Clinical characteristics associated with the prescribing of SSRI medication in adolescents with major unipolar depression.
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ABSTRACT:
SUBMITTER: Cousins L
PROVIDER: S-EPMC5102956 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:ObjectiveTo classify a cohort of depressed adolescents recruited to the UK IMPACT trial, according to trajectories of symptom change. We examined for predictors and compared the data-driven categories of patients with a priori operational definitions of treatment response.MethodSecondary data analysis using growth mixture modelling (GMM). Missing data were imputed. Trajectories of self-reported depressive symptoms were plotted using scores taken at six nominal time points over 86 weeks from randomisation in all 465 patients.ResultsA piecewise GMM categorised patients into two classes with initially similar and subsequently distinct trajectories. Both groups had a significant decline in depressive symptoms over the first 18 weeks. Eighty-four per cent (84.1%, n = 391) of patients were classed as 'continued-improvers' with symptoms reducing over the duration of the study. A further class of 15.9% (n = 74) of patients were termed 'halted-improvers' with higher baseline depression scores, faster early recovery but no further improvement after 18 weeks. Presence of baseline comorbidity somewhat increased membership to the halted-improvers class (OR = 1.40, CI: 1.00-1.96). By end of study, compared with classes, a clinical remission cut-off score (≤27) and a symptom reduction score (≥50%) indexing treatment response misclassified 15% and 31% of cases, respectively.ConclusionsA fast reduction in depressive symptoms in the first few weeks of treatment may not indicate a good prognosis. Halted improvement is only seen after 18 weeks of treatment. Longitudinal modelling may improve the precision of revealing differential responses to treatment. Improvement in depressive symptoms may be somewhat better in the year after treatment than previously considered.
| S-EPMC7216986 | biostudies-literature
Project description:BackgroundPsychotic major depression (PMD) is a subtype of depression with a poor prognosis. Previous studies have failed to find many differences between patients with PMD and those with non-psychotic major depression (NMD) or schizophrenia (SZ). We compared sociodemographic factors (including season of conception) and clinical characteristics between patients with PMD, NMD, and schizophrenia. Our aim was to provide data to help inform clinical diagnoses and future etiology research.MethodsThis study used data of all patients admitted to Shandong Mental Health Center from June 1, 2016 to December 31, 2017. We analyzed cases who had experienced an episode of PMD (International Classification of Diseases, Tenth Revision codes F32.3, F33.3), NMD (F32.0-2/9, F33.0-2/9), and SZ (F20-20.9). Data on sex, main discharge diagnosis, date of birth, ethnicity, family history of psychiatric diseases, marital status, age at first onset, education, allergy history, and presence of trigger events were collected. Odds ratios (OR) were calculated using logistic regression analyses. Missing values were filled using the k-nearest neighbor method.ResultsPMD patients were more likely to have a family history of psychiatric diseases in their first-, second-, and third-degree relatives ([OR] 1.701, 95% confidence interval [CI] 1.019-2.804) and to have obtained a higher level of education (OR 1.451, 95% CI 1.168-1.808) compared with depression patients without psychotic features. Compared to PMD patients, schizophrenia patients had lower education (OR 0.604, 95% CI 0.492-0.741), were more often divorced (OR 3.087, 95% CI 1.168-10.096), had a younger age of onset (OR 0.934, 95% CI 0.914-0.954), less likely to have a history of allergies (OR 0.604, 95% CI 0.492-0.741), and less likely to have experienced a trigger event 1 year before first onset (OR 0.420, 95% CI 0.267-0.661). Season of conception, ethnicity, and sex did not differ significantly between PMD and NMD or schizophrenia and PMD.ConclusionsPMD patients have more similarities with NMD patients than SZ patients in terms of demographic and clinical characteristics. The differences found between PMD and SZ, and PMD and NMD correlated with specificity of the diseases. Furthermore, allergy history should be considered in future epidemiological studies of psychotic disorders.
| S-EPMC8004453 | biostudies-literature
Project description:The authors assessed whether subthreshold hypomanic symptoms in patients with major depression predicted new-onset mania or hypomania.The authors identified 550 individuals followed for at least 1 year in the National Institute of Mental Health Collaborative Depression Study with a diagnosis of major depression at intake. All participants were screened at baseline for five manic symptoms: elevated mood, decreased need for sleep, unusually high energy, increased goal-directed activity, and grandiosity. Participants were followed prospectively for a mean of 17.5 years and up to 31 years. The Longitudinal Interval Follow-up Examination was used to monitor course of illness and to identify any hypomania or mania. The association of subthreshold hypomanic symptoms at baseline with subsequent hypomania or mania was determined in survival analyses using Cox proportional hazards regression.With a cumulative probability of one in four on survival analysis, 19.6% (N=108) of the sample experienced hypomania or mania, resulting in revision of diagnoses for 12.2% to bipolar II disorder and 7.5% to bipolar I disorder. Number of subthreshold hypomanic symptoms, presence of psychosis, and age at illness onset predicted progression to bipolar disorder. Decreased need for sleep, unusually high energy, and increased goal-directed activity were specifically implicated.Symptoms of hypomania, even when of low intensity, were frequently associated with subsequent progression to bipolar disorder, although the majority of patients who converted did not have any symptoms of hypomania at baseline. These results suggest that continued monitoring for the possibility of progression to bipolar disorder is necessary over the long-term course of major depressive disorder.
| S-EPMC3042431 | biostudies-literature
Project description:Randomized controlled trials in depressed patients selected for elevated suicidal risk are rare. The resultant lack of data leaves uncertainty about treatment in this population. This study compared a serotonin reuptake inhibitor with a noradrenergic/dopaminergic antidepressant in major depression with elevated suicidal risk factors. We conducted a double-blind, randomized, clinical pilot trial of paroxetine (N=36) or bupropion (N=38) in DSM IV major depression with a suicide attempt history or current suicidal ideation. The effects during acute (8 weeks) and continuation treatment (up to 16 weeks) were measured. Main outcomes were suicidal behavior and ideation. The secondary outcome was modified 17-item Hamilton Depression Rating Scale score subtracting the suicide item (mHDRS-17). Treatment was not associated with time to a suicidal event and no treatment main effect or treatment × time interaction on suicidal ideation or mHDRS-17 was found. Exploratory model selection showed modest advantages for paroxetine on: (1) mHDRS-17 (p=0.02); and (2) in a separate model adjusted for baseline depression, for suicidal ideation measured with the Beck Scale for Suicidal Ideation (p=0.03), with benefit increasing with baseline severity. Depressed patients with greater baseline suicidal ideation treated with paroxetine compared with bupropion appeared to experience greater acute improvement in suicidal ideation, after adjusting for global depression. Given the lack of evidence-based pharmacotherapy guidelines for suicidal, depressed patients-an important public health population-this preliminary finding merits further study.
| S-EPMC3260969 | biostudies-other
Project description:Despite the high prevalence of depression, anxiety, and use of antidepressant medications during pregnancy, there is much uncertainty around the impact of high levels of distress or antidepressant medications on the developing fetus. These intrauterine exposures may lead to epigenetic alterations to the DNA during this vulnerable time of fetal development, which may have important lifetime health consequences. In this study we investigated patterns of genome-wide DNA methylation using the Illumina Infinium Human Methylation450 BeadChip in the umbilical cord blood of neonates exposed to non-medicated maternal depression or anxiety (n = 13), or selective serotonin reuptake inhibitors (SSRIs) during pregnancy (n = 22), relative to unexposed neonates (n = 23). We identified 42 CpG sites with significantly different DNA methylation levels in neonates exposed to non-medicated depression or anxiety relative to controls. CpG site methylation was not significantly different in neonates exposed to SSRIs relative to the controls, after adjusting for multiple comparisons. In neonates exposed either to non-medicated maternal depression or SSRIs, the vast majority of CpG sites displayed lower DNA methylation relative to the controls, but differences were very small. A gene ontology analysis suggests significant clustering of the top genes associated with non-medicated maternal depression/anxiety, related to regulation of transcription, translation, and cell division processes (e.g., negative regulation of translation in response to oxidative stress, regulation of mRNA export from the nucleus, regulation of stem cell division). While the functional consequences of these findings are yet to be determined, these small DNA methylation differences may suggest a possible role for epigenetic processes in the development of neonates exposed to non-medicated maternal depression/anxiety.
| S-EPMC4143411 | biostudies-literature
Project description: Not available
| S-EPMC8434915 | biostudies-literature
Project description:The study compared distress levels among two groups of older adults who had been newly prescribed an antidepressant by their primary care physician, those with major depressive disorder (MDD) and those without MDD.This analysis used a convenience sample of participants (N=231) who had been newly prescribed an antidepressant in a randomized controlled trial of a program to improve antidepressant adherence and depression outcomes among older adults (?55). After determining the proportion of participants with and without MDD (using the Structured Clinical Interview for DSM-IV), the authors compared groups on demographic, clinical, and psychosocial characteristics, including the 12-Item Short-Form Health Survey physical and mental component summary scores (PCS and MCS). Logistic regression was used to test the association of these characteristics with antidepressant use in the absence of MDD.Most (57%) participants did not have MDD. This group was older (69.4 versus 64.7, p<.001), had a larger proportion of white participants (82% versus 56%, p<.001), and reported better physical (PCS, 43.4 versus 39.9, p=.03) and emotional (MCS, 40.2 versus 30.5, p<.001) well-being compared with the group with MDD. In the final regression model, white race (adjusted odds ratio [AOR]=3.11, p=.03) and better emotional well-being (AOR=1.16, p<.001) were associated with antidepressant use in the absence of MDD.Older adults prescribed antidepressants in the absence of MDD did not report similar distress levels compared with their counterparts with MDD. Given the continued emphasis on screening for depression in primary care, it is important to consider the potential for overtreatment.
| S-EPMC5411328 | biostudies-literature
Project description:ObjectiveSubclinical or subthreshold depressive symptoms (StD) are frequent in adolescence and are related to suicidality and onset of depression in adulthood, however, their neurobiology is poorly understood. We examined the relationship between StD and subcortical grey matter structures in unmedicated adolescents with no history of axis I diagnosis.Methods277 youths from Chicago aged 14 years participated, undergoing a structural MRI scan and completing the Revised Children's Anxiety and Depression Scale (RCADS). Blood samples provided a composite of five pro-inflammatory cytokines. Regions of interest (ROI) for vertex-based surface analysis were the left and right amygdala, hippocampus, thalamus, caudate, nucleus accumbens, pallidum and putamen. Covariates were age, pubertal status, socioeconomic disadvantage and intracranial volume. Males and females were analysed separately.ResultsStD had positive associations (outward shape) with subcortical morphology in the right amygdala and left hippocampus in females, and the bilateral putamen and the left caudate, hippocampus and thalamus in males. However, we also found negative associations with StD (inward contractions) in the hippocampus in females and the caudate in males. Pro-inflammatory cytokines did not mediate the relationship between StD and outward morphology or volume.ConclusionThis is one of the first studies to examine subcortical morphology of basal ganglia and thalamic regions related to StD in adolescents, and the first study to report mostly positive associations between StD, volume and outward morphology in youths. These findings could reflect intact neurogenesis or resilience to depression, however longitudinal research is needed to further understand the neurobiology of StD in adolescents.
| S-EPMC6994704 | biostudies-literature
Project description:Melatonin is a neurohormone that maintains the circadian rhythms of the body. Although we know the pathway of melatonin action in the brain, we lack comprehensive cross-sectional studies on the periphery of depressed patients.
2021-03-24 | GSE169459 | GEO
Project description:BACKGROUND:Differentiating between unipolar and bipolar depression can be clinically challenging, especially at first presentation. Patterns of cortisol secretion could aid diagnostic discrimination in affective disorders although there has been little comparative research to date. In this study, we investigated acute (saliva) and chronic (hair) cortisol levels concurrently in unmedicated unipolar and bipolar disorders by using conventional diagnostic criteria and self-report measures. METHODS:Patients with unipolar and bipolar major depression and healthy controls were recruited and assessed. Cortisol levels were extracted from saliva and hair specimens. Depressive features were investigated according to diagnostic groups and with a continuous self-report measure of bipolarity using the Hypomania Checklist (HCL-33). RESULTS:Whilst a trend towards a reduction in the total daily salivary cortisol output-area under the curve with respect to the ground (AUCg)-was detected in depressive disorders across diagnosis, the self-administrated bipolarity index suggested that an increase in bipolarity symptoms predicted lower cortisol levels using AUCg. Chronic cortisol measurement did not discriminate unipolar from bipolar depression. CONCLUSION:Results suggested that whilst a low total daily salivary cortisol output (AUCg) might be associated with depressive symptoms, a self-reported measure of bipolarity predicts lower daily cortisol output.
| S-EPMC7056775 | biostudies-literature