Pharmacological Treatment of Major Depressive Episodes with Mixed Features: A Systematic Review

Shim, In Hee; Bahk, Won‐Myong; Woo, Young Sup; Yoon, Bo-Hyun

doi:10.9758/cpn.2018.16.4.376

Cited by 20 publications

(11 citation statements)

References 30 publications

(33 reference statements)

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“…Furthermore, a double-blind placebo control study revealed that lurasidone improved depressive symptoms without affecting manic symptoms in mixed-feature variants ( 83 ). Several studies have compared mood-stabilizing atypical antipsychotics (including olanzapine, lurasidone, brexpiprazole, ziprasidone, and cariprazine) with placebo, assessing the efficacy in the acute phase of presumptive mixed-feature variants ( 40 , 84 , 85 ). The available studies support the expected benefits of mixed-feature variants, whereas the overall effect may be similar in these mood-stabilizing atypical antipsychotics ( 40 , 84 , 85 ).…”

Section: Clinical Evaluation Of Lurasidone and Preclinical Potentialsmentioning

confidence: 99%

“…Several studies have compared mood-stabilizing atypical antipsychotics (including olanzapine, lurasidone, brexpiprazole, ziprasidone, and cariprazine) with placebo, assessing the efficacy in the acute phase of presumptive mixed-feature variants ( 40 , 84 , 85 ). The available studies support the expected benefits of mixed-feature variants, whereas the overall effect may be similar in these mood-stabilizing atypical antipsychotics ( 40 , 84 , 85 ). To explore the efficacy of 5-HT7R antagonism against mixed-feature variants, the detailed clinical effects of conventional mood-stabilizing atypical antipsychotics and antidepressants on mixed-features variants need to be clinically investigated.…”

Section: Clinical Evaluation Of Lurasidone and Preclinical Potentialsmentioning

confidence: 99%

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Current Limitations and Candidate Potential of 5-HT7 Receptor Antagonism in Psychiatric Pharmacotherapy

et al. 2021

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Several mood-stabilizing atypical antipsychotics and antidepressants weakly block serotonin (5-HT) receptor type-7 (5-HT7R); however, the contributions of 5-HT7R antagonism to clinical efficacy and pathophysiology are yet to be clarified. A novel mood-stabilizing antipsychotic agent, lurasidone exhibits predominant binding affinity to 5-HT7R when compared with other monoamine receptors. To date, we have failed to discover the superior clinical efficacy of lurasidone on schizophrenia, mood, or anxiety disorders when compared with conventional mood-stabilizing atypical antipsychotics; however, numerous preclinical findings have indicated the possible potential of 5-HT7R antagonism against several neuropsychiatric disorders, as well as the generation of novel therapeutic options that could not be expected with conventional atypical antipsychotics. Traditional experimental techniques, electrophysiology, and microdialysis have demonstrated that the effects of 5-HT receptor type-1A (5-HT1AR) and 5-HT7R on neurotransmission are in contrast, but the effect of 5-HT1AR is more predominant than that of 5-HT7R, resulting in an insufficient understanding of the 5-HT7R function in the field of psychopharmacology. Accumulating knowledge regarding the pharmacodynamic profiles of 5-HT7R suggests that 5-HT7R is one of the key players in the establishment and remodeling of neural development and cytoarchitecture during the early developmental stage to the mature brain, and dysfunction or modulation of 5-HT7R is linked to the pathogenesis/pathophysiology of neuropsychiatric and neurodevelopmental disorders. In this review, to explore candidate novel applications for the treatment of several neuropsychiatric disorders, including mood disorders, schizophrenia, and other cognitive disturbance disorders, we discuss perspectives of psychopharmacology regarding the effects of 5-HT7R antagonism on transmission and intracellular signaling systems, based on preclinical findings.

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Section: Clinical Evaluation Of Lurasidone and Preclinical Potentialsmentioning

confidence: 99%

Section: Clinical Evaluation Of Lurasidone and Preclinical Potentialsmentioning

confidence: 99%

Current Limitations and Candidate Potential of 5-HT7 Receptor Antagonism in Psychiatric Pharmacotherapy

et al. 2021

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“…Affrontive symptoms of hypo/mania are correlated with both cognitive and somatic symptoms of depression (O’Rourke et al., 2021 ). This allows us to measure mixed depression and hypo/mania symptoms, common to most BD mood episodes (Shim et al., 2018 ). Developing measures specifically for EMA is ideal; most researchers instead cherry‐pick items from existing measures with limited pilot testing (i.e., psychometric properties untested; Trull & Ebner‐Priemer, 2020 ).…”

Section: Methodsmentioning

confidence: 99%

Ecological momentary assessment of mood and movement with bipolar disorder over time: Participant recruitment and efficacy of study methods

O’Rourke

Sixsmith

2021

Int J Methods Psych Res

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Objectives: Mobile technology and ambulatory research tools enable the study of human experience in vivo, when and where it occurs. This includes cognitive processes that cannot be directly measured or observed (e.g., emotion) but can be reported in the moment when prompted.Methods: For the Bipolar Affective Disorder and older Adults (BADAS) Study, 50 participants were randomly prompted twice daily to complete brief smartphone questionnaires. This included the Bipolar Disorder Symptom Scale which was developed to briefly measure symptoms of both depression (cognitive and somatic) and hypo/mania (affrontive symptoms and elation/loss of insight). Participants could also submit voluntary or unsolicited app responses anytime; all were time-and GPSstamped. Herein, we describe BADAS study methods that enabled effective recruitment, adherence and retention. Results:We collected 9600 app responses over 2 year, for an average response rate of 1.4�/day. Over an average of 145 consecutive days (range 2-435 days), BADAS participants reported depression and hypo/mania symptom levels (a.m. and p.m.), sleep quality (a.m.), medication adherence (a.m.) and any significant events of the day (p.m.). They received $1/day for the first 90 days after submitting both a.m. and p.m. questionnaires. Conclusion:BADAS study methods demonstrates the utility of ecological momentary assessment in longitudinal psychiatric research.

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“…Several recent papers, not reviewed here summarize the limited data on treatment of "unipolar " depression with mixed features (33,(74)(75)(76)(77) which may or may not proceed to bipolar disorder or in part have its own signature. As can be seen by the recency of papers quoted, up to date knowledge of the evolving literature is important as guidelines are already outdated.…”

Section: Specific Treatments For Depression With Family History Of Bimentioning

confidence: 99%

Depression Preceding Diagnosis of Bipolar Disorder

O′Donovan

Alda

2020

Front. Psychiatry

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This paper focuses on depression that precedes an onset of manifest bipolar disorder as early stage bipolar disorder. First, we review how to pragmatically identify the clinical characteristics of patients presenting with an episode of depression who subsequently go on to develop episodes of mania or hypomania. The existing literature shows a strong consensus: accurate identification of depression with early onset and recurrent course with multiple episodes, subthreshold hypomanic and/or mixed symptoms, and family history of bipolar disorder or completed suicide have been shown by multiple authors as signs pointing to bipolar diagnosis. This contrasts with relatively limited information available to guide management of such "pre-bipolar" (pre-declared bipolar) patients, especially those in the adult age range. Default assumption of unipolar depression at this stage carries significant risk. Antidepressants are still the most common pharmacological treatment used, but clinicians need to be aware of their potential harm. In some patients with unrecognized bipolar depression, antidepressants can not only produce switch to (hypo)mania, but also mixed symptoms, or worsening of depression with an increased risk of suicide. We review pragmatic management strategies in the literature beyond clinical guidelines that can be considered for this at-risk group encompassing the more recent child and adolescent literature. In the future, genetic research could make the early identification of bipolar depression easier by generating informative markers and polygenic risk scores.

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Pharmacological Treatment of Major Depressive Episodes with Mixed Features: A Systematic Review

Cited by 20 publications

References 30 publications

Current Limitations and Candidate Potential of 5-HT7 Receptor Antagonism in Psychiatric Pharmacotherapy

Current Limitations and Candidate Potential of 5-HT7 Receptor Antagonism in Psychiatric Pharmacotherapy

Ecological momentary assessment of mood and movement with bipolar disorder over time: Participant recruitment and efficacy of study methods

Depression Preceding Diagnosis of Bipolar Disorder

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