China
Africa
Explore chapters and articles related to this topic
The Management of Treatment-Resistant Depression
Published in Dr. Ather Muneer, Mood Disorders, 2018
Major depressive disorder (MDD) is an important cause of disability worldwide with significant impact on patients’ functioning and quality of life. Standard antidepressants are only effective for approximately one-third of MDD patients, as measured by remission, indicated by a score ≤ 7 on the 17-item Hamilton Rating Scale for Depression (HRSD). Furthermore, after multiple antidepressant trials, approximately one-third of patients still remain treatment resistant with substantial functional impairments. These figures are extrapolated from the results of the STAR*D (Sequenced Treatment Alternatives to Relieve Depression) trial, a very comprehensive and large clinical study on MDD.1 Treatment-resistant depression (TRD) is therefore a subject of high relevance as it seriously affects a significant proportion of MDD patients. While several definitions and staging models for TRD have been suggested, here this term will be used to broadly refer to an insufficient response to a single adequate trial of a first-line antidepressant. Of note, there is a lack of consensus on a unified definition of TRD, which is a limiting factor for progress in the field of MDD therapeutics.2Figure 8.1 gives a schematic representation of the phenomenon of TRD and illustrates that approximately 33% of patients with MDD remain symptomatic even after multiple trials of antidepressant medications.
Introduction
Published in Gueorguieva Ralitza, Statistical Methods in Psychiatry and Related Fields, 2017
The second data set is from the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) clinical trial (Gaynes et al.,2008; Trivedi et al., 2006). STAR*D is the largest randomized prospective study of outpatients with major depression to date. The first stage of this study was a 12-week course of citalopram, a selective serotonin reuptake inhibitor (SSRI) antidepressant and the outcome of interest was improvement in the total score from the Quick Inventory of Depression Symptomatology (QIDS) (Rush et al., 2006) questionnaire. Four thousand and nineteen subjects provided data on QIDS in the first phase. The total QIDS score is similar to the total HDRS score considered in the previous example and reflects total depression severity.
An Illustration of the Two-Tier Item Factor Analysis Model
Published in Steven P. Reise, Dennis A. Revicki, Handbook of Item Response Theory Modeling, 2014
We turn now to a real data application of the two-tier IFA model. The analysis discussed in this chapter is based on the item responses of 3,999 individuals who participated in the Sequenced Treatment Alternatives to Relieve Depression (STAR*D; Fava et al., 2003; Rush et al., 2004) trial.1 All participants satisfied DSM-IV criteria for nonpsychotic major depressive disorder, as indicated by a Hamilton Rating Scale for Depression (HAM-D) score of at least 14. The STAR*D studies were sponsored by the National Institute of Mental Health and conducted at 41 clinical outpatient facilities throughout the United States. Further information on the STAR*D trial and several publically available data sets can be found at www.star-d.org.
Associations of dysfunctional attitudes, ruminations and metacognitive beliefs about rumination with pharmacological treatment response in patients with first episode of major depression
Published in International Journal of Psychiatry in Clinical Practice, 2023
İlker Özben, Güliz Şenormancı, Onur Okan Demirci, Ömer Şenormancı
In STAR*D (Sequenced Treatment Alternatives to Relieve Depression) study, with its naturalistic design as one of the most important depression studies to date, only one-third of the cases fully remitted with the first-choice treatment application in the treatment of depression (Rush, 2007). It was also found that only 13% of the patients who did not respond well to initial antidepressant treatment could have full remission with the fourth drug treatment (Rush et al., 2006). In current treatment approaches, apart from pharmacological and biological treatment options, psychotherapy, especially CBT should be added to antidepressant treatment at all stages of depression treatment. This combination would increase the treatment response and remission rates in depression (Ijaz et al., 2018).
A comparison of real-world effectiveness of vortioxetine along the treatment algorithm for major depressive disorder
Published in Current Medical Research and Opinion, 2022
Rohini Bose, Syed Usman Hamdani, Fareed Aslam Minhas, Keira Joann Herr
Major depressive disorder (MDD), a condition defined by depressed mood and markedly reduced interest or pleasure, is one of the leading causes of disability worldwide1,2. Early and accurate diagnosis with appropriate treatment regimens are the key to achieving long-term treatment success3. The Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial shows that first-line treatment with an antidepressant elicits a response in approximately half of the patients and remission in roughly one-third. Subsequent second-line or later treatments are associated with even lower response and remission rates4. This evidence greatly underscores the importance of an appropriate choice of treatment earlier in the treatment paradigm. International guidelines recommend pharmacotherapy as first-line treatment for patients suffering from moderate-to-severe MDD5–8. While the use of selective serotonin-reuptake inhibitors is supported by the most evidence, their use is often associated with side effects, reduced treatment adherence and inadequate response.
Results of the European Group for the Study of Resistant Depression (GSRD) — basis for further research and clinical practice
Published in The World Journal of Biological Psychiatry, 2019
Lucie Bartova, Markus Dold, Alexander Kautzky, Chiara Fabbri, Marie Spies, Alessandro Serretti, Daniel Souery, Julien Mendlewicz, Joseph Zohar, Stuart Montgomery, Alexandra Schosser, Siegfried Kasper
The fact that 36.8% of the GSRD patients could be categorised as responders, 25.4% as non-responders and 37.8% as TRD patients underpins our postulation that the phenotype of TRD is best understood as a specific depressive state rather than a separate disease (Schosser et al. 2012b). This is corroborated by our finding that treatment response could be achieved in a third of antidepressant trials even after non-response to the previous two courses of antidepressant psychopharmacotherapy (Souery et al. 2015). This is of particular importance since a stepwise loss of antidepressant effectiveness with repeated antidepressant trials has been observed in BD-II (Amsterdam et al. 2016). Our postulation is further underlined by a meta-analysis performed by GSRD researchers. According to the results, early improvement of depressive symptoms lacks a reliable outcome predictor and, hence, antidepressant treatment should be continued in non-responding patients for at least 4 weeks regardless of the initial symptom severity and early signs of response (Olgiati et al. 2018). This concept is also supported by the fact that the majority of STAR*D patients achieved response or remission at or after 8 weeks of antidepressant treatment (Trivedi et al. 2006) or even later (Falola et al. 2017).