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Li X, Zhang H, Wu K, Fan B, Guo L, Liao Y, McIntyre RS, Wang W, Liu Y, Shi J, Chen Y, Shen M, Wang H, Li L, Han X, Lu C. Impact of painful physical symptoms on first-episode major depressive disorder in adults with subthreshold depressive symptoms: A prospective cohort study. Gen Hosp Psychiatry 2024; 86:1-9. [PMID: 38029479 DOI: 10.1016/j.genhosppsych.2023.11.008] [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: 10/21/2023] [Revised: 11/14/2023] [Accepted: 11/17/2023] [Indexed: 12/01/2023]
Abstract
OBJECTIVE To investigate the impact of baseline painful physical symptoms (PPS) on subsequent first-episode major depressive disorder (MDD) in adults with subthreshold depressive symptoms, including subgroup analyses to assess whether the associations differ in individuals with and without physical diseases. METHODS A total of 2343 adults with subthreshold depressive symptoms were recruited at 34 primary health care centers. PPS were measured at baseline. First-episode MDD during follow-up was diagnosed by professional psychiatrists using the Mini-International Neuropsychiatric Interview. RESULTS Baseline PPS showed independent impacts on first-episode MDD in adults with subthreshold depressive symptoms without physical diseases, but not in those with physical diseases. A non-linear association (P < 0.001) was observed between PPS burden and the risk of first-episode MDD. The HRs for first-episode MDD exhibited a rapidly increasing trend between PPS burden scores of 10-16, and maintained consistently high when scores exceeded 16. The analyses for specific PPS revealed that headache, neck pain, and heart or chest pain were independently associated with first-episode MDD in participants without physical diseases, the HRs were 1.57 (1.15-2.36), 1.53 (1.02-2.30), and 1.69 (1.14-2.50), respectively. Further network analysis demonstrated that heart or chest pain serves as a bridge symptom among the seven specific PPS and first-episode MDD in those without physical diseases. CONCLUSION PPS burden and heart or chest pain may be significant indicators for first-episode MDD in adults with subthreshold depressive symptoms without physical diseases. Future studies should investigate whether interventions targeting PPS can prevent episode MDD in this subthreshold population.
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Affiliation(s)
- Xiuwen Li
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, 510080 Guangzhou, People's Republic of China; Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Sun Yat-sen University, 510080 Guangzhou, People's Republic of China; Guangdong Engineering Technology Research Center of Nutrition Translation, Guangzhou 510080, China
| | - Huimin Zhang
- Department of Psychiatry, Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, People's Republic of China
| | - Keying Wu
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, 510080 Guangzhou, People's Republic of China; Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Sun Yat-sen University, 510080 Guangzhou, People's Republic of China; Guangdong Engineering Technology Research Center of Nutrition Translation, Guangzhou 510080, China
| | - Beifang Fan
- 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, 510080 Guangzhou, People's Republic of China; Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Sun Yat-sen University, 510080 Guangzhou, People's Republic of China; Guangdong Engineering Technology Research Center of Nutrition Translation, Guangzhou 510080, China
| | - Yuhua Liao
- Department of Psychiatry, Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, People's Republic of China
| | - Roger S McIntyre
- Mood Disorders Psychopharmacology Unit, University Health Network, Canada; Department of Psychiatry, University of Toronto, Canada; Department of Pharmacology, University of Toronto, Canada; Brain and Cognition Discovery Foundation, Toronto, ON, Canada; Braxia Health, Mississauga, ON, Canada
| | - Wanxin Wang
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, 510080 Guangzhou, People's Republic of China; Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Sun Yat-sen University, 510080 Guangzhou, People's Republic of China; Guangdong Engineering Technology Research Center of Nutrition Translation, Guangzhou 510080, China
| | - Yifeng Liu
- Department of Psychiatry, Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, People's Republic of China
| | - Jingman Shi
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, 510080 Guangzhou, People's Republic of China; Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Sun Yat-sen University, 510080 Guangzhou, People's Republic of China; Guangdong Engineering Technology Research Center of Nutrition Translation, Guangzhou 510080, China
| | - Yan Chen
- Department of Psychiatry, Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, People's Republic of China
| | - Manjun Shen
- Department of Psychiatry, Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, People's Republic of China
| | - Hongqiong Wang
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, 510080 Guangzhou, People's Republic of China; Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Sun Yat-sen University, 510080 Guangzhou, People's Republic of China; Guangdong Engineering Technology Research Center of Nutrition Translation, Guangzhou 510080, China
| | - Lingjiang Li
- Mental Health Institute of the Second Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Xue Han
- Department of Psychiatry, Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, People's Republic of China.
| | - Ciyong Lu
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, 510080 Guangzhou, People's Republic of China; Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Sun Yat-sen University, 510080 Guangzhou, People's Republic of China; Guangdong Engineering Technology Research Center of Nutrition Translation, Guangzhou 510080, China.
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Leuchter MK, Citrenbaum C, Wilson AC, Tibbe TD, Jackson NJ, Krantz DE, Wilke SA, Corlier J, Strouse TB, Hoftman GD, Tadayonnejad R, Koek RJ, Slan AR, Ginder ND, Distler MG, Artin H, Lee JH, Adelekun AE, Leuchter AF. A comparison of self- and observer-rated scales for detecting clinical improvement during repetitive transcranial stimulation (rTMS) treatment of depression. Psychiatry Res 2023; 330:115608. [PMID: 37984281 DOI: 10.1016/j.psychres.2023.115608] [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: 08/01/2023] [Revised: 11/06/2023] [Accepted: 11/11/2023] [Indexed: 11/22/2023]
Abstract
Clinical outcomes of repetitive Transcranial Magnetic Stimulation (rTMS) for treatment of Major Depressive Disorder (MDD) vary widely, and no single mood rating scale is standard for assessing rTMS outcomes. This study of 708 subjects undergoing clinical rTMS compared the performance of four scales in measuring symptom change during rTMS treatment. Self-report and observer ratings were examined weekly with the Inventory of Depressive Symptomatology 30-item (IDS), Patient Health Questionnaire 9-item (PHQ), Profile of Mood States 30-item (POMS), and Hamilton Depression Rating Scale 17-item (HDRS). While all scales were correlated and detected significant improvement, the degree of improvement over time as well as response (33-50%) and remission (20-24%) rates varied significantly. Higher baseline severity was associated with lower likelihood of remission, and greater improvement by sessions 5 and 10 predicted response across all scales. Use of only a single scale to assess outcome conferred 14-36% risk of failing to detect response/remission indicated by another scale. The PHQ was most likely to indicate improvement and least likely to miss response or remission. These findings indicate that assessment of symptom burden during rTMS treatment may be most accurately assessed through use of multiple instruments.
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Affiliation(s)
- Michael K Leuchter
- TMS Clinical and Research Program, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA 90024, USA.
| | - Cole Citrenbaum
- TMS Clinical and Research Program, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA 90024, USA
| | | | - Tristan D Tibbe
- Department of Psychology, University of California, Los Angeles, CA 90024, USA; Department of Medicine Statistics Core, David Geffen School of Medicine at UCLA 90024, USA
| | - Nicholas J Jackson
- Department of Medicine Statistics Core, David Geffen School of Medicine at UCLA 90024, USA
| | - David E Krantz
- TMS Clinical and Research Program, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA 90024, USA
| | - Scott A Wilke
- TMS Clinical and Research Program, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA 90024, USA
| | - Juliana Corlier
- TMS Clinical and Research Program, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA 90024, USA
| | - Thomas B Strouse
- TMS Clinical and Research Program, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA 90024, USA
| | - Gil D Hoftman
- TMS Clinical and Research Program, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA 90024, USA
| | - Reza Tadayonnejad
- TMS Clinical and Research Program, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA 90024, USA; Division of Humanities and Social Sciences, California Institute of Technology, Pasadena, CA, USA
| | - Ralph J Koek
- TMS Clinical and Research Program, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA 90024, USA
| | - Aaron R Slan
- TMS Clinical and Research Program, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA 90024, USA
| | - Nathaniel D Ginder
- TMS Clinical and Research Program, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA 90024, USA
| | - Margaret G Distler
- TMS Clinical and Research Program, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA 90024, USA
| | - Hewa Artin
- TMS Clinical and Research Program, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA 90024, USA
| | - John H Lee
- TMS Clinical and Research Program, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA 90024, USA
| | - Adesewa E Adelekun
- TMS Clinical and Research Program, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA 90024, USA
| | - Andrew F Leuchter
- TMS Clinical and Research Program, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA 90024, USA
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Fang S, Wu Z, Guo Y, Zhu W, Wan C, Yuan N, Chen J, Hao W, Mo X, Guo X, Fan L, Li X, Chen J. Roles of microglia in adult hippocampal neurogenesis in depression and their therapeutics. Front Immunol 2023; 14:1193053. [PMID: 37881439 PMCID: PMC10597707 DOI: 10.3389/fimmu.2023.1193053] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 09/20/2023] [Indexed: 10/27/2023] Open
Abstract
Adult hippocampal neurogenesis generates functional neurons from neural progenitor cells in the hippocampal dentate gyrus (DG) to complement and repair neurons and neural circuits, thus benefiting the treatment of depression. Increasing evidence has shown that aberrant microglial activity can disrupt the appropriate formation and development of functional properties of neurogenesis, which will play a crucial role in the occurrence and development of depression. However, the mechanisms of the crosstalk between microglia and adult hippocampal neurogenesis in depression are not yet fully understood. Therefore, in this review, we first introduce recent discoveries regarding the roles of microglia and adult hippocampal neurogenesis in the etiology of depression. Then, we systematically discuss the possible mechanisms of how microglia regulate adult hippocampal neurogenesis in depression according to recent studies, which involve toll-like receptors, microglial polarization, fractalkine-C-X3-C motif chemokine receptor 1, hypothalamic-pituitary-adrenal axis, cytokines, brain-derived neurotrophic factor, and the microbiota-gut-brain axis, etc. In addition, we summarize the promising drugs that could improve the adult hippocampal neurogenesis by regulating the microglia. These findings will help us understand the complicated pathological mechanisms of depression and shed light on the development of new treatment strategies for this disease.
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Affiliation(s)
- Shaoyi Fang
- Formula-Pattern of Traditional Chinese Medicine, School of Traditional Chinese Medicine, Jinan University, Guangzhou, China
| | - Zhibin Wu
- Formula-Pattern of Traditional Chinese Medicine, School of Traditional Chinese Medicine, Jinan University, Guangzhou, China
| | - Yali Guo
- Formula-Pattern of Traditional Chinese Medicine, School of Traditional Chinese Medicine, Jinan University, Guangzhou, China
| | - Wenjun Zhu
- Formula-Pattern of Traditional Chinese Medicine, School of Traditional Chinese Medicine, Jinan University, Guangzhou, China
| | - Chunmiao Wan
- Formula-Pattern of Traditional Chinese Medicine, School of Traditional Chinese Medicine, Jinan University, Guangzhou, China
| | - Naijun Yuan
- Formula-Pattern of Traditional Chinese Medicine, School of Traditional Chinese Medicine, Jinan University, Guangzhou, China
- Shenzhen People’s Hospital, 2Clinical Medical College, Jinan University, Shenzhen, China
| | - Jianbei Chen
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Wenzhi Hao
- Formula-Pattern of Traditional Chinese Medicine, School of Traditional Chinese Medicine, Jinan University, Guangzhou, China
| | - Xiaowei Mo
- Formula-Pattern of Traditional Chinese Medicine, School of Traditional Chinese Medicine, Jinan University, Guangzhou, China
| | - Xiaofang Guo
- Formula-Pattern of Traditional Chinese Medicine, School of Traditional Chinese Medicine, Jinan University, Guangzhou, China
| | - Lili Fan
- Formula-Pattern of Traditional Chinese Medicine, School of Traditional Chinese Medicine, Jinan University, Guangzhou, China
| | - Xiaojuan Li
- Formula-Pattern of Traditional Chinese Medicine, School of Traditional Chinese Medicine, Jinan University, Guangzhou, China
| | - Jiaxu Chen
- Formula-Pattern of Traditional Chinese Medicine, School of Traditional Chinese Medicine, Jinan University, Guangzhou, China
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
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Wu Z, Gan Y, Li N, Lan X, Wang C, Zhang F, Liu H, Li W, Ye Y, Hu Z, Ning Y, Zhou Y. Pain mediates the improvement of social functions of repeated intravenous ketamine in patients with unipolar and bipolar depression. J Affect Disord 2023; 334:152-158. [PMID: 37156269 DOI: 10.1016/j.jad.2023.04.122] [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: 03/17/2023] [Accepted: 04/29/2023] [Indexed: 05/10/2023]
Abstract
OBJECTIVE Previous research has shown that ketamine can improve social functions. In addition, evidence also suggests that ketamine can alleviate pain. Herein, we propose that ketamine-induced improvements in pain and depression are partially mediated by a reduction in pain. We aimed to determine whether improvements in pain-mediated changes in psychological function were associated with ketamine treatment. METHOD This trial included unipolar or bipolar patients (n = 103) who received 6 intravenous infusions (0.5 mg/kg) of ketamine over 2 weeks. The severity of current depressive symptoms and social function were evaluated by the Montgomery-Åsberg Depression Scale (MADRS), Self-Rating Depression Scale (SDS) and Global Assessment Function (GAF), respectively, at baseline and on day 13 and day 26. At the same time points, the three dimensions of pain, including the sensory index, affective index and present pain intensity (PPI), were measured by the Simple McGill Pain Scale (SF-MPQ). RESULTS The mixed model results showed that ketamine plays an important role in improving the psychosocial functioning of patients. There was a significant decrease from baseline to the day 13 and day 26, indicating that the pain index of the patient improved significantly. Mediation analysis showed that for SDS score (coef = -5.171, 95 % CI[-6.317, -4.025]) and GAF score (coef = 1.021, 95 % CI[0.848, 1.194]), the overall effect of ketamine was observable. The overall indirect and direct effects of ketamine on social functioning were significant (SDS: direct: coef = -1949 to -2114; total indirect: from 0.594 to 0.664; GAF: from 0.399 to 0.427; total indirect: coef = 0.593 to 0.664). The MADRS total score and emotional index were important mediators of the association between ketamine treatment and improvements in subjective and objective social functioning. CONCLUSION Depressive symptom severity and the affective index of pain partially mediated improvements in social function after six repeated ketamine treatments among patients with bipolar or unipolar depressive disorder.
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Affiliation(s)
- Zitao Wu
- School of Mental Health, Guangzhou Medical University, Guangzhou, China; The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China; Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
| | - Yujing Gan
- School of Mental Health, Guangzhou Medical University, Guangzhou, China; The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China; Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
| | - Nanxi Li
- School of Mental Health, Guangzhou Medical University, Guangzhou, China; The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China; Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
| | - Xiaofeng Lan
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China; Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
| | - Chengyu Wang
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China; Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
| | - Fan Zhang
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China; Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
| | - Haiyan Liu
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China; Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
| | - Weicheng Li
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China; Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
| | - Yanxiang Ye
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China; Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
| | - Zhibo Hu
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China; Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
| | - Yuping Ning
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China; Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
| | - Yanling Zhou
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China; Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China.
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Zimmerman M, Mackin DM. Reliability and validity of the difficult to treat depression questionnaire (DTDQ). Psychiatry Res 2023; 324:115225. [PMID: 37116322 DOI: 10.1016/j.psychres.2023.115225] [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: 02/11/2023] [Revised: 04/16/2023] [Accepted: 04/23/2023] [Indexed: 04/30/2023]
Abstract
It has recently been recommended that treatment resistant depression be reconceptualized and renamed as difficult to treat depression (DTD). A consensus statement by an expert panel identified multiple variables associated with DTD and emphasized the importance of conducting a comprehensive evaluation of patients to identify predictors of inadequate treatment response. For practical reasons, it would be desirable to develop a self-report scale that can be incorporated into clinical practice that identifies patient, clinical, and treatment risk factors for DTD. Nine hundred twenty depressed patients completed the Difficult to Treat Depression Questionnaire (DTDQ). A subset of patients completed the scale a second time and completed the Remission from Depression Questionnaire at admission and discharge from a partial hospital program. The DTDQ demonstrated excellent internal consistency and test-retest reliability. Both the total DTDQ and the number of prior failed medication trials, the metric primarily relied upon to classify treatment resistant depression, predicted outcome. However, the DTDQ continued to be significantly associated with outcome after controlling for the number of failed trials, whereas the number of failed trials did not predict outcome after controlling for DTDQ scores. The DTDQ is a reliable and valid measure of the recently discussed concept of DTD.
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Affiliation(s)
- Mark Zimmerman
- Department of Psychiatry and Human Behavior, Brown Medical School, Rhode Island Hospital, Providence, RI, United States.
| | - Daniel M Mackin
- Department of Psychiatry and Human Behavior, Brown Medical School, Rhode Island Hospital, Providence, RI, United States
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Owen-Smith AA, McDonald B, Sesay MM, Simon GE, McCracken CE. Depression Treatment Initiation Among Patients With Versus Without Chronic Pain. Psychosom Med 2023; 85:260-265. [PMID: 36917479 PMCID: PMC10073325 DOI: 10.1097/psy.0000000000001184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
OBJECTIVE The purpose of this study was to examine the extent to which the presence of chronic noncancer pain (CNCP) impacts the likelihood that patients with diagnoses of depression will initiate depression treatment compared with those without CNCP. METHODS We performed a retrospective cohort study of Kaiser Permanente of Georgia members older than 18 years who received a diagnosis of depression. Demographics and medical history were extracted from the electronic health record database. Members were further classified by the presence or absence of a CNCP diagnosis. Outcomes of interest were treated as time dependent and included ( 1 ) time to fulfillment of a new antidepressant medication and ( 2 ) time to a follow-up mental health encounter. Outcomes were compared between members with and without a CNCP diagnosis using Kaplan-Meier survival curves and Cox proportional hazard regression models. RESULTS During the study period, 22,996 members met the inclusion criteria and 27.4% had a diagnosis of CNCP. In the matched sample, there was no difference in the time to a new antidepressant fill among members with and without CNCP (hazard ratio = 0.96; 95% confidence interval = 0.90-1.02; p = .18). In contrast, members with CNCP were significantly less likely to have a new mental health encounter after diagnosis (hazard ratio = 0.87; 95% confidence interval = 0.81-0.94; p < .001). CONCLUSIONS Patients with CNCP were significantly less likely to have a new mental health encounter after a depression diagnosis compared with patients without CNCP. Additional outreach and consideration may be needed to improve initiation of depression treatment for newly diagnosed patients with comorbid depression and CNCP.
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Affiliation(s)
- Ashli A Owen-Smith
- From the Department of Health Policy and Behavioral Sciences (Owen-Smith), Georgia State University School of Public Health; Kaiser Permanente Georgia, Center for Research and Evaluation (Owen-Smith, McDonald, Sesay, McCracken), Atlanta, Georgia; and Kaiser Permanente Washington, Health Research Institute (Simon), Washington, DC
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Corlier J, Tadayonnejad R, Wilson AC, Lee JC, Marder KG, Ginder ND, Wilke SA, Levitt J, Krantz D, Leuchter AF. Repetitive transcranial magnetic stimulation treatment of major depressive disorder and comorbid chronic pain: response rates and neurophysiologic biomarkers. Psychol Med 2023; 53:823-832. [PMID: 34154683 PMCID: PMC9976020 DOI: 10.1017/s0033291721002178] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 04/16/2021] [Accepted: 05/13/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Major depressive disorder (MDD) and chronic pain are highly comorbid, and pain symptoms are associated with a poorer response to antidepressant medication treatment. It is unclear whether comorbid pain also is associated with a poorer response to treatment with repetitive transcranial magnetic stimulation (rTMS). METHODS 162 MDD subjects received 30 sessions of 10 Hz rTMS treatment administered to the left dorsolateral prefrontal cortex (DLPFC) with depression and pain symptoms measured before and after treatment. For a subset of 96 patients, a resting-state electroencephalogram (EEG) was recorded at baseline. Clinical outcome was compared between subjects with and without comorbid pain, and the relationships among outcome, pain severity, individual peak alpha frequency (PAF), and PAF phase-coherence in the EEG were examined. RESULTS 64.8% of all subjects reported pain, and both depressive and pain symptoms were significantly reduced after rTMS treatment, irrespective of age or gender. Patients with severe pain were 27% less likely to respond to MDD treatment than pain-free individuals. PAF was positively associated with pain severity. PAF phase-coherence in the somatosensory and default mode networks was significantly lower for MDD subjects with pain who failed to respond to MDD treatment. CONCLUSIONS Pain symptoms improved after rTMS to left DLPFC in MDD irrespective of age or gender, although the presence of chronic pain symptoms reduced the likelihood of treatment response. Individual PAF and baseline phase-coherence in the sensorimotor and midline regions may represent predictors of rTMS treatment outcome in comorbid pain and MDD.
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Affiliation(s)
- Juliana Corlier
- TMS Clinical and Research Service, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior, and the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, 760 Westwood Plaza, Los Angeles, CA 90024, USA
| | - Reza Tadayonnejad
- TMS Clinical and Research Service, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior, and the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, 760 Westwood Plaza, Los Angeles, CA 90024, USA
- Division of the Humanities and Social Sciences, California Institute of Technology, Pasadena, CA 91125, USA
| | - Andrew C Wilson
- TMS Clinical and Research Service, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior, and the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, 760 Westwood Plaza, Los Angeles, CA 90024, USA
| | - Jonathan C Lee
- TMS Clinical and Research Service, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior, and the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, 760 Westwood Plaza, Los Angeles, CA 90024, USA
| | - Katharine G Marder
- TMS Clinical and Research Service, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior, and the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, 760 Westwood Plaza, Los Angeles, CA 90024, USA
| | - Nathaniel D Ginder
- TMS Clinical and Research Service, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior, and the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, 760 Westwood Plaza, Los Angeles, CA 90024, USA
- VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd, Los Angeles, CA 90073, USA
| | - Scott A Wilke
- TMS Clinical and Research Service, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior, and the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, 760 Westwood Plaza, Los Angeles, CA 90024, USA
| | - Jennifer Levitt
- TMS Clinical and Research Service, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior, and the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, 760 Westwood Plaza, Los Angeles, CA 90024, USA
| | - David Krantz
- TMS Clinical and Research Service, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior, and the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, 760 Westwood Plaza, Los Angeles, CA 90024, USA
| | - Andrew F Leuchter
- TMS Clinical and Research Service, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior, and the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, 760 Westwood Plaza, Los Angeles, CA 90024, USA
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Yun Y, Zhang Q, Zhao W, Ma T, Fan H, Bai L, Ma B, Qi S, Wang Z, An H, Yang F. Relationship between the tryptophan-kynurenine pathway and painful physical symptoms in patients with major depressive disorder. J Psychosom Res 2022; 163:111069. [PMID: 36335711 DOI: 10.1016/j.jpsychores.2022.111069] [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: 07/15/2022] [Revised: 10/17/2022] [Accepted: 10/18/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVES To investigate the relationship between the tryptophan-kynurenine (TRP-KYN) pathway and painful physical symptoms (PPS) in major depressive disorder (MDD). METHODS Eighty-four patients with MDD (40 patients with PPS and 44 without PPS) and forty-six healthy controls (HC) were recruited. The serum levels of tryptophan (TRP), kynurenine(KYN), kynurenic acid (KA), quinolinic acid (QA), 3-hydroxy-kynurenine (3-HK), serotonin (5-HT) were measured using high-performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS). Depression, anxiety and pain were assessed using Hamilton Depression Scale (HAMD), Hamilton Anxiety Scale (HAMA) and Short-form McGill pain questionnaire (SFMPQ) respectively. RESULTS Patients in the MDD group exhibited significantly lower KA and 5-HT levels than HC, whereas MDD patients with PPS showed higher KYN and QA levels, and a higher KYN/TRP ratio than those without. There was a positive correlation between the scores of SFMPQ and QA levels and a negative correlation between the scores of SFMPQ and TRP levels or KA/QA ratios in MDD patients with PPS group. Stepwise multiple regression analysis showed that the KYN/TRP ratios, the KA/QA ratios, and the HAMD scores were significant predictor factors for SFMPQ scores. CONCLUSIONS These results demonstrated that the TRP-KYN pathway may play a role in the pathophysiology of pain in patients with major depressive disorder, suggesting that further studies of this pathway as a potential biomarker or therapeutic target are required.
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Affiliation(s)
- Yajun Yun
- Beijing HuiLongGuan Hospital, Peking University, Beijing, China
| | - Qi Zhang
- Wuxi Mental Health Center, Wuxi, China
| | - Wenxuan Zhao
- Beijing HuiLongGuan Hospital, Peking University, Beijing, China
| | - Ting Ma
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Hongzhen Fan
- Beijing HuiLongGuan Hospital, Peking University, Beijing, China
| | - Luyuan Bai
- Beijing HuiLongGuan Hospital, Peking University, Beijing, China
| | - Botao Ma
- Beijing HuiLongGuan Hospital, Peking University, Beijing, China
| | - Siyuan Qi
- Beijing HuiLongGuan Hospital, Peking University, Beijing, China
| | - Zhiren Wang
- Beijing HuiLongGuan Hospital, Peking University, Beijing, China
| | - Huimei An
- Beijing HuiLongGuan Hospital, Peking University, Beijing, China.
| | - Fude Yang
- Beijing HuiLongGuan Hospital, Peking University, Beijing, China.
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9
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Oluboka OJ, Katzman MA, Habert J, Khullar A, Oakander MA, McIntosh D, McIntyre RS, Soares CN, Lam RW, Klassen LJ, Tanguay R. Early Optimized Pharmacological Treatment in Patients With Depression and Chronic Pain. CNS Spectr 2022; 28:1-40. [PMID: 35195060 DOI: 10.1017/s1092852922000128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractMajor depressive disorder (MDD) is the leading cause of disability worldwide. Patients with MDD have high rates of comorbidity with mental and physical conditions, one of which is chronic pain. Chronic pain conditions themselves are also associated with significant disability, and the large number of patients with MDD who have chronic pain drives high levels of disability and compounds healthcare burden. The management of depression in patients who also have chronic pain can be particularly challenging due to underlying mechanisms that are common to both conditions, and because many patients with these conditions are already taking multiple medications. For these reasons, healthcare providers may be reluctant to treat such patients. The Canadian Network for Mood and Anxiety Treatments (CANMAT) guidelines provide evidence-based recommendations for the management of MDD and comorbid psychiatric and medical conditions such as anxiety, substance use disorder, and cardiovascular disease; however, comorbid chronic pain is not addressed. In this article, we provide an overview of the pathophysiological and clinical overlap between depression and chronic pain and review evidence-based pharmacological recommendations in current treatment guidelines for MDD and for chronic pain. Based on clinical experience with MDD patients with comorbid pain, we recommend rapidly and aggressively treating depression according to CANMAT treatment guidelines, using antidepressant medications with analgesic properties, while addressing pain with first-line pharmacotherapy as treatment for depression is optimized. We review options for treating pain symptoms that remain after response to antidepressant treatment is achieved.
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10
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Mirman AM, Corlier J, Wilson AC, Tadayonnejad R, Marder KG, Pleman CM, Krantz DE, Wilke SA, Levitt JG, Ginder ND, Ojha R, Daskalakis ZJ, Leuchter AF, Lee JC. Absence of early mood improvement as a robust predictor of rTMS nonresponse in major depressive disorder. Depress Anxiety 2022; 39:123-133. [PMID: 34990046 DOI: 10.1002/da.23237] [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: 04/05/2021] [Revised: 10/06/2021] [Accepted: 12/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Symptoms of major depressive disorder (MDD) are reported to change early in treatment with repetitive transcranial magnetic stimulation (rTMS). We evaluated early changes in sleep, anxiety, and mood as predictors of nonresponse to rTMS treatment. METHODS Three hundred twenty-nine subjects with nonpsychotic MDD completed a 6-week course of rTMS treatment. Subjects were stratified by the severity of their baseline depression, and had their overall depressive symptoms recorded every week of treatment. We evaluated lack of improvement in sleep, anxiety, and mood symptoms after 1 and 2 weeks as potential predictors of eventual nonresponse, defined as <50% improvement in compositive depressive symptoms after 6 weeks. This was measured as negative predictive value (NPV; the likelihood that lack of early symptom improvement accurately predicted eventual treatment nonresponse). RESULTS Subjects with severe or very severe baseline depression achieving <20% improvement in mood at 1 week were correctly predicted as nonresponders with NPVs largely >90%. At 2 weeks, subjects with very severe baseline depression who failed to demonstrate any improvement in mood were all nonresponders. Lack of improvement in sleep at 2 weeks was also a significant predictor. CONCLUSIONS Identifying a lack of early mood improvement is a practical and robust method to predict rTMS nonresponse. This suggests a treatment protocol change may be indicated in patients with more severe baseline depression showing minimal early mood improvement.
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Affiliation(s)
- Alex M Mirman
- Neuromodulation Division, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, California, USA.,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Juliana Corlier
- Neuromodulation Division, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, California, USA.,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Andrew C Wilson
- Neuromodulation Division, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, California, USA.,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Reza Tadayonnejad
- Neuromodulation Division, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, California, USA.,Division of the Humanities and Social Sciences, California Institute of Technology, Pasadena, California, USA
| | - Katharine G Marder
- Neuromodulation Division, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, California, USA.,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Christopher M Pleman
- Neuromodulation Division, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, California, USA.,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - David E Krantz
- Neuromodulation Division, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, California, USA.,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Scott A Wilke
- Neuromodulation Division, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, California, USA.,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Jennifer G Levitt
- Neuromodulation Division, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, California, USA.,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Nathaniel D Ginder
- Neuromodulation Division, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, California, USA.,VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Rashi Ojha
- Neuromodulation Division, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, California, USA.,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Zafiris J Daskalakis
- Department of Psychiatry, University of California San Diego School of Medicine, La Jolla, California, USA
| | - Andrew F Leuchter
- Neuromodulation Division, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, California, USA.,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Jonathan C Lee
- Neuromodulation Division, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, California, USA.,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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11
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Lan X, Zhou Y, Wang C, Li W, Zhang F, Liu H, Fu L, Wu K, McIntyre RS, Ning Y. Pre-treatment Pain Symptoms Influence Antidepressant Response to Ketamine in Depressive Patients. Front Psychiatry 2022; 13:793677. [PMID: 35370832 PMCID: PMC8967176 DOI: 10.3389/fpsyt.2022.793677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 02/11/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Pain strongly coexists with depression. Ketamine has great analgesic and antidepressant effects, acting as a promising role in treating depression with pain. Few studies have evaluated impact of pain symptoms on antidepressant effect of ketamine infusions. Thus, present study investigated whether pain symptoms in individuals with depression moderate response to ketamine. METHODS One hundred and four individuals with major depressive disorder and bipolar depression received six intravenous infusions of ketamine. The Montgomery-Åsberg Depression Rating Scale (MADRS) was administered at baseline, the next morning after each infusion and 2 weeks (Day 26) after the last infusion. Pain symptoms were collected at baseline using the short-form McGill Pain Questionnaire (SF-MPQ). RESULTS The prevalence of pain in patients with depression was 48.8%. Mix model analyses showed that pre-treatment pain symptoms assessed by each domain of SF-MPQ significantly moderated antidepressant response to six infusions of ketamine from baseline to day 26 (all p < 0.05). Then follow-up simple slopes analyses suggested that all patients across groups showed a significant symptomatic improvement after ketamine infusions (all p < 0.05), and patients with severe pain (across all domains of SF-MPQ) had greater improvement in depressive symptoms than those with mild pain or non-pain (all p < 0.05). CONCLUSION A significant and rapid improvement in depressive symptoms was observed in patients with depression and pain after ketamine treatment. Ketamine may be a novel and promising antidepressant preferentially for the therapy of depression with severe pain.
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Affiliation(s)
- Xiaofeng Lan
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China.,Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
| | - Yanling Zhou
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China.,Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
| | - Chengyu Wang
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China.,Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
| | - Weicheng Li
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China.,Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
| | - Fan Zhang
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China.,Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
| | - Haiyan Liu
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China.,Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
| | - Ling Fu
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China.,Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China.,The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Kai Wu
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China.,Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China.,Department of Biomedical Engineering, School of Materials Science and Engineering, South China University of Technology, Guangzhou, China
| | - Roger S McIntyre
- Canadian Rapid Treatment Center of Excellence, Mississauga, ON, Canada.,Mood Disorders Psychopharmacology Unit, Poul Hansen Family Centre for Depression, University Health Network, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada.,Brain and Cognition Discovery Foundation, Toronto, ON, Canada.,Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
| | - Yuping Ning
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China.,Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China.,The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
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12
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Glette M, Stiles TC, Jensen MP, Nilsen TIL, Borchgrevink PC, Landmark T. Impact of pain and catastrophizing on the long-term course of depression in the general population: the HUNT pain study. Pain 2021; 162:1650-1658. [PMID: 33416223 DOI: 10.1097/j.pain.0000000000002168] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 12/07/2020] [Indexed: 12/30/2022]
Abstract
ABSTRACT Pain and depression are episodic conditions that might take a chronic course. They are clearly related, but information on how they influence each other in the process of chronification is limited. Pain catastrophizing is hypothesized to play a role in the development of depression and chronic pain, but few longitudinal studies have investigated their association over a longer term. In this study, a random cohort from the general population (n = 4764) answered questions about pain, catastrophizing, and depression at 5 assessments in yearly intervals. Linear mixed models showed that within persons, increases in pain intensity and catastrophizing were independently associated with increases in depressive symptoms {mean change = -1.12, 95% confidence interval (CI) [-1.32 to -0.91] and -1.29, 95% CI [-1.52 to -1.05], respectively}. In prospective analyses restricted to individuals without depression above cutoff at baseline, chronic pain increased the risk of endorsing depression over the following 4 years (odds ratio = 2.01, 95% CI [1.71-2.37]). Seven percent showed a chronic course of depression, as indicated by scores above cutoff on at least 3 of 5 assessments. The number of years lived with chronic pain was associated with a chronic course of depression, with odds ratios increasing from 1.55 (95% CI [0.87-2.91]) to 14.19 (95% CI [8.99-22.41]) when reporting chronic pain on 2 vs 5 assessments compared with none. The results suggest that when pain intensity or catastrophizing change, depressive symptoms change in the same direction. When pain and catastrophizing become chronic, they seem to be mutually reinforcing determinants for chronic depression.
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Affiliation(s)
- Mari Glette
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
- National Competence Centre for Complex Symptom Disorders, Clinic of Anesthesia and Intensive Care, St. Olav's University Hospital, Trondheim, Norway
| | - Tore C Stiles
- National Competence Centre for Complex Symptom Disorders, Clinic of Anesthesia and Intensive Care, St. Olav's University Hospital, Trondheim, Norway
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA, United States
| | - Tom Ivar Lund Nilsen
- National Competence Centre for Complex Symptom Disorders, Clinic of Anesthesia and Intensive Care, St. Olav's University Hospital, Trondheim, Norway
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Petter C Borchgrevink
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
- National Competence Centre for Complex Symptom Disorders, Clinic of Anesthesia and Intensive Care, St. Olav's University Hospital, Trondheim, Norway
| | - Tormod Landmark
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
- National Competence Centre for Complex Symptom Disorders, Clinic of Anesthesia and Intensive Care, St. Olav's University Hospital, Trondheim, Norway
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13
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Sun DL, Liu QH, Li MJ, Yang Y, Zhang R, Li M, Xiang SY, Chen JH. Patient health questionnaire-15 (PHQ-15) to distinguish bipolar II disorder from major depressive disorder. Psychiatry Res 2020; 290:113026. [PMID: 32450414 DOI: 10.1016/j.psychres.2020.113026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 04/14/2020] [Accepted: 04/17/2020] [Indexed: 11/18/2022]
Abstract
A sequential-recruited clinical trial has been conducted to assess capacity of Patient Health Questionnaire-15 (PHQ-15) in distinguishing bipolar II disorder from major depressive disorder. A total of 73 patients (49 BD-II depression patients) filled sociodemographic characteristics, Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 Questionnaire (GAD-7), and PHQ-15. Sum score of PHQ-15 showed statistically significant difference in the two groups (t-test, P = 0.027). The area under the curve was 0.663 (P = 0.025), and the specificity was 0.75 at sum score of 13. Patients with BD-II depression has more somatic symptoms than MDD, and PHQ-15 might be used for identification.
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Affiliation(s)
- Da-Liang Sun
- Department of Psychiatry, Tianjin Anding Hospital, Tianjin Mental Health Center, Tianjin 300222, P.R. China
| | - Qing-He Liu
- Department of Psychiatry, Tianjin Anding Hospital, Tianjin Mental Health Center, Tianjin 300222, P.R. China
| | - Mei-Juan Li
- Department of Psychiatry, Tianjin Anding Hospital, Tianjin Mental Health Center, Tianjin 300222, P.R. China
| | - Yuan Yang
- Department of Psychiatry, Tianjin Anding Hospital, Tianjin Mental Health Center, Tianjin 300222, P.R. China
| | - Ran Zhang
- Department of Psychiatry, Tianjin Anding Hospital, Tianjin Mental Health Center, Tianjin 300222, P.R. China
| | - Min Li
- Department of Psychiatry, Tianjin Anding Hospital, Tianjin Mental Health Center, Tianjin 300222, P.R. China
| | - Si-Ying Xiang
- Shanghai Clinical Research Center for Mental Health, Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, P.R. China.
| | - Jian-Hua Chen
- Shanghai Clinical Research Center for Mental Health, Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, P.R. China; Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, UK.
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14
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Yuan H, Zhu X, Tang W, Cai Y, Shi S, Luo Q. Connectivity between the anterior insula and dorsolateral prefrontal cortex links early symptom improvement to treatment response. J Affect Disord 2020; 260:490-497. [PMID: 31539685 DOI: 10.1016/j.jad.2019.09.041] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 07/09/2019] [Accepted: 09/08/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND Early improvement (EI) following treatment with antidepressants is a widely reported predictor to the treatment response. This study aimed to identify the resting-state functional connectivity (rs-FC) and its related clinical features that link the treatment response at the time of EI. METHODS This study included 23 first-episode treatment-naive patients with MDD. After 2 weeks of antidepressant treatment, these patients received 3.0 Tesla resting-state functional magnetic resonance imaging scanning and were subgrouped into an EI group (N = 13) and a non-EI group (N = 10). Using the anterior insula (rAI) as a seed region, this study identified the rs-FC that were associated with both EI and the treatment response at week 12, and further tested the associations of the identified rs-FC with either the clinical features or the early symptom improvement. RESULTS Rs-FC between rAI and the left dorsolateral prefrontal cortex (dlPFC) was associated with EI (t21 = -6.091, p = 0.022 after FDR correction for multiple comparisons). This rs-FC was also associated with an interaction between EI and the treatment response at the week 12 (t21 = -5.361, p = 6.37e-5). Moreover, among the clinical features, this rs-FC was associated with the early symptom improvement in the insomnia, somatic symptoms, and anxiety symptoms, and these early symptom improvements were associated with the treatment response. CONCLUSION Rs-FC between the rAI and the left dlPFC played a crucial role in the early antidepressant effect, which linked the treatment response. The early treatment effect relating to rAI may represent an early symptom improvement in self-perceptual anxiety, somatic symptoms and insomnia.
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Affiliation(s)
- Hsinsung Yuan
- Psychiatry Department of Huashan Hospital, Fudan University, Shanghai, China; Psychiatry Department of Nanjing Meishan Hospital, Nanjing, China
| | - Xiao Zhu
- Psychiatry Department of Huashan Hospital, Fudan University, Shanghai, China
| | - Weijun Tang
- Radiological Department of Huashan Hospital, Fudan University, Shanghai, China
| | - Yiyun Cai
- Psychiatry Department of Huashan Hospital, Fudan University, Shanghai, China
| | - Shenxun Shi
- Psychiatry Department of Huashan Hospital, Fudan University, Shanghai, China.
| | - Qiang Luo
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China; Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence (Ministry of Education), Fudan University, Shanghai, China.
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15
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Altered regional homogeneity in patients with somatic depression: A resting-state fMRI study. J Affect Disord 2019; 246:498-505. [PMID: 30599374 DOI: 10.1016/j.jad.2018.12.066] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 11/27/2018] [Accepted: 12/20/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND Somatic symptoms are common among patients with major depressive disorder (MDD), and are known to negatively impact the course and severity of the disease. Although previous studies have attempted to explore the neuropathology of MDD, little is known regarding the neural basis of somatic symptoms in MDD. METHODS Resting-state functional magnetic resonance images of 28 MDD patients with somatic symptoms (somatic depression, SD), 30 patients without somatic symptoms (non-somatic depression, NSD) and 30 healthy controls (HC) were obtained. We investigated the neural basis of MDD with somatic symptoms based on the measure of regional homogeneity (ReHo). We also investigated whether the altered regional homogeneity may be correlated to any clinical features of depression. These comparison were also carried out in female and male subjects respectively. RESULTS The SD exhibited higher ReHo in the bilateral parahippocampus and left lingual gyrus than HC, as well as lower ReHo in the right frontal gyrus. Relative to NSD, the SD exhibited lower ReHo in the right middle frontal gyrus and left precentral gyrus. Furthermore, in the SD, ReHo in the left precentral gyrus was positively correlated with cognitive factor scores of the HAMD-17. In female subjects, SD exhibited increased ReHo in the right STG and decreased ReHo in the right MFG, relative to women of the NSD group. CONCLUSIONS Our preliminary findings indicated that abnormal ReHo in the frontal and temporal regions may play an important role in the neural basis of somatic depression.
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16
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Mlost J, Wąsik A, Michaluk JT, Antkiewicz-Michaluk L, Starowicz K. Changes in Monoaminergic Neurotransmission in an Animal Model of Osteoarthritis: The Role of Endocannabinoid Signaling. Front Mol Neurosci 2018; 11:466. [PMID: 30618615 PMCID: PMC6306412 DOI: 10.3389/fnmol.2018.00466] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 12/03/2018] [Indexed: 12/18/2022] Open
Abstract
Chronic pain is a main symptom of osteoarthritis (OA). Moreover, a high percentage of OA patients suffer from mental health problems. The endocannabinoid (EC) system has attracted attention as an emerging drug target for pain treatment together with its activity on the mesolimbic reward system. Understanding the circuits that govern the reward of pain relief is crucial for the search for effective analgesics. Therefore, we investigated the role of the EC system on dopamine (DA) and noradrenaline (NA) in an animal model of OA-related chronic pain. OA rats exhibited significant decreases in DA metabolism in the nucleus accumbens (NAc), striatum (STR) and hippocampus (HC). NA metabolism was also significantly decreased by chronic pain in OA rats; however, this disruption was limited to the frontal cortex (FCx) and HC. URB597 (an inhibitor of EC metabolism) treatment completely reversed the decreased DA metabolism, especially in the brain reward system and the HC. Furthermore, administration of URB597 normalized the impairment of NA activity in the HC but potentiated the decreased NA levels in the FCx. Our results demonstrated that chronic pain in OA rats was reflected by the inhibition of mesolimbic and mesocortical dopaminergic transmission, and may indicate the pro-pain role of NA in the FCx. The data provide understanding about changes in neurotransmission in chronic pain states and may explain the clinical improvement in perceived life quality following cannabinoid treatment. Additional mechanistic studies in preclinical models examining the intersection between chronic pain and reward circuits may offer new approaches for improving pain therapy.
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Affiliation(s)
- Jakub Mlost
- Department of Neurochemistry, Institute of Pharmacology, Polish Academy of Sciences, Kraków, Poland
| | - Agnieszka Wąsik
- Department of Neurochemistry, Institute of Pharmacology, Polish Academy of Sciences, Kraków, Poland
| | - Jerzy Tadeusz Michaluk
- Department of Neurochemistry, Institute of Pharmacology, Polish Academy of Sciences, Kraków, Poland
| | | | - Katarzyna Starowicz
- Department of Neurochemistry, Institute of Pharmacology, Polish Academy of Sciences, Kraków, Poland
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17
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Oneib B, Sabir M, Otheman Y, Ouanass A. [Depressive disorders in primary care: Clinical features and sociodemographic characteristics]. Rev Epidemiol Sante Publique 2018; 66:255-262. [PMID: 29866509 DOI: 10.1016/j.respe.2018.03.366] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 03/13/2018] [Accepted: 03/19/2018] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Our aim was to determine the reason for consultation and the clinical features of depressive disorders according to the diagnostic and statistical manual (DSM) 4th edition IV R in primary care and to identify if there is an association between sociodemographic characteristics and depressive pattern. MATERIALS AND METHODS In a cross-sectional study conducted to determinate the prevalence of depressive disorders in primary care, at three urban centers in two cities Salé and Oujda by five physicians, we recruited primary care 396 patients of whom 58 were depressed, among these patients we screened for depressive disorders, their clinical features, the melancholic characteristics and suicidal ideation using the Mini International Neuropsychiatric Interview. RESULTS Mean age of the 58 depressive patients was 46±15 years. They were predominantly female, inactive and of low socio-economic level. Approximately one-third of the patients were illiterate and single. The symptoms frequently encountered were sadness (63.7%), anhedonia (62%), insomnia (45.7%), anorexia (60.9%), psychomotor retardation (60.9%) and asthenia (73.9%). Somatic symptoms were present 99%, the most common complaint was pain that exhibited 68.6% prevalence. Suicidal ideations were found in 36.2% of these depressive patients. CONCLUSION The accuracy of the clinical features of patients with depression in primary care will facilitate the detection of these disorders by general practitioners and improve management of depression.
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Affiliation(s)
- B Oneib
- Département de psychiatrie, faculté de médecine, université Mohammed I, Oujda, Maroc.
| | - M Sabir
- Département de psychiatrie, faculté de médecine, université Mohammed VI, Maroc
| | - Y Otheman
- Centre psychiatrique universitaire El-Hassan, faculté de médecine, université Sidi-Mohammed-Benabdellah, Fès Maroc
| | - A Ouanass
- Département de psychiatrie, faculté de médecine, université Mohammed VI, Maroc
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Tokuoka H, Nishihara M, Fujikoshi S, Yoshikawa A, Kuga A. Predicting treatment outcomes of major depressive disorder by early improvement in painful physical symptoms: a pooled analysis of double-blind, placebo-controlled trials of duloxetine. Neuropsychiatr Dis Treat 2017; 13:2457-2467. [PMID: 29026309 PMCID: PMC5626379 DOI: 10.2147/ndt.s143093] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE We determined if early improvement in painful physical symptoms (PPS) can be a predictor of remission in the treatment of major depressive disorder (MDD). METHODS We included randomized, double-blind, parallel-group clinical trials of duloxetine (40-60 mg/day) versus placebo for the acute treatment of MDD with associated PPS. Only those studies using the Montgomery-Åsberg Depression Rating Scale (MADRS) and the Brief Pain Inventory - Short Form (BPI-SF) were included. Three studies met all criteria and included male or female outpatients aged ≥18 years who met the diagnostic criteria for MDD, had a MADRS total score ≥20, and had at least moderate pain (BPI-SF average pain score ≥3). Positive predictive values (PPVs) and negative predictive values (NPVs) of early improvement in PPS for remission were analyzed. PPVs were the proportion of patients with remission (MADRS total score ≤10) at week 8 out of patients who experienced early improvement in BPI-SF average pain score (≥30% decrease from baseline at week 1, 2, or 4). NPVs were the proportion of patients without remission (MADRS total score >10) at week 8 out of patients who did not experience early improvement in PPS. RESULTS Data from 1,320 patients were analyzed (duloxetine N=641 and placebo N=679). The overall remission (MADRS total score ≤10 at week 8) rate for the duloxetine group was significantly higher than the placebo group (38.5% vs 21.8%; P<0.0001). For both treatment groups, PPVs of early improvement in BPI-SF (30% improvement from baseline) were higher than the overall remission rate for all weeks examined (weeks 1, 2, and 4); in general, NPVs of early improvement in BPI-SF for nonremission were higher than the overall nonremission rate. CONCLUSION Early improvement in PPS can be a useful clinical indicator of subsequent treatment outcome for MDD patients with associated PPS.
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Affiliation(s)
- Hirofumi Tokuoka
- Bio-Medicine, Medicines Development Unit Japan, Eli Lilly Japan K.K., Kobe
| | - Makoto Nishihara
- Multidisciplinary Pain Center, Aichi Medical University, Nagakute, Aichi
| | | | - Aki Yoshikawa
- Scientific Communications, Medicines Development Unit Japan, Eli Lilly Japan K.K., Kobe, Japan
| | - Atsushi Kuga
- Bio-Medicine, Medicines Development Unit Japan, Eli Lilly Japan K.K., Kobe
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Jeon SW, Yoon SY, Ko YH, Joe SH, Kim YK, Han C, Yoon HK, Liu CY. Do Somatic Symptoms Predict the Severity of Depression? A Validation Study of the Korean Version of the Depression and Somatic Symptoms Scale. J Korean Med Sci 2016; 31:2002-2009. [PMID: 27822942 PMCID: PMC5102867 DOI: 10.3346/jkms.2016.31.12.2002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 09/03/2016] [Indexed: 11/20/2022] Open
Abstract
This study aimed at exploring the psychometric characteristics of the Korean Version of the Depression and Somatic Symptoms Scale (DSSS) in a clinical sample, and investigating the impact of somatic symptoms on the severity of depression. Participants were 203 consecutive outpatients with current major depressive disorders (MDD) or lifetime diagnosis of MDD. The DSSS was compared with the Montgomery-Åsberg Depression Rating Scale (MADRS) and the 17-items Hamilton Depression Rating Scale (HAMD). The DSSS showed a two-factor structure that accounted for 56.8% of the variance, as well as excellent internal consistency (Cronbach's alpha = 0.95), concurrent validity (r = 0.44-0.82), and temporal stability (intraclass correlation coefficient = 0.79). The DSSS had a high ability to identify patients in non-remission (area under receiver operating characteristic [ROC] curve = 0.887). Maximal discrimination between remission and non-full remission was obtained at a cut-off score of 22 (sensitivity = 82.1%, specificity = 81.4%). The number of somatic symptoms (the range of somatic symptoms) and the scores on the somatic subscale (SS, the severity of somatic symptoms) in non-remission patients were greater than those in remission patients. The number of somatic symptoms (slope = 0.148) and the SS score (slope = 0.472) were confirmed as excellent predictors of the depression severity as indicated by the MADRS scores. The findings indicate that the DSSS is a useful tool for simultaneously, rapidly, and accurately measuring depression and somatic symptoms in clinical practice settings and in consultation fields.
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Affiliation(s)
- Sang Won Jeon
- Department of Psychiatry, Korea University Ansan Hospital, Ansan, Korea
| | - Seo Young Yoon
- Department of Psychiatry, Korea University Ansan Hospital, Ansan, Korea
| | - Young Hoon Ko
- Department of Psychiatry, Korea University Ansan Hospital, Ansan, Korea.
| | - Sook Haeng Joe
- Department of Psychiatry, Korea University Guro Hospital, Seoul, Korea
| | - Yong Ku Kim
- Department of Psychiatry, Korea University Ansan Hospital, Ansan, Korea
| | - Changsu Han
- Department of Psychiatry, Korea University Ansan Hospital, Ansan, Korea
| | - Ho Kyoung Yoon
- Department of Psychiatry, Korea University Ansan Hospital, Ansan, Korea
| | - Chia Yih Liu
- Department of Psychiatry, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
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20
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Kivrak Y, Karademir B, Aygun H, Ersan Y, Ari M, Karaahmet E, Yagci I. The Effect of Agomelatine on the Nociceptive System. ACTA ACUST UNITED AC 2016. [DOI: 10.5455/bcp.20130925022745] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Yuksel Kivrak
- Kafkas University School of Medicine, Department of Psychiatry, Kars-Turkey
| | | | - Hayati Aygun
- Kafkas University School of Medicine, Department of Orthopedics and Traumatology, Kars-Turkey
| | - Yusuf Ersan
- Kafkas University Faculty of Science and Art, Department of Biology, Kars-Turkey
| | - Mustafa Ari
- Mustafa Kemal University School of Medicine, Department of Psychiatry, Hatay-Turkey
| | - Elif Karaahmet
- Canakkale Onsekiz Mart University School of Medicine, Department of Psychiatry, Canakkale-Turkey
| | - Ibrahim Yagci
- Kafkas University School of Medicine, Department of Psychiatry, Kars-Turkey
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21
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Radanov B. Somatoforme Schmerzstörung, Fibromyalgie und chronisches Müdigkeitssyndrom aus psychosomatischer Sicht. MANUELLE MEDIZIN 2016. [DOI: 10.1007/s00337-016-0175-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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22
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Reward deficiency and anti-reward in pain chronification. Neurosci Biobehav Rev 2016; 68:282-297. [DOI: 10.1016/j.neubiorev.2016.05.033] [Citation(s) in RCA: 132] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 05/26/2016] [Accepted: 05/27/2016] [Indexed: 12/12/2022]
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Zhao J, Luo D, Liang Z, Lao L, Rong J. Plant Natural Product Puerarin Ameliorates Depressive Behaviors and Chronic Pain in Mice with Spared Nerve Injury (SNI). Mol Neurobiol 2016; 54:2801-2812. [PMID: 27013468 DOI: 10.1007/s12035-016-9870-x] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Accepted: 03/17/2016] [Indexed: 12/16/2022]
Abstract
Simultaneous relief of the pain from body and brain remains an ongoing challenge. The aim of the present study was to clarify whether plant-derived isoflavone puerarin could ameliorate comorbid depression and pain. We investigated the effects of puerarin on depressive-like behaviors and neuropathic pain in C57BL/6 N mice with spared nerve injury (SNI). After SNI surgery, mice were allowed to recover spontaneously for 7 days and subsequently treated with puerarin, anti-depressant citalopram, and analgesic ibuprofen, alone or in combination, for 8 or 14 days. Forced swim test and tail suspension test were used to assess depressive-like behaviors, whereas von Frey filament test was used to estimate the sensitivity to the mechanical stimulation. Our results suggested that puerarin effectively ameliorated depression and pain in SNI mice although citalopram exhibited anti-depressant activity. In contrast, ibuprofen showed lesser activities against SNI-induced depression and pain. Further mechanistic studies revealed the uniqueness of puerarin as follows: (1) puerarin did not recover SNI-induced depletion of reduced glutathione and loss of superoxide dismutase (SOD), whereas citalopram and ibuprofen showed somewhat antioxidant activities; (2) puerarin markedly promoted the activation of CREB pathway although puerarin and citalopram activated ERK pathway to the same extent; (3) puerarin rapidly and persistently induced brain-derived neurotrophic factor (BDNF) expression whereas citalopram only induced BDNF expression after a prolonged stimulation. Collectively, these results suggest that puerarin may ameliorate the SNI-induced depression and pain via activating ERK, CREB, and BDNF pathways. Puerarin may serve as new lead compound for the development of novel therapeutics for depression and pain comorbidity.
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Affiliation(s)
- Jia Zhao
- School of Chinese Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, 10 Sassoon Road, Pokfulam, Hong Kong
| | - Dan Luo
- School of Chinese Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, 10 Sassoon Road, Pokfulam, Hong Kong
| | - Zhaohui Liang
- School of Chinese Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, 10 Sassoon Road, Pokfulam, Hong Kong
| | - Lixing Lao
- School of Chinese Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, 10 Sassoon Road, Pokfulam, Hong Kong
| | - Jianhui Rong
- School of Chinese Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, 10 Sassoon Road, Pokfulam, Hong Kong.
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Harada E, Tokuoka H, Fujikoshi S, Funai J, Wohlreich MM, Ossipov MH, Iwata N. Is duloxetine's effect on painful physical symptoms in depression an indirect result of improvement of depressive symptoms? Pooled analyses of three randomized controlled trials. Pain 2016; 157:577-584. [PMID: 26882344 PMCID: PMC4751744 DOI: 10.1097/j.pain.0000000000000406] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 10/06/2015] [Accepted: 10/27/2015] [Indexed: 11/26/2022]
Abstract
In treating Major Depressive Disorder with associated painful physical symptoms (PPS), the effect of duloxetine on PPS has been shown to decompose into a direct effect on PPS and an indirect effect on PPS via depressive symptoms (DS) improvement. To evaluate the changes in relative contributions of the direct and indirect effects over time, we analyzed pooled data from 3 randomized double-blind studies comparing duloxetine 60 mg/d with placebo in patients with major depressive disorder and PPS. Changes from baseline in Montgomery-Åsberg Depression Rating Scale total and Brief Pain Inventory-Short Form average pain score were assessed over 8 weeks. Path analysis examined the (1) direct effect of treatment on PPS and/or indirect effect on PPS via DS improvement and (2) direct effect of treatment on DS and/or indirect effect on DS via PPS improvement. At week 1, the direct effect of duloxetine on PPS (75.3%) was greater than the indirect effect through DS improvement (24.7%) but became less (22.6%) than the indirect effect (77.4%) by week 8. Initially, the direct effect of duloxetine on PPS was markedly greater than its indirect effect, whereas later the indirect effect predominated. Conversely, at week 1, the direct effect of treatment on DS (46.4%) was less than the indirect effect (53.6%), and by week 8 it superseded (62.6%) the indirect effect (37.4%). Thus, duloxetine would relieve PPS directly in the initial phase and indirectly via improving DS in the later phase.
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Affiliation(s)
- Eiji Harada
- Medical Science, Eli Lilly Japan K.K., Kobe, Hyogo, Japan
| | | | | | - Jumpei Funai
- Science Communications, Eli Lilly Japan K.K., Kobe, Hyogo, Japan
| | | | | | - Nakao Iwata
- Department of Psychiatry, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
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Jaracz J, Gattner K, Jaracz K, Górna K. Unexplained Painful Physical Symptoms in Patients with Major Depressive Disorder: Prevalence, Pathophysiology and Management. CNS Drugs 2016; 30:293-304. [PMID: 27048351 PMCID: PMC4839032 DOI: 10.1007/s40263-016-0328-5] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Patients with major depression often report pain. In this article, we review the current literature regarding the prevalence and consequences, as well as the pathophysiology, of unexplained painful physical symptoms (UPPS) in patients with major depressive disorder (MDD). UPPS are experienced by approximately two-thirds of depressed patients. The presence of UPPS makes a correct diagnosis of depression more difficult. Moreover, UPPS are a predictor of a poor response to treatment and a more chronic course of depression. Pain, in the course of depression, also has a negative impact on functioning and quality of life. Frequent comorbidity of depression and UPPS has inspired the formulation of an hypothesis regarding a shared neurobiological mechanism of both conditions. Evidence from neuroimaging studies has shown that frontal-limbic dysfunction in depression may explain abnormal pain processing, leading to the presence of UPPS. Increased levels of proinflamatory cytokines and substance P in patients with MDD may also clarify the pathophysiology of UPPS. Finally, dysfunction of the descending serotonergic and noradrenergic pathways that normally suppress ascending sensations has been proposed as a core mechanism of UPPS. Psychological factors such as catastrophizing also play a role in both depression and chronic pain. Therefore, pharmacological treatment and/or cognitive therapy are recommended in the treatment of depression with UPPS. Some data suggest that serotonin and noradrenaline reuptake inhibitors (SNRIs) are more effective than selective serotonin reuptake inhibitors (SSRIs) in the alleviation of depression and UPPS. However, the pooled analysis of eight randomised clinical trials showed similar efficacy of duloxetine (an SNRI) and paroxetine (an SSRI) in reducing UPPS in depression. Further integrative studies examining genetic factors (e.g. polymorphisms of genes for interleukins, serotonin transporter and receptors), molecular factors (e.g. cytokines, substance P) and neuroimaging findings (e.g. functional studies during painful stimulation) might provide further explanation of the pathophysiology of UPPS in MDD and therefore facilitate the development of more effective methods of treatment.
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Affiliation(s)
- Jan Jaracz
- Department of Adult Psychiatry, Poznan University of Medical Sciences, Szpitalna str 27/33, 60-572, Poznan, Poland.
| | - Karolina Gattner
- Department of Adult Psychiatry, Poznan University of Medical Sciences, Szpitalna str 27/33, 60-572, Poznan, Poland
| | - Krystyna Jaracz
- Department of Neurological and Psychiatric Nursing, Poznan University of Medical Sciences, Poznan, Poland
| | - Krystyna Górna
- Department of Neurological and Psychiatric Nursing, Poznan University of Medical Sciences, Poznan, Poland
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26
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Pain Affects Clinical Patterns and Treatment Outcomes for Patients With Major Depressive Disorder Taking Fluoxetine. J Clin Psychopharmacol 2015; 35:661-6. [PMID: 26479220 DOI: 10.1097/jcp.0000000000000410] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The aim of the study was to determine whether baseline pain was associated with discernible clinical features and treatment outcomes for patients with major depressive disorder (MDD) receiving 6-week fluoxetine treatment. A total of 131 inpatients with acutely ill MDD were enrolled to receive 20 mg of fluoxetine daily for 6 weeks. Pain was measured by the Short-Form 36 body pain index. Symptom severity, functional impairment, and severity of adverse events were assessed at baseline and again at weeks 1 to 4 and 6 using the 17-item Hamilton Depression Rating Scale, Modified Work and Social Adjustment Scale, and Utvalg for Kliniske Undersogelser Side Effect Rating Scale, respectively. Simple linear regression was employed to examine the clinical variables significantly associated with pain. The generalized estimating equations method was used to analyze the influence of pain on the 17-item Hamilton Depression Rating Scale, Modified Work and Social Adjustment Scale, and Utvalg for Kliniske Undersogelser Side Effect Rating Scale over time. Of the 131 participants, 119 (90.8%) who completed baseline pain measurements and had at least 1 postbaseline assessment were included in the analysis. Patients experiencing greater pain were more likely to have more severe depression, to be at greater risk of suicide, to have functional impairment, to experience stressful life events, and to have poor treatment outcomes. These findings suggest that pain was significantly associated with multiple aspects of patients with MDD. Patients with MDD with higher levels of pain were clinically useful in predicting poor outcomes after acute fluoxetine treatment.
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27
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Bi X, Breland JY, Moos RH, Cronkite RC. Longitudinal changes in somatic symptoms and family disagreements among depression and community groups: a 23-year study. BMC Psychiatry 2015; 15:240. [PMID: 26449276 PMCID: PMC4599756 DOI: 10.1186/s12888-015-0619-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 09/30/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Few longitudinal studies describe the relationship between somatic symptoms and family disagreements. We examined changes over time in somatic symptoms, family disagreements, their interrelationships, and whether these patterns differed between individuals treated for depression (depression group) and individuals from the same community (community group). METHODS We followed participants in the depression (N = 423) and community (N = 424) groups for 23 years (the community group was matched to the depression group on socioeconomic status, gender, and marital status). All participants were age 18+ and completed surveys at baseline, 1, 4, 10, and 23 year follow-ups. We assessed somatic symptoms and family disagreements at each time point and used latent growth curve modeling to examine change in these constructs over time. RESULTS Somatic symptoms and family disagreements changed differently over time. Somatic symptoms decreased between baseline and the 10 year follow-up, but increased between the 10 and 23 year follow-ups, whereas family disagreements decreased linearly over time. Somatic symptoms and family disagreements were higher at baseline and declined at a faster rate in the depression compared to the community group. The relationship between changes in somatic symptoms and changes in family disagreements was also stronger in the depression group: a larger decrease in somatic symptoms was associated with a larger decrease in family disagreements. CONCLUSIONS Longitudinal changes in somatic symptoms and family disagreements differ between depression and community groups. Individuals treated for depression had more somatic symptoms and family disagreements at baseline and improved at a faster rate compared to individuals in the community. Somatic symptoms and family disagreements may be important targets when treating depression, given the strong interrelationship among these factors in individuals with depression.
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Affiliation(s)
- Xiaoyu Bi
- Center for Innovation to Implementation, Health Services Research and Development (HSR&D), Veterans Affairs Palo Alto Health Care System (152-MPD), 795 Willow Road, Menlo Park, CA, 94025, USA.
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Rd, Stanford, CA, 94304, USA.
| | - Jessica Y Breland
- Center for Innovation to Implementation, Health Services Research and Development (HSR&D), Veterans Affairs Palo Alto Health Care System (152-MPD), 795 Willow Road, Menlo Park, CA, 94025, USA.
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Rd, Stanford, CA, 94304, USA.
| | - Rudolf H Moos
- Center for Innovation to Implementation, Health Services Research and Development (HSR&D), Veterans Affairs Palo Alto Health Care System (152-MPD), 795 Willow Road, Menlo Park, CA, 94025, USA.
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Rd, Stanford, CA, 94304, USA.
| | - Ruth C Cronkite
- Center for Innovation to Implementation, Health Services Research and Development (HSR&D), Veterans Affairs Palo Alto Health Care System (152-MPD), 795 Willow Road, Menlo Park, CA, 94025, USA.
- Department of Sociology, Stanford University, 450 Serra Mall, Stanford, CA, 94305, USA.
- Center for Primary Care and Outcomes Research, Stanford University, 117 Encina Commons, Stanford, CA, 94305, USA.
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28
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Cleare A, Pariante CM, Young AH, Anderson IM, Christmas D, Cowen PJ, Dickens C, Ferrier IN, Geddes J, Gilbody S, Haddad PM, Katona C, Lewis G, Malizia A, McAllister-Williams RH, Ramchandani P, Scott J, Taylor D, Uher R. Evidence-based guidelines for treating depressive disorders with antidepressants: A revision of the 2008 British Association for Psychopharmacology guidelines. J Psychopharmacol 2015; 29:459-525. [PMID: 25969470 DOI: 10.1177/0269881115581093] [Citation(s) in RCA: 399] [Impact Index Per Article: 44.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
A revision of the 2008 British Association for Psychopharmacology evidence-based guidelines for treating depressive disorders with antidepressants was undertaken in order to incorporate new evidence and to update the recommendations where appropriate. A consensus meeting involving experts in depressive disorders and their management was held in September 2012. Key areas in treating depression were reviewed and the strength of evidence and clinical implications were considered. The guidelines were then revised after extensive feedback from participants and interested parties. A literature review is provided which identifies the quality of evidence upon which the recommendations are made. These guidelines cover the nature and detection of depressive disorders, acute treatment with antidepressant drugs, choice of drug versus alternative treatment, practical issues in prescribing and management, next-step treatment, relapse prevention, treatment of relapse and stopping treatment. Significant changes since the last guidelines were published in 2008 include the availability of new antidepressant treatment options, improved evidence supporting certain augmentation strategies (drug and non-drug), management of potential long-term side effects, updated guidance for prescribing in elderly and adolescent populations and updated guidance for optimal prescribing. Suggestions for future research priorities are also made.
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Affiliation(s)
- Anthony Cleare
- Professor of Psychopharmacology & Affective Disorders, King's College London, Institute of Psychiatry, Psychology and Neuroscience, Centre for Affective Disorders, London, UK
| | - C M Pariante
- Professor of Biological Psychiatry, King's College London, Institute of Psychiatry, Psychology and Neuroscience, Centre for Affective Disorders, London, UK
| | - A H Young
- Professor of Psychiatry and Chair of Mood Disorders, King's College London, Institute of Psychiatry, Psychology and Neuroscience, Centre for Affective Disorders, London, UK
| | - I M Anderson
- Professor and Honorary Consultant Psychiatrist, University of Manchester Department of Psychiatry, University of Manchester, Manchester, UK
| | - D Christmas
- Consultant Psychiatrist, Advanced Interventions Service, Ninewells Hospital & Medical School, Dundee, UK
| | - P J Cowen
- Professor of Psychopharmacology, Psychopharmacology Research Unit, Neurosciences Building, University Department of Psychiatry, Warneford Hospital, Oxford, UK
| | - C Dickens
- Professor of Psychological Medicine, University of Exeter Medical School and Devon Partnership Trust, Exeter, UK
| | - I N Ferrier
- Professor of Psychiatry, Honorary Consultant Psychiatrist, School of Neurology, Neurobiology & Psychiatry, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - J Geddes
- Head, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - S Gilbody
- Director of the Mental Health and Addictions Research Group (MHARG), The Hull York Medical School, Department of Health Sciences, University of York, York, UK
| | - P M Haddad
- Consultant Psychiatrist, Cromwell House, Greater Manchester West Mental Health NHS Foundation Trust, Salford, UK
| | - C Katona
- Division of Psychiatry, University College London, London, UK
| | - G Lewis
- Division of Psychiatry, University College London, London, UK
| | - A Malizia
- Consultant in Neuropsychopharmacology and Neuromodulation, North Bristol NHS Trust, Rosa Burden Centre, Southmead Hospital, Bristol, UK
| | - R H McAllister-Williams
- Reader in Clinical Psychopharmacology, Institute of Neuroscience, Newcastle University, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - P Ramchandani
- Reader in Child and Adolescent Psychiatry, Centre for Mental Health, Imperial College London, London, UK
| | - J Scott
- Professor of Psychological Medicine, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - D Taylor
- Professor of Psychopharmacology, King's College London, London, UK
| | - R Uher
- Associate Professor, Canada Research Chair in Early Interventions, Dalhousie University, Department of Psychiatry, Halifax, NS, Canada
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Depression and pain: an appraisal of cost effectiveness and cost utility of antidepressants. J Psychiatr Res 2015; 63:123-31. [PMID: 25727051 DOI: 10.1016/j.jpsychires.2015.01.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Revised: 01/10/2015] [Accepted: 01/31/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND Although depression and chronic pain frequently co-occur, there is a lack of clarity in the literature regarding the cost-effectiveness and cost-utility of antidepressants in the presence of these two conditions. From the perspective of healthcare provider, the current study aims to compare the cost-effectiveness and cost-utility of antidepressants in a national cohort of depressed patients with and without comorbid pain conditions. METHODS Adult patients prescribed with antidepressants for depression were identified from the National Health Insurance Research Database in Taiwan (n=96,501). By using remission as effectiveness measure and quality-adjusted life years (QALYs) as utility measure, the cost-effectiveness and cost-utility were compared across selective serotonin reuptake inhibitors (SSRIs), serotonin norepinephrine reuptake inhibitors (SNRIs), and tricyclic antidepressants (TCAs), as well as by the presence of comorbid painful physical symptoms (PPS). RESULTS SSRIs dominated SNRIs in both the cost-effectiveness and cost-utility regardless of comorbid PPS. In comparison with TCAs, SSRIs were likely to be the cost-effective option for patients without PPS. In patients with PPS, the cost-utility advantage for SSRIs over TCAs varied with threshold willingness-to-pay levels. Comorbid PPS may be considered an effect modifier of the cost-utility comparisons between SSRIs and TCAs. CONCLUSIONS For depressed patients without PPS, SSRIs are likely to be cost-effective in improving remission rates and QALYs compared to TCAs and SNRIs. However, to improve cost-utility in those with comorbid PPS, people need to choose between SSRIs and TCAs according to threshold willingness-to-pay levels. Future research is warranted to clarify the impacts of different pain conditions on the economic evaluations of pharmacological treatments in patients with depression.
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Novick D, Hong J, Montgomery W, Dueñas H, Gado M, Haro JM. Predictors of remission in the treatment of major depressive disorder: real-world evidence from a 6-month prospective observational study. Neuropsychiatr Dis Treat 2015; 11:197-205. [PMID: 25653529 PMCID: PMC4309785 DOI: 10.2147/ndt.s75498] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND This study examined potential predictors of remission among patients treated for major depressive disorder (MDD) in a naturalistic clinical setting, mostly in the Middle East, East Asia, and Mexico. METHODS Data for this post hoc analysis were taken from a 6-month prospective, noninterventional, observational study that involved 1,549 MDD patients without sexual dysfunction at baseline in 12 countries worldwide. Depression severity was measured using the Clinical Global Impression of Severity and the 16-item Quick Inventory of Depressive Symptomatology Self-Report (QIDS-SR16). Depression-related pain was measured using the pain-related items of the Somatic Symptom Inventory. Remission was defined as a QIDS-SR16 score ≤5. Generalized estimating equation regression models were used to examine baseline factors associated with remission during follow-up. RESULTS Being from East Asia (odds ratio [OR] 0.48 versus Mexico; P<0.001), a higher level of depression severity at baseline (OR 0.77, P=0.003, for Clinical Global Impression of Severity; OR 0.92, P<0.001, for QIDS-SR16), more previous MDD episodes (OR 0.92, P=0.007), previous treatments/therapies for depression (OR 0.78, P=0.030), and having any significant psychiatric and medical comorbidity at baseline (OR 0.60, P<0.001) were negatively associated with remission, whereas being male (OR 1.29, P=0.026) and treatment with duloxetine (OR 2.38 versus selective serotonin reuptake inhibitors, P<0.001) were positively associated with remission. However, the association between Somatic Symptom Inventory pain scores and remission no longer appeared to be significant in this multiple regression (P=0.580), (P=0.008 in descriptive statistics), although it remained significant in a subgroup of patients treated with selective serotonin reuptake inhibitors (OR 0.97, P=0.023), but not in those treated with duloxetine (P=0.182). CONCLUSION These findings are largely consistent with previous reports from the USA and Europe. They also highlight the potential mediating role of treatment with duloxetine on the negative relationship between depression-related pain and outcomes of depression.
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Affiliation(s)
| | | | | | | | - Magdy Gado
- Eli Lilly and Company, Riyadh, Saudi Arabia
| | - Josep Maria Haro
- Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
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Pharmacological treatment of depression with and without headache disorders: an appraisal of cost effectiveness and cost utility of antidepressants. J Affect Disord 2015; 170:255-65. [PMID: 25261631 DOI: 10.1016/j.jad.2014.08.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 07/28/2014] [Accepted: 08/25/2014] [Indexed: 11/20/2022]
Abstract
BACKGROUND Depression and headache are highly prevalent in clinical settings. The co-occurrence of headache may impact choice of antidepressants, healthcare utilisation, and outcomes in patients with depression. The current study aims to examine the cost-effectiveness and cost-utility of different antidepressants for treating patients with depression and comorbid headache disorders. METHODS Adult patients prescribed with antidepressants for depression (n=96,501) were identified from the National Health Insurance Research Database in Taiwan. A cost-effectiveness and cost-utility analysis was conducted comparing selective serotonin reuptake inhibitors (SSRIs), serotonin norepinephrine reuptake inhibitors (SNRIs), and tricyclic antidepressants (TCAs), and by the presence of comorbid headache disorders and other pain conditions. RESULTS In this study, SSRIs dominated SNRIs in both cost-effectiveness and cost-utility. As revealed in the cost-effectiveness acceptability curves, TCAs were likely to have a cost-utility advantage compared to SSRIs and SNRIs in improving quality-adjusted life years (QALYs) for patients with comorbid headache; SSRIs remained as the most cost-effective option for patients with other pain conditions. LIMITATIONS Limitations include the use of proxy definition of remission as effectiveness measure and the adoption of utility values from previous studies. CONCLUSIONS Given a pre-determined willingness-to-pay level, TCAs can be considered as a cost-effective option to improve QALYs for depressed patients with headache disorders. Future research is needed to further clarify factors influencing the cost-effectiveness and cost-utility of pharmacological treatments in depressed patients with specific pain conditions.
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Hung CI, Liu CY, Chen CY, Yang CH, Wang SJ. The impacts of migraine and anxiety disorders on painful physical symptoms among patients with major depressive disorder. J Headache Pain 2014; 15:73. [PMID: 25382691 PMCID: PMC4236854 DOI: 10.1186/1129-2377-15-73] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 11/03/2014] [Indexed: 01/03/2023] Open
Abstract
Background No study has simultaneously investigated the impacts of migraine and anxiety disorders on painful physical symptoms (PPS) among patients with major depressive disorder (MDD). The study aimed to investigate this issue. Methods This open-label study enrolled 155 outpatients with MDD, who were then treated with venlafaxine 75 mg per day for four weeks. Eighty-five participants with good compliance completed the treatment. Migraine was diagnosed according to the International Classification of Headache Disorders. MDD and anxiety disorders were diagnosed using the Structured Clinical Interview for DSM-IV-TR. The visual analog scale (VAS) was used to evaluate the severity of eight PPS. Multiple linear and logistic regressions were used to investigate the impacts of migraine and anxiety disorders on PPS. Results Compared with patients without migraine, patients with migraine had a greater severity of PPS at baseline and post-treatment. After controlling for demographic variables and depressive severity, migraine independently predicted the intensities of eight PPS at baseline and four PPS post-treatment. Moreover, migraine independently predicted poorer treatment responses of chest pain and full remission of pains in the head, chest, neck and/or shoulder. Anxiety disorders predicted less full remission of pains in the abdomen and limbs. Conclusion Migraine and anxiety disorders have negative impacts on PPS among patients with MDD. Integrating the treatment of migraine and anxiety disorders into the management of depression might help to improve PPS and the prognosis of MDD.
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Affiliation(s)
| | | | | | | | - Shuu-Jiun Wang
- Department of Neurology, National Yang-Ming University School of Medicine and Taipei Veterans General Hospital, No, 201 Shi-Pai Road, Section 2, Taipei 112, Taiwan.
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Poleshuck EL, Gamble SA, Bellenger K, Lu N, Tu X, Sörensen S, Giles DE, Talbot NL. Randomized controlled trial of interpersonal psychotherapy versus enhanced treatment as usual for women with co-occurring depression and pelvic pain. J Psychosom Res 2014; 77:264-72. [PMID: 25280823 PMCID: PMC6983302 DOI: 10.1016/j.jpsychores.2014.07.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Revised: 07/18/2014] [Accepted: 07/19/2014] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Our study assessed the effectiveness of Interpersonal Psychotherapy (IPT) tailored for biomedical patients with depression and pain. IPT was compared to enhanced treatment as usual (E-TAU) among women with co-occurring depression and chronic pain presenting for care at a women's health or family medicine practice. We hypothesized that women presenting to urban medical practices with depression and chronic pain would benefit from IPT tailored to address their needs to a greater degree than from E-TAU. METHODS We conducted a randomized controlled psychotherapy trial of 61 women from 2 urban medical practices who met criteria for major depressive disorder and chronic pelvic pain. Participants were assigned to receive either 8 sessions of IPT or a facilitated psychotherapy referral to a community mental health center, and assessed for depression, social interactions, and pain at 0-, 12-, 24-, and 36-weeks, with score on the Hamilton Rating Scale for Depression as the primary outcome. Both intent-to-treat (ITT) and causal modeling analyses correcting for treatment attendance were conducted. RESULTS ITT analyses were not significant. In causal modeling analyses, participants assigned to IPT showed significantly more improvement for depression and social interactions, but not for pain. CONCLUSION IPT may be a viable option as part of a comprehensive treatment program for women in medical practices with depression and chronic pain. CLINICAL TRIALS REGISTRATION ClinicalTrials.gov, NCT00895999.
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Affiliation(s)
- Ellen L Poleshuck
- Department of Psychiatry, University of Rochester Medical Center, United States.
| | - Stephanie A Gamble
- Department of Psychiatry, University of Rochester Medical Center, United States
| | - Kelly Bellenger
- Department of Psychiatry, University of Rochester Medical Center, United States
| | - Naiji Lu
- Department of Psychiatry, University of Rochester Medical Center, United States
| | - Xin Tu
- Department of Psychiatry, University of Rochester Medical Center, United States
| | - Silvia Sörensen
- Department of Psychiatry, University of Rochester Medical Center, United States
| | - Donna E Giles
- Department of Psychiatry, University of Rochester Medical Center, United States
| | - Nancy L Talbot
- Department of Psychiatry, University of Rochester Medical Center, United States
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Fishbain DA, Cole B, Lewis JE, Gao J. Does pain interfere with antidepressant depression treatment response and remission in patients with depression and pain? An evidence-based structured review. PAIN MEDICINE 2014; 15:1522-39. [PMID: 25139618 DOI: 10.1111/pme.12448] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE The objective of this evidence-based structured review was to determine if there is consistent evidence that pain interferes with achieving antidepressant treatment response/remission of depression in patients with depression and pain. METHODS After exclusion criteria were applied, of 2,801 studies/reports, 17 studies addressed this question. They were sorted into the four hypotheses outlined herein after. The percentage of studies supporting/not supporting each hypothesis was calculated. The strength and consistency of the evidence for each hypothesis were rated according to the Agency for Health Care Research and Quality (AHRQ) guidelines. RESULTS For the first hypothesis (pretreatment pain levels will predict antidepressant depression response), nine out of 10 (90%) studies supported it. For the second hypothesis (treatment decreases in pain will be associated with antidepressant depression response), two out of two (100%) studies supported it. For the third hypothesis (pretreatment pain levels will predict antidepressant depression remission), six out of six (100%) studies supported it. For the fourth hypothesis (treatment decreases in pain will be associated with antidepressant depression remission), five out of five (100%) supported it. Utilizing these percentages and AHRQ guidelines, hypotheses 1, 3, and 4 received an A rating for consistency of studies in supporting them. A consistency rating for hypothesis 2 could not be generated because of too few studies in that group. CONCLUSIONS Consistent evidence was found that antidepressant treatment of depression in patients with depression and pain can be negatively impacted by pain for achieving depression response/remission. However, the overall number of studies supporting each hypothesis was small. In addition, several potential confounders of the results of this study were identified.
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Affiliation(s)
- David A Fishbain
- Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA; Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA; Department of Anesthesiology, University of Miami Miller School of Medicine, Miami, Florida, USA; Department of Psychiatry, Miami VA Medical Center, Miami, Florida, USA; The Rosomoff Comprehensive Pain Center, Douglas Gardens Hospital, Miami, Florida, USA
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Lenox-Smith A, Macdonald MTB, Reed C, Tylee A, Peveler R, Quail D, Wildgust HJ. Quality of Life in Depressed Patients in UK Primary Care: The FINDER Study. Neurol Ther 2013; 2:25-42. [PMID: 26000214 PMCID: PMC4389033 DOI: 10.1007/s40120-013-0006-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES To investigate the impact of depression and its treatment on health-related quality of life (HRQoL) in a naturalistic, primary care setting in the UK. METHODS The Factors Influencing Depression Endpoints Research (FINDER) study was a European, 6-month, prospective, observational study designed to estimate HRQoL in patients with a clinical diagnosis of depression. This paper examines primary care patients recruited in the UK. HRQoL was measured at baseline and at 3 and 6 months after starting antidepressant therapy using the Short Form 36 Health Status Survey and the European Quality of Life-5 Dimensions (EQ-5D). Regression analysis was used to identify baseline and treatment variables independently and significantly associated with HRQoL. Further analyses included the effect of caseness for depression on HRQoL, the effect of moderate/severe pain at baseline on HRQoL, changes in overall pain, pain interference scores, and the use of different antidepressants by pain cohort. RESULTS A total of 608 patients was recruited from 58 centres and mean HRQoL was significantly below reported population norms at baseline. Most improvement in HRQoL was seen at 3 months for EQ-5D, with small additional improvement at 6 months. Worse HRQoL outcomes at 6 months were associated with higher somatic symptoms score, duration of depression at baseline, and switching within antidepressant classes. Patients meeting the criteria for caseness for depression, or with significant pain at baseline showed less improvement in HRQoL scores at 6 months. CONCLUSION Patients presenting with depression in primary care show reduced HRQoL compared to population norms. HRQoL improves during antidepressant treatment particularly within the first 3 months. Nonpainful somatic symptoms, socioeconomic factors, depression variables and switching within antidepressant class predict poor HRQoL outcome. Pain is a common symptom in depressed patients and remains after 6 months' treatment. Pain and somatic symptoms should be assessed in all patients with depression in primary care.
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Affiliation(s)
- Alan Lenox-Smith
- Eli Lilly & Company Ltd., Lilly House, Priestley Road, Basingstoke, Hampshire RG24 9NL UK
| | - Mark T. B. Macdonald
- Eli Lilly & Company Ltd., Lilly House, Priestley Road, Basingstoke, Hampshire RG24 9NL UK
| | - Catherine Reed
- Eli Lilly & Company Ltd., Erl Wood Manor, Windlesham, Surrey GU20 6PH UK
| | - Andre Tylee
- Health Services and Population Research Department, Section of Primary Care Mental Health, Institute of Psychiatry, De Crespigny Park, Denmark Hill, London, SE5 8AF UK
| | - Robert Peveler
- Clinical Neurosciences Division, Southampton General Hospital, University of Southampton, Southampton, SO16 6YD UK
| | - Deborah Quail
- Eli Lilly & Company Ltd., Erl Wood Manor, Windlesham, Surrey GU20 6PH UK
| | - Hiram J. Wildgust
- Hiram Consulting Ltd., 11 Cricketers Close, Ackworth, Pontefract, West Yorkshire, WF7 7PW UK
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Treuer T, Liu CY, Salazar G, Kongsakon R, Jia F, Habil H, Lee MS, Lowry A, Dueñas H. Use of antidepressants in the treatment of depression in Asia: guidelines, clinical evidence, and experience revisited. Asia Pac Psychiatry 2013; 5:219-30. [PMID: 23857712 DOI: 10.1111/appy.12090] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2013] [Accepted: 05/21/2013] [Indexed: 12/19/2022]
Abstract
Major depressive disorder is prevalent worldwide, and only about half of those affected will experience no further episodes or symptoms. Additionally, depressive symptoms can be challenging to identify, with many patients going undiagnosed despite a wide variety of available treatment options. Antidepressants are the cornerstone of depression treatment; however, a large number of factors must be considered in selecting the treatment best suited to the individual. To help support physicians in this process, international and national treatment guidelines have been developed. This review evaluates the current use of antidepressant treatment for major depressive disorder in six Asian countries (China, Korea, Malaysia, Philippines, Taiwan, and Thailand). No remarkable differences were noted between Asian and international treatment guidelines or among those from within Asia as these are adapted from western guidelines, although there were some local variations. Importantly, a shortage of evidence-based information at a country level is the primary problem in developing guidelines appropriate for Asia, so most of the guidelines are consensus opinions derived from western research data utilized in western guidelines. Treatment guidelines need to evolve from being consensus based to evidence based when evidence is available, taking into consideration cost/effectiveness or cost/benefit with an evidence-based approach that more accurately reflects clinical experience as well as the attributes of each antidepressant. In everyday practice, physicians must tailor their treatment to the patient's clinical needs while considering associated external factors; better tools are needed to help them reach the best possible prescribing decisions which are of maximum benefit to patients.
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Affiliation(s)
- Tamás Treuer
- Neuroscience Research, Eli Lilly and Company, Budapest, Hungary
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Possible involvement of oxido-nitrosative stress induced neuro-inflammatory cascade and monoaminergic pathway: underpinning the correlation between nociceptive and depressive behaviour in a rodent model. J Affect Disord 2013; 151:1041-52. [PMID: 24126118 DOI: 10.1016/j.jad.2013.08.032] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Revised: 08/21/2013] [Accepted: 08/24/2013] [Indexed: 11/21/2022]
Abstract
BACKGROUND Pain and depression are frequent co-morbid disorders. The prevalence rate of depression is several times higher in patients with chronic pain than in the general population but the mechanism underlying this association is unknown. A combination of interactions between neurotransmitters, neuropeptides, oxidative and nitrosative stress and cytokines are thought to take part in pathogenesis of pain as well as depression. Thus, the aim of the present study was two-fold, first to investigate the interplay between nociception and associated depression and second to investigate the protective potential of berberine against the reserpine-induced nociceptive and depressive behaviour and further to explore the role of oxidative-nitrosative stress mediated inflammatory cascade and apoptotic signalling pathway in this dyad. METHODS AND RESULTS Nociception and associated depression were induced by administration of reserpine (1mg/kg subcutaneous daily) for three consecutive days. This behavioural deficit was integrated with decrease in the biogenic amine (dopamine, norepinephrine and serotonin) levels along with increased substance P concentration, oxidative-nitrosative stress, inflammatory cytokines, NF-κβ and caspase-3 levels in different brain regions (cortex and hippocampus) of the reserpinised rats. LIMITATION More studies are still warranted in similar rodent models of pain and depression, so, that the present findings can be further substantiated to establish the clinical effectiveness of berberine in a subset of patients suffering from pain as well as depression. CONCLUSION The findings from the current study suggested that reserpine-induced neurochemical alterations and dysregulation of oxidative-nitrosative stress induced inflammatory cascade underlies the co-morbidity of nociceptive behaviour and associated depression in rats.
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Jain FA, Hunter AM, Brooks JO, Leuchter AF. Predictive socioeconomic and clinical profiles of antidepressant response and remission. Depress Anxiety 2013; 30:624-30. [PMID: 23288666 DOI: 10.1002/da.22045] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Revised: 11/13/2012] [Accepted: 12/02/2012] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND There are many prognostic factors for treatment outcome in major depressive disorder (MDD). The predictive power of any single factor, however, is limited. We aimed to develop profiles of antidepressant response and remission based upon hierarchical combinations of baseline clinical and demographic factors. METHODS Using data from Level 1 of the Sequenced Treatment Alternatives to Relieve Depression trial (STAR*D), in which 2,876 participants with MDD were treated with citalopram, a signal-detection analysis was performed to identify hierarchical predictive profiles for patients with different treatment outcome. An automated algorithm was used to determine the optimal predictive variables by evaluating sensitivity, specificity, positive and negative predictive value, and test efficiency. RESULTS Hierarchical combinations of baseline clinical and demographic factors yielded profiles that significantly predicted treatment outcome. In contrast to an overall 47% response rate in STAR*D Level 1, response rates of profiled patient subgroups ranged from 31 to 63%. In contrast to an overall remission rate of 28%, identified subsets of patients had a 12 to 55% probability of remission. The predictors of antidepressant treatment outcome most commonly incorporated into profiles were related to socioeconomic status (e.g., income, education), whereas indicators of depressive symptom type and severity, as well as comorbid clinical conditions, were useful but less powerful predictors. CONCLUSIONS Hierarchical profiles of demographic and clinical baseline variables categorized patients according to the likelihood they would benefit from a single antidepressant trial. Socioeconomic factors had greater predictive power than symptoms or other clinical factors, and profiles combining multiple factors were stronger predictors than individual factors alone.
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Affiliation(s)
- Felipe A Jain
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, California 90024, USA.
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Pan YJ, Liu SK, Yeh LL. Factors affecting early attrition and later treatment course of antidepressant treatment of depression in naturalistic settings: an 18-month nationwide population-based study. J Psychiatr Res 2013; 47:916-25. [PMID: 23566422 DOI: 10.1016/j.jpsychires.2013.03.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Accepted: 03/07/2013] [Indexed: 10/27/2022]
Abstract
BACKGROUND Early attrition can impede treatment success of depression; its contributing factors and impacts on subsequent treatment course need further clarification. METHODS All Taiwanese adult patients prescribed with antidepressants for depression (n=216,557) in 2003 were identified through a total population health insurance claims database; their initial contact patterns could be classified into three types of attrition: non-attrition, returning attrition and non-returning attrition. Demographic and clinical characteristics associated with each attrition type were described and relationships between attrition type and subsequent treatment course over an 18-month follow-up period were examined with these demographic/clinical confounders being controlled for. RESULTS 41.6% of Study subjects had early attrition; among them, 35.3% returned to treatment later. Type of depression, medical/psychiatric comorbidities, painful physical symptoms and past treatment history, as well as prescribing physician specialty and choice of antidepressants, were associated with early attrition. Three types of follow-up pattern over the 18-month follow-up period were identified: sustained treatment-free, continuous treatment and late re-contacts. Patients remaining engaged with treatment within the first three months had higher odds of achieving sustained treatment-free (OR=1.21; 99% CI: 1.16, 1.27) and lower odds of having late re-contacts (OR=0.20; 99% CI: 0.19, 0.21) over the 18-month period, compared to those who returned after early attrition. CONCLUSIONS Early attrition is a significant barrier for depression treatment in daily clinical practice and has negative impacts on later treatment course and/or outcome. Early attrition needs to be minimized through shared decision-making, exchange of treatment preferences and proper patient-physician communication.
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Affiliation(s)
- Yi-Ju Pan
- Health Service and Population Research Department, Institute of Psychiatry, King's College London, United Kingdom
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Pan YJ, Cheng IC, Yeh LL, Cho YM, Feng J. Utilization of traditional Chinese medicine in patients treated for depression: A population-based study in Taiwan. Complement Ther Med 2013; 21:215-23. [DOI: 10.1016/j.ctim.2013.03.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2012] [Revised: 01/06/2013] [Accepted: 03/06/2013] [Indexed: 01/04/2023] Open
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Pan YJ, Knapp M, Yeh LL, Chen YP, McCrone P. Treatment costs for depression with pain and cardiovascular comorbidities. J Psychiatr Res 2013; 47:329-36. [PMID: 23228277 DOI: 10.1016/j.jpsychires.2012.11.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2012] [Revised: 10/30/2012] [Accepted: 11/09/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE As depressive disorders are highly heterogeneous, and as patients exhibit wide differences in clinical characteristics and comorbidities, we aim to examine whether and how demographic and clinical correlates affect healthcare costs for patients with depression in a real-world setting. METHOD A national cohort of adult patients (n = 216,557) who received treatment for depression was identified from the National Health Insurance Research Database in Taiwan. Factors associated with service use and healthcare costs over a 12-month period were explored, with a particular focus on past treatment history, comorbid physical illnesses, painful physical symptoms, and choice of initial antidepressants. RESULTS Depression severity, past treatment history, comorbid mental/physical illnesses, painful physical symptoms, and choice of initial antidepressants were found to be associated with healthcare costs in the following year, although the nature of the associations differed across cost categories. The presence of comorbid cardiovascular disease or certain painful physical symptoms at baseline was associated not only with higher non-psychiatric but also with higher psychiatric costs; moreover, patients with these comorbidities were shown to have increased use of psychiatric emergency and inpatient services. CONCLUSION Healthcare costs for depression are affected by a number of clinical characteristics and comorbidities of patients. The importance of comorbid pain and cardiovascular conditions warrants further research.
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Affiliation(s)
- Yi-Ju Pan
- Centre for the Economics of Mental and Physical Health, Health Service and Population Research Department, Institute of Psychiatry, King's College London, United Kingdom; Department of Psychiatry, Far Eastern Memorial Hospital, Taiwan.
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Reed C, Hong J, Novick D, Lenox-Smith A, Happich M. Health care costs before and after diagnosis of depression in patients with unexplained pain: a retrospective cohort study using the United Kingdom General Practice Research Database. CLINICOECONOMICS AND OUTCOMES RESEARCH 2013; 5:37-47. [PMID: 23355787 PMCID: PMC3552476 DOI: 10.2147/ceor.s38323] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose To assess the impact of pain severity and time to diagnosis of depression on health care costs for primary care patients with pre-existing unexplained pain symptoms who subsequently received a diagnosis of depression. Patients and methods This retrospective cohort study analyzed 4000 adults with unexplained pain (defined as painful physical symptoms [PPS] without any probable organic cause) and a subsequent diagnosis of depression, identified from the UK General Practice Research Database using diagnostic codes. Patients were categorized into four groups based on pain severity (milder or more severe; based on number of pain-relief medications and use of opioids) and time to diagnosis of depression (≤1 year or>1 year from PPS index date). Annual health care costs were calculated (2009 values) and included general practitioner (GP) consultations, secondary care referrals, and prescriptions for pain-relief medications for the 12 months before depression diagnosis and in the subsequent 2 years. Multivariate models of cost included time period as a main independent variable, and adjusted for age, gender, and comorbidities. Results Total annual health care costs before and after depression diagnosis for the four patient groups were higher for the groups with more severe pain (£819–£988 versus £565–£628; P < 0.001 for all pairwise comparisons) and highest for the group with more severe pain and longer time to depression diagnosis in the subsequent 2 years (P < 0.05). Total GP costs were highest in the group with more severe pain and longer time to depression diagnosis both before and after depression diagnosis (P < 0.05). In the second year following depression diagnosis, this group also had the highest secondary care referral costs (P < 0.01). The highest drug costs were in the groups with more severe pain (P < 0.001), although costs within each group were similar before and after depression diagnosis. Conclusion Among patients with unexplained pain symptoms, significant pain in combination with longer time from pain symptoms to depression diagnosis contribute to higher costs for the UK health care system.
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Affiliation(s)
- Catherine Reed
- Global Health Outcomes, Eli Lilly and Company, Windlesham, Surrey, UK
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Ball SG, Desaiah D, Zhang Q, Thase ME, Perahia DGS. Efficacy and safety of duloxetine 60 mg once daily in major depressive disorder: a review with expert commentary. Drugs Context 2013; 2013:212245. [PMID: 24432034 PMCID: PMC3884746 DOI: 10.7573/dic.212245] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Accepted: 08/21/2012] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE Major depressive disorder (MDD) is a significant public health concern and challenges health care providers to intervene with appropriate treatment. This article provides an overview of efficacy and safety information for duloxetine 60 mg/day in the treatment of MDD, including its effect on painful physical symptoms (PPS). DESIGN A literature search was conducted for articles and pooled analyses reporting information regarding the use of duloxetine 60 mg/day in placebo-controlled trials. SETTING Placebo-controlled, active-comparator, short- and long-term studies were reviewed. PARTICIPANTS Adult (≥18 years) patients with MDD. MEASUREMENTS Effect sizes for continuous outcome (change from baseline to endpoint) and categorical outcome (response and remission rates) were calculated using the primary measures of 17-item Hamilton Rating Scale for Depression (HAMD-17) or Montgomery-Åsberg Depression Rating Scale (MADRS) total score. The Brief Pain Inventory and Visual Analogue Scales were used to assess improvements in PPS. Glass estimation method was used to calculate effect sizes, and numbers needed to treat (NNT) were calculated based on HAMD-17 and MADRS total scores for remission and response rates. Safety data were examined via the incidence of treatment-emergent adverse events and by mean changes in vital-sign measures. RESULTS Treatment with duloxetine was associated with small-to-moderate effect sizes in the range of 0.12 to 0.72 for response rate and 0.07 to 0.65 for remission rate. NNTs were in the range of 3 to 16 for response and 3 to 29 for remission. Statistically significant improvements (p≤0.05) were observed in duloxetine-treated patients compared to placebo-treated patients in PPS and quality of life. The safety profile of the 60-mg dose was consistent with duloxetine labeling, with the most commonly observed significant adverse events being nausea, dry mouth, diarrhea, dizziness, constipation, fatigue, and decreased appetite. CONCLUSION These results reinforce the efficacy and tolerability of duloxetine 60 mg/day as an effective short- and long-term treatment for adults with MDD. The evidence of the independent analgesic effect of duloxetine 60 mg/day supports its use as a treatment for patients with PPS associated with depression. This review is limited by the fact that it included randomized clinical trials with different study designs. Furthermore, data from randomized controlled trials may not generalize well to real clinical practice.
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Affiliation(s)
- Susan G Ball
- Lilly Research Laboratory, Eli Lilly and Company, Indianapolis, IN, USA
| | - Durisala Desaiah
- Lilly Research Laboratory, Eli Lilly and Company, Indianapolis, IN, USA
| | - Qi Zhang
- Lilly Research Laboratory, Eli Lilly and Company, Indianapolis, IN, USA
| | - Michael E Thase
- Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
| | - David G S Perahia
- Lilly Research Centre, Windlesham, Surrey, UK; ; The Gordon Hospital, London, UK
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Romera I, Pérez V, Menchón JM, Schacht A, Papen R, Neuhauser D, Abbar M, Picard H, Gilaberte I. Early vs. conventional switching of antidepressants in patients with MDD and moderate to severe pain: a double-blind randomized study. J Affect Disord 2012; 143:47-55. [PMID: 22858211 DOI: 10.1016/j.jad.2012.05.024] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2012] [Revised: 05/17/2012] [Accepted: 05/17/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Concomitant painful physical symptoms in depressive patients frequently impair functioning and failure to treat these symptoms may adversely impact treatment outcomes of depression. Early vs. conventional switch of antidepressants were compared in patients with major depressive disorder (MDD) and moderate to severe pain. METHOD Pre-specified subgroup analysis of a 16-week, randomized, double-blind clinical study on MDD patients with >30 mm overall pain visual analog scale (VAS). Patients not achieving 30% reduction Hamilton Depression Rating Scale (HAM-D) after 4 weeks escitalopram (10 mg/day) were randomized to duloxetine 60-120 mg/day (early switch) or continued on escitalopram (conventional switch) with non-responders at week 8 switching to duloxetine. Endpoints were time to confirmed response and remission, VAS pain severity, and Sheehan disability scale (SDS). Switch strategies were compared using Kaplan-Meier, logistic regression, and repeated measures analyses. RESULTS No differences between early and conventional switching were found in time to confirmed response after randomization (3.9 vs. 4.1 weeks, p=0.511) or remission (6.0 vs. 8.0 weeks, p=0.238). Significantly lower VAS mean pain levels at for overall pain, headache, back pain, shoulder pain, interference with daily activities, and time being awake in pain were found for patients in the early switching group. Time to achieving normal functioning (SDS total score <6) was shorter in the early switching group (p=0.042). Safety results were comparable between switch strategies. CONCLUSIONS In MDD patients with moderate to severe painful physical symptoms not improving after 4 weeks of treatment with escitalopram, an earlier switch to duloxetine may lead to better pain and functional outcomes.
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Affiliation(s)
- Irene Romera
- Medical Department, Eli Lilly and Company, Madrid 28108, Spain.
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Brnabic A, Raskin J, Alev L, Serap Monkul E, Lowry A. Frequency and outcomes of painful physical symptoms in a naturalistic population with major depressive disorder: an analysis of pooled observational studies focusing on subjects aged 65 years and over. Int J Clin Pract 2012; 66:1158-67. [PMID: 23163495 DOI: 10.1111/ijcp.12014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
AIMS To estimate the frequency of painful physical symptoms (PPS) in elderly subjects (≥ 65 years) with major depressive disorder (MDD) in real-world clinical conditions and to establish whether PPS are associated with poor depression outcomes, including more severe depression and worse health-related quality of life (HRQoL). METHODS Observational studies of MDD that included assessment of PPS and elderly subjects were screened. Measures of PPS were based on the Somatic Symptom Inventory (SSI) or Visual Analogue Scale (VAS). Data from a variety of depressive symptom severity and HRQoL scales were used. Analysis cohorts were based on age [aged ≥ 65 years (elderly) or < 65 years (younger)] and/or PPS status (presence or absence); five subsets were used to examine specific outcomes in matched elderly subjects. RESULTS Data from seven studies (representing 26 countries) were collated. Of the 11,477 subjects, 14% were aged ≥ 65 years and 71% were classified as having PPS (PPS+). PPS were more frequent in elderly subjects (74% vs. 70% of younger subjects) and were positively associated with being female and Hispanic, and negatively associated with being East Asian in the elderly. The presence of PPS was associated with more severe clinical symptomatology and comparatively poorer HRQoL in elderly subjects. CONCLUSIONS PPS, although frequent in younger MDD patients, were slightly more frequent in elderly MDD patients and associated with comparatively poorer clinical and functional outcomes. As elderly patients report somatic symptoms more readily than emotional symptoms, physicians should consider depression in addition to physical causes when PPS are present.
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Affiliation(s)
- A Brnabic
- OptumInsight, Sydney, NSW, Australia.
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Brnabic A, Lin C, Monkul ES, Dueñas H, Raskin J. Major depressive disorder severity and the frequency of painful physical symptoms: a pooled analysis of observational studies. Curr Med Res Opin 2012; 28:1891-7. [PMID: 23145858 DOI: 10.1185/03007995.2012.748654] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE This retrospective post-hoc analysis of observational studies assesses the frequency of painful physical symptoms (PPS) in patients with major depressive disorder (MDD) of varied severity as may be seen in clinical practice. METHODS Observational studies of MDD that collected a clinician-reported measure of depression severity and included assessment of PPS were screened for this individual patient-level analysis. Six observational studies were included that enrolled outpatients with a diagnosis of MDD (assessed using the 17-item Hamilton depression scale, Hospital Anxiety and Depression Scale-Depression, or Inventory of Depressive Symptomatology). Measures of PPS were based on the original study assessment (modified Somatic Symptom Inventory [SSI] and Visual Analogue Scale [VAS]). Patients were divided into analysis cohorts based on the presence or absence of PPS. To model PPS status, odds ratios were calculated from logistic regression for cross-sectional analysis (main analysis) and generalized linear mixed models for longitudinal models (exploratory longitudinal analysis). RESULTS For the main analysis, four studies (N = 2943, 71.6% female, mean age 45.3 years) were identified. Of 2901 eligible patients, 61.7% were classified as having painful physical symptoms (PPS+). At study entry, 73.1% (957/1309) of patients in the severe category of depression, 56.8% (537/945) of those with moderate depression, and 45.6% (295/647) of those with mild depression were PPS+. The exploratory longitudinal analysis was performed using a subset (N = 2430) from the studies used in the main analysis plus two others (an additional 7984 patients, 6742 of which were modeled). The likelihood of patients that were PPS- at baseline later developing PPS was 5% to 13% greater for patients with increased depression severity (P < 0.001) and the likelihood of PPS+ patients later not having PPS was 9% to 17% less for patients with increased depression severity (P < 0.0001). CONCLUSIONS Since this is a retrospective aggregate analysis of several observational studies, and due to missing data, care should be taken in the interpretation of these results. Despite the use of adjustment techniques, selection bias and unmeasured confounding may still be an issue for comparative analysis as not all variables were collected for all studies. For patients treated in typical care settings, PPS were associated with depression severity. However, patients with mild and moderate depression also exhibited PPS. Clinicians should be aware that PPS are present, and may warrant treatment, across depression severities.
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Ball SG, Desaiah D, Spann ME, Zhang Q, Russell JM, Robinson MJ, Demyttenaere K. Efficacy of duloxetine on painful physical symptoms in major depressive disorder for patients with clinically significant painful physical symptoms at baseline: a meta-analysis of 11 double-blind, placebo-controlled clinical trials. Prim Care Companion CNS Disord 2012; 13:11r01181. [PMID: 22454807 DOI: 10.4088/pcc.11r01181] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2011] [Accepted: 06/23/2011] [Indexed: 10/14/2022] Open
Abstract
OBJECTIVE To review efficacy of duloxetine for physical symptoms and depressive illness in patients with at least mild to moderate major depressive disorder (MDD; DSM-IV) and clinically significant painful physical symptoms at baseline. DATA SOURCES Global database of duloxetine clinical trials (Eli Lilly and Company). STUDY SELECTION All 11 acute, double-blind, placebo-controlled studies of duloxetine (7 with duloxetine 60-mg doses and 4 with non-60-mg doses) in the database that used a scale to measure painful physical symptoms and were completed before March 17, 2011. DATA EXTRACTION For each study, patients with clinically significant pain levels at baseline (Visual Analog Scale overall pain rating ≥ 30, Numerical Rating Scale score ≥ 3, or Brief Pain Inventory 24-hour average pain rating ≥ 3) were selected in order to determine the effect sizes of duloxetine (compared with placebo for each trial) on the pain and depression measures. Overall effect sizes for both painful physical symptoms and MDD were obtained from the mean of individual-trial effect sizes, and each effect size was weighted relative to the number of patients within each study. DATA SYNTHESIS The overall mean effect sizes were as follows: painful physical symptoms-60-mg trials, 0.29 (95% CI, 0.06 to 0.52); non-60-mg trials, 0.13 (95% CI, -0.19 to 0.45); MDD-60-mg trials, 0.29 (95% CI, 0.18 to 0.40); non-60-mg trials, 0.16 (95% CI, 0.00 to 0.32). Across the 11 studies, the weighted effect size for painful physical symptoms was 0.26 (95% CI, 0.00 to 0.51) and for MDD, 0.25 (95% CI, 0.16 to 0.34). CONCLUSIONS According to this meta-analysis, duloxetine 60 mg once daily is as effective in improving painful physical symptoms as it is for depression in patients with MDD and clinically significant painful physical symptoms. The results of this meta-analysis indicate that duloxetine has small effect sizes in reducing painful physical symptoms and depressive symptoms in patients with MDD and clinically significant pain levels at baseline. Thus, the results of the study permit one to conclude that duloxetine has a clinically significant impact on painful physical symptoms and in reducing the severity of depressive symptoms. However, the results do not address its efficacy compared to other alternatives, as in all studies the comparator was placebo.
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Affiliation(s)
- Susan G Ball
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, Indiana (Drs Ball, Desaiah, Spann, Russell, and Robinson and Ms Zhang); and University Psychiatric Center-Campus Gasthuisberg, Leuven, Belgium (Dr Demyttenaere). Dr Spann is currently employed by Alcon Laboratories, Fort Worth, Texas
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Uher R, Carver S, Power RA, Mors O, Maier W, Rietschel M, Hauser J, Dernovsek MZ, Henigsberg N, Souery D, Placentino A, Farmer A, McGuffin P. Non-steroidal anti-inflammatory drugs and efficacy of antidepressants in major depressive disorder. Psychol Med 2012; 42:2027-2035. [PMID: 22391106 DOI: 10.1017/s0033291712000190] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND It has been proposed that non-steroidal anti-inflammatory drugs (NSAIDs) may interfere with the efficacy of antidepressants and contribute to treatment resistance in major depressive disorder (MDD). This effect requires replication and a test of whether it is specific to serotonin-reuptake inhibiting (SRI) antidepressants. METHOD We tested the effect of concomitant medication with NSAIDs on the efficacy of escitalopram, a SRI antidepressant, and nortriptyline, a tricyclic antidepressant, among 811 subjects with MDD treated for up to 12 weeks in the GENDEP study. Effects of NSAIDs on improvement of depressive symptoms were tested in mixed-effect linear models. Effects on remission were tested in logistic regression. Age, sex, baseline severity and centre of recruitment were considered as potential confounding factors. RESULTS Ten percent (n=78) of subjects were taking NSAIDs during the antidepressant treatment. Older subjects were significantly more likely to take NSAIDs. After controlling for age, sex, centre of recruitment and baseline severity, concomitant medication with NSAIDs did not significantly influence the efficacy of escitalopram [β=0.035, 95% confidence interval (CI) -0.145 to 0.215, p=0.704] or nortriptyline (β=0.075, 95% CI -0.131 to 0.281, p=0.476). Although slightly fewer subjects who took NSAIDs reached remission [odds ratio (OR) 0.80, 95% CI 0.49-1.31, p=0.383], this non-significant effect was reversed after controlling for age, sex, baseline severity and recruitment centre effects (OR 1.04, 95% CI 0.61-1.77, p=0.882). CONCLUSIONS NSAIDs are unlikely to affect the efficacy of SRI or other antidepressants. Concurrent use of NSAIDs and antidepressants does not need to be avoided.
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Affiliation(s)
- R Uher
- MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, UK.
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Kronenberg S. Anti-inflammatory drugs as moderators of antidepressant effects, especially those of the selective serotonin-reuptake inhibitor class. Expert Rev Clin Pharmacol 2012; 4:575-8. [PMID: 22114886 DOI: 10.1586/ecp.11.47] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Large studies examining remission rates obtained by antidepressants have yielded somewhat dismal results. In the well-reported Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study, only 36.8% of patients exhibited remission with the selective serotonin-reuptake inhibitor (SSRI) citalopram and the cumulative remission rate was 67% after multiple treatments were attempted. Warner-Schmidt et al. recently published an interesting paper that suggests specific mechanisms by which anti-inflammatory drugs inhibit the antidepressant effects of SSRIs. They employed well-established mouse models of depression: the tail suspension test and the forced swim test. In their experiment, ibuprofen significantly attenuated the antidepressant-like effects of SSRIs in both tests. The authors also presented data from the STAR*D study itself. These data - demonstrating higher remission rates for depressed patients receiving citalopram without concomitant NSAIDs (55.2%) than those receiving citalopram with NSAIDs (44.5%) - serve to illustrate the potential hindering effects of anti-inflammatory drugs.
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Affiliation(s)
- Sefi Kronenberg
- Department of Psychological Medicine, Schneider Children's Medical Center of Israel, 14 Kaplan Street, PO Box 559, PetachTikvah 49202, Israel.
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50
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Pompili M, Innamorati M, Serafini G, Gonda X, Campi S, Rapinesi C, Giordano G, Montebovi F, Palermo M, Giupponi G, Tatarelli R, Biondi M, Amore M, Sher L, Rihmer Z, Girardi P. How does subjective experience of pain relate to psychopathology among psychiatric patients? Gen Hosp Psychiatry 2012; 34:534-40. [PMID: 22595339 DOI: 10.1016/j.genhosppsych.2012.03.022] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Revised: 03/28/2012] [Accepted: 03/28/2012] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The study aimed to investigate to what extent general psychopathology is associated with subjective experience of pain in psychiatric outpatients without comorbidity with severe physical diagnosis and whether there are any differences in the experience of pain between genders or diagnoses. METHOD Participants were 575 consecutive outpatients affected by mood disorder or anxiety disorder. Patients completed the West Haven-Yale Multidimensional Pain Inventory (WHYMPI) and the Symptom Checklist 90-Revised. RESULTS Women had higher mean scores on the Global Severity Index (1.52±0.76 vs. 1.33±0.79), higher perception of negative responses from others (1.84±1.59 vs. 1.46±1.35) and higher perception of pain severity (3.31±1.73 vs. 2.88±1.63) than men. They also reported higher mean scores on the WHYMPI's General Activity (2.14±0.98 vs. 1.93±0.95) and Household Chores (3.64±1.75 vs. 2.27±1.58) and lower mean scores on the Outdoor Work (1.24±1.26 vs. 1.87±1.51) dimension than men. Higher pain severity, more negative responses from others and higher household chores are predictors of higher psychopathology, while the general level of activity may be considered as a protective factor. CONCLUSIONS Pain and its subjective experience play a central role in psychiatric disorders, and it is a great burden for patients and caregivers. Clinicians should pay more attention to recognize and adequately treat painful symptoms in patients with anxiety and depressive disorder.
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Affiliation(s)
- Maurizio Pompili
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.
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