Augmentation therapies for treatment-resistant depression: a systematic review and meta-analysis

Strawbridge, Rebecca; Carter, Ben; Marwood, Lindsey; Bandelow, Borwin; Tsapekos, Dimosthenis; Nikolova, Viktoriya L; Taylor, Rachael; Mantingh, Tim; Angel, Valeria De; Patrick, Fiona; Cleare, Anthony J.; Young, Allan H.

doi:10.1016/j.jad.2018.10.344

Cited by 21 publications

(29 citation statements)

References 40 publications

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“…TRT has been suggested to have some role as an augmentation treatment for resistant depression. The evidence, however, remains inconclusive (NICE, 2009;Nierenberg et al, 2006;Rush et al, 2009;Strawbridge et al, 2019;Zhou et al, 2015). Ultimately, we do not know when TRT should be used in patients with subclinical hypothyroidism.…”

Section: Subclinical Hypothyroidism and Mental Healthmentioning

confidence: 99%

Lithium-associated hypothyroidism and potential for reversibility after lithium discontinuation: Findings from the LiSIE retrospective cohort study

et al. 2019

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Background: The association between lithium and thyroid dysfunction has long been known. However, it remains unknown if lithium-associated hypothyroidism is reversible once lithium treatment has been stopped. Aims: To determine whether lithium-associated hypothyroidism was reversible in patients who subsequently discontinued lithium. Methods: A retrospective cohort study in the Swedish region of Norrbotten into the effects and side- effects of lithium treatment and other drugs for relapse prevention (Lithium – Study into Effects and Side Effects). For this particular study, we reviewed medical records between 1997 and 2015 of patients with lithium-associated hypothyroidism who had discontinued lithium. Results: Of 1340 patients screened, 90 were included. Of these, 27% had overt hypothyroidism at the start of thyroid replacement therapy. The mean delay from starting lithium to starting thyroid replacement therapy was 2.3 years (SD 4.7). In total, 50% of patients received thyroid replacement therapy within 10 months of starting lithium. Of 85 patients available for follow-up, 41% stopped thyroid replacement therapy after lithium discontinuation. Only six patients reinstated thyroid replacement therapy subsequently. Of these, only one had overt hypothyroidism. Conclusions: Lithium-associated hypothyroidism seems reversible in most patients once lithium has been discontinued. In such cases, thyroid replacement therapy discontinuation could be attempted much more often than currently done. Based on the limited evidence of our study, we can expect hypothyroidism to recur early after thyroid replacement therapy discontinuation, if at all.

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Section: Subclinical Hypothyroidism and Mental Healthmentioning

confidence: 99%

Lithium-associated hypothyroidism and potential for reversibility after lithium discontinuation: Findings from the LiSIE retrospective cohort study

et al. 2019

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“…26 Although the effect size for these medications is small to moderate, it is comparable with the effect size observed with traditional antidepressant medications. 27,28 During the past decade, many cross-sectional observational studies have investigated peripheral inflammatory biomarkers in MDD. A meta-analysis of 82 such studies comprising over 3000 patients reported that levels of interleukin (IL)-6, IL-10, Il-12, IL-13, IL-18, the soluble IL-2 receptor (sIL-2R), tumour necrosis factoralpha (TNF-α), the soluble TNF receptor 2 (sTNFR2), and chemokine ligand 2 (CCL-2) are significantly elevated in individuals with MDD compared with healthy controls.…”

Section: Resultsmentioning

confidence: 99%

Inflammation as a treatment target in mood disorders: review

et al. 2020

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Background Mood disorders, i.e. major depressive disorder (MDD) and bipolar disorders, are leading sources of disability worldwide. Currently available treatments do not yield remission in approximately a third of patients with a mood disorder. This is in part because these treatments do not target a specific core pathology underlying these heterogeneous disorders. In recent years, abnormal inflammatory processes have been identified as putative pathophysiological mechanisms and treatment targets in mood disorders, particularly among individuals with treatment-resistant conditions. Aims In this selective review, we aimed to summarise recent advances in the field of immunopsychiatry, including emerging pathophysiological models and findings from treatment ttrials of immunomodulatory agents for both MDD and bipolar disorders. Method We performed a literature review by searching Medline for clinical trials of immunomodulating agents as monotherapy or adjunctive treatments in MDD and bipolar disorders. Included studies are randomised controlled trials (RCTs), cluster RCTs or cross-over trials of immunomodulating agents that had an active comparator or a placebo-arm. Results Current evidence shows an association between inflammation and mood symptoms. However, there is conflicting evidence on whether this link is causal. Conclusions Future studies should focus on identifying specific neurobiological underpinnings for the putative causal association between an activated inflammatory response and mood disorders. Results of these studies are needed before further treatment trials of immunomodulatory agents can be justified.

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“…), antipsychotics (quetiapine, aripiprazole, amisulpride), ketamine, pindolol, and other drugs. [8][9][10][11] However, the search for further options is welcome, as current augmentation strategies are still ineffective in many cases.…”

Section: Introductionmentioning

confidence: 99%

Adjunctive vortioxetine for SSRI-resistant major depressive disorder: a “real-world” chart review study

Berardis¹,

Fornaro

Anastasia

et al. 2020

Braz. J. Psychiatry

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Objective: Selective serotonin reuptake inhibitors (SSRIs) are the cornerstone of treatment of major depressive disorder (MDD). However, non-response is common, often necessitating combination strategies. The present study assessed the efficacy of vortioxetine as an add-on therapy in patients with SSRI-resistant MDD. Methods: The charts of 36 adult outpatients with DSM-IV-TR MDD who had not achieved a response after at least 8 weeks of treatment with an SSRI were reviewed retrospectively. Subjects were treated with vortioxetine (5-20 mg/day) for 8 weeks added to the current SSRI. The main outcome measures were change from baseline in total Hamilton Scale for Depression (HAM-D) score and the rate of response (a 50% or greater reduction in HAM-D score and a Clinical Global Impression-Improvement module [CGI-I] score of 1 or 2 at endpoint). HAM-D scores p 7 were considered as remission. Additional outcome measures included the Snaith-Hamilton Pleasure Scale (SHAPS) and the Scale for Suicide Ideation (SSI). Results: 32 patients completed the 8 weeks of treatment. At 8 weeks, a significant reduction in HAM-D score was observed (p p 0.001), with response obtained by 41.7% and remission by 33.3% of patients. Significant reductions in SHAPS and SSI were also observed (p p 0.001 for both scales). Conclusions: Adjunctive vortioxetine may be useful and well-tolerated in stage I treatment-resistant depression. However, the limitations of this study (such as small sample size, absence of randomization and control group, retrospective design, etc.) must be considered.

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Augmentation therapies for treatment-resistant depression: a systematic review and meta-analysis

Cited by 21 publications

References 40 publications

Lithium-associated hypothyroidism and potential for reversibility after lithium discontinuation: Findings from the LiSIE retrospective cohort study

Lithium-associated hypothyroidism and potential for reversibility after lithium discontinuation: Findings from the LiSIE retrospective cohort study

Inflammation as a treatment target in mood disorders: review

Adjunctive vortioxetine for SSRI-resistant major depressive disorder: a “real-world” chart review study

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