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Treatment resistance in severe unipolar depression: No association with psychotic or melancholic features

Published on May 1, 2013in Annals of Clinical Psychiatry 1.29
Leonardo Zaninotto11
Estimated H-index: 11
,
Daniel Souery45
Estimated H-index: 45
+ 7 AuthorsAlessandro Serretti66
Estimated H-index: 66
Abstract
BACKGROUND: Depressive subtypes generally have been neglected in research on treatment efficacy. We studied a sample of 699 severe unipolar depressed patients to detect any association between depressive features and treatment resistance. METHODS: Participants were divided into psychotic (PSY, n = 90), melancholic (MEL, n = 430) and non-melancholic (n = 179) subjects according to clinical features. Formal diagnostic criteria (Mini International Neuropsychiatric Interview items), and items from 17-item Hamilton Rating Scale for Depression (HRSD17) were compared across groups. Non-responders were defined by a HRSD17 cut-off score of !17 after the last adequate antidepressant treatment. Treatment-resistant depression (TRD) was defined as the failure to respond to !2 adequate antidepressant trials. Non-linear regression models were designed to detect associations between depressive subtypes and TRD. RESULTS: PSY and MEL patients appeared to be more severely affected and to share some "core" melancholic symptoms. Both PSY and MEL patients reported a higher rate of seasonality. However, we found no clinical or illness course variable associated with TRD. CONCLUSIONS: Our results indicate that psychotic and melancholic depression share some "core" melancholia symptoms, while no distinguishing psychopathological feature appears to be associated with TRD in severely depressed patients.
  • References (55)
  • Citations (6)
References55
Newest
Candice R Quinn7
Estimated H-index: 7
(USYD: University of Sydney),
Anthony Harris43
Estimated H-index: 43
(USYD: University of Sydney),
Andrew H. Kemp58
Estimated H-index: 58
(USYD: University of Sydney)
Major depressive disorder is often considered to be a homogenous disorder that changes in terms of severity; however, the presence of distinct subtypes and a variety of presenting symptoms suggests much heterogeneity. Aiming to better understand the relationship between heterogeneity and diagnosis we used an exploratory approach to identify subtypes of depression on the basis of clinical symptoms and neuropsychological performance. Cluster analysis identified two groups of patients distinguished...
20 Citations Source Cite
Published on Feb 1, 2012in Bipolar Disorders 4.94
Bernard J. Carroll69
Estimated H-index: 69
13 Citations Source Cite
Published on Dec 1, 2011in Journal of Affective Disorders 4.08
Daniel Souery45
Estimated H-index: 45
(ULB: Université libre de Bruxelles),
Leonardo Zaninotto11
Estimated H-index: 11
(UNIBO: University of Bologna)
+ 8 AuthorsJulien Mendlewicz64
Estimated H-index: 64
(ULB: Université libre de Bruxelles)
Abstract Background The nosological and clinical implications of psychotic features in the course of mood disorders have been widely debated. Currently, no specification exists for defining a subgroup of lifetime Psychotic Mood Disorder (PMD) patients. Methods A total of 2178 patients were examined, including subjects with Bipolar Disorder (BP) type I (n = 519) and II (n = 207) and Major Depressive Disorder (n = 1452). Patients were divided between PMD (n = 645) and non-psychotic Mood Disorders ...
19 Citations Source Cite
Published on Dec 1, 2011in BMC Psychiatry 2.67
Wim H. Winthorst4
Estimated H-index: 4
(UG: University of Groningen),
Wendy Post13
Estimated H-index: 13
(UG: University of Groningen)
+ 2 AuthorsWillem A. Nolen81
Estimated H-index: 81
(UG: University of Groningen)
Background Little is known about seasonality of specific depressive symptoms and anxiety symptoms in different patient populations. This study aims to assess seasonal variation of depressive and anxiety symptoms in a primary care population and across participants who were classified in diagnostic groups 1) healthy controls 2) patients with a major depressive disorder, 3) patients with any anxiety disorder and 4) patients with a major depression and any anxiety disorder.
19 Citations Source Cite
Published on Oct 1, 2010in Psychological Medicine 5.64
V. Lux2
Estimated H-index: 2
(FU: Free University of Berlin),
Steven H. Aggen35
Estimated H-index: 35
(VCU: Virginia Commonwealth University),
Kenneth S. Kendler152
Estimated H-index: 152
(VCU: Virginia Commonwealth University)
Background. Severity is an important characteristic of major depression (MD) and an 'episode specifier' in DSM-IV classifying depressive episodes as 'mild', 'moderate' or 'severe'. These severity subtypes rely on three different measures of severity: number of criteria symptoms, severity of the symptoms and degree of functional disability. No prior empirical study has evaluated the coherence and validity of the DSM-IV definition of severity of MD. Method. In a sample of 1015 (518 males, 497 fema...
14 Citations Source Cite
Published on Jul 1, 2010in American Journal of Psychiatry 13.65
Gordon Parker81
Estimated H-index: 81
,
Max Fink48
Estimated H-index: 48
+ 14 AuthorsDavid Healy23
Estimated H-index: 23
Melancholia, a syndrome with a long history and distinctly specific psychopathological features, is inadequately differentiated from major depression by the DSM-IV specifier. It is neglected in clinical assessment (e.g., in STAR*D [1]) and treatment selection (e.g., in the Texas Medication Algorithm Project [2]). Nevertheless, it possesses a distinctive biological homogeneity in clinical experience and laboratory test markers, and it is differentially responsive to specific treatment interventio...
111 Citations Source Cite
Published on Jan 1, 2010in Psychotherapy and Psychosomatics 13.74
H. Edmund Pigott2
Estimated H-index: 2
,
Allan M. Leventhal1
Estimated H-index: 1
(UW: University of Washington)
+ 1 AuthorsJohn J. Boren2
Estimated H-index: 2
(UW: University of Washington)
Background: This paper examines the current status of research on the efficacy and effectiveness of antidepressants. Methods: This paper reviews four meta-analyse
197 Citations Source Cite
Published on Dec 31, 2008in The Journal of Clinical Psychiatry 4.02
Patrick J. McGrath36
Estimated H-index: 36
(Columbia University),
Ahsan Y. Khan14
Estimated H-index: 14
(KU: University of Kansas)
+ 7 AuthorsA. J. Rush112
Estimated H-index: 112
(UTSW: University of Texas Southwestern Medical Center)
This study examined demographic and clinical correlates of DSM-IV major depressive disorder with melancholic features and assessed whether melancholic features were predictive of response to a selective serotonin reuptake inhibitor antidepressant.Participants with major depressive disorder (N = 2875) at primary and specialty care sites who received the first step treatment with citalopram in the Sequenced Treatment Alternatives to Relieve Depression study were included. Patients were enrolled be...
67 Citations Source Cite
John P. A. Ioannidis147
Estimated H-index: 147
(FORTH: Foundation for Research & Technology – Hellas)
Antidepressants, in particular newer agents, are among the most widely prescribed medications worldwide with annual sales of billions of dollars. The introduction of these agents in the market has passed through seemingly strict regulatory control. Over a thousand randomized trials have been conducted with antidepressants. Statistically significant benefits have been repeatedly demonstrated and the medical literature is flooded with several hundreds of "positive" trials (both pre-approval and po...
115 Citations Source Cite
Published on Jul 15, 2007in The Journal of Clinical Psychiatry 4.02
Daniel Souery45
Estimated H-index: 45
,
Pierre Oswald14
Estimated H-index: 14
+ 9 AuthorsAlessandro Serretti66
Estimated H-index: 66
OBJECTIVES: Very few studies have investigated clinical features associated with treatment-resistant depression (TRD) defined as failure of at least 2 consecutive antidepressant trials. The primary objective of this multicenter study was to identify specific clinical and demographic factors associated with TRD in a large sample of patients with major depressive episodes that failed to reach response or remission after at least 2 consecutive adequate antidepressant treatments. METHOD: A total of ...
254 Citations Source Cite
Cited By6
Newest
Published on Jan 1, 2019in Acta Psychiatrica Scandinavica 4.69
Alexander Kautzky9
Estimated H-index: 9
(Medical University of Vienna),
Markus Dold12
Estimated H-index: 12
(Medical University of Vienna)
+ 12 AuthorsChiara Fabbri16
Estimated H-index: 16
(UNIBO: University of Bologna)
1 Citations Source Cite
Published on Dec 1, 2018in BMC Psychiatry 2.67
Nicolas Nuñez3
Estimated H-index: 3
(McGill University),
Stefano Comai17
Estimated H-index: 17
(McGill University)
+ 10 AuthorsNicola Low51
Estimated H-index: 51
(McGill University)
Background Some authors have hypothesized that Treatment-Resistant Unipolar Depression (TRD-UP) should be considered within the bipolar spectrum disorders and that hidden bipolarity may be a risk factor for TRD-UP. However, there are neither studies comparing clinical and sociodemographic data of patients with TRD-UP versus Bipolar (BP) disorders nor are there any examining differences versus Bipolar type I (BP-I) and Bipolar type II (BP-II).
Source Cite
Published on Jul 1, 2018in Pharmacological Reviews 18.89
Filippo Caraci34
Estimated H-index: 34
,
Francesca Calabrese28
Estimated H-index: 28
(University of Milan)
+ 9 AuthorsSiegfried Kasper76
Estimated H-index: 76
(Medical University of Vienna)
Major depressive disorder is one of the most prevalent and life-threatening forms of mental illnesses and a major cause of morbidity worldwide. Currently available antidepressants are effective for most patients, although around 30% are considered treatment resistant (TRD), a condition that is associated with a significant impairment of cognitive function and poor quality of life. In this respect, the identification of the molecular mechanisms contributing to TRD represents an essential step for...
3 Citations Source Cite
Published on Jan 1, 2018in The International Journal of Neuropsychopharmacology 4.21
Ching-Hua Lin12
Estimated H-index: 12
(KMU: Kaohsiung Medical University),
Chun-Jen Huang3
Estimated H-index: 3
(KMU: Kaohsiung Medical University),
Cheng-Chung Chen19
Estimated H-index: 19
(KMU: Kaohsiung Medical University)
2 Citations Source Cite
Published on Jan 1, 2016in Journal of Affective Disorders 4.08
Martina Balestri8
Estimated H-index: 8
(UNIBO: University of Bologna),
Raffaella Calati27
Estimated H-index: 27
(University of Montpellier)
+ 6 AuthorsAlessandro Serretti66
Estimated H-index: 66
(UNIBO: University of Bologna)
Abstract Background Few studies investigated socio-demographic and clinical predictors of non response and remission in treatment resistant depression (TRD) in the case of failure of more than two adequate antidepressant (AD) trial. The primary aim of this study was to investigate socio-demographic and clinical predictors of TRD defined as the lack of response to at least three adequate AD treatments, two of which prospectively evaluated. As secondary aims, we also investigated predictors of non...
23 Citations Source Cite
Published on Nov 1, 2014in Annals of Clinical Psychiatry 1.29
Leonardo Zaninotto11
Estimated H-index: 11
,
Daniel Souery45
Estimated H-index: 45
+ 7 AuthorsAlessandro Serretti66
Estimated H-index: 66
BACKGROUND: Major depression (MD) is currently viewed as a heterogeneous condition, characterized by different psychopathological dimensions. METHODS: Our sample was composed of 1,289 nonpsychotic bipolar/unipolar depressed patients. Participants were divided into mixed (MXD), melancholic (MEL), and anxious (ANX) depressed, according to a hierarchical functional model. Sociodemographic and clinical variables were compared across depressive subtypes by χ2 test and analysis of variance. The Young ...
4 Citations