Clinical characteristics and treatment outcomes of patients with major depressive disorder and comorbid anxiety disorders - results from a European multicenter study

Dold, Markus; Bartova, Lucie; Souery, Daniel; Mendlewicz, Julien; Serretti, Alessandro; Porcelli, Stefano; Zohar, Joseph; Montgomery, Stuart; Kasper, Siegfried

doi:10.1016/j.jpsychires.2017.02.020

Cited by 83 publications

(41 citation statements)

References 27 publications

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“…Cluster 1 membership among MDD cases, including the core depressive symptoms, psychomotor retardation, suicidal behavior (ideation or attempt), and somatic-anxiety (namely, gastrointestinal, indigestion, cardiovascular, palpitations, headaches, respiratory, and genitourinary symptoms), predicted TRD in half of such cases (14.1% of 28.2% of cluster 1 MDD patients). This is in line with previous evidence which, albeit failing to discriminate across different clinical subtypes of depression, highlighted the role of suicidal behavior-even those of mild to moderate intensity (27)-anxiety (25), and severity of the current MDE in the prediction of the treatment outcome (26,28), as well as the impact of psychotic features of depression in the prediction of subsequent TRD (45). This is also in line with previous evidence involving patients diagnosed using the codes provided by the Fourth Edition of the Manual (DSM-IV) (46), yet failing to adopt a data-generated clustering of psychopathology (47).…”

Section: Discussionsupporting

confidence: 92%

Predictors of Treatment Resistance Across Different Clinical Subtypes of Depression: Comparison of Unipolar vs. Bipolar Cases

et al. 2020

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Treatment-resistant depression (TRD) and treatment-resistant bipolar depression (TRBD) poses a significant clinical and societal burden, relying on different operational definitions and treatment approaches. The detection of clinical predictors of resistance is elusive, soliciting clinical subtyping of the depressive episodes, which represents the goal of the present study. Methods: A hundred and thirty-one depressed outpatients underwent psychopathological evaluation using major rating tools, including the Hamilton Rating Scale for Depression, which served for subsequent principal component analysis, followed-up by cluster analysis, with the ultimate goal to fetch different clinical subtypes of depression. Results: The cluster analysis identified two clinically interpretable, yet distinctive, groups among 53 bipolar (resistant cases = 15, or 28.3%) and 78 unipolar (resistant cases = 20, or 25.6%) patients. Among the MDD patients, cluster "1" included the following components: "Psychic symptoms, depressed mood, suicide, guilty, insomnia" and "genitourinary, gastrointestinal, weight loss, insight". Altogether, with broadly defined "mixed features," this latter cluster correctly predicted treatment outcome in 80.8% cases of MDD. The same "broadly-defined" mixed features of depression (namely, the standard Diagnostic and Statistical Manual for Mental Disorders, Fifth Edition-DSM-5-specifier plus increased energy, psychomotor activity, irritability) correctly classified 71.7% of BD cases, either as TRBD or not. Limitations: Small sample size and high rate of comorbidity. Conclusions: Although relying on different operational criteria and treatment history, TRD and TRBD seem to be consistently predicted by broadly defined mixed features among different clinical subtypes of depression, either unipolar or bipolar cases. If replicated by upcoming studies to encompass also biological and neuropsychological measures, the present study may aid in precision medicine and informed pharmacotherapy.

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Section: Discussionsupporting

confidence: 92%

Predictors of Treatment Resistance Across Different Clinical Subtypes of Depression: Comparison of Unipolar vs. Bipolar Cases

et al. 2020

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“…It extends the findings of other studies, suggesting that anxiety symptoms may not be playing a significant role in late‐life depression treatment response. Both a European naturalistic study (Dold et al, ) and a smaller study (Lenze et al, ) showed no significant difference in treatment response between older depressed patients with or without anxiety. Further, in a meta‐analysis of eight placebo‐controlled trials (Nelson et al, ) the OR of treatment response of antidepressant versus placebo was similar in older depressed adults with or without anxiety.…”

Section: Discussionmentioning

confidence: 95%

Comorbid anxiety in late‐life depression: Relationship with remission and suicidal ideation on venlafaxine treatment

et al. 2019

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Objective: The purpose of this study was to examine the influence of comorbid anxiety symptoms on antidepressant treatment remission in older adults with major depressive disorder (MDD). Method: In this multisite clinical trial, 468 older adults aged 60 years or older with MDD received open-label protocolized treatment with venlafaxine extended release (ER) titrated to a maximum of 300 mg daily. At baseline, anxiety was assessed with the Anxiety Sensitivity Index, the Brief Symptom Inventory (BSI) anxiety subscale, and the Penn State Worry Questionnaire. To measure treatment response, depressive symptoms and suicidality were assessed every 1-2 weeks with the Montgomery-Asberg Depression Rating Scale and the 19-item Scale for Suicide Ideation; anxiety was assessed with the BSI. Logistic regression and survival analysis were used to evaluate whether anxiety symptoms predicted depression remission.We also examined the relationships between anxiety scores and suicidality at baseline.Results: Baseline anxiety symptoms did not predict remission or time to remission of depressive symptoms. Depressive, worry, and panic symptoms decreased in parallel in patients with high anxiety. Anxiety symptoms were associated with the severity of depression and with suicidality.Conclusion: In older adults with MDD, comorbid anxiety symptoms are associated with symptom severity but do not affect antidepressant remission or time to remission. K E Y W O R D S antidepressants, anxiety/anxiety disorders, depression, geriatric/aging/elderly, suicide/self-harm Institute of Mental Health (R01 MH083660 and P30 MH90333 to University of Pittsburgh, R01 MH083648 to Washington University, and R01 MH083643 to University of Toronto).

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“…Beyond the inequalities in the prevalence of GAD, its co-occurrence with other mental disorders is not uncommon, especially with depression 48,49,50 . The co-occurrence of GAD and depression tends to be associated with greater severity of the conditions, as well as lower response or treatment dropout and additional risk of suicide 50,51 .…”

Section: Discussionmentioning

confidence: 99%

Transtornos mentais em adolescentes, jovens e adultos do Consórcio de Coortes de Nascimento brasileiras RPS (Ribeirão Preto, Pelotas e São Luís)

et al. 2020

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Resumo: Embora se reconheça que depressão e ansiedade resultem em incapacidades, bem como em prejuízos laborais e para os sistemas de saúde, pesquisas de base populacional são escassas no Brasil. Este estudo avaliou a prevalência de transtornos mentais em adolescentes, jovens e adultos e sua relação com características sociodemográficas em cinco coortes de nascimento (RPS): Ribeirão Preto (São Paulo), Pelotas (Rio Grande do Sul) e São Luís (Maranhão), Brasil. Episódio depressivo, risco de suicídio, fobia social e transtorno de ansiedade generalizada foram avaliados usando-se o Mini International Neuropsychiatric Interview. Intervalos de confiança bootstrap foram estimados e prevalências estratificadas por sexo e nível socioeconômico no programa R. Foram incluídos 12.350 participantes das coortes. Episódio depressivo maior atual foi mais prevalente em adolescentes de São Luís (15,8%; IC95%: 14,8-16,8) e nos adultos de Ribeirão Preto (12,9%; IC95%: 12,0-13,9). As maiores prevalências para risco de suicídio ocorreram nos adultos de Ribeirão Preto (13,7%; IC95%:12,7-14,7), fobia social e ansiedade generalizada nos jovens de Pelotas com 7% (IC95%: 6,3-7,7) e 16,5% (IC95%: 15,4-17,5), respectivamente. As menores prevalências de risco de suicídio ocorreram nos jovens de Pelotas (8,8%; IC95%: 8,0-9,6), fobia social nos jovens de Ribeirão Preto (1,8%; IC95%: 1,5-2,2) e ansiedade generalizada nos adolescentes de São Luís (3,5%; IC95%: 3,0-4,0). Em geral, os transtornos mentais foram mais prevalentes nas mulheres e naqueles com menor nível socioeconômico, independentemente do centro e idade, reforçando a necessidade de maior investimento em saúde mental no Brasil, sem desconsiderar determinantes de gênero e socioeconômicos.

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Clinical characteristics and treatment outcomes of patients with major depressive disorder and comorbid anxiety disorders - results from a European multicenter study

Cited by 83 publications

References 27 publications

Predictors of Treatment Resistance Across Different Clinical Subtypes of Depression: Comparison of Unipolar vs. Bipolar Cases

Predictors of Treatment Resistance Across Different Clinical Subtypes of Depression: Comparison of Unipolar vs. Bipolar Cases

Comorbid anxiety in late‐life depression: Relationship with remission and suicidal ideation on venlafaxine treatment

Transtornos mentais em adolescentes, jovens e adultos do Consórcio de Coortes de Nascimento brasileiras RPS (Ribeirão Preto, Pelotas e São Luís)

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