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Dold M, Möller HJ, Volz HP, Seifritz E, Schläfke S, Bartova L, Kasper S. Baseline symptom severity and efficacy of Silexan in patients with anxiety disorders: A symptom-based, patient-level analysis of randomized, placebo-controlled trials. Eur Psychiatry 2024; 67:e23. [PMID: 38425206 DOI: 10.1192/j.eurpsy.2024.16] [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] [Indexed: 03/02/2024] Open
Abstract
The influence of baseline severity on the efficacy of Silexan, a proprietary essential oil from Lavandula angustifolia, in anxiety disorders has not been investigated in a pooled dataset. We report on an individual patient data analysis of all five double-blind, randomized, placebo-controlled trials with Silexan in anxiety disorders. Eligible participants received Silexan 80 mg/d or placebo for 10 weeks. Analyses were based on the Hamilton Anxiety Rating Scale (HAMA), its psychic and somatic anxiety subscores, and the Clinical Global Impressions (CGI) scale. To correlate baseline severity with outcome, patients were segregated into mild, moderate, and severe cases. Altogether 1,172 patients (Silexan, n = 587; placebo, n = 585) were analyzed. For the HAMA total score, we found a significant association between the score at baseline and the treatment effect of Silexan versus placebo at week 10 (p < 0.001). HAMA items from the somatic domain scored lower at baseline and showed less improvement than items from the psychic domain, particularly in patients with mild or moderate baseline symptoms. For CGI item 2 (global improvement), significant efficacy favoring Silexan were observed in mild, moderate, and severe baseline symptom severity. Although significant improvements were found for all subsets, the more severe the initial symptoms, the greater the treatment effects documented by the HAMA. Overall this analysis confirms that Silexan is an effective treatment option in early or mild stages of anxiety disorder. Given its favorable safety profile, Silexan can thus fill a therapeutic gap in the treatment of (subsyndromal) anxiety disorders.
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Affiliation(s)
- Markus Dold
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Hans-Jürgen Möller
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University, Munich, Germany
| | - Hans-Peter Volz
- Hospital for Psychiatry, Psychotherapy and Psychosomatic Medicine Schloss Werneck, Werneck, Germany
| | - Erich Seifritz
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zürich, Switzerland
| | | | - Lucie Bartova
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Siegfried Kasper
- Center for Brain Research, Medical University of Vienna, Vienna, Austria
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Dold M, Bartova L, Volz HP, Seifritz E, Möller HJ, Schläfke S, Kasper S. Efficacy of Silexan in patients with anxiety disorders: a meta-analysis of randomized, placebo-controlled trials. Eur Arch Psychiatry Clin Neurosci 2023; 273:1615-1628. [PMID: 36717399 PMCID: PMC10465640 DOI: 10.1007/s00406-022-01547-w] [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: 07/07/2022] [Accepted: 12/19/2022] [Indexed: 01/31/2023]
Abstract
INTRODUCTION We report on a meta-analysis of Silexan, a proprietary active substance produced from Lavandula angustifolia, in subthreshold anxiety, mixed anxiety and depressive disorder (MADD), and generalized anxiety disorder (GAD). METHODS The present analyses are based on all currently completed 5 double-blind, randomized, placebo-controlled trials investigating Silexan in adult out-patients who received Silexan 1 × 80 mg/day or placebo for ten weeks according to random assignment (n = 1213). Efficacy was assessed based on the Hamilton Anxiety Rating Scale (HAMA), several anxiety self-rating scales, the Clinical Global Impression (CGI) scale, and the Short Form-36 (SF-36) health status questionnaire. RESULTS After ten weeks' treatment, Silexan was significantly superior to placebo in reducing the HAMA total score (including the psychic and somatic anxiety sub-scores) and self-rated anxiety. Based on a ≥ 50% HAMA total score reduction, the responder rate ratio was 1.34 favoring Silexan, and the rate ratio of subjects much or very much improved according to the CGI was 1.51. Silexan was also significantly superior in improving the physical and mental health summary scores of the SF-36. There were no significant between-group differences concerning the occurrence of adverse events (AEs), serious AEs, and premature withdrawal due to AEs. CONCLUSIONS This meta-analysis demonstrates that Silexan exerts significant anxiolytic effects in subthreshold anxiety, GAD and MADD that were consistently reflected in investigator ratings and patient-reported outcomes, including improvement of health-related life-quality, while showing favorable tolerability and safety.
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Affiliation(s)
- Markus Dold
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Lucie Bartova
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Hans-Peter Volz
- Hospital for Psychiatry, Psychotherapy and Psychosomatic Medicine Schloss Werneck, Balthasar-Neumann-Platz 1, 97440, Werneck, Germany
| | - Erich Seifritz
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital of the University of Zurich, Zurich, Switzerland
| | - Hans-Jürgen Möller
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University Munich, Nußbaumstraße 7, 80336, Munich, Germany
| | - Sandra Schläfke
- Dr. Willmar Schwabe GmbH & Co. KG, Willmar-Schwabe-Straße 4, 76227, Karlsruhe, Germany
| | - Siegfried Kasper
- Center of Brain Research, Medical University of Vienna, Spitalgasse 4, 1090, Vienna, Austria.
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Kraus C, Kautzky A, Watzal V, Gramser A, Kadriu B, Deng ZD, Bartova L, Zarate CA, Lanzenberger R, Souery D, Montgomery S, Mendlewicz J, Zohar J, Fanelli G, Serretti A, Kasper S. Body mass index and clinical outcomes in individuals with major depressive disorder: Findings from the GSRD European Multicenter Database. J Affect Disord 2023; 335:349-357. [PMID: 37196934 PMCID: PMC10502963 DOI: 10.1016/j.jad.2023.05.042] [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: 02/10/2023] [Revised: 05/11/2023] [Accepted: 05/14/2023] [Indexed: 05/19/2023]
Abstract
BACKGROUND Individuals with major depressive disorder (MDD) are at higher risk for obesity. In turn, weight gain is a predisposing factor for depression. Although clinical data are sparse, suicide risk also appears to be elevated in obese patients. This study used data from the European Group for the Study of Resistant Depression (GSRD) to investigate clinical outcomes associated with body mass index (BMI) in MDD. METHODS Data were drawn from 892 participants with MDD over the age of 18 years (580 female, 50.5 ± 13.6 years). Response and resistance to antidepressant medication, depression rating scale scores, and further clinical and sociodemographic variables were compared using multiple logistic and linear regressions controlled for age, sex, and risk of weight gain due to psychopharmacotherapy. RESULTS Of the 892 participants, 323 were categorized as treatment-responsive and 569 as treatment-resistant. Within this cohort, 278 (31.1 %) were overweight (BMI = 25-29.9 kg/m2) and 151 (16.9 %) were obese (BMI > 30 kg/m2). Elevated BMI was significantly associated with higher suicidality, longer duration of psychiatric hospitalizations over their lifetimes, earlier age of onset of MDD, and comorbidities. There was a trend-wise association of BMI with treatment resistance. LIMITATIONS Data were analyzed in a retrospective, cross-sectional design. BMI was used as an exclusive measure of overweight and obesity. CONCLUSIONS Participants with comorbid MDD and overweight/obesity were at risk for worse clinical outcomes, suggesting that weight gain should be closely monitored in individuals with MDD in daily clinical practice. Further studies are needed to explore the neurobiological mechanisms linking elevated BMI to impaired brain health.
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Affiliation(s)
- Christoph Kraus
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria; Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA; Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna.
| | - Alexander Kautzky
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria; Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna
| | - Victoria Watzal
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria; Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna
| | - Anna Gramser
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria; Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna
| | - Bashkim Kadriu
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Zhi-De Deng
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Lucie Bartova
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria; Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna
| | - Carlos A Zarate
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Rupert Lanzenberger
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria; Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna
| | - Daniel Souery
- Laboratoire de Psychologie Medicale, Université Libre de Bruxelles and Psy Pluriel at Epsylon Caring for Mental Health Brussels, Brussels, Belgium
| | | | | | - Joseph Zohar
- Department of Psychiatry, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Israel
| | - Giuseppe Fanelli
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Italy; Department of Human Genetics, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, the Netherlands
| | - Alessandro Serretti
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Italy
| | - Siegfried Kasper
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria; Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna; Center for Brain Research, Department of Molecular Neuroscience, Medical University of Vienna, Vienna, Austria
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Hartelius G, Muscat SA, Bartova L. Editorial: Bridging the gap: an interdisciplinary perspective on ketamine in psychiatric disorders. Front Psychiatry 2023; 14:1246891. [PMID: 37645640 PMCID: PMC10461637 DOI: 10.3389/fpsyt.2023.1246891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 07/24/2023] [Indexed: 08/31/2023] Open
Affiliation(s)
| | | | - Lucie Bartova
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
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Bartova L, Lanzenberger R, Rujescu D, Kasper S. Reply to: "The serotonin theory of depression: a systematic umbrella review of the evidence" published by Moncrieff J, Cooper RE, Stockmann T, Amendola S, Hengartner MP, Horowitz MA in Molecular Psychiatry (2022 Jul 20. doi: 10.1038/s41380-022-01661-0). Mol Psychiatry 2023; 28:3153-3154. [PMID: 37322062 DOI: 10.1038/s41380-023-02093-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 01/11/2023] [Accepted: 04/21/2023] [Indexed: 06/17/2023]
Affiliation(s)
- Lucie Bartova
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Rupert Lanzenberger
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Dan Rujescu
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Siegfried Kasper
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria.
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria.
- Center for Brain Research, Medical University of Vienna, Vienna, Austria.
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Preiss M, Rabl U, Popper V, Watzal V, Treiber M, Ivkic D, Praschak-Rieder N, Naderi-Heiden A, Fugger G, Frey R, Rujescu D, Bartova L. Case report: Hyperactive delirium after a single dose of zolpidem administered additionally to psychopharmacotherapy including clozapine. Front Psychiatry 2023; 14:1204009. [PMID: 37575586 PMCID: PMC10413097 DOI: 10.3389/fpsyt.2023.1204009] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 07/05/2023] [Indexed: 08/15/2023] Open
Abstract
The non-benzodiazepine hypnotic zolpidem is frequently administered as a short term psychopharmacotherapy for insomnia. Although it is well-established in a broad clinical routine and often well-tolerated, severe delirium and complex sleep behavior were reported in rare cases. Hereby, it remains unclear whether zolpidem's potential for delirium might be enhanced when combined with further psychopharmacotherapeutics. The present case report portrays a young male Caucasian inpatient with schizoaffective disorder, who was admitted due to severe hyperactive delirium after a single dose of zolpidem 10 mg that was administered in addition to already established psychopharmacotherapy including clozapine 200 mg/day, aripiprazole 15 mg/day and cariprazine 4.5 mg/day. In detail, disorientation, agitation, confabulations, bizarre behavior, and anterograde amnesia occurred shortly after ingestion of zolpidem and gained in intensity within a couple of hours. Once zolpidem was discontinued, the abovementioned symptoms subsided completely and did not reoccur. Since a clear temporal association could be drawn between the intake of zolpidem and the onset of hyperactive delirium, the present clinical experience should serve as a cautionary note for combining potent sedative-hypnotics and substances with anticholinergic properties, even in young adults in a good general condition. Moreover, our case argues for the necessity of further research into the pathomechanism of the interaction potential of non-benzodiazepines as zolpidem, especially with substances exerting anticholinergic properties, which are known for their potential to precipitate delirium. Therefore, the metabolic pathways of the concurrently administered substances should be further taken into account.
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Affiliation(s)
- Maximilian Preiss
- Department of Psychiatry and Psychotherapy, Clinical Division of General Psychiatry, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Ulrich Rabl
- Department of Psychiatry and Psychotherapy, Clinical Division of General Psychiatry, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Valentin Popper
- Department of Psychiatry and Psychotherapy, Clinical Division of General Psychiatry, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Victoria Watzal
- Department of Psychiatry and Psychotherapy, Clinical Division of General Psychiatry, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Michael Treiber
- Department of Psychiatry and Psychotherapy, Clinical Division of General Psychiatry, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Dominik Ivkic
- Department of Psychiatry and Psychotherapy, Clinical Division of General Psychiatry, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Nicole Praschak-Rieder
- Department of Psychiatry and Psychotherapy, Clinical Division of General Psychiatry, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Angela Naderi-Heiden
- Department of Psychiatry and Psychotherapy, Clinical Division of General Psychiatry, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Gernot Fugger
- Department of Psychiatry and Psychotherapy, Clinical Division of General Psychiatry, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Richard Frey
- Department of Psychiatry and Psychotherapy, Clinical Division of General Psychiatry, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Dan Rujescu
- Department of Psychiatry and Psychotherapy, Clinical Division of General Psychiatry, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Lucie Bartova
- Department of Psychiatry and Psychotherapy, Clinical Division of General Psychiatry, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
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7
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Watzal V, Godbersen GM, Weidenauer A, Willeit M, Popper V, Treiber M, Preiss M, Ivkic D, Rabl U, Fugger G, Frey R, Kraus C, Rujescu D, Bartova L. Case report: Interstitial pneumonitis after initiation of lamotrigine. Front Psychiatry 2023; 14:1203497. [PMID: 37465252 PMCID: PMC10351415 DOI: 10.3389/fpsyt.2023.1203497] [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: 04/10/2023] [Accepted: 06/06/2023] [Indexed: 07/20/2023] Open
Abstract
The second-generation anticonvulsant lamotrigine is widely used in the psychiatric field as a mood stabilizer or antidepressant augmentation therapy. Although particularly older anticonvulsants are known for their potential to cause hypersensitivity syndromes, newer antiepileptic drugs do hold a certain risk as well. Presenting a case of a 32-year-old male inpatient of African ethnicity suffering from a primary severe depressive episode in the course of a recurrent major depressive disorder, we report the occurrence of a rapid-onset drug-induced pneumonitis. Herewith, the interstitial pneumonitis occurred after the initiation of 25 mg lamotrigine as an augmentation therapy. Except for the clear temporal correlation between the administration of lamotrigine and the onset of pneumonitis, we did not reveal any further potentially causal diagnostic hints. Importantly, no relevant genetic variations of metabolizing enzymes or drug interactions resulting in lamotrigine overdosage as a potential cause of toxicity were identified. Our experience with a potentially life-threatening adverse drug reaction shortly after the initiation of the largely well-tolerated lamotrigine suggests a potential side effect under the second-generation anticonvulsant although similar adverse events are deemed to be very rare.
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Affiliation(s)
- Victoria Watzal
- Clinical Division of General Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Godber Mathis Godbersen
- Clinical Division of General Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Ana Weidenauer
- Clinical Division of General Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Matthäus Willeit
- Clinical Division of General Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Valentin Popper
- Clinical Division of General Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Michael Treiber
- Clinical Division of General Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Maximilian Preiss
- Clinical Division of General Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Dominik Ivkic
- Clinical Division of General Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Ulrich Rabl
- Clinical Division of General Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Gernot Fugger
- Clinical Division of General Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Richard Frey
- Clinical Division of General Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Christoph Kraus
- Clinical Division of General Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Dan Rujescu
- Clinical Division of General Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Lucie Bartova
- Clinical Division of General Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
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8
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Gallo S, El-Gazzar A, Zhutovsky P, Thomas RM, Javaheripour N, Li M, Bartova L, Bathula D, Dannlowski U, Davey C, Frodl T, Gotlib I, Grimm S, Grotegerd D, Hahn T, Hamilton PJ, Harrison BJ, Jansen A, Kircher T, Meyer B, Nenadić I, Olbrich S, Paul E, Pezawas L, Sacchet MD, Sämann P, Wagner G, Walter H, Walter M, van Wingen G. Functional connectivity signatures of major depressive disorder: machine learning analysis of two multicenter neuroimaging studies. Mol Psychiatry 2023; 28:3013-3022. [PMID: 36792654 PMCID: PMC10615764 DOI: 10.1038/s41380-023-01977-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [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: 10/22/2021] [Revised: 01/12/2023] [Accepted: 01/19/2023] [Indexed: 02/17/2023]
Abstract
The promise of machine learning has fueled the hope for developing diagnostic tools for psychiatry. Initial studies showed high accuracy for the identification of major depressive disorder (MDD) with resting-state connectivity, but progress has been hampered by the absence of large datasets. Here we used regular machine learning and advanced deep learning algorithms to differentiate patients with MDD from healthy controls and identify neurophysiological signatures of depression in two of the largest resting-state datasets for MDD. We obtained resting-state functional magnetic resonance imaging data from the REST-meta-MDD (N = 2338) and PsyMRI (N = 1039) consortia. Classification of functional connectivity matrices was done using support vector machines (SVM) and graph convolutional neural networks (GCN), and performance was evaluated using 5-fold cross-validation. Features were visualized using GCN-Explainer, an ablation study and univariate t-testing. The results showed a mean classification accuracy of 61% for MDD versus controls. Mean accuracy for classifying (non-)medicated subgroups was 62%. Sex classification accuracy was substantially better across datasets (73-81%). Visualization of the results showed that classifications were driven by stronger thalamic connections in both datasets, while nearly all other connections were weaker with small univariate effect sizes. These results suggest that whole brain resting-state connectivity is a reliable though poor biomarker for MDD, presumably due to disease heterogeneity as further supported by the higher accuracy for sex classification using the same methods. Deep learning revealed thalamic hyperconnectivity as a prominent neurophysiological signature of depression in both multicenter studies, which may guide the development of biomarkers in future studies.
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Affiliation(s)
- Selene Gallo
- Amsterdam UMC location University of Amsterdam, Department of Psychiatry, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Ahmed El-Gazzar
- Amsterdam UMC location University of Amsterdam, Department of Psychiatry, Meibergdreef 9, Amsterdam, The Netherlands.
- Amsterdam Neuroscience, Amsterdam, The Netherlands.
| | - Paul Zhutovsky
- Amsterdam UMC location University of Amsterdam, Department of Psychiatry, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Rajat M Thomas
- Amsterdam UMC location University of Amsterdam, Department of Psychiatry, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Nooshin Javaheripour
- Department Of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany
| | - Meng Li
- Department Of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany
| | - Lucie Bartova
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | | | - Udo Dannlowski
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Christopher Davey
- Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia
| | - Thomas Frodl
- Department of Psychiatry and Psychotherapy, Otto von Guericke University Magdeburg, Magdeburg, Germany
- German center for mental health, CIRC, Magdeburg, Germany
| | - Ian Gotlib
- Department of Psychology, Stanford University, Stanford, CA, 94305, USA
| | - Simone Grimm
- Department of Psychiatry, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Dominik Grotegerd
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Tim Hahn
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Paul J Hamilton
- Center for Social and Affective Neuroscience, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Ben J Harrison
- Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia
| | - Andreas Jansen
- Department Of Psychiatry, University of Marburg, Marburg, Germany
| | - Tilo Kircher
- Department Of Psychiatry, University of Marburg, Marburg, Germany
| | - Bernhard Meyer
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Igor Nenadić
- Department Of Psychiatry, University of Marburg, Marburg, Germany
| | - Sebastian Olbrich
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Zurich, Zurich, Switzerland
| | - Elisabeth Paul
- Center for Social and Affective Neuroscience, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Lukas Pezawas
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Matthew D Sacchet
- Center for Depression, Anxiety, and Stress Research, McLean Hospital, Harvard Medical School, Belmont, MA, USA
| | | | - Gerd Wagner
- Department Of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany
| | - Henrik Walter
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Psychiatry and Psychotherapy, Charitéplatz 1, D-10117, Berlin, Germany
| | - Martin Walter
- Department of Psychiatry and Psychotherapy, Otto von Guericke University Magdeburg, Magdeburg, Germany
- German center for mental health, CIRC, Magdeburg, Germany
| | - Guido van Wingen
- Amsterdam UMC location University of Amsterdam, Department of Psychiatry, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Amsterdam, The Netherlands
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Kautzky A, Bartova L, Fugger G, Dold M, Souery D, Montgomery S, Zohar J, Mendlewicz J, Fabbri C, Serretti A, Rujescu D, Kasper S. Age as a moderating factor of treatment resistance in depression. Eur Psychiatry 2023; 66:e35. [PMID: 37078509 DOI: 10.1192/j.eurpsy.2023.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND Treatment-resistant depression (TRD) is an important clinical challenge and may present differently between age groups. METHODS A total of 893 depressed patients recruited within the framework of the European research consortium "Group for the Studies of Resistant Depression" were assessed by generalized linear models regarding age effects (both as numerical and factorial predictors) on treatment outcome, number of lifetime depressive episodes, hospitalization time, and duration of the current episode. Effects of age as numerical predictor on the severity of common depressive symptoms, measured with Montgomery-Åsberg Depression Rating Scale (MADRS) for two-time points, were assessed by linear mixed models, respectively, for patients showing TRD and treatment response. A corrected p threshold of 0.001 was applied. RESULTS Overall symptom load reflected by MADRS (p < 0.0001) and lifetime hospitalization time (p < 0.0001) increased with age in TRD patients but not treatment responders. In TRD, higher age was predicting symptom severity of inner tension, reduced appetite, concentrations difficulties, and lassitude (all p ≤ 0.001). Regarding clinical significance, older TRD patients were more likely to report severe symptoms (item score > 4) for these items both before and after treatment (all p ≤ 0.001). CONCLUSIONS In this naturalistic sample of severely ill depressed patients, antidepressant treatment protocols were equally effective in addressing TRD in old age. However, specific symptoms such as sadness, appetite, and concentration showed an age-dependent presentation, impacting residual symptoms in severely affected TRD patients and calling for a precision approach by a better integration of age profiles in treatment recommendations.
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Affiliation(s)
- Alexander Kautzky
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Lucie Bartova
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Gernot Fugger
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Markus Dold
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Daniel Souery
- Université Libre de Bruxelles and Psy Pluriel Centre Europèen de Psychologie Medicale, Brussels, Belgium
| | | | - Joseph Zohar
- Psychiatric Division, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | | | - Chiara Fabbri
- Institute of Psychiatry, Psychology & Neuroscience, King's College, London, United Kingdom
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy
| | - Alessandro Serretti
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy
| | - Dan Rujescu
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Siegfried Kasper
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
- Center for Brain Research, Medical University of Vienna, Vienna, Austria
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Bartova L, Fugger G, Dold M, Kautzky A, Fanelli G, Zanardi R, Albani D, Weidenauer A, Rujescu D, Souery D, Mendlewic J, Montgomery S, Zohar J, Fabbri C, Serretti A, Kasper S. Real-world characteristics of European patients receiving SNRIs as first-line treatment for major depressive disorder. J Affect Disord 2023; 332:105-114. [PMID: 36958488 DOI: 10.1016/j.jad.2023.03.068] [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] [Received: 01/05/2023] [Revised: 03/16/2023] [Accepted: 03/20/2023] [Indexed: 03/25/2023]
Abstract
BACKGROUND Serotonin-norepinephrine reuptake inhibitors (SNRIs) are among the most frequently prescribed antidepressants (ADs) for major depressive disorder (MDD), with an increasing trend in the last decade. Given the relative dearth of information regarding rationales for their preferred use as first-line ADs in the broad clinical routine, the present study systematically investigated real-world characteristics of MDD patients prescribed either SNRIs or other AD substances across different countries and treatment settings. METHODS In the present secondary analyses based on a large European, multi-site, naturalistic and cross-sectional investigation with a retrospective assessment of treatment outcome, we firstly defined the proportion of MDD patients receiving SNRIs as first-line AD psychopharmacotherapy and secondly compared their sociodemographic and clinical characteristics to those patients prescribed alternative first-line ADs during their current major depressive episode (MDE). RESULTS Within the total sample of 1410 MDD patients, 336 (23.8 %) received first-line SNRIs. Compared to other ADs, SNRIs were significantly associated with inpatient care, suicidality and treatment resistance during the current MDE, and a longer lifetime duration of psychiatric hospitalizations. Moreover, greater severity of depressive symptoms at study entry, higher daily doses of the administered ADs, as well as more frequent prescriptions of psychopharmacotherapeutic add-on strategies in general and antipsychotic augmentation in particular, were significantly related to first-line SNRIs. CONCLUSIONS Considering the limitations of a cross-sectional and retrospective study design, our data point towards a preferred use of first-line SNRIs in a generally more severely ill MDD patients, although they did not lead to superior treatment outcomes compared to alternative ADs.
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Affiliation(s)
- Lucie Bartova
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria; Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy; Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria; Center for Brain Research, Medical University of Vienna, Vienna, Austria
| | - Gernot Fugger
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria; Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy; Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria; Psychiatric Day Hospital University Hospital St. Poelten, Karl Landsteiner Private University of Health Sciences, Krems an der Donau, Austria
| | - Markus Dold
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria; Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy; Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Alexander Kautzky
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria; Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Giuseppe Fanelli
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy; Department of Human Genetics, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, the Netherlands
| | - Raffaella Zanardi
- Vita-Salute San Raffaele University, Milano, Italy; Mood Disorders Unit, IRCCS Scientific Institute Ospedale San Raffaele, Milano, Italy
| | - Diego Albani
- Laboratory of Biology of Neurodegenerative Disorders, Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Ana Weidenauer
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria; Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Dan Rujescu
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria; Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Daniel Souery
- Psy Pluriel - European Centre of Psychological Medicine, Brussels, Belgium; School of Medicine, Free University of Brussels, Brussels, Belgium
| | - Julien Mendlewic
- School of Medicine, Free University of Brussels, Brussels, Belgium
| | - Stuart Montgomery
- Imperial College School of Medicine, University of London, London, United Kingdom
| | - Joseph Zohar
- Psychiatric Division, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Chiara Fabbri
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy; Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Alessandro Serretti
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy
| | - Siegfried Kasper
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria; Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria; Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom.
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Bartova L, Dold M, Fugger G, Weidenauer A, Rujescu D, Kasper S. Silexan for treatment of anxiety and depression in the context of COVID-19. Eur Neuropsychopharmacol 2023; 70:47-48. [PMID: 36867894 PMCID: PMC9946880 DOI: 10.1016/j.euroneuro.2023.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 02/13/2023] [Accepted: 02/15/2023] [Indexed: 02/25/2023]
Affiliation(s)
- Lucie Bartova
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria; Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Markus Dold
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria; Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Gernot Fugger
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria; Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria; Psychiatric Day Hospital, University Hospital St. Poelten, St. Poelten, Austria; Karl Landsteiner Private University of Health Sciences, Krems an der Donau, Austria
| | - Ana Weidenauer
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria; Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Dan Rujescu
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria; Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Siegfried Kasper
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria; Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria; Center for Brain Research, Medical University of Vienna, Vienna, Austria.
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12
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Volz HP, Bartečků E, Bartova L, Bessa J, De Berardis D, Dragasek J, Kozhuharov H, Ladea M, Lazáry J, Roca M, Usov G, Wichniak A, Godman B, Kasper S. Sick leave duration as a potential marker of functionality and disease severity in depression. Int J Psychiatry Clin Pract 2022; 26:406-416. [PMID: 35373692 DOI: 10.1080/13651501.2022.2054350] [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]
Abstract
Objective: To discuss the impact of depression on work and how depression-related sick leave duration could be a potential indicator and outcome for measuring functionality in depression.Methods: Our review was based on a literature search and expert opinion that emerged during a virtual meeting of European psychiatrists that was convened to discuss this topic.Results: Current evidence demonstrates that depression-related sick leave duration is influenced by multiple disease-, patient- and work-related factors, together with societal attitudes towards depression and socioeconomic conditions. A wide variety of pharmacological and non-pharmacological treatments and work-based interventions are effective in reducing depression-related sick leave duration and/or facilitating return to work. Recent real-world evidence showed that patients treated with antidepressant monotherapy appear to recover their working life faster than those receiving combination therapy. Although depression-related sick leave duration was found to correlate with severity of depressive symptoms, it cannot be used alone as a viable marker for disease severity.Conclusions: Given its multifactorial nature, depression-related sick leave duration is not on its own a viable outcome measure of depression severity but could be used as a secondary outcome alongside more formal severity measures and may also represent a useful measure of functionality in depression. Key pointsDepression in the working population and depression-related sick leave have a profound economic impact on societyDepression-related sick leave duration is influenced by multiple disease-, patient- and work-related factors, together with societal attitudes towards depression and socioeconomic conditionsA wide variety of pharmacological and non-pharmacological treatments and work-based interventions have been shown to be effective in reducing depression-related sick leave duration and/or facilitating return to workIn terms of pharmacological intervention, recent real-world evidence has shown that patients treated with antidepressant monotherapy are able to recover their working life faster than those treated with combination therapyAlthough depression-related sick leave duration has been shown to correlate with severity of depressive symptoms, it is not a viable outcome measure of depression severity on its own, but could be used as secondary outcome alongside more formal clinician- and patient-rated severity measuresDepression-related sick leave duration may, however, represent a viable outcome for measuring functionality in depression.
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Affiliation(s)
- Hans-Peter Volz
- Department of Psychotherapy and Psychosomatic Medicine, Hospital for Psychiatry, Werneck, Germany
| | - Elis Bartečků
- Department of Psychiatry, Masaryk University and University Hospital Brno, Brno, Czech Republic
| | - Lucie Bartova
- Department of Psychiatry and Psychotherapy (Division of General Psychiatry), Medical University of Vienna, Vienna, Austria
| | - João Bessa
- Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga, Portugal
| | - Domenico De Berardis
- NHS, Department of Mental Health, Psychiatric Service for Diagnosis and Treatment, Hospital "G. Mazzini", Teramo, Italy
| | - Jozef Dragasek
- First Department of Psychiatry, Pavol Jozef Šafárik University and University Hospital, Košice, Slovakia
| | - Hristo Kozhuharov
- Department of Psychiatry, University Hospital, "St. Marina", Varna, Bulgaria
| | - Maria Ladea
- University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania
| | - Judit Lazáry
- Nyírő Gyula National Institute of Psychiatry and Addictions, Budapest, Hungary
| | - Miquel Roca
- School of Medicine, Son Espases University Hospital, IUNICS/IDISBA, University of Balearic Islands, Palma de Mallorca, Spain
| | | | - Adam Wichniak
- Third Department of Psychiatry, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Brian Godman
- Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, Glasgow, UK.,School of Pharmacy, Faculty of Health Sciences, Sefako Makgatho Health Sciences University, Pretoria, South Africa.,Centre of Medical and Bio-allied Health Sciences Research, Ajman University, United Arab Emirates
| | - Siegfried Kasper
- Department of Psychiatry and Psychotherapy (Division of General Psychiatry), Medical University of Vienna, Vienna, Austria.,Center for Brain Research, Medical University of Vienna, Vienna, Austria
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Kroupa J, Buk M, Weichet J, Malikova H, Bartova L, Linkova H, Ionita O, Kozel M, Motovska Z, Kocka V. A pilot randomised trial of catheter-directed thrombolysis or standard anticoagulation for patients with intermediate-high risk acute pulmonary embolism. EUROINTERVENTION 2022; 18:e639-e646. [DOI: 10.4244/eij-d-21-01080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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14
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Bartova L, Fugger G, Dold M, Kautzky A, Rujescu D, Kasper S. Psychotherapy's Role for Treatment-Resistant Depression? Am J Psychiatry 2022; 179:687. [PMID: 36048491 DOI: 10.1176/appi.ajp.20220212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Lucie Bartova
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria (Bartova, Fugger, Dold, Kautzky, Rujescu, Kasper); Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy (Bartova, Dold); Center for Brain Research, Medical University of Vienna, Vienna, Austria (Kasper)
| | - Gernot Fugger
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria (Bartova, Fugger, Dold, Kautzky, Rujescu, Kasper); Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy (Bartova, Dold); Center for Brain Research, Medical University of Vienna, Vienna, Austria (Kasper)
| | - Markus Dold
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria (Bartova, Fugger, Dold, Kautzky, Rujescu, Kasper); Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy (Bartova, Dold); Center for Brain Research, Medical University of Vienna, Vienna, Austria (Kasper)
| | - Alexander Kautzky
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria (Bartova, Fugger, Dold, Kautzky, Rujescu, Kasper); Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy (Bartova, Dold); Center for Brain Research, Medical University of Vienna, Vienna, Austria (Kasper)
| | - Dan Rujescu
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria (Bartova, Fugger, Dold, Kautzky, Rujescu, Kasper); Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy (Bartova, Dold); Center for Brain Research, Medical University of Vienna, Vienna, Austria (Kasper)
| | - Siegfried Kasper
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria (Bartova, Fugger, Dold, Kautzky, Rujescu, Kasper); Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy (Bartova, Dold); Center for Brain Research, Medical University of Vienna, Vienna, Austria (Kasper)
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15
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Fugger G, Bartova L, Fabbri C, Fanelli G, Zanardi R, Dold M, Kautzky A, Rujescu D, Souery D, Mendlewicz J, Zohar J, Montgomery S, Serretti A, Kasper S. The sociodemographic and clinical phenotype of European patients with major depressive disorder undergoing first-line antidepressant treatment with NaSSAs. J Affect Disord 2022; 312:225-234. [PMID: 35691416 DOI: 10.1016/j.jad.2022.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 05/27/2022] [Accepted: 06/06/2022] [Indexed: 01/14/2023]
Affiliation(s)
- Gernot Fugger
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria; Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy
| | - Lucie Bartova
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria; Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy
| | - Chiara Fabbri
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy; Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Giuseppe Fanelli
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy; Department of Human Genetics, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, the Netherlands
| | - Raffaella Zanardi
- Vita-Salute San Raffaele University, Milano, Italy; Mood Disorders Unit, IRCCS Scientific Institute Ospedale San Raffaele, Milano, Italy
| | - Markus Dold
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria; Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy
| | - Alexander Kautzky
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Dan Rujescu
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Daniel Souery
- School of Medicine, Free University of Brussels, Brussels, Belgium; Psy Pluriel - European Centre of Psychological Medicine, Brussels, Belgium
| | | | - Joseph Zohar
- Psychiatric Division, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Stuart Montgomery
- Imperial College School of Medicine, University of London, London, United Kingdom
| | - Alessandro Serretti
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy
| | - Siegfried Kasper
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria; Center for Brain Research, Medical University of Vienna, Vienna, Austria.
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Bartova L, Fugger G, Dold M, Mitschek M, Zohar J, Mendlewicz J, Souery D, Montgomery S, Fabbri C, Serretti A, Kasper S. Psychotherapy employed additionally to Psychopharmacotherapy is not related to Better Treatment Outcome in Major Depressive Disorder. Eur Psychiatry 2022. [PMCID: PMC9567182 DOI: 10.1192/j.eurpsy.2022.229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Although numerous effective antidepressant (AD) strategies are available for the treatment of major depressive disorder (MDD), many patients do not achieve satisfactory treatment response. Objectives The aims of the present European, cross-sectional, multicenter, naturalistic study were (1) to determine the proportion of patients suffering from primary MDD who received additional psychotherapy to their ongoing psychopharmacotherapy and (2) to identify the associated socio-demographic and clinical patterns. Methods Patients receiving both treatments were compared to those lacking concomitant additional psychotherapy that was manual-driven psychotherapy (MDP) in all cases. Results While 68.8% of a total of 1279 MDD patients received exclusively psychopharmacotherapy, 31.2% underwent a psychopharmacotherapy-MDP combination. The latter patient population was rather younger, higher educated, employed, exhibited an earlier mean age of MDD onset, lower severity of current depressive symptoms with lower odds of suicidality and higher rates of melancholic features, and comorbid asthma and migraine, and was generally treated with lower daily doses of their first-line ADs. Whereas agomelatine was more commonly dispensed in these patients, selective serotonin reuptake inhibitors were more often prescribed in MDD patients lacking additional MDP. No significant between-group differences were detected in terms of treatment outcome. Conclusions The fact that the employment of additional MDP was not related to better treatment outcome in MDD represents our major and clinically most relevant finding. Generally, MDP was employed in a minority of our patients who experienced rather beneficial socio-demographic and clinical characteristics. This might reflect an inferior accessibility of these psychotherapeutic techniques for patients who are more severely ill and less socio-economically privileged. Disclosure References Bartova L, Fugger G, Dold M, Swoboda MMM, Zohar J, Mendlewicz J, Souery D, Montgomery S, Fabbri C, Serretti A, Kasper S. Combining psychopharmacotherapy and psychotherapy is not associated with better treatment outcome in major depressive disor
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Fugger G, Bartova L, Dold M, Fabbri C, Fanelli G, Zanardi R, Kautzky A, Zohar J, Souery D, Mendlewicz J, Montgomery S, Rujescu D, Serretti A, Kasper S. Evidence on sociodemographic and clinical correlates of antidepressant combination or augmentation with second-generation antipsychotics in major depressive disorder. Prog Neuropsychopharmacol Biol Psychiatry 2022; 114:110480. [PMID: 34826558 DOI: 10.1016/j.pnpbp.2021.110480] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 08/31/2021] [Revised: 11/04/2021] [Accepted: 11/21/2021] [Indexed: 11/25/2022]
Abstract
About two thirds of the patients with major depressive disorder (MDD) do not sufficiently respond to monotherapy with antidepressants (ADs) which makes them reliant on further treatment approaches. Hereby, combination of different ADs and augmentation with second-generation antipsychotics (SGAs) are widely used and recommended psychopharmacotherapeutic strategies. The present secondary analyses are based on an international, naturalistic, cross-sectional multicenter study conducted by the European Group for the Study of Resistant Depression. Comparing socio-demographic and clinical characteristics of 436 adult MDD patients receiving either SGAs (N = 191, 43.8%) or ADs (N = 245, 56.2%), that were additionally administered to their first-line AD psychopharmacotherapy, we aimed to identify possible trajectories of decision-making for clinicians regarding which treatment option to prefer in individual patients. Our most robust findings represent an association of SGA augmentation with the presence of psychotic symptoms, longer mean duration of lifetime psychiatric hospitalizations, employment of further augmentation strategies with mood-stabilizers and benzodiazepines, and a trend towards higher mean daily dosages of their first-line ADs and current suicidal risk. Treatment outcome was not significantly different between patients receiving either SGA augmentation or AD combination. Being aware of limitations inherent to the cross-sectional study design and the lack of randomization, more severe and rather chronic conditions in MDD seemed to encourage clinicians to choose SGA augmentation over AD combination. The fact that mood-stabilizers and/or benzodiazepines were more frequently co-administered with SGAs may represent a requirement of an overall refined psychopharmacotherapy including additional fast-acting agents with potent AD, tranquilizing and anti-suicidal effects in MDD patients experiencing challenging clinical manifestations. New glutamatergic substances seem to be promising in this regard.
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Affiliation(s)
- Gernot Fugger
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria; Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy
| | - Lucie Bartova
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria; Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy
| | - Markus Dold
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria; Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy
| | - Chiara Fabbri
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy; Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Giuseppe Fanelli
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy; Department of Human Genetics, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, the Netherlands
| | - Raffaella Zanardi
- Vita-Salute San Raffaele University, Milano, Italy; Mood Disorders Unit, IRCCS Scientific Institute Ospedale San Raffaele, Milano, Italy
| | - Alexander Kautzky
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Joseph Zohar
- Psychiatric Division, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Daniel Souery
- School of Medicine, Free University of Brussels, Brussels, Belgium; Psy Pluriel - European Centre of Psychological Medicine, Brussels, Belgium
| | | | - Stuart Montgomery
- Imperial College School of Medicine, University of London, London, United Kingdom
| | - Dan Rujescu
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Alessandro Serretti
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy
| | - Siegfried Kasper
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria; Center for Brain Research, Medical University of Vienna, Vienna, Austria.
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Swoboda MMM, Bartova L, Dremel M, Rabl U, Laggner A, Frey R. The Toxicity Potential of Antidepressants and Antipsychotics in Relation to Other Medication and Alcohol: A Naturalistic and Retrospective Study. Front Psychiatry 2022; 13:825546. [PMID: 35669269 PMCID: PMC9165614 DOI: 10.3389/fpsyt.2022.825546] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 04/11/2022] [Indexed: 01/09/2023] Open
Abstract
QT interval prolongation and ventricular tachyarrhythmia are potential adverse effects of antidepressant (AD) and antipsychotic- (AP) agents, especially when overdosed. Since AD and AP agents are often prescribed to patients suffering from suicidal intentions, it is essential to estimate these risks in the context of intoxications. This retrospective and naturalistic one-year registry study included 105 patients treated for oral intoxication at the University Department of Emergency Medicine in Vienna, Austria. AD/AP intoxications were present in 26 patients, while in the control group (n = 79) non-AD/AP drugs (n = 54) and exclusively alcohol (n = 25) were the toxic agents. QT intervals, the necessity of intubation, the extent of conscious state, and the subsequent discharge management were compared. The mean age was 34.94 ± 14.6 years, 62 patients (59%) were female. There were no significant between-group differences regarding QT prolongation >470 ms using Bazett's correction (p = 0.178), or >440 ms using Fridericia's correction (p = 0.760). No significant group differences concerning the need for intubation were observed (p = 0.747). The AD/AP and the control group did not significantly differ regarding Glasgow Coma Scale scores (p = 0.439). Patients with AD/AP intoxication were significantly more often transferred to the psychiatric department, while discharge to home was more likely in the control group (p = 0.002). These results suggest that the risk of a potentially life-threatening outcome in cases of intoxication with AD/AP is not substantially higher than in other easily available toxic agents, in line with the advantageous risk/benefit ratio of newer ADs and APs.
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Affiliation(s)
- Marleen M M Swoboda
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Lucie Bartova
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Marlene Dremel
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Ulrich Rabl
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Anton Laggner
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Richard Frey
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
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19
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Dold M, Bartova L, Fugger G, Mitschek MM, Fabbri C, Serretti A, Mendlewicz J, Souery D, Zohar J, Montgomery S, Kasper S. Pregabalin augmentation of antidepressants in major depression - results from a European multicenter study. J Affect Disord 2022; 296:485-492. [PMID: 34653701 DOI: 10.1016/j.jad.2021.09.063] [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: 07/19/2021] [Revised: 09/12/2021] [Accepted: 09/21/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND We aimed to investigate the prescription pattern of pregabalin augmentation of antidepressants in major depressive disorder (MDD) and to explore variables associated with add-on pregabalin treatment. METHODS 1410 MDD patients participated in this naturalistic European multicenter study with retrospective assessment of treatment response. Analyses of covariance, chi-squared tests, and binary logistic regressions were accomplished to determine differences in socio-demographic and clinical characteristics between MDD patients with and without pregabalin augmentation. RESULTS Add-on pregabalin was established in 102 (7.23%) MDD patients. Compared to those without receiving pregabalin, pregabalin-treated patients were characterized by a significantly higher likelihood for older age (mean: 54.74 ± 13.08 vs 49.93 ± 14.13 years), unemployment (78.43% vs 51.23%), melancholic features (83.33% vs 58.94%), inpatient treatment (72.55% vs 31.65%), previous psychiatric hospitalizations (13.52 ± 24.82 vs 4.96 ± 19.93 weeks), any somatic comorbidity (68.63% vs 44.57%), comorbid hypertension (37.25% vs 17.51%), more severe depressive symptom severity at the onset of the current episode (mean MADRS: 37.55 ± 9.00 vs 33.79 ± 7.52), receiving augmentation/combination treatment strategies in general (mean number of psychotropic drugs: 3.64 ± 0.92 vs 2.07 ± 1.17), and with antidepressants (50.00% vs 27.91%) and antipsychotics (46.08% vs 24.08%) in particular. LIMITATIONS Due to its observational cross-sectional study design, our patient sample might not be fully representative for MDD patients in primary care settings. CONCLUSIONS Our findings suggest that add-on pregabalin is particularly administered in more severe/difficult-to-treat MDD conditions, whereas no association between the prescription of adjunctive pregabalin and comorbid anxiety symptoms could be determined.
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Affiliation(s)
- Markus Dold
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria.
| | - Lucie Bartova
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Gernot Fugger
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Marleen Mm Mitschek
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Chiara Fabbri
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy; Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
| | - Alessandro Serretti
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy
| | | | - Daniel Souery
- School of Medicine, Free University of Brussels, Brussels, Belgium; Psy Pluriel - European Centre of Psychological Medicine, Brussels, Belgium
| | - Joseph Zohar
- Psychiatric Division, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | | | - Siegfried Kasper
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria; Center for Brain Research, Medical University of Vienna, Spitalgasse 23, Vienna A-1090, Austria.
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20
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Fugger G, Bartova L, Fabbri C, Fanelli G, Dold M, Swoboda MMM, Kautzky A, Zohar J, Souery D, Mendlewicz J, Montgomery S, Rujescu D, Serretti A, Kasper S. The sociodemographic and clinical profile of patients with major depressive disorder receiving SSRIs as first-line antidepressant treatment in European countries. Eur Arch Psychiatry Clin Neurosci 2022; 272:715-727. [PMID: 34989830 PMCID: PMC9095529 DOI: 10.1007/s00406-021-01368-3] [Citation(s) in RCA: 5] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 11/29/2021] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Due to favorable antidepressant (AD) efficacy and tolerability, selective-serotonin reuptake inhibitors (SSRIs) are consistently recommended as substances of first choice for the treatment of major depressive disorder (MDD) in international guidelines. However, little is known about the real-world clinical correlates of patients primarily prescribed SSRIs in contrast to those receiving alternative first-line ADs. METHODS These secondary analyses are based on a naturalistic, multinational cross-sectional study conducted by the European Group for the Study of Resistant Depression at ten research sites. We compared the socio-demographic and clinical characteristics of 1410 patients with primary MDD, who were either prescribed SSRIs or alternative substances as first-line AD treatment, using chi-squared tests, analyses of covariance, and logistic regression analyses. RESULTS SSRIs were prescribed in 52.1% of MDD patients who showed lower odds for unemployment, current severity of depressive symptoms, melancholic features, suicidality, as well as current inpatient treatment compared to patients receiving alternative first-line ADs. Furthermore, patients prescribed SSRIs less likely received add-on therapies including AD combination and augmentation with antipsychotics, and exhibited a trend towards higher response rates. CONCLUSION A more favorable socio-demographic and clinical profile associated with SSRIs in contrast to alternative first-line ADs may have guided European psychiatrists' treatment choice for SSRIs, rather than any relevant pharmacological differences in mechanisms of action of the investigated ADs. Our results must be cautiously interpreted in light of predictable biases resulting from the open treatment selection, the possible allocation of less severely ill patients to SSRIs as well as the cross-sectional study design that does not allow to ascertain any causal conclusions.
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Affiliation(s)
- Gernot Fugger
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria ,Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy
| | - Lucie Bartova
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria ,Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy
| | - Chiara Fabbri
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy ,Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Giuseppe Fanelli
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy ,Department of Human Genetics, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - Markus Dold
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | | | - Alexander Kautzky
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Joseph Zohar
- Psychiatric Division, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Daniel Souery
- School of Medicine, Free University of Brussels, Brussels, Belgium ,Psy Pluriel-European Centre of Psychological Medicine, Brussels, Belgium
| | | | - Stuart Montgomery
- Imperial College School of Medicine, University of London, London, UK
| | - Dan Rujescu
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Alessandro Serretti
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy
| | - Siegfried Kasper
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria. .,Center for Brain Research, Medical University of Vienna, Spitalgasse 4, 1090, Vienna, Austria.
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21
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Bartova L, Kasper S. [Chronobiology of Depression]. Psychiatr Danub 2021; 33:446-453. [PMID: 34795197 DOI: 10.24869/psyd.2021.446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Seasonal fluctuations in mood, drive, energy, sleeping- and eating behavior, weight, as well as further important mental and physical functions, and the utilization of light as an effective treatment option were already described by Hippocrates of Kos and Araeteus, the Cappadocian. The concept of the so-called seasonal affective disorder (SAD) as a disruption of the circadian rhythm precipitated by a deficiency of environmental light during darker seasons was first described in the 1980s. Furthermore, chronobiological and hormonal dysregulation in SAD patients was repeatedly shown to be accompanied by alterations on a neuroreceptor and neurotransmitter level and to normalize after remission. Hence, SAD represents one of the most important models of a chronobiological disorder with over 1000 international publications on its aetiology and treatment options, whereby their underpinnings could be elucidated on a clinical as well as molecular level. The present article summarizes the current understanding of etiological mechanisms of SAD and provides an overview of diagnostic and therapeutic strategies, which are based on available international evidence including clinical trials, systematic reviews, and meta-analyses. According to current recommendations of international guidelines, promising treatment options as bright light therapy, psychopharmacotherapy, therapeutic sleep deprivation, and their underlying mechanisms of action are presented.
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Affiliation(s)
- Lucie Bartova
- Klinische Abteilung für Allgemeine Psychiatrie, Universitätsklinik für Psychiatrie und Psychotherapie, Medizinische Universität Wien, Wien, Österreich
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22
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Bartova L, Fugger G, Dold M, Kautzky A, Swoboda MMM, Rujescu D, Zohar J, Souery D, Mendlewicz J, Montgomery S, Fabbri C, Serretti A, Kasper S. The Choice of Either Quetiapine or Aripiprazole as Augmentation Treatment in a European Naturalistic Sample of Patients With Major Depressive Disorder. Int J Neuropsychopharmacol 2021; 25:118-127. [PMID: 34637516 PMCID: PMC8832223 DOI: 10.1093/ijnp/pyab066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 07/11/2021] [Revised: 08/30/2021] [Accepted: 11/11/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Augmentation with second-generation antipsychotics (SGAs) represents an evidence-based psychopharmacotherapeutic strategy recommended in case of insufficient response to the first-line antidepressant (AD) treatment in major depressive disorder (MDD). Comparative evidence regarding efficacy and prescription preferences of the individual SGAs is scarce. METHODS In the scope of this European, multi-site, naturalistic cross-sectional investigation with retrospective assessment of treatment outcome, we compared sociodemographic and clinical characteristics of 187 MDD patients receiving either quetiapine (n = 150) or aripiprazole (n = 37) as augmentation of their first-line AD psychopharmacotherapy. RESULTS Comorbid posttraumatic stress disorder and diabetes were significantly associated with aripiprazole augmentation in our primary and post-hoc binary logistic regression analyses. Furthermore, we identified an association between aripiprazole co-administration and the presence of additional psychotic features, higher rates of AD combination treatment, and a longer duration of psychiatric hospitalizations during the lifetime, which, however, lost significance after correcting for multiple comparisons. Regarding treatment outcome, we found a trend of higher response rates and greater reductions in severity of depressive symptoms in MDD patients dispensed quetiapine. CONCLUSIONS Factors associated with a more chronic and severe profile of MDD seem to encourage clinicians to choose aripiprazole over quetiapine, that was, however, administered in the majority of our MDD patients, which might reflect the current approval situation allowing to prescribe exclusively quetiapine as on-label augmentation in MDD in Europe. Given the retrospective assessment of treatment response, the markedly smaller proportion of patients receiving aripiprazole augmentation generally showing an unfavorable disease profile, and the partially heterogeneous statistical robustness of our findings, further studies are required to elaborate on our observation and to generate unambiguous recommendations regarding the choice of first-line SGA augmentation in MDD.
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Affiliation(s)
- Lucie Bartova
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna,Austria,Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna,Italy
| | - Gernot Fugger
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna,Austria,Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna,Italy
| | - Markus Dold
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna,Austria
| | - Alexander Kautzky
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna,Austria
| | | | - Dan Rujescu
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna,Austria
| | - Joseph Zohar
- Psychiatric Division, Chaim Sheba Medical Center, Tel Hashomer,Israel
| | - Daniel Souery
- School of Medicine, Free University of Brussels, Brussels,Belgium,Psy Pluriel - European Centre of Psychological Medicine, Brussels,Belgium
| | | | - Stuart Montgomery
- Imperial College School of Medicine, University of London, London,United Kingdom
| | - Chiara Fabbri
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna,Italy,Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London,United Kingdom
| | - Alessandro Serretti
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna,Italy
| | - Siegfried Kasper
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna,Austria,Center for Brain Research, Medical University of Vienna, Vienna,Austria,Correspondence: Siegfried Kasper, MD, Professor Emeritus, Center for Brain Research, Medical University of Vienna, Spitalgasse 4, A-1090 Vienna, Austria ()
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23
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Javaheripour N, Li M, Chand T, Krug A, Kircher T, Dannlowski U, Nenadić I, Hamilton JP, Sacchet MD, Gotlib IH, Walter H, Frodl T, Grimm S, Harrison BJ, Wolf CR, Olbrich S, van Wingen G, Pezawas L, Parker G, Hyett MP, Sämann PG, Hahn T, Steinsträter O, Jansen A, Yuksel D, Kämpe R, Davey CG, Meyer B, Bartova L, Croy I, Walter M, Wagner G. Altered resting-state functional connectome in major depressive disorder: a mega-analysis from the PsyMRI consortium. Transl Psychiatry 2021; 11:511. [PMID: 34620830 PMCID: PMC8497531 DOI: 10.1038/s41398-021-01619-w] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [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] [Received: 08/03/2021] [Revised: 08/31/2021] [Accepted: 09/13/2021] [Indexed: 12/12/2022] Open
Abstract
Major depressive disorder (MDD) is associated with abnormal neural circuitry. It can be measured by assessing functional connectivity (FC) at resting-state functional MRI, that may help identifying neural markers of MDD and provide further efficient diagnosis and monitor treatment outcomes. The main aim of the present study is to investigate, in an unbiased way, functional alterations in patients with MDD using a large multi-center dataset from the PsyMRI consortium including 1546 participants from 19 centers ( www.psymri.com ). After applying strict exclusion criteria, the final sample consisted of 606 MDD patients (age: 35.8 ± 11.9 y.o.; females: 60.7%) and 476 healthy participants (age: 33.3 ± 11.0 y.o.; females: 56.7%). We found significant relative hypoconnectivity within somatosensory motor (SMN), salience (SN) networks and between SMN, SN, dorsal attention (DAN), and visual (VN) networks in MDD patients. No significant differences were detected within the default mode (DMN) and frontoparietal networks (FPN). In addition, alterations in network organization were observed in terms of significantly lower network segregation of SMN in MDD patients. Although medicated patients showed significantly lower FC within DMN, FPN, and SN than unmedicated patients, there were no differences between medicated and unmedicated groups in terms of network organization in SMN. We conclude that the network organization of cortical networks, involved in processing of sensory information, might be a more stable neuroimaging marker for MDD than previously assumed alterations in higher-order neural networks like DMN and FPN.
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Affiliation(s)
- Nooshin Javaheripour
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Philosophenweg 3, 07743, Jena, Germany
- Clinical Affective Neuroimaging Laboratory (CANLAB), Leipziger Str. 44, Building 65, 39120, Magdeburg, Germany
| | - Meng Li
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Philosophenweg 3, 07743, Jena, Germany
- Clinical Affective Neuroimaging Laboratory (CANLAB), Leipziger Str. 44, Building 65, 39120, Magdeburg, Germany
| | - Tara Chand
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Philosophenweg 3, 07743, Jena, Germany
- Clinical Affective Neuroimaging Laboratory (CANLAB), Leipziger Str. 44, Building 65, 39120, Magdeburg, Germany
| | - Axel Krug
- Department of Psychiatry and Psychotherapy, University of Bonn, 53127, Bonn, Germany
- Department of Psychiatry and Psychotherapy, Philipps Universität Marburg, Rudolf-Bultmann-Str. 8, 35039, Marburg, Germany
| | - Tilo Kircher
- Department of Psychiatry and Psychotherapy, Philipps Universität Marburg, Rudolf-Bultmann-Str. 8, 35039, Marburg, Germany
| | - Udo Dannlowski
- Institute for Translational Psychiatry, University of Münster, 48149, Münster, Germany
| | - Igor Nenadić
- Department of Psychiatry and Psychotherapy, Philipps Universität Marburg, Rudolf-Bultmann-Str. 8, 35039, Marburg, Germany
| | - J Paul Hamilton
- Center for Social and Affective Neuroscience, Center for Medical Image Science and Visualization, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Matthew D Sacchet
- Center for Depression, Anxiety, and Stress Research, McLean Hospital, Harvard Medical School, Belmont, MA, USA
| | - Ian H Gotlib
- Department of Psychology, Stanford University, Bldg. 420, Jordan Hall, Stanford, CA, 94305, USA
| | - Henrik Walter
- Department of Psychiatry and Psychotherapy CCM, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Berlin Institute of Health, Humboldt-Universität zu Berlin, Campus Charité Mitte, Charitéplatz 1, 10117, Berlin, Germany
| | - Thomas Frodl
- Department of Psychiatry and Psychotherapy, Otto von Guericke University Magdeburg, Leipzigerstr. 44, 39120, Magdeburg, Germany
| | - Simone Grimm
- Department of Psychiatry and Psychotherapy, CBF, Charité Universitätsmedizin Berlin, 12203, Berlin, Germany
| | - Ben J Harrison
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne, Victoria, Australia
| | - Christian Robert Wolf
- Center for Psychosocial Medicine, Department of General Psychiatry, University of Heidelberg, Heidelberg, Germany
| | - Sebastian Olbrich
- Department of Psychiatry, Psychotherapy and Psychosomatic, University Zürich, Zürich, Switzerland
| | - Guido van Wingen
- Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Lukas Pezawas
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Gordon Parker
- School of Psychiatry, AGSM Building, University of New South Wales, Sydney, Australia
| | - Matthew P Hyett
- School of Psychological Sciences, University of Western Australia, Perth, Australia
| | | | - Tim Hahn
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Olaf Steinsträter
- Department of Psychiatry and Psychotherapy, Philipps Universität Marburg, Rudolf-Bultmann-Str. 8, 35039, Marburg, Germany
| | - Andreas Jansen
- Department of Psychiatry and Psychotherapy & Marburg Center for Mind, Brain and Behavior - MCMBB, Philipps- Universität Marburg, Marburg, Germany
| | - Dilara Yuksel
- Center for Health Sciences, SRI International, 333 Ravenswood Avenue, Menlo Park, CA, USA
| | - Robin Kämpe
- Center for Social and Affective Neuroscience, Center for Medical Image Science and Visualization, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | | | - Bernhard Meyer
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Lucie Bartova
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Ilona Croy
- Department of Psychology, Friedrich Schiller University Jena, Jena, Germany
- Department of Psychotherapy and Psychosomatic Medicine, TU, Dresden, Germany
| | - Martin Walter
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Philosophenweg 3, 07743, Jena, Germany
- Clinical Affective Neuroimaging Laboratory (CANLAB), Leipziger Str. 44, Building 65, 39120, Magdeburg, Germany
- Leibniz Institute for Neurobiology, Brenneckestr. 6, 39118, Magdeburg, Germany
- Department of Psychiatry and Psychotherapy, University Tuebingen, Calwerstraße 14, 72076, Tuebingen, Germany
| | - Gerd Wagner
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Philosophenweg 3, 07743, Jena, Germany.
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24
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Sauerzopf U, Weidenauer A, Dajic I, Bauer M, Bartova L, Meyer B, Nics L, Philippe C, Pfaff S, Pichler V, Mitterhauser M, Wadsak W, Hacker M, Kasper S, Lanzenberger R, Pezawas L, Praschak-Rieder N, Willeit M. Disrupted relationship between blood glucose and brain dopamine D2/3 receptor binding in patients with first-episode schizophrenia. Neuroimage Clin 2021; 32:102813. [PMID: 34544031 PMCID: PMC8455866 DOI: 10.1016/j.nicl.2021.102813] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 08/29/2021] [Accepted: 08/30/2021] [Indexed: 01/11/2023]
Abstract
An elemental function of brain dopamine is to coordinate cognitive and motor resources for successful exploitation of environmental energy sources. Dopamine transmission, goal-directed behavior, and glucose homeostasis are altered in schizophrenia patients prior to and after initiation of pharmacological treatment. Thus, we investigated the relationship between blood glucose levels and brain dopamine signaling in drug-naïve patients with first-episode psychosis. We quantified blood glucose levels and binding of the dopamine D2/3 receptor agonist radioligand (+)-[11C]-PHNO in 15 medication-naïve patients and 27 healthy volunteers employing positron emission tomography. Whole-brain voxel-wise linear model analysis identified two clusters of significant interaction between blood glucose levels and diagnosis on (+)-[11C]-PHNO binding-potential values. We observed positive relationships between blood glucose levels and binding-potential values in healthy volunteers but negative ones in patients with first episode psychosis in a cluster surviving rigorous multiple testing correction located in the in the right ventral tegmental area. Another cluster of homologous behavior, however at a lower level of statistical significance, comprised the ventral striatum and pallidum. Extracellular dopamine levels are a major determinant of (+)-[11C]-PHNO binding in the brain. In line with the concept that increased dopamine signaling occurs when goal-directed behavior is needed for restoring energy supply, our data indicate that in healthy volunteers, extracellular dopamine levels are high when blood glucose levels are low and vice-versa. This relationship is reversed in patients with first-episode psychosis, possibly reflecting an underlying pathogenic alteration that links two seemingly unrelated aspects of the illness: altered dopamine signaling and dysfunctional glucose homeostasis.
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Affiliation(s)
- U Sauerzopf
- Department of Psychiatry and Psychotherapy, Division of General Psychiatry, Medical University of Vienna, Austria
| | - A Weidenauer
- Department of Psychiatry and Psychotherapy, Division of General Psychiatry, Medical University of Vienna, Austria
| | - I Dajic
- Department of Psychiatry and Psychotherapy, Division of General Psychiatry, Medical University of Vienna, Austria
| | - M Bauer
- Department of Psychiatry and Psychotherapy, Division of General Psychiatry, Medical University of Vienna, Austria; Department of Clinical Pharmacology, Medical University of Vienna, Austria
| | - L Bartova
- Department of Psychiatry and Psychotherapy, Division of General Psychiatry, Medical University of Vienna, Austria
| | - B Meyer
- Department of Psychiatry and Psychotherapy, Division of General Psychiatry, Medical University of Vienna, Austria
| | - L Nics
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Austria
| | - C Philippe
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Austria
| | - S Pfaff
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Austria
| | - V Pichler
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Austria
| | - M Mitterhauser
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Austria; Ludwig-Boltzmann-Institute Applied Diagnostics, Vienna, Austria
| | - W Wadsak
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Austria; Center for Biomarker Research in Medicine CBmed, Graz, Austria
| | - M Hacker
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Austria
| | - S Kasper
- Department of Psychiatry and Psychotherapy, Division of General Psychiatry, Medical University of Vienna, Austria; Centre for Brain Research, Medical University of Vienna, Austria
| | - R Lanzenberger
- Department of Psychiatry and Psychotherapy, Division of General Psychiatry, Medical University of Vienna, Austria
| | - L Pezawas
- Department of Psychiatry and Psychotherapy, Division of General Psychiatry, Medical University of Vienna, Austria
| | - N Praschak-Rieder
- Department of Psychiatry and Psychotherapy, Division of General Psychiatry, Medical University of Vienna, Austria
| | - M Willeit
- Department of Psychiatry and Psychotherapy, Division of General Psychiatry, Medical University of Vienna, Austria.
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Bartova L, Dold M, Fugger G, Kautzky A, Mitschek MMM, Weidenauer A, Hienert MG, Frey R, Mandelli L, Zohar J, Mendlewicz J, Souery D, Montgomery S, Fabbri C, Serretti A, Kasper S. Sex-related effects in major depressive disorder: Results of the European Group for the Study of Resistant Depression. Depress Anxiety 2021; 38:896-906. [PMID: 34110066 PMCID: PMC8453858 DOI: 10.1002/da.23165] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 02/19/2021] [Accepted: 04/19/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Sex-related effects on the evolution and phenotype of major depressive disorder (MDD) were reported previously. METHODS This European multicenter cross-sectional study compared sociodemographic, clinical, and treatment patterns between males and females in a real-world sample of 1410 in- and outpatients with current MDD. RESULTS Male MDD patients (33.1%) were rather inpatients, suffered from moderate to high suicidality levels, received noradrenergic and specific serotonergic antidepressants (ADs) as first-line AD treatment, generally higher mean AD daily doses, and showed a trend towards a more frequent administration of add-on treatments. Female MDD patients (66.9%) were rather outpatients, experienced lower suicidality levels, comorbid thyroid dysfunction, migraine, asthma, and a trend towards earlier disease onset. CONCLUSIONS The identified divergencies may contribute to the concept of male and female depressive syndromes and serve as predictors of disease severity and course, as they reflect phenomena that were repeatedly related to treatment-resistant depression (TRD). Especially the greater necessity of inpatient treatment and more complex psychopharmacotherapy in men may reflect increased therapeutic efforts undertaken to treat suicidality and to avoid TRD. Hence, considering sex may guide the diagnostic and treatment processes towards targeting challenging clinical manifestations including comorbidities and suicidality, and prevention of TRD and chronicity.
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Affiliation(s)
- Lucie Bartova
- Department of Psychiatry and PsychotherapyMedical University of ViennaViennaAustria
| | - Markus Dold
- Department of Psychiatry and PsychotherapyMedical University of ViennaViennaAustria
| | - Gernot Fugger
- Department of Psychiatry and PsychotherapyMedical University of ViennaViennaAustria
| | - Alexander Kautzky
- Department of Psychiatry and PsychotherapyMedical University of ViennaViennaAustria
| | | | - Ana Weidenauer
- Department of Psychiatry and PsychotherapyMedical University of ViennaViennaAustria
| | - Marius G. Hienert
- Department of Psychiatry and PsychotherapyMedical University of ViennaViennaAustria
| | - Richard Frey
- Department of Psychiatry and PsychotherapyMedical University of ViennaViennaAustria
| | - Laura Mandelli
- Department of Biomedical and NeuroMotor SciencesUniversity of BolognaBolognaItaly
| | - Joseph Zohar
- Psychiatric DivisionChaim Sheba Medical CenterTel HashomerIsrael
| | | | - Daniel Souery
- School of MedicineFree University of BrusselsBrusselsBelgium,Psy Pluriel ‐ European Centre of Psychological MedicineBrusselsBelgium
| | - Stuart Montgomery
- Imperial College School of MedicineUniversity of LondonLondonUnited Kingdom
| | - Chiara Fabbri
- Department of Biomedical and NeuroMotor SciencesUniversity of BolognaBolognaItaly,Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUnited Kingdom
| | - Alessandro Serretti
- Department of Biomedical and NeuroMotor SciencesUniversity of BolognaBolognaItaly
| | - Siegfried Kasper
- Department of Psychiatry and PsychotherapyMedical University of ViennaViennaAustria,Center for Brain ResearchMedical University of ViennaViennaAustria
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Bartova L, Fugger G, Dold M, Swoboda MMM, Zohar J, Mendlewicz J, Souery D, Montgomery S, Fabbri C, Serretti A, Kasper S. Combining psychopharmacotherapy and psychotherapy is not associated with better treatment outcome in major depressive disorder - evidence from the European Group for the Study of Resistant Depression. J Psychiatr Res 2021; 141:167-175. [PMID: 34216945 DOI: 10.1016/j.jpsychires.2021.06.028] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 02/22/2021] [Revised: 05/08/2021] [Accepted: 06/14/2021] [Indexed: 10/21/2022]
Abstract
Despite plenty of effective antidepressant (AD) treatments, the outcome of major depressive disorder (MDD) is often unsatisfactory, probably due to improvable exploitation of available therapies. This European, cross-sectional, naturalistic multicenter study investigated the frequency of additional psychotherapy in terms of a manual-driven psychotherapy (MDP) in 1410 adult in- and outpatients with MDD, who were primarily treated with AD psychopharmacotherapy. Socio-demographic and clinical patterns were compared between patients receiving both treatments and those lacking concomitant MDP. In a total of 1279 MDD patients (90.7%) with known status of additional MDP, those undergoing a psychopharmacotherapy-MDP combination (31.2%) were younger, higher educated, more often employed and less severely ill with lower odds for suicidality as compared to patients receiving exclusively psychopharmacotherapy (68.8%). They experienced an earlier mean age of MDD onset, melancholic features, comorbid asthma and migraine and received lower daily doses of their first-line ADs. While agomelatine was more often established in these patients, MDD patients without MDP received selective serotonin reuptake inhibitors more frequently. These two patient groups did not differ in terms of response, non-response and treatment resistant depression (TRD). Accordingly, the employment of additional MDP could not be related to better treatment outcomes in MDD. The fact that MDP was applied in a minority of patients with rather beneficial socio-demographic and clinical characteristics might reflect inferior accessibility of these psychotherapeutic techniques for socially and economically disadvantaged populations.
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Affiliation(s)
- Lucie Bartova
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria; Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy
| | - Gernot Fugger
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria; Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy
| | - Markus Dold
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria
| | | | - Joseph Zohar
- Psychiatric Division, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | | | - Daniel Souery
- School of Medicine, Free University of Brussels, Brussels, Belgium; Psy Pluriel - European Centre of Psychological Medicine, Brussels, Belgium
| | - Stuart Montgomery
- Imperial College School of Medicine, University of London, London, United Kingdom
| | - Chiara Fabbri
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy; Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, United Kingdom
| | - Alessandro Serretti
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy
| | - Siegfried Kasper
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria; Center for Brain Research, Medical University of Vienna, Vienna, Austria.
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Dold M, Bartova L, Fugger G, Kautzky A, Mitschek MMM, Fabbri C, Montgomery S, Zohar J, Souery D, Mendlewicz J, Serretti A, Kasper S. Melancholic features in major depression - a European multicenter study. Prog Neuropsychopharmacol Biol Psychiatry 2021; 110:110285. [PMID: 33609603 DOI: 10.1016/j.pnpbp.2021.110285] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 09/21/2020] [Revised: 01/31/2021] [Accepted: 02/12/2021] [Indexed: 10/22/2022]
Abstract
There is still a debate, if melancholic symptoms can be seen rather as a more severe subtype of major depressive disorder (MDD) or as a separate diagnostic entity. The present European multicenter study comprising altogether 1410 MDD in- and outpatients sought to investigate the influence of the presence of melancholic features in MDD patients. Analyses of covariance, chi-squared tests, and binary logistic regression analyses were accomplished to determine differences in socio-demographic and clinical variables between MDD patients with and without melancholia. We found a prevalence rate of 60.71% for melancholic features in MDD. Compared to non-melancholic MDD patients, they were characterized by a significantly higher likelihood for higher weight, unemployment, psychotic features, suicide risk, inpatient treatment, severe depressive symptoms, receiving add-on medication strategies in general, and adjunctive treatment with antidepressants, antipsychotics, benzodiazepine (BZD)/BZD-like drugs, low-potency antipsychotics, and pregabalin in particular. With regard to the antidepressant pharmacotherapy, we found a less frequent prescription of selective serotonin reuptake inhibitors (SSRIs) in melancholic MDD. No significant between-group differences were found for treatment response, non-response, and resistance. In summary, we explored primarily variables to be associated with melancholia which can be regarded as parameters for the presence of severe/difficult-to treat MDD conditions. Even if there is no evidence to realize any specific treatment strategy in melancholic MDD patients, their prescribed medication strategies were different from those for patients without melancholia.
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Affiliation(s)
- Markus Dold
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Lucie Bartova
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Gernot Fugger
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Alexander Kautzky
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Marleen M M Mitschek
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Chiara Fabbri
- Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, United Kingdom
| | | | - Joseph Zohar
- Psychiatric Division, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Daniel Souery
- School of Medicine, Free University of Brussels, Brussels, Belgium; Psy Pluriel - European Centre of Psychological Medicine, Brussels, Belgium
| | | | - Alessandro Serretti
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy
| | - Siegfried Kasper
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria; Center for Brain Research, Medical University of Vienna, Vienna, Austria.
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Mitschek MMM, Vanicek T, Unterholzner J, Kraus C, Weidenauer A, Naderi-Heiden A, Frey R, Silberbauer LR, Gryglewski G, Papageorgiou K, Winkler D, Dold M, Kasper S, Praschak-Rieder N, Bartova L. How to prevent and manage hyperammonemic encephalopathies in valproate therapy. Journal of Affective Disorders Reports 2021. [DOI: 10.1016/j.jadr.2021.100186] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
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Bartova L, Dold M, Fugger G, Kautzky A, Mitschek MMM, Weidenauer A, Handschuh PA, Frey R, Mandelli L, Zohar J, Mendlewicz J, Souery D, Montgomery S, Fabbri C, Serretti A, Kasper S. The Role of Relationship Status in Major Depressive Disorder - Results of the European Group for the Study of Resistant Depression. J Affect Disord 2021; 286:149-157. [PMID: 33725614 DOI: 10.1016/j.jad.2021.02.070] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 01/03/2021] [Revised: 02/17/2021] [Accepted: 02/25/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND While the association between relationship status and the development of depressive symptoms in the general population were reported previously, its relation to the severity and the course of major depressive disorder (MDD) as well as the treatment patterns and response rates needs to be elucidated. METHODS The present international multicenter cross-sectional study performed by the European Group for the Study of Resistant Depression (GSRD) investigated socio-demographic and clinical patterns of relationship status in a real-world sample of 1410 adult in- and outpatients with MDD as primary diagnosis. RESULTS While 49.9% of all MDD patients were partnered, 25.4% were separated, and 24.8% were single. Single relationship status was linked to younger mean age, earlier mean age of onset, and current suicidal risk. Being separated was related to older mean age, unemployment, greater symptom severity, current suicidal risk, and add-on treatment strategies. Partnered relationship status was associated with less frequent current suicidal risk. LIMITATIONS The retrospective assessment of treatment response that was exclusively based on psychopharmacotherapeutic strategies should be critically considered and weighed while interpreting the present results providing novel insights into the complex interaction of relationship status with the clinical phenotype of MDD. CONCLUSIONS Although MDD patients living in relationships do not seem to be omitted from the evolution of MDD, they may be spared from chronicity and suicidality. Hence, being aware of the current relationship status might support clinicians in the diagnostic and therapeutic process towards optimized management of such challenging clinical phenomena and their negative consequences.
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Affiliation(s)
- Lucie Bartova
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Markus Dold
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Gernot Fugger
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Alexander Kautzky
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | | | - Ana Weidenauer
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | | | - Richard Frey
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Laura Mandelli
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy
| | - Joseph Zohar
- Psychiatric Division, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | | | - Daniel Souery
- School of Medicine, Free University of Brussels, Brussels, Belgium; Psy Pluriel - European Centre of Psychological Medicine, Brussels, Belgium
| | - Stuart Montgomery
- Imperial College School of Medicine, University of London, London, United Kingdom
| | - Chiara Fabbri
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy; Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Alessandro Serretti
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy
| | - Siegfried Kasper
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria; Center for Brain Research, Medical University of Vienna, Vienna, Austria.
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Popper V, Unterholzner J, Bartova L, Strnad A, Baldinger-Melich P, Frey R, Fugger G. Mechanische Schutzfixierung – Herausforderungen und Management. psychopraxis neuropraxis 2021. [PMCID: PMC7871136 DOI: 10.1007/s00739-021-00701-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ZusammenfassungEinschränkungen der Bewegungsfreiheit psychiatrischer Patienten im Sinne einer mechanischen Fixierung sind in Österreich im Rahmen des Unterbringungsgesetzes zur Abwehr von Selbst- und Fremdgefährdung zulässig, sofern deren Anwendung verhältnismäßig ist. Neben rechtlichen Aspekten sind im Rahmen von Bewegungseinschränkungen auf das Krankenbett ethische Aspekte in Zusammenhang mit einem sorgfältigen klinischen Management unentbehrlich. International gibt es Bestrebungen, Zwangsmaßnahmen dieser Art in der Psychiatrie zu reduzieren. Breiter Konsensus besteht darüber, dass deren Anwendung als Ultima-Ratio-Intervention zu sehen ist, die ausschließlich in Situationen eingesetzt werden soll, die nicht durch gelindere Maßnahmen zu bewältigen sind. Die vorgestellten Fallvignetten aus der psychiatrischen Intermediate Care Station der Wiener Universitätsklinik sollen dies verdeutlichen.
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Affiliation(s)
- Valentin Popper
- Klinische Abteilung für Allgemeine Psychiatrie, Universitätsklinik für Psychiatrie und Psychotherapie, Währinger Gürtel 18–20, 1090 Wien, Österreich
| | - Jakob Unterholzner
- Klinische Abteilung für Allgemeine Psychiatrie, Universitätsklinik für Psychiatrie und Psychotherapie, Währinger Gürtel 18–20, 1090 Wien, Österreich
| | - Lucie Bartova
- Klinische Abteilung für Allgemeine Psychiatrie, Universitätsklinik für Psychiatrie und Psychotherapie, Währinger Gürtel 18–20, 1090 Wien, Österreich
| | - Alexandra Strnad
- Klinische Abteilung für Allgemeine Psychiatrie, Universitätsklinik für Psychiatrie und Psychotherapie, Währinger Gürtel 18–20, 1090 Wien, Österreich
| | - Pia Baldinger-Melich
- Klinische Abteilung für Allgemeine Psychiatrie, Universitätsklinik für Psychiatrie und Psychotherapie, Währinger Gürtel 18–20, 1090 Wien, Österreich
| | - Richard Frey
- Klinische Abteilung für Allgemeine Psychiatrie, Universitätsklinik für Psychiatrie und Psychotherapie, Währinger Gürtel 18–20, 1090 Wien, Österreich
| | - Gernot Fugger
- Klinische Abteilung für Allgemeine Psychiatrie, Universitätsklinik für Psychiatrie und Psychotherapie, Währinger Gürtel 18–20, 1090 Wien, Österreich
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Milenkovic I, Bartova L, Papageorgiou K, Kasper S, Traub-Weidinger T, Winkler D. Case Report: Bupropion Reduces the [ 123I]FP-CIT Binding to Striatal Dopamine Transporter. Front Psychiatry 2021; 12:631357. [PMID: 33692710 PMCID: PMC7937912 DOI: 10.3389/fpsyt.2021.631357] [Citation(s) in RCA: 1] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 01/29/2021] [Indexed: 11/13/2022] Open
Abstract
The diagnosis of parkinsonian syndromes in patients with severe depression may be challenging due to overlapping clinical phenomena, especially regarding psychomotor and affective symptoms. [123I]FP-CIT-SPECT is a useful method to detect degenerative parkinsonian disorders. However, some drugs may influence the tracer binding and thus alter the result. We present a case of 56-year-old female inpatient with difficult-to-treat late-onset depression. Since the current major depressive episode (MDE) was accompanied by psychotic features including delusions and hallucinations as well as hypokinesia, stooped posture and hypomimia, underlying degenerative parkinsonism was suspected. The pathologic [123I]FP-CIT-SPECT scan under ongoing antidepressant therapy with bupropion 300 mg/die (serum level of bupropion 43 ng/ml and hydroxybupropion 2,332 ng/ml) showed reduced [123I]FP-CIT binding throughout the striatum. The scan normalized upon a wash-out phase of four half-time periods (serum level of bupropion was 0.4 ng/ml and for hydroxybupropion 80.5 ng/ml). Our report should serve as a cautionary note for use of [123I]FP-CIT in depressed patients, particularly in those treated with drugs interfering with the dopamine transporter. Furthermore, our case argues for a need of consultation of a movement disorder specialist prior to dopamine transporter imaging.
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Affiliation(s)
- Ivan Milenkovic
- Department of Neurology, Medical University of Vienna, Vienna, Austria.,Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Lucie Bartova
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | | | - Siegfried Kasper
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Tatjana Traub-Weidinger
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Dietmar Winkler
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
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Kautzky A, Möller H, Dold M, Bartova L, Seemüller F, Laux G, Riedel M, Gaebel W, Kasper S. Combining machine learning algorithms for prediction of antidepressant treatment response. Acta Psychiatr Scand 2021; 143:36-49. [PMID: 33141944 PMCID: PMC7839691 DOI: 10.1111/acps.13250] [Citation(s) in RCA: 25] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 06/29/2020] [Accepted: 10/12/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Predictors for unfavorable treatment outcome in major depressive disorder (MDD) applicable for treatment selection are still lacking. The database of a longitudinal multicenter study on 1079 acutely depressed patients, performed by the German research network on depression (GRND), allows supervised and unsupervised learning to further elucidate the interplay of clinical and psycho-sociodemographic variables and their predictive impact on treatment outcome phenotypes. EXPERIMENTAL PROCEDURES Treatment response was defined by a change of HAM-D 17-item baseline score ≥50% and remission by the established threshold of ≤7, respectively, after up to eight weeks of inpatient treatment. After hierarchical symptom clustering and stratification by treatment subtypes (serotonin reuptake inhibitors, tricyclic antidepressants, antipsychotic, and lithium augmentation), prediction models for different outcome phenotypes were computed with random forest in a cross-center validation design. In total, 88 predictors were implemented. RESULTS Clustering revealed four distinct HAM-D subscores related to emotional, anxious, sleep, and appetite symptoms, respectively. After feature selection, classification models reached moderate to high accuracies up to 0.85. Highest accuracies were observed for the SSRI and TCA subgroups and for sleep and appetite symptoms, while anxious symptoms showed poor predictability. CONCLUSION Our results support a decisive role for machine learning in the management of antidepressant treatment. Treatment- and symptom-specific algorithms may increase accuracies by reducing heterogeneity. Especially, predictors related to duration of illness, baseline depression severity, anxiety and somatic symptoms, and personality traits moderate treatment success. However, prospectives application of machine learning models will be necessary to prove their value for the clinic.
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Affiliation(s)
- Alexander Kautzky
- Department of Psychiatry and PsychotherapyMedical University of ViennaViennaAustria
| | - Hans‐Juergen Möller
- Department of Psychiatry and PsychotherapyLudwig‐Maximilians‐Q3 University MunichMunichGermany
| | - Markus Dold
- Department of Psychiatry and PsychotherapyMedical University of ViennaViennaAustria
| | - Lucie Bartova
- Department of Psychiatry and PsychotherapyMedical University of ViennaViennaAustria
| | - Florian Seemüller
- Department of Psychiatry and PsychotherapyLudwig‐Maximilians‐Q3 University MunichMunichGermany,Department of Psychiatry and Psychotherapykbo‐Lech‐Mangfall‐KlinikGarmisch‐PartenkirchenGermany
| | - Gerd Laux
- Department of Psychiatry and Psychotherapykbo‐Inn‐Salzach‐KlinikumWasserburgGermany
| | - Michael Riedel
- Department of Psychiatry and PsychotherapyLudwig‐Maximilians‐Q3 University MunichMunichGermany,Department of PsychiatrySächsisches KrankenhausRodewischGermany
| | - Wolfgang Gaebel
- Department of Psychiatry and PsychotherapyMedical FacultyHeinrich‐Heine‐UniversityDüsseldorfGermany
| | - Siegfried Kasper
- Department of Psychiatry and PsychotherapyMedical University of ViennaViennaAustria
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Dold M, Bartova L, Fugger G, Mitschek MMM, Kautzky A, Frey R, Montgomery S, Zohar J, Mendlewicz J, Souery D, Fabbri C, Serretti A, Kasper S. Add-on benzodiazepine treatment in patients with major depressive disorder - results from a European cross-sectional multicenter study. Eur Neuropsychopharmacol 2020; 41:70-80. [PMID: 33046351 DOI: 10.1016/j.euroneuro.2020.09.636] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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: 05/13/2020] [Revised: 09/12/2020] [Accepted: 09/21/2020] [Indexed: 12/14/2022]
Abstract
Since many patients with major depressive disorder (MDD) do not satisfactorily respond to initial antidepressant monotherapy, add-on treatment strategies with other psychiatric compounds are often established. The present European multicenter cross-sectional study comprising 1410 MDD in- and outpatients investigated the prescription pattern of benzodiazepines as add-on treatment in the psychopharmacotherapy of MDD. Analyses of variance, chi-squared tests, and logistic regression analyses were conducted to examine differences in socio-demographic, clinical, and treatment characteristics between benzodiazepine users and non-users. The prescription rate for adjunctive benzodiazepine treatment amounted to 31.35%. The most often administered benzodiazepines were lorazepam (11.13%), clonazepam (6.74%), and alprazolam (6.60%). Benzodiazepine users exhibited more severe depressive symptoms expressed by a higher mean Montgomery and Åsberg Depression Rating Scale total score at study entry (26.92 ± 11.07 vs 23.55 ± 11.23, p<.0001) and at the beginning of the current major depressive episode (35.74 ± 8.08 vs 33.31 ± 7.40, p<.0001). Furthermore, they were characterized by a higher proportion of patients receiving additional augmentation/combination medications with antidepressants (40.95% vs 24.28%, p<.0001), antipsychotics (41.63% vs 18.39%, p<.0001), and low-potency antipsychotics (10.18% vs 4.75%, p<.0001). Moreover, benzodiazepine prescription was associated with older age, unemployment, inpatient treatment, suicide risk, psychotic and melancholic features, comorbid panic disorder, agoraphobia, social phobia, and obsessive-compulsive disorder. Taken together, our findings indicate that benzodiazepine augmentation in MDD is first of all established in severe/difficult-to-treat conditions and serves as predictor for the use of additional augmentation/combination treatment strategies.
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Affiliation(s)
- Markus Dold
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Lucie Bartova
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Gernot Fugger
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | | | - Alexander Kautzky
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Richard Frey
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Stuart Montgomery
- Imperial College School of Medicine, University of London, London, United Kingdom
| | - Joseph Zohar
- Psychiatric Division, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | | | - Daniel Souery
- School of Medicine, Free University of Brussels, Brussels, Belgium; Psy Pluriel - European Centre of Psychological Medicine, Brussels, Belgium
| | - Chiara Fabbri
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy; Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, United Kingdom
| | - Alessandro Serretti
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy
| | - Siegfried Kasper
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria; Center for Brain Research, Medical University of Vienna, Spitalgasse 4, A-1090 Vienna, Austria.
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Fugger G, Dold M, Bartova L, Mitschek MMM, Souery D, Mendlewicz J, Serretti A, Zohar J, Montgomery S, Fabbri C, Frey R, Kasper S. Clinical Correlates and Outcome of Major Depressive Disorder and Comorbid Migraine: A Report of the European Group for the Study of Resistant Depression. Int J Neuropsychopharmacol 2020; 23:571-577. [PMID: 32885810 PMCID: PMC7710912 DOI: 10.1093/ijnp/pyaa035] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 03/22/2020] [Accepted: 05/14/2020] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND The present multicenter study aimed at defining the clinical profile of patients with major depressive disorder (MDD) and comorbid migraine. METHODS Demographic and clinical information for 1410 MDD patients with vs without concurrent migraine were compared by descriptive statistics, analyses of covariance, and binary logistic regression analyses. RESULTS The point prevalence rate for comorbid migraine was 13.5% for female and 6.2% for male patients. MDD + migraine patients were significantly younger, heavier, more likely female, of non-Caucasian origin, outpatient, and suffering from asthma. The presence of MDD + migraine resulted in a significantly higher functional disability. First-line antidepressant treatment strategy revealed a trend towards agomelatine. Second-generation antipsychotics were significantly less often administered for augmentation treatment in migraineurs. Overall, MDD + migraine patients tended to respond worse to their pharmacotherapy. CONCLUSION Treatment guidelines for comorbid depression and migraine are warranted to ensure optimal efficacy and avoid possible pitfalls in psychopharmacotherapy, including serotonin syndrome.
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Affiliation(s)
- Gernot Fugger
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Markus Dold
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Lucie Bartova
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Marleen M M Mitschek
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Daniel Souery
- Université Libre de Bruxelles, Bruxelles, Belgium,Psy Pluriel Centre Européen de Psychologie Médicale, Bruxelles, Belgium
| | | | - Alessandro Serretti
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy
| | - Joseph Zohar
- Psychiatric Division, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | | | - Chiara Fabbri
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy,Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, United Kingdom
| | - Richard Frey
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Siegfried Kasper
- Center for Brain Research, Medical University of Vienna, Vienna, Austria,Correspondence: Siegfried Kasper, MD, Medical University of Vienna, Center for Brain Research, Spitalgasse 4, A-1090 Vienna, Austria ()
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Dold M, Bartova L, Kasper S. Treatment Response of Add-On Esketamine Nasal Spray in Resistant Major Depression in Relation to Add-On Second-Generation Antipsychotic Treatment. Int J Neuropsychopharmacol 2020; 23:440-445. [PMID: 32570275 PMCID: PMC7387762 DOI: 10.1093/ijnp/pyaa034] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [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] [Received: 02/14/2020] [Revised: 04/27/2020] [Accepted: 05/18/2020] [Indexed: 12/17/2022] Open
Abstract
In this meta-analysis, we aimed to estimate and compare the efficacy of add-on treatment of antidepressants with esketamine nasal spray and second-generation antipsychotics in patients with nonpsychotic major depressive disorder and inadequate response to antidepressants. Searching for acute-phase, double-blind, placebo-controlled, randomized trials, we found 22 second-generation antipsychotic (n = 8363) and 3 intranasal esketamine (n = 641) studies. Mean change in the Montgomery Åsberg Depression Rating Scale total score served as outcome. We determined a higher mean difference (vs placebo) for the pooled esketamine nasal spray trials (mean difference = 4.09, 95% confidence interval: 2.01 to 6.17) than for the pooled second-generation antipsychotic augmentation trials (mean difference = 2.05, 95% confidence interval: 1.51 to 2.59). Thus, the effect size for intranasal esketamine was nearly twice as high as those for the second-generation antipsychotics. This indicates high efficacy of add-on esketamine nasal spray in treatment-resistant major depressive disorder compared with other well-established, evidence-based pharmacological options such as augmentation with second-generation antipsychotics.
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Affiliation(s)
- Markus Dold
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Lucie Bartova
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Siegfried Kasper
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
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Weidenauer A, Bauer M, Sauerzopf U, Bartova L, Nics L, Pfaff S, Philippe C, Berroterán-Infante N, Pichler V, Meyer BM, Rabl U, Sezen P, Cumming P, Stimpfl T, Sitte HH, Lanzenberger R, Mossaheb N, Zimprich A, Rusjan P, Dorffner G, Mitterhauser M, Hacker M, Pezawas L, Kasper S, Wadsak W, Praschak-Rieder N, Willeit M. On the relationship of first-episode psychosis to the amphetamine-sensitized state: a dopamine D 2/3 receptor agonist radioligand study. Transl Psychiatry 2020; 10:2. [PMID: 32066718 PMCID: PMC7026156 DOI: 10.1038/s41398-019-0681-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [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: 09/02/2019] [Revised: 10/01/2019] [Accepted: 11/01/2019] [Indexed: 12/21/2022] Open
Abstract
Schizophrenia is characterized by increased behavioral and neurochemical responses to dopamine-releasing drugs. This prompted the hypothesis of psychosis as a state of "endogenous" sensitization of the dopamine system although the exact basis of dopaminergic disturbances and the possible role of prefrontal cortical regulation have remained uncertain. To show that patients with first-episode psychosis release more dopamine upon amphetamine-stimulation than healthy volunteers, and to reveal for the first time that prospective sensitization induced by repeated amphetamine exposure increases dopamine-release in stimulant-naïve healthy volunteers to levels observed in patients, we collected data on amphetamine-induced dopamine release using the dopamine D2/3 receptor agonist radioligand [11C]-(+)-PHNO and positron emission tomography. Healthy volunteers (n = 28, 14 female) underwent a baseline and then a post-amphetamine scan before and after a mildly sensitizing regimen of repeated oral amphetamine. Unmedicated patients with first-episode psychosis (n = 21; 6 female) underwent a single pair of baseline and then post-amphetamine scans. Furthermore, T1 weighted magnetic resonance imaging of the prefrontal cortex was performed. Patients with first-episode psychosis showed larger release of dopamine compared to healthy volunteers. After sensitization of healthy volunteers their dopamine release was significantly amplified and no longer different from that seen in patients. Healthy volunteers showed a negative correlation between prefrontal cortical volume and dopamine release. There was no such relationship after sensitization or in patients. Our data in patients with untreated first-episode psychosis confirm the "endogenous sensitization" hypothesis and support the notion of impaired prefrontal control of the dopamine system in schizophrenia.
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Affiliation(s)
- Ana Weidenauer
- Department of Psychiatry and Psychotherapy, Division of General Psychiatry, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Martin Bauer
- Department of Psychiatry and Psychotherapy, Division of General Psychiatry, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Ulrich Sauerzopf
- Department of Psychiatry and Psychotherapy, Division of General Psychiatry, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Lucie Bartova
- Department of Psychiatry and Psychotherapy, Division of General Psychiatry, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Lukas Nics
- Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Sarah Pfaff
- Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Cecile Philippe
- Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Neydher Berroterán-Infante
- Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Verena Pichler
- Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Bernhard M Meyer
- Department of Psychiatry and Psychotherapy, Division of General Psychiatry, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Ulrich Rabl
- Department of Psychiatry and Psychotherapy, Division of General Psychiatry, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Patrick Sezen
- Department of Psychiatry and Psychotherapy, Division of General Psychiatry, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Paul Cumming
- School of Psychology and Counseling and IHBI, Queensland University of Technology, Brisbane, Australia
- Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thomas Stimpfl
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Harald H Sitte
- Institute of Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Rupert Lanzenberger
- Department of Psychiatry and Psychotherapy, Division of General Psychiatry, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Nilufar Mossaheb
- Department of Psychiatry and Psychotherapy, Division of Social Psychiatry, Medical University of Vienna, Vienna, Austria
| | | | - Pablo Rusjan
- Research Imaging Centre, Centre for Addiction and Mental Health, University of Toronto, Toronto, Canada
| | - Georg Dorffner
- Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Markus Mitterhauser
- Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute Applied Diagnostics, Vienna, Austria
| | - Marcus Hacker
- Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Lukas Pezawas
- Department of Psychiatry and Psychotherapy, Division of General Psychiatry, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Siegfried Kasper
- Department of Psychiatry and Psychotherapy, Division of General Psychiatry, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Wolfgang Wadsak
- Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Nicole Praschak-Rieder
- Department of Psychiatry and Psychotherapy, Division of General Psychiatry, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Matthäus Willeit
- Department of Psychiatry and Psychotherapy, Division of General Psychiatry, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
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Fugger G, Dold M, Bartova L, Kautzky A, Souery D, Mendlewicz J, Serretti A, Zohar J, Montgomery S, Frey R, Kasper S. Major Depression and Comorbid Diabetes - Findings from the European Group for the Study of Resistant Depression. Prog Neuropsychopharmacol Biol Psychiatry 2019; 94:109638. [PMID: 31054944 DOI: 10.1016/j.pnpbp.2019.109638] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 04/01/2019] [Accepted: 04/30/2019] [Indexed: 02/08/2023]
Abstract
OBJECTIVE The major aim of this multicenter study of the European Group for the Study of Resistant Depression (GSRD) was to elucidate associations between major depressive disorder (MDD) and comorbid diabetes. METHODS Demographic and clinical information of 1410 patients with a primary MDD diagnosis according to DSM-IV were retrieved cross-sectionally between 2012 and 2016. By applying descriptive statistics, analyses of covariance (ANCOVA) and binary logistic regression analyses, a comparison between patient characteristics with and without comorbid diabetes was performed. RESULTS The point prevalence rate for comorbid diabetes across MDD patients was 6%. Individuals with MDD + comorbid diabetes were significantly older, heavier, more likely to be inpatient and diagnosed with additional comorbid chronic somatic diseases. In addition, current suicide risk was significantly increased and melancholic features were more likely pronounced. In general, patients in the MDD + diabetes group received a combination therapy with at least one additional antidepressant rather than various other augmentation strategies. CONCLUSION Our analyses depict a lower prevalence rate of diabetes in MDD patients than previous studies. However, in light of the prevalence of diabetes in the geographical area of the study, we found an increased risk for individuals with depression compared to the general population. Current suicide risk is markedly elevated and has to be thoroughly assessed in every patient with comorbid diabetes. Depression severity and treatment response remained unaffected by concurrent diabetes in MDD.
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Affiliation(s)
- Gernot Fugger
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Markus Dold
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Lucie Bartova
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Alexander Kautzky
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Daniel Souery
- Université Libre de Bruxelles, Bruxelles, Belgium; Psy Pluriel Centre Européen de Psychologie Médicale, Bruxelles, Belgium
| | | | - Alessandro Serretti
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy
| | - Joseph Zohar
- Psychiatric Division, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | | | - Richard Frey
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Siegfried Kasper
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria.
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Kautzky A, Dold M, Bartova L, Spies M, Vanicek T, Souery D, Montgomery S, Mendlewicz J, Zohar J, Fabbri C, Serretti A, Lanzenberger R, Kasper S. Refining Prediction in Treatment-Resistant Depression: Results of Machine Learning Analyses in the TRD III Sample. J Clin Psychiatry 2019; 79. [PMID: 29228516 DOI: 10.4088/jcp.16m11385] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [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: 12/06/2016] [Accepted: 10/11/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The study objective was to generate a prediction model for treatment-resistant depression (TRD) using machine learning featuring a large set of 47 clinical and sociodemographic predictors of treatment outcome. METHOD 552 Patients diagnosed with major depressive disorder (MDD) according to DSM-IV criteria were enrolled between 2011 and 2016. TRD was defined as failure to reach response to antidepressant treatment, characterized by a Montgomery-Asberg Depression Rating Scale (MADRS) score below 22 after at least 2 antidepressant trials of adequate length and dosage were administered. RandomForest (RF) was used for predicting treatment outcome phenotypes in a 10-fold cross-validation. RESULTS The full model with 47 predictors yielded an accuracy of 75.0%. When the number of predictors was reduced to 15, accuracies between 67.6% and 71.0% were attained for different test sets. The most informative predictors of treatment outcome were baseline MADRS score for the current episode; impairment of family, social, and work life; the timespan between first and last depressive episode; severity; suicidal risk; age; body mass index; and the number of lifetime depressive episodes as well as lifetime duration of hospitalization. CONCLUSIONS With the application of the machine learning algorithm RF, an efficient prediction model with an accuracy of 75.0% for forecasting treatment outcome could be generated, thus surpassing the predictive capabilities of clinical evaluation. We also supply a simplified algorithm of 15 easily collected clinical and sociodemographic predictors that can be obtained within approximately 10 minutes, which reached an accuracy of 70.6%. Thus, we are confident that our model will be validated within other samples to advance an accurate prediction model fit for clinical usage in TRD.
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Affiliation(s)
- Alexander Kautzky
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Markus Dold
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Lucie Bartova
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Marie Spies
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Thomas Vanicek
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Daniel Souery
- Université Libre de Bruxelles and Psy Pluriel Centre Europèen de Psychologie Medicale, Brussels, Belgium
| | | | | | - Joseph Zohar
- Psychiatric Division, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Chiara Fabbri
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Alessandro Serretti
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Rupert Lanzenberger
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Siegfried Kasper
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria. .,Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
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Bartova L, Dold M, Kautzky A, Fabbri C, Spies M, Serretti A, Souery D, Mendlewicz J, Zohar J, Montgomery S, Schosser A, Kasper S. Results of the European Group for the Study of Resistant Depression (GSRD) - basis for further research and clinical practice. World J Biol Psychiatry 2019; 20:427-448. [PMID: 31340696 DOI: 10.1080/15622975.2019.1635270] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [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: 10/26/2022]
Abstract
Objectives: The overview outlines two decades of research from the European Group for the Study of Resistant Depression (GSRD) that fundamentally impacted evidence-based algorithms for diagnostics and psychopharmacotherapy of treatment-resistant depression (TRD). Methods: The GSRD staging model characterising response, non-response and resistance to antidepressant (AD) treatment was applied to 2762 patients in eight European countries. Results: In case of non-response, dose escalation and switching between different AD classes did not show superiority over continuation of original AD treatment. Predictors for TRD were symptom severity, duration of the current major depressive episode (MDE), suicidality, psychotic and melancholic features, comorbid anxiety and personality disorders, add-on treatment, non-response to the first AD, adverse effects, high occupational level, recurrent disease course, previous hospitalisations, positive family history of MDD, early age of onset and novel associations of single nucleoid polymorphisms (SNPs) within the PPP3CC, ST8SIA2, CHL1, GAP43 and ITGB3 genes and gene pathways associated with neuroplasticity, intracellular signalling and chromatin silencing. A prediction model reaching accuracy of above 0.7 highlighted symptom severity, suicidality, comorbid anxiety and lifetime MDEs as the most informative predictors for TRD. Applying machine-learning algorithms, a signature of three SNPs of the BDNF, PPP3CC and HTR2A genes and lacking melancholia predicted treatment response. Conclusions: The GSRD findings offer a unique and balanced perspective on TRD representing foundation for further research elaborating on specific clinical and genetic hypotheses and treatment strategies within appropriate study-designs, especially interaction-based models and randomized controlled trials.
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Affiliation(s)
- Lucie Bartova
- Department of Psychiatry and Psychotherapy, Medical University of Vienna , Vienna , Austria
| | - Markus Dold
- Department of Psychiatry and Psychotherapy, Medical University of Vienna , Vienna , Austria
| | - Alexander Kautzky
- Department of Psychiatry and Psychotherapy, Medical University of Vienna , Vienna , Austria
| | - Chiara Fabbri
- Department of Biomedical and NeuroMotor Sciences, University of Bologna , Bologna , Italy.,Institute of Psychiatry, Psychology and Neuroscience, King's College London , London , United Kingdom
| | - Marie Spies
- Department of Psychiatry and Psychotherapy, Medical University of Vienna , Vienna , Austria
| | - Alessandro Serretti
- Department of Biomedical and NeuroMotor Sciences, University of Bologna , Bologna , Italy
| | | | | | - Joseph Zohar
- Psychiatric Division, Chaim Sheba Medical Center , Tel Hashomer , Israel
| | | | - Alexandra Schosser
- Department of Psychiatry and Psychotherapy, Medical University of Vienna , Vienna , Austria.,Zentrum für seelische Gesundheit Leopoldau, BBRZ-MED , Vienna , Austria
| | - Siegfried Kasper
- Department of Psychiatry and Psychotherapy, Medical University of Vienna , Vienna , Austria
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Fugger G, Dold M, Bartova L, Kautzky A, Souery D, Mendlewicz J, Serretti A, Zohar J, Montgomery S, Frey R, Kasper S. Comorbid hypertension in patients with major depressive disorder - Results from a European multicenter study. Eur Neuropsychopharmacol 2019; 29:777-785. [PMID: 31006562 DOI: 10.1016/j.euroneuro.2019.03.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [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: 11/14/2018] [Revised: 02/19/2019] [Accepted: 03/02/2019] [Indexed: 12/27/2022]
Abstract
The objective of the present multicenter study was to elucidate relevant associations between major depressive disorder (MDD) and comorbid hypertension that are known for their frequent co-occurrence and interaction with regard to functional disability. Demographic and clinical information of altogether 1410 patients were retrieved cross-sectionally. Consecutively, a comparison of patient characteristics between MDD subjects with and without comorbid hypertension were conducted by descriptive statistics, analyses of covariance (ANCOVA) and binary logistic regression analyses. The point prevalence rate for comorbid hypertension was 18.9%. Patients with MDD+comorbid hypertension were significantly older, heavier, more likely to be in a relationship, inpatient and diagnosed with further comorbid chronic somatic diseases including heart disease, diabetes and thyroid dysfunction. In addition, individuals with MDD and comorbid hypertension exhibited a higher score at the Montgomery and Åsberg Depression Rating Scale (MADRS) at onset of the current depressive episode. Melancholic features of depression showed a higher probability. The first line antidepressant treatment did not differ significantly between MDD subjects with versus without comorbid hypertension. Augmentation with pregabalin and combination with one additional antidepressant, however, were more common in the MDD+hypertension group. In conclusion, high blood pressure may influence illness severity and is associated with a distinct psychopathology in MDD patients. Patients with MDD and comorbid hypertension, that seems to be underdiagnosed in MDD patients compared to the general population, are subject to additional somatic diseases in almost 100 percent of the cases and hence, need to be screened and treated accordingly.
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Affiliation(s)
- Gernot Fugger
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria
| | - Markus Dold
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria
| | - Lucie Bartova
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria
| | - Alexander Kautzky
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria
| | - Daniel Souery
- Université Libre de Bruxelles, Bruxelles, Belgium; Psy Pluriel Centre Européen de Psychologie Médicale, Bruxelles, Belgium
| | | | - Alessandro Serretti
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy
| | - Joseph Zohar
- Psychiatric Division, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | | | - Richard Frey
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria
| | - Siegfried Kasper
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria.
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Meyer BM, Rabl U, Huemer J, Bartova L, Kalcher K, Provenzano J, Brandner C, Sezen P, Kasper S, Schatzberg AF, Moser E, Chen G, Pezawas L. Prefrontal networks dynamically related to recovery from major depressive disorder: a longitudinal pharmacological fMRI study. Transl Psychiatry 2019; 9:64. [PMID: 30718459 PMCID: PMC6362173 DOI: 10.1038/s41398-019-0395-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 01/03/2019] [Accepted: 01/10/2019] [Indexed: 12/28/2022] Open
Abstract
Due to lacking predictors of depression recovery, successful treatment of major depressive disorder (MDD) is frequently only achieved after therapeutic optimization leading to a prolonged suffering of patients. This study aimed to determine neural prognostic predictors identifying non-remitters prior or early after treatment initiation. Moreover, it intended to detect time-sensitive neural mediators indicating depression recovery. This longitudinal, interventional, single-arm, open-label, phase IV, pharmacological functional magnetic resonance imaging (fMRI) study comprised four scans at important stages prior (day 0) and after escitalopram treatment initiation (day 1, 28, and 56). Totally, 22 treatment-free MDD patients (age mean ± SD: 31.5 ± 7.7; females: 50%) suffering from a concurrent major depressive episode without any comorbid DSM-IV axis I diagnosis completed the study protocol. Primary outcome were neural prognostic predictors of depression recovery. Enhanced de-activation of anterior medial prefrontal cortex (amPFC, single neural mediator) indicated depression recovery correlating with MADRS score and working memory improvements. Strong dorsolateral PFC (dlPFC) activation and weak dlPFC-amPFC, dlPFC-posterior cingulate cortex (PCC), dlPFC-parietal lobe (PL) coupling (three prognostic predictors) hinted at depression recovery at day 0 and 1. Preresponse prediction of continuous (dlPFC-PL: R2day1 = 55.9%, 95% CI: 22.6-79%, P < 0.005) and dichotomous (specificity/sensitivity: SP/SNday1 = 0.91/0.82) recovery definitions remained significant after leave-one-out cross-validation. Identified prefrontal neural predictors might propel the future development of fMRI markers for clinical decision making, which could lead to increased response rates and adherence during acute phase treatment periods. Moreover, this study underscores the importance of the amPFC in depression recovery.
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Affiliation(s)
- Bernhard M. Meyer
- 0000 0000 9259 8492grid.22937.3dDivision of General Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Ulrich Rabl
- 0000 0000 9259 8492grid.22937.3dDivision of General Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Julia Huemer
- 0000 0000 9259 8492grid.22937.3dDepartment of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Lucie Bartova
- 0000 0000 9259 8492grid.22937.3dDivision of General Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Klaudius Kalcher
- 0000 0000 9259 8492grid.22937.3dMR Centre of Excellence, Medical University of Vienna, Vienna, Austria ,0000 0000 9259 8492grid.22937.3dCenter for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Julian Provenzano
- 0000 0000 9259 8492grid.22937.3dDivision of General Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Christoph Brandner
- 0000 0000 9259 8492grid.22937.3dDivision of General Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Patrick Sezen
- 0000 0000 9259 8492grid.22937.3dDivision of General Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Siegfried Kasper
- 0000 0000 9259 8492grid.22937.3dDivision of General Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Alan F. Schatzberg
- 0000000419368956grid.168010.eDepartment of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA USA
| | - Ewald Moser
- 0000 0000 9259 8492grid.22937.3dMR Centre of Excellence, Medical University of Vienna, Vienna, Austria ,0000 0000 9259 8492grid.22937.3dCenter for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Gang Chen
- 0000 0004 0464 0574grid.416868.5Scientific and Statistical Computational Core, National Institute of Mental Health, Bethesda, MA USA
| | - Lukas Pezawas
- Division of General Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria.
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Dold M, Bartova L, Kautzky A, Porcelli S, Montgomery S, Zohar J, Mendlewicz J, Souery D, Serretti A, Kasper S. Psychotic Features in Patients With Major Depressive Disorder: A Report From the European Group for the Study of Resistant Depression. J Clin Psychiatry 2019; 80. [PMID: 30677267 DOI: 10.4088/jcp.17m12090] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [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: 12/17/2017] [Accepted: 07/16/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To elucidate the impact of the presence of psychotic features in patients diagnosed with major depressive disorder (MDD) on sociodemographic, psychosocial, clinical, and response characteristics. METHODS A total of 1,410 DSM-IV-TR MDD patients were included in the present European multicenter study, which was conducted between 2011 and 2016. Analyses of covariance, χ² tests, and binary logistic regression analyses were performed to explore differences in sociodemographic and clinical variables between MDD patients with and without psychotic symptoms. RESULTS A prevalence rate of 10.92% for psychotic features was found in MDD. Compared to nonpsychotic MDD patients, those with psychotic features were characterized by a higher likelihood for melancholic characteristics (73.38% vs 59.16%, P = .0006), a higher rate of current suicide risk (60.39% vs 44.27%, P = .0002), greater likelihood of receiving inpatient treatment (55.84% vs 32.01%, P < .0001), greater depressive symptom severity (measured by various rating scales), and more often receiving augmentation/combination treatment strategies in general (81.17% vs 58.12%, P < .0001) and add-on therapy with antipsychotics (50.00% vs 22.69%, P < .0001) and benzodiazepines (47.40% vs 31.29%, P = .0001) in particular. Moreover, psychotic symptoms in MDD were highly predictive of treatment resistance, expressed by a more than 2.2-fold higher likelihood for resistance compared to nonpsychotic MDD patients (79.87% vs 35.75%, P < .0001). Only 3.25% of the patients with psychotic MDD achieved treatment response (vs 27.15% of those with nonpsychotic MDD, P < .0001). CONCLUSIONS These findings suggest that adequate diagnosis of psychotic features in MDD should be ensured in routine clinical care. As a combination of antipsychotics and antidepressants represents the first-line treatment option in psychotic MDD, the finding of a 2-fold higher prescription rate for antipsychotic drugs in psychotic versus nonpsychotic MDD patients reflects the current evidence.
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Affiliation(s)
- Markus Dold
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Lucie Bartova
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Alexander Kautzky
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Stefano Porcelli
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy
| | | | - Joseph Zohar
- Psychiatric Division, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | | | - Daniel Souery
- School of Medicine, Free University of Brussels, Brussels, Belgium.,Psy Pluriel-European Centre of Psychological Medicine, Brussels, Belgium
| | - Alessandro Serretti
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy
| | - Siegfried Kasper
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria. .,Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
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Fabbri C, Kasper S, Kautzky A, Bartova L, Dold M, Zohar J, Souery D, Montgomery S, Albani D, Raimondi I, Dikeos D, Rujescu D, Uher R, Lewis CM, Mendlewicz J, Serretti A. Genome-wide association study of treatment-resistance in depression and meta-analysis of three independent samples. Br J Psychiatry 2019; 214:36-41. [PMID: 30468137 DOI: 10.1192/bjp.2018.256] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [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: 01/08/2023]
Abstract
BACKGROUND Treatment-resistant depression (TRD) is the most problematic outcome of depression in terms of functional impairment, suicidal thoughts and decline in physical health.AimsTo investigate the genetic predictors of TRD using a genome-wide approach to contribute to the development of precision medicine. METHOD A sample recruited by the European Group for the Study of Resistant Depression (GSRD) including 1148 patients with major depressive disorder (MDD) was characterised for the occurrence of TRD (lack of response to at least two adequate antidepressant treatments) and genotyped using the Infinium PsychArray. Three clinically relevant patient groups were considered: TRD, responders and non-responders to the first antidepressant trial, thus outcomes were based on comparisons of these groups. Genetic analyses were performed at the variant, gene and gene-set (i.e. functionally related genes) level. Additive regression models of the outcomes and relevant covariates were used in the GSRD participants and in a fixed-effect meta-analysis performed between GSRD, STAR*D (n = 1316) and GENDEP (n = 761) participants. RESULTS No individual polymorphism or gene was associated with TRD, although some suggestive signals showed enrichment in cytoskeleton regulation, transcription modulation and calcium signalling. Two gene sets (GO:0043949 and GO:0000183) were associated with TRD versus response and TRD versus response and non-response to the first treatment in the GSRD participants and in the meta-analysis, respectively (corrected P = 0.030 and P = 0.027). CONCLUSIONS The identified gene sets are involved in cyclic adenosine monophosphate mediated signal and chromatin silencing, two processes previously implicated in antidepressant action. They represent possible biomarkers to implement personalised antidepressant treatments and targets for new antidepressants.Declaration of interestD.S. has received grant/research support from GlaxoSmithKline and Lundbeck; has served as a consultant or on advisory boards for AstraZeneca, Bristol-Myers Squibb, Eli Lilly, Janssen and Lundbeck. S.M. has been a consultant or served on advisory boards for: AstraZeneca, Bristol-Myers Squibb, Forest, Johnson & Johnson, Leo, Lundbeck, Medelink, Neurim, Pierre Fabre, Richter. S.K. has received grant/research support from Eli Lilly, Lundbeck, Bristol-Myers Squibb, GlaxoSmithKline, Organon, Sepracor and Servier; has served as a consultant or on advisory boards for AstraZeneca, Bristol-Myers Squibb, GlaxoSmithKline, Eli Lilly, Lundbeck, Pfizer, Organon, Schwabe, Sepracor, Servier, Janssen and Novartis; and has served on speakers' bureaus for AstraZeneca, Eli Lily, Lundbeck, Schwabe, Sepracor, Servier, Pierre Fabre, Janssen and Neuraxpharm. J.Z. has received grant/research support from Lundbeck, Servier, Brainsway and Pfizer, has served as a consultant or on advisory boards for Servier, Pfizer, Abbott, Lilly, Actelion, AstraZeneca and Roche and has served on speakers' bureaus for Lundbeck, Roch, Lilly, Servier, Pfizer and Abbott. J.M. is a member of the Board of the Lundbeck International Neuroscience Foundation and of Advisory Board of Servier. A.S. is or has been consultant/speaker for: Abbott, AbbVie, Angelini, Astra Zeneca, Clinical Data, Boehringer, Bristol Myers Squibb, Eli Lilly, GlaxoSmithKline, Innovapharma, Italfarmaco, Janssen, Lundbeck, Naurex, Pfizer, Polifarma, Sanofi and Servier. C.M.L. receives research support from RGA UK Services Limited.
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Affiliation(s)
- Chiara Fabbri
- Research Fellow,Department of Biomedical and NeuroMotor Sciences,University of Bologna,ItalyandInstitute of Psychiatry, Psychology and Neuroscience,King's College London,UK
| | - Siegfried Kasper
- Professor,Department of Psychiatry and Psychotherapy,Medical University Vienna,Austria
| | - Alexander Kautzky
- PhD Student,Department of Psychiatry and Psychotherapy,Medical University Vienna,Austria
| | - Lucie Bartova
- PhD Student,Department of Psychiatry and Psychotherapy,Medical University Vienna,Austria
| | - Markus Dold
- Associate Professor,Department of Psychiatry and Psychotherapy,Medical University Vienna,Austria
| | - Joseph Zohar
- Professor,Department of Psychiatry,Sheba Medical Center and Sackler School of Medicine,Tel Aviv University,Israel
| | - Daniel Souery
- Director,Laboratoire de Psychologie Medicale,Universitè Libre de Bruxelles and Psy Pluriel,Centre Européen de Psychologie Medicale,Brussels,Belgium
| | | | - Diego Albani
- Director,Unità Genetica delle Malattie Neurodegenerative, Istituto di Ricerche Farmacologiche Mario Negri IRCCS,Italy
| | - Ilaria Raimondi
- Research Fellow,Unità Genetica delle Malattie Neurodegenerative, Istituto di Ricerche Farmacologiche Mario Negri IRCCS,Italy
| | - Dimitris Dikeos
- Professor,Department of Psychiatry,Athens University Medical School,Greece
| | - Dan Rujescu
- Professor,University Clinic for Psychiatry, Psychotherapy and Psychosomatic, Martin-Luther-University Halle-Wittenberg,Germany
| | - Rudolf Uher
- Professor,Department of Psychiatry,Dalhousie University,Canada
| | - Cathryn M Lewis
- Professor,Institute of Psychiatry, Psychology and Neuroscience,King's College London,UK
| | | | - Alessandro Serretti
- Professor,Department of Biomedical and NeuroMotor Sciences,University of Bologna,Italy
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Kautzky A, Dold M, Bartova L, Spies M, Kranz GS, Souery D, Montgomery S, Mendlewicz J, Zohar J, Fabbri C, Serretti A, Lanzenberger R, Dikeos D, Rujescu D, Kasper S. Clinical factors predicting treatment resistant depression: affirmative results from the European multicenter study. Acta Psychiatr Scand 2019; 139:78-88. [PMID: 30291625 PMCID: PMC6586002 DOI: 10.1111/acps.12959] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [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] [Accepted: 08/15/2018] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Clinical variables were investigated in the 'treatment resistant depression (TRD)- III' sample to replicate earlier findings by the European research consortium 'Group for the Study of Resistant Depression' (GSRD) and enable cross-sample prediction of treatment outcome in TRD. EXPERIMENTAL PROCEDURES TRD was defined by a Montgomery and Åsberg Depression Rating Scale (MADRS) score ≥22 after at least two antidepressive trials. Response was defined by a decline in MADRS score by ≥50% and below a threshold of 22. Logistic regression was applied to replicate predictors for TRD among 16 clinical variables in 916 patients. Elastic net regression was applied for prediction of treatment outcome. RESULTS Symptom severity (odds ratio (OR) = 3.31), psychotic symptoms (OR = 2.52), suicidal risk (OR = 1.74), generalized anxiety disorder (OR = 1.68), inpatient status (OR = 1.65), higher number of antidepressants administered previously (OR = 1.23), and lifetime depressive episodes (OR = 1.15) as well as longer duration of the current episode (OR = 1.022) increased the risk of TRD. Prediction of TRD reached an accuracy of 0.86 in the independent validation set, TRD-I. CONCLUSION Symptom severity, suicidal risk, higher number of lifetime depressive episodes, and comorbid anxiety disorder were replicated as the most prominent risk factors for TRD. Significant predictors in TRD-III enabled robust prediction of treatment outcome in TRD-I.
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Affiliation(s)
- A. Kautzky
- Department of Psychiatry and PsychotherapyMedical University of ViennaViennaAustria
| | - M. Dold
- Department of Psychiatry and PsychotherapyMedical University of ViennaViennaAustria
| | - L. Bartova
- Department of Psychiatry and PsychotherapyMedical University of ViennaViennaAustria
| | - M. Spies
- Department of Psychiatry and PsychotherapyMedical University of ViennaViennaAustria
| | - G. S. Kranz
- Department of Psychiatry and PsychotherapyMedical University of ViennaViennaAustria,Department of Rehabilitation SciencesThe Hong Kong Polytechnic UniversityHung HomHong Kong
| | - D. Souery
- Universit_e Libre de Bruxelles and Psy Pluriel Centre Europ_een de Psychologie MedicaleBrusselsBelgium
| | | | - J. Mendlewicz
- School of MedicineFree University of BrusselsBrusselsBelgium
| | - J. Zohar
- Psychiatric DivisionChaim Sheba Medical CenterRamat GanIsrael
| | - C. Fabbri
- Department of Biomedical and NeuroMotor SciencesUniversity of BolognaBolognaItaly
| | - A. Serretti
- Department of Biomedical and NeuroMotor SciencesUniversity of BolognaBolognaItaly
| | - R. Lanzenberger
- Department of Psychiatry and PsychotherapyMedical University of ViennaViennaAustria
| | - D. Dikeos
- Department of PsychiatryAthens University Medical SchoolAthensGreece
| | - D. Rujescu
- University Clinic for Psychiatry, Psychotherapy and PsychosomaticMartin‐Luther‐University Halle‐WittenbergHalleGermany
| | - S. Kasper
- Department of Psychiatry and PsychotherapyMedical University of ViennaViennaAustria
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Caraci F, Calabrese F, Molteni R, Bartova L, Dold M, Leggio GM, Fabbri C, Mendlewicz J, Racagni G, Kasper S, Riva MA, Drago F. International Union of Basic and Clinical Pharmacology CIV: The Neurobiology of Treatment-resistant Depression: From Antidepressant Classifications to Novel Pharmacological Targets. Pharmacol Rev 2018; 70:475-504. [PMID: 29884653 DOI: 10.1124/pr.117.014977] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Major depressive disorder is one of the most prevalent and life-threatening forms of mental illnesses and a major cause of morbidity worldwide. Currently available antidepressants are effective for most patients, although around 30% are considered treatment resistant (TRD), a condition that is associated with a significant impairment of cognitive function and poor quality of life. In this respect, the identification of the molecular mechanisms contributing to TRD represents an essential step for the design of novel and more efficacious drugs able to modify the clinical course of this disorder and increase remission rates in clinical practice. New insights into the neurobiology of TRD have shed light on the role of a number of different mechanisms, including the glutamatergic system, immune/inflammatory systems, neurotrophin function, and epigenetics. Advances in drug discovery processes in TRD have also influenced the classification of antidepressant drugs and novel classifications are available, such as the neuroscience-based nomenclature that can incorporate such advances in drug development for TRD. This review aims to provide an up-to-date description of key mechanisms in TRD and describe current therapeutic strategies for TRD before examining novel approaches that may ultimately address important neurobiological mechanisms not targeted by currently available antidepressants. All in all, we suggest that drug targeting different neurobiological systems should be able to restore normal function but must also promote resilience to reduce the long-term vulnerability to recurrent depressive episodes.
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Affiliation(s)
- F Caraci
- Departments of Drug Sciences (F.Car.) and Biomedical and Biotechnological Sciences, School of Medicine (G.M.L., F.D.), University of Catania, Catania, Italy; Oasi-Research-Institute-IRCCS, Troina, Italy (F.Car.); Departments of Pharmacological and Biomolecular Sciences (F.Cal., G.R., M.A.R.) and Medical Biotechnology and Translational Medicine (R.M.), Università degli Studi di Milano, Milan, Italy; Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria (L.B., M.D., S.K.); Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy (C.F.); and School of Medicine, Universite' Libre de Bruxelles, Bruxelles, Belgium (J.M.)
| | - F Calabrese
- Departments of Drug Sciences (F.Car.) and Biomedical and Biotechnological Sciences, School of Medicine (G.M.L., F.D.), University of Catania, Catania, Italy; Oasi-Research-Institute-IRCCS, Troina, Italy (F.Car.); Departments of Pharmacological and Biomolecular Sciences (F.Cal., G.R., M.A.R.) and Medical Biotechnology and Translational Medicine (R.M.), Università degli Studi di Milano, Milan, Italy; Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria (L.B., M.D., S.K.); Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy (C.F.); and School of Medicine, Universite' Libre de Bruxelles, Bruxelles, Belgium (J.M.)
| | - R Molteni
- Departments of Drug Sciences (F.Car.) and Biomedical and Biotechnological Sciences, School of Medicine (G.M.L., F.D.), University of Catania, Catania, Italy; Oasi-Research-Institute-IRCCS, Troina, Italy (F.Car.); Departments of Pharmacological and Biomolecular Sciences (F.Cal., G.R., M.A.R.) and Medical Biotechnology and Translational Medicine (R.M.), Università degli Studi di Milano, Milan, Italy; Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria (L.B., M.D., S.K.); Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy (C.F.); and School of Medicine, Universite' Libre de Bruxelles, Bruxelles, Belgium (J.M.)
| | - L Bartova
- Departments of Drug Sciences (F.Car.) and Biomedical and Biotechnological Sciences, School of Medicine (G.M.L., F.D.), University of Catania, Catania, Italy; Oasi-Research-Institute-IRCCS, Troina, Italy (F.Car.); Departments of Pharmacological and Biomolecular Sciences (F.Cal., G.R., M.A.R.) and Medical Biotechnology and Translational Medicine (R.M.), Università degli Studi di Milano, Milan, Italy; Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria (L.B., M.D., S.K.); Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy (C.F.); and School of Medicine, Universite' Libre de Bruxelles, Bruxelles, Belgium (J.M.)
| | - M Dold
- Departments of Drug Sciences (F.Car.) and Biomedical and Biotechnological Sciences, School of Medicine (G.M.L., F.D.), University of Catania, Catania, Italy; Oasi-Research-Institute-IRCCS, Troina, Italy (F.Car.); Departments of Pharmacological and Biomolecular Sciences (F.Cal., G.R., M.A.R.) and Medical Biotechnology and Translational Medicine (R.M.), Università degli Studi di Milano, Milan, Italy; Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria (L.B., M.D., S.K.); Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy (C.F.); and School of Medicine, Universite' Libre de Bruxelles, Bruxelles, Belgium (J.M.)
| | - G M Leggio
- Departments of Drug Sciences (F.Car.) and Biomedical and Biotechnological Sciences, School of Medicine (G.M.L., F.D.), University of Catania, Catania, Italy; Oasi-Research-Institute-IRCCS, Troina, Italy (F.Car.); Departments of Pharmacological and Biomolecular Sciences (F.Cal., G.R., M.A.R.) and Medical Biotechnology and Translational Medicine (R.M.), Università degli Studi di Milano, Milan, Italy; Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria (L.B., M.D., S.K.); Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy (C.F.); and School of Medicine, Universite' Libre de Bruxelles, Bruxelles, Belgium (J.M.)
| | - C Fabbri
- Departments of Drug Sciences (F.Car.) and Biomedical and Biotechnological Sciences, School of Medicine (G.M.L., F.D.), University of Catania, Catania, Italy; Oasi-Research-Institute-IRCCS, Troina, Italy (F.Car.); Departments of Pharmacological and Biomolecular Sciences (F.Cal., G.R., M.A.R.) and Medical Biotechnology and Translational Medicine (R.M.), Università degli Studi di Milano, Milan, Italy; Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria (L.B., M.D., S.K.); Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy (C.F.); and School of Medicine, Universite' Libre de Bruxelles, Bruxelles, Belgium (J.M.)
| | - J Mendlewicz
- Departments of Drug Sciences (F.Car.) and Biomedical and Biotechnological Sciences, School of Medicine (G.M.L., F.D.), University of Catania, Catania, Italy; Oasi-Research-Institute-IRCCS, Troina, Italy (F.Car.); Departments of Pharmacological and Biomolecular Sciences (F.Cal., G.R., M.A.R.) and Medical Biotechnology and Translational Medicine (R.M.), Università degli Studi di Milano, Milan, Italy; Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria (L.B., M.D., S.K.); Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy (C.F.); and School of Medicine, Universite' Libre de Bruxelles, Bruxelles, Belgium (J.M.)
| | - G Racagni
- Departments of Drug Sciences (F.Car.) and Biomedical and Biotechnological Sciences, School of Medicine (G.M.L., F.D.), University of Catania, Catania, Italy; Oasi-Research-Institute-IRCCS, Troina, Italy (F.Car.); Departments of Pharmacological and Biomolecular Sciences (F.Cal., G.R., M.A.R.) and Medical Biotechnology and Translational Medicine (R.M.), Università degli Studi di Milano, Milan, Italy; Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria (L.B., M.D., S.K.); Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy (C.F.); and School of Medicine, Universite' Libre de Bruxelles, Bruxelles, Belgium (J.M.)
| | - S Kasper
- Departments of Drug Sciences (F.Car.) and Biomedical and Biotechnological Sciences, School of Medicine (G.M.L., F.D.), University of Catania, Catania, Italy; Oasi-Research-Institute-IRCCS, Troina, Italy (F.Car.); Departments of Pharmacological and Biomolecular Sciences (F.Cal., G.R., M.A.R.) and Medical Biotechnology and Translational Medicine (R.M.), Università degli Studi di Milano, Milan, Italy; Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria (L.B., M.D., S.K.); Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy (C.F.); and School of Medicine, Universite' Libre de Bruxelles, Bruxelles, Belgium (J.M.)
| | - M A Riva
- Departments of Drug Sciences (F.Car.) and Biomedical and Biotechnological Sciences, School of Medicine (G.M.L., F.D.), University of Catania, Catania, Italy; Oasi-Research-Institute-IRCCS, Troina, Italy (F.Car.); Departments of Pharmacological and Biomolecular Sciences (F.Cal., G.R., M.A.R.) and Medical Biotechnology and Translational Medicine (R.M.), Università degli Studi di Milano, Milan, Italy; Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria (L.B., M.D., S.K.); Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy (C.F.); and School of Medicine, Universite' Libre de Bruxelles, Bruxelles, Belgium (J.M.)
| | - F Drago
- Departments of Drug Sciences (F.Car.) and Biomedical and Biotechnological Sciences, School of Medicine (G.M.L., F.D.), University of Catania, Catania, Italy; Oasi-Research-Institute-IRCCS, Troina, Italy (F.Car.); Departments of Pharmacological and Biomolecular Sciences (F.Cal., G.R., M.A.R.) and Medical Biotechnology and Translational Medicine (R.M.), Università degli Studi di Milano, Milan, Italy; Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria (L.B., M.D., S.K.); Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy (C.F.); and School of Medicine, Universite' Libre de Bruxelles, Bruxelles, Belgium (J.M.)
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Dold M, Bartova L, Kautzky A, Serretti A, Porcelli S, Souery D, Mendlewicz J, Montgomery S, Zohar J, Kasper S. Clinical factors associated with augmentation treatment with second-generation antipsychotics and lithium in major depression - Results from a European multicenter study. Eur Neuropsychopharmacol 2018; 28:1305-1313. [PMID: 30446357 DOI: 10.1016/j.euroneuro.2018.10.003] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 10/12/2018] [Accepted: 10/23/2018] [Indexed: 10/27/2022]
Abstract
This cross-sectional European multicenter study with retrospective assessment of treatment response sought to determine variables associated with the administration of augmentation strategies with second-generation antipsychotics (SGAs) and lithium in the pharmacotherapy of major depressive disorder (MDD). In 349 DSM-IV-TR MDD patients, differences in socio-demographic, clinical, treatment, and pharmacological features between participants receiving add-on treatment of their antidepressants with either SGAs (n = 318) or lithium (n = 31) were investigated using analyses of covariance, chi-squared tests, and binary logistic regression analyses. As only significant between-group difference, we found SGA augmentation (compared with lithium augmentation) to be associated with high depressive symptom severity expressed by a higher mean Montgomery and Åsberg Depression Rating (MADRS) total score (27.19 ± 11.35 vs 18.87 ± 12.88, F = 14.82, p = < .0001) and a higher mean 21-item Hamilton Rating Scale for Depression (HAM-D) total score (21.27 ± 9.30 vs 13.74 ± 9.11, F = 18.60, p = < .0001). No significant differences for socio-demographic features, psychotic symptoms, suicidality, psychiatric and somatic comorbidities, antidepressant pharmacotherapy, and other add-on medications could be seen. Even if there was no significant superiority of one augmentation strategy with regard to treatment response pattern, a trend whereupon adjunctive SGAs were more likely dispensed in treatment-resistant and difficult-to-treat MDD conditions could be observed. In terms of the prescription pattern, we could demonstrate that lithium is less frequently used than SGAs in the clinical routine care which may reflect the need of continuous plasma level determinations and the anticipation of adverse effects.
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Affiliation(s)
- Markus Dold
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Lucie Bartova
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Alexander Kautzky
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Alessandro Serretti
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Viale Carlo Pepoli 5, 40123 Bologna, Italy
| | - Stefano Porcelli
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Viale Carlo Pepoli 5, 40123 Bologna, Italy
| | - Daniel Souery
- Psy Pluriel - European Center of Psychological Medicine, Rue des Trois Arbres 62, 1180 Brussels, Belgium; School of Medicine, Free University of Brussels, Route de Lennik 808, 1070 Brussels, Belgium
| | - Julien Mendlewicz
- School of Medicine, Free University of Brussels, Route de Lennik 808, 1070 Brussels, Belgium
| | - Stuart Montgomery
- Imperial College School of Medicine, University of London, PO Box 8751, London W13 8WH, United Kingdom
| | - Joseph Zohar
- Psychiatric Division, Chaim Sheba Medical Center, Tel Hashomer 52621, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Siegfried Kasper
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria.
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Nussbaumer-Streit B, Pjrek E, Kien C, Gartlehner G, Bartova L, Friedrich ME, Kasper S, Winkler D. Implementing prevention of seasonal affective disorder from patients' and physicians' perspectives - a qualitative study. BMC Psychiatry 2018; 18:372. [PMID: 30477472 PMCID: PMC6260561 DOI: 10.1186/s12888-018-1951-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 11/09/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Seasonal affective disorder (SAD) is a seasonally recurrent type of major depression that has detrimental effects on patients' lives during winter. Little is known about how it affects patients during summer and about patients' and physicians' perspectives on preventive SAD treatment. The aim of our study was to explore how SAD patients experience summers, what type of preventive treatment patients implement, which preventive treatment methods, if any, physicians recommend, and what factors facilitate or hinder implementation/recommendation of SAD prevention. METHODS We conducted 15 semi-structured interviews, ten with adult patients with a history of SAD and five with physicians. Transcripts were analyzed by two researchers using an inductive thematic analysis approach. RESULTS One group of patients was able to enjoy summer and ignore thoughts of the upcoming winter. The other group feared the impending depressive episode in winter, and this fear negatively impacted these patients' well-being during the summer. Preventive treatment was a relevant issue for all patients, and all but one person implemented SAD prevention during summer. We identified six factors that influenced patient use of preventive treatment of SAD. Four factors occur on an individual level (knowledge about disease and preventive treatment options, experience with treatment in acute phase, acceptability of intervention, willingness to take responsibility for oneself), one on an interpersonal level (social and work environment), and one on a structural level (healthcare system). All psychiatrists recommended some kind of preventive intervention, most commonly, lifestyle changes. Four factors influenced psychiatrists in recommending prevention of SAD (patient expectations, disease history and stability, risk/benefit ratio, lack of evidence). CONCLUSIONS Success in the implementation of SAD prevention does not solely depend on the willingness of the patients, but is also influenced by external factors. Raising awareness of SAD among general practitioners and low-level access to mental-health support could help patients find appropriate help sooner. To better guide the optimal treatment choice, comparative effectiveness research on treatments to prevent a new onset in patients with a history of SAD and clinical practice guidelines on SAD are needed.
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Affiliation(s)
- Barbara Nussbaumer-Streit
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
- Department for Evidence-based Medicine and Clinical Epidemiology, Danube-University Krems, Dr.-Karl-Dorrek Strasse 30, 3500 Krems a.d, Donau, Austria
| | - Edda Pjrek
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Christina Kien
- Department for Evidence-based Medicine and Clinical Epidemiology, Danube-University Krems, Dr.-Karl-Dorrek Strasse 30, 3500 Krems a.d, Donau, Austria
| | - Gerald Gartlehner
- Department for Evidence-based Medicine and Clinical Epidemiology, Danube-University Krems, Dr.-Karl-Dorrek Strasse 30, 3500 Krems a.d, Donau, Austria
- RTI International, 3400 Cornwallis Rd, Research Triangle Park, NC USA
| | - Lucie Bartova
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Michaela-Elena Friedrich
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Siegfried Kasper
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Dietmar Winkler
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
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Bartova L, Papageorgiou K, Milenkovic I, Dold M, Weidenauer A, Willeit M, Winkler D, Kasper S. Rapid antidepressant effect of S-ketamine in schizophrenia. Eur Neuropsychopharmacol 2018; 28:980-982. [PMID: 30041987 DOI: 10.1016/j.euroneuro.2018.05.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 02/28/2018] [Revised: 05/04/2018] [Accepted: 05/17/2018] [Indexed: 10/28/2022]
Abstract
Rapid anti-suicidal and antidepressant effects of ketamine have repeatedly been confirmed in unipolar and bipolar depression. Although meaningful antidepressant efficacy of ketamine has also been shown in depressed patients with a history of psychotic symptoms, its administration in psychotic disorders has largely been neglected due to its potential to exacerbate dissociative or psychotic symptoms. Presenting a case of a young female inpatient suffering from schizophrenia with a severe post-psychotic depression, we demonstrate a robust anti-suicidal and antidepressant effect of S-ketamine infusions administered thrice weekly for 3 weeks in total. Importantly, no relevant psychotic or dissociative symptoms occurred during the whole augmentation treatment period leading to a sustained remission of depressive symptoms and suicidality. Our safe and effective experience with intravenous S-ketamine might encourage researchers and clinicians to widen its administration range beyond the diagnosis of depression to enrich the current knowledge of ketamine effects in psychotic disorders.
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Affiliation(s)
- Lucie Bartova
- Department of Psychiatry and Psychotherapy, Clinical Division of General Psychiatry, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - Konstantinos Papageorgiou
- Department of Psychiatry and Psychotherapy, Clinical Division of General Psychiatry, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - Ivan Milenkovic
- Department of Psychiatry and Psychotherapy, Clinical Division of General Psychiatry, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria; Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - Markus Dold
- Department of Psychiatry and Psychotherapy, Clinical Division of General Psychiatry, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - Ana Weidenauer
- Department of Psychiatry and Psychotherapy, Clinical Division of General Psychiatry, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - Matthaeus Willeit
- Department of Psychiatry and Psychotherapy, Clinical Division of General Psychiatry, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - Dietmar Winkler
- Department of Psychiatry and Psychotherapy, Clinical Division of General Psychiatry, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - Siegfried Kasper
- Department of Psychiatry and Psychotherapy, Clinical Division of General Psychiatry, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria.
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Dold M, Bartova L, Rupprecht R, Kasper S. Dose Escalation of Antidepressants in Unipolar Depression: A Meta-Analysis of Double-Blind, Randomized Controlled Trials. Psychother Psychosom 2018; 86:283-291. [PMID: 28903107 DOI: 10.1159/000477770] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 05/18/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND As many patients with unipolar depression do not respond sufficiently to initial antidepressant monotherapy, a dose increase of the current administered antidepressant (dose escalation, high-dose treatment) is frequently carried out as next treatment measure. METHODS We conducted a meta-analysis which included all double-blind randomized controlled trials (RCTs) comparing a dose increase of antidepressants directly to continuation of standard-dose treatment in unipolar depressive patients who were non- responders to standard-dose pharmacotherapy. A mean change in the Hamilton Rating Scale for Depression (HAM-D) total score was the primary outcome. Secondary outcomes were response rates and discontinuation rates due to any reason, inefficacy, and adverse effects. Hedges g and risk ratios were calculated as effect sizes. RESULTS Seven double-blind RCTs (8 study arms) representing 1,208 participants were included. Fluoxetine (N [number of studies] = 2, n [number of patients] = 448), sertraline (N = 2, n = 272), paroxetine (N = 2, n = 146), duloxetine (N = 1, n = 255), and maprotiline (N = 1, n = 87) were investigated. Dose escalation was not more efficacious in HAM-D total score reduction than maintaining standard-dose treatment, neither for the pooled antidepressant group (N = 7, n = 999; Hedges g = -0.04, 95% CI: -0.20 to 0.12; p = 0.63) nor the individual antidepressants. No differences could be determined for response rates, all-cause discontinuation, and drop-outs due to inefficacy. Significantly more patients in the dose escalation group dropped out due to adverse effects than in the standard-dose continuation group. The metaregressions indicate no influence of baseline symptom severity or amounts of dose increments on effect sizes. CONCLUSIONS According to our meta-analytic findings, dose escalation after initial non-response to standard-dose pharmacotherapy cannot be regarded as general evidence-based treatment option in unipolar depression.
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Affiliation(s)
- Markus Dold
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
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Dold M, Bartova L, Mendlewicz J, Souery D, Serretti A, Porcelli S, Zohar J, Montgomery S, Kasper S. Clinical correlates of augmentation/combination treatment strategies in major depressive disorder. Acta Psychiatr Scand 2018; 137:401-412. [PMID: 29492960 PMCID: PMC5947736 DOI: 10.1111/acps.12870] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [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] [Accepted: 02/06/2018] [Indexed: 01/04/2023]
Abstract
OBJECTIVE This multicenter, multinational, cross-sectional study aimed to investigate clinical characteristics and treatment outcomes associated with augmentation/combination treatment strategies in major depressive disorder (MDD). METHOD Sociodemographic, clinical, and treatment features of 1410 adult MDD patients were compared between MDD patients treated with monotherapy and augmentation/combination medication using descriptive statistics, analyses of covariance (ancova), and Spearman's correlation analyses. RESULTS 60.64% of all participants received augmentation and/or combination strategies with a mean number of 2.18 ± 1.22 simultaneously prescribed psychiatric drugs. We found male gender, older age, Caucasian descent, higher weight, low educational status, absence of occupation, psychotic symptoms, melancholic and atypical features, suicide risk, in-patient treatment, longer duration of hospitalization, some psychiatric comorbidities (panic disorder, agoraphobia, obsessive-compulsive disorder, and bulimia nervosa), comorbid somatic comorbidity in general and concurrent hypertension, thyroid dysfunction, diabetes, and heart disease in particular, higher current and retrospective Montgomery and Åsberg Depression Rating Scale total scores, treatment resistance, and higher antidepressant dosing to be significantly associated with augmentation/combination treatment. These findings were corroborated when examining the number of concurrently administered psychiatric drugs in the statistical analyses. CONCLUSION Our findings suggest a clear association between augmentation/combination strategies and treatment-resistant/difficult-to-treat MDD conditions characterized by severe symptomatology and high amount of psychiatric and somatic comorbidities.
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Affiliation(s)
- M. Dold
- Department of Psychiatry and PsychotherapyMedical University of ViennaViennaAustria
| | - L. Bartova
- Department of Psychiatry and PsychotherapyMedical University of ViennaViennaAustria
| | - J. Mendlewicz
- School of MedicineFree University of BrusselsBrusselsBelgium
| | - D. Souery
- School of MedicineFree University of BrusselsBrusselsBelgium,European Centre of Psychological Medicine ‐ Psy PlurielBrusselsBelgium
| | - A. Serretti
- Department of Biomedical and NeuroMotor SciencesUniversity of BolognaBolognaItaly
| | - S. Porcelli
- Department of Biomedical and NeuroMotor SciencesUniversity of BolognaBolognaItaly
| | - J. Zohar
- Psychiatric DivisionChaim Sheba Medical CenterTel HashomerIsrael
| | - S. Montgomery
- Imperial CollegeUniversity of LondonLondonUnited Kingdom
| | - S. Kasper
- Department of Psychiatry and PsychotherapyMedical University of ViennaViennaAustria
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