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Jiang Y, Cheng Y, Du Z, Shen Y, Zhou Q, Ji Y, Zhu H. Unveiling potential adverse events associated with escitalopram oxalate: A real-world analysis based FDA adverse event reporting system database. J Psychopharmacol 2024; 38:567-578. [PMID: 38678377 DOI: 10.1177/02698811241249651] [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] [Indexed: 04/29/2024]
Abstract
OBJECTIVE The study aimed to conduct a multidimensional evaluation of potential adverse events (AEs) of escitalopram oxalate based on the FDA adverse event reporting system (FAERS) database. METHODS This study utilized the reporting odds ratio (ROR), proportional reporting ratio (PRR), Bayesian confidence propagation neural network (BCPNN), and multi-item gamma-poisson shrinker (MGPS) to mine and analyze data from the FAERS database from the first quarter of 2004 to the second quarter of 2023. RESULTS There was a total of 19,854 AE reports related to escitalopram oxalate, extracting 625 preferred terms (PTs), and covering 27 system organ classes (SOCs). The results showed that the number of reports by females was significantly higher than males, accounting for 57.68%. The reporting number was higher in 2018 and 2019, accounting for 9.50% and 10.18% of the total reports, respectively. The main reporters were consumers and other health professionals, accounting for 26.99% and 26.75% respectively. The majority of the reports were primarily from the United States. Newly emerging AE signals such as intentional overdose (n = 691, ROR 8.51, PRR 8.45, IC 3.05, Empirical Bayesian Geometric Mean (EBGM) 8.35), suicide attempt (n = 665, ROR 8.58, PRR 8.52, IC 3.06, EBGM 8.42), serum serotonin (n = 5, ROR 1044.78, PRR 1044.71, IC 2.56, EBGM 392.39), anti-actin antibody positive (n = 5, ROR 626.87, PRR 626.83, IC 2.56, EBGM 313.91), among others, were not mentioned in the drug's label. CONCLUSION While escitalopram oxalate has clear benefits in the treatment of depression and other mental health disorders, the presence of AEs also suggests risks associated with its use. Particularly concerning are risks of suicide and changes in serum serotonin levels.
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Affiliation(s)
- Ying Jiang
- Mental Health Center of Jiangnan University, Wuxi Central Rehabilitation Hospital, Jiangsu, China
| | - Yusi Cheng
- School of Intelligent Manufacturing, Nanjing University of Science and Technology, Jiangsu, China
| | - Zhiqiang Du
- Mental Health Center of Jiangnan University, Wuxi Central Rehabilitation Hospital, Jiangsu, China
| | - Yuan Shen
- Mental Health Center of Jiangnan University, Wuxi Central Rehabilitation Hospital, Jiangsu, China
| | - Qin Zhou
- Mental Health Center of Jiangnan University, Wuxi Central Rehabilitation Hospital, Jiangsu, China
| | - Yingying Ji
- Mental Health Center of Jiangnan University, Wuxi Central Rehabilitation Hospital, Jiangsu, China
| | - Haohao Zhu
- Mental Health Center of Jiangnan University, Wuxi Central Rehabilitation Hospital, Jiangsu, China
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Bloomfield-Clagett B, Ballard ED, Greenstein DK, Wilkinson ST, Grunebaum MF, Murrough JW, Mathew SJ, Phillips JL, Fava M, Sanacora G, Zarate CA. A Participant-Level Integrative Data Analysis of Differential Placebo Response for Suicidal Ideation and Nonsuicidal Depressive Symptoms in Clinical Trials of Intravenous Racemic Ketamine. Int J Neuropsychopharmacol 2022; 25:827-838. [PMID: 35994774 PMCID: PMC9593215 DOI: 10.1093/ijnp/pyac055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 06/03/2022] [Accepted: 08/22/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Clinical trials of intravenous (IV) racemic (R,S)-ketamine (hereafter referred to as IV ketamine) have consistently reported rapid and substantial reductions in overall depressive symptoms compared with saline (inactive placebo) or midazolam (active placebo). The evidence for IV ketamine's specific effects on suicidal ideation is less clear, however. This study sought to examine whether differential placebo (saline or midazolam) response to overall depressive symptoms vs suicidal ideation may help explain these divergent findings. METHODS Data for this participant-level integrative data analysis were drawn from 151 participants across 10 studies, and linear regression was used to examine the relationship between placebo response for suicidal ideation vs other depressive symptoms indexed from standard rating scales-specifically, depressed mood, anhedonia, anxiety, and guilt-over time. RESULTS For participants receiving saline placebo (n = 46), greater placebo response was observed for suicidal ideation compared with other symptoms indexed from standard depression rating scales, except for anxiety. For those receiving midazolam placebo (n = 105), greater placebo response was observed for suicidal ideation compared with depressed mood or anhedonia, and no significant differences were observed when comparing suicidal ideation with anxiety or guilt. CONCLUSIONS Taken together, the results provide preliminary evidence of a differential placebo response for suicidal ideation vs other depressive symptoms, while anxiety and suicidal ideation appear to produce similar placebo response profiles. These findings may help explain the more modest findings in clinical IV ketamine trials for suicidal ideation than overall depression.
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Affiliation(s)
- Bartholt Bloomfield-Clagett
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Elizabeth D Ballard
- Correspondence: Elizabeth D. Ballard, PhD, Building 10, CRC Room 7-5341, 10 Center Drive, MSC 1282, Bethesda, MD 20892 ()
| | - Deanna K Greenstein
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | | | - Michael F Grunebaum
- Department of Psychiatry, Columbia University Medical Center and New York State Psychiatric Institute, New York, USA
| | - James W Murrough
- Depression and Anxiety Center for Discovery and Treatment, Departments of Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sanjay J Mathew
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Jennifer L Phillips
- University of Ottawa Institute of Mental Health Research and Department of Psychiatry, Ottawa, ON, Canada
| | - Maurizio Fava
- Department of Psychiatry, Massachusetts General Hospital, Boston, USA
| | - Gerard Sanacora
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Carlos A Zarate
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
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Heuschen CBBCM, Mocking RJT, Zantvoord JB, Figueroa CA, Schene AH, Denys DAJP, Ruhé HG, Bockting CLH, Lok A. Suicidal ideation in remitted major depressive disorder predicts recurrence. J Psychiatr Res 2022; 151:65-72. [PMID: 35461004 DOI: 10.1016/j.jpsychires.2022.04.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 03/21/2022] [Accepted: 04/06/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Each year almost 800.000 people die from suicide, of which up to 87% are affected by major depressive disorder (MDD). Despite the strong association between suicidality and MDD, it remains unknown if suicidal symptoms during remission put remitted recurrent MDD patients (rrMDD) at risk for recurrence. METHODS At baseline we compared sociodemographic characteristics and suicidal symptoms in un-medicated rrMDD participants to matched never-depressed controls. We used the HDRS17 and IDS-SR30 to assess suicidal symptoms and depressive symptomatology. Next, we studied the longitudinal association between baseline suicidal symptoms and time to recurrence(s) in rrMDD during a 2.5-year follow-up period using cox regression analyses. Further, we studied with longitudinal data whether suicidal symptoms and depressive symptomatology were cross-sectionally associated using mixed model analysis. RESULTS At baseline, rrMDD participants (N = 73) had higher self-reported suicidal symptoms than matched never-depressed controls (N = 45) (χ2 = 12.09 p < .002). Self-reported suicidal symptoms were almost four times higher (27.9% versus 6.9%) compared to clinician-rated suicidal symptoms in rrMDD at baseline. Self-reported baseline suicidal symptoms, but not clinician-rated symptoms, predicted earlier MDD-recurrence during follow-up, independent of other residual depressive symptoms (χ2 = 7.26, p < .026). Higher suicidal symptoms were longitudinally related to higher depressive symptoms (HDRS17; F = 49.87, p < .001), IDS-SR30; (F = 22.36, p < .001). CONCLUSION This study showed that self-reported - but not clinician-rated - suicidal symptoms persist during remission in rrMDD and predict recurrence, independent from residual symptoms. We recommend to monitor both suicidal and depressive symptomatology during remission in rrMDD, preferably also including self-reported questionnaires apart from clinician-rated. It would be beneficial for future research to assess suicidality using questionnaires primarily designed for measuring suicidal ideation.
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Affiliation(s)
- Caroline B B C M Heuschen
- Amsterdam UMC, University of Amsterdam, Department of psychiatry, Meibergdreef 5, 1105 AZ, Amsterdam, the Netherlands.
| | - Roel J T Mocking
- Amsterdam UMC, University of Amsterdam, Department of psychiatry, Meibergdreef 5, 1105 AZ, Amsterdam, the Netherlands
| | - Jasper B Zantvoord
- Amsterdam UMC, University of Amsterdam, Department of psychiatry, Meibergdreef 5, 1105 AZ, Amsterdam, the Netherlands
| | - Caroline A Figueroa
- School of Social Welfare, University of California, Berkeley, United States; University Medical Centre Utrecht, Heidelberglaan, 100 3584 CX, Utrecht
| | - Aart H Schene
- Dept. of Psychiatry, Radboudumc, Nijmegen, the Netherlands; Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, the Netherlands
| | - Damiaan A J P Denys
- Amsterdam UMC, University of Amsterdam, Department of psychiatry, Meibergdreef 5, 1105 AZ, Amsterdam, the Netherlands
| | - Henricus G Ruhé
- Dept. of Psychiatry, Radboudumc, Nijmegen, the Netherlands; Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, the Netherlands
| | - Claudi L H Bockting
- Amsterdam UMC, University of Amsterdam, Department of psychiatry, Meibergdreef 5, 1105 AZ, Amsterdam, the Netherlands; Amsterdam Public Health Institute, Amsterdam UMC, Amsterdam, the Netherlands; Centre for Urban Mental Health, University of Amsterdam, Amsterdam, the Netherlands
| | - Anja Lok
- Amsterdam UMC, University of Amsterdam, Department of psychiatry, Meibergdreef 5, 1105 AZ, Amsterdam, the Netherlands; Amsterdam Public Health Institute, Amsterdam UMC, Amsterdam, the Netherlands; Centre for Urban Mental Health, University of Amsterdam, Amsterdam, the Netherlands
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Bloomfield-Clagett B, Greenstein DK, Kush JM, Musci R, Zarate CA, Ballard ED. Predictors of suicidal ideation trajectories in the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study. J Psychiatr Res 2022; 148:9-13. [PMID: 35085929 PMCID: PMC8961701 DOI: 10.1016/j.jpsychires.2022.01.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 12/13/2021] [Accepted: 01/09/2022] [Indexed: 12/28/2022]
Abstract
A better understanding of suicidal ideation (SI), including patterns of SI, may help elucidate links between depression, SI, and suicidal behavior. This study sought to identify trajectories of SI in a large, community-based clinical trial of participants with major depressive disorder (MDD) and to investigate the relationships between these trajectories and predictors of interest, including anxiety and anhedonia. A longitudinal latent class analysis was conducted in 3923 participants enrolled in Level 1 of the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study of citalopram for the treatment of MDD. An unconditional latent class analysis was conducted using SI at study weeks 0, 2, 4, 6, and 9 as the indicators. A multinomial regression was then conducted with SI trajectory as the outcome and anhedonia, severity of depressive symptoms, atypical depression, anxiety, history of suicide attempt, history of substance abuse, history of trauma, and other covariates as the predictors. Four SI trajectories were identified: 1) variable SI; 2) little-to-no SI; 3) persistent SI; and 4) improving SI. Compared to the little-to-no SI trajectory, those with more severe anhedonia were more likely to experience persistent SI, while those with more severe anxiety were more likely to experience improving SI. Factors that distinguish SI trajectories, such as anxiety and anhedonia, may be critical targets for intervention or profiles for prognosis.
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Affiliation(s)
- Bartholt Bloomfield-Clagett
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Dede K. Greenstein
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Joseph M. Kush
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Rashelle Musci
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Carlos A. Zarate
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Elizabeth D. Ballard
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
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Rangel-Malo RV, Molina-Lopez A, Jimenez-Tapia A, Lopez-Jimenez LA, Carriedo Garcia-Morato P, Gonzalez-Forteza CF. Changes After Emergency Assessment of Suicidal Patients: An Unexpected Outcome. Arch Suicide Res 2022; 26:896-911. [PMID: 33308106 DOI: 10.1080/13811118.2020.1845888] [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] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Acute Suicide Risk (ASR) is widely evaluated at Emergency Departments (ED). Little is known about follow-up of ASR after psychiatric ED evaluation, and if there are differences within No ASR (NASR) counterparts at baseline and afterwards. METHOD We developed a naturalistic, 3-month follow-up study of adult patients from a psychiatric ED in Mexico City. Depressive patients who asked voluntarily for an emergency consultation from July 1 to December 1, 2014, were included. We compared depression severity, suicidal ideation, adherence to treatment, and perceived social support scales both in ASR and NASR participants at baseline and follow-up interviews. RESULTS Participants (n = 120) were divided into ASR or NASR groups (n = 60 each). The ASR group obtained more negative scores in all scales at baseline evaluation. After three months, 85% (n = 51) of ASR and 75% (n = 45) of NASR completed the second interview. 5.21% (n = 3) of participants showed new suicidal behavior. At follow-up, the ASR group showed a higher relative response in depression scales and treatment adherence (p = 0.036), and lower scores in suicidal ideation scales than NASR group (p = 0.012). Perceived support from family was significantly higher in the NASR group (p = 0.016). DISCUSSION These relative higher responses in clinical scales suggest a paradoxical advantage of ASR over NASR patients, suggesting a hypothetical phenomenon similar to "The Tortoise and the Hare" effect. However, it is not applicable for all ASR patients. Results suggest suicidal patients experience stigma from their families. Further research and public health programs for ASR at ED should be implemented.
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Lengvenyte A, Olié E, Strumila R, Navickas A, Gonzalez Pinto A, Courtet P. Immediate and short-term efficacy of suicide-targeted interventions in suicidal individuals: A systematic review. World J Biol Psychiatry 2021; 22:670-685. [PMID: 33783294 DOI: 10.1080/15622975.2021.1907712] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To address the extreme suicide risk period following a suicidal crisis, we aimed to assess the current evidence for specific healthcare system-based interventions on suicide-related outcomes within one-week or one-month in individuals with current suicidal ideation (SI) or a recent suicide attempt (SA). METHODS We performed a database (Medline, Academic Search Complete, PsycARTICLES, the Cochrane library, PubMed) and manual reference search for randomised controlled trials, published between March 2000 and March 2020. Antisuicidal efficacy was defined as SI, SA, or a closely related concept. Quality was assessed with the Cochrane Risk of Bias 2 tool for randomised trials. RESULTS Out of 34 trials, five reported ketamine or esketamine superiority over placebo in reducing SI in depressed subjects within one week, while five studies had negative findings. Single trials reported positive results for one-month antisuicidal efficacy of buprenorphine, paroxetine, a crisis response plan, and assertive case management. Most trials were underpowered and had moderate-to-high risk of bias. CONCLUSIONS Preliminary mixed evidence suggests the possible utility of several pharmacological (ketamine, esketamine paroxetine, and buprenorphine) and non-pharmacological (a crisis response plan, and assertive case management) interventions. Only the immediate efficacy of ketamine was supported by multiple studies, and replication is needed.
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Affiliation(s)
- Aiste Lengvenyte
- Department of Emergency Psychiatry and Acute Care, CHU Montpellier, Montpellier, France.,IGF, Univ. Montpellier, CNRS, INSERM, Montpellier, France.,Faculty of Medicine, Institute of Clinical Medicine, Psychiatric Clinic, Vilnius University, Vilnius, Lithuania
| | - Emilie Olié
- Department of Emergency Psychiatry and Acute Care, CHU Montpellier, Montpellier, France.,IGF, Univ. Montpellier, CNRS, INSERM, Montpellier, France.,French Association of Biological Psychiatry and Neuropsychopharmacology
| | - Robertas Strumila
- Department of Emergency Psychiatry and Acute Care, CHU Montpellier, Montpellier, France.,IGF, Univ. Montpellier, CNRS, INSERM, Montpellier, France.,Faculty of Medicine, Institute of Clinical Medicine, Psychiatric Clinic, Vilnius University, Vilnius, Lithuania
| | - Alvydas Navickas
- Faculty of Medicine, Institute of Clinical Medicine, Psychiatric Clinic, Vilnius University, Vilnius, Lithuania
| | - Ana Gonzalez Pinto
- CIBERSAM; Bioaraba, Research Group on Severe Mental Illness; Osakidetza, Araba University Hospital, Psychiatry Service; Faculty of Medicine, Department of Neurosciences, University of the Basque Country UPV / EHU, Vitoria-Gasteiz, Spain.,Spanish Society of Biological Psychiatry
| | - Philippe Courtet
- Department of Emergency Psychiatry and Acute Care, CHU Montpellier, Montpellier, France.,IGF, Univ. Montpellier, CNRS, INSERM, Montpellier, France.,French Association of Biological Psychiatry and Neuropsychopharmacology
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Dai L, Wang P, Zhang P, Guo Q, Du H, Li F, He X, Luan R. The therapeutic effect of repetitive transcranial magnetic stimulation in elderly depression patients. Medicine (Baltimore) 2020; 99:e21493. [PMID: 32769884 PMCID: PMC7593033 DOI: 10.1097/md.0000000000021493] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Depression, a common psychiatric disorder in elderly, serves as a remarkable precipitating factor for suicide among the elderly people. Here, a randomized double-blinded study was performed to investigate the efficacy of repetitive transcranial magnetic stimulation (rTMS) on improving the clinical symptoms and reducing suicidal ideation in elderly patients with depression. METHODS In this study, 103 elderly patients with depression and suicidal ideation were randomly divided into 2 groups, 48 cases in the rTMS group and 55 cases in the control group (sham rTMS). Both groups received routine drug therapy with rTMS or sham rTMS. The patients received evaluation by Hamilton depression scale and self-rating idea of suicide scale before treatment and after 2 and 4 weeks of treatment, respectively. RESULTS The measurement from the present study demonstrated that Hamilton depression scale and self-rating idea of suicide scale scores decreased to varying degrees in the 2 groups after treatment, and the decrease was more significant in rTMS group. The rate of marked effectiveness was much higher in rTMS group after 2 weeks of treatment compared with the control group. Furthermore, the rate of moderate effectiveness at 4 weeks after treatment was significantly higher in rTMS group compared with the control group. CONCLUSION Together, the present study shows that rTMS with routine drug therapy exhibited effect with quick onset to improve the clinical symptoms and reduce suicidal ideation in elderly patients with depression.
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Affiliation(s)
- Lilei Dai
- Department of Clinical Psychology, Jingmen NO.2 People's Hospital, Jingmen, Hubei
| | - Peng Wang
- Department of Psychiatry, The Affiliated Xi’an Central Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi
| | - Panpan Zhang
- Department of Clinical Psychology, Jingmen Oral Hospital, Jingmen, Hubei, China
| | - Qingshan Guo
- Department of Clinical Psychology, Jingmen NO.2 People's Hospital, Jingmen, Hubei
| | - Hui Du
- Department of Clinical Psychology, Jingmen NO.2 People's Hospital, Jingmen, Hubei
| | - Fen Li
- Department of Clinical Psychology, Jingmen NO.2 People's Hospital, Jingmen, Hubei
| | - Xinfu He
- Department of Clinical Psychology, Jingmen NO.2 People's Hospital, Jingmen, Hubei
| | - Rongrong Luan
- Department of Psychiatry, The Affiliated Xi’an Central Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi
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Fawver J, Flanagan M, Smith T, Drouin M, Mirro M. The association of COMT genotype with buproprion treatment response in the treatment of major depressive disorder. Brain Behav 2020; 10:e01692. [PMID: 32459054 PMCID: PMC7375060 DOI: 10.1002/brb3.1692] [Citation(s) in RCA: 1] [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] [Received: 03/03/2020] [Revised: 04/23/2020] [Accepted: 05/11/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Pharmacodynamics and pharmacogenetics are being explored in pharmacological treatment response for major depressive disorder (MDD). Interactions between genotype and treatment response may be dose dependent. In this study, we examined whether MDD patients with Met/Met, Met/Val, and Val/Val COMT genotypes differed in their response to bupropion in terms of depression scores. METHODS This study utilized a convenience sample of 241 adult outpatients (≥18 years) who met DSM-5 criteria for MDD and had visits at a Midwest psychopharmacology clinic between February 2016 and January 2017. Exclusion criteria included various comorbid medical, neurological, and psychiatric conditions and current use of benzodiazepines or narcotics. Participants completed genetic testing and the 9 question patient-rated Patient Health Questionnaire (PHQ-9) at each clinic visit (M = 3.8 visits, SD = 1.5) and were prescribed bupropion or another antidepressant drug. All participants were adherent to pharmacotherapy treatment recommendations for >2 months following genetic testing. RESULTS Participants were mostly Caucasian (85.9%) outpatients (154 female and 87 male) who were 44.5 years old, on average (SD = 17.9). For Val carriers, high bupropion doses resulted in significantly lower PHQ-9 scores than no bupropion (t(868) = 5.04, p < .001) or low dose bupropion (t(868) = 3.29, p = .001). Val carriers differed significantly from Met/Met patients in response to high dose bupropion (t(868) = -2.03, p = .04), but not to low dose bupropion. CONCLUSION High-dose bupropion is beneficial for MDD patients with Met/Val or Val/Val COMT genotypes, but not for patients with Met/Met genotype. Prospective studies are necessary to replicate this pharmacodynamic relationship between bupropion and COMT genotypes and explore economic and clinical outcomes.
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Affiliation(s)
- Jay Fawver
- Parkview Health, Parkview Physicians Group (PPG) - Mind-Body Medicine, Fort Wayne, IN, USA
| | - Mindy Flanagan
- Parkview Mirro Center for Research and Innovation, Fort Wayne, IN, USA
| | | | - Michelle Drouin
- Parkview Mirro Center for Research and Innovation, Fort Wayne, IN, USA.,Purdue University Fort Wayne, Fort Wayne, IN, USA
| | - Michael Mirro
- Parkview Mirro Center for Research and Innovation, Fort Wayne, IN, USA.,IUPUI School of Informatics and Computing, Indianapolis, IN, USA.,Indiana University School of Medicine, Indianapolis, IN, USA
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