P.2.f.008 SSRI dose escalation versus duloxetine in treatment of major depressive disorder not responding to initial SSRI

Petrescu, B.M.; Vasile, D.; Vasiliu, O.; Tudor, C.; Mangalagiu, A.G.; Ungureanu, Didona

doi:10.1016/s0924-977x(14)70729-1

Cited by 9 publications

(5 citation statements)

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“…Case management conducted by a multi-disciplinary team is advisable, with the participation of obstetricians, mental health specialists, internists, and dietitians ( Tuncer et al, 2020 ). Psychotherapy is considered the main intervention for pregnant women with associated EDs and mood disorders, as the pharmacological agents could have teratogenic effects or insufficient data to support their safety in this population ( Petrescu et al, 2014 ; Vasiliu, 2019 ). Extrapolating data available in the case of other EDs, cognitive-behavioral therapy (CBT) seems to be the most supported by evidence intervention ( Linardon, 2018 ).…”

Section: Resultsmentioning

confidence: 99%

The complex interplay between psychosocial and biological factors in pregorexia nervosa — a rapid review

Vasiliu¹

2023

Front. Psychol.

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The importance of detecting eating disorders (EDs) during pregnancy cannot be overemphasized, because of the major negative effects this pathology has on both maternal and fetal health. Based on a rapid review including primary and secondary reports, PN may still be considered an elusive diagnosis entity, that partially overlaps with other EDs, either well-defined, like anorexia nervosa, or still in search of their own diagnosis criteria, like orthorexia nervosa. Neurochemical and hormonal factors, psychological and social mechanisms, along with lifestyle changes create a very complex framework for clinicians interested in defining the typical features of pregorexia nervosa (PN). The personal history of EDs is considered one of the most important risk factors for PN. The core diagnostic criteria for this entity are, so far, lack of gaining weight during pregnancy, an excessive focus on counting calories and/or intense physical exercising with a secondary decrease of interest in the fetus’s health, lack of acceptance of the change in body shape during pregnancy, and pathological attention for own body image. Regarding the treatment of PN, nutritional and psychosocial interventions are recommended but no specific therapeutic strategies for this disorder have been detected in the literature. Psychotherapy is considered the main intervention for pregnant women with associated EDs and mood disorders, as the pharmacological agents could have teratogenic effects or insufficient data to support their safety in this population. In conclusion, taking into consideration the methodological limitations of a rapid review, data supporting the existence of PN were found, mainly regarding tentative diagnostic criteria, risk factors, and pathophysiological aspects. These data, corroborated with the importance of preserving optimal mental health in a vulnerable population, e.g., pregnant women, justify the need for further research focused on finding specific diagnostic criteria and targeted therapeutic approaches.

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Section: Resultsmentioning

confidence: 99%

The complex interplay between psychosocial and biological factors in pregorexia nervosa — a rapid review

Vasiliu¹

2023

Front. Psychol.

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“…Therefore, whether defined as a variant of BDD or part of the OCD spectrum, a trial with selective serotonin reuptake inhibitors (SSRIs) seems to be granted. SSRIs have been associated with good results in both OCDs and some cases of FEDs, although negative studies on patients with anorexia nervosa exist [ 6 , 47 , 48 , 49 , 50 , 51 ]. Both CBT and SSRIs are recommended as first-line approaches for BDD [ 52 ].…”

Section: Discussionmentioning

confidence: 99%

At the Crossroads between Eating Disorders and Body Dysmorphic Disorders—The Case of Bigorexia Nervosa

Vasiliu

2023

Brain Sciences

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Bigorexia nervosa (BN) is a controversial nosological entity, considered either a feeding/eating disorder (FED) or a subtype of body dysmorphic disorder (BDD). This rapid review aims to explore the characteristic features of BN and identify evidence-based therapeutic interventions for this condition. Three electronic databases (PubMed, Cochrane, and Google Scholar) were searched for relevant information about BN, and 26 reports were reviewed in detail. The results showed that bodybuilders, weightlifters, and other populations involved in athletic activities are the most vulnerable to the onset of this disorder. Patients with BN should also be screened for physical and psychiatric comorbidities and complications, such as anabolic steroid use disorder, physical exercise addiction, and depressive or anxiety disorders. The main differential diagnoses for BN are schizophrenia spectrum disorders, depressive disorders, anxiety disorders, bodily distress disorder, and obsessive–compulsive disorders. Using validated screening instruments is considered very important from a clinical perspective, with the aim of providing early identification of this disorder. Therapeutic interventions for patients with BN are still in the early phases of development, and no specific pharmacological treatment has yet been identified. Since it is similar to the obsessive–compulsive spectrum, cognitive behavioral therapy has been suggested as a useful intervention; however, it has not yet been validated in large-scale clinical trials. In conclusion, based on the reviewed data, clarifying the concept of BN is of practical importance for constructing adequate prevention strategies and validating proper therapeutic interventions.

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“…In 3 of the 8 studies selected, [1][2][3] they find fault with the definition or rate of nonresponse. Of note, 2 of those studies 1,2 are not part of our prespecified primary analysis, which we labeled "strict analysis, " as opposed to our post hoc "broad analysis" (both meta-analyses unequivocally found no advantage of switching the antidepressant in comparison to continuation of the so far insufficient antidepressant).…”

Section: Drs Bschor and Baethge Replymentioning

confidence: 99%

The Gap Between the Randomized Controlled Trial–Based Evidence and Real-World Practice in Switching Strategies of Major Depressive Disorder

Chen

Mei²

2017

J. Clin. Psychiatry

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To the Editor: Switching to an antidepressant in a different pharmacologic class, which is often employed in clinical practice for major depressive disorder (MDD) patients who have not responded sufficiently to an initial antidepressant, usually yields better clinical outcome. However, some randomized controlled trials (RCTs) and RCT-based meta-analyses designed to test the efficacy of switching therapies suggest that switching to another antidepressant may not be superior to continuing the initial antidepressant. 1 Three reasons account for the gap between the conclusions of traditional clinical trials and our clinical experience in the real-world setting.The first-and main-reason for this gap is the use of inappropriate inclusion criteria for nonresponders to initial antidepressant treatment. In a study by Bose et al, 2 depressive patients who did not respond (< 50% Montgomery-Asberg Depression Rating Scale improvement) to 2 weeks of 10 mg/d of escitalopram were randomly assigned to further treatment in a protocol evaluating the efficacy of 20 mg/d escitalopram versus switching to 60 mg/d duloxetine. In clinical practice, it is difficult to reduce MDD symptoms by 50% in 2 weeks with a moderate dose of antidepressant. Patients meeting such criteria for nonresponse are therefore not true nonresponders and could achieve significant improvement in either the antidepressant continuation group or the switching group. Similarly, in Souery and colleagues' study, 3 achieving 50% total score reduction on the Hamilton Depression Rating Scale after 4-week treatment would have been difficult. Additionally, one study 4 did not clearly define the concept of nonresponse, only indicating that some of the patients previously treated with a selective serotonin reuptake inhibitor (SSRI) were switched to duloxetine. Inaccurate definition of nonresponse has therefore impaired the superiority of switching strategies, and a considerable proportion of patients could see clinical benefit if the dose were escalated or therapy time were extended longer until the onset of antidepressant action occurred. The most recent metaanalysis 5 of the antidepressant dose-response relationship has also shown that SSRIs are more efficient at higher doses, so it makes sense that patients experience continuous improvement after dose escalation in broad analysis, which may weaken the clinical benefit of switching strategies.Second, doses of switching antidepressants should be comparable and flexible during the study. One trial compared the efficacy of continuation of venlafaxine 75-375 mg/d with that of switching to fluoxetine 25/50 mg/d. 6 According to Hayasaka and coworkers' findings, 7 fluoxetine 40 mg/d is equivalent to venlafaxine 149.4 mg/d. So, it is no surprise that venlafaxine at a higher dose is more effective than fluoxetine.Third, randomization and blinding were used in most studies cited by this meta-analysis, so we should pay attention to analogous "placebo effects" in such antidepressant switching studies. When nonresponders who had little...

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P.2.f.008 SSRI dose escalation versus duloxetine in treatment of major depressive disorder not responding to initial SSRI

Cited by 9 publications

References 0 publications

The complex interplay between psychosocial and biological factors in pregorexia nervosa — a rapid review

The complex interplay between psychosocial and biological factors in pregorexia nervosa — a rapid review

At the Crossroads between Eating Disorders and Body Dysmorphic Disorders—The Case of Bigorexia Nervosa

The Gap Between the Randomized Controlled Trial–Based Evidence and Real-World Practice in Switching Strategies of Major Depressive Disorder

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