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Luciano M, Carmassi C, Sampogna G, Bertelloni CA, Abbate-Daga G, Albert U, Castellini G, Della Rocca B, Fantasia S, Menchetti M, Pedrinelli V, Pompili M, Signorelli MS, Tosato S, Fiorillo A. Longitudinal trajectories of psychosocial functioning in patients with pre-existing mental disorders after one year of COVID-19 pandemic. J Psychiatr Res 2024; 172:200-209. [PMID: 38401365 DOI: 10.1016/j.jpsychires.2024.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 01/09/2024] [Accepted: 02/07/2024] [Indexed: 02/26/2024]
Abstract
Aims of the present study were to prospectively assess psychosocial functioning trajectories during the COVID pandemic and the possible impact of sociodemographic variables, as well as of COVID-19 pandemic-related factors, on these trajectories, in a sample of patients with pre-existing severe mental disorders. Moreover, we aimed at identifying predictors of impairment in psychosocial functioning over a period of 9 months of COVID-19 pandemic. Patients were recruited during the 3rd wave of the COVID-19 pandemic (T0, March-April 2021) while strict containment measures were applied in Italy, and reassessed after 3 months (T1, June-July 2021), and after 6 months from T1 (T2- November-December 2021), during the 4th wave of COVID pandemic. A sample of 300 subject (out of the 527 subjects recruited at baseline) completed the T2 evaluation. Patients were assessed by: Work and Social Adjustment Scale (WSAS) for psychosocial functioning, Generalized Anxiety Disorder 7-Item (GAD-7) for anxiety symptoms, Patient Health Questionnaire-9 (PHQ-9) for depressive symptoms and the Impact of Events Scale-Revised, for post-traumatic symptoms. Cluster analyses identified 4 trajectories of functioning: the High, Stable Functioning group (N = 77), the Improvement Functioning group (N = 62), the Progressive Impairment group (N = 83) and the Persistent Severe Impairment group (N = 78) respectively. We found that predictors of higher WSAS score at T2 were higher WSAS score at T0 (B = 0.43, p < .001), PHQ scores at baseline >10 (B = 2.89, p < .05), while not living alone was found to be a protective factor (B = -2.5, p < .05). Results of the present study provides insights into the vulnerability of individuals with psychiatric disorders during times of crisis. Study findings can contribute to a better understanding of the specific needs of this population and inform interventions and support strategies.
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Affiliation(s)
- M Luciano
- Department of Psychiatry, University of Campania "Luigi Vanvitelli,", Naples, Italy.
| | - C Carmassi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - G Sampogna
- Department of Psychiatry, University of Campania "Luigi Vanvitelli,", Naples, Italy
| | - C A Bertelloni
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - G Abbate-Daga
- Department of Neurosciences "Rita Levi Montalcini", University of Turin, Turin, Italy
| | - U Albert
- Department of Medicine, Surgery and Health Sciences, University of Trieste and Department of Mental Health, Azienda Sanitaria Universitaria Giuliano Isontina - ASUGI, Trieste, Italy
| | - G Castellini
- Department of Health Sciences, University of Florence, Florence, Italy
| | - B Della Rocca
- Department of Psychiatry, University of Campania "Luigi Vanvitelli,", Naples, Italy
| | - S Fantasia
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - M Menchetti
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - V Pedrinelli
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - M Pompili
- Department of Neuroscience, Mental Health and Sense Organs, University of Rome "La Sapienza", Rome, Italy
| | - M S Signorelli
- Department of Clinical and Experimental Medicine, Psychiatry Unit, University of Catania, Catania, Italy
| | - S Tosato
- Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - A Fiorillo
- Department of Psychiatry, University of Campania "Luigi Vanvitelli,", Naples, Italy
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Wang J, Wu DD, DeLorenzo C, Yang J. Examining factors related to low performance of predicting remission in participants with major depressive disorder using neuroimaging data and other clinical features. PLoS One 2024; 19:e0299625. [PMID: 38547128 PMCID: PMC10977765 DOI: 10.1371/journal.pone.0299625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 02/13/2024] [Indexed: 04/02/2024] Open
Abstract
Major depressive disorder (MDD), a prevalent mental health issue, affects more than 8% of the US population, and almost 17% in the young group of 18-25 years old. Since Covid-19, its prevalence has become even more significant. However, the remission (being free of depression) rates of first-line antidepressant treatments on MDD are only about 30%. To improve treatment outcomes, researchers have built various predictive models for treatment responses and yet none of them have been adopted in clinical use. One reason is that most predictive models are based on data from subjective questionnaires, which are less reliable. Neuroimaging data are promising objective prognostic factors, but they are expensive to obtain and hence predictive models using neuroimaging data are limited and such studies were usually in small scale (N<100). In this paper, we proposed an advanced machine learning (ML) pipeline for small training dataset with large number of features. We implemented multiple imputation for missing data and repeated K-fold cross validation (CV) to robustly estimate predictive performances. Different feature selection methods and stacking methods using 6 general ML models including random forest, gradient boosting decision tree, XGBoost, penalized logistic regression, support vector machine (SVM), and neural network were examined to evaluate the model performances. All predictive models were compared using model performance metrics such as accuracy, balanced accuracy, area under ROC curve (AUC), sensitivity and specificity. Our proposed ML pipeline was applied to a training dataset and obtained an accuracy and AUC above 0.80. But such high performance failed while applying our ML pipeline using an external validation dataset from the EMBARC study which is a multi-center study. We further examined the possible reasons especially the site heterogeneity issue.
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Affiliation(s)
- Junying Wang
- Department of Applied Mathematics and Statistics, Stony Brook University, New York, New York, United states of America
| | - David D. Wu
- School of Engineering, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Christine DeLorenzo
- Department of Psychiatry and Behavioral Health, Stony Brook University, Stony Brook, New York, United States of America
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, New York, United States of America
| | - Jie Yang
- Department of Family, Population & Preventive Medicine, Stony Brook University, Stony Brook, New York, United States of America
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Tröger A, Miguel C, Ciharova M, de Ponti N, Durman G, Cuijpers P, Karyotaki E. Baseline depression severity as moderator on depression outcomes in psychotherapy and pharmacotherapy. J Affect Disord 2024; 344:86-99. [PMID: 37820960 DOI: 10.1016/j.jad.2023.10.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 10/02/2023] [Accepted: 10/08/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND Evidence-based treatments for adult depression include psychotherapy and pharmacotherapy, yet little is known about how baseline depression severity moderates treatment outcome. OBJECTIVES We aimed to compare the effects of psychotherapy and pharmacotherapy for adult depression and to examine the association between baseline depression severity and treatment outcome, converting multiple baseline depression measures into the scores of the Beck Depression Inventory, second edition (BDI-II). METHODS We conducted systematic searches in bibliographical databases up to September 2022 to identify randomized controlled trials (RCTs) in which psychotherapy was compared with pharmacotherapy in the treatment of adult depression. Various meta-regressions using the baseline depression severity as predictor of the relative effects of psychotherapy and pharmacotherapy were performed. RESULTS We identified 65 RCTs including 7250 participants for the meta-analyses and 56 RCTs including 5548 participants for the meta-regression. We found no significant difference between psychotherapy and pharmacotherapy (g = -0.08, 95 % CI: -0.2 to 0.04, p = 0.193) and baseline depression severity was not significantly associated with the relative effects of psychotherapy and pharmacotherapy (B = 0.0032, SE = 0.0096, p = 0.74). Results were similar in several sensitivity analyses. LIMITATIONS Limitations included the low quality of the included studies, and the omission of long-term effects and within-study variability. CONCLUSIONS We found no indication for a moderation effect of baseline depression severity on the relative effects of psychotherapy and pharmacotherapy. Thus, other factors such as availability and patients' preference must be considered when deciding for treatment options.
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Affiliation(s)
- Anna Tröger
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universitat Dresden, Dresden, Germany.
| | - Clara Miguel
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Marketa Ciharova
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Nino de Ponti
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Güldehan Durman
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Eirini Karyotaki
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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Pini S, Milrod B, Baldwin DS, Schiele MA, Massimetti G, Costa B, Martini C, Bandelow B, Domschke K, Abelli M. The relationship of separation anxiety with the age of onset of panic disorder. Early Interv Psychiatry 2023; 17:1172-1179. [PMID: 37051643 DOI: 10.1111/eip.13419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 01/16/2023] [Accepted: 03/28/2023] [Indexed: 04/14/2023]
Abstract
AIM This study aimed to investigate whether separation anxiety (SA) constitutes a dimension related to age at onset of panic disorder (PD), in homogeneous subgroups of outpatients with PD, based on their age of onset and symptom severity. METHODS A sample of 232 outpatients with PD was assessed with the Panic Disorder Severity Scale (PDSS) and the Sheehan Disability Scale (SDS) for functional impairments. Separation anxiety was evaluated using structured interviews and questionnaires. We applied a K-Means Cluster Analysis based on the standardized "PD age of onset" and "the PDSS total score" to identify distinct but homogeneous groups. RESULTS We identified three groups of patients: group 1 ("PD early onset/severe", N = 97, 42%, onset 23.2 ± 6.7 years), group 2 ("PD early onset/not severe", N = 76, 33%, onset 23.4 ± 6.0 years) and group 3 ("PD adult onset/not severe", N = 59, 25%, onset 42.8 ± 7.0 years). Patients with early onset/severe PD had significantly higher scores on all SA measures than PD late-onset/not severe. Regression analyses showed that SA scores, but not PDSS scores, were predictive of impairment in SDS work/school, social life, and family functioning domains. CONCLUSIONS Our data indicate a significant relationship between SA and PD with an earlier age of onset and an impact on individual functioning. This may have important implications for implementing preventive interventions targeting early risk factors for the subsequent onset of PD.
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Affiliation(s)
- Stefano Pini
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Barbara Milrod
- Albert Einstein College of Medicine, PRIME, (Psychiatric Research Institute of Montefiore Einstein), New York, New York, USA
| | - David S Baldwin
- Clinical and Experimental Sciences, Faculty of Medicine, Academic Centre, College Keep, University of Southampton, Southampton, UK
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Miriam A Schiele
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Gabriele Massimetti
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Barbara Costa
- Department of Pharmacy, University of Pisa, Pisa, Italy
| | | | - Borwin Bandelow
- Department of Psychiatry and Psychotherapy, University Medical Center Gottingen, Göttingen, Germany
| | - Katharina Domschke
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Center for Basics in NeuroModulation, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Marianna Abelli
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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Ross MK, Tulabandhula T, Bennett CC, Baek E, Kim D, Hussain F, Demos AP, Ning E, Langenecker SA, Ajilore O, Leow AD. A Novel Approach to Clustering Accelerometer Data for Application in Passive Predictions of Changes in Depression Severity. Sensors (Basel) 2023; 23:1585. [PMID: 36772625 PMCID: PMC9920816 DOI: 10.3390/s23031585] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 01/11/2023] [Accepted: 01/29/2023] [Indexed: 06/18/2023]
Abstract
The treatment of mood disorders, which can become a lifelong process, varies widely in efficacy between individuals. Most options to monitor mood rely on subjective self-reports and clinical visits, which can be burdensome and may not portray an accurate representation of what the individual is experiencing. A passive method to monitor mood could be a useful tool for those with these disorders. Some previously proposed models utilized sensors from smartphones and wearables, such as the accelerometer. This study examined a novel approach of processing accelerometer data collected from smartphones only while participants of the open-science branch of the BiAffect study were typing. The data were modeled by von Mises-Fisher distributions and weighted networks to identify clusters relating to different typing positions unique for each participant. Longitudinal features were derived from the clustered data and used in machine learning models to predict clinically relevant changes in depression from clinical and typing measures. Model accuracy was approximately 95%, with 97% area under the ROC curve (AUC). The accelerometer features outperformed the vast majority of clinical and typing features, which suggested that this new approach to analyzing accelerometer data could contribute towards unobtrusive detection of changes in depression severity without the need for clinical input.
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Affiliation(s)
- Mindy K. Ross
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL 60612, USA
- Department of Biomedical Engineering, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Theja Tulabandhula
- Department of Information and Decision Sciences, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Casey C. Bennett
- Department of Intelligence Computing, Hanyang University, Seoul 04763, Republic of Korea
- Department of Computing, DePaul University, Chicago, IL 60604, USA
| | - EuGene Baek
- Department of Intelligence Computing, Hanyang University, Seoul 04763, Republic of Korea
| | - Dohyeon Kim
- Department of Intelligence Computing, Hanyang University, Seoul 04763, Republic of Korea
| | - Faraz Hussain
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Alexander P. Demos
- Department of Psychology, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Emma Ning
- Department of Psychology, University of Illinois at Chicago, Chicago, IL 60612, USA
| | | | - Olusola Ajilore
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Alex D. Leow
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL 60612, USA
- Department of Biomedical Engineering, University of Illinois at Chicago, Chicago, IL 60612, USA
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van Dijk DA, Meijer RM, van den Boogaard TM, Spijker J, Ruhé HG, Peeters FPML. Worse off by waiting for treatment? The impact of waiting time on clinical course and treatment outcome for depression in routine care. J Affect Disord 2023; 322:205-211. [PMID: 36372129 DOI: 10.1016/j.jad.2022.11.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 08/31/2022] [Accepted: 11/06/2022] [Indexed: 11/13/2022]
Abstract
BACKGROUND Long-term untreated major depressive disorder (MDD) is associated with a less favorable clinical course. Waiting time, defined as the interval between diagnostic workup and treatment initiation, may be clinically relevant given the prolongation of the pre-existing duration of untreated MDD. However, it is currently unknown whether and to what extent waiting time affects treatment course in routine outpatient care. METHODS Retrospectively extracted data from 715 outpatients with MDD who received naturalistic outpatient MDD treatment were examined. Treatment outcome was defined as the difference in depression severity at the start of treatment and six months thereafter. Clinical course during waiting time was defined by the difference in severity at diagnostic workup and at treatment initiation. We analyzed the association between waiting time and treatment outcome and between waiting time and clinical course during this waiting time using multivariable regression analyses. We adjusted for severity and suicidality as potential confounders. RESULTS An increased duration of the waiting time was associated with a less favorable treatment outcome (B = 0.049, SE = 0.019, p = 0.01). This association persisted after adjustment for potential confounders (B = 0.053, SE = 0.02, p = 0.01). No association was found between length of waiting time and clinical course during waiting time. LIMITATIONS Strict definitions resulted in smaller sample sizes for the final analyses. The uncontrolled design may be questionable to definitively establish the impact of waiting time on treatment outcome. CONCLUSIONS A prolonged waiting time is significantly associated with less favorable treatment outcome. Reduction of waiting time deserves priority in depression treatment planning to improve clinical outcomes.
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Affiliation(s)
- D A van Dijk
- Department of Clinical Psychological Science, Faculty of Psychology & Neuroscience, Maastricht University, Maastricht, the Netherlands; Parnassia Group, PsyQ Haaglanden, Department of Mood Disorders, The Hague, the Netherlands.
| | - R M Meijer
- Antes/Parnassia Psychiatric Institute, Rotterdam, the Netherlands
| | - Th M van den Boogaard
- Parnassia Group, PsyQ Haaglanden, Department of Mood Disorders, The Hague, the Netherlands
| | - J Spijker
- Pro Persona Mental Healthcare, Nijmegen, the Netherlands; Behavioural Science Institute, Radboud University, Nijmegen, the Netherlands
| | - H G Ruhé
- Department of Psychiatry, Radboudumc, Nijmegen, the Netherlands; Donders Institute for Brain and Behaviour, Radboud University, Nijmegen, the Netherlands
| | - F P M L Peeters
- Department of Clinical Psychological Science, Faculty of Psychology & Neuroscience, Maastricht University, Maastricht, the Netherlands
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Gartlehner G, Dobrescu A, Chapman A, Toromanova A, Emprechtinger R, Persad E, Affengruber L, Pieh C, Klerings I, Wagner G. Nonpharmacologic and Pharmacologic Treatments of Adult Patients With Major Depressive Disorder: A Systematic Review and Network Meta-analysis for a Clinical Guideline by the American College of Physicians. Ann Intern Med 2023; 176:196-211. [PMID: 36689750 DOI: 10.7326/m22-1845] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Primary care patients and clinicians may prefer alternative options to second-generation antidepressants for major depressive disorder (MDD). PURPOSE To compare the benefits and harms of nonpharmacologic treatments with second-generation antidepressants as first-step interventions for acute MDD, and to compare second-step treatment strategies for patients who did not achieve remission after an initial attempt with antidepressants. DATA SOURCES English-language studies from several electronic databases from 1 January 1990 to 8 August 2022, trial registries, gray literature databases, and reference lists to identify unpublished research. STUDY SELECTION 2 investigators independently selected randomized trials of at least 6 weeks' duration. DATA EXTRACTION Reviewers abstracted data about study design and conduct, participants, interventions, and outcomes. They dually rated the risk of bias of studies and the certainty of evidence for outcomes of interest. DATA SYNTHESIS 65 randomized trials met the inclusion criteria; eligible data from nonrandomized studies were not found. Meta-analyses and network meta-analyses indicated similar benefits of most nonpharmacologic treatments and antidepressants as first-step treatments. Antidepressants had higher risks for discontinuation because of adverse events than most other treatments. For second-step therapies, different switching and augmentation strategies provided similar symptomatic relief. The certainty of evidence for most comparisons is low; findings should be interpreted cautiously. LIMITATIONS Many studies had methodological limitations or dosing inequalities; publication bias might have affected some comparisons. In some cases, conclusions could not be drawn because of insufficient evidence. CONCLUSION Although benefits seem to be similar among first- and second-step MDD treatments, the certainty of evidence is low for most comparisons. Clinicians and patients should focus on options with the most reliable evidence and take adverse event profiles and patient preferences into consideration. PRIMARY FUNDING SOURCE American College of Physicians. (PROSPERO: CRD42020204703).
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Affiliation(s)
- Gerald Gartlehner
- Cochrane Austria, Department for Evidence-based Medicine and Evaluation, University of Krems, Krems, Austria, and RTI International, Research Triangle Park, North Carolina (G.G.)
| | - Andreea Dobrescu
- Cochrane Austria, Department for Evidence-based Medicine and Evaluation, University of Krems, Krems, Austria (A.D., A.C., A.T., E.P., I.K., G.W.)
| | - Andrea Chapman
- Cochrane Austria, Department for Evidence-based Medicine and Evaluation, University of Krems, Krems, Austria (A.D., A.C., A.T., E.P., I.K., G.W.)
| | - Ana Toromanova
- Cochrane Austria, Department for Evidence-based Medicine and Evaluation, University of Krems, Krems, Austria (A.D., A.C., A.T., E.P., I.K., G.W.)
| | | | - Emma Persad
- Cochrane Austria, Department for Evidence-based Medicine and Evaluation, University of Krems, Krems, Austria (A.D., A.C., A.T., E.P., I.K., G.W.)
| | - Lisa Affengruber
- Cochrane Austria, Department for Evidence-based Medicine and Evaluation, University of Krems, Krems, Austria, and Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands (L.A.)
| | - Christoph Pieh
- Department for Psychotherapy and Biopsychosocial Health, University of Krems, Krems, Austria (C.P.)
| | - Irma Klerings
- Cochrane Austria, Department for Evidence-based Medicine and Evaluation, University of Krems, Krems, Austria (A.D., A.C., A.T., E.P., I.K., G.W.)
| | - Gernot Wagner
- Cochrane Austria, Department for Evidence-based Medicine and Evaluation, University of Krems, Krems, Austria (A.D., A.C., A.T., E.P., I.K., G.W.)
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Goldberg JF. Perspectives on the success rate of current antidepressant pharmacotherapy. Expert Opin Pharmacother 2022; 23:1781-1791. [PMID: 36259350 DOI: 10.1080/14656566.2022.2138333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION There has been growing debate about the effectiveness of traditional antidepressants for the treatment of depression, and whether the clinical trials literature overstates the value of existing agents. Antidepressant efficacy is limited by suboptimal remission rates, lack of robust efficacy across diverse depressed subgroups, slow onset, and challenges managing tolerability. Clinicians can better navigate uncertainties in this area by recognizing patient-specific clinical and prognostic factors that influence the likelihood of antidepressant drug response. AREAS COVERED The author summarizes pertinent literature regarding drug-placebo differences in antidepressant outcome as well as patient-specific factors that influence antidepressant drug responsivity across subtypes of depressive disorders. EXPERT OPINION Standardized effect sizes for most monoaminergic antidepressants are relatively modest. At least one-third of treatment response derives from nonspecific (yet substantial) placebo effects, limiting the ability to compare antidepressant medication effects to that of "no treatment." Patients with high baseline depressive symptom severity are less likely to respond to placebo but may be more responsive to antidepressant pharmacotherapy than is the case in mild forms of depression. Patient satisfaction with antidepressant response must take into consideration not only efficacy for reducing symptoms but also drug tolerability/acceptability and tangible improvement in functional outcome and quality of life.
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Affiliation(s)
- Joseph F Goldberg
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY
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9
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Elsaesser M, Herpertz S, Piosczyk H, Jenkner C, Hautzinger M, Schramm E. Modular-based psychotherapy (MoBa) versus cognitive-behavioural therapy (CBT) for patients with depression, comorbidities and a history of childhood maltreatment: study protocol for a randomised controlled feasibility trial. BMJ Open 2022; 12:e057672. [PMID: 35820739 PMCID: PMC9277372 DOI: 10.1136/bmjopen-2021-057672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION In depression treatment, most patients do not reach response or remission with current psychotherapeutic approaches. Major reasons for individual non-response are interindividual heterogeneity of etiological mechanisms and pathological forms, and a high rate of comorbid disorders. Personalised treatments targeting comorbidities as well as underlying transdiagnostic mechanisms and factors like early childhood maltreatment may lead to better outcomes. A modular-based psychotherapy (MoBa) approach provides a treatment model of independent and flexible therapy elements within a systematic treatment algorithm to combine and integrate existing evidence-based approaches. By optimally tailoring module selection and application to the specific needs of each patient, MoBa has great potential to improve the currently unsatisfying results of psychotherapy as a bridge between disorder-specific and personalised approaches. METHODS AND ANALYSIS In a randomised controlled feasibility trial, N=70 outpatients with episodic or persistent major depression, comorbidity and childhood maltreatment are treated in 20 individual sessions with MoBa or standard cognitive-behavioural therapy for depression. The three modules of MoBa focus on deficits associated with early childhood maltreatment: the systems of negative valence, social processes and arousal. According to a specific questionnaire-based treatment algorithm, elements from cognitive behavioural analysis system of psychotherapy, mentalisation-based psychotherapy and/or mindfulness-based cognitive therapy are integrated for a personalised modular procedure.As a proof of concept, this trial will provide evidence for the feasibility and efficacy (post-treatment and 6-month follow-up) of a modular add-on approach for patients with depression, comorbidities and a history of childhood maltreatment. Crucial feasibility aspects include targeted psychopathological mechanisms, selection (treatment algorithm), sequence and application of modules, as well as training and supervision of the study therapists. ETHICS AND DISSEMINATION This study obtained approval from the independent Ethics Committees of the University of Freiburg and the University of Heidelberg. All findings will be disseminated broadly via peer-reviewed articles in scientific journals and contributions to national and international conferences. TRIAL REGISTRATION NUMBER DRKS00022093.
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Affiliation(s)
- Moritz Elsaesser
- Department of Psychiatry and Psychotherapy, Medical Center and Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Sabine Herpertz
- Department of General Psychiatry, Heidelberg University, Heidelberg, Germany
| | - Hannah Piosczyk
- Department of Psychiatry and Psychotherapy, Medical Center and Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Carolin Jenkner
- Clinical Trials Unit, Universitatsklinikum Freiburg, Freiburg, Germany
| | - Martin Hautzinger
- Department of Psychology, Clinical Psychology, and Psychotherapy, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Elisabeth Schramm
- Department of Psychiatry and Psychotherapy, Medical Center and Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
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Herzog P, Feldmann M, Kube T, Langs G, Gärtner T, Rauh E, Doerr R, Hillert A, Voderholzer U, Rief W, Endres D, Brakemeier EL. Inpatient psychotherapy for depression in a large routine clinical care sample: A Bayesian approach to examining clinical outcomes and predictors of change. J Affect Disord 2022; 305:133-143. [PMID: 35219740 DOI: 10.1016/j.jad.2022.02.057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 02/16/2022] [Accepted: 02/20/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND A routinely collected dataset was analyzed (1) to determine the naturalistic effectiveness of inpatient psychotherapy for depression in routine psychotherapeutic care, and (2) to identify potential predictors of change. METHODS In a sample of 22,681 inpatients with depression, pre-post and pre-follow-up effect sizes were computed for various outcome variables. To build a probabilistic model of predictors of change, an independent component analysis generated components from demographic and clinical data, and Bayesian EFA extracted factors from the available pre-test, post-test and follow-up questionnaires in a subsample (N = 6377). To select the best-fitted model, the BIC of different path models were compared. A Bayesian path analysis was performed to identify the most important factors to predict changes. RESULTS Effect sizes were large for the primary outcome and moderate for various secondary outcomes. Almost all pretreatment factors exerted significant influences on different baseline factors. Several factors were found to be resistant to change during treatment: suicidality, agoraphobia, life dissatisfaction, physical disability and pain. The strongest cross-loadings were observed from suicidality on negative cognitions, from agoraphobia on anxiety, and from physical disability on perceived disability. LIMITATIONS No causal conclusions can be drawn directly from our results as we only used cross-lagged panel data without control group. CONCLUSIONS The results indicate large effects of inpatient psychotherapy for depression in routine clinical care. The direct influence of pretreatment factors decreased over the course of treatment. However, some factors appeared stable and difficult to treat, which might hinder treatment outcome. Findings of different predictors of change are discussed.
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Affiliation(s)
- Philipp Herzog
- Philipps-University of Marburg, Department of Clinical Psychology and Psychotherapy, Gutenbergstraße 18, D-35032 Marburg, Germany; University of Greifswald, Department of Clinical Psychology and Psychotherapy, Franz-Mehring-Straße 47, D-17489 Greifswald, Germany; University of Koblenz-Landau, Department of Clinical Psychology and Psychotherapy, Ostbahnstraße 10, D-76829 Landau, Germany.
| | - Matthias Feldmann
- Philipps-University of Marburg, Department of Clinical Psychology and Psychotherapy, Gutenbergstraße 18, D-35032 Marburg, Germany
| | - Tobias Kube
- Philipps-University of Marburg, Department of Clinical Psychology and Psychotherapy, Gutenbergstraße 18, D-35032 Marburg, Germany; University of Koblenz-Landau, Department of Clinical Psychology and Psychotherapy, Ostbahnstraße 10, D-76829 Landau, Germany
| | - Gernot Langs
- Schön-Klinik Bad Bramstedt, Psychosomatic Clinic, Birkenweg 10, D-24576 Bad Bramstedt, Germany
| | - Thomas Gärtner
- Schön-Klinik Bad Arolsen, Psychosomatic Clinic, Hofgarten 10, D-34454 Bad Arolsen, Germany
| | - Elisabeth Rauh
- Schön-Klinik Bad Staffelstein, Psychsomatic Clinic, Am Kurpark 11, D-96231 Bad Staffelstein, Germany
| | - Robert Doerr
- Schön-Klinik Berchtesgadener Land, Psychosomatic Clinic, Malterhöh 1, D-83471 Schönau am Königssee, Germany
| | - Andreas Hillert
- Schön-Klinik Roseneck, Psychosomatic Clinic, Am Roseneck 6, D-83209 Prien am Chiemsee, Germany
| | - Ulrich Voderholzer
- Schön-Klinik Roseneck, Psychosomatic Clinic, Am Roseneck 6, D-83209 Prien am Chiemsee, Germany; University Hospital of Munich, Department of Psychiatry and Psychotherapy, Nußbaumstraße 7, D-80336 München, Germany
| | - Winfried Rief
- Philipps-University of Marburg, Department of Clinical Psychology and Psychotherapy, Gutenbergstraße 18, D-35032 Marburg, Germany
| | - Dominik Endres
- Philipps-University of Marburg, Department of Theoretical Neuroscience, Gutenbergstraße 18, D-35032 Marburg, Germany
| | - Eva-Lotta Brakemeier
- Philipps-University of Marburg, Department of Clinical Psychology and Psychotherapy, Gutenbergstraße 18, D-35032 Marburg, Germany; University of Greifswald, Department of Clinical Psychology and Psychotherapy, Franz-Mehring-Straße 47, D-17489 Greifswald, Germany
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11
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Huibers MJH, Van Bronswijk SC, Peeters FPML, Lemmens LHJM. Does psychological process change during psychotherapy predict long-term depression outcome after successful cognitive therapy or interpersonal psychotherapy? Secondary analysis of a randomized trial. Psychother Res 2022; 32:1047-1063. [PMID: 35442870 DOI: 10.1080/10503307.2022.2064251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE Psychotherapies for depression are similarly effective, but the processes through which these therapies work have not been identified. We focus on psychological process changes during therapy as predictors of long-term depression outcome in treatment responders. METHOD Secondary analysis of a randomized trial comparing cognitive therapy (CT) and interpersonal psychotherapy (IPT) that focuses on 85 treatment responders. Using mixed-effects models, changes during therapy (0-7 months) on nine process variables were associated with depression severity (BDI-II) at follow-up (7-24 months). RESULTS A decrease in dysfunctional attitudes was associated with a decrease in depression scores over time. Improved self-esteem was associated with less depression at follow-up (borderline significant). More improvement in both work and social functioning and interpersonal problems was associated with better depression outcomes in IPT relative to CT, while less improvement in work and social functioning and interpersonal problems was associated with better outcomes in CT relative to IPT. CONCLUSIONS Less negative thinking during therapy is associated with lower depression severity in time, while changes during therapy in work and social functioning and interpersonal problems appear to predict different long-term outcomes in CT vs. IPT. If replicated, these findings can be used to guide clinical decision-making during psychotherapy.
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Affiliation(s)
- Marcus J H Huibers
- Department of Clinical Psychology, Utrecht University, Utrecht, Netherlands.,NPI Centre for Personality Disorders/Arkin, Amsterdam, Netherlands
| | - Suzanne C Van Bronswijk
- Department of Clinical Psychological Science, Maastricht University, Maastricht, Netherlands
| | - Frenk P M L Peeters
- Department of Clinical Psychological Science, Maastricht University, Maastricht, Netherlands
| | - Lotte H J M Lemmens
- Department of Clinical Psychological Science, Maastricht University, Maastricht, Netherlands
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Abstract
BACKGROUND The Attention Deficit Hyperactivity Disorder (ADHD) Teen Integrative Data Analysis Longitudinal (TIDAL) dataset integrates data from four randomized trials. METHOD Participants with ADHD (N = 854; 72.5% male, 92.5% racial/ethnic minority, ages 10-17) were assessed three times across 12 months. Data includes parent, self, and teacher ratings, observations, and school records. The battery was harmonized using an Integrative Data Analysis (IDA) approach to form variables that assign unique values to all participants. RESULTS The data will be used to investigate: (1) profiles that organize the heterogeneous population into clinically meaningful subgroups, (2) whether these profiles predict treatment response, (3) heterogeneity in treatment response and variables that predict this response, (4) how treatment characteristics and adjunctive supports predict treatment response, and (5) mediators of treatment and whether these mechanisms are moderated by treatment characteristics. CONCLUSIONS The ADHD TIDAL Dataset will be openly shared with the field to maximize its utility.
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Affiliation(s)
- Margaret H Sibley
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle Children's Research Insitute, 2001 8th Ave., Suite 400, Seattle, WA, 98117, USA.
- Department of Psychiatry & Behavioral Health, Florida International University, 11200 SW 8th Street, Miami, FL, 33199, USA.
| | - Stefany J Coxe
- Department of Psychology, Florida International University, 11200 SW 8th Street, Miami, FL, 33199, USA
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13
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Kappelmann N, Rein M, Fietz J, Mayberg HS, Craighead WE, Dunlop BW, Nemeroff CB, Keller M, Klein DN, Arnow BA, Husain N, Jarrett RB, Vittengl JR, Menchetti M, Parker G, Barber JP, Bastos AG, Dekker J, Peen J, Keck ME, Kopf-Beck J. Psychotherapy or medication for depression? Using individual symptom meta-analyses to derive a Symptom-Oriented Therapy (SOrT) metric for a personalised psychiatry. BMC Med 2020; 18:170. [PMID: 32498707 PMCID: PMC7273646 DOI: 10.1186/s12916-020-01623-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 05/07/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Antidepressant medication (ADM) and psychotherapy are effective treatments for major depressive disorder (MDD). It is unclear, however, if treatments differ in their effectiveness at the symptom level and whether symptom information can be utilised to inform treatment allocation. The present study synthesises comparative effectiveness information from randomised controlled trials (RCTs) of ADM versus psychotherapy for MDD at the symptom level and develops and tests the Symptom-Oriented Therapy (SOrT) metric for precision treatment allocation. METHODS First, we conducted systematic review and meta-analyses of RCTs comparing ADM and psychotherapy at the individual symptom level. We searched PubMed Medline, PsycINFO, and the Cochrane Central Register of Controlled Trials databases, a database specific for psychotherapy RCTs, and looked for unpublished RCTs. Random-effects meta-analyses were applied on sum-scores and for individual symptoms for the Hamilton Rating Scale for Depression (HAM-D) and Beck Depression Inventory (BDI) measures. Second, we computed the SOrT metric, which combines meta-analytic effect sizes with patients' symptom profiles. The SOrT metric was evaluated using data from the Munich Antidepressant Response Signature (MARS) study (n = 407) and the Emory Predictors of Remission in Depression to Individual and Combined Treatments (PReDICT) study (n = 234). RESULTS The systematic review identified 38 RCTs for qualitative inclusion, 27 and 19 for quantitative inclusion at the sum-score level, and 9 and 4 for quantitative inclusion on individual symptom level for the HAM-D and BDI, respectively. Neither meta-analytic strategy revealed significant differences in the effectiveness of ADM and psychotherapy across the two depression measures. The SOrT metric did not show meaningful associations with other clinical variables in the MARS sample, and there was no indication of utility of the metric for better treatment allocation from PReDICT data. CONCLUSIONS This registered report showed no differences of ADM and psychotherapy for the treatment of MDD at sum-score and symptom levels. Symptom-based metrics such as the proposed SOrT metric do not inform allocation to these treatments, but predictive value of symptom information requires further testing for other treatment comparisons.
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Affiliation(s)
- Nils Kappelmann
- Max Planck Institute of Psychiatry, Kraepelinstraße 2-10, 80804, Munich, Germany.
- International Max Planck Research School for Translational Psychiatry (IMPRS-TP), Munich, Germany.
| | - Martin Rein
- Max Planck Institute of Psychiatry, Kraepelinstraße 2-10, 80804, Munich, Germany
| | - Julia Fietz
- Max Planck Institute of Psychiatry, Kraepelinstraße 2-10, 80804, Munich, Germany
- International Max Planck Research School for Translational Psychiatry (IMPRS-TP), Munich, Germany
| | - Helen S Mayberg
- Department of Neurology and Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - W Edward Craighead
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
- Department of Psychology, Emory University, Atlanta, GA, USA
| | - Boadie W Dunlop
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Charles B Nemeroff
- Institute for Early Life Adversity Research, University of Texas Dell Medical School in Austin, Austin, TX, USA
| | - Martin Keller
- Department of Psychiatry and Human Behavior, Brown University School of Medicine, Providence, RI, USA
| | - Daniel N Klein
- Department of Psychology, Stony Brook University, Stony Brook, NY, USA
| | - Bruce A Arnow
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, 94304, USA
| | - Nusrat Husain
- Division of Psychology and Mental Health, The University of Manchester, Manchester, UK
| | - Robin B Jarrett
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Marco Menchetti
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Gordon Parker
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Jacques P Barber
- Gordon F. Derner School of Psychology, Adelphi University, Garden City, New York, USA
| | - Andre G Bastos
- Contemporary Institute of Psychoanalysis and Transdisciplinarity of Porto Alegre, Porto Alegre, Brazil
| | - Jack Dekker
- Department of Research, Arkin Mental Health Care, Amsterdam, Netherlands
| | - Jaap Peen
- Department of Research, Arkin Mental Health Care, Amsterdam, Netherlands
| | - Martin E Keck
- Max Planck Institute of Psychiatry, Kraepelinstraße 2-10, 80804, Munich, Germany
| | - Johannes Kopf-Beck
- Max Planck Institute of Psychiatry, Kraepelinstraße 2-10, 80804, Munich, Germany
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14
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Ravitz P, Watson P, Lawson A, Constantino MJ, Bernecker S, Park J, Swartz HA. Interpersonal Psychotherapy: A Scoping Review and Historical Perspective (1974-2017). Harv Rev Psychiatry 2019; 27:165-80. [PMID: 30883446 DOI: 10.1097/HRP.0000000000000219] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Interpersonal Psychotherapy (IPT) is an affect- and relationally focused, time-limited treatment supported by research spanning >4 decades. IPT focuses on stressful interpersonal experiences of loss, life changes, disputes, and social isolation. It emphasizes the role of relationships in recovery. This scoping review describes, within a historical perspective, IPT's evolution as an evidence-supported treatment of psychiatric disorders. METHODS English-language publications (n = 1119) identified via EMBASE, MEDLINE, PsycINFO, and Web of Science databases (1974-2017), augmented with manual reference searches, were coded for clinical focus, population demographics, format, setting, publication type, and research type. Quantitative and qualitative analyses identified IPT publications' characteristics and trends over four epochs of psychotherapy research. RESULTS IPT literature primarily focused on depression (n = 772 articles; 69%), eating disorders (n = 135; 12%), anxiety disorders (n = 68; 6%), and bipolar disorder (n = 44; 4%), with rising publication rates and numbers of well-conducted randomized, controlled trials over time, justifying inclusion in consensus treatment guidelines. Research trends shifted from efficacy trials to effectiveness studies and population-based dissemination initiatives. Process research examined correlates of improvement and efficacy moderators. Innovations included global initiatives, prevention trials, and digital, web-based training and treatment. CONCLUSION Sparked by clinical innovations and scientific advances, IPT has evolved as an effective treatment of psychiatric disorders across the lifespan for diverse patients, including underserved clinical populations. Future research to elucidate mechanisms of change, improve access, and adapt to changing frameworks of psychopathology and treatment planning is needed. IPT addresses the universal centrality of relationships to mental health, which is as relevant today as it was over 40 years ago.
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15
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Alang S, McAlpine D. Treatment Modalities and Perceived Effectiveness of Treatment Among Adults With Depression. Health Serv Insights 2020; 13:1178632920918288. [PMID: 32425544 PMCID: PMC7218458 DOI: 10.1177/1178632920918288] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 03/20/2020] [Indexed: 12/15/2022] Open
Abstract
Patient-reported outcomes of mental health treatment, such as perceived effectiveness, are important. They indicate whether treatment is perceived to reduce symptoms and minimize psychiatric disability. Outpatient treatment for depression typically includes medication or counseling, either alone or in combination. This study examines the relationship between treatment modality and perceived effectiveness of treatment. Using a sample of adults who received outpatient treatment for depression from the 2015-2016 National Survey on Drug Use and Health (N = 4169), logistic regressions estimated the odds of rating treatment as effective among persons who received medication only, counseling only, and a combination of medication and counseling. There were no differences in perceived effectiveness between counseling only and medication only. However, receiving both was associated with greater odds of rating treatment as effective. Poor self-rated health and severe mental illness were associated with lower perceived effectiveness of medication. Those with substance use problems had lower odds of rating counseling and both counseling and medication as effective. A combined treatment for depression may be perceived as better than single-modality treatment. Therefore, there might be benefits to increasing access to both forms of treatment for persons less likely to rate either single modality as effective.
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Affiliation(s)
- Sirry Alang
- Department of Sociology and Anthropology, and Program in Health, Medicine, and Society, Lehigh University, Bethlehem, PA, USA
| | - Donna McAlpine
- Division of Health Policy & Management, School of Public Health, University of Minnesota, Minneapolis, MN, USA
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16
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Cuijpers P, Noma H, Karyotaki E, Vinkers CH, Cipriani A, Furukawa TA. A network meta-analysis of the effects of psychotherapies, pharmacotherapies and their combination in the treatment of adult depression. World Psychiatry 2020; 19:92-107. [PMID: 31922679 PMCID: PMC6953550 DOI: 10.1002/wps.20701] [Citation(s) in RCA: 185] [Impact Index Per Article: 46.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
No network meta-analysis has examined the relative effects of psychotherapies, pharmacotherapies and their combination in the treatment of adult depression, while this is a very important clinical issue. We conducted systematic searches in bibliographical databases to identify randomized trials in which a psychotherapy and a pharmacotherapy for the acute or long-term treatment of depression were compared with each other, or in which the combination of a psychotherapy and a pharmacotherapy was compared with either one alone. The main outcome was treatment response (50% improvement between baseline and endpoint). Remission and acceptability (defined as study drop-out for any reason) were also examined. Possible moderators that were assessed included chronic and treatment-resistant depression and baseline severity of depression. Data were pooled as relative risk (RR) using a random-effects model. A total of 101 studies with 11,910 patients were included. Depression in most studies was moderate to severe. In the network meta-analysis, combined treatment was more effective than psychotherapy alone (RR=1.27; 95% CI: 1.14-1.39) and pharmacotherapy alone (RR=1.25; 95% CI: 1.14-1.37) in achieving response at the end of treatment. No significant difference was found between psychotherapy alone and pharmacotherapy alone (RR=0.99; 95% CI: 0.92-1.08). Similar results were found for remission. Combined treatment (RR=1.23; 95% CI: 1.05-1.45) and psychotherapy alone (RR=1.17; 95% CI: 1.02-1.32) were more acceptable than pharmacotherapy. Results were similar for chronic and treatment-resistant depression. The combination of psychotherapy and pharmacotherapy seems to be the best choice for patients with moderate depression. More research is needed on long-term effects of treatments (including cost-effectiveness), on the impact of specific pharmacological and non-pharmacological approaches, and on the effects in specific populations of patients.
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Affiliation(s)
- Pim Cuijpers
- Department of Clinical, Neuro and Developmental PsychologyAmsterdam Public Health Research Institute, Vrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Hisashi Noma
- Department of Data ScienceInstitute of Statistical MathematicsTokyoJapan
| | - Eirini Karyotaki
- Department of Clinical, Neuro and Developmental PsychologyAmsterdam Public Health Research Institute, Vrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Christiaan H. Vinkers
- Department of PsychiatryAmsterdam UMC (location VUmc)AmsterdamThe Netherlands,Department of Anatomy and NeurosciencesAmsterdam UMC (location VUmc)AmsterdamThe Netherlands
| | - Andrea Cipriani
- Department of Psychiatry Warneford Hospital, University of OxfordOxfordUK,Oxford Health NHS Foundation Trust, Warneford HospitalOxfordUK
| | - Toshi A. Furukawa
- Department of Health Promotion and Human BehaviorKyoto University Graduate School of Medicine, School of Public HealthKyotoJapan
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17
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Jassi A, Lenhard F, Krebs G, Gumpert M, Jolstedt M, Andrén P, Nord M, Aspvall K, Wahlund T, Volz C, Mataix-Cols D. The Work and Social Adjustment Scale, Youth and Parent Versions: Psychometric Evaluation of a Brief Measure of Functional Impairment in Young People. Child Psychiatry Hum Dev 2020; 51:453-60. [PMID: 32006302 DOI: 10.1007/s10578-020-00956-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The Work and Social Adjustment Scale (WSAS) is a brief global measure of functional impairment that is widely used in adult health. We have adapted the WSAS for its use in youth, the WSAS-Youth version (WSAS-Y) and WSAS-Parent version (WSAS-P). This study evaluated the psychometric properties of the scale. The internal consistency, factor structure, convergent and divergent validity, test-retest reliability and sensitivity to change of the WSAS-Y/P were studied in 525 children and adolescents with obsessive-compulsive disorder and related disorders receiving treatment. The internal consistency of the WSAS-Y/P was excellent across diagnostic groups and time-points. Exploratory factor analysis extracted a single-factor of functional impairment, explaining in excess of 85% of the variance. The test-retest reliability was adequate. The WSAS-Y/P correlated more strongly with other measures of functional impairment than with measures of symptom severity, indicating good convergent/divergent validity. Finally, the WSAS-Y/P was highly sensitive to change after treatment.
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18
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Whiston A, Bockting CLH, Semkovska M. Towards personalising treatment: a systematic review and meta-analysis of face-to-face efficacy moderators of cognitive-behavioral therapy and interpersonal psychotherapy for major depressive disorder. Psychol Med 2019; 49:2657-2668. [PMID: 31615583 DOI: 10.1017/s0033291719002812] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Consistent evidence suggests that face-to-face cognitive-behavioural therapy (CBT) and interpersonal psychotherapy (IPT) may be equally effective depression treatments. Current clinical research focuses on detecting the best predictors-moderators of efficacy to guide treatment personalisation. However, individual moderator studies show inconsistent findings. This systematic review and meta-analysis aimed to compare the efficacy of CBT and IPT, including combined treatment with antidepressants for depression, and evaluate the predictive power of demographic, clinical presentation and treatment characteristics moderators for both therapies. METHODS PsycArticles, PsycINFO, PubMed and Cochrane Library were systematically searched through December 2017 for studies that have assessed individuals with major depression receiving either CBT or IPT in a face-to-face format both at pre- and post-treatment. Random-effects moderator meta-analyses were conducted. RESULTS In total 168 samples from 137 studies including 11 374 participants qualified for the meta-analytic review. CBT and IPT were equally effective across all but one prespecified moderators. For psychotherapy delivered without concomitant antidepressant treatment [antidepressant medications (ADMs)], CBT was superior to IPT (g = 1.68, Qbetweenp = 0.037). Within-CBT moderator analyses showed that increased CBT efficacy was associated with lower age, high initial depression severity, individual format of administration and no adjunctive ADMs. Within-IPT analyses showed comparable efficacy across all moderators. CONCLUSIONS Clinical guidance around combined treatment (psychotherapy plus ADMs) should be reconsidered. CBT alone is superior to IPT alone and to combined treatment, while IPT alone is non-inferior to combined treatment. More research is needed to assess the moderating effect of older age and number of previous episodes on IPT efficacy.
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Affiliation(s)
- Aoife Whiston
- Department of Psychology, University of Limerick, Limerick, Ireland
| | - Claudi L H Bockting
- Department of Psychiatry, Academic Medical Centre, University of Amsterdam, Amsterdam, Netherlands
| | - Maria Semkovska
- Department of Psychology, University of Limerick, Limerick, Ireland
- Health Research Institute, University of Limerick, Limerick, Ireland
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Andersen BL, Valentine TR, Lo SB, Carbone DP, Presley CJ, Shields PG. Newly diagnosed patients with advanced non-small cell lung cancer: A clinical description of those with moderate to severe depressive symptoms. Lung Cancer 2019; 145:195-204. [PMID: 31806360 DOI: 10.1016/j.lungcan.2019.11.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 11/19/2019] [Accepted: 11/20/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The aims of this observational study were to 1) accrue newly diagnosed patients with advanced-stage non-small cell lung cancer (NSCLC) awaiting the start of first-line treatment and identify those with moderate to severe depressive symptoms and, 2) provide a clinical description of the multiple, co-occurring psychological and behavioral difficulties and physical symptoms that potentially exacerbate and maintain depressive symptoms. MATERIALS AND METHODS Patients with stage IV NSCLC (N = 186) were enrolled in an observational study (ClinicalTrials.gov Identifier: NCT03199651) and completed the American Society of Clinical Oncology-recommended screening measure for depression (Patient Health Questionnaire-9 [PHQ-9]). Individuals with none/mild (n = 119; 64 %), moderate (n = 52; 28 %), and severe (n = 15; 8 %) depressive symptoms were identified. Patients also completed measures of hopelessness, generalized anxiety disorder (GAD) symptoms, stress, illness perceptions, functional status, and symptoms. RESULTS Patients with severe depressive symptoms reported concomitant feelings of hopelessness (elevating risk for suicidal behavior), anxiety symptoms suggestive of GAD, and traumatic, cancer-specific stress. They perceived lung cancer as consequential for their lives and not controllable with treatment. Pain and multiple severe symptoms were present along with substantial functional impairment. Patients with moderate depressive symptoms had generally lower levels of disturbance, though still substantial. The most salient differences were low GAD symptom severity and fewer functional impairments for those with moderate symptoms. CONCLUSIONS Depressive symptoms of moderate to severe levels co-occur in a matrix of clinical levels of anxiety symptoms, traumatic stress, impaired functional status, and pain and other physical symptoms. All of the latter factors have been shown, individually and collectively, to contribute to the maintenance or exacerbation of depressive symptoms. As life-extending targeted and immunotherapy use expands, prompt identification of patients with moderate to severe depressive symptoms, referral for evaluation, and psychological/behavioral treatment are key to maximizing treatment outcomes and quality of life for individuals with advanced NSCLC.
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Affiliation(s)
- B L Andersen
- Department of Psychology, The Ohio State University, United States.
| | - T R Valentine
- Department of Psychology, The Ohio State University, United States
| | - S B Lo
- Department of Psychology, The Ohio State University, United States
| | - D P Carbone
- Department of Internal Medicine, Division of Medical Oncology, The Ohio State University Comprehensive Cancer Center and The James Cancer Hospital/Solove Research Institute, United States
| | - C J Presley
- Department of Internal Medicine, Division of Medical Oncology, The Ohio State University Comprehensive Cancer Center and The James Cancer Hospital/Solove Research Institute, United States
| | - P G Shields
- Department of Internal Medicine, Division of Medical Oncology, The Ohio State University Comprehensive Cancer Center and The James Cancer Hospital/Solove Research Institute, United States
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20
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Balter LJT, Higgs S, Aldred S, Bosch JA, Raymond JE. Inflammation Mediates Body Weight and Ageing Effects on Psychomotor Slowing. Sci Rep 2019; 9:15727. [PMID: 31673089 PMCID: PMC6823347 DOI: 10.1038/s41598-019-52062-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 10/07/2019] [Indexed: 01/02/2023] Open
Abstract
Inflammation (immune system activation) affects neuronal function and may have consequences for the efficiency and speed of functional brain processes. Indeed, unusually slow psychomotor speed, a measure predictive of behavioural performance and health outcomes, is found with obesity and ageing, two conditions also associated with chronic inflammation. Yet whether inflammation is the mediating factor remains unclear. Here, we assessed inflammation by indexing interleukin-6 level in blood and measured psychomotor speed as well as indices of selective visual attention in young (mean = 26 years) or old (mean = 71 years) adults (N = 83) who were either lean or currently significantly overweight (mean body mass index = 22.4 and 33.8, respectively). Inflammation was positively and significantly correlated with psychomotor speed, age, and body mass index but not with attention measures. Using mediation analyses we show for the first time that inflammation fully accounts for the significant psychomotor slowing found in those with high BMI. Moreover, we further show that age-related psychomotor slowing is partially mediated by inflammation. These findings support the proposal that reducing inflammation may mitigate weight- and age-related cognitive decline and thereby improve performance on daily tasks and health outcomes more generally.
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Affiliation(s)
- Leonie J T Balter
- School of Psychology, University of Birmingham, Birmingham, B15 2TT, UK. .,Psychology Department, Clinical Psychology, University of Amsterdam, Amsterdam, 1018 WT, The Netherlands.
| | - Suzanne Higgs
- School of Psychology, University of Birmingham, Birmingham, B15 2TT, UK
| | - Sarah Aldred
- School of Sport, Exercise, and Rehabilitation Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - Jos A Bosch
- Psychology Department, Clinical Psychology, University of Amsterdam, Amsterdam, 1018 WT, The Netherlands
| | - Jane E Raymond
- School of Psychology, University of Birmingham, Birmingham, B15 2TT, UK
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Pearson R, Pisner D, Meyer B, Shumake J, Beevers CG. A machine learning ensemble to predict treatment outcomes following an Internet intervention for depression. Psychol Med 2019; 49:2330-2341. [PMID: 30392475 PMCID: PMC6763538 DOI: 10.1017/s003329171800315x] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 09/06/2018] [Accepted: 10/05/2018] [Indexed: 11/06/2022]
Abstract
BACKGROUND Some Internet interventions are regarded as effective treatments for adult depression, but less is known about who responds to this form of treatment. METHOD An elastic net and random forest were trained to predict depression symptoms and related disability after an 8-week course of an Internet intervention, Deprexis, involving adults (N = 283) from across the USA. Candidate predictors included psychopathology, demographics, treatment expectancies, treatment usage, and environmental context obtained from population databases. Model performance was evaluated using predictive R2$\lpar R_{{\rm pred}}^2\rpar\comma $ the expected variance explained in a new sample, estimated by 10 repetitions of 10-fold cross-validation. RESULTS An ensemble model was created by averaging the predictions of the elastic net and random forest. Model performance was compared with a benchmark linear autoregressive model that predicted each outcome using only its baseline. The ensemble predicted more variance in post-treatment depression (8.0% gain, 95% CI 0.8-15; total $R_{{\rm pred}}^2 \; $= 0.25), disability (5.0% gain, 95% CI -0.3 to 10; total $R_{{\rm pred}}^2 \; $= 0.25), and well-being (11.6% gain, 95% CI 4.9-19; total $R_{{\rm pred}}^2 \; $= 0.29) than the benchmark model. Important predictors included comorbid psychopathology, particularly total psychopathology and dysthymia, low symptom-related disability, treatment credibility, lower access to therapists, and time spent using certain Deprexis modules. CONCLUSION A number of variables predict symptom improvement following an Internet intervention, but each of these variables makes relatively small contributions. Machine learning ensembles may be a promising statistical approach for identifying the cumulative contribution of many weak predictors to psychosocial depression treatment response.
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Affiliation(s)
- Rahel Pearson
- Department of Psychology, Institute for Mental Health Research, University of Texas at Austin, Austin, TX, USA
| | - Derek Pisner
- Department of Psychology, Institute for Mental Health Research, University of Texas at Austin, Austin, TX, USA
| | - Björn Meyer
- Gaia AG, Hamburg, Germany
- University of London, London, England, UK
| | - Jason Shumake
- Department of Psychology, Institute for Mental Health Research, University of Texas at Austin, Austin, TX, USA
| | - Christopher G. Beevers
- Department of Psychology, Institute for Mental Health Research, University of Texas at Austin, Austin, TX, USA
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van Krugten FCW, Goorden M, van Balkom AJLM, van Oppen P, Ruhé HG, van Schaik DJF, Brouwer WBF, Hakkaart-van Roijen L. The decision tool unipolar depression (DTUD): a new measure to facilitate the early identification of patients with major depressive disorder in need of highly specialized care. BMC Psychiatry 2019; 19:179. [PMID: 31185975 PMCID: PMC6560755 DOI: 10.1186/s12888-019-2165-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 05/29/2019] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Selection of the optimal initial treatment in patients with major depressive disorder (MDD) in need of highly specialized care has the potential to benefit treatment outcomes and cost-effectiveness of treatment strategies. However, to date, there is a paucity of measures that could guide the selection of the initial treatment, in particular to indicate which patients with MDD are in need of highly specialized care. Recognizing this gap, this paper reports on the development and psychometric evaluation of the Decision Tool Unipolar Depression (DTUD), aimed to facilitate the early identification of patients with MDD in need of highly specialized care. METHODS The DTUD was developed using a mixed-methods approach, consisting of a systematic review and a concept mapping study. To evaluate the psychometric features of the DTUD, a cross-sectional multicenter study was conducted. A total of 243 patients with MDD were evaluated with the DTUD. Feasibility was operationalized as the time required to complete the DTUD and the content clarity of the DTUD. Inter-rater reliability was evaluated using Krippendorf's alpha. The Maudsley Staging Method (MSM) and the Dutch Measure for quantification of Treatment Resistance in Depression (DM-TRD) were administered to assess the convergent validity. A receiver operator characteristic curve was generated to evaluate the criterion validity and establish the optimal cut-off value. RESULTS The mean administration time was 4.49 min (SD = 2.71), and the content of the total DTUD was judged as clear in 94.7% of the evaluations. Inter-rater reliability values ranged from 0.69 to 0.91. Higher scores on the DTUD were associated with higher scores on the MSM (rs = 0.47) and DM-TRD (rs = 0.53). Based on the maximum Youden index (0.494), maximum discrimination was reached at a cut-off score of ≥5 (sensitivity 67%, specificity 83%). CONCLUSION The DTUD demonstrated to be a tool with solid psychometric properties and, therefore, is a promising measure for the early identification of patients with MDD in need of highly specialized care. Use of the DTUD has the potential to facilitate the selection and initiation of the optimal initial treatment in patients with MDD, which in turn may improve the clinical effectiveness and cost-effectiveness of treatment strategies.
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Affiliation(s)
- Frédérique C. W. van Krugten
- 0000000092621349grid.6906.9Erasmus School of Health Policy & Management, Erasmus University Rotterdam, PO Box 1738, 3000 DR Rotterdam, The Netherlands
| | - Maartje Goorden
- 0000000092621349grid.6906.9Erasmus School of Health Policy & Management, Erasmus University Rotterdam, PO Box 1738, 3000 DR Rotterdam, The Netherlands
| | - Anton J. L. M. van Balkom
- 0000 0004 1754 9227grid.12380.38Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands ,0000 0004 0435 165Xgrid.16872.3aAmsterdam Public Health Research Institute, Amsterdam, The Netherlands ,0000 0004 0546 0540grid.420193.dAcademic Outpatient Clinic, GGZ InGeest, Amsterdam, The Netherlands
| | - Patricia van Oppen
- 0000 0004 1754 9227grid.12380.38Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands ,0000 0004 0435 165Xgrid.16872.3aAmsterdam Public Health Research Institute, Amsterdam, The Netherlands ,0000 0004 0546 0540grid.420193.dAcademic Outpatient Clinic, GGZ InGeest, Amsterdam, The Netherlands
| | - Henricus G. Ruhé
- 0000000404654431grid.5650.6Department of Psychiatry, Academic Medical Center, Amsterdam, The Netherlands ,0000 0004 0444 9382grid.10417.33Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Digna J. F. van Schaik
- 0000 0004 1754 9227grid.12380.38Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands ,0000 0004 0435 165Xgrid.16872.3aAmsterdam Public Health Research Institute, Amsterdam, The Netherlands ,0000 0004 0546 0540grid.420193.dAcademic Outpatient Clinic, GGZ InGeest, Amsterdam, The Netherlands
| | - Werner B. F. Brouwer
- 0000000092621349grid.6906.9Erasmus School of Health Policy & Management, Erasmus University Rotterdam, PO Box 1738, 3000 DR Rotterdam, The Netherlands
| | - Leona Hakkaart-van Roijen
- 0000000092621349grid.6906.9Erasmus School of Health Policy & Management, Erasmus University Rotterdam, PO Box 1738, 3000 DR Rotterdam, The Netherlands
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Zisook S, Johnson GR, Tal I, Hicks P, Chen P, Davis L, Thase M, Zhao Y, Vertrees J, Mohamed S. General Predictors and Moderators of Depression Remission: A VAST-D Report. Am J Psychiatry 2019; 176:348-357. [PMID: 30947531 DOI: 10.1176/appi.ajp.2018.18091079] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Almost two-thirds of patients with major depressive disorder do not achieve remission with initial treatments. Thus, identifying and providing effective, feasible, and safe "next-step" treatments are clinical imperatives. This study explores patient baseline features that might help clinicians select between commonly used next-step treatments. METHODS The authors used data from the U.S. Department of Veterans Affairs (VA) Augmentation and Switching Treatments for Improving Depression Outcomes (VAST-D) study, a multisite, randomized, single-blind trial of 1,522 Veterans Health Administration patients who did not have an adequate response to at least one course of antidepressant treatment meeting minimal standards for dosage and duration. For 12 weeks, participants received one of three possible next-step treatments: switch to another antidepressant-sustained-release bupropion; combination with another antidepressant-sustained-release bupropion; or augmentation with an antipsychotic-aripiprazole. Life table regression models were used to identify baseline characteristics associated with remission overall (general predictors) and their interaction with remission among the three treatment groups (moderators). RESULTS Remission was more likely for individuals who were employed, less severely and chronically depressed, less anxious, not experiencing complicated grief symptoms, did not experience childhood adversity, and had better quality of life and positive mental health. Two features suggested specific next-step treatment selections: age ≥65 years (for whom augmentation with aripiprazole was more effective than switch to bupropion) and severe mixed hypomanic symptoms (for which augmentation with aripiprazole and combination with bupropion were more effective than switch to bupropion). CONCLUSIONS If replicated, these preliminary findings could help clinicians determine which patients with depression requiring next-step treatment will benefit most from a specific augmentation, combination, or switching strategy.
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Affiliation(s)
- Sidney Zisook
- VA San Diego Healthcare System (Zisook, Tal); the Department of Psychiatry, University of California San Diego (Zisook); Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, West Haven (Johnson, Zhao); the Department of Psychiatry, Texas A&M College of Medicine, Temple (Hicks); Louis Stokes VA Medical Center and the Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland (Chen); Tuscaloosa VA Medical Center, Tuscaloosa, Ala. (Davis); University of Alabama School of Medicine, Birmingham (Davis); Philadelphia VA Medical Center (Thase); Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, N.Mex. (Vertrees); and the VA New England Mental Illness Research, Education, and Clinical Center, VA Connecticut Healthcare System, West Haven (Mohamed)
| | - Gary R Johnson
- VA San Diego Healthcare System (Zisook, Tal); the Department of Psychiatry, University of California San Diego (Zisook); Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, West Haven (Johnson, Zhao); the Department of Psychiatry, Texas A&M College of Medicine, Temple (Hicks); Louis Stokes VA Medical Center and the Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland (Chen); Tuscaloosa VA Medical Center, Tuscaloosa, Ala. (Davis); University of Alabama School of Medicine, Birmingham (Davis); Philadelphia VA Medical Center (Thase); Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, N.Mex. (Vertrees); and the VA New England Mental Illness Research, Education, and Clinical Center, VA Connecticut Healthcare System, West Haven (Mohamed)
| | - Ilanit Tal
- VA San Diego Healthcare System (Zisook, Tal); the Department of Psychiatry, University of California San Diego (Zisook); Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, West Haven (Johnson, Zhao); the Department of Psychiatry, Texas A&M College of Medicine, Temple (Hicks); Louis Stokes VA Medical Center and the Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland (Chen); Tuscaloosa VA Medical Center, Tuscaloosa, Ala. (Davis); University of Alabama School of Medicine, Birmingham (Davis); Philadelphia VA Medical Center (Thase); Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, N.Mex. (Vertrees); and the VA New England Mental Illness Research, Education, and Clinical Center, VA Connecticut Healthcare System, West Haven (Mohamed)
| | - Paul Hicks
- VA San Diego Healthcare System (Zisook, Tal); the Department of Psychiatry, University of California San Diego (Zisook); Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, West Haven (Johnson, Zhao); the Department of Psychiatry, Texas A&M College of Medicine, Temple (Hicks); Louis Stokes VA Medical Center and the Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland (Chen); Tuscaloosa VA Medical Center, Tuscaloosa, Ala. (Davis); University of Alabama School of Medicine, Birmingham (Davis); Philadelphia VA Medical Center (Thase); Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, N.Mex. (Vertrees); and the VA New England Mental Illness Research, Education, and Clinical Center, VA Connecticut Healthcare System, West Haven (Mohamed)
| | - Peijun Chen
- VA San Diego Healthcare System (Zisook, Tal); the Department of Psychiatry, University of California San Diego (Zisook); Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, West Haven (Johnson, Zhao); the Department of Psychiatry, Texas A&M College of Medicine, Temple (Hicks); Louis Stokes VA Medical Center and the Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland (Chen); Tuscaloosa VA Medical Center, Tuscaloosa, Ala. (Davis); University of Alabama School of Medicine, Birmingham (Davis); Philadelphia VA Medical Center (Thase); Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, N.Mex. (Vertrees); and the VA New England Mental Illness Research, Education, and Clinical Center, VA Connecticut Healthcare System, West Haven (Mohamed)
| | - Lori Davis
- VA San Diego Healthcare System (Zisook, Tal); the Department of Psychiatry, University of California San Diego (Zisook); Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, West Haven (Johnson, Zhao); the Department of Psychiatry, Texas A&M College of Medicine, Temple (Hicks); Louis Stokes VA Medical Center and the Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland (Chen); Tuscaloosa VA Medical Center, Tuscaloosa, Ala. (Davis); University of Alabama School of Medicine, Birmingham (Davis); Philadelphia VA Medical Center (Thase); Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, N.Mex. (Vertrees); and the VA New England Mental Illness Research, Education, and Clinical Center, VA Connecticut Healthcare System, West Haven (Mohamed)
| | - Michael Thase
- VA San Diego Healthcare System (Zisook, Tal); the Department of Psychiatry, University of California San Diego (Zisook); Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, West Haven (Johnson, Zhao); the Department of Psychiatry, Texas A&M College of Medicine, Temple (Hicks); Louis Stokes VA Medical Center and the Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland (Chen); Tuscaloosa VA Medical Center, Tuscaloosa, Ala. (Davis); University of Alabama School of Medicine, Birmingham (Davis); Philadelphia VA Medical Center (Thase); Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, N.Mex. (Vertrees); and the VA New England Mental Illness Research, Education, and Clinical Center, VA Connecticut Healthcare System, West Haven (Mohamed)
| | - Yinjun Zhao
- VA San Diego Healthcare System (Zisook, Tal); the Department of Psychiatry, University of California San Diego (Zisook); Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, West Haven (Johnson, Zhao); the Department of Psychiatry, Texas A&M College of Medicine, Temple (Hicks); Louis Stokes VA Medical Center and the Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland (Chen); Tuscaloosa VA Medical Center, Tuscaloosa, Ala. (Davis); University of Alabama School of Medicine, Birmingham (Davis); Philadelphia VA Medical Center (Thase); Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, N.Mex. (Vertrees); and the VA New England Mental Illness Research, Education, and Clinical Center, VA Connecticut Healthcare System, West Haven (Mohamed)
| | - Julia Vertrees
- VA San Diego Healthcare System (Zisook, Tal); the Department of Psychiatry, University of California San Diego (Zisook); Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, West Haven (Johnson, Zhao); the Department of Psychiatry, Texas A&M College of Medicine, Temple (Hicks); Louis Stokes VA Medical Center and the Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland (Chen); Tuscaloosa VA Medical Center, Tuscaloosa, Ala. (Davis); University of Alabama School of Medicine, Birmingham (Davis); Philadelphia VA Medical Center (Thase); Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, N.Mex. (Vertrees); and the VA New England Mental Illness Research, Education, and Clinical Center, VA Connecticut Healthcare System, West Haven (Mohamed)
| | - Somaia Mohamed
- VA San Diego Healthcare System (Zisook, Tal); the Department of Psychiatry, University of California San Diego (Zisook); Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, West Haven (Johnson, Zhao); the Department of Psychiatry, Texas A&M College of Medicine, Temple (Hicks); Louis Stokes VA Medical Center and the Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland (Chen); Tuscaloosa VA Medical Center, Tuscaloosa, Ala. (Davis); University of Alabama School of Medicine, Birmingham (Davis); Philadelphia VA Medical Center (Thase); Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, N.Mex. (Vertrees); and the VA New England Mental Illness Research, Education, and Clinical Center, VA Connecticut Healthcare System, West Haven (Mohamed)
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Furukawa TA, Karyotaki E, Suganuma A, Pompoli A, Ostinelli EG, Cipriani A, Cuijpers P, Efthimiou O. Dismantling, personalising and optimising internet cognitive-behavioural therapy for depression: a study protocol for individual participant data component network meta-analysis. BMJ Open 2019; 8:e026137. [PMID: 30798295 PMCID: PMC6278798 DOI: 10.1136/bmjopen-2018-026137] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Psychotherapy is a complex intervention, consisting of various components and being implemented flexibly in consideration of individual patient's characteristics. It is then of utmost importance to know which of the various components or combinations thereof are more efficacious, what their specific effect sizes are and which types of patients may benefit more from different components or their combinations. METHODS AND ANALYSIS Internet-delivered cognitive-behavioural therapy (iCBT) offers a unique opportunity to systematically review and quantitatively disentangle the efficacy of various components because, unlike face-to-face cognitive-behavioural therapy, it allows identification of constituent components that are actually delivered to patients. We will systematically identify all randomised controlled trials that compared any form of iCBT against another form or a control intervention in the acute phase treatment of adult depression. We will apply component network meta-analysis (cNMA) to dismantle efficacy of individual components. We will use individual participant data in the cNMA to identify participant-level prognostic factors and effect modifiers for different components. ETHICS AND DISSEMINATION The investigators of the primary trials will have obtained ethical approval for the data used in the present study and for sharing the data, if this was necessary, according to local requirements and was not covered from the initial ethic assessment. Results from this study will be published in peer-reviewed journals and presented at relevant conferences. PROSPERO REGISTRATION NUMBER CRD42018104683.
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Affiliation(s)
- Toshi A Furukawa
- Departments of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/ School of Public Health, Kyoto, Japan
| | - Eirini Karyotaki
- Department of Clinical, Neuro-, and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Aya Suganuma
- Departments of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/ School of Public Health, Kyoto, Japan
- Amsterdam Public Health research institute, Faculty of Behavioural and Movement Sciences, Vrije Universiteit, Amsterdam, The Netherlands
| | | | | | - Andrea Cipriani
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Pim Cuijpers
- Department of Clinical, Neuro-, and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health research institute, Faculty of Behavioural and Movement Sciences, Vrije Universiteit, Amsterdam, The Netherlands
| | - Orestis Efthimiou
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
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Gurpegui D, Ortuño F, Gurpegui M. Temperament traits and remission of depression: A naturalistic six-month longitudinal study. J Affect Disord 2019; 243:494-502. [PMID: 30286414 DOI: 10.1016/j.jad.2018.09.041] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Revised: 08/22/2018] [Accepted: 09/15/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND The aim of this naturalistic longitudinal study was to add evidence regarding the potential of Cloninger's temperament traits (novelty seeking, harm avoidance, reward dependence and persistence) for predicting the effect of pharmacological treatment on the rates of therapeutic response and remission. METHODS The study was based on 200 outpatients with unipolar depressive disorders of different severity and course of illness, and extended up to 6 months of follow-up. Patients were assessed in their temperament with the Tridimensional Personality Questionnaire (TPQ) and their condition was classified (in course and severity) according to the International Classification of Diseases, Tenth revision (ICD-10) diagnostic criteria for research. Patients were blindly rated (concerning other predicting variables) on the improved Clinical Global Impression-Severity scale for depression (iCGI-S) at baseline, 6 weeks, 3 months and 6 months. Outcome measures at the last observation carried forward were therapeutic response (reduction of ≥50% in the last iCGI-S) and remission (last iCGI-S = 0), which were available for 187 patients. RESULTS Remission was independently and directly associated with length of follow-up, and inversely with the baseline iCGI-S score and harm avoidance (patients in the high tertile had a 2.7 likelihood of non-remission in comparison with those in the low tertile); persistence was found to have a complex, V-shape relationship with remission. Within a sub-sample of more severe cases (n = 118), having higher harm avoidance scores, a more favorable outcome was associated with higher reward dependence and the non-smoking condition. LIMITATIONS With a naturalistic, non-experimental design, the sample may not be representative of the general population. CONCLUSIONS Temperament traits may help predict outcome in patients treated for depression.
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Affiliation(s)
- David Gurpegui
- Department of Psychiatry and Medical Psychology, Faculty of Medicine and Clínica Universidad de Navarra, Universidad de Navarra, Pamplona, Spain
| | - Felipe Ortuño
- Department of Psychiatry and Medical Psychology, Faculty of Medicine and Clínica Universidad de Navarra, Universidad de Navarra, Pamplona, Spain
| | - Manuel Gurpegui
- Department of Psychiatry, Faculty of Medicine, CTS-549 Research Group, Institute of Neurosciences, Universidad de Granada, Av. Investigación 11 - Torre A, Planta 9, E-18071 Granada, Spain.
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Vittengl JR, Clark LA, Smits JAJ, Thase ME, Jarrett RB. Do comorbid social and other anxiety disorders predict outcomes during and after cognitive therapy for depression? J Affect Disord 2019; 242:150-158. [PMID: 30176494 PMCID: PMC6151272 DOI: 10.1016/j.jad.2018.08.053] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 07/25/2018] [Accepted: 08/12/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Cognitive therapy (CT) improves symptoms in adults with major depressive disorder (MDD) plus comorbid anxiety disorder, but the specific type of anxiety may influence outcomes. This study compared CT outcomes among adults with MDD plus social, other, or no comorbid anxiety disorders. METHODS Outpatients with recurrent MDD (N = 523, including 87 with social and 110 with other comorbid anxiety disorders) received acute-phase CT. Higher risk responders (n = 241 with partial or unstable response) were randomized to 8 months of continuation treatment (CT or clinical management plus fluoxetine or pill placebo), followed by 24 months of assessment. Lower risk responders (n = 49) were assessed for 32 months without additional research treatment. Depression, anxiety symptoms, and social avoidance were measured repeatedly. RESULTS Other (non-social), but not social, anxiety disorders predicted elevated depression and anxiety symptoms throughout and after acute-phase CT. Social, but not other, anxiety disorder predicted greater reduction in depressive symptoms during acute-phase CT and elevated social avoidance during and after acute-phase CT. LIMITATIONS Anxiety disorders were assessed only before acute-phase treatment. The anxiety symptom measure was brief. Generalization to other patient populations and treatments is unknown. CONCLUSIONS Non-social comorbid anxiety disorders may reduce the efficacy of acute-phase CT for MDD by diminishing both short- and longer term outcomes relative to depressed patients without comorbid anxiety disorders. Comorbid social anxiety disorder may increase relative reductions in depressive symptoms during acute-phase CT for MDD, but patients with comorbid social anxiety disorder may require specialized focus on social avoidance during CT.
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Affiliation(s)
| | - Lee Anna Clark
- Department of Psychology, University of Notre Dame, Notre Dame, IN, USA
| | - Jasper A J Smits
- Department of Psychology, University of Texas at Austin, Asutin, TX, USA
| | - Michael E Thase
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Robin B Jarrett
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA.
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Furukawa TA, Efthimiou O, Weitz ES, Cipriani A, Keller MB, Kocsis JH, Klein DN, Michalak J, Salanti G, Cuijpers P, Schramm E. Cognitive-Behavioral Analysis System of Psychotherapy, Drug, or Their Combination for Persistent Depressive Disorder: Personalizing the Treatment Choice Using Individual Participant Data Network Metaregression. Psychother Psychosom 2018; 87:140-153. [PMID: 29847831 DOI: 10.1159/000489227] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/25/2017] [Accepted: 04/11/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND Persistent depressive disorder is prevalent, disabling, and often difficult to treat. The cognitive-behavioral analysis system of psychotherapy (CBASP) is the only psychotherapy specifically developed for its treatment. However, we do not know which of CBASP, antidepressant pharmacotherapy, or their combination is the most efficacious and for which types of patients. This study aims to present personalized prediction models to facilitate shared decision-making in treatment choices to match patients' characteristics and preferences based on individual participant data network metaregression. METHODS We conducted a comprehensive search for randomized controlled trials comparing any two of CBASP, pharmacotherapy, or their combination and sought individual participant data from identified trials. The primary outcomes were reduction in depressive symptom severity for efficacy and dropouts due to any reason for treatment acceptability. RESULTS All 3 identified studies (1,036 participants) were included in the present analyses. On average, the combination therapy showed significant superiority over both monotherapies in terms of efficacy and acceptability, while the latter 2 treatments showed essentially similar results. Baseline depression, anxiety, prior pharmacotherapy, age, and depression subtypes moderated their relative efficacy, which indicated that for certain subgroups of patients either drug therapy or CBASP alone was a recommendable treatment option that is less costly, may have fewer adverse effects and match an individual patient's preferences. An interactive web app (https://kokoro.med.kyoto-u.ac.jp/CBASP/prediction/) shows the predicted disease course for all possible combinations of patient characteristics. CONCLUSIONS Individual participant data network metaregression enables treatment recommendations based on individual patient characteristics.
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Affiliation(s)
- Toshi A Furukawa
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - Orestis Efthimiou
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Erica S Weitz
- Department of Clinical, Neuro- and Developmental Psychology, and EMGO Institute for Health and Care Research, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Andrea Cipriani
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Martin B Keller
- Department of Psychiatry and Human Behavior, Brown University, Providence, Rhode Island, USA
| | - James H Kocsis
- Department of Psychiatry, Weill Cornell Medical College, New York, New York, USA
| | - Daniel N Klein
- Department of Psychology, Stony Brook University, Stony Brook, New York, USA
| | - Johannes Michalak
- Department of Psychology and Psychotherapy, Witten/Herdecke University, Witten, Germany
| | - Georgia Salanti
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Pim Cuijpers
- Department of Clinical, Neuro- and Developmental Psychology, and EMGO Institute for Health and Care Research, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Elisabeth Schramm
- Department of Psychiatry and Psychotherapy, University Medical Center Freiburg, Freiburg, Germany
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López-Cruz L, Salamone JD, Correa M. Caffeine and Selective Adenosine Receptor Antagonists as New Therapeutic Tools for the Motivational Symptoms of Depression. Front Pharmacol 2018; 9:526. [PMID: 29910727 PMCID: PMC5992708 DOI: 10.3389/fphar.2018.00526] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 05/01/2018] [Indexed: 01/06/2023] Open
Abstract
Major depressive disorder is one of the most common and debilitating psychiatric disorders. Some of the motivational symptoms of depression, such anergia (lack of self-reported energy) and fatigue are relatively resistant to traditional treatments such as serotonin uptake inhibitors. Thus, new pharmacological targets are being investigated. Epidemiological data suggest that caffeine consumption can have an impact on aspects of depressive symptomatology. Caffeine is a non-selective adenosine antagonist for A1/A2A receptors, and has been demonstrated to modulate behavior in classical animal models of depression. Moreover, selective adenosine receptor antagonists are being assessed for their antidepressant effects in animal studies. This review focuses on how caffeine and selective adenosine antagonists can improve different aspects of depression in humans, as well as in animal models. The effects on motivational symptoms of depression such as anergia, fatigue, and psychomotor slowing receive particular attention. Thus, the ability of adenosine receptor antagonists to reverse the anergia induced by dopamine antagonism or depletion is of special interest. In conclusion, although further studies are needed, it appears that caffeine and selective adenosine receptor antagonists could be therapeutic agents for the treatment of motivational dysfunction in depression.
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Affiliation(s)
- Laura López-Cruz
- Àrea de Psicobiologia, Universitat Jaume I, Castellón de la Plana, Spain
| | - John D. Salamone
- Behavioral Neuroscience Division, University of Connecticut, Storrs, CT, United States
| | - Mercè Correa
- Àrea de Psicobiologia, Universitat Jaume I, Castellón de la Plana, Spain
- Behavioral Neuroscience Division, University of Connecticut, Storrs, CT, United States
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van Bronswijk SC, Lemmens LHJM, Huibers MJH, Arntz A, Peeters FPML. The influence of comorbid anxiety on the effectiveness of Cognitive Therapy and Interpersonal Psychotherapy for Major Depressive Disorder. J Affect Disord 2018; 232:52-60. [PMID: 29477584 DOI: 10.1016/j.jad.2018.02.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Revised: 01/17/2018] [Accepted: 02/11/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND Anxious depression is an important subtype of Major Depressive Disorder (MDD) defined by both syndromal (anxiety disorders) and dimensional (anxiety symptoms) criteria. A debated question is how anxiety affects MDD treatment. This study examined the impact of comorbid anxiety disorders and symptoms on the effectiveness of and dropout during Cognitive Therapy (CT) and Interpersonal Psychotherapy (IPT) for MDD. METHODS Depressed individuals were randomized to CT (n = 76) or IPT (n = 75). Outcome was depression severity measured with the Beck Depression Inventory-II (BDI-II) at the start of each therapy session, post treatment, and monthly up to five months follow-up. Anxiety disorders were assessed with the Structured Clinical Interview for DSM-IV Axis I disorders, (phobic) anxiety symptoms were assessed with Brief Symptom Inventory subscales. RESULTS Approximately one third of participants had a comorbid anxiety disorder. Comorbid anxiety disorders and anxiety symptoms were associated with less favorable depression change during IPT as compared to CT in the treatment phase, but not in the trial follow-up phase. Individuals with a comorbid anxiety disorder had significantly higher treatment dropout during both treatments. LIMITATIONS Not all therapists and participants were blind to the assessment of comorbid anxiety disorders and the assessments were performed by one rater. CONCLUSIONS A preference for CT over IPT for MDD is justifiable when comorbid anxiety is present, although long-term differences are not established and replication of this finding is needed. Clinicians should be aware of the risk of dropout for depressed individuals with an anxiety disorder.
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Affiliation(s)
- Suzanne C van Bronswijk
- Department of Psychiatry and Psychology, Maastricht University Medical Center+, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands; School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
| | - Lotte H J M Lemmens
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Marcus J H Huibers
- Department of Clinical Psychology, VU University Amsterdam, Amsterdam, The Netherlands; Department of Psychology, University of Pennsylvania, Philadelphia, PA, USA
| | - Arnoud Arntz
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands; Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Frenk P M L Peeters
- Department of Psychiatry and Psychology, Maastricht University Medical Center+, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands; School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
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30
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Callari A, Mauri M, Miniati M, Mancino M, Bracci G, Dell'Osso L, Greco C. Treatment of Depression in Patients with Breast Cancer: A Critical Review. Tumori 2018; 99:623-33. [DOI: 10.1177/030089161309900511] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Aims and background To summarize current knowledge on psychopharmacological and psychotherapeutic options for patients with breast cancer and comorbid depression, starting from the psychiatric viewpoint. Issues on diagnostic boundaries of depression and outcome measures are raised. Methods We completed a literature review from the last 30 years (until March 2012) using PubMed by pairing the key words: ‘breast cancer and depression treatment’ (about 1431 works, including 207 reviews), ‘breast cancer and antidepressants’ (about 305 works, including 66 reviews), and in particular ‘selective serotonin reuptake inhibitors and breast cancer’ (38 works, including 10 reviews) and ‘breast cancer and psychotherapy’ (603 works, including 84 reviews). Papers in the English language were selected, including recent reviews. Results There is little evidence for the superiority of any one specific intervention with pharmacological options or psychotherapy. The heterogeneity of assessment criteria, the small number of subjects collected in systematic studies, the difficulty in adopting standardized outcome measures, and the limited numbers of available drugs with a favorable side effect profile are the main limitations that emerge from the literature. No conclusive findings are available on mid-term/long-term treatment strategies, or when depression is part of a bipolar disorder. Conclusions Further research is necessary to define the most appropriate approach to depression when it occurs in comorbidity with breast cancer. A more accurate definition of the clinical phenotypes of depression in the special population of patients with breast cancer is suggested as a key issue.
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Affiliation(s)
- Antonio Callari
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
| | - Mauro Mauri
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
| | - Mario Miniati
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
| | | | - Giulia Bracci
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
- Department of Psychiatry, Columbia University Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, New York, NY, USA
| | - Liliana Dell'Osso
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
| | - Carlo Greco
- Department of Radiotherapy, University of Pisa, Pisa, Italy
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Pedersen G, Kvarstein EH, Wilberg T. The Work and Social Adjustment Scale: Psychometric properties and validity among males and females, and outpatients with and without personality disorders. Personal Ment Health 2017; 11:215-228. [PMID: 28681505 DOI: 10.1002/pmh.1382] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 05/11/2017] [Accepted: 05/15/2017] [Indexed: 11/11/2022]
Abstract
The Work and Social Adjustment Scale (WSAS) is an outcome measure assessing degree of functional impairment. Its psychometric properties, validity and sensitivity to change have been supported in several studies. However, no explicit psychometric or validity study of WSAS has been performed on data from a large sample of psychiatric outpatients, with and without personality disorders. The aim of this study was therefore to provide additional knowledge of the properties of WSAS in such a sample. The material comprised data from 1371 patients, from 15 different units participating in the Norwegian Network of Personality-Focused Treatment Programs. Psychometric properties of the scale, such as measurement invariance among males and females, longitudinal invariance, as well as associations with other clinical measures and sensitivity to change were analysed. The results confirm that WSAS constitutes a reliable, unidimensional and gender invariant measure, sensitive to change and to severity of mental distress. Although highly associated with levels of depression, WSAS measures a clinically important aspect of impairment. Copyright © 2017 John Wiley & Sons, Ltd.
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Affiliation(s)
- G Pedersen
- Oslo University Hospital, Department of Personality Psychiatry, Division of Mental Health and Addiction, Oslo, Norway.,NORMENT, KG Jebsen Center for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Norway
| | - E H Kvarstein
- Oslo University Hospital, Department of Personality Psychiatry, Division of Mental Health and Addiction, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Norway
| | - T Wilberg
- Institute of Clinical Medicine, University of Oslo, Norway.,Department of Research and Development, Division of Mental Health and Addiction, Oslo University Hospital, Norway
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Dunlop BW, Kelley ME, Aponte-Rivera V, Mletzko-Crowe T, Kinkead B, Ritchie JC, Nemeroff CB, Edward Craighead W, Mayberg HS. Effects of Patient Preferences on Outcomes in the Predictors of Remission in Depression to Individual and Combined Treatments (PReDICT) Study. Am J Psychiatry 2017; 174:546-556. [PMID: 28335624 PMCID: PMC6690210 DOI: 10.1176/appi.ajp.2016.16050517] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE The Predictors of Remission in Depression to Individual and Combined Treatments [PReDICT] study aimed to identify clinical and biological factors predictive of treatment outcomes in major depressive disorder among treatment-naive adults. The authors evaluated the efficacy of cognitive-behavioral therapy (CBT) and two antidepressant medications (escitalopram and duloxetine) in patients with major depression and examined the moderating effect of patients' treatment preferences on outcomes. METHOD Adults aged 18-65 with treatment-naive major depression were randomly assigned with equal likelihood to 12 weeks of treatment with escitalopram (10-20 mg/day), duloxetine (30-60 mg/day), or CBT (16 50-minute sessions). Prior to randomization, patients indicated whether they preferred medication or CBT or had no preference. The primary outcome was change in the 17-item Hamilton Depression Rating Scale (HAM-D), administered by raters blinded to treatment. RESULTS A total of 344 patients were randomly assigned, with a mean baseline HAM-D score of 19.8 (SD=3.8). The mean estimated overall decreases in HAM-D score did not significantly differ between treatments (CBT: 10.2, escitalopram: 11.1, duloxetine: 11.2). Last observation carried forward remission rates did not significantly differ between treatments (CBT: 41.9%, escitalopram: 46.7%, duloxetine: 54.7%). Patients matched to their preferred treatment were more likely to complete the trial but not more likely to achieve remission. CONCLUSIONS Treatment guidelines that recommend either an evidence-based psychotherapy or antidepressant medication for nonpsychotic major depression can be extended to treatment-naive patients. Treatment preferences among patients without prior treatment exposure do not significantly moderate symptomatic outcomes.
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Affiliation(s)
- Boadie W. Dunlop
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA
| | - Mary E. Kelley
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Vivianne Aponte-Rivera
- Department of Psychiatry and Behavioral Sciences, Tulane University School of Medicine, New Orleans, LA, USA
| | - Tanja Mletzko-Crowe
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA
| | - Becky Kinkead
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA
| | - James C. Ritchie
- Department of Clinical Pathology, Emory University School of Medicine, Atlanta, GA, USA
| | - Charles B. Nemeroff
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - W. Edward Craighead
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA.,Department of Psychology, Emory University, Atlanta, GA, USA
| | - Helen S. Mayberg
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA.,Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA
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Abstract
The importance of subgroup analyses has been increasing due to a growing interest in personalized medicine and targeted therapies. Considering designs with multiple nested subgroups and a continuous endpoint, we develop methods for the analysis and sample size determination. First, we consider the joint distribution of standardized test statistics that correspond to each (sub)population. We derive multivariate exact distributions where possible, providing approximations otherwise. Based on these results, we present sample size calculation procedures. Uncertainties about nuisance parameters which are needed for sample size calculations make the study prone to misspecifications. We discuss how a sample size review can be performed in order to make the study more robust. To this end, we implement an internal pilot study design where the variances and prevalences of the subgroups are reestimated in a blinded fashion and the sample size is recalculated accordingly. Simulations show that the procedures presented here do not inflate the type I error significantly and maintain the prespecified power as long as the sample size of the smallest subgroup is not too small. We pay special attention to the case of small sample sizes and attain a lower boundary for the size of the internal pilot study.
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Affiliation(s)
- Marius Placzek
- Department of Medical Statistics, University Medical Center Goettingen, Goettingen, Germany
| | - Tim Friede
- Department of Medical Statistics, University Medical Center Goettingen, Goettingen, Germany
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O'Hara R, Beaudreau SA, Gould CE, Froehlich W, Kraemer HC. Handling clinical comorbidity in randomized clinical trials in psychiatry. J Psychiatr Res 2017; 86:26-33. [PMID: 27886637 DOI: 10.1016/j.jpsychires.2016.11.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 09/26/2016] [Accepted: 11/15/2016] [Indexed: 11/24/2022]
Abstract
The purpose of this paper is to a) outline the importance of including patients with clinical comorbidities in Randomized Clinical Trials (RCTs) of psychiatric treatments; and b) to propose a specific approach for best handling, analyzing and interpreting the data on clinical comorbidities in terms of their impact on treatment outcomes. To do this we first define and describe clinical comorbidity and differentiate it from other forms of comorbidity. We then describe the methodological and analytical problems associated with excluding patients with clinically comorbid conditions from RCTs, including the impact on the outcomes of RCTs in psychiatry and the impact on evidence-based clinical decision-making. We then address the challenges inherent to including patients with clinical comorbidities in RCTs. Finally, we propose a methodological and analytic approach to deal with these issues in RCTs which aims to significantly improve the information yielded from RCTs in psychiatry, and thus improve clinical decision-making.
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Delgadillo J, Groom M. Using Psychoeducation and Role Induction to Improve Completion Rates in Cognitive Behavioural Therapy. Behav Cogn Psychother 2017; 45:170-84. [PMID: 28229807 DOI: 10.1017/S1352465816000643] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Pre-treatment role induction interventions have been suggested to potentially enhance attendance and clinical outcomes in psychotherapy. AIMS This study aimed to evaluate the effects of a programme of three transdiagnostic seminars (TDS) for patients with common mental disorders accessing cognitive behavioural therapy (CBT) in primary care. TDS included CBT psychoeducation and role induction. METHOD A random sample of patients (n = 49) participated in TDS followed by CBT (TDS+CBT) and they were compared with matched controls (n = 49) accessing usual CBT. TDS participants rated the relevance and quality of this intervention using an acceptability questionnaire (AQ). Treatment completion (vs dropout) rates were compared across groups using chi-square tests. Post-treatment changes in depression (PHQ-9) and anxiety (GAD-7) symptoms were compared between groups using analysis of covariance controlling for potential confounders. Analyses were based on intention-to-treat principles. RESULTS Mean AQ ratings of the TDS intervention were comparable across diagnostic groups (p = .05). Treatment completion rates were significantly higher (p = .02) in the TDS+CBT group (87.8%) by comparison with usual CBT (68.8%). However, no significant differences in post-treatment symptom changes were found for depression (p = .34) or anxiety measures (p = .71). CONCLUSIONS Incorporating a psychoeducational role induction prior to CBT significantly improved treatment retention, but not overall symptom reductions.
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Sukhodolsky DG, Woods DW, Piacentini J, Wilhelm S, Peterson AL, Katsovich L, Dziura J, Walkup JT, Scahill L. Moderators and predictors of response to behavior therapy for tics in Tourette syndrome. Neurology 2017; 88:1029-1036. [PMID: 28202705 DOI: 10.1212/wnl.0000000000003710] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 12/20/2016] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE To examine moderators and predictors of response to behavior therapy for tics in children and adults with Tourette syndrome and chronic tic disorders. METHODS Data from 2 10-week, multisite studies (1 in children and 1 in adults; total n = 248) comparing comprehensive behavioral intervention for tics (CBIT) to psychoeducation and supportive therapy (PST) were combined for moderator analyses. Participants (177 male, 71 female) had a mean age of 21.5 ± 13.9 years (range 9-69). Demographic and clinical characteristics, baseline tic-suppressing medication, and co-occurring psychiatric disorders were tested as potential moderators for CBIT vs PST or predictors of outcome regardless of treatment assignment. Main outcomes measures were the Yale Global Tic Severity Scale Total Tic score and the Clinical Global Impression-Improvement score assessed by masked evaluators. RESULTS The presence of tic medication significantly moderated response to CBIT vs PST (p = 0.01). Participants showed tic reduction after CBIT regardless of tic medication status, but only participants receiving tic medication showed reduction of tics after PST. Co-occurring psychiatric disorders, age, sex, family functioning, tic characteristics, and treatment expectancy did not moderate response. Across both treatments, greater tic severity (p = 0.005) and positive participant expectancy (p = 0.01) predicted greater tic improvement. Anxiety disorders (p = 0.042) and premonitory urge severity (p = 0.005) predicted lower tic reduction. CONCLUSIONS Presence of co-occurring attention-deficit/hyperactivity disorder, obsessive-compulsive disorder, or anxiety disorders did not moderate response to CBIT. Although participants on tic medication showed improvement after CBIT, the difference between CBIT and PST was greater for participants who were not on tic-suppressing medication. CLINICALTRIALSGOV IDENTIFIERS The child and adult CBIT studies are listed on clinical trials.gov (NCT00218777 and NCT00231985, respectively). CLASSIFICATION OF EVIDENCE This study provides Class I evidence that CBIT is effective in reducing tic severity across subgroups of patients with chronic tic disorders, although the difference between treatments was smaller for participants on tic-suppressing medications, suggesting reduced efficacy in this subgroup.
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Affiliation(s)
- Denis G Sukhodolsky
- From Yale University School of Medicine (D.G.S., L.K., J.D.), New Haven, CT; Marquette University (D.W.W.), Milwaukee, WI; University of California at Los Angeles Geffen School of Medicine (J.P.); Massachusetts General Hospital/Harvard Medical School (S.W.), Boston; University of Texas Health Science Center at San Antonio (A.L.P.); Weill Cornell Medical College (J.T.W.), New York, NY; and Marcus Autism Center (L.S.), Emory University School of Medicine, Atlanta, GA.
| | - Douglas W Woods
- From Yale University School of Medicine (D.G.S., L.K., J.D.), New Haven, CT; Marquette University (D.W.W.), Milwaukee, WI; University of California at Los Angeles Geffen School of Medicine (J.P.); Massachusetts General Hospital/Harvard Medical School (S.W.), Boston; University of Texas Health Science Center at San Antonio (A.L.P.); Weill Cornell Medical College (J.T.W.), New York, NY; and Marcus Autism Center (L.S.), Emory University School of Medicine, Atlanta, GA
| | - John Piacentini
- From Yale University School of Medicine (D.G.S., L.K., J.D.), New Haven, CT; Marquette University (D.W.W.), Milwaukee, WI; University of California at Los Angeles Geffen School of Medicine (J.P.); Massachusetts General Hospital/Harvard Medical School (S.W.), Boston; University of Texas Health Science Center at San Antonio (A.L.P.); Weill Cornell Medical College (J.T.W.), New York, NY; and Marcus Autism Center (L.S.), Emory University School of Medicine, Atlanta, GA
| | - Sabine Wilhelm
- From Yale University School of Medicine (D.G.S., L.K., J.D.), New Haven, CT; Marquette University (D.W.W.), Milwaukee, WI; University of California at Los Angeles Geffen School of Medicine (J.P.); Massachusetts General Hospital/Harvard Medical School (S.W.), Boston; University of Texas Health Science Center at San Antonio (A.L.P.); Weill Cornell Medical College (J.T.W.), New York, NY; and Marcus Autism Center (L.S.), Emory University School of Medicine, Atlanta, GA
| | - Alan L Peterson
- From Yale University School of Medicine (D.G.S., L.K., J.D.), New Haven, CT; Marquette University (D.W.W.), Milwaukee, WI; University of California at Los Angeles Geffen School of Medicine (J.P.); Massachusetts General Hospital/Harvard Medical School (S.W.), Boston; University of Texas Health Science Center at San Antonio (A.L.P.); Weill Cornell Medical College (J.T.W.), New York, NY; and Marcus Autism Center (L.S.), Emory University School of Medicine, Atlanta, GA
| | - Lily Katsovich
- From Yale University School of Medicine (D.G.S., L.K., J.D.), New Haven, CT; Marquette University (D.W.W.), Milwaukee, WI; University of California at Los Angeles Geffen School of Medicine (J.P.); Massachusetts General Hospital/Harvard Medical School (S.W.), Boston; University of Texas Health Science Center at San Antonio (A.L.P.); Weill Cornell Medical College (J.T.W.), New York, NY; and Marcus Autism Center (L.S.), Emory University School of Medicine, Atlanta, GA
| | - James Dziura
- From Yale University School of Medicine (D.G.S., L.K., J.D.), New Haven, CT; Marquette University (D.W.W.), Milwaukee, WI; University of California at Los Angeles Geffen School of Medicine (J.P.); Massachusetts General Hospital/Harvard Medical School (S.W.), Boston; University of Texas Health Science Center at San Antonio (A.L.P.); Weill Cornell Medical College (J.T.W.), New York, NY; and Marcus Autism Center (L.S.), Emory University School of Medicine, Atlanta, GA
| | - John T Walkup
- From Yale University School of Medicine (D.G.S., L.K., J.D.), New Haven, CT; Marquette University (D.W.W.), Milwaukee, WI; University of California at Los Angeles Geffen School of Medicine (J.P.); Massachusetts General Hospital/Harvard Medical School (S.W.), Boston; University of Texas Health Science Center at San Antonio (A.L.P.); Weill Cornell Medical College (J.T.W.), New York, NY; and Marcus Autism Center (L.S.), Emory University School of Medicine, Atlanta, GA
| | - Lawrence Scahill
- From Yale University School of Medicine (D.G.S., L.K., J.D.), New Haven, CT; Marquette University (D.W.W.), Milwaukee, WI; University of California at Los Angeles Geffen School of Medicine (J.P.); Massachusetts General Hospital/Harvard Medical School (S.W.), Boston; University of Texas Health Science Center at San Antonio (A.L.P.); Weill Cornell Medical College (J.T.W.), New York, NY; and Marcus Autism Center (L.S.), Emory University School of Medicine, Atlanta, GA
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Kessler RC, van Loo HM, Wardenaar KJ, Bossarte RM, Brenner LA, Ebert DD, de Jonge P, Nierenberg AA, Rosellini AJ, Sampson NA, Schoevers RA, Wilcox MA, Zaslavsky AM. Using patient self-reports to study heterogeneity of treatment effects in major depressive disorder. Epidemiol Psychiatr Sci 2017; 26:22-36. [PMID: 26810628 DOI: 10.1017/S2045796016000020] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
BACKGROUNDS Clinicians need guidance to address the heterogeneity of treatment responses of patients with major depressive disorder (MDD). While prediction schemes based on symptom clustering and biomarkers have so far not yielded results of sufficient strength to inform clinical decision-making, prediction schemes based on big data predictive analytic models might be more practically useful. METHOD We review evidence suggesting that prediction equations based on symptoms and other easily-assessed clinical features found in previous research to predict MDD treatment outcomes might provide a foundation for developing predictive analytic clinical decision support models that could help clinicians select optimal (personalised) MDD treatments. These methods could also be useful in targeting patient subsamples for more expensive biomarker assessments. RESULTS Approximately two dozen baseline variables obtained from medical records or patient reports have been found repeatedly in MDD treatment trials to predict overall treatment outcomes (i.e., intervention v. control) or differential treatment outcomes (i.e., intervention A v. intervention B). Similar evidence has been found in observational studies of MDD persistence-severity. However, no treatment studies have yet attempted to develop treatment outcome equations using the full set of these predictors. Promising preliminary empirical results coupled with recent developments in statistical methodology suggest that models could be developed to provide useful clinical decision support in personalised treatment selection. These tools could also provide a strong foundation to increase statistical power in focused studies of biomarkers and MDD heterogeneity of treatment response in subsequent controlled trials. CONCLUSIONS Coordinated efforts are needed to develop a protocol for systematically collecting information about established predictors of heterogeneity of MDD treatment response in large observational treatment studies, applying and refining these models in subsequent pragmatic trials, carrying out pooled secondary analyses to extract the maximum amount of information from these coordinated studies, and using this information to focus future discovery efforts in the segment of the patient population in which continued uncertainty about treatment response exists.
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Cristea IA, Gentili C, Pietrini P, Cuijpers P. Sponsorship bias in the comparative efficacy of psychotherapy and pharmacotherapy for adult depression: meta-analysis. Br J Psychiatry 2017; 210:16-23. [PMID: 27810891 DOI: 10.1192/bjp.bp.115.179275] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 03/06/2016] [Accepted: 06/25/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND Sponsorship bias has never been investigated for non-pharmacological treatments like psychotherapy. AIMS We examined industry funding and author financial conflict of interest (COI) in randomised controlled trials directly comparing psychotherapy and pharmacotherapy in depression. METHOD We conducted a meta-analysis with subgroup comparisons for industry v. non-industry-funded trials, and respectively for trial reports with author financial COI v. those without. RESULTS In total, 45 studies were included. In most analyses, pharmacotherapy consistently showed significant effectiveness over psychotherapy, g = -0.11 (95% CI -0.21 to -0.02) in industry-funded trials. Differences between industry and non-industry-funded trials were significant, a result only partly confirmed in sensitivity analyses. We identified five instances where authors of the original article had not reported financial COI. CONCLUSIONS Industry-funded trials for depression appear to subtly favour pharmacotherapy over psychotherapy. Disclosure of all financial ties with the pharmaceutical industry should be encouraged.
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Affiliation(s)
- Ioana A Cristea
- Ioana A. Cristea, Department of Clinical Psychology and Psychotherapy, Babes Bolyai University, Cluj-Napoca, Romania, and Department of General Psychology, University of Padova, Padova, Italy; Claudio Gentili, Department of General Psychology, University of Padova, Padova, Italy, Pietro Pietrini, IMT Institute for Advanced Studies, Lucca, Italy; Pim Cuijpers, Department of Clinical Psychology, VU University and EMGO Institute for Health and Care Research, Amsterdam, The Netherlands
| | - Claudio Gentili
- Ioana A. Cristea, Department of Clinical Psychology and Psychotherapy, Babes Bolyai University, Cluj-Napoca, Romania, and Department of General Psychology, University of Padova, Padova, Italy; Claudio Gentili, Department of General Psychology, University of Padova, Padova, Italy, Pietro Pietrini, IMT Institute for Advanced Studies, Lucca, Italy; Pim Cuijpers, Department of Clinical Psychology, VU University and EMGO Institute for Health and Care Research, Amsterdam, The Netherlands
| | - Pietro Pietrini
- Ioana A. Cristea, Department of Clinical Psychology and Psychotherapy, Babes Bolyai University, Cluj-Napoca, Romania, and Department of General Psychology, University of Padova, Padova, Italy; Claudio Gentili, Department of General Psychology, University of Padova, Padova, Italy, Pietro Pietrini, IMT Institute for Advanced Studies, Lucca, Italy; Pim Cuijpers, Department of Clinical Psychology, VU University and EMGO Institute for Health and Care Research, Amsterdam, The Netherlands
| | - Pim Cuijpers
- Ioana A. Cristea, Department of Clinical Psychology and Psychotherapy, Babes Bolyai University, Cluj-Napoca, Romania, and Department of General Psychology, University of Padova, Padova, Italy; Claudio Gentili, Department of General Psychology, University of Padova, Padova, Italy, Pietro Pietrini, IMT Institute for Advanced Studies, Lucca, Italy; Pim Cuijpers, Department of Clinical Psychology, VU University and EMGO Institute for Health and Care Research, Amsterdam, The Netherlands
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Peeters FPML, Ruhe HG, Wichers M, Abidi L, Kaub K, van der Lande HJ, Spijker J, Huibers MJH, Schene AH. The Dutch Measure for quantification of Treatment Resistance in Depression (DM-TRD): an extension of the Maudsley Staging Method. J Affect Disord 2016; 205:365-371. [PMID: 27568174 DOI: 10.1016/j.jad.2016.08.019] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Revised: 06/30/2016] [Accepted: 08/14/2016] [Indexed: 12/28/2022]
Abstract
BACKGROUND Treatment resistant depression (TRD) is common in daily practice. An empirical, widely accepted and applicable measure to quantify TRD is lacking. Previously, the Maudsley Staging Method (MSM) showed good validity. We aimed to improve the MSM by refining and extending its items resulting in the Dutch Measure for quantification of TRD (DM-TRD). METHODS In addition to duration, severity and failed treatments in the current depressive episode, we added items for functional impairment, comorbid anxiety, personality disorders and psychosocial stressors. We extended the augmentation section and added items for failed psychotherapy and intensified treatment. We examined psychometric properties of the DM-TRD and tested prediction of future depressive symptoms and remission after 16 weeks in 274 (DSM-IV) depressed in- and outpatients entering naturalistic treatment. RESULTS The DM-TRD showed excellent inter-/intra-rater reliability. Higher scores were associated with more symptoms and less remission during follow-up. The DM-TRD outperformed the MSM in prediction of future depressive symptomatology. Remission was predicted equally well by both measures. Longer duration of the current episode, larger functional impairment and larger baseline symptom severity were the strongest predictors of symptomatology at follow-up. Longer duration and larger functional impairment were negatively associated with remission. LIMITATIONS Longer follow-up could have increased predictive power. Addition of items for somatic co-morbidity, childhood adversity and psychotic features must be investigated further. CONCLUSION The DM-TRD has excellent psychometric properties and better predictive validity for clinical outcome than other sophisticated measure published to date. Its use in clinical practice and research will improve treatment planning in TRD-patients.
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Affiliation(s)
- Frenk P M L Peeters
- Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine and Life Sciences, Maastricht University, the Netherlands
| | - Henricus G Ruhe
- Program for Mood Disorders, Department of Psychiatry, Academisch Medisch Centrum, University of Amsterdam, the Netherlands; University of Groningen, University Medical Center Groningen, Mood and Anxiety Disorders, Department of Psychiatry, Groningen, the Netherlands
| | - Marieke Wichers
- University of Groningen, University Medical Center Groningen, Interdisciplinary Center for the Pathophysiology and Emotion regulation, Department of Psychiatry, Groningen, the Netherlands
| | - Latifa Abidi
- Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine and Life Sciences, Maastricht University, the Netherlands
| | - Karin Kaub
- Program for Mood Disorders, Department of Psychiatry, Academisch Medisch Centrum, University of Amsterdam, the Netherlands
| | - H Josephine van der Lande
- Program for Mood Disorders, Department of Psychiatry, Academisch Medisch Centrum, University of Amsterdam, the Netherlands
| | - Jan Spijker
- ProPersona Mental Healthcare, Nijmegen, the Netherlands
| | - Marcus J H Huibers
- Department of Clinical Psychology, Faculty of Psychology and Education VU University Amsterdam, the Netherlands
| | - Aart H Schene
- Program for Mood Disorders, Department of Psychiatry, Academisch Medisch Centrum, University of Amsterdam, the Netherlands; Department of Psychiatry, Radboud University Medical Center, Nijmegen, the Netherlands; Donders Institute, Radboud University, Nijmegen, the Netherlands
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Wallace ML, Simsek B, Kupfer DJ, Swartz HA, Fagiolini A, Frank E. An approach to revealing clinically relevant subgroups across the mood spectrum. J Affect Disord 2016; 203:265-274. [PMID: 27314813 PMCID: PMC5066164 DOI: 10.1016/j.jad.2016.06.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 05/20/2016] [Accepted: 06/05/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Individuals diagnosed with bipolar 1 disorder (BP1), bipolar 2 disorder (BP2), or major depressive disorder (MDD) experience varying levels of depressive and (hypo)manic symptoms. Clarifying symptom heterogeneity is meaningful, as even subthreshold symptoms may impact quality of life and treatment outcome. The MOODS Lifetime self-report instrument was designed to capture the full range of depressive and (hypo)manic characteristics. METHODS This study applied clustering methods to 347 currently depressed adults with MDD, BP2, or BP1 to reveal naturally occurring MOODS subgroups. Subgroups were then compared on baseline clinical and demographic characteristics and as well as depressive and (hypo)manic symptoms over twenty weeks of treatment. RESULTS Four subgroups were identified: (1) high depressive and (hypo)manic symptoms (N=77, 22%), (2) moderate depressive and (hypo)manic symptoms (N=115, 33%), (3) low depressive and moderate (hypo)manic symptoms (N=82, 24%), and (4) low depressive and (hypo)manic symptoms (N=73, 21%). Individuals in the low depressive/moderate (hypo)manic subgroup had poorer quality of life and greater depressive symptoms over the course of treatment. Individuals in the high and moderate severity subgroups had greater substance use, longer duration of illness, and greater (hypo)manic symptoms throughout treatment. Treatment outcomes were primarily driven by individuals diagnosed with MDD. LIMITATIONS The sample was drawn from three randomized clinical trials. Validation is required for this exploratory study. CONCLUSIONS After validation, these subgroups may inform classification and personalized treatment beyond categorical diagnosis.
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Affiliation(s)
- Meredith L. Wallace
- Department of Psychiatry, University of Pittsburgh, Pittsburgh PA,Department of Statistics, University of Pittsburgh, Pittsburgh PA
| | - Burcin Simsek
- Department of Statistics, University of Pittsburgh, Pittsburgh PA
| | - David J. Kupfer
- Department of Psychiatry, University of Pittsburgh, Pittsburgh PA
| | - Holly A. Swartz
- Department of Psychiatry, University of Pittsburgh, Pittsburgh PA
| | | | - Ellen Frank
- Department of Psychiatry, University of Pittsburgh, Pittsburgh PA
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Ulbricht CM, Dumenci L, Rothschild AJ, Lapane KL. Changes in depression subtypes for women during treatment with citalopram: a latent transition analysis. Arch Womens Ment Health 2016; 19:769-78. [PMID: 26802021 DOI: 10.1007/s00737-016-0606-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 01/09/2016] [Indexed: 11/24/2022]
Abstract
UNLABELLED The aim of this study was to characterize latent subtypes of major depression and changes in these subtypes among women receiving citalopram in the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial. Latent transition analysis was applied to data from 755 women who completed baseline and week 12 study visits in level 1 of STAR*D. Items from the self-report version of the Quick Inventory of Depressive Symptomatology were used as indicators of latent depression subtype. Four subtypes were identified at baseline and week 12. The baseline subtypes were Mild (21 %), Moderate (30 %), Severe with Increased Appetite (16 %), and Severe with Decreased Appetite (34 %). The subtypes at week 12 were Symptom Resolution (65 %), Mild (23 %), Moderate (9 %), and Severe with Psychomotor Disturbances (3 %). Women in the Moderate subtype at baseline had the greatest chance of moving to Symptom Resolution (87 %). Women in the Severe with Decreased Appetite subtype had the lowest chance of transitioning to Symptom Resolution (46 %). Depression severity and appetite distinguished depression subtypes for women before treatment with citalopram. Depression severity and psychomotor disturbances characterized the subtypes after treatment. This work highlights the need to consider how depression treatment changes different symptoms instead of relying exclusively on summary rating scores. CLINICAL TRIAL REGISTRATION www.clinicaltrials.gov , NCT00021528.
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Affiliation(s)
- Christine M Ulbricht
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA.
| | - Levent Dumenci
- Department of Epidemiology and Biostatistics, Temple University College of Public Health, Philadelphia, PA, USA
| | - Anthony J Rothschild
- Department of Psychiatry, University of Massachusetts Medical School and UMassMemorial HealthCare, Worcester, MA, USA
| | - Kate L Lapane
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA
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Duan-Porter W, Goldstein KM, McDuffie JR, Hughes JM, Clowse MEB, Klap RS, Masilamani V, Allen LaPointe NM, Nagi A, Gierisch JM, Williams JW. Reporting of Sex Effects by Systematic Reviews on Interventions for Depression, Diabetes, and Chronic Pain. Ann Intern Med 2016; 165:184-93. [PMID: 27111355 PMCID: PMC6611166 DOI: 10.7326/m15-2877] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Systematic reviews (SRs) have the potential to contribute uniquely to the evaluation of sex and gender differences (termed "sex effects"). This article describes the reporting of sex effects by SRs on interventions for depression, type 2 diabetes mellitus, and chronic pain conditions (chronic low back pain, knee osteoarthritis, and fibromyalgia). It includes SRs published since 1 October 2009 that evaluate medications, behavioral interventions, exercise, quality improvement, and some condition-specific treatments. The reporting of sex effects by primary randomized, controlled trials is also examined. Of 313 eligible SRs (86 for depression, 159 for type 2 diabetes mellitus, and 68 for chronic pain), few (n = 29) reported sex effects. Most SRs reporting sex effects used metaregression, whereas 9 SRs used subgroup analysis or individual-patient data meta-analysis. The proportion of SRs reporting the sex distribution of primary studies varied from a low of 31% (n = 8) for low back pain to a high of 68% (n = 23) for fibromyalgia. Primary randomized, controlled trials also infrequently reported sex effects, and most lacked an adequate sample size to examine them. Therefore, all SRs should report the proportion of women enrolled in primary studies and evaluate sex effects using appropriate methods whenever power is adequate.
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Trivedi MH, McGrath PJ, Fava M, Parsey RV, Kurian BT, Phillips ML, Oquendo MA, Bruder G, Pizzagalli D, Toups M, Cooper C, Adams P, Weyandt S, Morris DW, Grannemann BD, Ogden RT, Buckner R, McInnis M, Kraemer HC, Petkova E, Carmody TJ, Weissman MM. Establishing moderators and biosignatures of antidepressant response in clinical care (EMBARC): Rationale and design. J Psychiatr Res 2016; 78:11-23. [PMID: 27038550 PMCID: PMC6100771 DOI: 10.1016/j.jpsychires.2016.03.001] [Citation(s) in RCA: 180] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 03/02/2016] [Accepted: 03/03/2016] [Indexed: 12/28/2022]
Abstract
UNLABELLED Remission rates for Major Depressive Disorder (MDD) are low and unpredictable for any given antidepressant. No biological or clinical marker has demonstrated sufficient ability to match individuals to efficacious treatment. Biosignatures developed from the systematic exploration of multiple biological markers, which optimize treatment selection for individuals (moderators) and provide early indication of ultimate treatment response (mediators) are needed. The rationale and design of a multi-site, placebo-controlled randomized clinical trial of sertraline examining moderators and mediators of treatment response is described. The target sample is 300 participants with early onset (≤30 years) recurrent MDD. Non-responders to an 8-week trial are switched double blind to either bupropion (for sertraline non-responders) or sertraline (for placebo non-responders) for an additional 8 weeks. Clinical moderators include anxious depression, early trauma, gender, melancholic and atypical depression, anger attacks, Axis II disorder, hypersomnia/fatigue, and chronicity of depression. Biological moderator and mediators include cerebral cortical thickness, task-based fMRI (reward and emotion conflict), resting connectivity, diffusion tensor imaging (DTI), arterial spin labeling (ASL), electroencephalograpy (EEG), cortical evoked potentials, and behavioral/cognitive tasks evaluated at baseline and week 1, except DTI, assessed only at baseline. The study is designed to standardize assessment of biomarkers across multiple sites as well as institute replicable quality control methods, and to use advanced data analytic methods to integrate these markers. A Differential Depression Treatment Response Index (DTRI) will be developed. The data, including biological samples (DNA, RNA, and plasma collected before and during treatment), will become available in a public scientific repository. CLINICAL TRIAL REGISTRATION Establishing Moderators and Biosignatures of Antidepressant Response for Clinical Care for Depression (EMBARC). Identifier: NCT01407094. URL: http://clinicaltrials.gov/show/NCT01407094.
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Affiliation(s)
| | - Patrick J McGrath
- New York State Psychiatric Institute & Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY, USA
| | | | | | - Benji T Kurian
- University of Texas, Southwestern Medical Center, Dallas, TX, USA
| | | | - Maria A Oquendo
- New York State Psychiatric Institute & Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY, USA
| | - Gerard Bruder
- New York State Psychiatric Institute & Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY, USA
| | | | - Marisa Toups
- University of Texas, Southwestern Medical Center, Dallas, TX, USA
| | - Crystal Cooper
- University of Texas, Southwestern Medical Center, Dallas, TX, USA
| | - Phil Adams
- New York State Psychiatric Institute & Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY, USA
| | - Sarah Weyandt
- University of Texas, Southwestern Medical Center, Dallas, TX, USA
| | - David W Morris
- University of Texas, Southwestern Medical Center, Dallas, TX, USA
| | | | | | | | | | | | | | - Thomas J Carmody
- University of Texas, Southwestern Medical Center, Dallas, TX, USA
| | - Myrna M Weissman
- New York State Psychiatric Institute & Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY, USA
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Furukawa TA, Schramm E, Weitz ES, Salanti G, Efthimiou O, Michalak J, Watanabe N, Cipriani A, Keller MB, Kocsis JH, Klein DN, Cuijpers P. Cognitive-Behavioural Analysis System of Psychotherapy (CBASP), a drug, or their combination: differential therapeutics for persistent depressive disorder: a study protocol of an individual participant data network meta-analysis. BMJ Open 2016; 6:e011769. [PMID: 27147393 PMCID: PMC4861112 DOI: 10.1136/bmjopen-2016-011769] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION Despite important advances in psychological and pharmacological treatments of persistent depressive disorders in the past decades, their responses remain typically slow and poor, and differential responses among different modalities of treatments or their combinations are not well understood. Cognitive-Behavioural Analysis System of Psychotherapy (CBASP) is the only psychotherapy that has been specifically designed for chronic depression and has been examined in an increasing number of trials against medications, alone or in combination. When several treatment alternatives are available for a certain condition, network meta-analysis (NMA) provides a powerful tool to examine their relative efficacy by combining all direct and indirect comparisons. Individual participant data (IPD) meta-analysis enables exploration of impacts of individual characteristics that lead to a differentiated approach matching treatments to specific subgroups of patients. METHODS AND ANALYSIS We will search for all randomised controlled trials that compared CBASP, pharmacotherapy or their combination, in the treatment of patients with persistent depressive disorder, in Cochrane CENTRAL, PUBMED, SCOPUS and PsycINFO, supplemented by personal contacts. Individual participant data will be sought from the principal investigators of all the identified trials. Our primary outcomes are depression severity as measured on a continuous observer-rated scale for depression, and dropouts for any reason as a proxy measure of overall treatment acceptability. We will conduct a one-step IPD-NMA to compare CBASP, medications and their combinations, and also carry out a meta-regression to identify their prognostic factors and effect moderators. The model will be fitted in OpenBUGS, using vague priors for all location parameters. For the heterogeneity we will use a half-normal prior on the SD. ETHICS AND DISSEMINATION This study requires no ethical approval. We will publish the findings in a peer-reviewed journal. The study results will contribute to more finely differentiated therapeutics for patients suffering from this chronically disabling disorder. TRIAL REGISTRATION NUMBER CRD42016035886.
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Affiliation(s)
- Toshi A Furukawa
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - Elisabeth Schramm
- Department of Psychiatry and Psychotherapy, University Medical Center Freiburg, Freiburg, Germany
| | - Erica S Weitz
- Department of Clinical, Neuro and Developmental Psychology, EMGO Institute for Health and Care Research, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Georgia Salanti
- Institute of Social and Preventive Medicine (ISPM) & Bern Institute of Primary Care (BIHAM), University of Bern, Bern, Switzerland
| | - Orestis Efthimiou
- Institute of Social and Preventive Medicine (ISPM) & Bern Institute of Primary Care (BIHAM), University of Bern, Bern, Switzerland
| | - Johannes Michalak
- Department of Psychology and Psychotherapy, Witten/Herdecke University, Witten, Germany
| | - Norio Watanabe
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | | | - Martin B Keller
- Department of Psychiatry and Human Behavior, Brown University, Providence, Rhode Island, USA
| | - James H Kocsis
- Department of Psychiatry, Weill Cornell Medical College, New York, New York, USA
| | - Daniel N Klein
- Department of Psychology, Stony Brook University, Stony Brook, New York, USA
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, EMGO Institute for Health and Care Research, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Abstract
A sizable proportion of psychiatric patients will seek clinical evaluation and treatment for anxiety symptoms reportedly refractory to treatment. This apparent lack of response is either due to “pseudo-resistance” (a failure to have received and adhered to a recognized and effective treatment or treatments for their condition) or to true “treatment resistance.” Pseudo-resistance can be due to clinician errors in selecting and delivering an appropriate treatment effectively, or to patient nonadherence to a course of treatment. True treatment resistance can be due to unrecognized exogenous anxiogenic factors (eg, caffeine overuse, sleep deprivation, use of alcohol or marijuana) or an incorrect diagnosis (eg, atypical bipolar illness, occult substance abuse, attention deficit-hyperactivity disorder). Once the above factors are eliminated, treatment should focus on combining effective medications and cognitive behavioral therapy, combining several medications (augmentation), or employing novel medications or psychotherapies not typically indicated as first-line evidence-based anxiety treatments.
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Affiliation(s)
- Peter Roy-Byrne
- Professor of Psychiatry, University of Washington School of Medicine, Harborview Medical Center, Seattle, Washington, USA; Founding Partner, Psychiatric Medicine Associates, Seattle, Wash-ington, USA
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Delgadillo J, Moreea O, Lutz W. Different people respond differently to therapy: A demonstration using patient profiling and risk stratification. Behav Res Ther 2016; 79:15-22. [DOI: 10.1016/j.brat.2016.02.003] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 12/24/2015] [Accepted: 02/18/2016] [Indexed: 10/22/2022]
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Abstract
The burden of depression in men is high. Current diagnostic criteria may not fully capture men's experience with depression. Descriptions of the heterogeneity in depression among men are lacking. The purpose of the study was to characterize latent subtypes of major depression and changes in these subtypes among men receiving citalopram in Level 1 of the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial. Latent transition analysis was applied to data from 387 men who completed baseline and Week 12 study visits in Level 1 of STAR*D. Items from the self-report version of the Quick Inventory of Depressive Symptomatology were used as indicators of latent depression subtypes. Four statuses were identified at baseline and Week 12. Baseline statuses were Mild (10% of men), Moderate (53%), Severe with Psychomotor Slowing (20%), and Severe with Psychomotor Agitation (17%). At Week 12, the statuses were Symptom Resolution (41%), Mild (36%), Moderate (18%), and Severe with Psychomotor Slowing (5%). Men in the Mild status were most likely to transition to Symptom Resolution (probability = 69%). Men in the Severe with Agitation status were least likely to transition to Symptom Resolution (probability = 0%). This work highlights the need to not focus solely on summary rating scores but to also consider patterns of symptoms when treating depression.
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Affiliation(s)
| | - Levent Dumenci
- 2 Temple University College of Public Health, Philadelphia, PA, USA
| | - Anthony J Rothschild
- 1 University of Massachusetts Medical School, Worcester, MA, USA.,3 UMassMemorial HealthCare, Worcester, MA, USA
| | - Kate L Lapane
- 1 University of Massachusetts Medical School, Worcester, MA, USA
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Driessen E, Hollon SD, Bockting CLH, Cuijpers P, Turner EH. Does Publication Bias Inflate the Apparent Efficacy of Psychological Treatment for Major Depressive Disorder? A Systematic Review and Meta-Analysis of US National Institutes of Health-Funded Trials. PLoS One 2015; 10:e0137864. [PMID: 26422604 PMCID: PMC4589340 DOI: 10.1371/journal.pone.0137864] [Citation(s) in RCA: 121] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 08/22/2015] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The efficacy of antidepressant medication has been shown empirically to be overestimated due to publication bias, but this has only been inferred statistically with regard to psychological treatment for depression. We assessed directly the extent of study publication bias in trials examining the efficacy of psychological treatment for depression. METHODS AND FINDINGS We identified US National Institutes of Health grants awarded to fund randomized clinical trials comparing psychological treatment to control conditions or other treatments in patients diagnosed with major depressive disorder for the period 1972-2008, and we determined whether those grants led to publications. For studies that were not published, data were requested from investigators and included in the meta-analyses. Thirteen (23.6%) of the 55 funded grants that began trials did not result in publications, and two others never started. Among comparisons to control conditions, adding unpublished studies (Hedges' g = 0.20; CI95% -0.11~0.51; k = 6) to published studies (g = 0.52; 0.37~0.68; k = 20) reduced the psychotherapy effect size point estimate (g = 0.39; 0.08~0.70) by 25%. Moreover, these findings may overestimate the "true" effect of psychological treatment for depression as outcome reporting bias could not be examined quantitatively. CONCLUSION The efficacy of psychological interventions for depression has been overestimated in the published literature, just as it has been for pharmacotherapy. Both are efficacious but not to the extent that the published literature would suggest. Funding agencies and journals should archive both original protocols and raw data from treatment trials to allow the detection and correction of outcome reporting bias. Clinicians, guidelines developers, and decision makers should be aware that the published literature overestimates the effects of the predominant treatments for depression.
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Affiliation(s)
- Ellen Driessen
- Department of Clinical, Neuro and Developmental Psychology, Faculty of Behavioural and Movement Sciences, VU University Amsterdam, Amsterdam, The Netherlands
- EMGO Institute for Health and Care Research, VU University and VU University Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Steven D. Hollon
- Department of Psychology, Vanderbilt University, Nashville, Tennessee, United States of America
| | - Claudi L. H. Bockting
- Department of Clinical Psychology, University of Groningen, Groningen, The Netherlands
- Department of Clinical and Health Psychology, Utrecht University, Utrecht, The Netherlands
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Faculty of Behavioural and Movement Sciences, VU University Amsterdam, Amsterdam, The Netherlands
- EMGO Institute for Health and Care Research, VU University and VU University Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Erick H. Turner
- Behavioral Health and Neurosciences Division, VA Portland Health Care System, Portland, Oregon, United States of America
- Departments of Psychiatry and Pharmacology, Oregon Health & Science University, Portland, Oregon, United States of America
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Carter JD, Crowe MT, Jordan J, McIntosh VVW, Frampton C, Joyce PR. Predictors of response to CBT and IPT for depression; the contribution of therapy process. Behav Res Ther 2015; 74:72-9. [PMID: 26432173 DOI: 10.1016/j.brat.2015.09.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Revised: 09/12/2015] [Accepted: 09/15/2015] [Indexed: 11/12/2022]
Abstract
Little is known about the factors that contribute to a positive psychotherapy outcome. There is still considerable debate as to whether specific factors (e.g. severity of symptoms, comorbidity) or nonspecific factors (e.g. alliance, therapy process) are most important in influencing outcome. This study examined the additional contribution that therapeutic process and alliance made to previously identified specific predictors of response to CBT and IPT for depression over the course of therapy. The previously identified specific factors were belief that childhood reasons caused the depression, recurrent depression, perceptions about how logical therapy was and comorbid personality disorder symptoms. One hundred and sixty five adult outpatients with major depression were treated for depression in a randomised clinical trial examining predictors of response to Cognitive Behavior Therapy and Interpersonal Psychotherapy. All therapy sessions were audiorecorded to enable objective ratings of therapeutic process and alliance. Process factors - patient psychic distress, patient participation and patient alliance had the strongest associations with outcome. The early and middle stage of therapy process did not account for any additional variance other than that previously identified by the patient predictors, however, at the end stage of therapy process contributed a further 14%.
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Affiliation(s)
- Janet D Carter
- Department of Psychology, University of Canterbury, Private Bag 4800, Christchurch, New Zealand.
| | - Marie T Crowe
- Department of Psychological Medicine, University of Otago, PO Box 4345, Christchurch, New Zealand.
| | - Jennifer Jordan
- Department of Psychological Medicine, University of Otago, PO Box 4345, Christchurch, New Zealand.
| | - Virginia V W McIntosh
- Department of Psychological Medicine, University of Otago, PO Box 4345, Christchurch, New Zealand.
| | - Christopher Frampton
- Department of Psychological Medicine, University of Otago, PO Box 4345, Christchurch, New Zealand.
| | - Peter R Joyce
- Department of Psychological Medicine, University of Otago, PO Box 4345, Christchurch, New Zealand.
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