Treatment, outcome and predictors of response in elderly depressed in-patients

1997 ◽  
Vol 170 (5) ◽  
pp. 436-440 ◽  
Author(s):  
T. J. Heeren ◽  
P. Derksen ◽  
B. F. V. Heycop Ten Ham ◽  
P. P. J. Van Gent
Keyword(s):  
Clinical Trials ◽  
Treatment Outcome ◽  
Rating Scale ◽  
Antidepressant Treatment ◽  
Psychiatric Hospitals ◽  
The Elderly ◽  
Full Recovery ◽  
Treatment Expectations ◽  
Predictors Of Response ◽  
Vigorous Treatment

BackgroundFull recovery rates in naturalistic studies of the treatment of elderly depressives are invariably lower than in clinical trials. This may be the result of inadequate treatment due to the lack of clear treatment strategy recommendations for the elderly.MethodThis is a naturalistic prospective study of depressed elderly in-patients in three Dutch psychiatric hospitals. Patients were included when they suffered from any mood disorder according to DSM - III - R criteria. Severity of the depression was measured on the Montgomery -Asberg Rating Scale.ResultsAntidepressants were prescribed to more than 90% of the patients. More than half of them received only one treatment. The dose of the antidepressants was less than the recommended dose for adults in 55% of cases. Full recovery from the depressive episode was achieved in less than half of the patients (33–45%).ConclusionsIn the present study a relatively poor outcome of the antidepressant treatment of elderly depressives has been found. A combination of low treatment expectations and fear of vigorous treatment seems to have been important.

Assessment of mature serum brain-derived neurotrophic factor (BDNF) is not superior to total serum BDNF in prediction of antidepressant treatment outcome

2016 ◽  
Vol 33 (S1) ◽  
pp. S410-S410 ◽  
Author(s):  
A. Eckert ◽  
T. Mikoteit ◽  
J. Beck ◽  
U.M. Hemmeter ◽  
S. Brand ◽  
...  
Keyword(s):  
Treatment Outcome ◽  
Treatment Response ◽  
Rating Scale ◽  
Antidepressant Treatment ◽  
Serum Levels ◽  
Total Serum ◽  
Enzyme Linked Immunosorbent Assay ◽  
Functional Link ◽  
Neurotrophic Activity ◽  
Serum Bdnf

BackgroundSerum BDNF levels are decreased in major depressive disorder (MDD) and tend to normalize under antidepressant treatment, serving as a treatment outcome predictor. BDNF is initially synthetized as precursor protein proBDNF and is cleaved to mature BDNF (mBDNF) while only the latter exerts neurotrophic activity.AimThe aim was to explore if a specific enzyme-linked immunosorbent assay (ELISA) kit for mBDNF in serum would be superior to the unspecific assessment of total serum BDNF in predicting treatment response in MDD.MethodsTwenty-five patients with MDD underwent standardized treatment with duloxetine. Severity of depression was measured by Hamilton Depression Rating Scale (HDRS) at baseline (BL), after one (W1), two (W2) and six weeks (W6) of treatment. Treatment response was defined as a HDRS ≥ 50% reduction of BL score at W6. mBDNF and total BDNF serum levels were determined at BL, W1 and W2.ResultsA high and stable correlation was found between mBDNF and total BDNF serum levels over all measurements. The predictive value of mBDNF BL levels and mBDNFΔW1 to response was similar to that of total BDNF BL and total BDNFΔW1. The assessment of serum mBDNF was not superior to total BDNF in prediction of treatment outcome.ConclusionsNot only baseline total BDNF but also mBDNF is predictive to treatment outcome. The later might represent the main player in this respect, which supports the idea of a functional link between neuroplasticity and MDD.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Integrated genome-wide methylation and expression analyses reveal functional predictors of response to antidepressants

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Chelsey Ju ◽  
Laura M. Fiori ◽  
Raoul Belzeaux ◽  
Jean-Francois Theroux ◽  
Gary Gang Chen ◽  
...  
Keyword(s):  
Treatment Response ◽  
Rating Scale ◽  
Antidepressant Treatment ◽  
Dna And Rna ◽  
Predictors Of Response ◽  
Genome Wide ◽  
Scale Scores ◽  
Before And After ◽  
Pre Treatment ◽  
Functional Components

Abstract Major depressive disorder (MDD) is primarily treated with antidepressants, yet many patients fail to respond adequately, and identifying antidepressant response biomarkers is thus of clinical significance. Some hypothesis-driven investigations of epigenetic markers for treatment response have been previously made, but genome-wide approaches remain unexplored. Healthy participants (n = 112) and MDD patients (n = 211) between 18–60 years old were recruited for an 8-week trial of escitalopram treatment. Responders and non-responders were identified using differential Montgomery-Åsberg Depression Rating Scale scores before and after treatment. Genome-wide DNA methylation and gene expression analyses were assessed using the Infinium MethylationEPIC Beadchip and HumanHT-12 v4 Expression Beadchip, respectively, on pre-treatment peripheral blood DNA and RNA samples. Differentially methylated positions (DMPs) located in regions of differentially expressed genes between responders (n = 82) and non-responders (n = 95) were identified, and technically validated using a targeted sequencing approach. Three DMPs located in the genes CHN2 (cg23687322, p = 0.00043 and cg06926818, p = 0.0014) and JAK2 (cg08339825, p = 0.00021) were the most significantly associated with mRNA expression changes and subsequently validated. Replication was then conducted with non-responders (n = 76) and responders (n = 71) in an external cohort that underwent a similar antidepressant trial. One CHN2 site (cg06926818; p = 0.03) was successfully replicated. Our findings indicate that differential methylation at CpG sites upstream of the CHN2 and JAK2 TSS regions are possible peripheral predictors of antidepressant treatment response. Future studies can provide further insight on robustness of our candidate biomarkers, and greater characterization of functional components.

T3 Blood Levels and Treatment Outcome in Depression

2001 ◽  
Vol 31 (4) ◽  
pp. 367-373 ◽  
Author(s):  
Dan V. Iosifescu ◽  
Shauna Howarth ◽  
Jonathan E. Alpert ◽  
Andrew A. Nierenberg ◽  
John J. Worthington ◽  
...  
Keyword(s):  
Treatment Outcome ◽  
Depressive Symptoms ◽  
Rating Scale ◽  
Antidepressant Treatment ◽  
Blood Levels ◽  
Score Change ◽  
Baseline Severity ◽  
Severity Of Depression ◽  
Dsm Iv ◽  
Hamilton Rating Scale

Objective: We examined the correlation between the basal triiodothyronine resin uptake (T3-RU) levels in depressed subjects and the response to antidepressant treatment. Method: We treated with fluoxetine 235 outpatients meeting DSM-IV criteria for major depression. We measured T3 resin uptake (T3-RU) levels before the onset of treatment. The 17-item Hamilton Rating Scale for Depression (Ham-D-17) was administered before, during and after the eight weeks of treatment to assess changes in depressive symptoms. Results: 16 patients (6.8 percent) had low T3-RU levels (range 16.5–21), and 7 patients (3.0 percent) had high T3-RU levels (range 36–38). No relationship was found between T3-RU levels and clinical improvement, defined as either total Ham-D-17 score change or Ham-D-17 score ≤ 7 in the last 3 weeks of treatment, even after adjusting for baseline severity of depression. Conclusion: Abnormal T3-RU levels are rather uncommon in outpatient depression and do not correlate with the response to antidepressant treatment or lack thereof.

The clinical application of ABCB1 genotyping in antidepressant treatment: a pilot study

CNS Spectrums ◽  
2013 ◽  
Vol 19 (2) ◽  
pp. 165-175 ◽  
Author(s):  
Barbara Breitenstein ◽  
Sandra Scheuer ◽  
Hildegard Pfister ◽  
Manfred Uhr ◽  
Susanne Lucae ◽  
...  
Keyword(s):  
Treatment Outcome ◽  
Hospital Stay ◽  
Clinical Application ◽  
Clinical Decision Making ◽  
Rating Scale ◽  
Antidepressant Treatment ◽  
Nucleotide Polymorphisms ◽  
Abcb1 Gene ◽  
Duration Of Hospital Stay ◽  
Remission Rates

BackgroundThe gene product of the ABCB1 gene, the P-glycoprotein, functions as a custodian molecule in the blood–brain barrier and regulates the access of most antidepressants into the brain. Previous studies showed that ABCB1 polymorphisms predicted the response to antidepressants that are substrates of the P-gp, while the response to nonsubstrates was not influenced by ABCB1 polymorphisms. The aim of the present study was to evaluate the clinical application of ABCB1 genotyping in antidepressant pharmacotherapy.MethodsData came from 58 depressed inpatients participating in the Munich Antidepressant Response Signature (MARS) project, whose ABCB1 gene test results were implemented into the clinical decision making process. Hamilton Depression Rating Scale (HAM-D) scores, remission rates, and duration of hospital stay were documented with dose and kind of antidepressant treatment.ResultsPatients who received ABCB1 genotyping had higher remission rates [χ2(1) = 6.596, p = 0.005, 1-sided] and lower Hamilton sores [t(111) = 2.091, p = 0.0195, 1-sided] at the time of discharge from hospital as compared to patients without ABCB1 testing. Among major allele homozygotes for ABCB1 single nucleotide polymorphisms (SNPs) rs2032583 and rs2235015 (TT/GG genotype), an increase in dose was associated with a shorter duration of hospital stay [rho(28) = –0.441, p = 0.009, 1-sided], whereas other treatment strategies (eg, switching to a nonsubstrate) showed no significant associations with better treatment outcome.DiscussionThe implementation of ABCB1 genotyping as a diagnostic tool influenced clinical decisions and led to an improvement of treatment outcome. Patients carrying the TT/GG genotype seemed to benefit from an increase in P-gp substrate dose.ConclusionResults suggest that antidepressant treatment of depression can be optimized by the clinical application of ABCB1 genotyping.

scholarly journals Adjunct Therapy With Glycyrrhiza Glabra Rapidly Improves Outcome in Depression—A Pilot Study to Support 11-Beta-Hydroxysteroid Dehydrogenase Type 2 Inhibition as a New Target

2020 ◽  
Vol 11 ◽  
Author(s):  
Harald Murck ◽  
Lisa Lehr ◽  
Johannes Hahn ◽  
Matthias C. Braunisch ◽  
Daniela Jezova ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Treatment Outcome ◽  
Systolic Blood Pressure ◽  
Rating Scale ◽  
Antidepressant Treatment ◽  
Hydroxysteroid Dehydrogenase ◽  
Glycyrrhiza Glabra ◽  
Open Label ◽  
Lower Systolic Blood Pressure

Mineralocorticoid-receptor (MR) dysfunction as expressed by low systolic blood pressure and a high salivary aldosterone/cortisol ratio predicts less favorable antidepressant treatment outcome. Inhibition of peripheral 11-beta-hydroxysteroid-dehydrogenase type 2 (11betaHSD2) reverses these markers. We therefore tested the hypothesis that the 11betaHSD2 inhibitor glycyrrhizin affects treatment outcome via this mechanism. We administered Glycyrrhiza glabra (GG) extract containing 7–8 % of glycyrrhizin at a dose of 2 × 700 mg daily adjunct to standard antidepressants in hospitalized patients with major depression. These subjects were compared in an open-label fashion with patients, who did not receive GG (treatment as usual, TAU). Assessments were done at baseline and approximately 2 weeks after. Twelve subjects were treated with GG and compared to 55 subjects with TAU. At week 2, the Hamilton Depression Rating Scale (HAMD-21) change from baseline as well as the CGI-S change showed a significant time × treatment interaction (p < 0.03), indicating a possible therapeutic benefit of GG. Clinical benefit seems to be more pronounced in subjects with lower systolic blood pressure and significantly correlated with reduced sleep duration in the GG group. Our preliminary data show that treatment with the 11betaHSD2 inhibitor glycyrrhizin may possess a beneficial effect on antidepressant response, which may be specific to a defined depression subtype.

Semi-structured Depression Scale Sensitive to Change with Treatment for Use in the Elderly

1994 ◽  
Vol 164 (4) ◽  
pp. 522-527 ◽  
Author(s):  
A. V. Ravindran ◽  
K. Welburn ◽  
J. R. M. Copeland
Keyword(s):  
Rating Scales ◽  
Rating Scale ◽  
Antidepressant Treatment ◽  
Depression Scale ◽  
The Elderly ◽  
Structured Interview ◽  
The Core ◽  
New Instrument ◽  
Before And After ◽  
Hamilton Rating Scale

The construction of a semi-structured interview depression scale that is sensitive to change for use in the elderly is described. Depression items from a well validated diagnostic instrument, the Geriatric Mental State Schedule (GMSS), were used as the core items in the development of the instrument. Improvement in depression in 80 elderly patients was independently assessed with two standard rating scales for depression, the Hamilton Rating Scale for Depression and the Beck Depression Inventory, and by an independent clinician's judgement before and after standard antidepressant treatment. Depression items that were sensitive to change were retained from the core items to form the new instrument. Results indicate that this scale is reliable and valid, shows better correlation with both the clinician's and the patient's judgement of improvement than the standard instruments, and is sparing of the rater's time.

The intestinal microbiota as a predictor for antidepressant treatment outcome in geriatric depression: a prospective pilot study

2021 ◽  
pp. 1-13
Author(s):  
S. Melanie Lee ◽  
Tien S. Dong ◽  
Beatrix Krause-Sorio ◽  
Prabha Siddarth ◽  
Michaela M. Milillo ◽  
...  
Keyword(s):  
Treatment Outcome ◽  
Los Angeles ◽  
Gut Microbiota ◽  
Rating Scale ◽  
Antidepressant Treatment ◽  
Controlled Trial ◽  
Fecal Microbiota ◽  
Post Treatment ◽  
Geriatric Depression ◽  
Α Diversity

ABSTRACT Objectives: (1) To investigate if gut microbiota can be a predictor of remission in geriatric depression and to identify features of the gut microbiota that is associated with remission. (2) To determine if changes in gut microbiota occur with remission in geriatric depression. Design: Secondary analysis of a parent randomized placebo-controlled trial (NCT02466958). Setting: Los Angeles, CA, USA (2016-2018) Participants: Seventeen subjects with major depressive disorder, over 60 years of age, 41.2% female. Intervention: Levomilacipran (LVM) or placebo. Measurements: Remission was defined by Hamilton Depression Rating Scale score of 6 or less at 12 weeks. 16S-ribosomal RNA sequencing based fecal microbiota composition and diversity were measured at baseline and 12 weeks. Differences in fecal microbiota were evaluated between remitters and non-remitters as well as between baseline and post-treatment samples. LVM and placebo groups were combined in all the analyses. Results: Baseline microbiota showed no community level α-diversity or β-diversity differences between remitters and non-remitters. At the individual taxa level, a random forest classifier created with nine genera from the baseline microbiota was highly accurate in predicting remission (AUC = .857). Of these, baseline enrichment of Faecalibacterium, Agathobacter and Roseburia relative to a reference frame was associated with treatment outcome of remission. Differential abundance analysis revealed significant genus level changes from baseline to post-treatment in remitters, but not in non-remitters. Conclusions: This is the first study demonstrating fecal microbiota as a potential predictor of treatment response in geriatric depression. Our findings need to be confirmed in larger prospective studies.

Dimensions of anxiety in Major depressive disorder and their use in predicting antidepressant treatment outcome: an iSPOT-D report

2019 ◽  
Vol 50 (6) ◽  
pp. 1032-1042 ◽  
Author(s):  
Taylor A. Braund ◽  
Donna M. Palmer ◽  
Leanne M. Williams ◽  
Anthony W. F. Harris
Keyword(s):  
Major Depressive Disorder ◽  
Treatment Outcome ◽  
Depressive Disorder ◽  
Clinical Features ◽  
Rating Scale ◽  
Depressive Symptomatology ◽  
Antidepressant Treatment ◽  
Anxiety Symptoms ◽  
Major Depressive ◽  
Somatic Anxiety

AbstractBackgroundMajor depressive disorder (MDD) commonly co-occurs with clinically significant levels of anxiety. However, anxiety symptoms are varied and have been inconsistently associated with clinical, functional, and antidepressant treatment outcomes. We aimed to identify and characterise dimensions of anxiety in people with MDD and their use in predicting antidepressant treatment outcome.Method1008 adults with a current diagnosis of single-episode or recurrent, nonpsychotic, MDD were assessed at baseline on clinical features and cognitive/physiological functioning. Participants were then randomised to one of three commonly prescribed antidepressants and reassessed at 8 weeks regarding symptom change, as well as remission and response, on the 17-item Hamilton Rating Scale Depression (HRSD17) and the 16-item Quick Inventory of Depressive Symptomatology (QIDS-SR16). Exploratory factor analysis was used on items from scales assessing anxiety symptoms, and resulting factors were assessed against clinical features and cognitive/physiological functioning. Factors were also assessed on their ability to predict treatment outcome.ResultsThree factors emerged relating to stress, cognitive anxiety, and somatic anxiety. All factors showed high internal consistency, minimal cross-loadings, and unique clinical and functional profiles. Furthermore, only higher somatic anxiety was associated with poorer QIDS-SR16 remission, even after adjusting for covariates and multiple comparisons.ConclusionsAnxiety symptoms in people with MDD can be separated onto distinct factors that differentially respond to treatment outcome. Furthermore, these factors do not align with subscales of established measures of anxiety. Future research should consider cognitive and somatic symptoms of anxiety separately when assessing anxiety in MDD and their use in predicting treatment outcome.

scholarly journals Prediction of Antidepressant Treatment Outcome Using Event-Related Potential in Patients with Major Depressive Disorder

Diagnostics ◽  
2020 ◽  
Vol 10 (5) ◽  
pp. 276
Author(s):  
Hyun Seo Lee ◽  
Seung Yeon Baik ◽  
Yong-Wook Kim ◽  
Jeong-Youn Kim ◽  
Seung-Hwan Lee
Keyword(s):  
Major Depressive Disorder ◽  
Treatment Outcome ◽  
Depressive Disorder ◽  
Auditory Evoked Potentials ◽  
Rating Scale ◽  
Antidepressant Treatment ◽  
Event Related Potential ◽  
Major Depressive ◽  
Good Treatment Response ◽  
Treatment Responsiveness

(1) Background: Prediction of treatment outcome has been one of the core objectives in clinical research of patients with major depressive disorder (MDD). This study explored the possibility of event-related potential (ERP) markers to predict antidepressant treatment outcomes among MDD patients; (2) Methods: Fifty-two patients with MDD were recruited and evaluated through Hamilton depression (HAM-D), Hamilton anxiety rating scale (HAM-A), and CORE. Patients underwent a battery of ERP measures including frontal alpha symmetry (FAA) in the low alpha band (8–10 Hz), mismatch negativity (MMN), and loudness-dependent auditory evoked potentials (LDAEP); (3) Results: During the eight weeks of study, 61% of patients achieved remission, and 77% showed successful treatment responsiveness. Patients with low FAA in F5/F6 demonstrated a significantly higher remission/response ratio and better treatment responsiveness (F (2.560, 117.755) = 3.84, p = 0.016) compared to patients with high FAA. In addition, greater FAA in F7/F8 EEG channels was significantly associated with greater melancholia scores (r = 0.34, p = 0.018). Other ERP markers lacked any significant effect; (4) Conclusions: Our results suggested low FAA (i.e., greater left frontal activity) could reflect a good treatment response in MDD patients. These findings support that FAA could be a promising index in understanding both MDD and melancholic subtype.

A New Depression Scale Designed to be Sensitive to Change

1979 ◽  
Vol 134 (4) ◽  
pp. 382-389 ◽  
Author(s):  
Stuart A. Montgomery ◽  
Marie Åsberg
Keyword(s):  
Clinical Trials ◽  
Rating Scale ◽  
Antidepressant Treatment ◽  
Antidepressant Drugs ◽  
Depression Scale ◽  
Depressive Illness ◽  
Sensitivity To Change ◽  
Ethical Implications ◽  
Hamilton Rating Scale ◽  
Better Than

SummaryThe construction of a depression rating scale designed to be particularly sensitive to treatment effects is described. Ratings of 54 English and 52 Swedish patients on a 65 item comprehensive psychopathology scale were used to identify the 17 most commonly occurring symptoms in primary depressive illness in the combined sample.Ratings on these 17 items for 64 patients participating in studies of four different antidepressant drugs were used to create a depression scale consisting of the 10 items which showed the largest changes with treatment and the highest correlation to overall change.The inter-rater reliability of the new depression scale was high. Scores on the scale correlated significantly with scores on a standard rating scale for depression, the Hamilton Rating Scale (HRS), indicating its validity as a general severity estimate. Its capacity to differentiate between responders and non-responders to antidepressant treatment was better than the HRS, indicating greater sensitivity to change. The practical and ethical implications in terms of smaller sample sizes in clinical trials are discussed.

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