Antidepressants in clinical practice: limitations of assessment methods and drug response

Kennedy, Sidney H.; Eisfeld, Beata S.; Meyer, Jeffrey H.; Bagby, R. Michael

doi:10.1002/hup.189

Cited by 28 publications

(15 citation statements)

References 41 publications

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“…Patients with typical or atypical depression responded to acute ECT treatment, and a majority showed a remission of depressive symptoms with the odds of remitting being greater in the atypical group, despite the fact that the atypical group had a higher likelihood of being treatment resistant at baseline. This finding echoes recent pharmacotherapy research showing that patients with atypical depression have a response rate similar to that of patients with typical depression when being treated with antidepressants 29 and contrasts with earlier reports 30,31 that indicated a preferential response to monoamine oxidase inhibitors (MAOIs) as opposed to tricyclic antidepressants in outpatients with atypical depression.…”

Section: Discussionsupporting

confidence: 45%

The Efficacy of Acute Electroconvulsive Therapy in Atypical Depression

Husain¹,

McClintock²,

Rush³

et al. 2008

J. Clin. Psychiatry

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Objective-This study examined the characteristics and outcomes of patients with major depressive disorder (MDD), with or without atypical features, who were treated with acute bilateral electroconvulsive therapy (ECT).Method-Analyses were conducted with 489 patients who met DSM-IV criteria for MDD. Subjects were identified as typical or atypical on the basis of the Structured Clinical Interview for DSM-IV obtained at baseline prior to ECT. Depression symptom severity was measured by the 24-item Hamilton Rating Scale for Depression ) and the 30-item Inventory of Depressive Symptomatology-Self-Report ). Remission was defined as at least a 60% decrease from baseline in HAM-D 24 score and a total score of 10 or below on the last 2 consecutive HAM-D 24 ratings. The randomized controlled trial was performed from 1997 to 2004.Results-The typical (N = 453) and atypical (N = 36) groups differed in several sociodemographic and clinical variables including gender (p = .0071), age (p = .0005), treatment resistance (p = .0014), and age at first illness onset (p < .0001) and onset of current episode (p = . 0008). Following an acute course of bilateral ECT, a considerable portion of both the typical (67.1%) and the atypical (80.6%) groups reached remission. The atypical group was 2.6 (95% CI = 1.1 to 6.2) times more likely to remit than the typical group after adjustment for age, psychosis, gender, clinical site, and depression severity based on the HAM-D 24 .© Copyright 2008 Physicians Postgraduate Press, Inc.Corresponding author and reprints: Mustafa M. Husain, M.D., Department of Psychiatry, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas,.. Drug names: lithium (Eskalith, Lithobid, and others), nortriptyline (Pamelor and others), phenelzine sulfate (Nardil). Disclosure of off-label usage:The authors have determined that, to the best of their knowledge, no investigational information about pharmaceutical agents that is outside U.S. Food and Drug Administration-approved labeling has been presented in this article. Conclusion-Acute ECT is an efficacious treatment for depressed patients with typical or atypical symptom features. NIH Public AccessThere is limited research examining the treatment of atypical depression with electroconvulsive therapy (ECT). Early research 1,2 suggested that ECT was ineffective in treating atypical depression. Although ECT resulted in minor improvement in mood, 2 many patients with atypical depressive features did not maintain the effect. However, neither study categorically defined atypical depression. They regarded atypical as being different from typical depression on the basis of undefined or varying symptom feature differences. Also, the study of West and Dally 2 was confounded by inclusion of patients who had primary anxiety disorders and secondary depression.While this early research has served as the basis for clinical decision making for decades, advances in both the understanding of atypical depression and the techniques involved in ECT recommend a reevaluation of...

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Section: Discussionsupporting

confidence: 45%

The Efficacy of Acute Electroconvulsive Therapy in Atypical Depression

Husain¹,

McClintock²,

Rush³

et al. 2008

J. Clin. Psychiatry

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“…25 Approximately 30%-40% of the patients fail to respond to treatment and less than 60% achieve remission. 26 Depression treatment guidelines recommend continued drug therapy for 6-12 months following remission of acute symptoms. 7 Agomelatine a synthetic analogue of melatonin, serves to regulate various circadian rhythms, including sleep-wake cycles.…”

Section: Discussionmentioning

confidence: 99%

Comparative efficacy of agomelatine versus sertraline in major depressive disorder in Himalayan region of India

Mehta

Gupta

Kumar

et al. 2017

Int J Basic Clin Pharmacol

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Background: Depression, a major common affective disorder which carries excess mortality through suicide. Among various drug classes available SSRI’s are usually a choice, but many patients show inadequate response, residual symptoms or discontinue medication due to intolerable side effects. Disturbances of circadian rhythm function are an etiopathogenic hallmark of depression. The degree of circadian misalignment correlates with the severity of depression and circadian abnormalities may partially be a consequence of alterations in behavior and sleep patterns that accompany depression. Agomelatine an agonist acts on MT1 and MT2 receptors and antagonist of 5HT2c receptors contributes to its resynchronization of circadian rhythms, enhancement of dopaminergic and adrenergic input to the frontal cortex, induction of hippocampal neurogenesis, and ultimately, to its antidepressant effect.Methods: The study was randomized, prospective, comparative and interventional regarding the efficacy of therapy. Hundred consenting patients of MDD attending psychiatry OPD were screened for possible enrollment into group A(Agomelatine) and group B(Sertraline). Patients were assessed by semi-structured case recording form, DSM-IV- TR Criteria for major depressive episode, Hamilton Rating Scale for Depression (HAM-D) and Clinical Global Impressions for severity (CGI-S) at baseline and CGI for improvement (CGI-I), every two weeks interval and final assessment at 8 weeks.Results: Socio-demographic parameters like age and sex distribution, marital status, locality, family type, educational status, occupation and socio-economic class were comparable between two groups. Similarly baseline HAM-D and CGI-S values between the two groups were statistically non-significant. HAM-D, CGI-S and CGI-I values at eight weeks among the two groups were also statistically non-significant but in all three sertraline had decreased the values to a greater extent and showed a trend towards improvement.Conclusions: Both groups had shown significant decrease in scores of all scales i.e. HAM-D, CGI-S, and CGI-I at the end of 8th week as compared to baseline scores, indicating that the uses of agomelatine and sertraline have resulted in significant improvement in symptoms of patients of MDD and reinforcing there efficacy in treatment of MDD. No statistical difference was observed between two groups.

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“…The depression treatment guidelines usually recommend the continuation of pharmacological treatment for 6–12 months following the remission of acute symptoms 6. Despite numerous efficacious antidepressants, treatment efficacy is not always optimal; approximately 30%–40% of the patients fail to respond to treatment and less than 60% of them achieve remission 7. Absence of or non-adherence to the recommended long-term treatment with antidepressants is associated with higher rates of relapse 6,8.…”

Section: Treatment Of Depressionmentioning

confidence: 99%

“…Depressed patients can experience a mild or severe difficulty falling asleep, sleep fragmentation, and early morning awakening 21. The electroencephalogram usually shows a typically reduced latency to the first REM (rapid eye movement) episode, an increased number of awakenings and arousals, an increased proportion of REM sleep, and reduced slow-wave activity during non-REM sleep compared with normal controls 7,11,22,23. Non-REM sleep (stage 1, stage 2, and slow-wave sleep) is mainly regulated by the homeostatic sleep system, while REM sleep is modulated by the circadian system 24.…”

Section: Circadian Rhythms and Depressionmentioning

confidence: 99%

Efficacy and tolerability of agomelatine in the treatment of depression

Plesničar¹

2014

PPA

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Depression is a severe and usually recurrent mental disorder which often leads to a significant impairment of everyday functioning, a reduced quality of life, and also great suffering of the patients. The treatment of a depressive disorder is not only limited to acute treatment; it also requires prolonged management. Patient compliance is of utmost importance. Unpleasant adverse effects and their impact on everyday living often lead to a premature discontinuation of antidepressant treatment and result in an unfavorable treatment outcome. The new antidepressant agomelatine, a melatonergic MT1/MT2 agonist and 5-HT2C receptor antagonist, has exhibited good antidepressant efficacy in acute, short-term, and long-term treatment. The adverse effect profile of agomelatine has been proven to be favorable and comparable to placebo, which is very important for good treatment compliance and adherence.

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Antidepressants in clinical practice: limitations of assessment methods and drug response

Cited by 28 publications

References 41 publications

The Efficacy of Acute Electroconvulsive Therapy in Atypical Depression

The Efficacy of Acute Electroconvulsive Therapy in Atypical Depression

Comparative efficacy of agomelatine versus sertraline in major depressive disorder in Himalayan region of India

Efficacy and tolerability of agomelatine in the treatment of depression

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