying subjective experience of overactivation of thought processes remains poorly documented. METHODS Qualitative analysis of audiotaped interviews explored subjective experience of thought overactivation in patients with mood disorders (sample 1, n = 45). Quantitative analysis considered the properties of a newly developed rating scale in sample 1, in an additional sample of patients with mood disorders (sample 2, n = 37) and in healthy subjects (sample 3, n = 38). RESULTS Qualitative analysis of individual interviews revealed that 5 conceptual categories characterized thought overactivation: sequential thought flow, overstimulation, competition for resource allocation, unexpected/unexplained onset, and association with mood and emotions. A principal component analysis of the initial 16-item rating scale indicated that a single component explained 55.9% of the variance, with major and exclusive contributions from 9 items, which were retained in the final 9-item Subjective Thought Overactivation Questionnaire (STOQ; Cronbach's α = 0.95). Total score correlated significantly with activation, depression and perceived conflict subscales of the Internal State Scale (ISS; rs = 0.57-0.66, p < 0.001). It was associated with decreased well-being (ISS; rs = -0.48, p = 0.001) and increased state anxiety (State-Trait Anxiety Inventory; rs = 0.60, p < 0.001). The STOQ score was significantly higher in patients than in healthy subjects. It allowed distinguishing between ISS mood states, with the highest median score in mixed states. LIMITATIONS Sample size, representativeness, possible bias in qualitative analysis, and quality of expert consensus. CONCLUSIONS Qualitative analysis of clinical interviews, together with a new short rating scale, contributed to a documentation of subjective thought overactivation, an important but often undetected feature in mood disorders.
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Affiliation(s)
- Ineke Keizer
- Division of General Psychiatry, Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
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Angst J. Bipolar disorders in DSM-5: strengths, problems and perspectives. Int J Bipolar Disord 2013; 1:12. [PMID: 25505679 PMCID: PMC4230689 DOI: 10.1186/2194-7511-1-12] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Accepted: 07/03/2013] [Indexed: 12/16/2022] Open
Abstract
The diagnostic classification of mood disorders by the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) had two major shortcomings: an underdiagnosis of bipolar disorders and a large proportion of treated patients had to be allocated to the vague NOS groups ‘not otherwise specified’. Several new subthreshold groups of depression, bipolar disorders and mixed states are now operationally defined in DSM-5. In addition, hypomanic and manic episodes occurring during antidepressant treatments are, under certain conditions, accepted as criteria for bipolar disorders. The diagnosis of bipolarity now requires, as entry criterion A, not only the presence of elated or irritable mood but also the association of these symptoms with increased energy/activity. This restriction will unfortunately change the diagnoses of some patients from DSM-IV bipolar I and II disorders to subdiagnostic bipolar syndromes. Nonetheless, overall, DSM-5 is a step in the right direction, specifying more subdiagnostic categories with an improved dimensional approach to severity. DSM-5 may also have an impact on patient selection for placebo-controlled drug trials with antidepressants.
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Affiliation(s)
- Jules Angst
- Research Department, Zurich University Psychiatric Hospital, Lenggstrasse 31, Zurich, 8032 Switzerland
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Fletcher K, Parker G, Paterson A, Synnott H. High-risk behaviour in hypomanic states. J Affect Disord 2013; 150:50-6. [PMID: 23489397 DOI: 10.1016/j.jad.2013.02.018] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Revised: 02/05/2013] [Accepted: 02/06/2013] [Indexed: 11/12/2022]
Abstract
BACKGROUND Risk-taking behaviours during hypomanic states are recognised, however the high-risk nature of some behaviours-including the potential for harm to both the individual and others-has not been detailed in the research literature. The current study examines risk-taking behaviours and their consequences (including their potential for impairment) in those with a bipolar II condition. METHOD Participants were recruited from the Sydney-based Black Dog Institute Depression Clinic. Diagnostic assignment of bipolar II disorder was based on clinician judgement and formal DSM-IV criteria. Participants completed a series of detailed questions assessing previous risk-taking behaviours during hypomanic states. RESULTS The sample comprised a total of 93 participants. Risk-taking behaviours during hypomania included spending significant amounts of money, excessive alcohol or drug use, dangerous driving and endangering sexual activities. Key consequences included interpersonal conflict, substantial financial burden and feelings of guilt, shame and remorse. Despite recognition of the risks and consequences associated with hypomanic behaviours, less than one-fifth of participants agreed that hypomania should be treated because of the associated risks. LIMITATIONS Study limitations included a cross-sectional design, reliance on self-report information, lack of controlling for current mood state, and comprised a tertiary referral sample that may be weighted to more severe cases. Findings may therefore not be generalisable and require replication. CONCLUSIONS Risk-taking behaviours during hypomania are common, and often linked with serious consequences. Whilst hypomania is often enjoyed and romanticised by patients-leading to ambivalence around treatment of such states-careful consideration of the impact of risk-taking behaviour is necessary, while the study raises the question as to what is 'impairment' in hypomania. Findings should advance clinical management by identifying those high-risk behaviours that would benefit from pre-emptive weighting in developing individual's wellbeing plans for managing the condition.
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Affiliation(s)
- Kathryn Fletcher
- School of Psychiatry, University of New South Wales, NSW, Australia.
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Paterniti S, Bisserbe JC. Pharmacotherapy for bipolar disorder and concordance with treatment guidelines: survey of a general population sample referred to a tertiary care service. BMC Psychiatry 2013; 13:211. [PMID: 23941445 PMCID: PMC3751340 DOI: 10.1186/1471-244x-13-211] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Accepted: 08/05/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Many new approaches have been adopted for the treatment of bipolar disorder (BD) in the past few years, which strived to produce more positive outcomes. To enhance the quality of care, several guideline recommendations have been developed. For study purposes, we monitored the prescription of psychotropic drugs administered to bipolar patients who had been referred to tertiary care services, and assessed the degree to which treatment met specific guidelines. METHODS Between December 2006 and February 2009, we assessed 113 individuals suffering from BD who had been referred to the Royal Ottawa Mental Health Centre (ROMHC) Mood Disorders Program by physicians within the community, mostly general practitioners. The Structured Clinical Interview for DSM-IV-TR was used to assess diagnosis. The prescribed treatment was compared with specific Canadian guidelines (CANMAT, 2009). Univariate analyses and logistic regression were used to assess the contribution of demographic and clinical factors for concordance of treatment with guidelines. RESULTS Thirty-two subjects had BD type I (BD-I), and 81 subjects had BD type II (BD-II). All subjects with BD-I, and 90% of the BD-II group were given at least one psychotropic treatment. Lithium was more often prescribed for subjects with BD-I (62%) than those with BD-II (19%). Antidepressants were the most frequently prescribed class of psychotropics. Sixty-eight percent of subjects received treatment concordant with guidelines by medication and dose. The presence of a current hypomanic episode was independently associated with poorer concordance to guidelines. In more than half the cases, the inappropriate use of antidepressants was at the origin of the non concordance of treatment with respect to guidelines. Absence of psychotropic treatment in bipolar II patients and inadequate dosage of mood stabilizers were the two other main causes of non concordance with guidelines. CONCLUSIONS The factors related to treatment not concordant with guidelines should be further explored to determine appropriate strategies in implementing the use of guidelines in clinical practice.
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Kuiper S, McLean L, Fritz K, Lampe L, Malhi GS. Getting depression clinical practice guidelines right: time for change? Acta Psychiatr Scand 2013:24-30. [PMID: 23909694 DOI: 10.1111/acps.12176] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE As part of a series of papers ['Chronobiology of mood disorders' Malhi & Kuiper. Acta Psychiatr Scand 2013;128(Suppl. 444):2-15; and 'It's time we managed depression: The emerging role of chronobiology' Malhi et al. Acta Psychiatr Scand 2013;128(Suppl. 444):1] examining chronobiology in the context of depression, this article examines recent western clinical practice guidelines (CPGs) for the treatment of depression with respect to the recommendations they make, in particular as regards chronobiological treatments, and briefly considers the implications of their methodology and approach. METHOD Five international treatment guidelines, which had been published in the past 5 years, were identified, representing North American and European views. Chosen guidelines were reviewed by the authors, and the relevant recommendations were distributed for discussion and subsequent synthesis. RESULTS Most current guidelines do not address chronobiology in detail. Chronotherapeutic recommendations are tentative, although agomelatine is considered as an option for major depression and bright light therapy for seasonal affective disorder. Sleep deprivation is not routinely recommended. CONCLUSION Recommendations are limited by the lack of reliable therapeutic markers for chronotherapeutics. Current evidence supports use of light therapy in seasonal depression, but in non-seasonal depression there is insufficient evidence to support reliance on chronotherapeutics over existing treatment modalities.
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Affiliation(s)
| | | | - K. Fritz
- CADE Clinic; Department of Psychiatry; Royal North Shore Hospital; Sydney; New South Wales; Australia
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Mizuno T, Omata N, Murata T, Mitsuya H, Maruoka N, Mita K, Kiyono Y, Okazawa H, Ikeda H, Wada Y. Mania: Not the opposite of depression, but an extension? Neuronal plasticity and polarity. Med Hypotheses 2013; 81:175-9. [DOI: 10.1016/j.mehy.2013.05.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Revised: 05/05/2013] [Accepted: 05/15/2013] [Indexed: 10/26/2022]
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Abstract
Bipolar depression remains a major unresolved challenge for psychiatric therapeutics. It is associated with significant disability and mortality and represents the major proportion of the approximately half of follow-up time spent in morbid states despite use of available treatments. Evidence regarding effectiveness of standard treatments, particularly with antidepressants, remains limited and inconsistent. We reviewed available clinical and research literature concerning treatment with antidepressants in bipolar depression and its comparison with unipolar depression. Research evidence concerning efficacy and safety of commonly used antidepressant treatments for acute bipolar depression is very limited. Nevertheless, an updated meta-analysis indicated that overall efficacy was significantly greater with antidepressants than with placebo-treatment and not less than was found in trials for unipolar major depression. Moreover, risks of non-spontaneous mood-switching specifically associated with antidepressant treatment are less than appears to be widely believed. The findings encourage additional efforts to test antidepressants adequately in bipolar depression, and to consider options for depression in types I vs. II bipolar disorder, depression with subsyndromal hypomania and optimal treatment of mixed agitated-dysphoric states--both short- and long-term. Many therapeutic trials considered were small, varied in design, often involved co-treatments, or lacked adequate controls.
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Abstract
Bipolar disorder refers to a group of affective disorders, which together are characterised by depressive and manic or hypomanic episodes. These disorders include: bipolar disorder type I (depressive and manic episodes: this disorder can be diagnosed on the basis of one manic episode); bipolar disorder type II (depressive and hypomanic episodes); cyclothymic disorder (hypomanic and depressive symptoms that do not meet criteria for depressive episodes); and bipolar disorder not otherwise specified (depressive and hypomanic-like symptoms that do not meet the diagnostic criteria for any of the aforementioned disorders). Bipolar disorder type II is especially difficult to diagnose accurately because of the difficulty in differentiation of this disorder from recurrent unipolar depression (recurrent depressive episodes) in depressed patients. The identification of objective biomarkers that represent pathophysiologic processes that differ between bipolar disorder and unipolar depression can both inform bipolar disorder diagnosis and provide biological targets for the development of new and personalised treatments. Neuroimaging studies could help the identification of biomarkers that differentiate bipolar disorder from unipolar depression, but the problem in detection of a clear boundary between these disorders suggests that they might be better represented as a continuum of affective disorders. Innovative combinations of neuroimaging and pattern recognition approaches can identify individual patterns of neural structure and function that accurately ascertain where a patient might lie on a behavioural scale. Ultimately, an integrative approach, with several biological measurements using different scales, could yield patterns of biomarkers (biosignatures) to help identify biological targets for personalised and new treatments for all affective disorders.
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Affiliation(s)
- Mary L Phillips
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh, Pittsburgh, PA 15213, USA.
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Mitchell PB. Bipolar disorder: the shift to overdiagnosis. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2012; 57:659-65. [PMID: 23149281 DOI: 10.1177/070674371205701103] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Sometimes dramatically changing vogues in diagnostic practice in psychiatry resemble the volatility of international share markets. One such quickly shifting diagnostic area has been that of bipolar disorder (BD). Historically regarded as a relatively uncommon condition until recent decades, the construct of BD underwent a major expansion in the 1990s and 2000s with promulgation of the concept of the soft bipolar spectrum disorder, from which the recent research focus on subthreshold BD presentations was derived. Related to this has been renewed interest in treatments for BD from the pharmaceutical industry. The increasing rates of diagnosis have largely related to BD II, for which there has been a dramatic broadening of diagnostic criteria. This article critically reviews research data, both for broadening the diagnostic criteria for BD and, conversely, for the growing evidence of overdiagnosis in clinical practice. Why does this debate matter? I would suggest that there are many valid reasons to be concerned about overdiagnosis: first, the potential for overtreatment or inappropriate treatment of such patients with mood stabilizing treatments, including antipsychotics; second, the potential for diagnostic oversimplification, with consequent diagnostic deskilling and loss of credibility for the psychiatric profession; and third, the potential major impact on etiologic research for this condition. Psychiatry should not uncritically accept the shift to overdiagnosis, which has developed a rapid momentum in recent decades, in both clinical and academic circles. We must ensure, as a profession, that any change in diagnostic practice is underpinned by rigorous and critical research inquiry.
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Affiliation(s)
- Philip B Mitchell
- School of Psychiatry, University of New South Wales, Sydney, Australia.
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Hegerl U, Hensch T. The vigilance regulation model of affective disorders and ADHD. Neurosci Biobehav Rev 2012; 44:45-57. [PMID: 23092655 DOI: 10.1016/j.neubiorev.2012.10.008] [Citation(s) in RCA: 135] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2012] [Revised: 10/09/2012] [Accepted: 10/15/2012] [Indexed: 10/27/2022]
Abstract
According to the recently proposed vigilance model of affective disorders (vigilance in the sense of "brain arousal"), manic behaviour is partly interpreted as an autoregulatory attempt to stabilise vigilance by creating a stimulating environment, and the sensation avoidance and withdrawal in Major Depressive Disorder (MDD) is seen as an autoregulatory reaction to tonically increased vigilance. Indeed, using a newly developed EEG-based algorithm, hyperstable vigilance was found in MDD, and the contrary, with rapid drops to sleep stages, in mania. Furthermore, destabilising vigilance (e.g. by sleep deprivation) triggers (hypo)mania and improves depression, whereas stabilising vigilance, e.g. by prolonged sleep, improves mania. ADHD and mania have common symptoms, and the unstable vigilance might be a common pathophysiology. There is even evidence that psychostimulants might ameliorate both ADHD and mania. Hyperactivity of the noradrenergic system could explain both the high vigilance level in MDD and, as recently argued, anhedonia and behavioural inhibition. Interestingly, antidepressants and electroconvulsions decrease the firing rate of neurons in the noradrenergic locus coeruleus, whereas many antimanic drugs have opposite effects.
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Key Words
- Vigilance regulation, Arousal, EEG, Autoregulatory behaviour, Sensation seeking, Novelty seeking, Mania, ADHD, Bipolar disorder, Depression, Noradrenergic system, Norepinephrine, Locus coeruleus, Anti-manic drugs, Antidepressants
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Affiliation(s)
- Ulrich Hegerl
- Department of Psychiatry and Psychotherapy, University of Leipzig, Semmelweisstr. 10, 04103, Leipzig, Germany.
| | - Tilman Hensch
- Department of Psychiatry and Psychotherapy, University of Leipzig, Semmelweisstr. 10, 04103, Leipzig, Germany
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Possible association of CUX1 gene polymorphisms with antidepressant response in major depressive disorder. THE PHARMACOGENOMICS JOURNAL 2012; 13:354-8. [PMID: 22584459 DOI: 10.1038/tpj.2012.18] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Revised: 04/12/2012] [Accepted: 04/13/2012] [Indexed: 01/19/2023]
Abstract
Association between response to antidepressant treatment and genetic polymorphisms was examined in two independent Japanese samples of patients with major depressive disorder (MDD). Genome-wide approach using the Illumina Human CNV370-quad Bead Chip was utilized in the analysis of the 92 MDD patients in the first sample. In all, 11 non-intergenic single-nucleotide polymorphisms with uncorrected allelic P-value <0.0001 were selected for the subsequent association analyses in the second sample of 136 MDD patients. Difference in allele distribution between responders and nonresponders were found in the second-stage sample for rs365836 and rs201522 of the CUX1 gene (P=0.005 and 0.004, respectively). The allelic P-values for rs365836 and rs201522 in both samples combined were 0.0000023 and 0.0000040, respectively. Our results provide the first evidence that polymorphisms of the CUX1 gene may be associated with response to antidepressant treatment in Japanese patients with MDD.
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Parker G, Fletcher K, Blanch B, Greenfield L. Take-up and profile of individuals accessing a web-based bipolar self-test screening measure. J Affect Disord 2012; 138:117-22. [PMID: 22284017 DOI: 10.1016/j.jad.2011.12.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2011] [Revised: 12/05/2011] [Accepted: 12/05/2011] [Indexed: 11/30/2022]
Abstract
BACKGROUND Early detection of bipolar disorder is associated with improved long term outcome. In this study, we profile individuals accessing a web-based self-report screening tool for bipolar disorder. METHOD Participants accessing the self-screening tool for bipolar disorder (the Mood Swings Questionnaire; MSQ) via the Black Dog Institute website were asked to indicate whether they were willing to participate in a research study evaluating the tool. Demographic details, mood disorder history, previous treatments and the impact of mood problems were assessed, followed by completion of the MSQ to determine the likelihood of a bipolar disorder diagnosis. RESULTS During the first year of the study, the bipolar self-screening test web-page was viewed 278,279 times. A total of 5803 were eligible to provide baseline data, and 4829 completed the MSQ. Of these, 65% were assigned a preliminary bipolar disorder diagnosis based on MSQ cut-off scores, with the majority (89%) expecting such a result, feeling reassured (64%) by the result, and viewing the self-test as helpful (94%). Encouragingly, over 70% indicated they would follow-up this suggested diagnosis with a health professional. Personal, social and relationship 'costs' were rated as more severe than financial costs in relation to the bipolar condition, highlighting the burden of illness across differing domains. LIMITATIONS Results may not be generalizable to a community sample of individuals diagnosed with bipolar disorder. CONCLUSION This web-based (E-health) screening strategy has proven to be extremely successful. Firstly, participants viewed the self-screening tool as useful, supporting the need for easily accessible mental health screening tools to assist with early detection and diagnosis. Secondly, this method has provided quantitative data on help-seeking behaviors, strategies employed to assist with mood problems, response to diagnosis, and the impact of a bipolar condition, which has previously been explored predominantly through qualitative means. The success of this strategy will next be assessed encouraging participants to have any bipolar disorder confirmed and more condition-specific management implemented to determine impact in illness course.
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Affiliation(s)
- Gordon Parker
- School of Psychiatry, University of New South Wales, NSW, Australia.
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Maalouf FT, Brent DA. Child and adolescent depression intervention overview: what works, for whom and how well? Child Adolesc Psychiatr Clin N Am 2012; 21:299-312, viii. [PMID: 22537728 DOI: 10.1016/j.chc.2012.01.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The authors review the currently available evidence-based treatments of child and adolescent major depressive disorder. Medication monotherapy, namely with selective serotonin reuptake inhibitors, is supported by large clinical trials in adolescents. For mild to moderate depression, cognitive behavior therapy (CBT) and interpersonal therapy are reasonable options as monotherapies. There is also evidence that the combination of medication and CBT is superior to medication alone for accelerating the pace of treatment response and remission, despite some negative studies. Response, remission, and recurrence rates after acute treatment and during long-term follow-ups are also presented and discussed.
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Affiliation(s)
- Fadi T Maalouf
- Department of Psychiatry, American University of Beirut Medical Center, Beirut, Lebanon.
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50
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Maalouf FT, Porta G, Vitiello B, Emslie G, Mayes T, Clarke G, Wagner KD, Asarnow JR, Spirito A, Keller M, Birmaher B, Ryan N, Shamseddeen W, Iyengar S, Brent D. Do sub-syndromal manic symptoms influence outcome in treatment resistant depression in adolescents? A latent class analysis from the TORDIA study. J Affect Disord 2012; 138:86-95. [PMID: 22284022 PMCID: PMC3621087 DOI: 10.1016/j.jad.2011.12.021] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2011] [Accepted: 12/01/2011] [Indexed: 12/01/2022]
Abstract
BACKGROUND To identify distinct depressive symptom trajectories in the TORDIA study and determine their correlates. METHODS Latent Class Growth Analysis (LCGA) using the Children's Depression Rating Scale-Revised (CDRS-R) through 72 weeks from intake. RESULTS 3 classes were identified: (1) little change in symptomatic status ("NO"), comprising 24.9% of participants, with a 72-week remission rate of 25.3%; (2) slow, steady improvement ("SLOW"), comprising 47.9% of participants, with a remission rate of 60.0%, and (3) rapid symptom response ("GO"), comprising 27.2% of participants, with a remission rate of 85.7%. Higher baseline CDRS-R (p<0.001) and poorer functioning (p=0.03) were the strongest discriminators between NO and GO. Higher baseline CDRS (p<0.001) and scores on the Mania Rating Scale (MRS) (p=0.01) were the strongest discriminators between SLOW and GO. Other variables differentiating GO from both NO and from SLOW, were better baseline functioning, lower hopelessness, and lower family conflict. Both NO and SLOW showed increases on the MRS over time compared to GO (ps ≤ 0.04), and increasing MRS was strongly associated with lack of remission by 72 weeks (p=0.02). LIMITATIONS High rate of open treatment by the end of the follow-up period creates difficulty in drawing clear inferences about the long-term impact of initial randomization. CONCLUSION Along with depressive severity, sub-syndromal manic symptoms, at baseline, and over time emerged as important predictors and correlates of poor outcome in this sample. Further research is needed on the treatment of severe depression, and on the assessment and management of sub-syndromal manic symptoms in treatment resistant depression.
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