Time course of improvement under antidepressant treatment: A survival-analytical approach

Stassen, Hans H.; Delini‐Stula, A.; Angst, J.

doi:10.1016/0924-977x(93)90264-m

Cited by 182 publications

(132 citation statements)

References 15 publications

Supporting

Mentioning

124

Contrasting

Unclassified

Order By: Relevance

“…In our earlier study (Katz et al, 1987), the clinical effects detected within the first 2 weeks were large and were predictive of eventual positive clinical outcome. Findings from a number of other studies (Small et al, 1981;Coryell et al, 1982;Khan et al, 1989;Nagayama et al, 1991;Stassen et al, 1993;Boyer and Feighner, 1994) have also confirmed the positive role of early clinical actions in predicting treatment outcome. The capacity to predict outcome early in treatment would not only shorten the length of a treatment trial but should also decrease morbidity and the risk of suicide from prolonged depressive symptoms (Kiloh et al, 1988).…”

Section: Introductionsupporting

confidence: 61%

“…The lack of a placebo control group in several of the other prediction studies, for example, Nagayama et al (1991), also brought into question the etiology of these reported early clinical actions. Recent reviews of relevant research on the issue of the onset of action of AD drugs (Stassen et al, 1993;Katz et al, 1996Katz et al, / 1997Gelenberg and Chesen, 2000) concluded that none of these studies, including ours, had fully met the requirements of a definitive study on response onset. Thus, the question as to whether ADs do or do not induce specific predictive behavioral actions within the first 2 weeks of drug treatment is still unresolved.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Onset and Early Behavioral Effects of Pharmacologically Different Antidepressants and Placebo in Depression

Katz

Tekell

Bowden

et al. 2003

Neuropsychopharmacol

233

153

View full text Add to dashboard Cite

This study was aimed at resolving the time course of clinical action of antidepressants (ADs) and the type of early behavioral changes that precede recovery in treatment-responsive depressed patients. The first goal was to identify, during the first 2 weeks of treatment, the onset of clinical actions of the selective serotonin reuptake inhibitor (SSRI), paroxetine, and the selective noradrenergic reuptake inhibitor, desipramine (DMI). The second aim was to test the hypothesis that the two pharmacologic subtypes would induce different early behavioral changes in treatment-responsive patients. The design was a randomized, parallel group, placebo-controlled, double-blind study for 6 weeks of treatment following a 1-week washout period. The study utilized measures of the major behavioral components of the depressive disorder as well as overall severity. The results indicated that the onset of clinical actions of DMI ranged from 3 to 13 days, averaged 13 days for paroxetine, and was 16-42 days for placebo. Furthermore, as hypothesized, the different types of ADs initially impacted different behavioral aspects of the disorder. After 1 week of treatment, DMI produced greater reductions in motor retardation and depressed mood than did paroxetine and placebo, and this difference persisted at the second week of treatment. Early improvement in depressed mood-motor retardation differentiated patients who responded to DMI after 6 weeks of treatment from those that did not. Paroxetine initially reduced anxiety more in responders than in nonresponders, and by the second week, significantly improved depressed mood and distressed expression in responders to a greater extent. Depressed patients who responded to placebo showed no consistent early pattern of behavior improvement. Early drug-specific behavioral changes were highly predictive of ultimate clinical response to the different ADs, results that could eventually be applied directly to clinical practice.

show abstract

Section: Introductionsupporting

confidence: 61%

Section: Introductionmentioning

confidence: 99%

Onset and Early Behavioral Effects of Pharmacologically Different Antidepressants and Placebo in Depression

Katz

Tekell

Bowden

et al. 2003

Neuropsychopharmacol

233

153

View full text Add to dashboard Cite

show abstract

“…In contrast, survival-analytical methods suggest that among responders, onset of action occurs in more than 70% of cases within the first two weeks of treatment, with an early onset of action being highly predictive of later response. (Angst and Stassen, personal communication; Stassen et al 1993Stassen et al , 1997Coryell et al 1982;Boyer and Feighner 1994).…”

Section: Onset and Speed Of Action Of Antidepressantsmentioning

confidence: 99%

“…Demonstrating a statistical difference between drug and placebo at one week of treatment is, for statistical and other reasons, not adequate in itself to establish one drug as having a faster action. Stassen et al (1993) developed a more persuasive approach to determining onset and speed of action by analyzing change within each of the treated patients. They defined a 20% reduction on the HDRS as a sufficiently stable index of improvement, with the additional requirement that the improvement when measured on subsequent days throughout the course of treatment not fall below 15%.…”

Section: Onset and Speed Of Action Of Antidepressantsmentioning

confidence: 99%

“…"Improvement", for example, must be distinguished from "full response" and "remission." Stassen et al (1993) adopted the 20% criterion for the HDRS as the index of improvement, and the time point at which 50% improvement is achieved, as the definition of response. Montgomery (1995), for other reasons, proposed 25% as the initial threshold for improvement.…”

Section: Onset and Speed Of Action Of Antidepressantsmentioning

confidence: 99%

See 1 more Smart Citation

Enhancing the Technology of Clinical Trials and the Trials Model to Evaluate Newly Developed, Targeted Antidepressants

Katz

Halbreich

Bowden

et al. 2002

Neuropsychopharmacology

View full text Add to dashboard Cite

Concern about disappointing results from recent multicenter trials of new antidepressants prompted several ACNP workshops on "improving the technology of clinical trials." The workshops focused on technical problems, such as patient screening, reliability of clinical ratings, and the role of the placebo control. They aimed to determine how to 27 , NO . 3 ducing adverse events, and lessening the complexity of dosing regimens. In addition, attention is currently focused on accelerating the onset of drug action to generate more rapidly acting antidepressants. Unfortunately, recently conducted multi-center clinical trials of some of these agents encountered serious technical problems and did not produce the results anticipated from preclinical studies. Although this may be partly due to limitations in extrapolating pre-clinical data to patients, it may also be that there are significant constraints in the current clinical trials model that make it difficult to demonstrate efficacy.The current clinical trials model is now 30 years old. The essential principles of randomization, double blind evaluation, and a placebo control remain sound. But other important aspects of the research design and the methodology are no longer sufficient or well suited to the testing of these new drugs. In effect, such deficiencies in current trial methodologies make it increasingly difficult to demonstrate antidepressant efficacy of these new drugs.One important reason the current model has proved inadequate is that it was initially applied to hospitalized depressed patients. Today new drugs are tested almost exclusively on outpatient samples, many of whom are symptomatic volunteers, responding to advertisements. Depressed outpatients have milder depressive symptomatology than the predominantly inpatient samples used to test the first established drugs. Patients with milder severity provide a narrower range of possible change, and produce a greater number of placebo responders (Fisher et al. 1965;Bowden et al. 2000;Khan et al. 2002).As a consequence of the smaller difference between active treatment and placebo treatment, larger patient samples and/or more sensitive clinical methods are needed to detect differences between drug and placebo. The most commonly utilized scales, the Hamilton Depression Rating Scale (HDRS) (Hamilton 1960) and the Clinical Global Impression Scale (CGI) (Guy 1976), were designed to measure changes in overall severity of the disorder. These scales are not sufficiently sensitive to assess the specific behavioral changes brought about by the newer drugs (Montgomery and Asberg 1979). Further, intensive evaluation of symptomatology and behavioral change are carried out infrequently with outpatients, making evaluation of rapidity of response problematic. Consequently, it appears important to improve the technology applied to assessing the specific actions, onset, and efficacy of the newer drugs.Acknowledging the increased complexity of the goals of clinical trials and the need to improve trial procedures, the desi...

show abstract

Transcranial Magnetic Stimulation

George

Lisanby²,

Sackeïm³

1999

Arch Gen Psychiatry

429

View full text Add to dashboard Cite

In the 1990s, it is difficult to open a newspaper or watch television and not find someone claiming that magnets promote healing. Rarely do these claims stem from double-blind, peer-reviewed studies, making it difficult to separate the wheat from the chaff. The current fads resemble those at the end of the last century, when many were falsely touting the benefits of direct electrical and weak magnetic stimulation. Yet in the midst of this popular interest in magnetic therapy, a new neuroscience field has developed that uses powerful magnetic fields to alter brain activity--transcranial magnetic stimulation. This review examines the basic principles underlying transcranial magnetic stimulation, and describes how it differs from electrical stimulation or other uses of magnets. Initial studies in this field are critically summarized, particularly as they pertain to the pathophysiology and treatment of neuropsychiatric disorders. Transcranial magnetic stimulation is a promising new research and, perhaps, therapeutic tool, but more work remains before it can be fully integrated in psychiatry's diagnostic and therapeutic armamentarium.

show abstract

Time course of improvement under antidepressant treatment: A survival-analytical approach

Cited by 182 publications

References 15 publications

Onset and Early Behavioral Effects of Pharmacologically Different Antidepressants and Placebo in Depression

Onset and Early Behavioral Effects of Pharmacologically Different Antidepressants and Placebo in Depression

Enhancing the Technology of Clinical Trials and the Trials Model to Evaluate Newly Developed, Targeted Antidepressants

Transcranial Magnetic Stimulation

Contact Info

Product

Resources

About