Citalopram dose-response revisited using an alternative psychometric approach to evaluate clinical effects of four fixed citalopram doses compared to placebo in patients with major depression

Bech, Per; Tanghøj, Per; Andersen, H.; Overø, K. Fredricson

doi:10.1007/s00213-002-1147-6

Cited by 78 publications

(54 citation statements)

References 17 publications

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“…Our findings are in line with findings of previous studies [11,20,26,[40][41][42][43][44] and extend the evidence to support the Maier and Bech subscale as a valid alternative for the HDRS. This is relevant not only for the planning and conduction of clinical trials [40][41][42], but also for clinical practice [20,26].…”

Section: Previous Comparative Studiessupporting

confidence: 93%

“…This is relevant not only for the planning and conduction of clinical trials [40][41][42], but also for clinical practice [20,26]. Hooper and Bakish [26] found equal performance of the Bech subscale compared with the Montgomery Asberg Depression Rating Scale (MADRS) [30].…”

Section: Previous Comparative Studiesmentioning

confidence: 99%

“…Hooper and Bakish [26] found equal sensitivity to change during treatment for the 6-item Bech subscale compared with the HDRS 17-item version. Moller [32] and Bech et al [42][43][44] used the Bech subscale to reexamine treatment efficacy of SSRIs and mirtazapine (vs TCAs or placebo). The latter publications did not provide data for the Maier subscale.…”

Section: Introductionmentioning

confidence: 99%

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Clinical use of the Hamilton Depression Rating Scale: is increased efficiency possible? A post hoc comparison of Hamilton Depression Rating Scale, Maier and Bech subscales, Clinical Global Impression, and Symptom Checklist-90 scores

Ruhé

Dekker

Peen³

et al. 2005

Comprehensive Psychiatry

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Background: The 17-item Hamilton Depression Rating Scale (HDRS) is used as a semi-gold standard in research. In treatment guidelines, the HDRS measurements serve to determine response and remission and guide clinical decision making for nonresponders. However, its use in clinical practice is limited, possibly because the HDRS is time consuming. In addition, the multidimensional HDRS is criticized for not measuring a unidimensional aspect as depression severity. The Maier and the Bech, two 6-item severity subscales extracted from the HDRS, are relatively unknown. This paper investigates whether the measurements obtained with these subscales are comparable with the original HDRS measurements. Methods: Data from 2 randomized controlled trials in 482 male and female patients, diagnosed with a major depression (with or without dysthymia) according to Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition, of whom 219 participated in the trials, were reanalyzed. A standardized stepwise psychopharmacological treatment was compared with a combination of pharmacotherapy with Short Psychodynamic Supportive Psychotherapy in a psychiatric outpatient department. Outcome measures were internal consistency and concurrent validity of HDRS, Maier, Bech, Clinical Global Impression scales, and Symptom Checklist depression subscale. Effect sizes of HDRS, Maier, and Bech were used to compare measured treatment effects for the randomized subjects participating in the trials. Item Response Theory was used to obtain conversion tables for the HDRS, Maier, Bech, and Symptom Checklist depression subscale. Results: We found moderate internal consistency (Cronbach a c 0.6-0.7) and high correlations of the Maier and Bech subscales with overall HDRS scores. Overall, there were no clinically relevant differences in effect sizes between Maier, Bech, and HDRS, although some differences were statistically significant. Receiver operating characteristic curves showed no difference between Maier and Bech to define remission but showed the Clinical Global Impression ratings to be unreliable. A cutoff V 4 corresponded with an HDRS V 7 criterion in both subscales. Conclusion: In clinical practice, both Maier and Bech scales can be used as equivalents of the HDRS, but will be more efficient. D

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Section: Previous Comparative Studiessupporting

confidence: 93%

Section: Previous Comparative Studiesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Clinical use of the Hamilton Depression Rating Scale: is increased efficiency possible? A post hoc comparison of Hamilton Depression Rating Scale, Maier and Bech subscales, Clinical Global Impression, and Symptom Checklist-90 scores

Ruhé

Dekker

Peen³

et al. 2005

Comprehensive Psychiatry

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“…In a previous dose-response trial with citalopram [18], the HAM-D 6 had been shown to be more sensitive than the HAM-D 17 in differentiating between placebo and the fixed doses of 10, 20, 40 and 60 mg citalopram daily over a treatment period of 6 weeks. This study in patients with major depression (age range from 18 to 65 years) identified 40 mg citalopram to be the optimal dose to achieve antidepressive effect [18].…”

Section: Methodsmentioning

confidence: 99%

Dose Response to Adjunctive Light Therapy in Citalopram-Treated Patients with Post-Stroke Depression

Søndergaard

Jarden

Martiny

et al. 2006

Psychother Psychosom

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Background:Post-stroke depression affects the outcome of stroke rehabilitation and is observed in approximately 30% of all stroke patients. We investigated whether the addition of light treatment to medical antidepressants influences the course of depression as measured by the Hamilton Depression Scale. Methods: The effect of a combination of light therapy and citalopram in stroke victims receiving citalopram was examined by use of two different doses of light therapy under double-blind conditions. Altogether, 63 patients were included in the study. The mean age was 74.9 years. Results: After 4 weeks of therapy, the 6-item subscale of the Hamilton Depression Scale showed a statistically significantly larger improvement in patients receiving high-intensity light treatment compared to those treated with medium-intensity light (p < 0.05). Conclusion: This pilot study demonstrates a dose response effect of light used as an adjunct therapy to antidepressants in post-stroke patients with major depression.

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“…When fluoxetine was used as an active comparator in placebocontrolled venlafaxine trials (Table 1) Regarding citalopram, a dose-response relationship was identified (Bech et al 2002), as 40 mg was found to be the optimal dose. In most placebo-controlled escitalopram trials the Montgomery-Å sberg Depression Rating Scale (Montgomery & Å sberg, 1979) has been used as outcome measure but in our analysis (Bech et al 2004) the HAMD 6 has also been included, and we showed that 20 mg was the optimal dose with an effect size of 0.61.…”

Section: Introductionmentioning

confidence: 99%

Is the antidepressive effect of second-generation antidepressants a myth?

Bech

2009

Psychol. Med.

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Two recent meta-analyses on second-generation antidepressants versus placebo in mild to moderate forms of major depression, based on data on all randomized clinical trials using the Hamilton Depression Scale (HAMD) submitted to FDA, have shown an effect size of y0.30 in favour of antidepressants in the acute therapy of major depression. The clinical significance of an effect size at this level was found to be so poor that these meta-analyses have subscribed to the myth of an exclusively placebo-like effect of second-generation antidepressants. A re-allocation of HAMD items focusing on those items measuring severity of clinical depression, the HAMD 6 , has identified effect sizes of o0.40 for second-generation antidepressants in placebo-controlled trials for which even a dose-response relationship can be demonstrated. In the relapse-prevention phase during continuation therapy of patients with major depression, the advantage of second-generation antidepressants over placebo was as significant as in the acute therapy phase. To explore a myth is not to deny the facts but rather to re-allocate them.

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Citalopram dose-response revisited using an alternative psychometric approach to evaluate clinical effects of four fixed citalopram doses compared to placebo in patients with major depression

Cited by 78 publications

References 17 publications

Clinical use of the Hamilton Depression Rating Scale: is increased efficiency possible? A post hoc comparison of Hamilton Depression Rating Scale, Maier and Bech subscales, Clinical Global Impression, and Symptom Checklist-90 scores

Clinical use of the Hamilton Depression Rating Scale: is increased efficiency possible? A post hoc comparison of Hamilton Depression Rating Scale, Maier and Bech subscales, Clinical Global Impression, and Symptom Checklist-90 scores

Dose Response to Adjunctive Light Therapy in Citalopram-Treated Patients with Post-Stroke Depression

Is the antidepressive effect of second-generation antidepressants a myth?

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