Study Finds Depression Subtype May Not Be Relevant in Selecting Treatment

From Psychiatric News Alert: There may be no preferential antidepressant pharmacotherapy for treating subtypes of major depressive disorder (MDD), according to a study published online in AJP in Advance, “Depression Subtypes in Predicting Antidepressant Response: A Report From the iSPOT-D Trial.

oweirieoeA. John Rush, M.D., a professor of psychiatry and behavioral sciences at Duke University School of Medicine, and colleagues conducted a study with 1,008 individuals with MDD to assess the proportions of participants who met at least one criteria for MDD subtype—melancholic, atypical, and anxious depression—and compared subtype profiles on remission and change in depressive symptoms after eight weeks of treatment with escitalopram, sertraline, or extended-release venlafaxine. Improvement of symptoms and likelihood of remission were quantified by the 16-item Quick Inventory of Depressive Symptomology-Self Report.

The researchers found that 39 percent of the studied individuals exhibited at least one pure form of a depressive subtype, with atypical subtype being the most prevalent at 15 percent. Approximately 36 percent of the participants met criteria for more than one subtype. As it relates to antidepressant treatment, the results showed that participants in all subtype groups exhibited a similar statistically significant reduction in symptoms and did not differ in the likelihood to remit.

“Whether pure or mixed, subtypes were not differentially predictive of overall acute treatment outcomes or differentially predictive of efficacy among the three antidepressant medications,” the researchers concluded. “If replicated, these findings would suggest that the clinical utility of these subtypes in treatment selection is minimal.”

The iSPOT-D trial (International Study to Predict Optimized Treatment – in Depression) is the largest personalized medicine research study in mental health.

To read more about treatments for major depressive disorder, see the Manual of Clinical Psychopharmacology, Eighth Edition, by Alan Schatzberg, M.D., and Charles DeBattista, M.D., D.M.H., from American Psychiatric Publishing.

Image Credit: MorgueFile

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Better Screening and Treatment Access Needed for Teens With Major Depression

Severe MDD was more common among older adolescents, and girls had two to three times the risk of MDD and four times the risk of severe depression than boys. image credit: zea_lenanet | DPC

Severe MDD was more common among older adolescents and girls. image credit: zea_lenanet | DPC

From Psychiatric News Alert: About 60% of teenagers with DSM-IV major depressive disorder (MDD) receive treatment, but only 35% were treated by a mental health professional, according to a nationally representative survey of 10,123 adolescents.

Lifetime prevalence of MDD was 11% among that sample, and 12-month prevalence was 7.5%, said Shelli Avenevoli, Ph.D., of the Division of Translational Research at the National Institute of Mental Health and colleagues in the January Journal of the American Academy of Child and Adolescent Psychiatry. Age and gender influenced prevalence, they said.

“The majority of depressed adolescents did not receive treatment specifically for their depression or from the mental health sector for any emotional or behavioral problem. These findings underscore the ubiquitous nature of this disorder in youth, suggest that a significant portion of depressive disorders have their first onset in adolescence, and support the notion of routine and universal screening during adolescence.”

To read more about treatment of adolescent depression, see:

Advantages of Long-Acting Injectable Antipsychotics

With studies showing schizophrenia to be treatment refractory in one-fifth of those affected, psychiatrists are exploring other options to the delivery of effective treatment. At APA’s Institute on Psychiatric Services in San Francisco, some of the leading experts in psychopharmacology led a research symposium on the benefits of long-acting injectable (LAI) antipsychotic medications.Said Steven Potkin, M.D., director of clinical research at the University of California, Irvine:

“Psychiatrists who were trained during my time of training, think that long-acting injectable antipsychotics should be used for the most refractory, noncompliant, and difficult to treat patients. However, there is accumulating evidence that very early in the course of illness that this should be offered as an option, since half of the patients with first-episode psychosis discontinue medication after they are discharged from a hospital.”

Research on part of the “accumulating evidence” on long-acting injectable antipsychotics was presented by Keith Nuechterlein, Ph.D., a distinguished professor of psychiatry at the University of California, Los Angeles, who led a randomized study comparing LAI risperidone with oral rispiderone in 83 individuals who had a first psychotic episode within the two years prior to the study. The results showed that after one year of treatment, participants who received the daily oral form of risperidone had a 33%relapse rate, compared with 5% in those treated weekly with LAI risperidone. In addition, individuals in the oral risperidone cohort were four times more likely to be hospitalized than those taking the LAI version.

“We were struck that these were among the most dramatic results that have occurred for long-acting injectables—and it was in first-episode patients,” said Nuechterlein, adding that not only did patients experience advantages regarding outcomes associated with LAIs, but the patients accepted LAI medication quite readily. (The study was funded by the National Institutes of Health and Janssen Pharmaceuticals.)

“This symposium was an invitation for psychiatrists to rethink when is it appropriate to offer patients long-acting injectable medication. Should it be reserved only for refractory patients, or should it be offered to people earlier in the course [of illness]… or at any stage of illness? Of course, LAIs are not for everyone, but our patients should definitely be given options.”