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Severe treatment resistant major depression

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https://www.readbyqxmd.com/read/29924506/clinical-predictors-of-extrapyramidal-symptoms-associated-with-aripiprazole-augmentation-for-the-treatment-of-late-life-depression-in-a-randomized-controlled-trial
#1
Jonathan H Hsu, Benoit H Mulsant, Eric J Lenze, Marcos Sanches, Jordan F Karp, Charles F Reynolds, Daniel M Blumberger
OBJECTIVE: Augmentation with aripiprazole is an effective pharmacotherapy for treatment-resistant late-life depression (LLD). However, aripiprazole can cause extrapyramidal symptoms (EPS) such as akathisia and parkinsonism; these symptoms are distressing and can contribute to treatment discontinuation. We investigated the clinical trajectories and predictors of akathisia and parkinsonism in older patients receiving aripiprazole augmentation for treatment-resistant LLD. METHODS: Between 2009 and 2013, depressed older adults who did not remit with venlafaxine were randomized to aripiprazole or placebo in a 12-week trial...
June 19, 2018: Journal of Clinical Psychiatry
https://www.readbyqxmd.com/read/29879133/predictive-modeling-of-treatment-resistant-depression-using-data-from-star-d-and-an-independent-clinical-study
#2
Zhi Nie, Srinivasan Vairavan, Vaibhav A Narayan, Jieping Ye, Qingqin S Li
Identification of risk factors of treatment resistance may be useful to guide treatment selection, avoid inefficient trial-and-error, and improve major depressive disorder (MDD) care. We extended the work in predictive modeling of treatment resistant depression (TRD) via partition of the data from the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) cohort into a training and a testing dataset. We also included data from a small yet completely independent cohort RIS-INT-93 as an external test dataset...
2018: PloS One
https://www.readbyqxmd.com/read/29860382/major-depression-and-the-degree-of-suicidality-results-of-the-european-group-for-the-study-of-resistant-depression-gsrd
#3
Markus Dold, Lucie Bartova, Gernot Fugger, Alexander Kautzky, Daniel Souery, Julien Mendlewicz, George N Papadimitriou, Dimitris Dikeos, Panagiotis Ferentinos, Stefano Porcelli, Alessandro Serretti, Joseph Zohar, Stuart Montgomery, Siegfried Kasper
Background: This European multicenter study aimed to elucidate suicidality in major depressive disorder. Previous surveys suggest a prevalence of suicidality in major depressive disorder of ≥50%, but little is known about the association of different degrees of suicidality with socio-demographic, psychosocial, and clinical characteristics. Methods: We stratified 1410 major depressive disorder patients into 3 categories of suicidality based on the Hamilton Rating Scale for Depression item 3 (suicidality) ratings (0=no suicidality; 1-2=mild/moderate suicidality; 3-4=severe suicidality)...
June 1, 2018: International Journal of Neuropsychopharmacology
https://www.readbyqxmd.com/read/29805096/early-relapse-er-transcranial-magnetic-stimulation-tms-in-treatment-resistant-major-depression
#4
Saxby Pridmore, Sheila Erger, Marzena Rybak, Erin Kelly, Tamara May
BACKGROUND: There is interest in using TMS to keep patients with severe relapsing depression as well as possible, once remission has been achieved. This has been conceptualized as 'maintaining' the remission. One protocol employs series of 5 TMS sessions over 3 or 5 days, at about monthly intervals. We have suggested this practice is better conceptualized as early relapse (ER) TMS. AIM: To determine whether 5 TMS sessions at about monthly intervals are effective in keeping patients relatively well, and whether the concept of ER-TMS can be supported...
May 22, 2018: Brain Stimulation
https://www.readbyqxmd.com/read/29800779/antidepressant-treatment-resistance-is-associated-with-increased-inflammatory-markers-in-patients-with-major-depressive-disorder
#5
Ebrahim Haroon, Alexander W Daguanno, Bobbi J Woolwine, David R Goldsmith, Wendy M Baer, Evanthia C Wommack, Jennifer C Felger, Andrew H Miller
BACKGROUND: One third of patients with major depressive disorder (MDD) fail to respond to currently available antidepressant medications. Inflammation may contribute to treatment non-response through effects on neurotransmitter systems relevant to antidepressant efficacy. In post-hoc analyses, increased concentrations of inflammatory markers prior to treatment predict poor antidepressant response. However, limited data exists on whether depressed patients with multiple failed treatment trials in their current episode of depression exhibit increased inflammation...
May 19, 2018: Psychoneuroendocrinology
https://www.readbyqxmd.com/read/29774621/increase-of-frontal-cerebral-blood-volume-during-transcranial-magnetic-stimulation-in-depression-is-related-to-treatment-effectiveness-a-pilot-study-with-near-infrared-spectroscopy
#6
Toshikazu Shinba, Nobutoshi Kariya, Saori Matsuda, Hanae Matsuda, Yusuke Obara
AIM: Alterations of cerebral blood flow have been reported in studies of depression treated by transcranial magnetic stimulation (TMS). However, the relationship between these changes in activity during stimulation and the effectiveness of TMS is not known. The aim of this study was to determine whether changes in frontal cerebral blood volume measured as frontal hemoglobin concentration (fHbC) during TMS are correlated with clinical outcomes of treatment. METHODS: Fifteen drug-resistant patients with depression underwent a standard treatment regimen of TMS to the left dorsolateral prefrontal cortex...
May 18, 2018: Psychiatry and Clinical Neurosciences
https://www.readbyqxmd.com/read/29761488/psychological-therapies-for-treatment-resistant-depression-in-adults
#7
REVIEW
Sharea Ijaz, Philippa Davies, Catherine J Williams, David Kessler, Glyn Lewis, Nicola Wiles
BACKGROUND: Antidepressants are a first-line treatment for adults with moderate to severe major depression. However, many people prescribed antidepressants for depression don't respond fully to such medication, and little evidence is available to inform the most appropriate 'next step' treatment for such patients, who may be referred to as having treatment-resistant depression (TRD). National Institute for Health and Care Excellence (NICE) guidance suggests that the 'next step' for those who do not respond to antidepressants may include a change in the dose or type of antidepressant medication, the addition of another medication, or the start of psychotherapy...
May 14, 2018: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/29760763/an-open-label-flexible-dose-adaptive-study-evaluating-the-efficacy-of-vortioxetine-in-subjects-with-panic-disorder
#8
Anish Shah, Joanne Northcutt
Background: Despite the current treatments available for panic disorder (PD), as many as one-third of patients have persistent and treatment-resistant panic attacks. Vortioxetine is an approved medicine for major depressive disorder and has been shown to have anxiolytic properties. The purpose of this study was to evaluate its efficacy and safety in an adult population with a diagnosis of PD. Methods: The study design was open label with flexible dose strategies (5, 10, or 20 mg) with a treatment period of 10 weeks...
2018: Annals of General Psychiatry
https://www.readbyqxmd.com/read/29751598/informed-consent-decision-making-in-deep-brain-stimulation
#9
REVIEW
Gabriele Mandarelli, Germana Moretti, Massimo Pasquini, Giuseppe Nicolò, Stefano Ferracuti
Deep brain stimulation (DBS) has proved useful for several movement disorders (Parkinson’s disease, essential tremor, dystonia), in which first and/or second line pharmacological treatments were inefficacious. Initial evidence of DBS efficacy exists for refractory obsessive-compulsive disorder, treatment-resistant major depressive disorder, and impulse control disorders. Ethical concerns have been raised about the use of an invasive surgical approach involving the central nervous system in patients with possible impairment in cognitive functioning and decision-making capacity...
May 11, 2018: Brain Sciences
https://www.readbyqxmd.com/read/29750548/predictors-of-response-to-combined-wake-and-light-therapy-in-treatment-resistant-inpatients-with-depression
#10
Mette Kragh, Erik Roj Larsen, Klaus Martiny, Dorthe Norden Møller, Camilla Schultz Wihlborg, Tove Lindhardt, Poul Videbech
There is growing evidence for combined chronotherapeutic interventions as adjunctive treatments for major depression. However, as the treatments can be demanding, we need to identify predictors of response. This study aimed to describe predictors of response, remission and deterioration in the short-term phase, as well as predictors of long-term response. The predictors investigated were gender, type of depression, severity of depression, treatment resistance, quetiapine use, general self-efficacy, educational level and positive diurnal variation...
May 11, 2018: Chronobiology International
https://www.readbyqxmd.com/read/29737182/effect-of-high-frequency-repetitive-transcranial-magnetic-stimulation-rtms-in-patients-with-comorbid-panic-disorder-and-major-depression
#11
Saurabh Kumar, Swarndeep Singh, Arpit Parmar, Rohit Verma, Nand Kumar
OBJECTIVE: To explore the role of dorsolateral prefrontal cortex (DLPFC) stimulation in the treatment of panic disorder with comorbid depression. METHODS: The present study reports findings from retrospective analysis of 13 treatment-resistant patients diagnosed with comorbid panic disorder and depression, given 20 sessions of high-frequency transcranial magnetic stimulation (rTMS) over left-DLPFC over a period of 1 month. RESULTS: There was a significant reduction in both the panic and depressive symptom severity, assessed by applying Panic Disorder Severity Scale (PDSS) and Hamilton Depression Rating Scale (HDRS) at baseline and after 20 sessions of rTMS...
May 1, 2018: Australasian Psychiatry: Bulletin of Royal Australian and New Zealand College of Psychiatrists
https://www.readbyqxmd.com/read/29736744/antidepressant-efficacy-and-tolerability-of-ketamine-and-esketamine-a-critical-review
#12
REVIEW
P Molero, J A Ramos-Quiroga, R Martin-Santos, E Calvo-Sánchez, L Gutiérrez-Rojas, J J Meana
Ketamine and its enantiomer S-ketamine (esketamine) are promising candidates to produce a rapid-onset antidepressant effect in treatment-resistant depression. Ketamine causes continued blockade of the glutamate N-methyl-D-aspartate (NMDA) receptor, though this might not primarily mediate the antidepressant effect. Alternative hypotheses include selectivity for the NMDA receptor subtype containing the NMDA receptor subunit 2B (NR2B), inhibition of the phosphorylation of the eukaryotic elongation factor 2 (eEF2) kinase, increased expression of brain-derived neurotrophic factor (BDNF) and tropomyosin receptor kinase B (TrKB), and activation of the mammalian target of rapamycin (mTOR) signaling pathway, alongside other independent actions attributed to the ketamine metabolism to R-hydroxynorketamine (R-HNK)...
May 7, 2018: CNS Drugs
https://www.readbyqxmd.com/read/29726344/effectiveness-of-theta-burst-versus-high-frequency-repetitive-transcranial-magnetic-stimulation-in-patients-with-depression-three-d-a-randomised-non-inferiority-trial
#13
Daniel M Blumberger, Fidel Vila-Rodriguez, Kevin E Thorpe, Kfir Feffer, Yoshihiro Noda, Peter Giacobbe, Yuliya Knyahnytska, Sidney H Kennedy, Raymond W Lam, Zafiris J Daskalakis, Jonathan Downar
BACKGROUND: Treatment-resistant major depressive disorder is common; repetitive transcranial magnetic stimulation (rTMS) by use of high-frequency (10 Hz) left-side dorsolateral prefrontal cortex stimulation is an evidence-based treatment for this disorder. Intermittent theta burst stimulation (iTBS) is a newer form of rTMS that can be delivered in 3 min, versus 37·5 min for a standard 10 Hz treatment session. We aimed to establish the clinical effectiveness, safety, and tolerability of iTBS compared with standard 10 Hz rTMS in adults with treatment-resistant depression...
April 28, 2018: Lancet
https://www.readbyqxmd.com/read/29705022/comorbid-thyroid-disease-in-patients-with-major-depressive-disorder-results-from-the-european-group-for-the-study-of-resistant-depression-gsrd
#14
Gernot Fugger, Markus Dold, Lucie Bartova, Alexander Kautzky, Daniel Souery, Julien Mendlewicz, Alessandro Serretti, Joseph Zohar, Stuart Montgomery, Richard Frey, Siegfried Kasper
This multicenter study of the European Group for the Study of Resistant Depression (GSRD) aimed to explore the association between major depressive disorder (MDD) and comorbid thyroid disease. A total number of 1410 patients` characteristics in terms of demographic and clinical information were compared between MDD subjects with and without concurrent thyroid disease using descriptive statistics, analyses of covariance (ANCOVA) and binary logistic regression analyses. We determined a point prevalence rate for comorbid hypothyroidism of 13...
June 2018: European Neuropsychopharmacology: the Journal of the European College of Neuropsychopharmacology
https://www.readbyqxmd.com/read/29701939/bilateral-repetitive-transcranial-magnetic-stimulation-decreases-suicidal-ideation-in-depression
#15
Cory R Weissman, Daniel M Blumberger, Patrick E Brown, Moshe Isserles, Tarek K Rajji, Jonathan Downar, Benoit H Mulsant, Paul B Fitzgerald, Zafiris J Daskalakis
OBJECTIVE: The purpose of this study was to evaluate the effects of repetitive transcranial magnetic stimulation (rTMS) on suicidal ideation in patients with treatment-resistant major depression (TRD) (patients who failed to clinically respond to at least 2 medication trials). METHODS: We pooled data from 2 published prospective randomized controlled trials of rTMS applied to the dorsolateral prefrontal cortex in patients with TRD. We compared the effect of bilateral, left unilateral, and sham rTMS on suicidal ideation as measured by the suicide item of the 17-item Hamilton Depression Rating Scale (HDRS) (N = 156)...
April 17, 2018: Journal of Clinical Psychiatry
https://www.readbyqxmd.com/read/29618967/closing-the-loop-on-deep-brain-stimulation-for-treatment-resistant-depression
#16
REVIEW
Alik S Widge, Donald A Malone, Darin D Dougherty
Major depressive episodes are the largest cause of psychiatric disability, and can often resist treatment with medication and psychotherapy. Advances in the understanding of the neural circuit basis of depression, combined with the success of deep brain stimulation (DBS) in movement disorders, spurred several groups to test DBS for treatment-resistant depression. Multiple brain sites have now been stimulated in open-label and blinded studies. Initial open-label results were dramatic, but follow-on controlled/blinded clinical trials produced inconsistent results, with both successes and failures to meet endpoints...
2018: Frontiers in Neuroscience
https://www.readbyqxmd.com/read/29577229/comparison-of-guidelines-for-the-treatment-of-unipolar-depression-a-focus-on-pharmacotherapy-and-neurostimulation
#17
REVIEW
A J Bayes, G B Parker
OBJECTIVE: To determine the level of agreement across a set of evidence-based guidelines for management of the unipolar depressive disorders and with a focus on physical treatments. METHOD: A literature search was undertaken using the terms 'depression', 'depressive' and 'guidelines', using PubMed, Cochrane Database of Systematic Reviews and the National Guideline Clearinghouse. Twelve national psychiatric or professional guideline-producing organizations were identified from the period 2007-2017, with guidelines qualitatively reviewed by two assessors...
March 25, 2018: Acta Psychiatrica Scandinavica
https://www.readbyqxmd.com/read/29560909/subgenual-anterior-cingulate-medial-orbitofrontal-functional-connectivity-in-medication-resistant-major-depression-a-neurobiological-marker-for-accelerated-intermittent-theta-burst-stimulation-treatment
#18
Chris Baeken, Romain Duprat, Guo-Rong Wu, Rudi De Raedt, Kees van Heeringen
BACKGROUND: Accelerated repetitive transcranial magnetic stimulation paradigms have been shown to result in fast decreases in depressive symptoms and suicidal ideation. Although the subgenual anterior cingulate cortex (sgACC) region has been put forward as a possible biological marker, so far, no studies evaluated the clinical effects of accelerated intermittent theta burst stimulation (aiTBS) on sgACC functional connectivity (FC). METHODS: Fifty patients with treatment-resistant depression were enrolled in this registered randomized double-blind sham-controlled crossover aiTBS treatment study...
October 2017: Biological Psychiatry: Cognitive Neuroscience and Neuroimaging
https://www.readbyqxmd.com/read/29492960/clinical-correlates-of-augmentation-combination-treatment-strategies-in-major-depressive-disorder
#19
M Dold, L Bartova, J Mendlewicz, D Souery, A Serretti, S Porcelli, J Zohar, S Montgomery, S Kasper
OBJECTIVE: This multicenter, multinational, cross-sectional study aimed to investigate clinical characteristics and treatment outcomes associated with augmentation/combination treatment strategies in major depressive disorder (MDD). METHOD: Sociodemographic, clinical, and treatment features of 1410 adult MDD patients were compared between MDD patients treated with monotherapy and augmentation/combination medication using descriptive statistics, analyses of covariance (ancova), and Spearman's correlation analyses...
May 2018: Acta Psychiatrica Scandinavica
https://www.readbyqxmd.com/read/29489077/inflammation-and-improvement-of-depression-following-electroconvulsive-therapy-in-treatment-resistant-depression
#20
Jennifer L Kruse, Eliza Congdon, Richard Olmstead, Stephanie Njau, Elizabeth C Breen, Katherine L Narr, Randall Espinoza, Michael R Irwin
OBJECTIVE: Electroconvulsive therapy (ECT) is the most robust acute treatment for severe major depressive disorder, yet clinical response is variable. Inflammation is associated with depression, especially in women, and levels of C-reactive protein (CRP) and interleukin (IL)-6 predict response to antidepressant medications. This study evaluated whether markers of inflammation predicted response to electroconvulsive therapy (ECT) in patients with treatment-resistant depression and to what extent this association differed between men and women...
March 2018: Journal of Clinical Psychiatry
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