Prediction of the Amitriptyline Response: Psychopathology Versus Neuroendocrinology

Personality pathology and response to somatic treatments for major depression: A critical review

“…Five studies have examined the effect of Axis I1 pathology on treatment response with tricyclic antidepressants (Frank et al, 1987;Peselow et al, 1992;Pilkonis and Frank, 1988;Sauer et al, 1986;Shea et al, 1990). Sauer and colleagues (1986) were among the first to report on the effects of Axis I1 pathology in a sample which received a homogeneous somatic treatment-in this case, the tricyclic amitriptyline.…”

“…It is significant to note that only 5 of the 14 reviewed Axis I1 studies (Davidson et al, 1985;Peselow et al, 1992;Sat0 et al, 1993;Sauer et al, 1986;Zimmerman et al, 1986) ensured that all participating subjects received the same somatic treatment, to the exclusion of all other forms of antidepressant therapy. As noted previously, the use of multiple somatic treatment modalities within the same study, especially when there is no random assignment of subjects to different treatment groups, raises the possibility that bias has been introduced into a study as a result of differential assignment of PD subjects to various treatment conditions (e.g., suicidal borderline subjects might be less likely to receive fluoxetine).…”

“…One study (Reich, 1990) has relied on data obtained from self-report questionnaires, which seem to be more subject to recall biases associated with depressive mood states (Zimmerman et al, 1991), and therefore less well suited for use in depression research. Additionally, six studies have relied on some form of chart review for the assessment of personality disorders (Black et al, 1988;Charney et al, 1981;Davidson et al, 1985;MacEwan and Remick, 1988;Sauer et al, 1986;Shea et al, 1990).' The chart review method is poorly suited to obtaining a comprehensive picture of personality pathology, inasmuch as chart notes are typically somewhat sketchy, and unlikely to contain precise information necessary for an accurate evaluation of every criterion enumerated under each of the 11 DSM-111-R AXIS I1 personality disorders.…”

Fast versus slow onset of depressive episodes: A clinical criterion for subtyping patients with major depression

“…Surprisingly, systematic studies of this clinical aspect are largely absent. An important exception is the study by Sauer et al [12] who tested the value of clinical and neuroendocrinological variables for the prediction of the amitriptyline response in patients suffering from DSM-III major depressive episodes. In this context, ''DSM-III depressive psychotic features, DSM-III personality disorder and sudden onset of illness were significantly associated with poor treatment response and explained 34% of the outcome variance'' ( [12], p. 284).…”

“…An important exception is the study by Sauer et al [12] who tested the value of clinical and neuroendocrinological variables for the prediction of the amitriptyline response in patients suffering from DSM-III major depressive episodes. In this context, ''DSM-III depressive psychotic features, DSM-III personality disorder and sudden onset of illness were significantly associated with poor treatment response and explained 34% of the outcome variance'' ( [12], p. 284). Using a newly developed onset of depression inventory (ODI), we recently found a clearly faster onset in patients with bipolar versus unipolar depression [8] (also [6]).…”