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Dormegny-Jeanjean LC, de Billy C, Mainberger O, Weibel S, Schorr B, Obrecht A, Landré L, Berna F, Causin JB, Blanc F, Danila V, Tomsa M, Pfleger G, Meyer C, Humbert I, Javelot H, Meyer G, Bertschy G, Foucher JR. Potential efficacy of dopaminergic antidepressants in treatment resistant anergic-anhedonic depression results of the chronic anergic-anhedonic depression open trial - CADOT. Front Psychiatry 2023; 14:1194090. [PMID: 37829759 PMCID: PMC10565009 DOI: 10.3389/fpsyt.2023.1194090] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 08/02/2023] [Indexed: 10/14/2023] Open
Abstract
Introduction Among treatment-resistant depression (TRD), we identified anergic-anhedonic clinical presentations (TRAD) as putatively responsive to pro-dopaminergic strategies. Based on the literature, non-selective monoamine oxidase inhibitors (MAOI) and dopamine D2 receptor agonists (D2RAG) were sequentially introduced, frequently under the coverage of a mood stabilizer. This two-step therapeutic strategy will be referred to as the Dopaminergic Antidepressant Therapy Algorithm (DATA). We describe the short and long-term outcomes of TRAD managed according to DATA guidelines. Method Out of 52 outpatients with TRAD treated with DATA in a single expert center, 48 were included in the analysis [severity - QIDS (Quick Inventory of Depressive Symptomatology) = 16 ± 3; episode duration = 4.1 ± 2.7 years; Thase and Rush resistance stage = 2.9 ± 0.6; functioning - GAF (Global Assessment of Functioning) = 41 ± 8]. These were followed-up for a median (1st - 3rd quartile) of 4 (1-9) months before being prescribed the first dopaminergic treatment and remitters were followed up 21 (11-33) months after remission. Results At the end of DATA step 1, 25 patients were in remission (QIDS <6; 52% [38-66%]). After DATA step 2, 37 patients were in remission (77% [65-89%]) to whom 5 patients with a QIDS score = 6 could be added (88% [78-97%]). Many of these patients felt subjectively remitted (GAF = 74 ± 10). There was a significant benefit to combining MAOI with D2RAG which was maintained for at least 18 months in 30 patients (79% [62-95%]). Conclusion These results support TRAD sensitivity to pro-dopaminergic interventions. However, some clinical heterogeneities remain in our sample and suggest some improvement in the description of dopamine-sensitive form(s).
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Affiliation(s)
- Ludovic Christophe Dormegny-Jeanjean
- Treatment resistant depression expert center of Alsace (CEDRA), Strasbourg-Rouffach-Erstein-Brumath, Rouffach, France
- Non-Invasive neuroModulation Center of Strasbourg (CEMNIS), University Hospital of Strasbourg, Strasbourg, France
- CNRS UMR 7357 iCube, neurophysiology, FMTS, University of Strasbourg, Strasbourg, France
| | - Clément de Billy
- Treatment resistant depression expert center of Alsace (CEDRA), Strasbourg-Rouffach-Erstein-Brumath, Rouffach, France
- Non-Invasive neuroModulation Center of Strasbourg (CEMNIS), University Hospital of Strasbourg, Strasbourg, France
- CNRS UMR 7357 iCube, neurophysiology, FMTS, University of Strasbourg, Strasbourg, France
| | - Olivier Mainberger
- Treatment resistant depression expert center of Alsace (CEDRA), Strasbourg-Rouffach-Erstein-Brumath, Rouffach, France
- Non-Invasive neuroModulation Center of Strasbourg (CEMNIS), University Hospital of Strasbourg, Strasbourg, France
- CNRS UMR 7357 iCube, neurophysiology, FMTS, University of Strasbourg, Strasbourg, France
| | - Sébastien Weibel
- Treatment resistant depression expert center of Alsace (CEDRA), Strasbourg-Rouffach-Erstein-Brumath, Rouffach, France
- Department of Psychiatry and Mental Health – University Hospital of Strasbourg, University of Strasbourg, Strasbourg, France
- INSERM UMR 1114, Physiopathology and Cognitive Psychopathology of Schizophrenia, University of Strasbourg, Strasbourg, France
| | - Benoit Schorr
- Department of Psychiatry and Mental Health – University Hospital of Strasbourg, University of Strasbourg, Strasbourg, France
- INSERM UMR 1114, Physiopathology and Cognitive Psychopathology of Schizophrenia, University of Strasbourg, Strasbourg, France
- Geriatrics Department and Expert Center for Neurocognitive Disorders, University Hospital of Strasbourg, Strasbourg, France
| | - Alexandre Obrecht
- Treatment resistant depression expert center of Alsace (CEDRA), Strasbourg-Rouffach-Erstein-Brumath, Rouffach, France
- Non-Invasive neuroModulation Center of Strasbourg (CEMNIS), University Hospital of Strasbourg, Strasbourg, France
| | - Lionel Landré
- CNRS UMR 7357 iCube, neurophysiology, FMTS, University of Strasbourg, Strasbourg, France
| | - Fabrice Berna
- Department of Psychiatry and Mental Health – University Hospital of Strasbourg, University of Strasbourg, Strasbourg, France
- INSERM UMR 1114, Physiopathology and Cognitive Psychopathology of Schizophrenia, University of Strasbourg, Strasbourg, France
| | - Jean-Baptiste Causin
- Treatment resistant depression expert center of Alsace (CEDRA), Strasbourg-Rouffach-Erstein-Brumath, Rouffach, France
- Department of Psychiatry and Mental Health – University Hospital of Strasbourg, University of Strasbourg, Strasbourg, France
- INSERM UMR 1114, Physiopathology and Cognitive Psychopathology of Schizophrenia, University of Strasbourg, Strasbourg, France
| | - Frederic Blanc
- CNRS UMR 7357 iCube, neurophysiology, FMTS, University of Strasbourg, Strasbourg, France
- Geriatrics Department and Expert Center for Neurocognitive Disorders, University Hospital of Strasbourg, Strasbourg, France
| | - Vlad Danila
- Treatment resistant depression expert center of Alsace (CEDRA), Strasbourg-Rouffach-Erstein-Brumath, Rouffach, France
- Department of Psychiatry “Pole 8/9”, Rouffach Psychiatric Hospital, Rouffach, France
| | - Mihaela Tomsa
- Treatment resistant depression expert center of Alsace (CEDRA), Strasbourg-Rouffach-Erstein-Brumath, Rouffach, France
- Department of Psychiatry “Pole 8/9”, Rouffach Psychiatric Hospital, Rouffach, France
| | - Geraldine Pfleger
- Treatment resistant depression expert center of Alsace (CEDRA), Strasbourg-Rouffach-Erstein-Brumath, Rouffach, France
- Department of Integrated Psychiatric Care, Centre Hospitalier d’Erstein, Erstein, France
| | - Camille Meyer
- Treatment resistant depression expert center of Alsace (CEDRA), Strasbourg-Rouffach-Erstein-Brumath, Rouffach, France
- Non-Invasive neuroModulation Center of Strasbourg (CEMNIS), University Hospital of Strasbourg, Strasbourg, France
- Department of Psychiatry and Mental Health – University Hospital of Strasbourg, University of Strasbourg, Strasbourg, France
| | - Ilia Humbert
- Treatment resistant depression expert center of Alsace (CEDRA), Strasbourg-Rouffach-Erstein-Brumath, Rouffach, France
- Non-Invasive neuroModulation Center of Strasbourg (CEMNIS), University Hospital of Strasbourg, Strasbourg, France
- Department of Psychiatry and Mental Health – University Hospital of Strasbourg, University of Strasbourg, Strasbourg, France
| | - Hervé Javelot
- Treatment resistant depression expert center of Alsace (CEDRA), Strasbourg-Rouffach-Erstein-Brumath, Rouffach, France
- Expert center in Psychopharmacology, Etablissement public de santé Alsace nord (EPSAN), Bischwiller, France
| | - Guillaume Meyer
- Treatment resistant depression expert center of Alsace (CEDRA), Strasbourg-Rouffach-Erstein-Brumath, Rouffach, France
- Department of Psychopharmacology, Centre Hospitalier d’Erstein, Lingolsheim, France
| | - Gilles Bertschy
- Treatment resistant depression expert center of Alsace (CEDRA), Strasbourg-Rouffach-Erstein-Brumath, Rouffach, France
- Department of Psychiatry and Mental Health – University Hospital of Strasbourg, University of Strasbourg, Strasbourg, France
- INSERM UMR 1114, Physiopathology and Cognitive Psychopathology of Schizophrenia, University of Strasbourg, Strasbourg, France
| | - Jack Rene Foucher
- Treatment resistant depression expert center of Alsace (CEDRA), Strasbourg-Rouffach-Erstein-Brumath, Rouffach, France
- Non-Invasive neuroModulation Center of Strasbourg (CEMNIS), University Hospital of Strasbourg, Strasbourg, France
- CNRS UMR 7357 iCube, neurophysiology, FMTS, University of Strasbourg, Strasbourg, France
- Department of Psychiatry and Mental Health – University Hospital of Strasbourg, University of Strasbourg, Strasbourg, France
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