Improving the Care of Patients Who Have Treatment-Resistant Depression: The Promise of the PCORnet Mood Network

Nierenberg, Andrew A.; Sylvia, Louisa G.; Doederlein, Allen; Edgman‐Levitan, Susan; Muskin, Alies; Jewell, Lucinda; Walker, Muffy; Goodman, Dan; Farahbakhsh, M.; Hearing, Casey; Tovey, Roberta; Deckersbach, Thilo

doi:10.4088/jcp.14com09570

Cited by 1 publication

(1 citation statement)

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“…Notwithstanding the availability of results from efficacy studies, and more recently meta-analyses that report on and compare between-agent efficacy in MDD, there is a paucity of “real-world” effectiveness studies in MDD as augmentation to determine the most appropriate and acceptable treatment to patients and clinicians. It is hoped that results from the Patient-Centered Outcomes Research Institute (PCORI) will provide instructive insights as to the appropriate “best next steps” when an initial antidepressant is unsuccessful 101 . Instead, pharmacological treatments should be integrated with general lifestyle improvement, risk factor modification, sleep hygiene, psychoeducation, and, in some cases, manual-based psychotherapy.…”

Section: Discussionmentioning

confidence: 99%

Treating to target in major depressive disorder: response to remission to functional recovery

2015

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Treating to target in chronic diseases [e.g. Major Depressive Disorder (MDD)] fosters precision, consistency, and appropriateness of treatment selection and sequencing. Therapeutic target definitions/endpoints in MDD should satisfy patient-, provider-, and societal expectations. Functional recovery in depression and return to both physical and mental health are the overarching therapeutic objectives. Treating to target in MDD implies multidimensional symptomatic remission, with a particular emphasis on cognitive function and aspects of positive mental health. Several atypical antipsychotic agents (i.e. brexpiprazole, aripiprazole, quetiapine) are FDA-approved as augmentation agents in MDD. Vortioxetine, duloxetine, and psychostimulants have evidence of independent, direct, and robust effects on cognitive function in MDD. Vortioxetine is the only agent that demonstrates efficacy across multiple cognitive domains in MDD associated with functional recovery. Measurement-based care, health information technology/systems, and integrated care models (e.g. medical homes) provide requisite tools and health environments for optimal health outcomes in MDD. Achieving remission in MDD does not equate to health. Return to positive mental health as well as full functioning provide the impetus to pivot away from traditional provider-defined outcomes toward an inclusive perspective involving patient- and society-defined outcomes (i.e. optimization of human capital). As in other chronic diseases, treating to target (e.g. cognitive function) further increases the probability of achieving optimal health outcomes.

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Section: Discussionmentioning

confidence: 99%