1
|
Leuchter AF, Phillips B, Jin Y, Cook IA, Feifel D, Goethe J, Husain M, Carpenter L, Thase M, Krystal A, Burke W, Howland R, Sheline Y, Jain R, Aaronson S, Iosifescu D, O’Reardon J, Gilmer W, Burgoyne K, Lisanby S, George M. Safety and Efficacy of Synchronized Transcranial Magnetic Stimulation for the Treatment of Major Depressive Disorder. Brain Stimul 2015. [DOI: 10.1016/j.brs.2015.01.287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
2
|
Solvason HB, Husain M, Fitzgerald PB, Rosenquist P, McCall WV, Kimball J, Gilmer W, Demitrack MA, Lisanby SH. Improvement in quality of life with left prefrontal transcranial magnetic stimulation in patients with pharmacoresistant major depression: acute and six month outcomes. Brain Stimul 2013; 7:219-25. [PMID: 24332384 DOI: 10.1016/j.brs.2013.10.008] [Citation(s) in RCA: 25] [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] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Revised: 10/10/2013] [Accepted: 10/25/2013] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Transcranial magnetic stimulation (TMS) is a safe and effective treatment for major depression. We describe quality of life (QOL) outcomes from acute treatment with TMS, and describe the durability of benefit across 24-weeks. METHODS Three hundred and one medication-free patients with pharmacoresistant major depression were randomized to active or sham TMS in a 6-week controlled trial. Nonresponders to the 6-week blinded phase of the study were enrolled in a 6-week open-label study without unblinding the prior treatment assignment. Responders and partial responders to both the blinded (active or sham treatment) or open acute treatment phases were tapered off TMS over three weeks, while initiating maintenance antidepressant medication monotherapy. These subjects entered the 24-week study to examine the durability of response to TMS. The Medical Outcomes Study-36 Item Short Form (SF-36) and the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q) were used to measure overall function and QOL. During the 24-week durability of effect study, QOL assessments were done at study entry and at the end of 24-weeks. RESULTS Statistically significant improvement in both functional status and QOL outcomes was observed in patients treated with active TMS compared with sham TMS during the acute phase of the randomized, sham-controlled trial. Similar benefits were observed in patients who entered the open-label extension study. These improvements were sustained across the 24-week follow up study. CONCLUSIONS Acute treatment with TMS improved functional status and QOL outcomes in patients with major depression. This clinical effect was durable in long-term follow up.
Collapse
Affiliation(s)
- H B Solvason
- Department of Psychiatry, Stanford University Medical Center, Stanford University, 401 Quarry Road, Palo Alto, CA 94305 USA.
| | - M Husain
- University of Texas Southwestern Medical School, Dallas, TX, USA
| | | | | | - W V McCall
- Medical College of Georgia, Augusta, GA, USA
| | - J Kimball
- Wake Forest University, Winston-Salem, NC, USA
| | - W Gilmer
- Northwestern University, Chicago, IL, USA
| | | | | |
Collapse
|
3
|
Gilmer W, McLeod SD, Jeng BH. Laboratory model of bursting pressures of femtosecond laser-assisted penetrating keratoplasty wounds using novel pattern designs. Br J Ophthalmol 2012; 96:1273-4. [PMID: 22694963 DOI: 10.1136/bjophthalmol-2012-302037] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
4
|
Patkar A, Gilmer W, Pae CU, Vöhringer PA, Ziffra M, Pirok E, Mulligan M, Filkowski MM, Whitham EA, Holtzman NS, Thommi SB, Logvinenko T, Loebel A, Masand P, Ghaemi SN. A 6 week randomized double-blind placebo-controlled trial of ziprasidone for the acute depressive mixed state. PLoS One 2012; 7:e34757. [PMID: 22545088 PMCID: PMC3335844 DOI: 10.1371/journal.pone.0034757] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2011] [Accepted: 03/05/2012] [Indexed: 11/18/2022] Open
Abstract
Objective To examine the efficacy of ziprasidone vs. placebo for the depressive mixed state in patients with bipolar disorder type II or major depressive disorder (MDD). Methods 73 patients were randomized in a double-blinded, placebo-controlled study to ziprasidone (40-160 mg/d) or placebo for 6 weeks. They met DSM-IV criteria for a major depressive episode (MDE), while also meeting 2 or 3 (but not more nor less) DSM-IV manic criteria. They did not meet DSM-IV criteria for a mixed or manic episode. Baseline psychotropic drugs were continued unchanged. The primary endpoint measured was Montgomery- Åsberg Depression Rating Scale (MADRS) scores over time. The mean dose of ziprasidone was 129.7±45.3 mg/day and 126.1±47.1 mg/day for placebo. Results The primary outcome analysis indicated efficacy of ziprasidone versus placebo (p = 0.0038). Efficacy was more pronounced in type II bipolar disorder than in MDD (p = 0.036). Overall ziprasidone was well tolerated, without notable worsening of weight or extrapyramidal symptoms. Conclusions There was a statistically significant benefit with ziprasidone versus placebo in this first RCT of any medication for the provisional diagnostic concept of the depressive mixed state. Trial Registration Clinicaltrials.gov NCT00490542
Collapse
Affiliation(s)
- Ashwin Patkar
- Department of Psychiatry, Duke University Medical Center, Durham, North Carolina, United States of America
| | - William Gilmer
- Department of Psychiatry, Northwestern University, School of Medicine, Chicago, Illinois, United States of America
| | - Chi-un Pae
- Department of Psychiatry, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Paul A. Vöhringer
- Mood Disorders Program, Department of Psychiatry, Tufts Medical Center, Boston, Massachusetts, United States of America
- Hospital Clinico, Facultad de Medicina, Universidad Chile, Santiago, Chile
- Graduate Program, Clinical and Translational Science Institute, Sackler School of Graduate and Biomedical Sciences, Tufts University, Boston, Massachusetts, United States of America
| | - Michael Ziffra
- Department of Psychiatry, Northwestern University, School of Medicine, Chicago, Illinois, United States of America
| | - Edward Pirok
- Department of Psychiatry, Northwestern University, School of Medicine, Chicago, Illinois, United States of America
| | - Molly Mulligan
- Department of Psychiatry, Northwestern University, School of Medicine, Chicago, Illinois, United States of America
| | - Megan M. Filkowski
- Department of Psychiatry, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Elizabeth A. Whitham
- Mood Disorders Program, Department of Psychiatry, Tufts Medical Center, Boston, Massachusetts, United States of America
| | - Niki S. Holtzman
- Mood Disorders Program, Department of Psychiatry, Tufts Medical Center, Boston, Massachusetts, United States of America
| | - Sairah B. Thommi
- Mood Disorders Program, Department of Psychiatry, Tufts Medical Center, Boston, Massachusetts, United States of America
| | - Tanya Logvinenko
- Biostatistics Research Center at the Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts, United States of America
| | - Antony Loebel
- Sunovion Pharmaceuticals, Fort Lee, New Jersey, United States of America
| | - Prakash Masand
- Department of Psychiatry, Duke University Medical Center, Durham, North Carolina, United States of America
| | - S. Nassir Ghaemi
- Mood Disorders Program, Department of Psychiatry, Tufts Medical Center, Boston, Massachusetts, United States of America
- Tufts University School of Medicine, Boston, Massachusetts, United States of America
- * E-mail:
| |
Collapse
|
5
|
Pae CU, Vöhringer PA, Holtzman NS, Thommi SB, Patkar A, Gilmer W, Ghaemi SN. Mixed depression: a study of its phenomenology and relation to treatment response. J Affect Disord 2012; 136:1059-61. [PMID: 22173265 DOI: 10.1016/j.jad.2011.11.024] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2011] [Accepted: 11/14/2011] [Indexed: 10/14/2022]
Abstract
BACKGROUND Mixed depression reflects the occurrence of a major depressive episode with subsyndromal manic symptoms. Not recognized in DSM-IV, it is included in the proposed changes for DSM-5. Observational and cross-sectional studies have suggested that mixed depression is present in up to one-half of major depressive episodes, whether in MDD or bipolar disorder. Based on observational studies, antidepressants appear to be less effective, and neuroleptics more effective, in mixed than pure depression (major depressive episodes with no manic symptoms). In this report, we examine the specific manic symptoms that are most present in mixed depression, especially as they correlate with prospectively assessed treatment response. METHODS In 72 patients treated in a randomized clinical trial (ziprasidone versus placebo), we assessed the phenomenology of manic symptom type at study entry and their influence as predictors of treatment response. RESULTS The most common symptom presentation was a clinical triad of flight of ideas (60%), distractibility (58%), and irritable mood (55%). Irritable mood was the major predictor of treatment response. DSM-based diagnostic distinctions between MDD and bipolar disorder (type II) did not predict treatment response. CONCLUSION In this prospective study, mixed depression seems to be most commonly associated with irritable mood, flight of ideas, and distractibility, with irritability being an important predictor of treatment outcome with neuroleptic agents. If these data are correct, in the presence of mixed depression, the DSM-based dichotomy between MDD and bipolar disorder does not appear to influence treatment response.
Collapse
Affiliation(s)
- Chi-Un Pae
- Department of Psychiatry, Duke University Medical Center, Durham, NC, United States
| | | | | | | | | | | | | |
Collapse
|
6
|
Pae CU, Patkar AA, Gilmer W, Holtzman N, Thommi SB, Ghaemi SN. Predictors of response to ziprasidone: results from a 6-week randomized double-blind, placebo-controlled trial for acute depressive mixed state. Pharmacopsychiatry 2012; 45:152-5. [PMID: 22294238 DOI: 10.1055/s-0031-1297984] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
INTRODUCTION The present study is aimed at investigating possible predictors of response to ziprasidone in a sample of patients with mixed depressive state. METHODS 72 patients were randomized to either ziprasidone or placebo and treated prospectively for 6 weeks. The clinical response and remission were defined with various clinical variables including Montgomery Asberg Depression Rating Scale. Further outcome measures included predictors of remission and other clinical variables over time. RESULTS None of the variables under investigation were significantly associated with response or remission at 6 weeks (all p-values>0.003, respectively). CONCLUSIONS Further investigations are warranted due to clear limitations, mostly small sample size and use of concomitant medications.
Collapse
Affiliation(s)
- C-U Pae
- Department of Psychiatry, Duke University Medical Center, Durham, NC, USA
| | | | | | | | | | | |
Collapse
|
7
|
Fintelmann RE, Gilmer W, Bloomer MM, Jeng BH. Recurrent Lecythophora mutabilis keratitis and endophthalmitis after deep anterior lamellar keratoplasty. ACTA ACUST UNITED AC 2011; 129:108-10. [PMID: 21220641 DOI: 10.1001/archophthalmol.2010.335] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Robert E Fintelmann
- Department of Ophthalmology, University of California, San Francisco, San Francisco, CA 94143-0730, USA
| | | | | | | |
Collapse
|
8
|
Correa R, Akiskal H, Gilmer W, Nierenberg AA, Trivedi M, Zisook S. Is unrecognized bipolar disorder a frequent contributor to apparent treatment resistant depression? J Affect Disord 2010; 127:10-8. [PMID: 20655113 DOI: 10.1016/j.jad.2010.06.036] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [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] [Received: 05/25/2010] [Accepted: 06/28/2010] [Indexed: 11/18/2022]
Abstract
BACKGROUND There is widespread clinical belief that unrecognized bipolar disorder (BD) is a frequent contributor to apparent treatment resistant depression (TRD). This review attempts to assess the degree to which prevailing empirical data supports that view. METHODS All English-language articles published between January 1998 and January 2008 that focused on adults with major depressive disorder (MDD) and BD bearing on the question "Is unrecognized BD a frequent contributor to apparent TRD in patients initially diagnosed with MDD?" were reviewed. RESULTS 196 articles were reviewed; the preponderance of the data suggested: 1) TRD populations demonstrate high rates of hidden bipolar disorder, 2) there is not sufficient evidence to unequivocally support or reject the hypothesis that patients who relapse despite continued antidepressant treatment are likely to have bipolar spectrum disorder, 3) patients initially diagnosed with MDD do not demonstrate high rates of switching to mania or hypomania when treated with antidepressants and 4) in patients diagnosed with BD, antidepressants are not robustly effective and are poorly tolerated. LIMITATIONS The main limitation of this review is that none of the individual studies were designed to test our primary hypothesis. CONCLUSIONS This review provides at least moderate support to the hypothesis that BD is a contributor to apparent TRD. Thus, clinicians treating MDD are urged to search for "soft" signs of bipolarity and to be prepared to alter diagnosis and treatment strategies accordingly.
Collapse
Affiliation(s)
- R Correa
- Department of Psychiatry, University of California San Diego (UCSD), USA
| | | | | | | | | | | |
Collapse
|
9
|
Janicak PG, Nahas Z, Lisanby SH, Solvason HB, Sampson SM, McDonald WM, Marangell LB, Rosenquist P, McCall WV, Kimball J, O’Reardon JP, Loo C, Husain MH, Krystal A, Gilmer W, Dowd SM, Demitrack MA, Schatzberg AF. Durability of clinical benefit with transcranial magnetic stimulation (TMS) in the treatment of pharmacoresistant major depression: assessment of relapse during a 6-month, multisite, open-label study. Brain Stimul 2010; 3:187-99. [DOI: 10.1016/j.brs.2010.07.003] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2010] [Revised: 07/08/2010] [Accepted: 07/13/2010] [Indexed: 10/19/2022] Open
|
10
|
Friedman ES, Wisniewski SR, Gilmer W, Nierenberg AA, Rush AJ, Fava M, Zisook S, Balasubramani GK, Trivedi MH. Sociodemographic, clinical, and treatment characteristics associated with worsened depression during treatment with citalopram: results of the NIMH STAR(*)D trial. Depress Anxiety 2009; 26:612-21. [PMID: 19382183 DOI: 10.1002/da.20568] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [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: 11/05/2022] Open
Abstract
CONTEXT Outcomes of antidepressant medication treatment for major depressive disorder include remission, response, and nonresponse. But nonresponse can include depression that worsened over the course of treatment, an outcome that has received scant attention. OBJECTIVE To describe baseline sociodemographic, clinical, and treatment characteristics associated with worsened depression during a trial of citalopram. DESIGN, PARTICIPANTS, AND SETTINGS: Open-label clinical trial of 2,876 adult outpatients seen in 18 primary and 23 psychiatric-care settings. INTERVENTION Citalopram was delivered using measurement-based care and flexible dosing with the aim of achieving symptom remission. Symptom and side effect ratings were obtained at each treatment visit. MAIN OUTCOME MEASURES Worsened depression was defined as an exit score >or=3 points above the pretreatment (baseline) score on the 16-item QIDS-SR. Baseline sociodemographic, clinical, and treatment characteristics were examined for association with worsened depression. RESULTS Of 2,864 outpatients who returned for >or=2 post baseline visits, 150 (5.2%) had worsened depression at study exit. Baseline characteristics independently associated with increased worsened depression included African-American race (OR=2.02), having less than a college education (OR=2.36), posttraumatic stress disorder (OR=1.78), drug abuse (OR=1.97), hypochondriasis (OR=2.74). Participants with worsened depression spent less time in treatment; had fewer treatment visits; exited the study sooner; had more frequent, intense, and burdensome adverse effects; and were more intolerant of medication. CONCLUSIONS The presence of certain baseline characteristics indicated a greater likelihood of worsened depression during antidepressant treatment. Patients with these characteristics should be monitored closely during treatment and may be candidates for more aggressive treatment.
Collapse
Affiliation(s)
- Edward S Friedman
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Lisanby SH, Husain MM, Rosenquist PB, Maixner D, Gutierrez R, Krystal A, Gilmer W, Marangell LB, Aaronson S, Daskalakis ZJ, Canterbury R, Richelson E, Sackeim HA, George MS. Daily left prefrontal repetitive transcranial magnetic stimulation in the acute treatment of major depression: clinical predictors of outcome in a multisite, randomized controlled clinical trial. Neuropsychopharmacology 2009; 34:522-34. [PMID: 18704101 DOI: 10.1038/npp.2008.118] [Citation(s) in RCA: 221] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Randomized controlled trials support the antidepressant efficacy of transcranial magnetic stimulation (TMS); however, there is individual variability in the magnitude of response. Examination of response predictors has been hampered by methodological limitations such as small sample sizes and single-site study designs. Data from a multisite sham-controlled trial of the antidepressant efficacy of TMS provided an opportunity to examine predictors of acute outcome. An open-label extension for patients who failed to improve provided the opportunity for confirmatory analysis. Treatment was administered to the left dorsolateral prefrontal cortex at 10 pulses per second, 120% of motor threshold, for a total of 3000 pulses per day. Change on the Montgomery-Asberg Depression Rating Scale after 4 weeks was the primary efficacy outcome. A total of 301 patients with nonpsychotic unipolar major depression at 23 centers were randomized to active or sham TMS. Univariate predictor analyses showed that the degree of prior treatment resistance in the current episode was a predictor of positive treatment outcome in both the controlled study and the open-label extension trial. In the randomized trial, shorter duration of current episode was also associated with a better outcome. In the open-label extension study, absence of anxiety disorder comorbidity was associated with an improved outcome, but duration of current episode was not. The number of prior treatment failures was the strongest predictor for positive response to acute treatment with TMS. Shorter duration of current illness and lack of anxiety comorbidity may also confer an increased likelihood of good antidepressant response to TMS.
Collapse
Affiliation(s)
- Sarah H Lisanby
- Division of Brain Stimulation and Therapeutic Modulation, Department of Psychiatry, Columbia University, New York State Psychiatric Institute, New York, NY 10032, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Abstract
Among 163 patients presenting with the clinical features of a TIA, extensive testing identified only 2 patients with nonatherosclerotic causes. We conclude that most patients with a TIA have atherosclerotic vascular disease and that screening tests for other etiologies have a low yield.
Collapse
Affiliation(s)
- L A Rolak
- Department of Neurology, Baylor College of Medicine, Houston, TX 77030
| | | | | |
Collapse
|
13
|
Gilmer W. Physicians and the long arm of the law: how far does it reach? J Leg Med (N Y) 1977; 5:25-9. [PMID: 301908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
|
14
|
Gilmer W. Restrictive covenants. Caveat conductus: let the one who has been hired beware. J Leg Med (N Y) 1976; 4:GP/IM/DO 40-2. [PMID: 1083403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
|
15
|
Gilmer W. Professional liability of physicians to third parties. J Leg Med (N Y) 1975; 3:35-7. [PMID: 1079832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
|
16
|
Gilmer W. Pension reform benefits professionals too. J Leg Med (N Y) 1975; 3:39-40. [PMID: 1078686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
|