Is prior course of illness relevant to acute or longer-term outcomes in depressed out-patients? A STAR*D report

Rush, A. John; Wisniewski, Stephen R.; Zisook, Sidney; Fava, Maurizio; Sung, So-Young; Haley, Charlotte; Chan, Herng Nieng; Gilmer, William S.; Warden, Diane; Nierenberg, Andrew A.; Balasubramani, Goundappa K.; Gaynes, Bradley N.; Trivedi, Madhukar H.; Hollon, Steven D.

doi:10.1017/s0033291711002170

Cited by 52 publications

(43 citation statements)

References 49 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…19 Baseline characteristics associated with lower remission rates in STAR*D included high baseline depression severity and chronicity of illness, 19 with the lowest rates and slower onset of remission seen in patients with chronic index depression episodes. Among remitted patients, both chronicity and recurrence were associated with higher risk of relapse in STAR*D. 20 Of note, patients in the current study had similar baseline characteristics to those associated with the low remission rates seen in STAR*D, including high mean baseline depression severity, chronicity of illness, and recurrent depression (eg, in the current study, mean MADRS baseline score was 36, mean duration of symptoms was 11 years, and 76% of patients had recurrent depression).…”

Section: Discussionmentioning

confidence: 94%

Efficacy and Safety of Levomilnacipran Sustained Release 40 mg, 80 mg, or 120 mg in Major Depressive Disorder

Asnis¹,

Bose²,

Gommoll³

et al. 2013

J. Clin. Psychiatry

125

View full text Add to dashboard Cite

Objective: This phase 3, randomized, double-blind, placebo-controlled study evaluated the efficacy and tolerability of fixed-dose levomilnacipran sustained release (SR) compared with placebo in patients with major depressive disorder (MDD); the study was conducted from September 2009-May 2011.Method: Outpatients met DSM-IV-TR criteria for MDD with an ongoing major depressive episode ≥ 8 weeks' duration. After a 1-week placebo lead-in, patients were randomly assigned to receive placebo (n = 179) or levomilnacipran SR 40 mg (n = 181), 80 mg (n = 181), or 120 mg (n = 183) once daily for 8 weeks of double-blind treatment, followed by a 2-week double-blind down-taper. The primary efficacy parameter was change from baseline on the clinician-rated Montgomery-Asberg Depression Rating Scale (MADRS) total score. The prespecified secondary efficacy parameter was change from baseline in Sheehan Disability Scale (SDS) total score. Additional efficacy measures included the 17-item Hamilton Depression Rating Scale (HDRS 17 ) and Clinical Global Impressions-Severity of Illness (CGI-S) and -Improvement (CGI-I). Safety and tolerability were also evaluated. Results:The least squares mean difference (LSMD) for change from baseline in MADRS total score was significantly superior to placebo for all dose groups: −3.23 (P = .0186), −3.99 (P = .0038), and −4.86 (P = .0005) for levomilnacipran SR 40, 80, and 120 mg, respectively. The LSMD was significantly different for levomilnacipran SR 80 mg and 120 mg versus placebo on the SDS (−2.51 and −2.57, respectively, P < .05 for both doses), HDRS 17 (−2.09 and −2.34, respectively, P < .05 for both doses), CGI-S (−0.43 [P < .01] and −0.35 [P < .05], respectively), and CGI-I (−0.34 and −0.32, respectively, P < .05 for both doses) assessments. The most common treatmentemergent adverse events (≥ 10% of any treatment group) were headache, nausea, constipation, dry mouth, increased heart rate, and hyperhidrosis.Conclusions: Levomilnacipran SR demonstrated significant improvement in depressive symptoms and functioning relative to placebo. In this study, levomilnacipran SR was generally well tolerated. September 28, 2012; accepted January 28, 2013 (doi:10.4088/JCP.12m08197 T he complex nature of major depressive disorder (MDD) suggests that recovery may be most appropriately judged by multiple factors. Even when patients achieve symptom improvement, impaired social and occupational functioning may persist and interfere with well-being. As such, it has been suggested that return to wellness in patients with MDD may be better defined by evaluating a combination of symptoms, functional status, and pathophysiologic changes. Submitted:1 The development of effective and safe new medications that address all aspects of MDD treatment is essential.Levomilnacipran (1S, 2R-milnacipran) is a potent and selective serotonin-norepinephrine reuptake inhibitor (SNRI) in late-stage clinical development for treatment of MDD in adults. A sustained release (SR) formulation of levomilnacipran was developed to al...

show abstract

Section: Discussionmentioning

confidence: 94%

Efficacy and Safety of Levomilnacipran Sustained Release 40 mg, 80 mg, or 120 mg in Major Depressive Disorder

Asnis¹,

Bose²,

Gommoll³

et al. 2013

J. Clin. Psychiatry

125

View full text Add to dashboard Cite

show abstract

“…Si bien nuestro estudio es corto en seguimiento para recurrencia y cronicidad, la tendencia de la remisión más lo publicado por otros autores reafirman la cronicidad y menor respuesta terapéutica en un grupo de pacientes 19,21,34,46 .…”

Section: Discussionunclassified

Características clínicas del trastorno depresivo mayor en tratamiento en el nivel secundario de atención

Salvo

Saldivia

Parra³

et al. 2017

Rev. méd. Chile

View full text Add to dashboard Cite

show abstract

“…The STAR*D trial did not include AAPs as an option for next treatment steps. However, although the investigators did not intend to include chronic or recurrent MDD, almost 85 % of subjects had such conditions [4,27]. According to a recent subanalysis of the STAR*D trial, remission rates were lowest and slowest for those with chronic index episodes [27].…”

Section: How Long Do You Continue Augmentation Drugs? (Dr Han)mentioning

confidence: 99%

“…However, although the investigators did not intend to include chronic or recurrent MDD, almost 85 % of subjects had such conditions [4,27]. According to a recent subanalysis of the STAR*D trial, remission rates were lowest and slowest for those with chronic index episodes [27]. Relapse was most likely for the chronic and recurrent group, whereas it was least likely for the nonchronic, nonrecurrent group [27].…”

Section: How Long Do You Continue Augmentation Drugs? (Dr Han)mentioning

confidence: 99%

“…According to a recent subanalysis of the STAR*D trial, remission rates were lowest and slowest for those with chronic index episodes [27]. Relapse was most likely for the chronic and recurrent group, whereas it was least likely for the nonchronic, nonrecurrent group [27]. A recent study of combined treatment of aripiprazole and venlafaxine at the beginning of treatment (12 weeks) found that the venlafaxine and aripiprazole combination was tolerable and efficacious in the treatment of patients with chronic or recurrent MDD, in which 70 % of the subjects experienced remission at any time during the study [28].…”

Section: How Long Do You Continue Augmentation Drugs? (Dr Han)mentioning

confidence: 99%

See 1 more Smart Citation

Management of Chronic Depressive Patients with Residual Symptoms

et al. 2013

View full text Add to dashboard Cite

Various clinical issues are involved in the appropriate diagnosis and proper treatment interventions for patients with major depressive disorder (MDD). Despite a number of diverse antidepressants for treating MDD now, response and remission rates following adequate trials of antidepressant intervention are still not satisfactory. Furthermore, a significant proportion of MDD patients have residual symptoms, which are associated with increased relapse and recurrence of MDD, leading to negative impacts on the clinical course and outcomes of MDD. Timely and appropriate decision-making regarding the proper management of such cases is required in our routine daily practice. These issues are illustrated and also framed by one MDD case with a complicated clinical course. This review paper may give physicians clinical insight into how we can effectively and properly evaluate and manage such patients in clinical practice.

show abstract

Is prior course of illness relevant to acute or longer-term outcomes in depressed out-patients? A STAR*D report

Abstract: Recurrent MDD is the norm for out-patients, of whom 15% also have a chronic index episode. Chronic and recurrent course of MDD may be useful in predicting acute and long-term MDD treatment outcomes.

Cited by 52 publications

References 49 publications

Efficacy and Safety of Levomilnacipran Sustained Release 40 mg, 80 mg, or 120 mg in Major Depressive Disorder

Efficacy and Safety of Levomilnacipran Sustained Release 40 mg, 80 mg, or 120 mg in Major Depressive Disorder

Características clínicas del trastorno depresivo mayor en tratamiento en el nivel secundario de atención

Management of Chronic Depressive Patients with Residual Symptoms

Contact Info

Product

Resources

About