Average Hamilton Depression Rating Scale Research Articles

Journal Digest: Post-COVID Depression; Locus Coeruleus and Alzheimer’s; CY-BOCS Reliability; and More

Journal Digest: Post-COVID Depression; Locus Coeruleus and Alzheimer’s; CY-BOCS Reliability; and More

Agomelatine might be more appropriate for elderly, depressed, type 2 diabetes mellitus patients than paroxetine/fluoxetine.

Agomelatine was a novel and melatonergic antidepressant. The present study was conducted to find out whether age was an important factor for agomelatine in treating depressed type 2 diabetes mellitus (T2DM) patients. In total, 193 depressed T2DM patients were included. There were 84 patients ranged from 27 years old to 49 years old (age phase I) (n = 44 receiving agomelatine, n = 40 receiving paroxetine or fluoxetine), and 109 patients ranged from 50 years old to 70 years old (age phase II) (n = 56 receiving agomelatine, n = 53 receiving paroxetine or fluoxetine). The Hamilton Depression Rating Scale (HDRS) score, Hamilton Anxiety Rating Scale (HARS) score, fasting plasma glucose (FPG), hemoglobin A1c (HbA1c) level and body mass index (BMI) were assessed after 12 weeks treatment. After treatment, we found that among patients in age phase I, there were no significant differences in final average HDRS score, HARS score, FPG, HbA1c level, BMI, response rate and remission rate between the two groups. However, among patients in age phase II, compared to patients receiving paroxetine or fluoxetine, patients receiving agomelatine had the significantly lower average HDRS score, HARS score, HbA1c level and BMI, and significantly higher response rate and remission rate. The incidence of treatment-related adverse events was similar between the two groups in both age phases. These results suggested that age was an important factor for agomelatine in treating depressed T2DM patients. Compared to paroxetine/fluoxetine, agomelatine might be more appropriate for elderly depressed T2DM patients.

One (effect) size does not fit at all: Interpreting clinical significance and effect sizes in depression treatment trials.

The efficacy of antidepressants in major depressive disorder has been continually questioned, mainly on the basis of studies using the sum-score of the Hamilton Depression Rating Scale as a primary outcome parameter. On this measure antidepressants show a standardised mean difference of around 0.3, which some authors suggested is below the cut-off for clinical significance. Prompted by a recent review that, using this argument, concluded antidepressants should not be used for adults with major depressive disorder, we (a) review the evidence in support of the cut-off for clinical significance espoused in that article (a Hamilton Depression Rating Scale standardised mean difference of 0.875); (b) discuss the limitations of average Hamilton Depression Rating Scale sum-score differences between groups as measure of clinical significance; (c) explore alternative measures of clinical importance; and (d) suggest future directions to help overcome disagreements on how to define clinical significance. We conclude that (a) the proposed Hamilton Depression Rating Scale cut-off of 0.875 has no scientific basis and is likely misleading; (b) there is no agreed upon way of delineating clinically significant from clinically insignificant; (c) evidence suggests the Hamilton Depression Rating Scale sum-score underestimates antidepressant efficacy; and (d) future clinical trials should consider including measures directly reflective of functioning and wellbeing, in addition to measures focused on depression psychopathology.

Efficacy of ginkgo biloba extract as augmentation of venlafaxine in treating post-stroke depression.

BackgroundPost-stroke depression (PSD) is one of the most common psychiatric diseases afflicting stroke survivors. This study was conducted to assess the efficacy of ginkgo biloba extract as augmentation of venlafaxine in treating PSD.MethodsThe included PSD patients were randomly assigned into the experiment group (receiving ginkgo biloba extract plus venlafaxine) and control group (receiving venlafaxine alone). The treatment was continued for eight weeks. The Hamilton Depression Rating Scale (HDRS) and the Self-rating Depression Scale (SDS) were used to assess the depressive symptoms. The National Institutes of Health Stroke Scale (NIHSS) was used to assess the neurological defect, and the Activities of Daily Living (ADL) was used to assess recovery of abilities of patients after stroke. Meanwhile, the levels of serum 5-hydroxytryptamine (5-HT) and brain-derived neurotrophic factor (BDNF) were measured before and after treatment. The dose of venlafaxine used and adverse events were also recorded.ResultsEach group had 40 PSD patients. After treatment, the depressive symptoms, neurological defect and living function were significantly improved in both groups. But the patients receiving ginkgo biloba extract plus venlafaxine had the significantly lower average HDRS score (p=0.0008), SDS score (p<0.00001), NIHSS score (p=0.00001), and higher average ADL score (p=0.0005). Meanwhile, compared to the control group, patients in the experiment group had the significantly higher 5-HT (p<0.00001) level and BDNF level (p<0.00001), needed lower dose of venlafaxine (p=0.007), and experienced fewer adverse events.ConclusionThese results demonstrated that the ginkgo biloba extract was a good augmentation of venlafaxine in treating PSD and should be further investigated.

Efficacy of betahistine plus cognitive behavioral therapy on residual dizziness after successful canalith repositioning procedure for benign paroxysmal positional vertigo.

BackgroundSome patients still complain of residual dizziness after successful canalith repositioning procedure (CRP) for benign paroxysmal positional vertigo (BPPV). Previous study found that compared to the low-dose betahistine, the high-dose betahistine could yield better efficacy in treating residual dizziness. Therefore, this study was conducted to assess whether the addition of cognitive behavioral therapy (CBT) could make low-dose betahistine produce similar results to high-dose betahistine in treating residual dizziness.MethodsThe recruited patients were randomly assigned to receive either low-dose betahistine (6 mg/time, three times/day) or high-dose betahistine (12 mg/time, three times/day). Patients in the low-dose group also received CBT (twice a week, 1 hour per time). The treatment was continued for 4 weeks. The duration of residual dizziness, 25-item Dizziness Handicap Inventory (DHI), Hamilton Anxiety Rating Scale (HARS), and Hamilton Depression Rating Scale (HDRS) were recorded and analyzed. The duration of residual dizziness and DHI score were the primary outcomes, and the HARS and HDRS scores were the secondary outcomes.ResultsEach group had 50 patients. After treatment, the average DHI scores, HDRS scores, and HARS scores were significantly decreased in both groups. The duration of residual dizziness and average DHI score were nonsignificantly different (P=0.08; P=0.06) between the two groups, although they were lower in the low-dose group. Compared to the high-dose group, the low-dose group had the significantly lower average HDRS score (P=0.007) and HARS score (P=0.02). Meanwhile, four patients in the high-dose group experienced intolerable stomach upset.ConclusionThese results demonstrated that the addition of CBT could make low-dose beta-histine produce similar results to high-dose betahistine in treating residual dizziness. Moreover, the low-dose betahistine plus CBT showed some advantages over high-dose betahistine in relieving depressive and anxiety symptoms and should be further explored.

Efficacy and safety of high-frequency repetitive transcranial magnetic stimulation for post-stroke depression: A systematic review

Objective To evaluate the efficacy and safety of high-frequency repetitive transcranial magnetic stimulation (rTMS) in the treatment of post-stroke depression (PSD). Methods The Cochrane Library, Medline, EMbase and CBMdisc were electronically searched for reports of randomized and controlled trials (RCTs) of high-frequency rTMS in the treatment of PSD before October 2017. Two researchers screened the reports independently, extracted data and assessed the risk of bias in the included studies. The meta-analysis was performed using version 5.1 of the RevMan software. Results A total of 26 RCTs were included, covering 1810 patients with PSD. The meta-analysis showed that the remission rate [relative risk (RR)=2.15, 95%CI (1.64, 2.83)] and the effectiveness [RR=1.66, 95%CI (1.28, 2.15)] of high-frequency rTMS group were significantly higher than in the control groups. Compared with the control group, the average Hamilton depression rating scale (HAMD) score of the high-frequency rTMS groups was significantly lower than in the control groups. There was no significant difference in withdrawal between the two groups after treatment [RR=0.55, 95%CI (0.18, 1.65)]. The incidence of headaches was significantly higher in the high-frequency rTMS group than among the controls. Conclusion High-frequency rTMS has a good curative effect and better acceptability for PSD patients, but attention should be given to headaches and other adverse reactions. Due to the limited number of studies and their quality, these conclusions still need to be verified in better-quality studies. Key words: High-frequency magnetic stimulation; Transcranial magnetic stimulation; Magnetic stimulation; Depression; Stroke

Agomelatine versus fluoxetine in glycemic control and treating depressive and anxiety symptoms in type 2 diabetes mellitus subjects: a single-blind randomized controlled trial

BackgroundDepressive and anxiety symptoms could seriously affect the quality of life of type 2 diabetes mellitus (T2DM) subjects. Currently, little is known about the efficacy and acceptability of agomelatine versus fluoxetine in treating these symptoms in T2DM subjects. Therefore, this study was performed to find out which one was better in treating these symptoms in T2DM subjects.Materials and methodsT2DM subjects with depressive and anxiety symptoms were randomly assigned to receive either fluoxetine (30–40 mg/day) or agomelatine (25–50 mg/day). The treatment was continued for 12 weeks. The data of the Hamilton Depression Rating Scale (HDRS) and Hamilton Anxiety Rating Scale (HARS) were collected (at baseline and also at weeks 4, 8 and 12) to assess the depressive and anxiety symptoms, respectively. The metabolic parameters, including body mass index (BMI), fasting plasma glucose (FPG) and hemoglobin A1c (HbA1c), were assessed at baseline and after 12 weeks of treatment. The treatment-related adverse events during the scheduled treatment period were recorded to compare the acceptability of these two drugs.ResultsAfter 12 weeks of treatment, the average HDRS and HARS scores were significantly decreased in both groups. The average HDRS scores were not significantly different between the two groups, although the agomelatine group had a lower average HDRS score. The response and remission rates were similar between the two groups, and these two drugs had no significant effects on BMI and FPG. However, compared with the fluoxetine group, the agomelatine group had the significantly lower average HARS score (p=0.0017) and lower average HbA1c level (p<0.00001). Moreover, the incidence of adverse events was significantly lower in the agomelatine group than in the fluoxetine group (p=0.032).ConclusionBoth fluoxetine and agomelatine could effectively reduce depressive and anxiety symptoms in T2DM subjects, but agomelatine might be more effective and acceptable. Future studies with more subjects are needed to support and validate our conclusion.

Agomelatine versus paroxetine in treating depressive and anxiety symptoms in patients with chronic kidney disease.

ObjectiveDepressive and anxiety symptoms could affect the quality of life and prognostic outcomes in chronic kidney disease (CKD) patients, but only a few studies focus on the interventions to manage or prevent these symptoms in CKD patients. Therefore, this study was conducted to compare the efficacy and acceptability of agomelatine versus paroxetine in treating depressive and anxiety symptoms in CKD patients.MethodsCKD stage 2–4 patients with depressive and anxiety symptoms were included. The first patient was randomized in April 2013 and the last clinic visit occurred in March 2017. The included patients were randomly assigned to receive paroxetine 20–40 mg/day or agomelatine 25–50 mg/day. The treatment was continued for 12 weeks. The Hamilton Depression Rating Scale (HDRS) (17-item) and Hamilton Anxiety Rating Scale (HARS) were the primary outcome measures, and the response rate, remission rate, and Activities of Daily Living (ADL) scale were the secondary outcome measures. Meanwhile, the adverse events were recorded during the whole treatment period.ResultsAt baseline and week 4, both groups had similar average HDRS and HARS scores. But at week 8 and 12, compared to the patients receiving paroxetine, the patients receiving agomelatine had significantly lower average HDRS scores (p=0.002, p=0.001, respectively) and HARS scores (p<0.00001, p<0.00001, respectively). At week 12, the patients receiving agomelatine had a non-significantly lower average ADL score, and non-significantly higher response and remission rates. The adverse events in both groups were mild and transient.ConclusionThese results demonstrated that the agomelatine had some advantages over par-oxetine in treating CKD stage 2–4 patients with depressive and anxiety symptoms, and future studies are needed to further explore its efficacy and acceptability.

Efficacy of Bupropion XR in Treatment-Resistant Elderly Patients

Many of the patients with depression fail to achieve an adequate response to a given antidepressant. Depression is often overlooked in elderly persons, which may produce a greater risk of suicide in this age group. The antidepressive characteristic of bupropion has been already validated in several studies. However, to the best of our knowledge, there is no research concerning treatment-resistant depressive elderly patients with bupropion. We present a consecutive series of elderly patients (13 subjects: 6 men and 7 women) with major depression. All patients were older than 60 years, with diagnosis of major depressive disorder according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition and were treatment resistant. Patients were treated openly for 6 weeks with bupropion XR (300 mg/d). Efficacy was assessed at baseline and every 3 weeks using the Hamilton Depression Rating Scale, the Montgomery-Asberg Depressive Rating Scale, and the Clinical Global Impression--Severity of Illness Scale. The treatment was generally well tolerated without serious events. In all patients, the average Hamilton Depression Rating Scale scores diminished from 41.1 to 17.2 at the sixth week (P < 0.0001), the Montgomery-Asberg Depressive Rating Scale scores diminished from 44.0 to 19.9 (P < 0.0001), and Clinical Global Impression-Severity of Illness scores diminished from 5.7 to 3.2 (P < 0.0001). Of the 13 patients, 9 patients had marked and very marked improvement, and 4 patients did not demonstrate any mental state change. Treatment-resistant depressive elderly patients positively responded to and tolerated bupropion XR well. This case series demonstrates that bupropion could be a promising alternative therapy for elderly patients with treatment-resistant major depressive disorder. Further randomized controlled studies are necessary.

Deep TMS in a resistant major depressive disorder: a brief report

Repetitive transcranial magnetic stimulation (rTMS) has proven effective. Recently, a greater intracranial penetration coil has been developed. We tested the efficacy of the coil in the treatment of resistant major depression. Our sample included seven patients suffering from major depression who were treated using Brainsway's H1-coil connected to a Magstim rapid 2 stimulator. Deep TMS treatment was given to each patient in five sessions per week over a period of 4 weeks. Patients were treated with 120% intensity of the motor threshold and a frequency of 20 HZ with a total of 1,680 pulses per session. Five patients completed 20 sessions: one attained remission (Hamilton Depression Rating Scale (HDRS)=9); three patients reached a reduction of more than 50% in their pre-treatment HDRS; and one patient achieved a partial response (i.e., the HDRS score dropped from 21 to 12). Average HDRS score dropped to 12.6 and average Hamilton Anxiety Rating Scale score dropped to 9.Two patients dropped out: one due to insomnia and the second due to a lack of response. Compared to the pooled response and remission rates when treating major depression with rTMS, deep TMS as used in this study is at least similarly effective. Still, a severe limitation of this study is its small sample size, which makes the comparison of the two methods in terms of their effectiveness or side effects impossible. Greater numbers of subjects should be studied to achieve this aim. An H1 deep TMS coil could be used as an alternative treatment for major depressive disorder.

FC01-03 - Deep brain stimulation of subcallosal cingulate gyrus for treatment resistant depression

BackgroundDeep brain stimulation (DBS) of the subcallosal cingulate gyrus (SCG) has been suggested to improve depressive symptoms in treatment-resistant depression (TRD). We now report preliminary results of DBS and one-year follow up in six patients.MethodsSix patients with severe TRD (Thase Resistance Index&gt;4) underwent DBS surgery and subsequent monthly assessments. DBS response was defined as ≥50% reduction in the 17-item Hamilton Depression Rating Scale (HDRS) or HDRS&lt; 8 (remission). Electrodes location was assessed in each patient by means of pre/post-DBS MRIs co-registration.ResultsDBS led to early and late reductions of average HDRS (from 22.5 to 9.8 and 6.25 respectively, see Figure 1 for evolution of HDRS mean scores). One month after surgery 16.7% of patients met criteria for response and for remission. Three months after response rates increased to 66.7% while remission rates were maintained. At six months, 66.7% of patients were responders. After 9 months, response rates arose up to 83.4% and these rates were largely maintained at 12 months. Remission rates showed similar growth over follow-up. No substantial differences were observed in electrodes location, and they were not found to be related to response or remission rates. The number of serious adverse effects was small with no patient experiencing permanent deficits.ConclusionsThis study suggests that DBS is relatively safe and provides significant improvement in patients with TRD. Improvement on average seems to be linearly progressive and, once melioration is achieved, it is maintained for at least one year. The procedure is well tolerated.

Identifying and managing depression in women.

Depression is a complex disease often occurring with comorbid mental health or medical illnesses. It is highly prevalent and treated most frequently by a primary care physician (PCP). Depression affects the total health status of the patients who have it, and depression patients with comorbidities generally experience worse outcomes. It is also one of the most costly chronic illnesses, as measured by absenteeism and reduced productivity at work, direct medical costs, and suicide-related costs. Despite its high prevalence and being a frequent illness encountered during clinic visits, depression presents many challenges for the PCP in diagnosing and managing the illness and in bringing a patient to full remission. But depression is a highly treatable disorder. With appropriate diagnosis and intervention, depression can be reversed and most patients return to normal functioning. To provide an overview of a case study of a 24-month, managed care, depression care management program that incorporated a bilayered approach to optimize patient outcomes. Patients being treated for depression by a PCP were assigned a care coach who provided educational and goal-setting training by telephone. Psychiatric medical directors were involved in overseeing the treatment plan and consulted with PCPs to optimize treatment plans. Initial outcomes of this program indicate that it was successful in improving patient care and also in reducing overall costs associated with a depressed population. Results included a reduction in the average Hamilton Depression Rating Scale from 10.4 to 5.6, a 56% reduction in hospital admissions for depression, and an 18% total reduction in health care costs per member per month.

Interventions Can Alleviate Demoralization

Back to table of contents Previous article Next article Professional NewsFull AccessInterventions Can Alleviate DemoralizationJoan Arehart-TreichelJoan Arehart-TreichelSearch for more papers by this authorPublished Online:3 Jun 2005https://doi.org/10.1176/pn.40.11.00400010aSome evidence from American studies buttresses that from Italian research that demoralization is common among persons who have heart disease, cancer, or other kinds of medical conditions (see story above).The American evidence comes from James Griffith, M.D., and Lynne Gaby, M.D., of the consultation-liaison psychiatry faculty at George Washington University Medical Center in Washington, D.C.Griffith told Psychiatric News that several years ago he and Gaby reviewed 100 psychiatric consultations that had been conducted either by themselves or by psychiatry residents they supervised. All of the consultations had been undertaken in response to medical and surgical colleagues' request to “evaluate and treat a patient's depression,” which is the most common reason why medical colleagues ask them to consult on their cases.Griffth and Gaby found that in 52 of the 100 consultations, patients had been given “a depressive disorder” as the primary psychiatric diagnosis (the average Hamilton Depression Rating Scale score was 20), whereas in the remaining 48 consultations, patients had been given“ demoralization” as the primary psychiatric descriptor (the average Hamilton score was 11, which is just higher than the normal range).Thus, demoralization rather than a mood disorder was the major problem for many of these patients, Griffith said.Moreover, Griffith continued, “We have learned that these patients respond quickly and robustly to two kinds of interventions.... [The interventions are] taking immediate steps at the bedside to relieve either physical or emotional suffering and helping patients regain a sense of hope or dignity or purpose in living that they lost.”For example, Griffith explained, a psychiatrist can do the following:Normalize the patient's distress. State to the patient, “I do not believe that you have a psychiatric disorder. You are someone coping normally with a hard situation. Almost anyone would feel as badly as you are feeling in this situation.”Inquire about the patient's priority of concerns. Ask, for example,“ What are you most concerned about?”Partner with the patient in managing some aspect of the situation. This might be relieving physical suffering, such as physical pain, nausea, or insomnia; mobilizing friends or family to visit; or making a phone call to get financial affairs in order.Ask existential questions that mobilize resilience. For example:“ During hard times like this, from where do you draw hope?”“ Which people or what things give you reason to want to live?”Griffith and Gaby offered other suggestions on how to help demoralized patients, as well as vignettes illustrating those suggestions, in the April Psychosomatics.The article “Brief Psychotherapy at the Bedside: Countering Demoralization From Medical Illness” is posted online at<http://psy.psychiatryonline.org/cgi/content/full/46/2/109>.▪ Psychosomatics 2005 46 109 ISSUES NewArchived

ECT Need Not Be Treatment Of Last Resort, Data Suggest

ECT Need Not Be Treatment Of Last Resort, Data Suggest

Antidepressants: Partial Response in Chronic Depression

Although most studies of chronic depression show significant improvements with antidepressants versus placebo, the average Hamilton Depression Rating Scale results attained in the active-treatment group range between 10 and 14, suggesting that many patients only partially responded and failed to reach premorbid levels of symptom remission. Studies on the fate of these patients suggest that they are much more vulnerable to relapse, work impairment and suicide. Thus, partial response may be one form of treatment resistance, falling between total failure of response in a minority of patients, and a tendency to relapse or recur despite adequate maintenance treatment. Further study is needed to address the problem of improving the quality of response and attempting to reduce the detrimental effects of depressive illness in terms of relapse and recurrence.

A Controlled Trial of Adinazolam versus Desipramine in Geriatric Depression

Thirty outpatients between the ages of 60 and 85 with DSM-III Major Depression entered an 8 week randomized, double-blind comparison of desipramine and adinazolam mesylate, a triazolobenzodiazepine derivative. Outcome was assessed on several measures including the Hamilton Depression Rating Scale (HDRS), Montgomery-Asberg Rating Scale, Clinical Global Impressions (CGI), the 35-item Self-Rating Symptom Scale, and Carroll Depression Scale. Patients in both groups demonstrated a highly significant decrease in average HDRS scores (p less than 0.001) over the course of the study. Adinazolam was associated with significantly greater reduction in average HDRS scores by the third day. Repeated measures analysis of variance showed a significantly greater reduction in HDRS scores for adinazolam over the course of the study. The study medications were associated with distinct patterns of adverse reactions. Desipramine more often produced dry mouth, constipation and nervousness, while adinazolam was more likely to cause drowsiness and lightheadedness. Three of these elderly patients, all of whom were taking desipramine reported at least one fall during the study. Adinazolam may be a promising agent in the treatment of depression in the elderly.