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Papakostas GI, Trivedi MH, Shelton RC, Iosifescu DV, Thase ME, Jha MK, Mathew SJ, DeBattista C, Dokucu ME, Brawman-Mintzer O, Currier GW, McCall WV, Modirrousta M, Macaluso M, Bystritsky A, Rodriguez FV, Nelson EB, Yeung AS, Feeney A, MacGregor LC, Carmody T, Fava M. Comparative effectiveness research trial for antidepressant incomplete and non-responders with treatment resistant depression (ASCERTAIN-TRD) a randomized clinical trial. Mol Psychiatry 2024:10.1038/s41380-024-02468-x. [PMID: 38454079 DOI: 10.1038/s41380-024-02468-x] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 01/23/2024] [Accepted: 01/29/2024] [Indexed: 03/09/2024]
Abstract
Further research is needed to help improve both the standard of care and the outcome for patients with treatment-resistant depression. A particularly critical evidence gap exists with respect to whether pharmacological or non-pharmacological augmentation is superior to antidepressant switch, or vice-versa. The objective of this study was to compare the effectiveness of augmentation with aripiprazole or repetitive transcranial magnetic stimulation versus switching to the antidepressant venlafaxine XR (or duloxetine for those not eligible to receive venlafaxine) for treatment-resistant depression. In this multi-site, 8-week, randomized, open-label study, 278 subjects (196 females and 82 males, mean age 45.6 years (SD 15.3)) with treatment-resistant depression were assigned in a 1:1:1 fashion to treatment with either of these three interventions; 235 subjects completed the study. 260 randomized subjects with at least one post-baseline Montgomery-Asberg Depression Rating (MADRS) assessment were included in the analysis. Repetitive transcranial magnetic stimulation (score change (standard error (se)) = -17.39 (1.3) (p = 0.015) but not aripiprazole augmentation (score change (se) = -14.9 (1.1) (p = 0.069) was superior to switch (score change (se) = -13.22 (1.1)) on the MADRS. Aripiprazole (mean change (se) = -37.79 (2.9) (p = 0.003) but not repetitive transcranial magnetic stimulation augmentation (mean change (se) = -42.96 (3.6) (p = 0.031) was superior to switch (mean change (se) = -34.45 (3.0)) on the symptoms of depression questionnaire. Repetitive transcranial magnetic stimulation augmentation was shown to be more effective than switching antidepressants in treatment-resistant depression on the study primary measure. In light of these findings, clinicians should consider repetitive transcranial magnetic stimulation augmentation early-on for treatment-resistant depression.Trial registration: ClinicalTrials.gov, NCT02977299.
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Affiliation(s)
| | | | | | - Dan V Iosifescu
- Nathan Kline Institute for Psychiatric Research and New York University School of Medicine, New York, NY, USA
| | - Michael E Thase
- Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
| | - Manish K Jha
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | | | | | | | - Glenn W Currier
- Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | | | | | - Matthew Macaluso
- University of Alabama at Birmingham, Birmingham, AL, USA
- University of Kansas School of Medicine, Wichita, KS, USA
| | - Alexander Bystritsky
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, LA, USA
| | | | - Erik B Nelson
- University of Cincinnati Academic Health Center, Cincinnati, OH, USA
| | - Albert S Yeung
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Anna Feeney
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Leslie C MacGregor
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Thomas Carmody
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Maurizio Fava
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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Whitaker T, Farrand KF, Thase ME. A Phase 2 Open Label Study of Efficacy, Safety, and Tolerability of SLS-002 (Intranasal Racemic Ketamine) in Adults with MDD at Imminent Risk of Suicide. Psychopharmacol Bull 2024; 54:8-17. [PMID: 38449472 PMCID: PMC10913863] [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] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
Background Despite the prevalence of Major Depressive Disorder (MDD) and the propensity of affected individuals to eventually die by suicide, there is no therapeutic approved specifically for suicidal ideation and behavior (SI/B) in MDD. The NMDA receptor antagonist ketamine has been investigated for the treatment of depression and shown to have a rapid effect on symptoms. Spravato® (esketamine) is approved by the FDA for use in treatment-resistant depression and Major Depressive Episodes with Suicidal Ideation based on studies conducted in adults also taking standard antidepressants. While esketamine was associated with a large reduction in suicidality indicators, the effects did not significantly exceed those associated with placebo. Racemic ketamine, a mixture of both esketamine and arketamine, may hold greater potential for the rapid alleviation of SI/B. SLS-002 was developed as an investigational intranasal racemic ketamine for the treatment of SI/B in individuals with MDD. Methods In part one of a two-part clinical trial, the safety, tolerability, and potential effectiveness of SLS-002 were evaluated in an open label study of 17 patients with MDD hospitalized with acute SI/B. Results Treatment with SLS-002 was associated with a significant reduction in depression and suicidality indicators on four clinical scales: the Montgomery-Åsberg Depression Rating Scale, the Sheehan-Suicidality Tracking Scale, and the Clinical and Patient Global Impression Scales for SI/B. SLS-002 was well tolerated with an acceptable safety profile. Conclusions The results of this open label study support the continued development of SLS-002. The randomized double-blind placebo-controlled part two of this trial was recently completed.
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Affiliation(s)
- Timothy Whitaker
- Whitaker, MD, Chief Medical Officer, Head of Research & Development, Seelos Therapeutics, Inc., New York, NY
| | - Kimberly F Farrand
- Farrand, MPH, Senior Director, Clinical Development, Seelos Therapeutics, Inc., New York, NY
| | - Michael E Thase
- Thase, MD, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA and Corporal Michael J Crescenz Veterans Affairs Medical Center, Philadelphia, PA
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Thase ME, Yeung PP, Rekeda L, Liu M, Varughese S. Safety and tolerability of cariprazine for the adjunctive treatment of major depressive disorder: a pooled analysis of phase 2b/phase 3 clinical trials. Int Clin Psychopharmacol 2024:00004850-990000000-00124. [PMID: 38277187 DOI: 10.1097/yic.0000000000000528] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
To characterize the safety and tolerability of adjunctive cariprazine in patients with major depressive disorder (MDD) and inadequate response to monotherapy antidepressant treatment (ADT). Post hoc analyses evaluated pooled data from 2 fixed-dose phase 3 cariprazine studies (1.5 and 3 mg/d [approved doses for MDD]). In a separate safety analysis, cariprazine 0.1-4.5 mg/d was evaluated using data from the 2 fixed-dose trials plus 3 flexible-dose studies grouped by modal-daily dose. In the pooled phase 3 studies (placebo = 503, 1.5 mg/d = 502, 3 mg/d = 503), overall cariprazine-treated patients had high rates of study completion (90%). Patients had mostly mild/moderate treatment-emergent adverse events that caused premature discontinuation of 4.3%. Only akathisia, nausea, and insomnia occurred in ≥5% of cariprazine patients (any group) and at twice the rate of placebo; potential dose-dependent responses were observed for akathisia and insomnia. Cariprazine had a neutral metabolic profile, with mean weight increase of <1 kg. Modal-dose results were similar, and both analyses were consistent with the known safety profile of cariprazine across its approved indications. Adjunctive cariprazine therapy was safe and generally well tolerated in patients with MDD who had not obtained an adequate response to ADT monotherapy; no new safety signals were identified.
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Affiliation(s)
- Michael E Thase
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | | | - Meng Liu
- AbbVie, Florham Park, New Jersey, USA
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Vest BM, Wray LO, Thase ME, Brady LA, Chapman SR, Oslin DW. Providers' Use of Pharmacogenetic Testing to Inform Antidepressant Prescribing: Results of Qualitative Interviews. Psychiatr Serv 2023; 74:1270-1276. [PMID: 37528698 DOI: 10.1176/appi.ps.20220537] [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: 08/03/2023]
Abstract
OBJECTIVE Pharmacogenetic testing (PGx) for patients experiencing depression has been associated with modest improvements in symptoms. However, little is known about providers' use of PGx, including how and for whom providers use the test results in clinical decision making. In this article, results from qualitative interviews on the experience of providers participating in a pragmatic trial of PGx are described; implications of the providers' experiences are highlighted to inform future implementation of PGx. METHODS Interviews were conducted with providers participating in the trial (N=61) who treated veterans who had depression. Questions were informed by the Consolidated Framework for Implementation Research. A rapid analytic approach was used. RESULTS Two main themes were identified: perceptions regarding which patients would likely benefit from PGx and approaches to using the test results in prescribing. Providers generally expressed positive experiences with using PGx results. However, the providers varied in application of the test results to clinical decision making regarding medications, were uncertain about how much to rely on the results, and differed in perceptions about which patients would benefit from PGx. CONCLUSIONS To support future implementation, policies and procedures are needed, as well as mechanisms to support ongoing provider education on PGx.
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Affiliation(s)
- Bonnie M Vest
- Department of Family Medicine, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo (Vest, Wray, Brady); Center for Integrated Healthcare, U.S. Department of Veterans Affairs (VA) Western New York Healthcare System, Buffalo (Vest, Wray); Veterans Integrated Service Network (VISN) 4, Mental Illness, Research, Education and Clinical Center (MIRECC), Corporal Michael J. Crescenz VA Medical Center, Philadelphia (Thase, Oslin); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Thase, Oslin); VISN 4 MIRECC, VA Pittsburgh Healthcare System, Pittsburgh (Chapman)
| | - Laura O Wray
- Department of Family Medicine, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo (Vest, Wray, Brady); Center for Integrated Healthcare, U.S. Department of Veterans Affairs (VA) Western New York Healthcare System, Buffalo (Vest, Wray); Veterans Integrated Service Network (VISN) 4, Mental Illness, Research, Education and Clinical Center (MIRECC), Corporal Michael J. Crescenz VA Medical Center, Philadelphia (Thase, Oslin); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Thase, Oslin); VISN 4 MIRECC, VA Pittsburgh Healthcare System, Pittsburgh (Chapman)
| | - Michael E Thase
- Department of Family Medicine, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo (Vest, Wray, Brady); Center for Integrated Healthcare, U.S. Department of Veterans Affairs (VA) Western New York Healthcare System, Buffalo (Vest, Wray); Veterans Integrated Service Network (VISN) 4, Mental Illness, Research, Education and Clinical Center (MIRECC), Corporal Michael J. Crescenz VA Medical Center, Philadelphia (Thase, Oslin); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Thase, Oslin); VISN 4 MIRECC, VA Pittsburgh Healthcare System, Pittsburgh (Chapman)
| | - Laura A Brady
- Department of Family Medicine, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo (Vest, Wray, Brady); Center for Integrated Healthcare, U.S. Department of Veterans Affairs (VA) Western New York Healthcare System, Buffalo (Vest, Wray); Veterans Integrated Service Network (VISN) 4, Mental Illness, Research, Education and Clinical Center (MIRECC), Corporal Michael J. Crescenz VA Medical Center, Philadelphia (Thase, Oslin); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Thase, Oslin); VISN 4 MIRECC, VA Pittsburgh Healthcare System, Pittsburgh (Chapman)
| | - Sara R Chapman
- Department of Family Medicine, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo (Vest, Wray, Brady); Center for Integrated Healthcare, U.S. Department of Veterans Affairs (VA) Western New York Healthcare System, Buffalo (Vest, Wray); Veterans Integrated Service Network (VISN) 4, Mental Illness, Research, Education and Clinical Center (MIRECC), Corporal Michael J. Crescenz VA Medical Center, Philadelphia (Thase, Oslin); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Thase, Oslin); VISN 4 MIRECC, VA Pittsburgh Healthcare System, Pittsburgh (Chapman)
| | - David W Oslin
- Department of Family Medicine, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo (Vest, Wray, Brady); Center for Integrated Healthcare, U.S. Department of Veterans Affairs (VA) Western New York Healthcare System, Buffalo (Vest, Wray); Veterans Integrated Service Network (VISN) 4, Mental Illness, Research, Education and Clinical Center (MIRECC), Corporal Michael J. Crescenz VA Medical Center, Philadelphia (Thase, Oslin); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Thase, Oslin); VISN 4 MIRECC, VA Pittsburgh Healthcare System, Pittsburgh (Chapman)
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Kitay BM, Murphy E, Macaluso M, Corlett PR, Hershenberg R, Joormann J, Martinez-Kaigi V, Nikayin S, Rhee TG, Sanacora G, Shelton RC, Thase ME, Wilkinson ST. Cognitive behavioral therapy following esketamine for major depression and suicidal ideation for relapse prevention: The CBT-ENDURE randomized clinical trial study protocol. Psychiatry Res 2023; 330:115585. [PMID: 37935086 DOI: 10.1016/j.psychres.2023.115585] [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: 08/28/2023] [Revised: 10/26/2023] [Accepted: 10/28/2023] [Indexed: 11/09/2023]
Abstract
In 2020, esketamine received a supplemental indication as a therapy for major depression with suicidal ideation (MDSI), based on protocols enrolling hospitalized patients. Given the high risk of suicide following hospital discharge and the high relapse rates following discontinuation of esketamine, the optimal long-term treatment approach remains unclear. Cognitive behavioral therapy (CBT) is highly effective in relapse prevention and has been shown to prevent suicide attempts in high-risk populations. Here we describe the study protocol for the CBT-ENDURE trial: Cognitive Behavioral Therapy Following Esketamine for Major Depression and SUicidal Ideation for RElapse Prevention. Patients with depression (N = 100) who are admitted to hospital or are outpatients with clinically significant suicidal ideation will be enrolled in the study. All patients will receive esketamine (twice weekly for four weeks) and will be randomly assigned (1:1 ratio) to receive a 16-week course of CBT plus treatment as usual (CBT group) or treatment as usual only (TAU only group). Patients are followed for a total of 6 months. Supported under a funding announcement from NIMH to conduct safety and feasibility trials for patients at high risk for suicide, the primary outcome of the CBT-ENDURE study is feasibility (as measured by recruitment and retention), with a key secondary outcome being relapse among those who experience substantial benefit following two weeks of esketamine.
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Affiliation(s)
- Brandon M Kitay
- Department of Psychiatry, Emory University School of Medicine, United States
| | - Eva Murphy
- Department of Psychiatry, Yale School of Medicine, United States
| | - Matthew Macaluso
- Department of Psychiatry and Behavioral Neurobiology, Heersink School of Medicine, University of Alabama at Birmingham, 100 York St, STE 2J, New Haven, CT 06511, United States
| | - Philip R Corlett
- Department of Psychiatry, Yale School of Medicine, United States
| | - Rachel Hershenberg
- Department of Psychiatry, Emory University School of Medicine, United States
| | - Jutta Joormann
- Department of Psychology, Yale University, United States
| | | | - Sina Nikayin
- Department of Psychiatry, Yale School of Medicine, United States
| | - Taeho Greg Rhee
- Department of Psychiatry, Yale School of Medicine, United States; Department of Public Health Science, School of Medicine, University of Connecticut, United States
| | - Gerard Sanacora
- Department of Psychiatry, Yale School of Medicine, United States
| | - Richard C Shelton
- Department of Psychiatry and Behavioral Neurobiology, Heersink School of Medicine, University of Alabama at Birmingham, 100 York St, STE 2J, New Haven, CT 06511, United States
| | - Michael E Thase
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, United States
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Thase ME. Recent developments pertaining to treatment-resistant depression: a 40-year perspective. World Psychiatry 2023; 22:413-414. [PMID: 37713557 PMCID: PMC10503918 DOI: 10.1002/wps.21134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/21/2023] [Indexed: 09/17/2023] Open
Affiliation(s)
- Michael E Thase
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, and Corpora Michael J Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA
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7
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Thase ME. Have Effective Antidepressants Finally Arrived? Developments in Major Depressive Disorder Therapy. J Clin Psychiatry 2023; 84:mulmdd3048sho. [PMID: 37585245 DOI: 10.4088/jcp.mulmdd3048sho] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/17/2023]
Abstract
Among the greatest unmet needs in major depressive disorder (MDD) is a lack of effective pharmacotherapies for patients who do not respond to first- and second-line antidepressant medications. After decades of muted progress, optimism regarding the future of MDD therapy rose after scientists serendipitously uncovered the antidepressant effects of ketamine. The discovery of ketamine's antidepressant effects inspired the search for related newer medications, such as S-ketamine. Orally administered NMDA antagonists have also demonstrated considerable promise in recently concluded, late-stage clinical trials. Researchers evaluating an extended-release combination of bupropion (105 mg) and dextromethorphan (45 mg) found that recipients experienced a decline in MADRS total score. Neurosteroids, such as brexanolone and zuranolone, appear to represent another class of antidepressants. These drugs appear to modulate GABA neurotransmission, which has long been known to be a pathway for drugs that are used to treat insomnia and anxiety. After nearly 50 years of legal injunctions against their use, psychedelic drugs have attracted interest among researchers seeking alternative antidepressants. Psilocybin, derived from mushrooms, remains under investigation for its benefits in treatment-resistant depression.
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Affiliation(s)
- Michael E Thase
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia
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Chai Y, Gehrman P, Yu M, Mao T, Deng Y, Rao J, Shi H, Quan P, Xu J, Zhang X, Lei H, Fang Z, Xu S, Boland E, Goldschmied JR, Barilla H, Goel N, Basner M, Thase ME, Sheline YI, Dinges DF, Detre JA, Zhang X, Rao H. Enhanced amygdala-cingulate connectivity associates with better mood in both healthy and depressive individuals after sleep deprivation. Proc Natl Acad Sci U S A 2023; 120:e2214505120. [PMID: 37339227 PMCID: PMC10293819 DOI: 10.1073/pnas.2214505120] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 05/08/2023] [Indexed: 06/22/2023] Open
Abstract
Sleep loss robustly disrupts mood and emotion regulation in healthy individuals but can have a transient antidepressant effect in a subset of patients with depression. The neural mechanisms underlying this paradoxical effect remain unclear. Previous studies suggest that the amygdala and dorsal nexus (DN) play key roles in depressive mood regulation. Here, we used functional MRI to examine associations between amygdala- and DN-related resting-state connectivity alterations and mood changes after one night of total sleep deprivation (TSD) in both healthy adults and patients with major depressive disorder using strictly controlled in-laboratory studies. Behavioral data showed that TSD increased negative mood in healthy participants but reduced depressive symptoms in 43% of patients. Imaging data showed that TSD enhanced both amygdala- and DN-related connectivity in healthy participants. Moreover, enhanced amygdala connectivity to the anterior cingulate cortex (ACC) after TSD associated with better mood in healthy participants and antidepressant effects in depressed patients. These findings support the key role of the amygdala-cingulate circuit in mood regulation in both healthy and depressed populations and suggest that rapid antidepressant treatment may target the enhancement of amygdala-ACC connectivity.
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Affiliation(s)
- Ya Chai
- Key Laboratory of Brain-Machine Intelligence for Information Behavior (Ministry of Education and Shanghai), School of Business and Management, Shanghai International Studies University, Shanghai201620, China
- Center for Functional Neuroimaging and Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA19104
| | - Philip Gehrman
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA19104
| | - Meichen Yu
- Indiana Alzheimer’s Disease Research Center, School of Medicine, Indiana University, Indianapolis, IN46202
- Indiana University Network Science Institute, Bloomington, IN47408
| | - Tianxin Mao
- Key Laboratory of Brain-Machine Intelligence for Information Behavior (Ministry of Education and Shanghai), School of Business and Management, Shanghai International Studies University, Shanghai201620, China
- Center for Functional Neuroimaging and Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA19104
| | - Yao Deng
- Key Laboratory of Brain-Machine Intelligence for Information Behavior (Ministry of Education and Shanghai), School of Business and Management, Shanghai International Studies University, Shanghai201620, China
- Center for Functional Neuroimaging and Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA19104
| | - Joy Rao
- Center for Functional Neuroimaging and Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA19104
| | - Hui Shi
- Center for Functional Neuroimaging and Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA19104
- Beijing An Zhen Hospital, Capital Medical University, Beijing100029, China
| | - Peng Quan
- Center for Functional Neuroimaging and Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA19104
- Research Center for Quality of Life and Applied Psychology, Guangdong Medical University, Dongguan, Guangdong524023, China
| | - Jing Xu
- Key Laboratory of Brain-Machine Intelligence for Information Behavior (Ministry of Education and Shanghai), School of Business and Management, Shanghai International Studies University, Shanghai201620, China
- Center for Functional Neuroimaging and Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA19104
| | - Xiaocui Zhang
- Center for Functional Neuroimaging and Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA19104
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan410017, China
| | - Hui Lei
- Center for Functional Neuroimaging and Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA19104
- College of Education, Hunan Agricultural University, Changsha, Hunan410127, China
| | - Zhuo Fang
- Center for Functional Neuroimaging and Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA19104
- Brain and Mind Research Institute, University of Ottawa, Ottawa, ON K1H 8M5, Canada
| | - Sihua Xu
- Key Laboratory of Brain-Machine Intelligence for Information Behavior (Ministry of Education and Shanghai), School of Business and Management, Shanghai International Studies University, Shanghai201620, China
- Center for Functional Neuroimaging and Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA19104
| | - Elaine Boland
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA19104
- Mental Illness Research Education and Clinical Center, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA19104
| | - Jennifer R. Goldschmied
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA19104
| | - Holly Barilla
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA19104
| | - Namni Goel
- Biological Rhythms Research Laboratory, Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL60612
| | - Mathias Basner
- Division of Sleep and Chronobiology, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA19104
| | - Michael E. Thase
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA19104
- Mental Illness Research Education and Clinical Center, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA19104
| | - Yvette I. Sheline
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA19104
- Center for Neuromodulation in Depression and Stress, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA19104
| | - David F. Dinges
- Division of Sleep and Chronobiology, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA19104
| | - John A. Detre
- Center for Functional Neuroimaging and Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA19104
| | - Xiaochu Zhang
- Key Laboratory of Brain-Machine Intelligence for Information Behavior (Ministry of Education and Shanghai), School of Business and Management, Shanghai International Studies University, Shanghai201620, China
- Department of Radiology, the First Affiliated Hospital of University of Science and Technology of China, School of Life Science, Division of Life Science and Medicine, University of Science and Technology of China, Hefei, Anhui230026, China
- Department of Psychology, School of Humanities and Social Science, University of Science and Technology of China, Anhui230026, China
| | - Hengyi Rao
- Key Laboratory of Brain-Machine Intelligence for Information Behavior (Ministry of Education and Shanghai), School of Business and Management, Shanghai International Studies University, Shanghai201620, China
- Center for Functional Neuroimaging and Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA19104
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Thase ME, Stahl SM, McIntyre RS, Matthews-Hayes T, Rolin D, Patel M, Harrington A, Maletic V, Jackson WC, Vieta E. Screening for Bipolar I Disorder and the Rapid Mood Screener: Results of a Nationwide Health Care Provider Survey. Prim Care Companion CNS Disord 2023; 25. [PMID: 37115145 DOI: 10.4088/pcc.22m03322] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Abstract
Objective: Effective screening for bipolar I disorder can lead to enhanced assessment, improved diagnosis, and better patient outcomes. The Rapid Mood Screener (RMS), a new bipolar I disorder screening tool, was evaluated in a nationwide survey of health care providers (HCPs). Methods: Eligible HCPs were asked to describe their opinions/current use of screening tools, assess the RMS, and evaluate the RMS versus the Mood Disorder Questionnaire (MDQ). Results were stratified by primary care and psychiatric specialty. Findings were reported using descriptive statistics; statistical significance was reported at the 95% confidence level. Results: Among respondents (N = 200), 82% used a tool to screen for major depressive disorder (MDD), while 32% used a tool for bipolar disorder. Most HCPs were aware of the MDQ (85%), but only 29% reported current use. According to HCPs, the RMS was significantly better than the MDQ on all screening tool attributes (eg, sensitivity/specificity, brevity, practicality, easy scoring; P < .05 for all). Significantly more HCPs reported that they would use the RMS versus the MDQ (81% vs 19%, P < .05); 76% reported that they would screen new patients with depressive symptoms, and 68% indicated they would rescreen patients with a depression diagnosis. Most HCPs (84%) said the RMS would have a positive impact on their practice, with 46% saying they would screen more patients for bipolar disorder. Discussion: In our survey, the RMS was favorably evaluated by HCPs. A large percentage of respondents preferred the RMS over the MDQ and indicated that it would likely have a positive impact on clinicians' screening behavior.
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Affiliation(s)
- Michael E Thase
- Department of Psychiatry, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
- Corresponding author: Michael E. Thase, MD, Department of Psychiatry, Mood and Anxiety Disorders Treatment and Research Program, 3535 Market St, Ste 670, Philadelphia, PA 19104-3309
| | - Stephen M Stahl
- Department of Psychiatry and Neuroscience, University of California Riverside School of Medicine, California
| | - Roger S McIntyre
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | | | - Donna Rolin
- School of Nursing, the University of Texas at Austin, School of Nursing, Austin, Texas
| | - Mehul Patel
- AbbVie, North Chicago, Illinois (at the time of the study)
| | | | - Vladimir Maletic
- Department of Psychiatry/Behavioral Science, University of South Carolina School of Medicine, Greenville, South Carolina
| | - W Clay Jackson
- Department of Family Medicine and Department of Psychiatry, University of Tennessee College of Medicine, Memphis, Tennessee
| | - Eduard Vieta
- University of Barcelona, Institute of Neuroscience, Hospital Clinic, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
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10
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McIntyre RS, Therrien F, Ismail Z, Meehan SR, Miguelez M, Larsen KG, Chen D, MacKenzie EM, Thase ME. Effects of adjunctive brexpiprazole on patient life engagement in major depressive disorder: Post hoc analysis of Inventory of Depressive Symptomatology Self-Report data. J Psychiatr Res 2023; 162:71-78. [PMID: 37099968 DOI: 10.1016/j.jpsychires.2023.04.012] [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: 10/27/2022] [Revised: 04/04/2023] [Accepted: 04/08/2023] [Indexed: 04/28/2023]
Abstract
BACKGROUND Patient-reported outcomes can capture domains that are meaningful to patients, such as life engagement in major depressive disorder (MDD), which reflects life fulfillment, well-being, and participation in valued and meaningful activities. This analysis investigated the effects of brexpiprazole adjunct to antidepressant treatment (ADT) on patient life engagement over the short and long term, using the 10-item Inventory of Depressive Symptomatology Self-Report (IDS-SR10) Life Engagement subscale. METHODS Short-term data were pooled from three 6-week, randomized, double-blind studies of ADT + brexpiprazole 2-3 mg/day versus ADT + placebo in adult outpatients with MDD (DSM-IV-TR criteria) and inadequate response to ADTs. Long-term data were from a 26-52-week, open-label extension study of ADT + brexpiprazole 0.5-3 mg/day. RESULTS Over 6 weeks, ADT + brexpiprazole (n = 579) showed greater improvement in IDS-SR10 Life Engagement subscale score than ADT + placebo (n = 583), with a least squares mean difference of -1.19 (95% confidence limits: -1.78, -0.59; p = 0.0001; Cohen's d effect size: 0.23). Greater improvement for ADT + brexpiprazole versus ADT + placebo (p < 0.05) was also observed on eight life engagement items, with effect sizes ranging from 0.12 to 0.24. In the long-term study, mean (standard deviation) IDS-SR10 Life Engagement subscale score changed by -2.4 (4.9) points to Week 26 (n = 2047), and -3.7 (5.3) points to Week 52 (n = 768), with mean improvements on all ten items. CONCLUSIONS Beyond its efficacy on depressive symptoms, adjunctive brexpiprazole may improve patient life engagement, thereby helping patients with MDD to achieve personally meaningful functional outcomes.
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Affiliation(s)
- Roger S McIntyre
- Mood Disorders Psychopharmacology Unit, University Health Network, University of Toronto, Toronto, ON, Canada.
| | | | - Zahinoor Ismail
- Departments of Psychiatry, Clinical Neurosciences, and Community Health Sciences, Hotchkiss Brain Institute and O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
| | | | - Maia Miguelez
- Otsuka Pharmaceutical Development & Commercialization Inc., Princeton, NJ, USA
| | | | - Dalei Chen
- Otsuka Pharmaceutical Development & Commercialization Inc., Princeton, NJ, USA
| | | | - Michael E Thase
- Perelman School of Medicine, University of Pennsylvania and the Philadelphia Veterans Affairs Medical Center, Philadelphia, PA, USA
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11
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Thase ME. A New Option for Depressed Patients Who Do Not Respond to Antidepressant Medications. Am J Psychiatry 2023; 180:188-189. [PMID: 36855879 DOI: 10.1176/appi.ajp.20230039] [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: 03/02/2023]
Affiliation(s)
- Michael E Thase
- Department of Psychiatry, Perelman School of Medicine of the University of Pennsylvania, Philadelphia
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12
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Thase ME, Ismail Z, Meehan SR, Weiss C, Regnier SA, Larsen KG, McIntyre RS. Assessment of patient life engagement in major depressive disorder using items from the Inventory of Depressive Symptomatology Self-Report (IDS-SR). J Psychiatr Res 2023; 161:132-139. [PMID: 36921501 DOI: 10.1016/j.jpsychires.2023.02.008] [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: 09/01/2022] [Revised: 01/24/2023] [Accepted: 02/05/2023] [Indexed: 02/08/2023]
Abstract
BACKGROUND Patient-reported outcomes can measure domains that are personally meaningful, such as life engagement, which reflects motivation, pleasure, and well-being. This study explored whether certain items from the Inventory of Depressive Symptomatology Self-Report (IDS-SR) can capture patient life engagement in major depressive disorder (MDD). METHODS IDS-SR life engagement items were identified by a) a panel of expert psychiatrists (n = 4), b) patient interviews (n = 20), and c) a principal component analysis (PCA) to explore clustering of items. Psychometric analyses were performed on potential subscales, and a minimal clinically important difference (MCID) was estimated by anchor- and distribution-based methods. IDS-SR data were obtained from three randomized controlled trials of adjunctive brexpiprazole in MDD. RESULTS Expert psychiatrists selected 10 items by consensus from the IDS-SR that might capture patient life engagement (Cronbach's alpha, 0.82; item-total correlations, 0.36-0.58). Patient interviews identified 13 items as moderately to very relevant to life engagement (Cronbach's alpha, 0.85; item-total correlations, 0.35-0.61). The PCA revealed a cluster that included all 10 items selected by psychiatrists and 11 items identified by patients. Expert psychiatrists intentionally distinguished life engagement and core depressive symptoms, although patient insights and the PCA indicated that these aspects of MDD are strongly linked. The 10-item IDS-SR life engagement subscale had an MCID of 3-5 points. CONCLUSIONS Different approaches consistently identified a subset of 10 IDS-SR items that can measure life engagement in MDD, which may be suitable to group into an IDS-SR life engagement subscale.
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Affiliation(s)
- Michael E Thase
- Perelman School of Medicine, University of Pennsylvania and the Philadelphia Veterans Affairs Medical Center, Philadelphia, PA, USA.
| | - Zahinoor Ismail
- Departments of Psychiatry, Clinical Neurosciences, and Community Health Sciences, Hotchkiss Brain Institute and O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
| | | | - Catherine Weiss
- Otsuka Pharmaceutical Development & Commercialization Inc., Princeton, NJ, USA
| | | | | | - Roger S McIntyre
- Mood Disorders Psychopharmacology Unit, University Health Network, University of Toronto, Toronto, ON, Canada
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13
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Thase ME. Ongoing phase 2/3 trials of psychotropic drugs: is help finally on the way? World Psychiatry 2023; 22:80-82. [PMID: 36640392 PMCID: PMC9840510 DOI: 10.1002/wps.21064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/17/2022] [Indexed: 01/15/2023] Open
Affiliation(s)
- Michael E. Thase
- Perelman School of Medicine, University of Pennsylvania, Corporal M.J. Crescenz Veterans Affairs Medical CenterPhiladelphiaPAUSA
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McIntyre RS, Ismail Z, Watling CP, Weiss C, Meehan SR, Musingarimi P, Thase ME. Patient-reported outcome measures for life engagement in mental health: a systematic review. J Patient Rep Outcomes 2022; 6:62. [PMID: 35689159 PMCID: PMC9187792 DOI: 10.1186/s41687-022-00468-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 05/17/2022] [Indexed: 01/07/2023] Open
Abstract
Background Life engagement in the context of mental health is a broad term that describes positive health aspects relating to cognition, vitality, motivation and reward, and the ability to feel pleasure—concepts that are meaningful to patients. The aim of this systematic literature review was to identify validated patient-reported outcomes (PROs) that can assess any aspect of life engagement in adults, in the field of general mental health. Methods This was a systematic literature review of articles in English from the MEDLINE database (date of search: September 9, 2020). The search strategy had three components: (1) terms to capture PROs; (2) terms to capture mental health; and (3) terms to capture aspects of life engagement. Articles were eligible if they included a PRO that: (1) is named; (2) can be used across mental health disorders; (3) is used to assess any aspect of life engagement; and (4) has undergone psychometric validation and/or qualitative content validation. A list of PROs was extracted. Results A total of 1585 records were screened and 233 articles were eligible for inclusion. Within these 233 articles, 49 distinct PROs were identified, two of which specifically captured their authors’ interpretation of life engagement: the Engaged Living Scale (ELS) and the Life Engagement Test (LET). However, while the ELS and LET covered motivation and reward, life fulfillment, and value-based living, neither scale captured the cognitive or vitality aspects of life engagement. The remaining identified PROs generally captured single aspects of life engagement, most commonly motivation/reward/energy–apathy, pleasure–anhedonia, and mental/psychological well-being. Conclusion Numerous PROs are available that may capture aspects of life engagement. However, a need remains for a new PRO that can be used in clinical trials to provide a more comprehensive description of the improvements in life engagement that patients with mental health disorders may experience with successful treatment.
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Dirks B, Fava M, Atkinson SD, Joyce M, Thase ME, Howell B, Lin T, Stankovic S. Adjunctive Pimavanserin in Patients with Major Depressive Disorder: Combined Results from Two Randomized, Double-Blind, Placebo-Controlled Phase 3 Studies. Psychopharmacol Bull 2022; 52:8-30. [PMID: 36339271 PMCID: PMC9611795] [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] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Objective In a phase 2 study, pimavanserin demonstrated efficacy as adjunctive treatment for major depressive disorder (MDD). Subsequently, two phase 3 studies (NCT03968159 in the US; NCT03999918 in Europe) were initiated to examine the efficacy and safety of adjunctive pimavanserin in subjects with MDD and inadequate response to antidepressant treatment. Studies were combined with a prespecified statistical analysis plan owing to recruitment challenges related to the COVID-19 pandemic. Experimental design The randomized, double-blind studies enrolled 298 patients with MDD and inadequate response to current antidepressants. Patients were randomly assigned 1:1 to pimavanserin or placebo added to current antidepressant for 6 weeks. Primary endpoint was change from baseline to week 5 in the Hamilton Rating Scale for Depression, 17-item version (HAM-D-17). Principal observations There was no effect of pimavanserin in change from baseline to week 5 in the HAM-D-17 (pimavanserin [n = 138]: least-squares mean [LSM] [standard error {SE}], -9.0 [0.58]; placebo [n = 135]: -8.1 [0.58]; mixed-effects model for repeated measures LSM [SE] difference, -0.9 [0.82], P = 0.2956). Nominal improvement with pimavanserin was observed on 2 secondary endpoints: Clinical Global Impressions-Severity scale, Karolinska Sleepiness Scale. Treatment-emergent adverse events occurred in 58.1% of pimavanserin-treated and 54.7% of placebo-treated patients. Conclusions Adjunctive pimavanserin did not significantly improve depressive symptoms, although pimavanserin was well tolerated.
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Affiliation(s)
- Bryan Dirks
- Bryan Dirks, Acadia Pharmaceuticals Inc, San Diego, CA, USA
| | - Maurizio Fava
- Maurizio Fava, Department of Psychiatry, Massachusetts General Hospital, and Harvard Medical School, Boston, MA, USA
| | | | - Mark Joyce
- Mark Joyce, CNS Healthcare, Jacksonville, FL, USA
| | - Michael E Thase
- Michael E. Thase, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania and the Philadelphia Veterans Affairs Medical Center, Philadelphia, PA, USA
| | - Becky Howell
- Becky Howell, Acadia Pharmaceuticals Inc, Princeton, NJ, USA
| | - Tim Lin
- Tim Lin, Acadia Pharmaceuticals Inc, San Diego, CA, USA
| | - Serge Stankovic
- Serge Stankovic, Acadia Pharmaceuticals Inc, San Diego, CA, USA
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16
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Correll CU, Ismail Z, McIntyre RS, Rafeyan R, Thase ME. Patient Functioning, Life Engagement, and Treatment Goals in Major Depressive Disorder. J Clin Psychiatry 2022; 83. [PMID: 36070581 DOI: 10.4088/jcp.lu21112ah3] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Outcome measures in major depressive disorder have traditionally focused on characteristic symptoms included in the DSM-5 definition of major depressive disorder (MDD): depressed mood, lack of interest or pleasure in activities, fatigue, guilt, and change in weight/appetite. Addressing these symptoms is clearly a treatment priority, especially in the acute stages of the treatment process. However, patients express that, beyond symptom relief, they have additional goals: restoration of functioning and of the feeling that one can participate in, and engage with, their own life. Life engagement encompasses aspects of life experience relating to cognition (including cognition colored by emotion), vitality, motivation and reward, and the ability to feel pleasure. In a recent roundtable meeting, a panel of 5 experts discussed life engagement and its relationship to symptoms and functioning in patients with major depressive disorder and schizophrenia. This Academic Highlights, part 3 in a series, summarizes the experts' discussion of how life engagement can be integrated into patient-centered discussions of treatment goals, as well as how it can inform treatment selection in for those with MDD.
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Affiliation(s)
- Christoph U Correll
- Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York.,Charité Universitätsmedizin, Berlin, Germany
| | - Zahinoor Ismail
- Department of Psychiatry, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Roger S McIntyre
- Mood Disorder Psychopharmacology Unit, University Health Network, Department of Psychiatry, University of Toronto.,Institute of Medical Science, University of Toronto.,Departments of Psychiatry and Pharmacology, University of Toronto, Toronto, Ontario, Canada
| | - Roueen Rafeyan
- Department of Psychiatry, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Michael E Thase
- Department of Psychiatry, Perelman School of Medicine of the University of Pennsylvania.,Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
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17
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Markowitz JC, Wright JH, Peeters F, Thase ME, Kocsis JH, Sudak DM. Psychotherapy's Role for Treatment-Resistant Depression: Reply to Bartova et al. Am J Psychiatry 2022; 179:688. [PMID: 36048496 DOI: 10.1176/appi.ajp.20220212r] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- John C Markowitz
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons and New York State Psychiatric Institute, New York
| | - Jesse H Wright
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons and New York State Psychiatric Institute, New York
| | - Frenk Peeters
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons and New York State Psychiatric Institute, New York
| | - Michael E Thase
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons and New York State Psychiatric Institute, New York
| | - James H Kocsis
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons and New York State Psychiatric Institute, New York
| | - Donna M Sudak
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons and New York State Psychiatric Institute, New York
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18
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Correll CU, Ismail Z, McIntyre RS, Rafeyan R, Thase ME. Patient Functioning, Life Engagement, and Treatment Goals in Schizophrenia. J Clin Psychiatry 2022; 83. [PMID: 35980255 DOI: 10.4088/jcp.lu21112ah2] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Unmet needs in the treatment of schizophrenia include nonadherence to treatment, symptom relapse, incomplete functional recovery, and poor quality of life. Incorporating the patient's perspective into the treatment plan and measuring treatment outcomes that are meaningful to patients is an important part of addressing these issues. Goal setting is associated with greater improvements in motivation and role functioning, but clinicians should keep in mind that their goals for treatment may not align with those of their patients. Patients tend to think about their lives more holistically than clinicians, with equal weight given to social and clinical needs, and improved functioning and engagement with life are likely to emerge as priorities, beyond the need for symptom control. In a recent roundtable meeting, a panel of 5 experts discussed life engagement and its relationship to symptoms and functioning in patients with major depressive disorder (MDD) and schizophrenia. This Academic Highlights, part 2 in a series, summarizes the experts' discussion of how life engagement can inform goal-setting and treatment selection in patients with schizophrenia.
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Affiliation(s)
- Christoph U Correll
- Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York.,Charité Universitätsmedizin, Berlin, Germany
| | - Zahinoor Ismail
- Department of Psychiatry, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Roger S McIntyre
- Mood Disorder Psychopharmacology Unit, University Health Network, Department of Psychiatry, University of Toronto.,Institute of Medical Science, University of Toronto.,Departments of Psychiatry and Pharmacology, University of Toronto, Toronto, Ontario, Canada
| | - Roueen Rafeyan
- Department of Psychiatry, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Michael E Thase
- Department of Psychiatry, Perelman School of Medicine of the University of Pennsylvania.,Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
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Correll CU, Ismail Z, McIntyre RS, Rafeyan R, Thase ME. Patient Functioning and Life Engagement: Unmet Needs in Major Depressive Disorder and Schizophrenia. J Clin Psychiatry 2022; 83. [PMID: 35921511 DOI: 10.4088/jcp.lu21112ah1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Definitions of treatment success used in clinical trials of medications for serious mental illness have generally focused on reduction in symptoms assessed via observer-rated instruments such as the Montgomery-Asberg Depression Rating Scale and the Hamilton Depression Rating Scale in MDD and the Positive and Negative Syndrome Scale (PANSS) and Brief Psychiatric Rating Scale in schizophrenia. In recent years, there has been a shift toward incorporating outcomes into clinical research that are patient-reported and reflect outcomes and goals that are meaningful to the patient. These outcomes include aspects of functioning (eg, activities of daily living and role fulfillment), as well as life engagement, which interacts with symptomatic and functional outcomes and encompasses aspects such as motivation and vitality. In a recent roundtable meeting, a panel of 5 experts discussed life engagement and its relationship to symptoms and functioning in patients with major depressive disorder (MDD) and schizophrenia. This Academic Highlights summarizes their discussion.
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Affiliation(s)
- Christoph U Correll
- Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York.,Charité Universitätsmedizin, Berlin, Germany
| | - Zahinoor Ismail
- Department of Psychiatry, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Roger S McIntyre
- Mood Disorder Psychopharmacology Unit, University Health Network, Department of Psychiatry, University of Toronto.,Institute of Medical Science, University of Toronto.,Departments of Psychiatry and Pharmacology, University of Toronto, Toronto, Ontario, Canada
| | - Roueen Rafeyan
- Department of Psychiatry, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Michael E Thase
- Department of Psychiatry, Perelman School of Medicine of the University of Pennsylvania.,Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
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Van den Eynde V, Abdelmoemin WR, Abraham MM, Amsterdam JD, Anderson IM, Andrade C, Baker GB, Beekman ATF, Berk M, Birkenhäger TK, Blackwell BB, Blier P, Blom MBJ, Bodkin AJ, Cattaneo CI, Dantz B, Davidson J, Dunlop BW, Estévez RF, Feinberg SS, Finberg JPM, Fochtmann LJ, Gotlib D, Holt A, Insel TR, Larsen JK, Mago R, Menkes DB, Meyer JM, Nutt DJ, Parker G, Rego MD, Richelson E, Ruhé HG, Sáiz-Ruiz J, Stahl SM, Steele T, Thase ME, Ulrich S, van Balkom AJLM, Vieta E, Whyte I, Young AH, Gillman PK. The prescriber's guide to classic MAO inhibitors (phenelzine, tranylcypromine, isocarboxazid) for treatment-resistant depression. CNS Spectr 2022; 28:1-14. [PMID: 35837681 DOI: 10.1017/s1092852922000906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This article is a clinical guide which discusses the "state-of-the-art" usage of the classic monoamine oxidase inhibitor (MAOI) antidepressants (phenelzine, tranylcypromine, and isocarboxazid) in modern psychiatric practice. The guide is for all clinicians, including those who may not be experienced MAOI prescribers. It discusses indications, drug-drug interactions, side-effect management, and the safety of various augmentation strategies. There is a clear and broad consensus (more than 70 international expert endorsers), based on 6 decades of experience, for the recommendations herein exposited. They are based on empirical evidence and expert opinion-this guide is presented as a new specialist-consensus standard. The guide provides practical clinical advice, and is the basis for the rational use of these drugs, particularly because it improves and updates knowledge, and corrects the various misconceptions that have hitherto been prominent in the literature, partly due to insufficient knowledge of pharmacology. The guide suggests that MAOIs should always be considered in cases of treatment-resistant depression (including those melancholic in nature), and prior to electroconvulsive therapy-while taking into account of patient preference. In selected cases, they may be considered earlier in the treatment algorithm than has previously been customary, and should not be regarded as drugs of last resort; they may prove decisively effective when many other treatments have failed. The guide clarifies key points on the concomitant use of incorrectly proscribed drugs such as methylphenidate and some tricyclic antidepressants. It also illustrates the straightforward "bridging" methods that may be used to transition simply and safely from other antidepressants to MAOIs.
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Affiliation(s)
| | | | | | - Jay D Amsterdam
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ian M Anderson
- Department of Psychiatry, University of Manchester, Manchester, UK
| | - Chittaranjan Andrade
- Department of Psychopharmacology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Glen B Baker
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
| | - Aartjan T F Beekman
- Department of Psychiatry, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Michael Berk
- Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, VIC, Australia
| | - Tom K Birkenhäger
- Department of Psychiatry, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Barry B Blackwell
- Department of Psychiatry, University of Wisconsin, Milwaukee, WI, USA
| | - Pierre Blier
- Departments of Psychiatry and Cellular & Molecular Medicine, University of Ottawa, Ottawa, ON, Canada
| | | | | | | | - Bezalel Dantz
- Department of Psychiatry and Behavioral Sciences, Rush Medical College, Chicago, IL, USA
| | - Jonathan Davidson
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
| | - Boadie W Dunlop
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA, USA
| | - Ryan F Estévez
- College of Medicine, University of Central Florida, Orlando, FL, USA
| | - Shalom S Feinberg
- Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, New York, NY, USA
| | - John P M Finberg
- Department of Molecular Pharmacology, Technion-Israel Institute of Technology, Haifa, Israel
| | - Laura J Fochtmann
- Department of Psychiatry, Department of Pharmacological Sciences, and Biomedical Informatics, Stony Brook University Renaissance School of Medicine, Stony Brook, NY, USA
| | | | - Andrew Holt
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
| | - Thomas R Insel
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Jens K Larsen
- Department of Affective Disorders, Aarhus University Hospital, Aarhus, Denmark
| | - Rajnish Mago
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - David B Menkes
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Jonathan M Meyer
- Department of Psychiatry, UC San Diego School of Medicine, San Diego, CA, USA
| | - David J Nutt
- Department of Brain Sciences, Imperial College, London, UK
| | - Gordon Parker
- Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, NSW, Australia
| | - Mark D Rego
- Yale Institute for Global Health, Yale School of Medicine, New Haven, CT, USA
| | - Elliott Richelson
- Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, FL, USA
| | - Henricus G Ruhé
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Stephen M Stahl
- Department of Psychiatry and Neuroscience, University of California, Riverside, Riverside, CA, USA
| | - Thomas Steele
- Department of Psychiatry and Behavioral Sciences, University of South Carolina, Columbia, SC, USA
| | - Michael E Thase
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Anton J L M van Balkom
- Department of Psychiatry, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Eduard Vieta
- Department of Psychiatry and Psychology, University of Barcelona Hospital Clinic, Barcelona, Spain
| | - Ian Whyte
- Department of Clinical Toxicology and Pharmacology, University of Newcastle, Callaghan, NSW, Australia
| | - Allan H Young
- Department of Psychological Medicine, King's College London, London, UK
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21
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Oslin DW, Lynch KG, Shih MC, Ingram EP, Wray LO, Chapman SR, Kranzler HR, Gelernter J, Pyne JM, Stone A, DuVall SL, Lehmann LS, Thase ME. Effect of Pharmacogenomic Testing for Drug-Gene Interactions on Medication Selection and Remission of Symptoms in Major Depressive Disorder: The PRIME Care Randomized Clinical Trial. JAMA 2022; 328:151-161. [PMID: 35819423 PMCID: PMC9277497 DOI: 10.1001/jama.2022.9805] [Citation(s) in RCA: 46] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
IMPORTANCE Selecting effective antidepressants for the treatment of major depressive disorder (MDD) is an imprecise practice, with remission rates of about 30% at the initial treatment. OBJECTIVE To determine whether pharmacogenomic testing affects antidepressant medication selection and whether such testing leads to better clinical outcomes. DESIGN, SETTING, AND PARTICIPANTS A pragmatic, randomized clinical trial that compared treatment guided by pharmacogenomic testing vs usual care. Participants included 676 clinicians and 1944 patients. Participants were enrolled from 22 Department of Veterans Affairs medical centers from July 2017 through February 2021, with follow-up ending November 2021. Eligible patients were those with MDD who were initiating or switching treatment with a single antidepressant. Exclusion criteria included an active substance use disorder, mania, psychosis, or concurrent treatment with a specified list of medications. INTERVENTIONS Results from a commercial pharmacogenomic test were given to clinicians in the pharmacogenomic-guided group (n = 966). The comparison group received usual care and access to pharmacogenomic results after 24 weeks (n = 978). MAIN OUTCOMES AND MEASURES The co-primary outcomes were the proportion of prescriptions with a predicted drug-gene interaction written in the 30 days after randomization and remission of depressive symptoms as measured by the Patient Health Questionnaire-9 (PHQ-9) (remission was defined as PHQ-9 ≤ 5). Remission was analyzed as a repeated measure across 24 weeks by blinded raters. RESULTS Among 1944 patients who were randomized (mean age, 48 years; 491 women [25%]), 1541 (79%) completed the 24-week assessment. The estimated risks for receiving an antidepressant with none, moderate, and substantial drug-gene interactions for the pharmacogenomic-guided group were 59.3%, 30.0%, and 10.7% compared with 25.7%, 54.6%, and 19.7% in the usual care group. The pharmacogenomic-guided group was more likely to receive a medication with a lower potential drug-gene interaction for no drug-gene vs moderate/substantial interaction (odds ratio [OR], 4.32 [95% CI, 3.47 to 5.39]; P < .001) and no/moderate vs substantial interaction (OR, 2.08 [95% CI, 1.52 to 2.84]; P = .005) (P < .001 for overall comparison). Remission rates over 24 weeks were higher among patients whose care was guided by pharmacogenomic testing than those in usual care (OR, 1.28 [95% CI, 1.05 to 1.57]; P = .02; risk difference, 2.8% [95% CI, 0.6% to 5.1%]) but were not significantly higher at week 24 when 130 patients in the pharmacogenomic-guided group and 126 patients in the usual care group were in remission (estimated risk difference, 1.5% [95% CI, -2.4% to 5.3%]; P = .45). CONCLUSIONS AND RELEVANCE Among patients with MDD, provision of pharmacogenomic testing for drug-gene interactions reduced prescription of medications with predicted drug-gene interactions compared with usual care. Provision of test results had small nonpersistent effects on symptom remission. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03170362.
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Affiliation(s)
- David W. Oslin
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania
- Department of Psychiatry, University of Pennsylvania, Philadelphia
| | - Kevin G. Lynch
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania
- Department of Psychiatry, University of Pennsylvania, Philadelphia
| | - Mei-Chiung Shih
- VA Cooperative Studies Coordinating Center, Palo Alto, California
- Department of Biomedical Data Science, Stanford University, Palo Alto, California
| | - Erin P. Ingram
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania
| | - Laura O. Wray
- VA Center for Integrated Healthcare, Buffalo, New York
- VA Office of Mental Health and Suicide Prevention, Washington, DC
- Division of Geriatrics and Palliative Care, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
| | | | - Henry R. Kranzler
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania
- Department of Psychiatry, University of Pennsylvania, Philadelphia
| | - Joel Gelernter
- VA Connecticut Healthcare System, West Haven
- Departments of Psychiatry, Genetics, and Neuroscience, Yale University School of Medicine, New Haven, Connecticut
| | - Jeffrey M. Pyne
- Central Arkansas Veterans Healthcare System, Little Rock
- Psychiatric Research Institute, University of Arkansas for Medical Sciences, Little Rock
| | | | - Scott L. DuVall
- VA Informatics and Computing Infrastructure, Salt Lake City, Utah
- VA Salt Lake City Health Care System, Salt Lake City, Utah
- Department of Internal Medicine Division of Epidemiology, University of Utah School of Medicine, Salt Lake City
| | - Lisa Soleymani Lehmann
- VA Boston Healthcare System, Boston, Massachusetts
- Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
- Google, Mountain View, California
| | - Michael E. Thase
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania
- Department of Psychiatry, University of Pennsylvania, Philadelphia
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22
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Khazanov GK, Morris PE, Beed A, Jager-Hyman S, Myhre K, McKay JR, Feinn RS, Boland EM, Thase ME. Do financial incentives increase mental health treatment engagement? A meta-analysis. J Consult Clin Psychol 2022; 90:528-544. [PMID: 35771513 PMCID: PMC10603786 DOI: 10.1037/ccp0000737] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Engagement in mental health treatment is low, which can lead to poor outcomes. We evaluated the efficacy of offering patients financial incentives to increase their mental health treatment engagement, also referred to as contingency management. METHOD We meta-analyzed studies offering financial incentives for mental health treatment engagement, including increasing treatment attendance, medication adherence, and treatment goal completion. Analyses were run within a multilevel framework. All study designs were included, and sensitivity analyses were run including only randomized and high-quality studies. RESULTS About 80% of interventions incentivized treatment for substance use disorders. Financial incentives significantly increased treatment attendance (Hedges' g = 0.49, [0.33, 0.64], k = 30, I2 = 83.14), medication adherence (Hedges' g = 0.95, [0.47, 1.44], k = 6, I2 = 87.73), and treatment goal completion (Hedges' g = 0.61, [0.22, 0.99], k = 5, I2 = 60.55), including completing homework, signing treatment plans, and reducing problematic behavior. CONCLUSIONS Financial incentives increase treatment engagement with medium to large effect sizes. We provide strong evidence for their effectiveness in increasing substance use treatment engagement and preliminary evidence for their effectiveness in increasing treatment engagement for other mental health disorders. Future research should prioritize testing the efficacy of incentivizing treatment engagement for mental health disorders aside from substance use. Research must also identify ways to incentivize treatment engagement that improve functioning and long-term outcomes and address ethical and systemic barriers to implementing these interventions. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
- Gabriela K Khazanov
- Mental Illness Research, Education, and Clinical Center of the Veterans Integrated Service Network 4, Crescenz Veterans Affairs Medical Center
| | | | | | - Shari Jager-Hyman
- Department of Psychiatry, Penn Center for the Prevention of Suicide, University of Pennsylvania
| | - Karoline Myhre
- Department of Psychiatry, Penn Center for the Prevention of Suicide, University of Pennsylvania
| | - James R McKay
- Department of Psychiatry, University of Pennsylvania
| | - Richard S Feinn
- Frank H. Netter MD School of Medicine, Quinnipiac University
| | - Elaine M Boland
- Mental Illness Research, Education, and Clinical Center of the Veterans Integrated Service Network 4, Crescenz Veterans Affairs Medical Center
| | - Michael E Thase
- Mental Illness Research, Education, and Clinical Center of the Veterans Integrated Service Network 4, Crescenz Veterans Affairs Medical Center
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23
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Vittengl JR, Clark LA, Thase ME, Jarrett RB. Does Symptom Linkage Density Predict Outcomes in Cognitive Therapy for Recurrent Depression? J Psychopathol Behav Assess 2022; 44:469-480. [PMID: 35937855 PMCID: PMC9354858 DOI: 10.1007/s10862-021-09914-y] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2021] [Indexed: 11/28/2022]
Abstract
Background Acute-phase cognitive therapy (CT) is an efficacious treatment for major depressive disorder (MDD), but how CT helps patients is incompletely understood. As a potential means to clarify CT mechanisms, we defined "symptom linkage density" (SLD) as a patient's mean time-lagged correlation among nine depressive symptoms across 13 weekly assessments. We hypothesized that patients with higher SLD during CT have better outcomes (treatment response, and fewer symptoms after response), and we explored whether SLD correlated with other possible CT processes (growth in social adjustment and CT skills). Method Data were drawn from two clinical trials of CT for adult outpatients with recurrent MDD (primary sample n = 475, replication sample n = 146). In both samples, patients and clinicians completed measures of depressive symptoms and social adjustment repeatedly during CT. In the primary sample, patients and cognitive therapists rated patients' CT skills. After CT, responders were assessed for 32 (primary sample) or 24 (replication sample) additional months to measure long-term depression outcomes. Results Higher SLD predicted increases in social adjustment (both samples) and CT skills (primary sample) during CT, CT response (both samples), and lower MDD severity for at least 2 years after CT response (both samples). Analyses controlled patient-level symptom means and variability to estimate SLD's incremental predictive validity. Conclusions These novel findings from two independent samples with longitudinal follow-up require further replication and extension. SLD may reflect or facilitate generalization of CT skills, improvement in social functioning, or other processes responsible for CT's shorter and longer term benefits.
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Affiliation(s)
- Jeffrey R. Vittengl
- Department of Psychology, Truman State University, Kirksville, Missouri, USA
| | - Lee Anna Clark
- Department of Psychology, University of Notre Dame, Notre Dame, Indiana, USA
| | - Michael E. Thase
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Robin B. Jarrett
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
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24
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Thase ME. Commentary on the Hamilton Rating Scale for Depression: 60+ Years Old and Still Relevant to the Assessment of Antidepressant Treatment Outcomes. Psychopharmacol Bull 2022; 52:154-156. [PMID: 35721815 PMCID: PMC9172556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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25
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Thase ME, Jacobsen PL, Hanson E, Xu R, Tolkoff M, Murthy NV. Vortioxetine 5, 10, and 20 mg significantly reduces the risk of relapse compared with placebo in patients with remitted major depressive disorder: The RESET study. J Affect Disord 2022; 303:123-130. [PMID: 35131363 DOI: 10.1016/j.jad.2022.02.002] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 02/01/2022] [Accepted: 02/03/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Maintenance therapy for major depressive disorder (MDD) is typically recommended at the dose on which the patient was stabilized. However, for some patients, dose alteration may be required. We investigated multiple vortioxetine doses versus placebo for relapse prevention in patients achieving remission with vortioxetine 10 mg daily. METHODS In this US-based, randomized withdrawal study, outpatients (N = 1106, aged 18-75 years) with recurrent MDD (Montgomery-Åsberg Depression Rating Scale [MADRS] score ≥26), a current major depressive episode (MDE) (8 weeks-18 months' duration), and ≥2 previous MDEs were treated with open-label vortioxetine 10 mg once daily orally for 16 weeks. Responders at week 8 (≥50% MADRS score reduction) achieving remission (MADRS score ≤12) at weeks 14 and 16 (N = 580) were randomized to vortioxetine 5, 10, or 20 mg or placebo in a 32-week double-blind period. The primary outcome was time to first relapse over the first 28 weeks; secondary outcomes (relapse, change in total MADRS, Clinician Global Impression-Severity [CGI-S]) were evaluated at 32 weeks. RESULTS Time to relapse was longer and cumulative relapse rates were lower for vortioxetine 5 mg (19.3%), 10 mg (17.9%), and 20 mg (17.4%) versus placebo (32.5%) over 28 weeks (p<0.05 for all). CGI-S scores remained stable and adverse events were generally mild-to-moderate. LIMITATIONS Extrapolation of results to patients achieving remission with vortioxetine doses other than 10 mg should be made with caution. CONCLUSION For patients with MDD achieving symptomatic remission at 10 mg/day, all doses of vortioxetine were effective for relapse prevention, with acceptable tolerability.
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Affiliation(s)
- Michael E Thase
- Department of Psychiatry, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, and the Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, US
| | | | | | - Rengyi Xu
- Takeda Development Center Americas, Inc., Cambridge, MA US
| | - Max Tolkoff
- Takeda Development Center Americas, Inc., Cambridge, MA US
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26
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Berger AA, Sottosanti ER, Winnick A, Keefe J, Gilbert E, Hasoon J, Thase ME, Kaye AD, Viswanath O, Urits I. Suvorexant in the Treatment of Difficulty Falling and Staying Asleep (Insomnia). Psychopharmacol Bull 2022; 52:68-90. [PMID: 35342199 PMCID: PMC8896749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Abstract
Purpose of Review Insomnia affects more than 10% of the population and causes significant discomfort and disability. Suvorexant is an orexin receptor antagonist that specifically targets the wake-sleep cycle. This review summarizes recent and seminal evidence in the biological and physiological evidence of insomnia, the mechanism of action of suvorexant in treating insomnia, and clinical evidence regarding its use. Recent Findings There is no single clear diagnosis for insomnia, and thus prevalence is not entirely clear, but it is estimated to affect 10%-30% of the adult population. Comorbidities include obesity, diabetes, and various psychiatric conditions, and insomnia likely has a contributing role in these conditions. Insomnia, by definition, impacts sleep quality and also wakefulness, including academic success and work efficiency. Insomnia is likely related to genetic susceptibility and a triggering event, leading to hyper-arousal states and functional brain disturbances. This leads to hyperactivity of the hypothalamic-pituitary-adrenal axis, over-secretion of corticotropin-releasing factor, and aberrancy in neurotransmitter release. Though several pharmacological options exist for the treatment of insomnia, there is equivocal data regarding their efficacy or limits to their use due to side effects and contraindications. Suvorexant is a novel dual orexin receptor antagonist, which is shown to improve sleep by reducing arousals. Unlike classical therapeutics, suvorexant does not alter the sleep profile; it prolongs the time spent in each sleep state. Though it may cause some somnolence, it is milder than reported with other drugs. Summary Multiple clinical studies support the use of suvorexant in insomnia. In primary insomnia, suvorexant is effective (over placebo), as measured by polysomnography and reported by patients, in both attaining and maintaining sleep. Similar, albeit to a smaller degree, results were found in secondary insomnia. Suvorexant carries two significant advantages over existing therapies; it has a much better safety profile in approved doses, and it preserves natural sleep architecture, thus promoting more restful sleep and recovery. Unfortunately, data exists mostly for suvorexant versus placebo, and head-to-head trials with common hypnotics are needed to assess the true efficacy of suvorexant over the alternatives. And while tolerance is less likely to develop, close monitoring of post-marketing data is required to evaluate for long term adverse events and efficacy.
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27
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Rush AJ, Sackeim HA, Conway CR, Bunker MT, Hollon SD, Demyttenaere K, Young AH, Aaronson ST, Dibué M, Thase ME, McAllister-Williams RH. Clinical research challenges posed by difficult-to-treat depression. Psychol Med 2022; 52:419-432. [PMID: 34991768 PMCID: PMC8883824 DOI: 10.1017/s0033291721004943] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [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: 06/30/2021] [Revised: 11/02/2021] [Accepted: 11/09/2021] [Indexed: 12/13/2022]
Abstract
Approximately one-third of individuals in a major depressive episode will not achieve sustained remission despite multiple, well-delivered treatments. These patients experience prolonged suffering and disproportionately utilize mental and general health care resources. The recently proposed clinical heuristic of 'difficult-to-treat depression' (DTD) aims to broaden our understanding and focus attention on the identification, clinical management, treatment selection, and outcomes of such individuals. Clinical trial methodologies developed to detect short-term therapeutic effects in treatment-responsive populations may not be appropriate in DTD. This report reviews three essential challenges for clinical intervention research in DTD: (1) how to define and subtype this heterogeneous group of patients; (2) how, when, and by what methods to select, acquire, compile, and interpret clinically meaningful outcome metrics; and (3) how to choose among alternative clinical trial design options to promote causal inference and generalizability. The boundaries of DTD are uncertain, and an evidence-based taxonomy and reliable assessment tools are preconditions for clinical research and subtyping. Traditional outcome metrics in treatment-responsive depression may not apply to DTD, as they largely reflect the only short-term symptomatic change and do not incorporate durability of benefit, side effect burden, or sustained impact on quality of life or daily function. The trial methodology will also require modification as trials will likely be of longer duration to examine the sustained impact, raising complex issues regarding control group selection, blinding and its integrity, and concomitant treatments.
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Affiliation(s)
- A. John Rush
- Duke-NUS Medical School, Singapore
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
- Department of Psychiatry, Texas Tech University, Permian Basin, TX, USA
| | - Harold A. Sackeim
- Departments of Psychiatry and Radiology, Columbia University, New York, NY, USA
| | - Charles R. Conway
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, USA
| | | | - Steven D. Hollon
- Departments of Psychology and Psychiatry, Vanderbilt University, Nashville, TN, USA
| | - Koen Demyttenaere
- University Psychiatric Center, KU Leuven, Leuven, Belgium
- Faculty of Medicine, KU Leuven, Leuven, Belgium
| | - Allan H. Young
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK
| | - Scott T. Aaronson
- Department of Clinical Research, Sheppard Pratt Health System, Baltimore, MD, USA
| | - Maxine Dibué
- Department of Neurosurgery, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- Medical Affairs Europe, LivaNova Deutschland GmbH, Munich, Germany
| | - Michael E. Thase
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - R. Hamish McAllister-Williams
- Northern Centre for Mood Disorders, Newcastle University, Newcastle upon Tyne, UK
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
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28
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Affiliation(s)
- John C Markowitz
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons and New York State Psychiatric Institute, New York (Markowitz); Department of Psychiatry and Behavioral Sciences, University of Louisville, Louisville (Wright); Department of Clinical Psychological Science, Maastricht University, Maastricht, the Netherlands (Peeters); Department of Psychiatry, University of Pennsylvania, Philadelphia (Thase); Department of Psychiatry, Weill Medical College of Cornell University, New York (Kocsis); Department of Psychiatry, Drexel University, Philadelphia (Sudak)
| | - Jesse H Wright
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons and New York State Psychiatric Institute, New York (Markowitz); Department of Psychiatry and Behavioral Sciences, University of Louisville, Louisville (Wright); Department of Clinical Psychological Science, Maastricht University, Maastricht, the Netherlands (Peeters); Department of Psychiatry, University of Pennsylvania, Philadelphia (Thase); Department of Psychiatry, Weill Medical College of Cornell University, New York (Kocsis); Department of Psychiatry, Drexel University, Philadelphia (Sudak)
| | - Frenk Peeters
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons and New York State Psychiatric Institute, New York (Markowitz); Department of Psychiatry and Behavioral Sciences, University of Louisville, Louisville (Wright); Department of Clinical Psychological Science, Maastricht University, Maastricht, the Netherlands (Peeters); Department of Psychiatry, University of Pennsylvania, Philadelphia (Thase); Department of Psychiatry, Weill Medical College of Cornell University, New York (Kocsis); Department of Psychiatry, Drexel University, Philadelphia (Sudak)
| | - Michael E Thase
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons and New York State Psychiatric Institute, New York (Markowitz); Department of Psychiatry and Behavioral Sciences, University of Louisville, Louisville (Wright); Department of Clinical Psychological Science, Maastricht University, Maastricht, the Netherlands (Peeters); Department of Psychiatry, University of Pennsylvania, Philadelphia (Thase); Department of Psychiatry, Weill Medical College of Cornell University, New York (Kocsis); Department of Psychiatry, Drexel University, Philadelphia (Sudak)
| | - James H Kocsis
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons and New York State Psychiatric Institute, New York (Markowitz); Department of Psychiatry and Behavioral Sciences, University of Louisville, Louisville (Wright); Department of Clinical Psychological Science, Maastricht University, Maastricht, the Netherlands (Peeters); Department of Psychiatry, University of Pennsylvania, Philadelphia (Thase); Department of Psychiatry, Weill Medical College of Cornell University, New York (Kocsis); Department of Psychiatry, Drexel University, Philadelphia (Sudak)
| | - Donna M Sudak
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons and New York State Psychiatric Institute, New York (Markowitz); Department of Psychiatry and Behavioral Sciences, University of Louisville, Louisville (Wright); Department of Clinical Psychological Science, Maastricht University, Maastricht, the Netherlands (Peeters); Department of Psychiatry, University of Pennsylvania, Philadelphia (Thase); Department of Psychiatry, Weill Medical College of Cornell University, New York (Kocsis); Department of Psychiatry, Drexel University, Philadelphia (Sudak)
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29
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Thase ME. In Memoriam: Aaron T. Beck, MD, 1921-2021. J Clin Psychiatry 2022. [PMID: 34985834 DOI: 10.4088/jcp.20f14370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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30
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Vittengl JR, Clark LA, Thase ME, Jarrett RB. Levels of depressed mood and low interest for two years after response to cognitive therapy for recurrent depression. Behav Res Ther 2022; 148:103996. [PMID: 34775120 PMCID: PMC8712398 DOI: 10.1016/j.brat.2021.103996] [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] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 09/13/2021] [Accepted: 11/07/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Major depressive disorder (MDD) involves depressed mood (high negative affect, predominantly) and low interest/pleasure (low positive affect). In past research, negative affect has improved more than positive affect during acute-phase antidepressant medication or cognitive therapy (CT). We extended this literature by differentiating depressed mood and two dimensions of low interest (general and sexual), assessing persistence of symptom differences after acute-phase CT response, and testing whether continuation treatment acted differently on depressed mood versus low interest. METHODS We analyzed data from two randomized controlled trials. Patients with recurrent MDD first received acute-phase CT. Then, responders were randomized to 8-month continuation treatments and assessed for 16-24 additional months. RESULTS Depressed mood and low general interest improved more than low sexual interest during acute-phase CT. Among responders, these symptom differences persisted for at least 2 years and were not changed by continuation CT or antidepressant medication. LIMITATIONS Generalization of findings to other patient populations and treatments is uncertain. Depressed mood and low interest scales were constructed from standard symptom measures and overlapped empirically. CONCLUSIONS Less improvement during CT, and persistent low sexual interest despite continuation treatment, highlights the need for MDD treatments more effectively targeting this positive affective symptom.
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Affiliation(s)
| | - Lee Anna Clark
- Department of Psychology, University of Notre Dame, Notre Dame, IN, USA
| | - Michael E Thase
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Robin B Jarrett
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX, USA.
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31
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Ehrlich TJ, Bhat J, Horwege AM, Mathalon DH, Glover GH, Roach BJ, Badran BW, Forman SD, George MS, Scott JC, Thase ME, Yesavage JA, Yurgelun-Todd DA, Rosen AC. Ruminative reflection is associated with anticorrelations between the orbitofrontal cortex and the default mode network in depression: implications for repetitive transcranial magnetic stimulation. Brain Imaging Behav 2022; 16:1186-1195. [PMID: 34860349 PMCID: PMC9107429 DOI: 10.1007/s11682-021-00596-4] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2021] [Indexed: 02/01/2023]
Abstract
Patients with depression who ruminate repeatedly focus on depressive thoughts; however, there are two cognitive subtypes of rumination, reflection and brooding, each associated with different prognoses. Reflection involves problem-solving and is associated with positive outcomes, whereas brooding involves passive, negative, comparison with other people and is associated with poor outcomes. Rumination has also been related to atypical functional hyperconnectivity between the default mode network and subgenual prefrontal cortex. Repetitive pulse transcranial magnetic stimulation of the prefrontal cortex has been shown to alter functional connectivity, suggesting that the abnormal connectivity associated with rumination could potentially be altered. This study examined potential repetitive pulse transcranial magnetic stimulation prefrontal cortical targets that could modulate one or both of these rumination subtypes. Forty-three patients who took part in a trial of repetitive pulse transcranial magnetic stimulation completed the Rumination Response Scale questionnaire and resting-state functional magnetic resonance imaging. Seed to voxel functional connectivity analyses identified an anticorrelation between the left lateral orbitofrontal cortex (-44, 26, -8; k = 172) with the default mode network-subgenual region in relation to higher levels of reflection. Parallel analyses were not significant for brooding or the RRS total score. These findings extend previous studies of rumination and identify a potential mechanistic model for symptom-based neuromodulation of rumination.
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Affiliation(s)
- Tobin J Ehrlich
- Veterans Affairs Palo Alto Health Care System, 3801 Miranda Ave (151Y), Palo Alto, CA, 94304, USA
- University of Michigan, Ann Arbor, MI, USA
| | - Jyoti Bhat
- Veterans Affairs Palo Alto Health Care System, 3801 Miranda Ave (151Y), Palo Alto, CA, 94304, USA
- Palo Alto Veterans Institute for Research, Palo Alto, CA, 94304, USA
| | - Andrea M Horwege
- Veterans Affairs Palo Alto Health Care System, 3801 Miranda Ave (151Y), Palo Alto, CA, 94304, USA
| | - Daniel H Mathalon
- Mental Health Service, San Francisco Veterans Affairs Health Care System, University of California, San Francisco, San Francisco, CA, USA
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA
| | - Gary H Glover
- Department of Radiology, Stanford University, Stanford, CA, USA
| | - Brian J Roach
- Mental Health Service, San Francisco Veterans Affairs Health Care System, University of California, San Francisco, San Francisco, CA, USA
- Northern California Institute for Research and Education, San Francisco Veterans Affairs Medical Center, University of California, San Francisco, San Francisco, CA, USA
| | - Bashar W Badran
- Brain Stimulation Division, Department of Psychiatry, Medical University of South Carolina, Charleston, SC, USA
| | - Steven D Forman
- Department of Veterans Affairs, Veterans Affairs Medical Center, Pittsburgh, PA, USA
- Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Mark S George
- Brain Stimulation Division, Department of Psychiatry, Medical University of South Carolina, Charleston, SC, USA
- Ralph H. Johnson VA Medical Center, Charleston, SC, USA
| | - J Cobb Scott
- VISN4 Mental Illness Research, Education, and Clinical Center at the Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, 19104, USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Michael E Thase
- VISN4 Mental Illness Research, Education, and Clinical Center at the Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, 19104, USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jerome A Yesavage
- Veterans Affairs Palo Alto Health Care System, 3801 Miranda Ave (151Y), Palo Alto, CA, 94304, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Deborah A Yurgelun-Todd
- Rocky Mountain Network Mental Illness Research Education and Clinical Centers (VISN 19), VA Salt Lake City Health Care System, Salt Lake City, UT, USA
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Allyson C Rosen
- Veterans Affairs Palo Alto Health Care System, 3801 Miranda Ave (151Y), Palo Alto, CA, 94304, USA.
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA.
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Weiss C, Meehan SR, Brown TM, Gupta C, Mørup MF, Thase ME, McIntyre RS, Ismail Z. Effects of adjunctive brexpiprazole on calmness and life engagement in major depressive disorder: post hoc analysis of patient-reported outcomes from clinical trial exit interviews. J Patient Rep Outcomes 2021; 5:128. [PMID: 34894307 PMCID: PMC8665966 DOI: 10.1186/s41687-021-00380-4] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 09/25/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Though often overlooked, calming patients and increasing their life engagement are key factors in the treatment of major depressive disorder (MDD). This study aimed to test the hypothesis that adjunctive brexpiprazole increases calmness and life engagement among patients with MDD, based on clinical trial exit interviews. METHODS This was a pooled analysis of exit interview data from three exploratory, open-label studies of adjunctive brexpiprazole 1-3 mg/day. The studies enrolled 105 outpatients with MDD (DSM-IV-TR criteria), a current depressive episode, and inadequate response to antidepressant treatment during the current episode. Patients were interviewed if they completed the end-of-treatment visit (Week 6 or Week 12, depending on the study). Exit interviews took the form of semi-structured telephone interviews in which patients were asked mostly qualitative questions about their symptoms prior to the start of the study, and about improvements they had noted during treatment. Interview transcripts were reviewed and codes were assigned to calmness and life engagement vocabulary, allowing aggregation of the frequency of improvement in various domains. RESULTS 79.8% (83/104) of patients described improvements consistent with at least one calmness term, most commonly feeling less anxious (46.2%) or less irritable (44.2%). A four-domain concept of patient life engagement was developed in which 88.6% (93/105) of patients described improvements consistent with at least one domain, specifically, emotional (77.1%), physical (75.2%), social (41.9%), and/or cognitive (36.2%). Of the patients who described improvement in calmness, 96.4% (80/83) also described improvement in life engagement. CONCLUSIONS Analysis of exit interview data suggests that patients were calmer and more engaged with life following treatment with adjunctive brexpiprazole. Thus, adjunctive brexpiprazole may provide a benefit on subjective patient outcomes in addition to the improvement in depressive symptoms shown by clinical rating scale data. TRIAL REGISTRATION Data used in this post hoc analysis came from ClinicalTrials.gov identifiers: NCT02012218, NCT02013531, NCT02013609.
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Affiliation(s)
- Catherine Weiss
- Otsuka Pharmaceutical Development & Commercialization Inc., 508 Carnegie Center Drive, 1 University Square Drive, Princeton, NJ, 08540, USA.
| | | | | | | | | | - Michael E Thase
- Perelman School of Medicine, University of Pennsylvania and the Philadelphia Veterans Affairs Medical Center, Philadelphia, PA, USA
| | - Roger S McIntyre
- Mood Disorders Psychopharmacology Unit, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Zahinoor Ismail
- Departments of Psychiatry, Clinical Neurosciences, and Community Health Sciences, Hotchkiss Brain Institute and O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
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Fiedorowicz JG, Brown L, Li J, Parikh SV, Dunlop BW, Forester BP, Shelton RC, Thase ME, Macaluso M, Yu K, Greden JF. Obesogenic Medications and Weight Gain Over 24 Weeks in Patients with Depression: Results from the GUIDED Study. Psychopharmacol Bull 2021; 51:8-30. [PMID: 34887596 PMCID: PMC8601756] [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] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Weight gain is a common side-effect of medications used to treat major depressive disorder (MDD). We sought to estimate the frequency of weight gain for obesogenic medications prescribed for MDD and to evaluate if bupropion mitigated risk for weight gain. We analyzed a prospective cohort of patients with weight available at baseline and 12 weeks (n = 1,032) or 24 weeks (n = 871) in a post hoc analysis of the Genomics Used to Improve DEpression Decisions (GUIDED) study of patients with MDD who failed at least one medication trial. We compared weight gain between those on versus not on medications with high risk for weight gain, including a subgroup receiving combination treatment with bupropion. A second analysis evaluated weight gain across traditional medication classes, adjusting for potential confounding variables. Those on medications identified as high risk for weight gain were significantly more likely to experience clinically significant weight gain (≥3%) at 12 weeks (29.3% vs. 16.3%, p < .001) and 24 weeks (33.5% vs. 23.5%, p = .015). No protection from clinically significant weight gain was observed among patients treated with a high-risk medication concomitantly with bupropion (N = 31, 35% and 52% with clinically significant weight gain at 12 and 24 weeks). Antipsychotic medications and tricyclic antidepressants were most often associated with clinically significant weight gain. This study helps quantify the real-world risk of weight gain for patients with MDD on medications with high risk for weight gain, especially for patients taking antipsychotics. Concurrent treatment with bupropion does not appear to mitigate the weight gain risk.
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Affiliation(s)
- Jess G Fiedorowicz
- Fiedorowicz, University of Ottawa, The Ottawa Hospital, Ottawa Hospital Research Institute; Brown, Li, Yu, Myriad Genetics, Inc.; Parikh, Greden, University of Michigan; Dunlop, Emory University School of Medicine; Forester, McLean Hospital and Harvard Medical School; Shelton, University of Alabama at Birmingham; Thase, University of Pennsylvania, Macaluso, UAB
| | - Lisa Brown
- Fiedorowicz, University of Ottawa, The Ottawa Hospital, Ottawa Hospital Research Institute; Brown, Li, Yu, Myriad Genetics, Inc.; Parikh, Greden, University of Michigan; Dunlop, Emory University School of Medicine; Forester, McLean Hospital and Harvard Medical School; Shelton, University of Alabama at Birmingham; Thase, University of Pennsylvania, Macaluso, UAB
| | - James Li
- Fiedorowicz, University of Ottawa, The Ottawa Hospital, Ottawa Hospital Research Institute; Brown, Li, Yu, Myriad Genetics, Inc.; Parikh, Greden, University of Michigan; Dunlop, Emory University School of Medicine; Forester, McLean Hospital and Harvard Medical School; Shelton, University of Alabama at Birmingham; Thase, University of Pennsylvania, Macaluso, UAB
| | - Sagar V Parikh
- Fiedorowicz, University of Ottawa, The Ottawa Hospital, Ottawa Hospital Research Institute; Brown, Li, Yu, Myriad Genetics, Inc.; Parikh, Greden, University of Michigan; Dunlop, Emory University School of Medicine; Forester, McLean Hospital and Harvard Medical School; Shelton, University of Alabama at Birmingham; Thase, University of Pennsylvania, Macaluso, UAB
| | - Boadie W Dunlop
- Fiedorowicz, University of Ottawa, The Ottawa Hospital, Ottawa Hospital Research Institute; Brown, Li, Yu, Myriad Genetics, Inc.; Parikh, Greden, University of Michigan; Dunlop, Emory University School of Medicine; Forester, McLean Hospital and Harvard Medical School; Shelton, University of Alabama at Birmingham; Thase, University of Pennsylvania, Macaluso, UAB
| | - Brent P Forester
- Fiedorowicz, University of Ottawa, The Ottawa Hospital, Ottawa Hospital Research Institute; Brown, Li, Yu, Myriad Genetics, Inc.; Parikh, Greden, University of Michigan; Dunlop, Emory University School of Medicine; Forester, McLean Hospital and Harvard Medical School; Shelton, University of Alabama at Birmingham; Thase, University of Pennsylvania, Macaluso, UAB
| | - Richard C Shelton
- Fiedorowicz, University of Ottawa, The Ottawa Hospital, Ottawa Hospital Research Institute; Brown, Li, Yu, Myriad Genetics, Inc.; Parikh, Greden, University of Michigan; Dunlop, Emory University School of Medicine; Forester, McLean Hospital and Harvard Medical School; Shelton, University of Alabama at Birmingham; Thase, University of Pennsylvania, Macaluso, UAB
| | - Michael E Thase
- Fiedorowicz, University of Ottawa, The Ottawa Hospital, Ottawa Hospital Research Institute; Brown, Li, Yu, Myriad Genetics, Inc.; Parikh, Greden, University of Michigan; Dunlop, Emory University School of Medicine; Forester, McLean Hospital and Harvard Medical School; Shelton, University of Alabama at Birmingham; Thase, University of Pennsylvania, Macaluso, UAB
| | - Matthew Macaluso
- Fiedorowicz, University of Ottawa, The Ottawa Hospital, Ottawa Hospital Research Institute; Brown, Li, Yu, Myriad Genetics, Inc.; Parikh, Greden, University of Michigan; Dunlop, Emory University School of Medicine; Forester, McLean Hospital and Harvard Medical School; Shelton, University of Alabama at Birmingham; Thase, University of Pennsylvania, Macaluso, UAB
| | - Kunbo Yu
- Fiedorowicz, University of Ottawa, The Ottawa Hospital, Ottawa Hospital Research Institute; Brown, Li, Yu, Myriad Genetics, Inc.; Parikh, Greden, University of Michigan; Dunlop, Emory University School of Medicine; Forester, McLean Hospital and Harvard Medical School; Shelton, University of Alabama at Birmingham; Thase, University of Pennsylvania, Macaluso, UAB
| | - John F Greden
- Fiedorowicz, University of Ottawa, The Ottawa Hospital, Ottawa Hospital Research Institute; Brown, Li, Yu, Myriad Genetics, Inc.; Parikh, Greden, University of Michigan; Dunlop, Emory University School of Medicine; Forester, McLean Hospital and Harvard Medical School; Shelton, University of Alabama at Birmingham; Thase, University of Pennsylvania, Macaluso, UAB
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Rush AJ, Sackeim HA, Conway CR, Bunker MT, Hollon SD, Demyttenaere K, Young AH, Aaronson ST, Dibue M, Thase ME. Research challenges in chronic diseases: Difficult to treat depression. Brain Stimul 2021. [DOI: 10.1016/j.brs.2021.10.448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Daly EJ, Turkoz I, Salvadore G, Fedgchin M, Ionescu DF, Starr HL, Borentain S, Trivedi MH, Thase ME, Singh JB. The effect of esketamine in patients with treatment-resistant depression with and without comorbid anxiety symptoms or disorder. Depress Anxiety 2021; 38:1120-1130. [PMID: 34293233 PMCID: PMC9291524 DOI: 10.1002/da.23193] [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: 12/23/2020] [Revised: 04/23/2021] [Accepted: 06/11/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Comorbid anxiety is generally associated with poorer response to antidepressant treatment. This post hoc analysis explored the efficacy of esketamine plus an antidepressant in patients with treatment-resistant depression (TRD) with or without comorbid anxiety. METHODS TRANSFORM-2, a double-blind, flexible-dose, 4-week study (NCT02418585), randomized adults with TRD to placebo or esketamine nasal spray, each with a newly-initiated oral antidepressant. Comorbid anxiety was defined as clinically noteworthy anxiety symptoms (7-item Generalized Anxiety Disorder scale [GAD-7] score ≥10) at screening and baseline or comorbid anxiety disorder diagnosis at screening. Treatment effect based on change in Montgomery-Åsberg Depression Rating Scale (MADRS) total score, and response and remission were examined by presence/absence of comorbid anxiety using analysis of covariance and logistic regression models. RESULTS Approximately 72% (162/223) of patients had baseline comorbid anxiety. Esketamine-treated patients with and without anxiety demonstrated significant reductions in MADRS (mean [SD] change from baseline at day 28: -21.0 [12.51] and -22.7 [11.98], respectively). Higher rates of response and remission, and a significantly greater decrease in MADRS score at day 28 were observed compared to antidepressant/placebo, regardless of comorbid anxiety (with anxiety: difference in LS means [95% CI] -4.2 [-8.1, -0.3]; without anxiety: -7.5 [-13.7, -1.3]). There was no significant interaction of treatment and comorbid anxiety (p = .371). Notably, in the antidepressant/placebo group improvement was similar in those with and without comorbid anxiety. CONCLUSION Post hoc data support efficacy of esketamine plus an oral antidepressant in patients with TRD, regardless of comorbid anxiety.
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Affiliation(s)
- Ella J. Daly
- Department of Neuroscience Medical AffairsJanssen Scientific Affairs, LLCTitusvilleNew JerseyUSA
| | - Ibrahim Turkoz
- Department of Statistics & Decision SciencesJanssen Research & Development, LLCTitusvilleNew JerseyUSA
| | - Giacomo Salvadore
- Department of NeuroscienceJanssen Research & Development, LLCTitusvilleNew JerseyUSA
| | - Maggie Fedgchin
- Department of NeuroscienceJanssen Research & Development, LLCTitusvilleNew JerseyUSA
| | - Dawn F. Ionescu
- Department of NeuroscienceJanssen Research & Development, LLCSan DiegoCaliforniaUSA
| | - H. Lynn Starr
- Department of Neuroscience Medical AffairsJanssen Scientific Affairs, LLCTitusvilleNew JerseyUSA
| | - Stephane Borentain
- Department of Neuroscience Medical AffairsJanssen Scientific Affairs, LLCTitusvilleNew JerseyUSA
| | - Madhukar H. Trivedi
- Department of PsychiatryUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Michael E. Thase
- Department of Psychiatry, Perelman School of MedicineUniversity of Pennsylvania and the Corporal Michael J. Crescenz VAMCPhiladelphiaPennsylvaniaUSA
| | - Jaskaran B. Singh
- Department of NeuroscienceJanssen Research & Development, LLCSan DiegoCaliforniaUSA
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Perlis ML, Morales KH, Vargas I, Muench A, Seewald M, Gooneratne N, Grandner MA, Thase ME, Kaptchuk TJ, Ader R. Durability of treatment response to zolpidem using a partial reinforcement regimen: does this strategy require priming? Sleep Med 2021; 87:56-61. [PMID: 34509775 PMCID: PMC9014427 DOI: 10.1016/j.sleep.2021.04.041] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 04/07/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Previous research has shown that after one month of full dose nightly treatment with zolpidem (priming), subjects with chronic insomnia (CI) switched to intermittent dosing with medication and placebos were able to maintain their treatment responses. This approach to maintenance therapy is referred to as partial reinforcement. The present study sought to assess whether priming is required for partial reinforcement or whether intermittent dosing with placebos (50% placebos and 50% active medication) can, by itself, be used for both acute and extended treatment. METHOD 55 CI subjects underwent a baseline evaluation (Phase-1) and then were randomized to one of two conditions in Phase-2 of the study: one month of (1) nightly medication use with standard-dose zolpidem (QHS [n = 39]) or (2) intermittent dosing with standard-dose zolpidem and placebos (IDwP [n = 16]). In Phase-3 (three months), the QHS group was re-randomized to either continued QHS full dose treatment (FD/FD) or to IDwP dose treatment (FD/VD). Treatment response rates and Total Wake Time (TWT = [SL + WASO + EMA]) were assessed during each phase of the study. RESULTS In Phase-2, 77% (QHS) and 50% (IDwP) subjects exhibited treatment responses (p = 0.09) where the average change in TWT was similar. In Phase-3, 73% (FD/FD), 57% (FD/VD), and 88% (VD/VD) of subjects exhibited continued treatment responses (p = 0.22) where the average improvement in TWT continued with FD/FD and remained stable for FD/VD and VD/VD (p < 0.01). CONCLUSION These results suggest that intermittent dosing with placebos can maintain effects but do not allow for the additional clinical gains afforded by continuous treatment.
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Affiliation(s)
- Michael L Perlis
- Behavioral Sleep Medicine Program, Department of Psychiatry, University of Pennsylvania, USA; Center for Sleep and Circadian Neurobiology, Department of Medicine, University of Pennsylvania, USA; School or Nursing, University of Pennsylvania, USA.
| | - Knashawn H Morales
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, USA
| | - Ivan Vargas
- Department of Psychological Science, University of Arkansas, USA
| | - Alexandria Muench
- Behavioral Sleep Medicine Program, Department of Psychiatry, University of Pennsylvania, USA; Center for Sleep and Circadian Neurobiology, Department of Medicine, University of Pennsylvania, USA
| | - Mark Seewald
- Behavioral Sleep Medicine Program, Department of Psychiatry, University of Pennsylvania, USA; Center for Sleep and Circadian Neurobiology, Department of Medicine, University of Pennsylvania, USA
| | - Nalaka Gooneratne
- Behavioral Sleep Medicine Program, Department of Psychiatry, University of Pennsylvania, USA; Center for Sleep and Circadian Neurobiology, Department of Medicine, University of Pennsylvania, USA
| | | | - Michael E Thase
- Behavioral Sleep Medicine Program, Department of Psychiatry, University of Pennsylvania, USA
| | - Ted J Kaptchuk
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, USA
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Khazanov GK, Forbes CN, Dunn BD, Thase ME. Addressing anhedonia to increase depression treatment engagement. Br J Clin Psychol 2021; 61:255-280. [PMID: 34625993 DOI: 10.1111/bjc.12335] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 08/30/2021] [Indexed: 12/14/2022]
Abstract
Anhedonia, or reward system dysfunction, is associated with poorer treatment outcomes among depressed individuals. The role of anhedonia in treatment engagement, however, has not yet been explored. We review research on components of reward functioning impaired in depression, including effort valuation, reward anticipation, initial responsiveness, reward learning, reward probability, and reward delay, highlighting potential barriers to treatment engagement associated with these components. We then propose interventions to improve treatment initiation and continuation by addressing deficits in each component of reward functioning, focusing on modifications of existing evidence-based interventions to meet the needs of individuals with heightened anhedonia. We describe potential settings for these interventions and times at which they can be delivered during the process of referring individuals to mental health treatment, conducting intakes or assessments, and providing treatment. Additionally, we note the advantages of using screening processes already in place in primary care, workplace, school, and online settings to identify individuals with heightened anhedonia who may benefit from these interventions. We conclude with suggestions for future research on the impact of anhedonia on treatment engagement and the efficacy of interventions to address it. PRACTITIONER POINTS: Many depressed individuals who might benefit from treatment do not initiate it or discontinue early. One barrier to treatment engagement may be anhedonia, a core symptom of depression characterized by loss of interest or pleasure in usual activities. We describe brief interventions to improve treatment engagement in individuals with anhedonia that can be implemented during the referral process or early in treatment. We argue that interventions aiming to improve treatment engagement in depressed individuals that target anhedonia may be particularly effective.
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Affiliation(s)
- Gabriela K Khazanov
- Mental Illness Research, Education, and Clinical Center of the Veterans Integrated Service Network 4, Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
| | | | | | - Michael E Thase
- Mental Illness Research, Education, and Clinical Center of the Veterans Integrated Service Network 4, Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
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Dodd S, Bauer M, Carvalho AF, Eyre H, Fava M, Kasper S, Kennedy SH, Khoo JP, Lopez Jaramillo C, Malhi GS, McIntyre RS, Mitchell PB, Castro AMP, Ratheesh A, Severus E, Suppes T, Trivedi MH, Thase ME, Yatham LN, Young AH, Berk M. A clinical approach to treatment resistance in depressed patients: What to do when the usual treatments don't work well enough? World J Biol Psychiatry 2021; 22:483-494. [PMID: 33289425 DOI: 10.1080/15622975.2020.1851052] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [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] [Indexed: 01/12/2023]
Abstract
BACKGROUND Major depressive disorder is a common, recurrent, disabling and costly disorder that is often severe and/or chronic, and for which non-remission on guideline concordant first-line antidepressant treatment is the norm. A sizeable percentage of patients diagnosed with MDD do not achieve full remission after receiving antidepressant treatment. How to understand or approach these 'refractory', 'TRD' or 'difficult to treat' patients need to be revisited. Treatment resistant depression (TRD) has been described elsewhere as failure to respond to adequate treatment by two different antidepressants. This definition is problematic as it suggests that TRD is a subtype of major depressive disorder (MDD), inferring a boundary between TRD and depression that is not treatment resistant. However, there is scant evidence to suggest that a discrete TRD entity exists as a distinct subtype of MDD, which itself is not a discrete or homogeneous entity. Similarly, the boundary between TRD and other forms of depression is predicated at least in part on regulatory and research requirements rather than biological evidence or clinical utility. AIM This paper aims to investigate the notion of treatment failure in order to understand (i) what is TRD in the context of a broader formulation based on the understanding of depression, (ii) what factors make an individual patient difficult to treat, and (iii) what is the appropriate and individualised treatment strategy, predicated on an individual with refractory forms of depression? METHOD Expert contributors to this paper were sought internationally by contacting representatives of key professional societies in the treatment of MDD - World Federation of Societies for Biological Psychiatry, Australasian Society for Bipolar and Depressive Disorders, International Society for Affective Disorders, Collegium Internationale Neuro-Psychopharmacologium and the Canadian Network for Mood and Anxiety Treatments. The manuscript was prepared through iterative editing. OUTCOMES The concept of TRD as a discrete subtype of MDD, defined by failure to respond to pharmacotherapy, is not supported by evidence. Between 15 and 30% of depressive episodes fail to respond to adequate trials of 2 antidepressants, and 68% of individuals do not achieve remission from depression after a first-line course of antidepressant treatment. Failure to respond to antidepressant treatment, somatic therapies or psychotherapies may often reflect other factors including; biological resistance, diagnostic error, limitations of current therapies, psychosocial variables, a past history of exposure to childhood maltreatment or abuse, job satisfaction, personality disorders, co-morbid mental and physical disorders, substance use or non-adherence to treatment. Only a subset of patients not responding to antidepressant treatment can be explained through pharmacokinetic or pharmacodynamics mechanisms. We propose that non remitting MDD should be personalised, and propose a strategy of 'deconstructing depression'. By this approach, the clinician considers which factors contribute to making this individual both depressed and 'resistant' to previous therapeutic approaches. Clinical formulation is required to understand the nature of the depression. Many predictors of response are not biological, and reflect a confluence of biological, psychological, and sociocultural factors, which may influence the illness in a particular individual. After deconstructing depression at a personalised level, a personalised treatment plan can be constructed. The treatment plan needs to address the factors that have contributed to the individual's hard to treat depression. In addition, an individual with a history of illness may have a lot of accumulated life issues due to consequences of their illness, and these should be addressed in a recovery plan. LIMITATIONS A 'deconstructing depression' qualitative rubric does not easily provide clear inclusion and exclusion criteria for researchers wanting to investigate TRD. CONCLUSIONS MDD is a polymorphic disorder and many individuals who fail to respond to standard pharmacotherapy and are considered hard to treat. These patients are best served by personalised approaches that deconstruct the factors that have contributed to the patient's depression and implementing a treatment plan that adequately addresses these factors. The existence of TRD as a discrete and distinct subtype of MDD, defined by two treatment failures, is not supported by evidence.
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Affiliation(s)
- Seetal Dodd
- IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, Geelong, Australia.,Department of Psychiatry, University of Melbourne, Melbourne, Australia.,Barwon Health, University Hospital Geelong, Geelong, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Michael Bauer
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany
| | - Andre F Carvalho
- IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, Geelong, Australia.,Department of Psychiatry, University of Toronto and Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Harris Eyre
- IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, Geelong, Australia.,Discipline of Psychiatry, School of Medicine, The University of Adelaide, Adelaide, Australia
| | - Maurizio Fava
- Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Siegfried Kasper
- Center for Brain Research, Medical University of Vienna, Vienna, Austria
| | - Sidney H Kennedy
- Department of Psychiatry, University of Toronto and Centre for Depression and Suicide Studies, St Michael's Hospital, Toronto, Canada
| | | | | | - Gin S Malhi
- Department of Psychiatry, Faculty of Medicine and Health, Northern Clinical School, The University of Sydney, Sydney, Australia.,Academic Department of Psychiatry, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, Australia.,CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, Australia
| | - Roger S McIntyre
- Department of Psychiatry, University of Toronto and Centre for Addiction and Mental Health (CAMH), Toronto, Canada.,Mood Disorders Psychopharmacology Unit, Toronto, Canada.,Brain and Cognition Discovery Foundation, Toronto, Canada
| | - Philip B Mitchell
- School of Psychiatry, University of New South Wales, and Black Dog Institute, Sydney, Australia
| | - Angela Marianne Paredes Castro
- IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, Geelong, Australia
| | - Aswin Ratheesh
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia.,Orygen The National Centre of Excellence in Youth Mental Health, Parkville, Australia
| | - Emanuel Severus
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany
| | - Trisha Suppes
- VA Health Care System, Palo Alto, CA, and Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Madhukar H Trivedi
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Michael E Thase
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Lakshmi N Yatham
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Allan H Young
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London & South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent, UK
| | - Michael Berk
- IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, Geelong, Australia.,Department of Psychiatry, University of Melbourne, Melbourne, Australia.,Barwon Health, University Hospital Geelong, Geelong, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia.,Orygen The National Centre of Excellence in Youth Mental Health, Parkville, Australia.,The Florey Institute of Neuroscience and Mental Health, Parkville, Australia
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Krystal JH, Chow B, Vessicchio J, Henrie AM, Neylan TC, Krystal AD, Marx BP, Xu K, Jindal RD, Davis LL, Schnurr PP, Stein MB, Thase ME, Ventura B, Huang GD, Shih MC. Design of the National Adaptive Trial for PTSD-related Insomnia (NAP Study), VA Cooperative Study Program (CSP) #2016. Contemp Clin Trials 2021; 109:106540. [PMID: 34416369 DOI: 10.1016/j.cct.2021.106540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 08/09/2021] [Accepted: 08/10/2021] [Indexed: 11/15/2022]
Abstract
There are currently no validated pharmacotherapies for posttraumatic stress disorder (PTSD)-related insomnia. The purpose of the National Adaptive Trial for PTSD-Related Insomnia (NAP Study) is to efficiently compare to placebo the effects of three insomnia medications with different mechanisms of action that are already prescribed widely to veterans diagnosed with PTSD within U.S. Department of Veterans Affairs (VA) Medical Centers. This study plans to enroll 1224 patients from 34 VA Medical Centers into a 12- week prospective, randomized placebo-controlled clinical trial comparing trazodone, eszopiclone, and gabapentin. The primary outcome measure is insomnia, assessed with the Insomnia Severity Index. A novel aspect of this study is its adaptive design. At the recruitment midpoint, an interim analysis will be conducted to inform a decision to close recruitment to any "futile" arms (i.e. arms where further recruitment is very unlikely to yield a significant result) while maintaining the overall study recruitment target. This step could result in the enrichment of the remaining study arms, enhancing statistical power for the remaining comparisons to placebo. This study will also explore clinical, actigraphic, and biochemical predictors of treatment response that may guide future biomarker development. Lastly, due to the COVID-19 pandemic, this study will allow the consenting process and follow-up visits to be conducted via video or phone contact if in-person meetings are not possible. Overall, this study aims to identify at least one effective pharmacotherapy for PTSD-related insomnia, and, perhaps, to generate definitive negative data to reduce the use of ineffective insomnia medications. NATIONAL CLINICAL TRIAL (NCT) IDENTIFIED NUMBER: NCT03668041.
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Affiliation(s)
- John H Krystal
- Clinical Neuroscience Division, National Center for PTSD, VA Connecticut Healthcare System, West Haven, CT, United States of America; Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States of America; Departments of Neuroscience and Psychology, Yale University, New Haven, CT, United States of America.
| | - Bruce Chow
- Cooperative Studies Program Coordinating Center (CSPCC), VA Palo Alto Healthcare System, Palo Alto, CA, United States of America
| | - Jennifer Vessicchio
- Clinical Neuroscience Division, National Center for PTSD, VA Connecticut Healthcare System, West Haven, CT, United States of America; Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States of America
| | - Adam M Henrie
- Cooperative Studies Program, Clinical Research Pharmacy Coordinating Center (CSPCRPCC), U.S. Department of Veterans Affairs, Albuquerque, NM, United States of America
| | - Thomas C Neylan
- Department of Psychiatry and UCSF Weill Institute for Neurosciences, School of Medicine, University of California, San Francisco, CA; VA San Francisco Healthcare System, San Francisco, CA, United States of America
| | - Andrew D Krystal
- Department of Psychiatry and UCSF Weill Institute for Neurosciences, School of Medicine, University of California, San Francisco, CA
| | - Brian P Marx
- Behavioral Sciences Division, National Center for PTSD, VA Boston Healthcare System, Boston, MA, Department of Psychiatry, Boston University School of Medicine, Boston, MA, United States of America
| | - Ke Xu
- Clinical Neuroscience Division, National Center for PTSD, VA Connecticut Healthcare System, West Haven, CT, United States of America; Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States of America
| | - Ripu D Jindal
- Department of Psychiatry, Birmingham VA Medical Center, Departments of Neurology and Psychiatry, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Lori L Davis
- Tuscaloosa VA Medical Center, Tuscaloosa, AL, United States of America; Department of Psychiatry, University of Alabama School of Medicine, Birmingham, AL, United States of America
| | - Paula P Schnurr
- Executive Division, National Center for PTSD, White River Junction, VT, Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH, United States of America
| | - Murray B Stein
- VA San Diego Healthcare System, San Diego, CA, Departments of Psychiatry, Family Medicine, and Public Health, University of California, San Diego, CA, United States of America
| | - Michael E Thase
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States of America
| | - Beverly Ventura
- Cooperative Studies Program Coordinating Center (CSPCC), VA Palo Alto Healthcare System, Palo Alto, CA, United States of America
| | - Grant D Huang
- Cooperative Studies Program, Office of Research and Development, U.S. Department of Veterans Affairs, Washington, DC, United States of America
| | - Mei-Chiung Shih
- Cooperative Studies Program Coordinating Center (CSPCC), VA Palo Alto Healthcare System, Palo Alto, CA, United States of America; Department of Biomedical Data Science, Stanford School of Medicine, Stanford, CA, United States of America
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Savitz A, Wajs E, Zhang Y, Xu H, Etropolski M, Thase ME, Drevets WC. Efficacy and Safety of Seltorexant as Adjunctive Therapy in Major Depressive Disorder: A Phase 2b, Randomized, Placebo-Controlled, Adaptive Dose-Finding Study. Int J Neuropsychopharmacol 2021; 24:965-976. [PMID: 34324636 PMCID: PMC8653874 DOI: 10.1093/ijnp/pyab050] [Citation(s) in RCA: 10] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 06/04/2021] [Accepted: 07/27/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Seltorexant, a selective antagonist of human orexin-2 receptors, demonstrated antidepressant effects in a previous exploratory study in patients with major depressive disorder (MDD). METHODS To replicate and extend this observation, a double-blind, adaptive dose-finding study was performed in patients with MDD who had an inadequate response to 1-3 selective serotonin/serotonin-norepinephrine reuptake inhibitors in the current episode. Patients were randomized (2:1:1) to placebo or seltorexant (20 mg or 40 mg) once-daily, administered adjunctively to the antidepressant the patient had been receiving at screening. After an interim analysis (6 weeks post-randomization of 160th patient), newly recruited patients randomly received (3:3:1) placebo or seltorexant 10 mg or 20 mg; the 40-mg dose was no longer assigned. Patients were stratified by baseline Insomnia Severity Index (ISI) scores (ISI ≥ 15 vs < 15). The primary endpoint was change from baseline Montgomery-Åsberg Depression Rating Scale (MADRS) total score at week 6. RESULTS Mixed-Model for Repeated Measures analysis showed a greater improvement in MADRS total score in the seltorexant 20-mg group vs placebo at weeks 3 and 6; least-square means difference (90% CI): -4.5 (-6.96; -2.07), P = .003; and -3.1 (-6.13; -0.16), P = .083, respectively. The improvement in MADRS score at week 6 for seltorexant 20 mg was greater in patients with baseline ISI ≥ 15 vs those with ISI < 15; least-square means difference (90% CI) vs placebo: -4.9 (-8.98; -0.80) and -0.7 (-5.16; 3.76), respectively. The most common (≥5%) adverse events with seltorexant were somnolence, headache, and nausea. CONCLUSIONS A clinically meaningful reduction of depressive symptoms was observed for seltorexant 20 mg. In the subset of patients with sleep disturbance (ISI ≥ 15), a larger treatment difference between seltorexant 20 mg and placebo was observed, warranting further investigation. No new safety signal was identified. REGISTRATION ClinicalTrials.gov Identifier: NCT03227224. PREVIOUS PRESENTATION Poster presented at 58th Annual Meeting of American College of Neuropsychopharmacology (ACNP), December 8-11, 2019, Orlando, FL.
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Affiliation(s)
- Adam Savitz
- Janssen Research & Development, LLC, Titusville, New Jersey, USA,Correspondence: Adam Savitz, MD, Janssen Research & Development, LLC, 1125 Trenton-Harbourton Road, Titusville, NJ 08560 ()
| | - Ewa Wajs
- Janssen Research & Development, LLC, Beerse, Belgium
| | - Yun Zhang
- Janssen Research & Development, LLC, Fremont, California, USA
| | - Haiyan Xu
- Janssen Research & Development, LLC, Titusville, New Jersey, USA
| | - Mila Etropolski
- Janssen Research & Development, LLC, Titusville, New Jersey, USA
| | - Michael E Thase
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, and Corporal Michael J. Crescenz VAMC, Philadelphia, Pennsylvania, USA
| | - Wayne C Drevets
- Janssen Research & Development LLC, San Diego, California, USA
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Goldschmied JR, Sengupta A, Sharma A, Taylor L, Morales KH, Thase ME, Thase ME, Weljie A, Kayser MS. Treatment of Insomnia with Zaleplon in HIV+ Significantly Improves Sleep and Depression. Psychopharmacol Bull 2021; 51:50-64. [PMID: 34421144 PMCID: PMC8374930] [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] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
More than 50% of individuals who are HIV positive report insomnia, which can reduce HIV treatment adherence, impair quality of life, and contribute to metabolic dysfunction. Major depressive disorder is also highly comorbid in this population, leading to further impairment. There is evidence that treating insomnia may improve not only sleep, but depression and metabolic function, as well. The present study aimed to examine the effects of pharmacotherapeutic treatment of insomnia on sleep, depression, and metabolic functioning in individuals with HIV. 20 individuals with asymptomatic seropositive HIV and comorbid insomnia and depression were administered zaleplon for 6 weeks. Insomnia severity was assessed using the Insomnia Severity Index and Epworth Sleepiness Scale, and depression severity was assessed using the Quick Inventory of Depression, both prior to treatment and 6 weeks post treatment. Metabolomic changes were assessed using a comprehensive platform measuring ~2000 lipid features and polar metabolites. Linear mixed effects models demonstrated that 6 weeks of treatment with zaleplon significantly improved symptoms of both insomnia and depression. Metabolomic analyses also demonstrated that changes in insomnia severity were associated with significant changes in key branched chain amino acid metabolites. Our results show that improvement in insomnia is associated with reduced depressive symptoms and beneficial metabolomic changes. Additionally, changes in key branched chain amino acid metabolites following treatment may serve as useful biomarkers of treatment response.
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Affiliation(s)
- Jennifer R Goldschmied
- Goldschmied, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA; Chronobiology and Sleep Institute, University of Pennsylvania, Philadelphia, PA. Sengupta, Department of Systems Pharmacology and Translational Therapeutics, University of Pennsylvania, Philadelphia, PA. Sharma, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA. Taylor, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA. Morales, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA; Department of Biostatistics, Epidemiology & Informatics, University of Pennsylvania, Philadelphia, PA. Thase, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA. Weljie, Department of Systems Pharmacology and Translational Therapeutics, University of Pennsylvania, Philadelphia, PA. Kayser, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA; Chronobiology and Sleep Institute, University of Pennsylvania, Philadelphia, PA
| | - Arjun Sengupta
- Goldschmied, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA; Chronobiology and Sleep Institute, University of Pennsylvania, Philadelphia, PA. Sengupta, Department of Systems Pharmacology and Translational Therapeutics, University of Pennsylvania, Philadelphia, PA. Sharma, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA. Taylor, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA. Morales, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA; Department of Biostatistics, Epidemiology & Informatics, University of Pennsylvania, Philadelphia, PA. Thase, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA. Weljie, Department of Systems Pharmacology and Translational Therapeutics, University of Pennsylvania, Philadelphia, PA. Kayser, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA; Chronobiology and Sleep Institute, University of Pennsylvania, Philadelphia, PA
| | - Anup Sharma
- Goldschmied, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA; Chronobiology and Sleep Institute, University of Pennsylvania, Philadelphia, PA. Sengupta, Department of Systems Pharmacology and Translational Therapeutics, University of Pennsylvania, Philadelphia, PA. Sharma, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA. Taylor, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA. Morales, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA; Department of Biostatistics, Epidemiology & Informatics, University of Pennsylvania, Philadelphia, PA. Thase, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA. Weljie, Department of Systems Pharmacology and Translational Therapeutics, University of Pennsylvania, Philadelphia, PA. Kayser, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA; Chronobiology and Sleep Institute, University of Pennsylvania, Philadelphia, PA
| | - Lynne Taylor
- Goldschmied, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA; Chronobiology and Sleep Institute, University of Pennsylvania, Philadelphia, PA. Sengupta, Department of Systems Pharmacology and Translational Therapeutics, University of Pennsylvania, Philadelphia, PA. Sharma, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA. Taylor, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA. Morales, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA; Department of Biostatistics, Epidemiology & Informatics, University of Pennsylvania, Philadelphia, PA. Thase, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA. Weljie, Department of Systems Pharmacology and Translational Therapeutics, University of Pennsylvania, Philadelphia, PA. Kayser, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA; Chronobiology and Sleep Institute, University of Pennsylvania, Philadelphia, PA
| | - Knashawn H Morales
- Goldschmied, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA; Chronobiology and Sleep Institute, University of Pennsylvania, Philadelphia, PA. Sengupta, Department of Systems Pharmacology and Translational Therapeutics, University of Pennsylvania, Philadelphia, PA. Sharma, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA. Taylor, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA. Morales, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA; Department of Biostatistics, Epidemiology & Informatics, University of Pennsylvania, Philadelphia, PA. Thase, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA. Weljie, Department of Systems Pharmacology and Translational Therapeutics, University of Pennsylvania, Philadelphia, PA. Kayser, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA; Chronobiology and Sleep Institute, University of Pennsylvania, Philadelphia, PA
| | - Michael E Thase
- Goldschmied, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA; Chronobiology and Sleep Institute, University of Pennsylvania, Philadelphia, PA. Sengupta, Department of Systems Pharmacology and Translational Therapeutics, University of Pennsylvania, Philadelphia, PA. Sharma, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA. Taylor, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA. Morales, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA; Department of Biostatistics, Epidemiology & Informatics, University of Pennsylvania, Philadelphia, PA. Thase, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA. Weljie, Department of Systems Pharmacology and Translational Therapeutics, University of Pennsylvania, Philadelphia, PA. Kayser, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA; Chronobiology and Sleep Institute, University of Pennsylvania, Philadelphia, PA
| | - Michael E Thase
- Goldschmied, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA; Chronobiology and Sleep Institute, University of Pennsylvania, Philadelphia, PA. Sengupta, Department of Systems Pharmacology and Translational Therapeutics, University of Pennsylvania, Philadelphia, PA. Sharma, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA. Taylor, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA. Morales, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA; Department of Biostatistics, Epidemiology & Informatics, University of Pennsylvania, Philadelphia, PA. Thase, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA. Weljie, Department of Systems Pharmacology and Translational Therapeutics, University of Pennsylvania, Philadelphia, PA. Kayser, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA; Chronobiology and Sleep Institute, University of Pennsylvania, Philadelphia, PA
| | - Aalim Weljie
- Goldschmied, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA; Chronobiology and Sleep Institute, University of Pennsylvania, Philadelphia, PA. Sengupta, Department of Systems Pharmacology and Translational Therapeutics, University of Pennsylvania, Philadelphia, PA. Sharma, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA. Taylor, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA. Morales, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA; Department of Biostatistics, Epidemiology & Informatics, University of Pennsylvania, Philadelphia, PA. Thase, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA. Weljie, Department of Systems Pharmacology and Translational Therapeutics, University of Pennsylvania, Philadelphia, PA. Kayser, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA; Chronobiology and Sleep Institute, University of Pennsylvania, Philadelphia, PA
| | - Matthew S Kayser
- Goldschmied, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA; Chronobiology and Sleep Institute, University of Pennsylvania, Philadelphia, PA. Sengupta, Department of Systems Pharmacology and Translational Therapeutics, University of Pennsylvania, Philadelphia, PA. Sharma, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA. Taylor, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA. Morales, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA; Department of Biostatistics, Epidemiology & Informatics, University of Pennsylvania, Philadelphia, PA. Thase, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA. Weljie, Department of Systems Pharmacology and Translational Therapeutics, University of Pennsylvania, Philadelphia, PA. Kayser, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA; Chronobiology and Sleep Institute, University of Pennsylvania, Philadelphia, PA
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Thase ME, Harrington A, Calabrese J, Montgomery S, Niu X, Patel MD. Evaluation of MADRS severity thresholds in patients with bipolar depression. J Affect Disord 2021; 286:58-63. [PMID: 33677183 DOI: 10.1016/j.jad.2021.02.043] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 12/18/2020] [Revised: 02/08/2021] [Accepted: 02/12/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND The Montgomery-Åsberg Depression Rating Scale (MADRS) is commonly used to assess depression symptom changes in clinical trials; however, the score itself can be difficult to interpret without clinical context. Categories of depression severity corresponding to MADRS total score have not been established for bipolar depression, which was the objective of this study. METHODS Data were pooled from 3 randomized, double-blind, placebo-controlled trials of cariprazine in patients with bipolar I depression; placebo and cariprazine arms were pooled. An anchor-based approach was used to map MADRS total score to the clinician-rated, 7-category Clinical Global Impression of Severity scale (CGI-S). Spearman's correlation coefficient was used to assess associations between MADRS total and CGI-S scores. Optimal MADRS severity thresholds for each CGI-S category was determined via Youden index using receiver operating characteristic (ROC) analyses. RESULTS Using data from 1523 patients with bipolar depression, mean MADRS total scores were positively correlated with mean CGI-S scores at week 6 (r = 0.87; P<.0001). Using ROC curves, MADRS severity thresholds corresponding to each CGI-S category were estimated with high sensitivity and specificity: 0-6 for "normal, not at all ill", 7-12 for "borderline mentally ill", 13-18 for "mildly ill", 19-23 for "moderately ill", 24-36 for "markedly ill", 37-39 for "severely ill", and ≥40 for "extremely ill". CONCLUSIONS Utilizing data from 3 clinical trials of patients with bipolar depression, MADRS severity thresholds were identified. These empirical findings may help clinicians contextualize MADRS results from bipolar clinical research and apply to their practice. TRIAL REGISTRATION clinicaltrials.gov NCT01396447, NCT02670538, NCT02670551.
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Affiliation(s)
| | | | - Joseph Calabrese
- University Hospitals Cleveland Medical Center, Cleveland, OH, USA
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Rosen AC, Bhat JV, Cardenas VA, Ehrlich TJ, Horwege AM, Mathalon DH, Roach BJ, Glover GH, Badran BW, Forman SD, George MS, Thase ME, Yurgelun-Todd D, Sughrue ME, Doyen SP, Nicholas PJ, Scott JC, Tian L, Yesavage JA. Targeting location relates to treatment response in active but not sham rTMS stimulation. Brain Stimul 2021; 14:703-709. [PMID: 33866020 PMCID: PMC8884259 DOI: 10.1016/j.brs.2021.04.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 03/25/2021] [Accepted: 04/01/2021] [Indexed: 11/28/2022] Open
Abstract
Background: Precise targeting of brain functional networks is believed critical for treatment efficacy of rTMS (repetitive pulse transcranial magnetic stimulation) in treatment resistant major depression. Objective: To use imaging data from a “failed” clinical trial of rTMS in Veterans to test whether treatment response was associated with rTMS coil location in active but not sham stimulation, and compare fMRI functional connectivity between those stimulation locations. Methods: An imaging substudy of 49 Veterans (mean age, 56 years; range, 27e78 years; 39 male) from a randomized, sham-controlled, double-blinded clinical trial of rTMS treatment, grouping participants by clinical response, followed by group comparisons of treatment locations identified by individualized fiducial markers on structural MRI and resting state fMRI derived networks. Results: The average stimulation location for responders versus nonresponders differed in the active but not in the sham condition (P = .02). The average responder location derived from the active condition showed significant negative functional connectivity with the subgenual cingulate (P < .001) while the nonresponder location did not (P = .17), a finding replicated in independent cohorts of 84 depressed and 35 neurotypical participants. The responder and nonresponder stimulation locations evoked different seed based networks (FDR corrected clusters, all P < .03), revealing additional brain regions related to rTMS treatment outcome. Conclusion: These results provide evidence from a randomized controlled trial that clinical response to rTMS is related to accuracy in targeting the region within DLPFC that is negatively correlated with subgenual cingulate. These results support the validity of a neuro-functionally informed rTMS therapy target in Veterans.
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Affiliation(s)
- A C Rosen
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA; Department of Psychiatry, Stanford University, Stanford, CA, 94305, USA.
| | - J V Bhat
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA; Palo Alto Veterans Institute for Research, Palo Alto, CA, 94304, USA
| | - V A Cardenas
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - T J Ehrlich
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA; University of Michigan, Ann Arbor, USA
| | - A M Horwege
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - D H Mathalon
- Mental Health Service, San Francisco Veterans Affairs Health Care System, University of California, San Francisco, CA, USA; Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA
| | - B J Roach
- Mental Health Service, San Francisco Veterans Affairs Health Care System, University of California, San Francisco, CA, USA; Northern California Institute for Research and Education, San Francisco Veterans Affairs Medical Center, University of California, San Francisco, CA, USA
| | - G H Glover
- Department of Radiology, Stanford University, Stanford, CA, USA
| | - B W Badran
- Brain Stimulation Division, Department of Psychiatry, Medical University of South Carolina, Charleston, SC, USA
| | - S D Forman
- Department of Veterans Affairs, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA; Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - M S George
- Brain Stimulation Division, Department of Psychiatry, Medical University of South Carolina, Charleston, SC, USA; Ralph H. Johnson VA Medical Center, Charleston, SC, USA
| | - M E Thase
- VISN4 Mental Illness Research, Education, and Clinical Center at the Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, 19104, USA; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - D Yurgelun-Todd
- Rocky Mountain Network Mental Illness Research Education and Clinical Centers (VISN 19), VA Salt Lake City Health Care System, Salt Lake City, UT, USA; Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - M E Sughrue
- Omniscient Neurotechnologies, Sydney, Australia; Prince of Wales Hospital, Randwick, NSW, Australia
| | - S P Doyen
- Omniscient Neurotechnologies, Sydney, Australia
| | | | - J C Scott
- VISN4 Mental Illness Research, Education, and Clinical Center at the Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, 19104, USA; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - L Tian
- Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, CA, USA
| | - J A Yesavage
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA; Department of Psychiatry, Stanford University, Stanford, CA, 94305, USA
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Perlis ML, Morales KH, Vargas I, Posner DA, Grandner MA, Muench AL, Seewald MW, Gooneratne NS, Kloss JD, Gencarelli AM, Khader WS, Thase ME, Ellis JG. The natural history of insomnia: Does sleep extension differentiate between those that do and do not develop chronic insomnia? J Sleep Res 2021; 30:e13342. [PMID: 33853197 DOI: 10.1111/jsr.13342] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 03/04/2021] [Accepted: 03/05/2021] [Indexed: 11/27/2022]
Abstract
According to the "3P model" of insomnia, the variable that mediates the transition from acute insomnia (AI) to chronic insomnia is "sleep extension" (the behavioural tendency to expand sleep opportunity to compensate for sleep loss). In the present analysis, we sought to evaluate how time in bed (TIB) varies relative to the new onset of AI and chronic insomnia. A total of 1,248 subjects were recruited as good sleepers (GS). Subjects were monitored over 1 year with sleep diaries. State transitions were defined, a priori, for AI, recovered from AI (AI-REC), and for chronic insomnia (AI-CI). Two additional groupings were added based on profiles that were unanticipated: subjects that exhibited persistent poor sleep following AI (AI-PPS [those that neither recovered or developed chronic insomnia]) and subjects that recovered from chronic insomnia (CI-REC). All the groups (GS, AI-REC, AI-CI, AI-PPS and CI-REC) were evaluated for TIB differences with longitudinal mixed effects models. Post hoc analyses for the percentage of the groups that were typed as TIB "restrictors, maintainers, and expanders" were conducted using longitudinal mixed effects models and contingency analyses. Significant differences for pre-post AI TIB were not detected for the insomnia groups. Trends were apparent for the AI-CI group, which suggested that minor increases in TIB occurred weeks before the declared onset of AI. Additionally, it was found that a significantly larger percentage of AI-CI subjects engaged in sleep extension (as compared to GS). The present data suggest that transition from AI to chronic insomnia does not appear to be initiated by sleep extension and the transition may occur before the elapse of 3 months of ≥3 nights of sleep continuity disturbance. Given these findings, it may be that the mismatch between sleep ability and sleep opportunity is perpetuated over time given the failure to "naturally" engage in sleep restriction (as opposed to sleep extension).
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Affiliation(s)
- Michael L Perlis
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - Knashawn H Morales
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA, USA
| | - Ivan Vargas
- Department of Psychological Sciences, University of Arkansas, Fayetteville, AR, USA
| | - Donn A Posner
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA
| | | | | | - Mark W Seewald
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Jacqueline D Kloss
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - Amy M Gencarelli
- Department of Psychology, East Carolina University, Greenville, NC, USA
| | | | - Michael E Thase
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - Jason G Ellis
- Northumbria Center for Sleep Research, Northumbria University, Newcastle, UK
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Vittengl JR, Clark LA, Thase ME, Jarrett RB. Stability and Change in Relations Between Personality Traits and the Interpersonal Problems Circumplex During Cognitive Therapy for Recurrent Depression. Assessment 2021; 29:1158-1171. [PMID: 33794674 DOI: 10.1177/10731911211005183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Both personality impairment and maladaptive-range traits are necessary for diagnosis in the alternative model of personality disorder. We clarified personality impairment-trait connections using measures of the interpersonal problems circumplex and personality traits among adult outpatients (N = 351) with major depressive disorder receiving cognitive therapy (CT). The trait scales' circumplex projections were summarized by elevation (correlations with general interpersonal problems), amplitude (specific relations to the circumplex dimensions of dominance and affiliation), and angle (predominant orientation in the two-dimensional circumplex). Most trait scales showed hypothesized circumplex relations, including substantive elevation (e.g., negative temperament, mistrust), amplitude (e.g., aggression, detachment), and expected angles (e.g., positive temperament and manipulativeness oriented toward overly nurturant/intrusive or domineering/vindictive problems, respectively), that were stable across time during CT. These results revealed meaningful and consistent impairment-trait connections, even during CT when mean depressive affect decreased substantially.
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Affiliation(s)
| | | | | | - Robin B Jarrett
- The University of Texas Southwestern Medical Center, Dallas, TX, USA
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Bowden CL, Priesmeyer R, Tohen M, Singh V, Calabrese JR, Ketter T, Nierenberg A, Thase ME, Siegel G, Siegel LH, Mintz J, El-Mallakh RS, McElroy SL, Martinez M. Development of a Patient-Centered Software System to Facilitate Effective Management of Bipolar Disorder. Psychopharmacol Bull 2021; 51:8-19. [PMID: 34092819 PMCID: PMC8146566] [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] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Self-management of bipolar disorder (BD) is an important component of treatment. METHODS We developed a patient-centered computational software system based on concepts from nonlinear systems (chaos) theory with mobile access to assist in managing BD known as KIOS. KIOS tracks interacting symptoms to determine theprecise state of a BD patient. Once the patient's state is identified and the trajectory of the patient established, specific advice is generated to help manage the course of the disease. KIOS also provides analytics that can be used by clinicians and researchers to track outcomes and the course of illness. A 12-week field test was completed. RESULTS In 20 BD subjects, use of KIOS was associated with improvements in primary symptom categories of BD. Usability and generated advice were rated as a median of 6 out of a maximum of 7. CONCLUSIONS The KIOS focus on change illuminates problems in the same way that humans experience them, implying that the future state will be consequent to changes made to impact the current state. Randomized clinical trial is indicated.
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Affiliation(s)
- Charles L Bowden
- Bowden, M.D., Emeritus Professor, Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, Texas. Priesmeyer, PhD., Jurica Professor of Management, Department of Management and Marketing, St Mary's University, San Antonio, Texas. Tohen, M.D., Dr.P.H., M.B.A, University Distinguished Professor and Chairman, Department of Psychiatry and Behavioral Sciences, University of New Mexico Health Sciences Center, Albuquerque, New Mexico. Singh, M.D., Deceased. Calabrese, M.D., Director, Mood Disorders Program, UH Cleveland Medical Center Case Western Reserve University School of Medicine, Cleveland, Ohio. Ketter, M.D, Emeritus Professor, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California. Nierenberg, M.D., Director, Dauten Family Center for Bipolar Treatment Innovation Massachusetts General Hospital, Harvard Medical School. Thase, M.D., Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. Gregg Siegel, M.S, Biomedical Development Corporation, San Antonio, Texas. Leslie H. Siegel, M.F.A, Biomedical Development Corporation, San Antonio, Texas. Mintz, PhD., Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, Texas. Mallakh, M.D., Mood Disorders Research Program, Depression Center, Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky. McElroy, M.D., Professor of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, Ohio. Martinez, M.D., Professor and Mary Avis Weir Chair in Psychiatry, Director, Adult Mood Disorders Program, Co-Director, Mind, Brain, and Behavior, Department of Psychiatry and Behavioral Sciences University of Texas Health Science Center San Antonio, San Antonio, Texas
| | - Richard Priesmeyer
- Bowden, M.D., Emeritus Professor, Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, Texas. Priesmeyer, PhD., Jurica Professor of Management, Department of Management and Marketing, St Mary's University, San Antonio, Texas. Tohen, M.D., Dr.P.H., M.B.A, University Distinguished Professor and Chairman, Department of Psychiatry and Behavioral Sciences, University of New Mexico Health Sciences Center, Albuquerque, New Mexico. Singh, M.D., Deceased. Calabrese, M.D., Director, Mood Disorders Program, UH Cleveland Medical Center Case Western Reserve University School of Medicine, Cleveland, Ohio. Ketter, M.D, Emeritus Professor, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California. Nierenberg, M.D., Director, Dauten Family Center for Bipolar Treatment Innovation Massachusetts General Hospital, Harvard Medical School. Thase, M.D., Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. Gregg Siegel, M.S, Biomedical Development Corporation, San Antonio, Texas. Leslie H. Siegel, M.F.A, Biomedical Development Corporation, San Antonio, Texas. Mintz, PhD., Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, Texas. Mallakh, M.D., Mood Disorders Research Program, Depression Center, Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky. McElroy, M.D., Professor of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, Ohio. Martinez, M.D., Professor and Mary Avis Weir Chair in Psychiatry, Director, Adult Mood Disorders Program, Co-Director, Mind, Brain, and Behavior, Department of Psychiatry and Behavioral Sciences University of Texas Health Science Center San Antonio, San Antonio, Texas
| | - Mauricio Tohen
- Bowden, M.D., Emeritus Professor, Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, Texas. Priesmeyer, PhD., Jurica Professor of Management, Department of Management and Marketing, St Mary's University, San Antonio, Texas. Tohen, M.D., Dr.P.H., M.B.A, University Distinguished Professor and Chairman, Department of Psychiatry and Behavioral Sciences, University of New Mexico Health Sciences Center, Albuquerque, New Mexico. Singh, M.D., Deceased. Calabrese, M.D., Director, Mood Disorders Program, UH Cleveland Medical Center Case Western Reserve University School of Medicine, Cleveland, Ohio. Ketter, M.D, Emeritus Professor, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California. Nierenberg, M.D., Director, Dauten Family Center for Bipolar Treatment Innovation Massachusetts General Hospital, Harvard Medical School. Thase, M.D., Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. Gregg Siegel, M.S, Biomedical Development Corporation, San Antonio, Texas. Leslie H. Siegel, M.F.A, Biomedical Development Corporation, San Antonio, Texas. Mintz, PhD., Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, Texas. Mallakh, M.D., Mood Disorders Research Program, Depression Center, Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky. McElroy, M.D., Professor of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, Ohio. Martinez, M.D., Professor and Mary Avis Weir Chair in Psychiatry, Director, Adult Mood Disorders Program, Co-Director, Mind, Brain, and Behavior, Department of Psychiatry and Behavioral Sciences University of Texas Health Science Center San Antonio, San Antonio, Texas
| | - Vivek Singh
- Bowden, M.D., Emeritus Professor, Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, Texas. Priesmeyer, PhD., Jurica Professor of Management, Department of Management and Marketing, St Mary's University, San Antonio, Texas. Tohen, M.D., Dr.P.H., M.B.A, University Distinguished Professor and Chairman, Department of Psychiatry and Behavioral Sciences, University of New Mexico Health Sciences Center, Albuquerque, New Mexico. Singh, M.D., Deceased. Calabrese, M.D., Director, Mood Disorders Program, UH Cleveland Medical Center Case Western Reserve University School of Medicine, Cleveland, Ohio. Ketter, M.D, Emeritus Professor, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California. Nierenberg, M.D., Director, Dauten Family Center for Bipolar Treatment Innovation Massachusetts General Hospital, Harvard Medical School. Thase, M.D., Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. Gregg Siegel, M.S, Biomedical Development Corporation, San Antonio, Texas. Leslie H. Siegel, M.F.A, Biomedical Development Corporation, San Antonio, Texas. Mintz, PhD., Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, Texas. Mallakh, M.D., Mood Disorders Research Program, Depression Center, Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky. McElroy, M.D., Professor of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, Ohio. Martinez, M.D., Professor and Mary Avis Weir Chair in Psychiatry, Director, Adult Mood Disorders Program, Co-Director, Mind, Brain, and Behavior, Department of Psychiatry and Behavioral Sciences University of Texas Health Science Center San Antonio, San Antonio, Texas
| | - Joseph R Calabrese
- Bowden, M.D., Emeritus Professor, Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, Texas. Priesmeyer, PhD., Jurica Professor of Management, Department of Management and Marketing, St Mary's University, San Antonio, Texas. Tohen, M.D., Dr.P.H., M.B.A, University Distinguished Professor and Chairman, Department of Psychiatry and Behavioral Sciences, University of New Mexico Health Sciences Center, Albuquerque, New Mexico. Singh, M.D., Deceased. Calabrese, M.D., Director, Mood Disorders Program, UH Cleveland Medical Center Case Western Reserve University School of Medicine, Cleveland, Ohio. Ketter, M.D, Emeritus Professor, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California. Nierenberg, M.D., Director, Dauten Family Center for Bipolar Treatment Innovation Massachusetts General Hospital, Harvard Medical School. Thase, M.D., Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. Gregg Siegel, M.S, Biomedical Development Corporation, San Antonio, Texas. Leslie H. Siegel, M.F.A, Biomedical Development Corporation, San Antonio, Texas. Mintz, PhD., Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, Texas. Mallakh, M.D., Mood Disorders Research Program, Depression Center, Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky. McElroy, M.D., Professor of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, Ohio. Martinez, M.D., Professor and Mary Avis Weir Chair in Psychiatry, Director, Adult Mood Disorders Program, Co-Director, Mind, Brain, and Behavior, Department of Psychiatry and Behavioral Sciences University of Texas Health Science Center San Antonio, San Antonio, Texas
| | - Terry Ketter
- Bowden, M.D., Emeritus Professor, Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, Texas. Priesmeyer, PhD., Jurica Professor of Management, Department of Management and Marketing, St Mary's University, San Antonio, Texas. Tohen, M.D., Dr.P.H., M.B.A, University Distinguished Professor and Chairman, Department of Psychiatry and Behavioral Sciences, University of New Mexico Health Sciences Center, Albuquerque, New Mexico. Singh, M.D., Deceased. Calabrese, M.D., Director, Mood Disorders Program, UH Cleveland Medical Center Case Western Reserve University School of Medicine, Cleveland, Ohio. Ketter, M.D, Emeritus Professor, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California. Nierenberg, M.D., Director, Dauten Family Center for Bipolar Treatment Innovation Massachusetts General Hospital, Harvard Medical School. Thase, M.D., Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. Gregg Siegel, M.S, Biomedical Development Corporation, San Antonio, Texas. Leslie H. Siegel, M.F.A, Biomedical Development Corporation, San Antonio, Texas. Mintz, PhD., Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, Texas. Mallakh, M.D., Mood Disorders Research Program, Depression Center, Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky. McElroy, M.D., Professor of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, Ohio. Martinez, M.D., Professor and Mary Avis Weir Chair in Psychiatry, Director, Adult Mood Disorders Program, Co-Director, Mind, Brain, and Behavior, Department of Psychiatry and Behavioral Sciences University of Texas Health Science Center San Antonio, San Antonio, Texas
| | - Andrew Nierenberg
- Bowden, M.D., Emeritus Professor, Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, Texas. Priesmeyer, PhD., Jurica Professor of Management, Department of Management and Marketing, St Mary's University, San Antonio, Texas. Tohen, M.D., Dr.P.H., M.B.A, University Distinguished Professor and Chairman, Department of Psychiatry and Behavioral Sciences, University of New Mexico Health Sciences Center, Albuquerque, New Mexico. Singh, M.D., Deceased. Calabrese, M.D., Director, Mood Disorders Program, UH Cleveland Medical Center Case Western Reserve University School of Medicine, Cleveland, Ohio. Ketter, M.D, Emeritus Professor, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California. Nierenberg, M.D., Director, Dauten Family Center for Bipolar Treatment Innovation Massachusetts General Hospital, Harvard Medical School. Thase, M.D., Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. Gregg Siegel, M.S, Biomedical Development Corporation, San Antonio, Texas. Leslie H. Siegel, M.F.A, Biomedical Development Corporation, San Antonio, Texas. Mintz, PhD., Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, Texas. Mallakh, M.D., Mood Disorders Research Program, Depression Center, Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky. McElroy, M.D., Professor of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, Ohio. Martinez, M.D., Professor and Mary Avis Weir Chair in Psychiatry, Director, Adult Mood Disorders Program, Co-Director, Mind, Brain, and Behavior, Department of Psychiatry and Behavioral Sciences University of Texas Health Science Center San Antonio, San Antonio, Texas
| | - Michael E Thase
- Bowden, M.D., Emeritus Professor, Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, Texas. Priesmeyer, PhD., Jurica Professor of Management, Department of Management and Marketing, St Mary's University, San Antonio, Texas. Tohen, M.D., Dr.P.H., M.B.A, University Distinguished Professor and Chairman, Department of Psychiatry and Behavioral Sciences, University of New Mexico Health Sciences Center, Albuquerque, New Mexico. Singh, M.D., Deceased. Calabrese, M.D., Director, Mood Disorders Program, UH Cleveland Medical Center Case Western Reserve University School of Medicine, Cleveland, Ohio. Ketter, M.D, Emeritus Professor, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California. Nierenberg, M.D., Director, Dauten Family Center for Bipolar Treatment Innovation Massachusetts General Hospital, Harvard Medical School. Thase, M.D., Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. Gregg Siegel, M.S, Biomedical Development Corporation, San Antonio, Texas. Leslie H. Siegel, M.F.A, Biomedical Development Corporation, San Antonio, Texas. Mintz, PhD., Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, Texas. Mallakh, M.D., Mood Disorders Research Program, Depression Center, Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky. McElroy, M.D., Professor of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, Ohio. Martinez, M.D., Professor and Mary Avis Weir Chair in Psychiatry, Director, Adult Mood Disorders Program, Co-Director, Mind, Brain, and Behavior, Department of Psychiatry and Behavioral Sciences University of Texas Health Science Center San Antonio, San Antonio, Texas
| | - Gregg Siegel
- Bowden, M.D., Emeritus Professor, Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, Texas. Priesmeyer, PhD., Jurica Professor of Management, Department of Management and Marketing, St Mary's University, San Antonio, Texas. Tohen, M.D., Dr.P.H., M.B.A, University Distinguished Professor and Chairman, Department of Psychiatry and Behavioral Sciences, University of New Mexico Health Sciences Center, Albuquerque, New Mexico. Singh, M.D., Deceased. Calabrese, M.D., Director, Mood Disorders Program, UH Cleveland Medical Center Case Western Reserve University School of Medicine, Cleveland, Ohio. Ketter, M.D, Emeritus Professor, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California. Nierenberg, M.D., Director, Dauten Family Center for Bipolar Treatment Innovation Massachusetts General Hospital, Harvard Medical School. Thase, M.D., Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. Gregg Siegel, M.S, Biomedical Development Corporation, San Antonio, Texas. Leslie H. Siegel, M.F.A, Biomedical Development Corporation, San Antonio, Texas. Mintz, PhD., Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, Texas. Mallakh, M.D., Mood Disorders Research Program, Depression Center, Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky. McElroy, M.D., Professor of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, Ohio. Martinez, M.D., Professor and Mary Avis Weir Chair in Psychiatry, Director, Adult Mood Disorders Program, Co-Director, Mind, Brain, and Behavior, Department of Psychiatry and Behavioral Sciences University of Texas Health Science Center San Antonio, San Antonio, Texas
| | - Leslie H Siegel
- Bowden, M.D., Emeritus Professor, Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, Texas. Priesmeyer, PhD., Jurica Professor of Management, Department of Management and Marketing, St Mary's University, San Antonio, Texas. Tohen, M.D., Dr.P.H., M.B.A, University Distinguished Professor and Chairman, Department of Psychiatry and Behavioral Sciences, University of New Mexico Health Sciences Center, Albuquerque, New Mexico. Singh, M.D., Deceased. Calabrese, M.D., Director, Mood Disorders Program, UH Cleveland Medical Center Case Western Reserve University School of Medicine, Cleveland, Ohio. Ketter, M.D, Emeritus Professor, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California. Nierenberg, M.D., Director, Dauten Family Center for Bipolar Treatment Innovation Massachusetts General Hospital, Harvard Medical School. Thase, M.D., Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. Gregg Siegel, M.S, Biomedical Development Corporation, San Antonio, Texas. Leslie H. Siegel, M.F.A, Biomedical Development Corporation, San Antonio, Texas. Mintz, PhD., Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, Texas. Mallakh, M.D., Mood Disorders Research Program, Depression Center, Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky. McElroy, M.D., Professor of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, Ohio. Martinez, M.D., Professor and Mary Avis Weir Chair in Psychiatry, Director, Adult Mood Disorders Program, Co-Director, Mind, Brain, and Behavior, Department of Psychiatry and Behavioral Sciences University of Texas Health Science Center San Antonio, San Antonio, Texas
| | - Jim Mintz
- Bowden, M.D., Emeritus Professor, Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, Texas. Priesmeyer, PhD., Jurica Professor of Management, Department of Management and Marketing, St Mary's University, San Antonio, Texas. Tohen, M.D., Dr.P.H., M.B.A, University Distinguished Professor and Chairman, Department of Psychiatry and Behavioral Sciences, University of New Mexico Health Sciences Center, Albuquerque, New Mexico. Singh, M.D., Deceased. Calabrese, M.D., Director, Mood Disorders Program, UH Cleveland Medical Center Case Western Reserve University School of Medicine, Cleveland, Ohio. Ketter, M.D, Emeritus Professor, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California. Nierenberg, M.D., Director, Dauten Family Center for Bipolar Treatment Innovation Massachusetts General Hospital, Harvard Medical School. Thase, M.D., Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. Gregg Siegel, M.S, Biomedical Development Corporation, San Antonio, Texas. Leslie H. Siegel, M.F.A, Biomedical Development Corporation, San Antonio, Texas. Mintz, PhD., Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, Texas. Mallakh, M.D., Mood Disorders Research Program, Depression Center, Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky. McElroy, M.D., Professor of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, Ohio. Martinez, M.D., Professor and Mary Avis Weir Chair in Psychiatry, Director, Adult Mood Disorders Program, Co-Director, Mind, Brain, and Behavior, Department of Psychiatry and Behavioral Sciences University of Texas Health Science Center San Antonio, San Antonio, Texas
| | - Rif S El-Mallakh
- Bowden, M.D., Emeritus Professor, Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, Texas. Priesmeyer, PhD., Jurica Professor of Management, Department of Management and Marketing, St Mary's University, San Antonio, Texas. Tohen, M.D., Dr.P.H., M.B.A, University Distinguished Professor and Chairman, Department of Psychiatry and Behavioral Sciences, University of New Mexico Health Sciences Center, Albuquerque, New Mexico. Singh, M.D., Deceased. Calabrese, M.D., Director, Mood Disorders Program, UH Cleveland Medical Center Case Western Reserve University School of Medicine, Cleveland, Ohio. Ketter, M.D, Emeritus Professor, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California. Nierenberg, M.D., Director, Dauten Family Center for Bipolar Treatment Innovation Massachusetts General Hospital, Harvard Medical School. Thase, M.D., Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. Gregg Siegel, M.S, Biomedical Development Corporation, San Antonio, Texas. Leslie H. Siegel, M.F.A, Biomedical Development Corporation, San Antonio, Texas. Mintz, PhD., Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, Texas. Mallakh, M.D., Mood Disorders Research Program, Depression Center, Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky. McElroy, M.D., Professor of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, Ohio. Martinez, M.D., Professor and Mary Avis Weir Chair in Psychiatry, Director, Adult Mood Disorders Program, Co-Director, Mind, Brain, and Behavior, Department of Psychiatry and Behavioral Sciences University of Texas Health Science Center San Antonio, San Antonio, Texas
| | - Susan L McElroy
- Bowden, M.D., Emeritus Professor, Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, Texas. Priesmeyer, PhD., Jurica Professor of Management, Department of Management and Marketing, St Mary's University, San Antonio, Texas. Tohen, M.D., Dr.P.H., M.B.A, University Distinguished Professor and Chairman, Department of Psychiatry and Behavioral Sciences, University of New Mexico Health Sciences Center, Albuquerque, New Mexico. Singh, M.D., Deceased. Calabrese, M.D., Director, Mood Disorders Program, UH Cleveland Medical Center Case Western Reserve University School of Medicine, Cleveland, Ohio. Ketter, M.D, Emeritus Professor, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California. Nierenberg, M.D., Director, Dauten Family Center for Bipolar Treatment Innovation Massachusetts General Hospital, Harvard Medical School. Thase, M.D., Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. Gregg Siegel, M.S, Biomedical Development Corporation, San Antonio, Texas. Leslie H. Siegel, M.F.A, Biomedical Development Corporation, San Antonio, Texas. Mintz, PhD., Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, Texas. Mallakh, M.D., Mood Disorders Research Program, Depression Center, Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky. McElroy, M.D., Professor of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, Ohio. Martinez, M.D., Professor and Mary Avis Weir Chair in Psychiatry, Director, Adult Mood Disorders Program, Co-Director, Mind, Brain, and Behavior, Department of Psychiatry and Behavioral Sciences University of Texas Health Science Center San Antonio, San Antonio, Texas
| | - Melissa Martinez
- Bowden, M.D., Emeritus Professor, Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, Texas. Priesmeyer, PhD., Jurica Professor of Management, Department of Management and Marketing, St Mary's University, San Antonio, Texas. Tohen, M.D., Dr.P.H., M.B.A, University Distinguished Professor and Chairman, Department of Psychiatry and Behavioral Sciences, University of New Mexico Health Sciences Center, Albuquerque, New Mexico. Singh, M.D., Deceased. Calabrese, M.D., Director, Mood Disorders Program, UH Cleveland Medical Center Case Western Reserve University School of Medicine, Cleveland, Ohio. Ketter, M.D, Emeritus Professor, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California. Nierenberg, M.D., Director, Dauten Family Center for Bipolar Treatment Innovation Massachusetts General Hospital, Harvard Medical School. Thase, M.D., Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. Gregg Siegel, M.S, Biomedical Development Corporation, San Antonio, Texas. Leslie H. Siegel, M.F.A, Biomedical Development Corporation, San Antonio, Texas. Mintz, PhD., Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, Texas. Mallakh, M.D., Mood Disorders Research Program, Depression Center, Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky. McElroy, M.D., Professor of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, Ohio. Martinez, M.D., Professor and Mary Avis Weir Chair in Psychiatry, Director, Adult Mood Disorders Program, Co-Director, Mind, Brain, and Behavior, Department of Psychiatry and Behavioral Sciences University of Texas Health Science Center San Antonio, San Antonio, Texas
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Ramsey CM, Lynch KG, Thase ME, Gelernter J, Kranzler HR, Pyne JM, Shih MC, Stone A, Oslin DW. Prevalence of predicted gene-drug interactions for antidepressants in the treatment of major depressive disorder in the Precision Medicine in Mental Health Care Study. J Affect Disord 2021; 282:1272-1277. [PMID: 33601706 DOI: 10.1016/j.jad.2021.01.034] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 12/28/2020] [Accepted: 01/10/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Pharmacogenetic (PGx) testing is a potentially important, but understudied approach to precision medicine that could improve prescribing practices for antidepressants (ADs) in patients with Major Depressive Disorder (MDD). Thus, it is important to understand the scope of its potential impact and to identify patients who may benefit most from PGx-guided care. METHODS Participants were treatment-seeking US veterans (N=1149) with MDD enrolled in the Precision Medicine in Mental Health Care study, a pragmatic multi-site, randomized, controlled trial that examines the utility of PGx testing in the context of pharmacotherapy for MDD. We report the prevalence of ADs with predicted moderate and clinically significant gene-drug interaction potential based on next-intended treatment. We also examined demographic and treatment history characteristics as predictors of the gene-drug interaction potential of participants' next-intended treatment. RESULTS Prevalence of the next-intended AD with moderate or clinically significant gene-drug interaction was 45.1% and19.3%. Previous treatment with an AD in the past two years was associated with a 1.59 increased likelihood of having a next-intended AD treatment with predicted clinically significant gene-drug interaction (95% CI: 1.08-2.35). LIMITATIONS The gene-drug interaction potential of ADs is specific to the PGx test panel used in this study and may not generalize to other PGx test panels. CONCLUSIONS PGx testing could benefit one in five patients prescribed ADs with clinically significant gene-drug interaction potential. Patients with prior AD treatment are more likely to have an AD with significant gene-drug interaction potential as their next-intended treatment and therefore may benefit most from PGx testing.
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Affiliation(s)
- Christine M Ramsey
- Veterans Integrated Service Network 4 Mental Illness Research, Education, and Clinical Center (MIRECC), Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA; Yale School of Medicine, Yale University, New Haven, CT, USA.
| | - Kevin G Lynch
- Veterans Integrated Service Network 4 Mental Illness Research, Education, and Clinical Center (MIRECC), Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Michael E Thase
- Veterans Integrated Service Network 4 Mental Illness Research, Education, and Clinical Center (MIRECC), Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Joel Gelernter
- Yale School of Medicine, Yale University, New Haven, CT, USA; VA Connecticut Healthcare System, West Haven, CT, USA
| | - Henry R Kranzler
- Veterans Integrated Service Network 4 Mental Illness Research, Education, and Clinical Center (MIRECC), Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jeffrey M Pyne
- Central Arkansas Veterans Healthcare System; University of Arkansas Medical Sciences
| | - Mei-Chiung Shih
- VA Cooperative Studies Program Coordinating Center, Palo Alto Healthcare System, Palo Alto, CA, USA; Stanford School of Medicine, Stanford University, Stanford, CA, USA
| | | | - David W Oslin
- Veterans Integrated Service Network 4 Mental Illness Research, Education, and Clinical Center (MIRECC), Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Khazanov GK, Xu C, Hollon SD, DeRubeis RJ, Thase ME. Adding cognitive therapy to antidepressant medications decreases suicidal ideation. J Affect Disord 2021; 281:183-191. [PMID: 33326891 PMCID: PMC7855962 DOI: 10.1016/j.jad.2020.12.032] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 11/19/2020] [Accepted: 12/05/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Psychotherapy for depression and antidepressant medications have both been associated with decreases in suicidal ideation. Studies have not examined whether adding psychotherapy to antidepressant medications further reduces suicidal ideation relative to medications alone in adults. METHODS Participants (N = 452) were randomized to 7 months of treatment with antidepressant medications or combined treatment with both medications and cognitive therapy for depression. We examined change in the suicide items from the Beck Depression Inventory (BDI) and Hamilton Depression Rating Scale (HDRS) across treatment using Bayesian generalized linear mixed models for non-continuous outcomes. RESULTS Suicidal ideation decreased across treatment. When measured with the BDI, participants receiving both cognitive therapy and antidepressant medications showed 17% greater reductions in suicidal ideation relative to those receiving medications alone; this effect remained significant when controlling for depression severity. While the same pattern was observed when suicidal ideation was measured with the HDRS, the effect was smaller (7%) and not statistically significant. When BDI and HDRS scores were combined, participants receiving both therapy and medications showed 9% greater reductions in suicidal ideation relative to those receiving medications alone; this effect was marginally significant when controlling for depression severity. LIMITATIONS This is a secondary analysis of a randomized clinical trial designed to treat depression, in which suicidal ideation was assessed using single-item measures. CONCLUSIONS Adding cognitive therapy to antidepressant medications may reduce suicidal ideation to a greater extent than medications alone. Pending replication, combination treatment may be preferred for individuals with suicidal ideation. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00057577.
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Affiliation(s)
- Gabriela K Khazanov
- Mental Illness Research, Education, and Clinical Center of the Veterans Integrated Service Network 4, Crescenz Veterans Affairs Medical Center.
| | - Colin Xu
- Department of Psychology, University of Pennsylvania
| | | | | | - Michael E Thase
- Mental Illness Research, Education, and Clinical Center of the Veterans Integrated Service Network 4, Crescenz Veterans Affairs Medical Center
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Zisook S, Johnson GR, Hicks P, Chen P, Beresford T, Michalets JP, Rao S, Thase ME, Wilcox J, Sevilimedu V, Mohamed S. Continuation phase treatment outcomes for switching, combining, or augmenting strategies for treatment-resistant major depressive disorder: A VAST-D report. Depress Anxiety 2021; 38:185-195. [PMID: 33225492 DOI: 10.1002/da.23114] [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: 12/06/2019] [Revised: 09/18/2020] [Accepted: 10/18/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND This secondary analysis of the VA Augmentation and Switching Treatments for Depression study compared the continuation phase treatment outcomes of three commonly used second-step treatment strategies following at least one prior failed medication treatment attempt. METHODS In total, 1522 outpatients with MDD were randomized to switching to bupropion-SR (S-BUP), combining with bupropion-SR (C-BUP), or augmenting with aripiprazole (A-ARI). Following 12 weeks of acute phase treatment, 725 entered the 24-week continuation treatment phase. Depressive symptom severity, relapse, "emergent" remission, anxiety, suicidal ideation, quality of life, health status, and side effects were compared. RESULTS We did not find clinically significant differential treatment effects with the exception that A-ARI was associated with less anxiety than S-BUP or C-BUP. Participants who entered continuation treatment as remitters had milder depressive symptom severity and lower relapse rates than those not in remission; they also experienced more improvement on most other outcomes. A-ARI was associated with less anxiety, insomnia, and dry mouth but more somnolence, extrapyramidal effects, akathisia, abnormal laboratory values, and appetite and weight gain. CONCLUSIONS Continuation treatment is a dynamic period. Regardless of the treatment, participants who entered continuation treatment at Week 12 in full remission continued to have better outcomes over the subsequent 24 weeks than those who were not in remission at the start of the continuation phase.
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Affiliation(s)
- Sidney Zisook
- Mental Health, VA San Diego Healthcare System, San Diego, California, USA.,The Department of Psychiatry, University of California San Diego, La Jolla, California, USA
| | - Gary R Johnson
- Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, West Haven, Connecticut, USA
| | - Paul Hicks
- The Department of Psychiatry, Texas A&M College of Medicine, Temple, Texas, USA
| | - Peijun Chen
- The Department of Psychiatry, School of Medicine, Louis Stokes VA Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Thomas Beresford
- Mental Health, Rocky Mountain Regional VA Medical Center, Aurora, Colorado, USA
| | | | - Sanjai Rao
- Mental Health, VA San Diego Healthcare System, San Diego, California, USA
| | - Michael E Thase
- Mental Health, Philadelphia VA Medical Center, Philadelphia, Pennsylvania, USA
| | - James Wilcox
- Mental Health, Southern Arizona VA Healthcare System, Tucson, Arizona, USA
| | - Varadan Sevilimedu
- Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, West Haven, Connecticut, USA
| | - Somaia Mohamed
- VA Connecticut Healthcare System, West Haven, Connecticut, USA
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50
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Rothschild AJ, Parikh SV, Hain D, Law R, Thase ME, Dunlop BW, DeBattista C, Conway CR, Forester BP, Shelton RC, Macaluso M, Brown K, Lewis D, Gutin A, Jablonski MR, Greden JF. Clinical validation of combinatorial pharmacogenomic testing and single-gene guidelines in predicting psychotropic medication blood levels and clinical outcomes in patients with depression. Psychiatry Res 2021; 296:113649. [PMID: 33360967 DOI: 10.1016/j.psychres.2020.113649] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 09/25/2020] [Accepted: 12/12/2020] [Indexed: 12/13/2022]
Abstract
We evaluated the clinical validity of a combinatorial pharmacogenomic test and single-gene Clinical Pharmacogenetics Implementation Consortium (CPIC) guidelines against patient outcomes and medication blood levels to assess their ability to inform prescribing in major depressive disorder (MDD). This is a secondary analysis of the Genomics Used to Improve DEpression Decisions (GUIDED) randomized-controlled trial, which included patients with a diagnosis of MDD, and ≥1 prior medication failure. The ability to predict increased/decreased medication metabolism was validated against blood levels at screening (adjusted for age, sex, smoking status). The ability of predicted gene-drug interactions (pharmacogenomic test) or therapeutic recommendations (single-gene guidelines) to predict patient outcomes was validated against week 8 outcomes (17-item Hamilton Depression Rating Scale; symptom improvement, response, remission). Analyses were performed for patients taking any eligible medication (outcomes N=1,022, blood levels N=1,034) and the subset taking medications with single-gene guidelines (outcomes N=584, blood levels N=372). The combinatorial pharmacogenomic test was the only significant predictor of patient outcomes. Both the combinatorial pharmacogenomic test and single-gene guidelines were significant predictors of blood levels for all medications when evaluated separately; however, only the combinatorial pharmacogenomic test remained significant when both were included in the multivariate model. There were no substantial differences when all medications were evaluated or for the subset with single-gene guidelines. Overall, this evaluation of clinical validity demonstrates that the combinatorial pharmacogenomic test was a superior predictor of patient outcomes and medication blood levels when compared with guidelines based on individual genes.
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Affiliation(s)
- Anthony J Rothschild
- University of Massachusetts Medical School and UMass Memorial Healthcare, Worcester, MA 01655, United States.
| | - Sagar V Parikh
- University of Michigan Comprehensive Depression Center and Department of Psychiatry, and National Network of Depression Centers, Ann Arbor, MI 48109, United States
| | - Daniel Hain
- Myriad Neuroscience, Mason, OH 45040, United States
| | - Rebecca Law
- Myriad Neuroscience, Mason, OH 45040, United States
| | - Michael E Thase
- Perelman School of Medicine of the University of Pennsylvania and the Corporal Michael Crescenz VAMC, Philadelphia, PA 19104, United States
| | - Boadie W Dunlop
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA 30329, United States
| | - Charles DeBattista
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, United States
| | - Charles R Conway
- Department of Psychiatry, Washington University School of Medicine, and the John Cochran Veteran's Administration Hospital, St. Louis, MO 63110, United States
| | - Brent P Forester
- McLean Hospital, Division of Geriatric Psychiatry, Belmont, MA 02478, United States; Harvard Medical School, Boston, MA, United States
| | - Richard C Shelton
- Department of Psychiatry and Behavioral Neurobiology and School of Medicine, The University of Alabama at Birmingham, Birmingham, AL, United States
| | - Matthew Macaluso
- Department of Psychiatry and Behavioral Neurobiology and School of Medicine, The University of Alabama at Birmingham, Birmingham, AL, United States
| | - Krystal Brown
- Myriad Genetics, Inc., Salt Lake City, UT 84108, United States
| | - David Lewis
- Myriad Neuroscience, Mason, OH 45040, United States
| | - Alexander Gutin
- Myriad Genetics, Inc., Salt Lake City, UT 84108, United States
| | | | - John F Greden
- University of Michigan Comprehensive Depression Center and Department of Psychiatry, and National Network of Depression Centers, Ann Arbor, MI 48109, United States
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