Nonresponse to first-line pharmacotherapy may predict relapse and recurrence of remitted geriatric depression

Flint, Alastair J.; Rifat, Sandra L.

doi:10.1002/da.1028

Cited by 7 publications

(2 citation statements)

References 29 publications

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“…Relapse after remission with ECT appears heightened in TRD (Sackeim et al, 1990(Sackeim et al, , 2001b. Similarly, some TRD patients may improve with a change in antidepressant pharmacotherapy, but rapidly lose benefit (Flint and Rifat, 2001).…”

Section: Introductionmentioning

confidence: 98%

Durability of antidepressant response to vagus nerve stimulation (VNS)

Sackeïm

Brannan²,

Rush

et al. 2007

Int. J. Neuropsychopharm.

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This study characterized the durability of improvement in patients who responded early or late while receiving vagus nerve stimulation (VNS). In both a pilot and pivotal study, patients were identified who had at least a 50% reduction in symptom scores 3 months (early responders) or 12 months (late responders) after starting VNS. Probabilities were determined for maintenance of response at 12-month and 24-month time-points. Consistency of improvement throughout the 24-month study period was evaluated, testing for change in serial depression ratings. In the pilot study, 30.5%, 23.7% and 45.8% were early responders, later responders, and non-responders, respectively. These rates were 14.6%, 19.5%, and 65.9% in the pivotal trial. The potential confound of alterations in antidepressant treatment was examined in the pivotal trial. In the pilot study, 72.2% and 61.1% of early responders (n=18) were responders at 12 and 24 months, respectively; 78.8% of late responders (n=14) were responders at 24 months. In the pivotal trial, of early responders (n=30), 63.3% and 76.7% maintained response at 12 and 24 months, respectively; of late responders (n=40), 65.0% maintained response at 24 months. Early and late responders had fewer changes in medication than non-responders across the pivotal study period. In both studies, analyses of serial depression ratings showed stable improvement in early and late responders. These samples had exceptional levels of chronicity and treatment resistance. Yet patients who showed substantial clinical benefit maintained the improvement at remarkably high rates. This durability of benefit was not attributable to alterations in other treatments.

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Section: Introductionmentioning

confidence: 98%

Durability of antidepressant response to vagus nerve stimulation (VNS)

Sackeïm

Brannan²,

Rush

et al. 2007

Int. J. Neuropsychopharm.

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“…Anxiety symptoms, medical burden, executive dysfunction, psychomotor change, and ‘treatment resistance’ during an index episode of depression have each been associated with increased risk of relapse/recurrence of major depression [44-48]. These variables are therefore included as covariates in the Cox model examining risk of relapse.…”

Section: Methodsmentioning

confidence: 99%

Sustaining remission of psychotic depression: rationale, design and methodology of STOP-PD ΙΙ

et al. 2013

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BackgroundPsychotic depression (PD) is a severe disabling disorder with considerable morbidity and mortality. Electroconvulsive therapy and pharmacotherapy are each efficacious in the treatment of PD. Expert guidelines recommend the combination of antidepressant and antipsychotic medications in the acute pharmacologic treatment of PD. However, little is known about the continuation treatment of PD. Of particular concern, it is not known whether antipsychotic medication needs to be continued once an episode of PD responds to pharmacotherapy. This issue has profound clinical importance. On the one hand, the unnecessary continuation of antipsychotic medication exposes a patient to adverse effects, such as weight gain and metabolic disturbance. On the other hand, premature discontinuation of antipsychotic medication has the potential risk of early relapse of a severe disorder.Methods/designThe primary goal of this multicenter randomized placebo-controlled trial is to assess the risks and benefits of continuing antipsychotic medication in persons with PD once the episode of depression has responded to treatment with an antidepressant and an antipsychotic. Secondary goals are to examine age and genetic polymorphisms as predictors or moderators of treatment variability, potentially leading to more personalized treatment of PD. Individuals aged 18-85 years with unipolar psychotic depression receive up to 12 weeks of open-label treatment with sertraline and olanzapine. Participants who achieve remission of psychosis and remission/near-remission of depressive symptoms continue with 8 weeks of open-label treatment to ensure stability of remission. Participants with stability of remission are then randomized to 36 weeks of double-blind treatment with either sertraline and olanzapine or sertraline and placebo. Relapse is the primary outcome. Metabolic changes are a secondary outcome.DiscussionThis trial will provide clinicians with much-needed evidence to guide the continuation and maintenance treatment of one of the most disabling and lethal of psychiatric disorders.Trial registration and URLNCT: NCT01427608

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Current Awareness

2001

Int J Geriat Psychiatry

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In order to keep subscribers up‐to‐date with the latest developments in their field, John Wiley & Sons are providing a current awareness service in each issue of the journal. The bibliography contains newly published material in the field of geriatric psychiatry. Each bibliography is divided into 9 sections: 1 Books, Reviews & Symposia; 2 General; 3 Assessment; 4 Epidemiology; 5 Therapy; 6 Care; 7 Dementia; 8 Depression; 9 Psychology. Within each section, articles are listed in alphabetical order with respect to author. If, in the preceding period, no publications are located relevant to any one of these headings, that section will be omitted

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Nonresponse to first-line pharmacotherapy may predict relapse and recurrence of remitted geriatric depression

Cited by 7 publications

References 29 publications

Durability of antidepressant response to vagus nerve stimulation (VNS)

Durability of antidepressant response to vagus nerve stimulation (VNS)

Sustaining remission of psychotic depression: rationale, design and methodology of STOP-PD ΙΙ

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