Remitter Rates Research Articles

Safety and Efficacy of Mirtazapine Compared to Sertraline in Hemodialysis Patients with Major Depressive Disorder: A Randomized Controlled Clinical Trial

Background: This study aimed to compare the efficacy and tolerability of mirtazapine and sertraline in moderately depressed patients undergoing chronic hemodialysis therapy. Methods: In this double-blind clinical study, 54 hemodialysis patients diagnosed with moderate to severe depression, scoring greater than 18 on the Beck Depression Inventory, version II (BDI-II), were randomly assigned to receive 12 weeks of treatment with either mirtazapine (15mg/day) plus placebo or sertraline (50 mg/day) plus placebo. Efficacy outcomes were assessed by evaluating changes in baseline BDI-II scores, as well as rates of response and remission at weeks 2, 4, 8, and 12 of treatment. The impact of the antidepressant treatment on the patient’s health-related quality of life was also assessed at the end of the treatment phase, with ratings ranging from 0 (the worst impact) to 10 (the best impact). Safety and tolerability of the study medications were monitored using an antidepressant side effect checklist and through spontaneous participant reports. Both efficacy and tolerability analyses were conducted on the intent-to-treat sample. The p-values less than 0.01 based on Bonferroni's multiple-testing correction method were considered statistically significant. Results: The mixed models for repeated measures analysis revealed a significant time effect on depression symptoms (p < 0.001), indicating improvement in both treatment groups over the study period. However, the treatment effect was not significant (p = 0.160), suggesting no overall difference in depressive symptoms between groups. The interaction between time and treatment was significant (p = 0.020), indicating varying changes in depressive symptoms over time between treatment groups. At week two, patients receiving mirtazapine had a lower mean BDI-II score than those receiving sertraline (15.62±5.24 versus 18.92±5.03), but the difference between the groups was not statistically significant (p-value = 0.022). Subsequent assessments at weeks 4, 8, and 12 showed comparable mean BDI-II scores between both treatment groups. Furthermore, at all assessment points, the rate of responders (≥50% reduction in BDI-II total score from baseline) and the rate of remitters (BDI-II total score of <10) were similar between the treatment groups. However, mirtazapine- treated patients scored higher in assessing the overall impact of the treatment on their quality of life compared to the sertraline-treated group (7.40±1.18 versus 6.51±1.15 p-value = 0.007). Regarding safety and tolerability, although there were differences in the pattern of adverse effects between the treatment groups, the proportion of patients experiencing at least one adverse effect and the rate of dropouts were similar between the two groups, indicating comparable tolerability for both medications. Conclusion: Our results suggest that the efficacy and tolerability of mirtazapine are equivalent to those of sertraline in treating moderate depression in hemodialysis patients. However, mirtazapine appears to have a more favorable effect on patients' health-related quality of life compared to sertraline. Trial Registration: The trial was registered at the Iranian Registry of Clinical Trials (https://www. irct.ir/trial/66756, identifier code: IRCT20120215009014N445). Registration date: 2022-11-09.

Migrants’ Remittances, Agricultural Producer Service and Wage Inequality in the Dual Economy

Previous literature finds that migrants’ remittance narrows down wage inequality between skilled and unskilled labor, since the external funds flow into the rural area and raise wage rate of unskilled labor. However, it should be noted that the structure of agricultural production has also changed and small-scale agriculture utilizes remittance to purchase producer service that could substitute unskilled labor. The paper establishes three-sector general equilibrium models and theoretically analyzes the impact of an increase in remittance rate on wage inequality between skilled and unskilled labor. In the primary stage of service sector, an increase in remittance rate reduces both skilled and unskilled wage rate and has an ambiguous impact on wage inequality. The obtained result of wage inequality is robust even when we extend the basic theoretical model by considering the popularization stage of service sector.

The association of ARRB1 polymorphisms with response to antidepressant treatment in depressed patients.

Introduction: β-arrestin 1, a protein encoded by ARRB1 involved in receptor signaling, is a potential biomarker for the response to antidepressant drug (ATD) treatment in depression. We examined ARRB1 genetic variants for their association with response following ATD treatment in METADAP, a cohort of 6-month ATD-treated depressed patients. Methods: Patients (n = 388) were assessed at baseline (M0) and after 1 (M1), 3 (M3), and 6months (M6) of treatment for Hamilton Depression Rating Scale (HDRS) changes, response, and remission. Whole-gene ARRB1 variants identified from high-throughput sequencing were separated by a minor allele frequency (MAF)≥5%. Frequent variants (i.e., MAF≥5%) annotated by RegulomeDB as likely affecting transcription factor binding were analyzed using mixed-effects models. Rare variants (i.e., MAF<5%) were analyzed using a variant set analysis. Results: The variant set analysis of rare variants was significant in explaining HDRS score changes (T = 878.9; p = 0.0033) and remission (T = -1974.1; p = 0.034). Rare variant counts were significant in explaining response (p = 0.016), remission (p = 0.022), and HDRS scores at M1 (p = 0.0021) and M3 (p=<0.001). rs553664 and rs536852 were significantly associated with the HDRS score (rs553664: p = 0.0055 | rs536852: p = 0.046) and remission (rs553664: p = 0.026 | rs536852: p = 0.012) through their interactions with time. At M6, significantly higher HDRS scores were observed in rs553664 AA homozygotes (13.98 ± 1.06) compared to AG heterozygotes (10.59 ± 0.86; p = 0.014) and in rs536852GG homozygotes (14.88 ± 1.10) compared to AG heterozygotes (11.26 ± 0.95; p = 0.0061). Significantly lower remitter rates were observed in rs536852GG homozygotes (8%, n = 56) compared to AG heterozygotes (42%, n = 105) at M6 (p = 0.0018). Conclusion: Our results suggest ARRB1 variants may influence the response to ATD treatment in depressed patients. Further analysis of functional ARRB1 variants and rare variant burden in other populations would help corroborate our exploratory analysis. β-arrestin 1 and genetic variants of ARRB1 may be useful clinical biomarkers for clinical improvement following ATD treatment in depressed individuals. Clinical Trial Registration: clinicaltrials.gov; identifier NCT00526383.

0452 Lemborexant Treatment of Older Adults with Insomnia and Objective Short Sleep: Rates of Response and Remission

Abstract Introduction In Phase 3 Study 304 (NCT02783729), lemborexant (LEM) provided significant benefit versus placebo (PBO) on polysomnographic (PSG) endpoints and sleep diary-based sleep onset and maintenance outcomes over 1mo in subjects with insomnia disorder. The study also included the Insomnia Severity Index (ISI) to ensure sufficient insomnia severity at baseline (ISI total score ≥13) and for use as an outcome measure. Subjects met criteria for insomnia disorder and were confirmed to spend between 7-9 hours in bed. Subjects had insomnia with objective short sleep (ISS; [total sleep time; TST] &amp;lt;6hrs) or objective long sleep (TST ≥6hrs). Since patients with ISS may respond less well to therapeutic approaches such as cognitive behavioral therapy for insomnia (CBT-I), we examined rates of response and remission with LEM as defined by the ISI in the ISS subgroup. Methods Study 304 was a 1mo, randomized, double-blind, PBO- and active-controlled, parallel-group study in female (age ≥55y) and male (age ≥65y) subjects (n=1006). Subjects received PBO, LEM 5mg (LEM5), LEM 10mg (LEM10), or zolpidem tartrate extended-release 6.25 mg (not reported). Baseline PSGs were obtained during a single-blind PBO run-in, followed by paired PSGs on Nights 1/2 and Nights 29/30. The ISI was given at baseline and end of treatment. For these post-hoc analyses, responders were defined as subjects whose decrease from baseline on the ISI was ≥7pts, while remitters achieved ISI total scores &amp;lt;8pts. LEM5 and LEM10 vs PBO differences were evaluated using chi-square tests. Results 525/743 (70.66%) of subjects in the PBO/LEM groups were in the ISS subgroup. For LEM5, 99/176 (56.25%) were responders and 49/176 (27.84%) were remitters. For LEM10, 97/180 (53.89%) were responders and 50/180 (27.78%) were remitters. For the PBO group, 59/140 (42.14%) were responders and 21/140 (15.00%) were remitters. The responder and remitter rates for LEM5 and LEM10 were statistically significantly greater than those for PBO (all P&amp;lt;0.05). Conclusion Older adults with ISS achieved clinically meaningful improvement with LEM as assessed at the end of one month of treatment, with nearly 30% considered remitters and &amp;gt;50% considered treatment responders. LEM is a potential therapy for ISS patients who may have limited response to CBT-I. Support (If Any) Eisai Inc.

Diaspora remittances and development of small and medium enterprises in Benin-City, Nigeria

The study examined diaspora remittances and the development of small and medium enterprises (SMEs) in Benin-City. The objective of the study is to establish the impacts of diaspora remittances on the development of SMEs in Benin- City. The survey approach involved an online study. The major sources of data used were primary and secondary data. The primary data were elicited through the use of an online questionnaire. The data were analyzed and presented using a statistical technique such as tables and percentages. The secondary data adopted a longitudinal research design covering the period 1991-2018, which is readily available in World Bank data. The technique adopted is multiple regressions to test the hypothesis. E-view econometric software 8.0 was used for the analysis. The result revealed that in the long run, migrant remittance (MRI) and exchange rate (EXCR) which is a supporting variable have a positive and significant impact on the development of small and medium enterprises (DSMEs) in Nigeria. The result also revealed that most diaspora remittances are on consumption. Based on the above findings, it was recommended that the government should develop a policy framework that will harness the effort of diaspora toward the development of the economy of the state, and Edo state government should collaborate with agencies in charge of remittances to remove all encumbrances to remittances to encourage the diaspora to improve on their remittances.

Multiarticular chronic tophaceous gout: A benign disorder with malignant presentation

Gout is a metabolic disorder caused by deposition of MSU (monosodium urate crystals ) in joints and associated inflammatory reaction to it. It usually affects elderly men and postmenopausal women. Chronic tophaceous gout takes usually 10 years to appear due to recurrent episodes of gouty arthritis. Our case is a 55 year male person with multiarticular tophaceous gouty arthritis. Pharmacological treatment has high remittance rate. Surgical treatment is seldom required for gout and isusually reserved for cases of recurrent attacks with deformities, severe pain, infection and joint destruction. Our case is interesting due to the fact that it is early onset and treated only by pharmacological means.

Rural-urban migration with remittances and welfare analysis

Given the growing importance of rural-urban migration with remittances to rural development and urban income inequality, this paper proposes a theoretical model to investigate unskilled migration with remittances and the relevant welfare implications. Migrants remit part of their wage incomes to support their families of origin out of distinct motivations. The adequate explanation for this behavior may be “enlightened self-interest.” Alongside that, we introduce the mental cost of migration, which means that both migrants and remaining members suffer when migrants leave their families and generate the utility loss. We then construct a modified Melitz model with these ingredients to examine the urbanization process and corresponding welfare issues. The results show that when the remittance increases, it will enlarge the inequality between entrepreneurs and migrant workers. Moreover, when the trade cost is relatively small, the average utility level of migrant households is increasing in the remittance rate. Finally, we employ a numerical approach to simulate the optimal remittance rate and compare the results of different scenarios.

Migrant remittance, agricultural producer services, and environmental pollution

ABSTRACT This paper established ageneral equilibrium model to study the effects of the changes of remittance rate in the migrant workers’ income on environmental pollution. We found that, in the capital specific case, the increase of urban-rural migrants’ remittance rate will increase the total remittance of the migrant workers, increase the demand of agricultural sector for agricultural producer services and decrease the environmental level, but it has no influence on the output level of the urban industrial sector; and in the mobile capital case, the increase of urban-rural migrants’remittance rate will increase the total remittance of the migrant workers, increase the demand of agricultural sector for agricultural producer services, decrease the output level of the urban industrial sector and improve the environmental level.

Rural-urban migrants' remittances and wage inequality: Evidence from China

There is a link between rural-urban remittances and wage inequality. However, the existing literature sheds little light on this topic. In this study, we establish a three-sector general equilibrium model to investigate the effects of rural-urban migrants’ remittances on wage inequality. Further, we use Chinese macroeconomic data to calibrate the parameters and conduct analysis with numerical simulation. We find that, when rural-urban migrants raise their remittance rate, wage inequality between skilled labour and the urban formal sector remains unchanged in the sector-specific capital case but narrows in the sector-mobile capital case. Moreover, in the sector-specific case, skilled and unskilled wage inequalities, w&lt;sub&gt;SY&lt;/sub&gt; and w&lt;sub&gt;SZ&lt;/sub&gt;, decrease at the same rate as the urban-rural wage inequalities, w&lt;sub&gt;XY&lt;/sub&gt; and w&lt;sub&gt;XZ&lt;/sub&gt;, respectively. In the mobile case, however, the former declines faster than the latter.

The Potential Utility of Aripiprazole Augmentation for Major Depressive Disorder with Mixed Features Specifier: A Retrospective Study.

ObjectiveThe present study aimed to observe potential benefit of aripiprazole augmentation in the treatment of major depressive disorder with mixed specifier (MDDM) in naturalistic treatment setting.MethodsData were collected from MDDM patients using a retrospective chart review for 8 weeks (week –8 and week 0) in routine practice. All patients were on current antidepressants upon starting of aripiprazole. Patients were treated without restriction of doses of aripiprazole. The primary endpoint was the mean change of Montgomery–Åsberg Depression Rating Scale (MADRS) total scores along with various secondary endpoint measures.ResultsIn total 38 patients were analyzed. The changes of MADRS, Clinical Global Impression (CGI)-severity, Young Mania Rating Scale, Sheehan Disability Scale, and CGI-clinical benefit total scores from baseline to the endpoint were −7.1, −0.8, −4.9, −4.1, and −3.6, respectively (all p < 0.0001). At the endpoint, the responder and remitter rates by MADRS score criteria were approximately 32% and 21%, respectively.ConclusionThe present findings have clearly shown the effectiveness and tolerability of aripiprazole augmentation for MDDM patients in routine practice. The present study warrants subsequent, adequately-powered, well-controlled studies for generalizability near future.

Nexus between Tourism and Gross Domestic Product in Sri Lanka

Nowadays, policy makers believe that the tourism is a positive tool for economic growth of nations because which helps to economies of countries by several ways. In Sri Lankan experience it was not statistically confirmed. The aim of this study was to test the nexus between the tourism earnings and the gross domestic product in Sri Lanka. To test this nexus this study used time series data during the period of 1970 to 2014, and employed the multiple regressions model. In this study, the gross domestic product in constant price was used as dependant variable and exchange rate, foreign remittance, tourism earning, and inflation rate were considered as independent variables. Based on the regression outcomes, this study found that the tourism positively maintained the nexus on the gross domestic product in Sri Lanka at five percent significant level.

Clinical status after two-weeks of antidepressant treatment: A prognostic factor in unipolar major depression?

Although most unipolar depression clinical guidelines advise against evaluating the efficacy of antidepressant pharmacological treatment until it has been administered in therapeutic doses for a minimum of 4–6 weeks, there is an increasing tendency to make therapeutic decisions after only 2 weeks of treatment. We present a study which aim is to determine whether the clinical course, following 2 weeks of antidepressant treatment, allows therapeutic decisions to be made for patients affected by a moderate/severe depressive episode. The study has an 8-week, prospective, observational design in which all consecutive in- and outpatients with moderate/severe unipolar major depression aged over 17 years received antidepressant treatment based on a standardized treatment protocol. Clinical status was assessed at baseline and at 2-, 4-, and 8-weeks. The final sample consisted of a total of 114 subjects. In our sample, the rate of remitters versus non-remitters was similar between the 2-week improvers and the 2-week non-improvers. It should also be emphasized that it was not possible to explain, based on the epidemiological and clinical characteristics assessed, which 2-week non-improvers would tend towards remission and which would show a partial or full response. Based on these results, for patients affected by a moderate/severe unipolar depressive episode, it would not be appropriate to make new therapeutic decisions following 2 weeks of anti-depressive pharmacological treatment depending on whether the patient has shown clinical improvement or not.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Overeating and binge eating in emerging adulthood: 10-year stability and risk factors.

Overeating (eating an unusually large amount of food) and binge eating (overeating with loss of control [LOC]) predict adverse health consequences in adolescence. We aimed to characterize the stability of and risk factors for these distinct but interrelated constructs during critical developmental transitions. We used a population-based sample (n = 1,902) that completed surveys at 5-year intervals spanning adolescence and young adulthood. The trajectories of no overeating, overeating, binge eating, and binge eating disorder (BED; recurrent binge eating with associated distress) were characterized using cross-tabulations. Body mass index, depressive symptoms, self-esteem, and body satisfaction were examined as risk factors for no overeating, overeating, and binge eating (including BED) 5-years later using multinomial logistic regression. We found that all overeating categories tended to remit to no overeating at 5-year follow-up. Although overeating had the lowest remittance rates at each time-point, binge eating and BED showed higher rates of persistence or worsening of symptoms during the transition from late adolescence/early young adulthood to early/middle young adulthood. Overeating and binge eating had similar risk factors, although for females, depressive symptoms, body satisfaction, and self-esteem in late adolescence/early young adulthood differentially predicted binge eating versus overeating in early/middle young adulthood (ps < .05). While overeating with or without LOC tends to remit over time, problematic eating persists for a subset of individuals. Greater psychosocial problems in late adolescence/early young adulthood predicted greater odds of binge eating relative to overeating in early/middle young adulthood among females, indicating that poorer psychosocial functioning in this developmental stage portends more severe eating-related psychopathology later in life.

Achieving human security for migrants: the limits of state policies and migration-development initiatives

The Philippines is one of the top migrant sending countries and is often lauded as a model migrant country due to its skilled migrant labor force, high remittance rates and forward-thinking government policies. However, it is often criticized for its policies of exploitative labor migrant export, its dependency to migrant remittances, and its failure to offer migrant protection. In recent years, scholars and policy makers have suggested using human security as an approach to address the challenges of migration. By bringing the focus away from the state to becoming people-centered, human security aims to address the problems of statelessness, the lack of migrant protection, human rights, and offers long-term solutions to migration. Since the Philippines is highly dependent on migrant labor and is in the forefront of promoting migrant conditions in the international arena, some relevant questions can be raised: what are the role and benefits of using a human security approach for migrants? How does the Philippines attempt to secure human security for its migrants? Has the Philippines achieved human security for its migrants? This paper argues that as the Philippines grew more dependent on labor migration, human security for migrants is attempted by the state through an institutionalized set of policies and assumptions. The promise of migrant welfare and human security is premised on the following points: creating better policies and institutionalizing migrant state agencies, creating national laws together with bilateral and multilateral agreements on migration and in recent years, and the promotion of migration and development initiatives. While these attempts may hold promise, they suffer from limitations on implementation and sustainability. In the final analysis, human security can only be achieved by working towards a national dialogue on migration where stakeholders from the state, civil society organizations, and migrant groups participate in the national debate on the future of migration. Only by reaching a national dialogue on responsive and long-term policies that are grounded in human security can the country go beyond the view that migration and development policies are a catch-all panacea to the problems of migrant protection and long-term economic development in the homeland.

Randomized, placebo-controlled, adjunctive study of armodafinil for bipolar I depression: implications of novel drug design and heterogeneity of concurrent bipolar maintenance treatments.

BackgroundSome, but not all, prior investigations suggest armodafinil may have utility as an adjunctive treatment in bipolar I depression.MethodsMulticenter, randomized, double-blind study in patients aged 18 to 65 years experiencing a depressive episode despite maintenance therapy for bipolar I disorder. Patients were randomized to receive adjunctive armodafinil 150 mg/day or adjunctive placebo for 8 weeks. Primary efficacy outcome was change from baseline in 30-Item Inventory of Depressive Symptomatology–Clinician-Rated (IDS-C30) total score at week 8. Safety and tolerability were monitored.ResultsOf 656 patients screened, 399 were randomized, of whom 308 (77 %) were taking a protocol-allowed mood stabilizer as monotherapy. The primary efficacy outcome did not reach statistical significance; however, several secondary efficacy outcomes demonstrated statistically significant advantages for adjunctive armodafinil (n = 197) over adjunctive placebo (n = 196), including Clinical Global Impression of Severity of Illness for depression (weeks 6, 8, and endpoint; all P < 0.05), Global Assessment of Functioning (weeks 4, 8, and endpoint; all P < 0.02), IDS-C30 remitter rates (week 8 and endpoint; both P < 0.02), and mean change from baseline in IDS-C30 total score at week 7 (P < 0.05). Adjunctive armodafinil and adjunctive placebo were generally well tolerated. Although adjunctive armodafinil compared with adjunctive placebo yielded a higher headache rate (15 vs 8 %), it yielded similar (generally favorably low) rates of all-cause discontinuation (16 vs 16 %), adverse event discontinuation (4 vs 5 %), nausea (6 vs 4 %), ≥7 % weight gain (2 vs 5 %), anxiety (4 vs 3 %), insomnia (3 vs 2 %), sedation/somnolence (1 vs 1 %), and hypomania (0 vs <1 %).ConclusionsIn this study, adjunctive armodafinil compared with adjunctive placebo in bipolar I depression did not separate in the primary efficacy outcome but demonstrated advantages for several secondary efficacy outcomes and was generally well tolerated. Additional research is warranted and necessary to better identify clinical predictors (e.g., atypical depressive symptoms, specific anti-manic/mood-stabilizing agents used) that would provide optimized, individualized therapeutics for bipolar depression.Trial registrationClinicalTrials.gov: NCT01305408

Inflammatory markers and chronic exposure to fluoxetine, divalproex, and placebo in intermittent explosive disorder

Intermittent Explosive Disorder (IED) is a disorder of impulsive aggression affecting 4–7% of the U.S. population during some period of life. In addition to other biological correlates, elevations of plasma inflammatory markers have been reported in IED, compared with control, subjects. In this study we sought to explore if treatment exposure to anti-aggressive agents, compared with placebo, would be associated with a reduction in circulating levels of inflammatory markers. Thirty IED subjects, from a 12-week, double-blind, randomized, placebo-controlled trial of fluoxetine and divalproex, in which both pre- and post-treatment levels of C-Reactive Protein (CRP), interleukin (IL)-1β, IL-2, IL-6, IL-8, IL-10 and tumor necrosis factor (TNF)-α were obtained. Efficacy measures included the Overt Aggression Scale-Modified (OAS-M) score for Aggression and for Irritability, rate of Clinical Global Impression of Improvement (CGI-I), and rate of IED Remitters at study completion. As compared to placebo, neither fluoxetine nor divalproex reduced any of the measures of aggression. In addition, levels of CRP and pro- and anti-inflammatory cytokines showed no changes from pre- to post-treatment for any treatment condition. Correlations between pre- and post- treatment plasma CRP/cytokines were substantial (mean r=0.71, r2=0.50, p<0.001). Overall, circulating markers of inflammation markers were unaffected by treatment with fluoxetine or divalproex, consistent with the absence of change in measures of impulsive aggression.

Therapeutic reference range for plasma concentrations of paroxetine in patients with major depressive disorders.

We investigated the relationship between plasma concentrations of paroxetine and the therapeutic effect of the drug, and we evaluated the therapeutic reference range for plasma concentration of paroxetine in patients with major depressive disorders (MDD). In this study, 120 patients with MDD were treated with 10-40 mg/d of paroxetine for 6 weeks, and 89 patients completed the protocol. The Montgomery-Asberg Depression Rating Scale (MADRS) was used to evaluate the patients at 0, 1, 2, 4, and 6 weeks. At the 6-week treatment time point, the patients were divided into 7 groups according to their paroxetine plasma concentrations in increments of 20 ng/mL. We used an analysis of variance and a χ test to define the therapeutic reference range for plasma paroxetine concentrations. We used 50% as the cutoff values for the percentage of MADRS improvement to determine the responder rates, and we defined remitters as patients with MADRS scores <10 at the 6-week treatment time point. We analyzed the responder and remitter rates of the patients according to their plasma paroxetine concentrations: 20 ng/mL, 40 ng/mL, and 60 ng/mL using the χ test. According to the results of the χ test in the responder rates, the 20-60 ng/mL plasma paroxetine group showed the highest effect size. The results of this study suggested that a range of 20-60 ng/mL is the therapeutic reference range for concentrations of paroxetine in plasma in patients with MDD.

Treatment of major depression with bilateral theta burst stimulation: A randomized controlled pilot trial

BackgroundCurrent efforts to improve clinical effectiveness and utility of repetitive transcranial magnetic stimulation (rTMS) in the treatment of major depression (MD) include theta burst stimulation (TBS), a patterned form of rTMS. Here, we investigated the efficacy of bilateral TBS to the dorsolateral prefrontal cortex (dlPFC) in patients with MD in additon to ongoing medication and psychotherapy. MethodsIn this randomized-controlled trial, thirty-two patients with MD were treated for six weeks (thirty sessions) with either successively intermittent, activity enhancing TBS (iTBS) to the left and continuous, inhibiting TBS (cTBS) to the right dlPFC or with bilateral sham stimulation. Primary outcome measure was the proportion of treatment response defined as a Montgomery–Åsberg Depression Rating Scale (MADRS)≤50% compared to baseline. Secondary outcomes comprised response and remission rates of the Hamilton Depression Rating Scale (HAMD) and the Beck Depression Inventory (BDI). ResultsA larger number of responders were found in the cTBS (n=9) compared to the sham-stimulation (n=4) group (odds ratio: 3.86; Wald χ2=3.9, p=0.048). On secondary endpoint analysis, patient-reported outcome as assessed by the BDI, pointed towards a higher rate of remitters in the cTBS (n=6) than in the sham (n=1) group (odds ratio: 9; Wald χ2=3.5, p=0.061). LimitationsWith regard to the pilot character of the study and the small sample size, the results have to be considered as preliminary. ConclusionsThese findings provide first evidence that six weeks treatment of MDD with iTBS to the left and cTBS to the right dlPFC for six weeks is safe, feasible and superior to sham stimulation applied add-on to pharmacological and psychotherapeutic treatment.

Impact of Motivational Pharmacotherapy on Treatment Retention Among Depressed Latinos

Compared to non-Latino Whites, U.S. racial/ethnic minority groups show higher non-adherence with outpatient antidepressant therapy, including lower retention, despite adjusting for sociodemographic and insurance covariates. Culturally salient concerns about antidepressants leading to ambivalence about treatment engagement may contribute to this discrepancy. To improve treatment adherence among depressed Latinos, we developed motivational pharmacotherapy, a novel approach that combines motivational interviewing, standard pharmacotherapy, and attention to Latino cultural concerns about antidepressants. This 12-week, open-trial, pre-post pilot study assessed the impact of motivational pharmacotherapy on antidepressant therapy retention, response (symptoms, functioning, and quality of life), and visit duration among n = 50 first-generation Latino outpatients with major depressive disorder. At study endpoint, 20% of patients discontinued treatment, with a mean therapy duration of 74.2 out of 84 days. Patients' symptoms, psychosocial functioning, and quality of life improved significantly. Mean visit length was 36.7 minutes for visit 1 and 24.3 minutes for subsequent visits, compatible with use in community clinics. Responder and remitter rates were 82% and 68%. Compared to published Latino proportions of non-retention (32–53%) and previous studies at our clinic with similar samples and medications (36–46%), Motivational pharmacotherapy appears to improve Latino retention in antidepressant therapy and should be investigated further in controlled designs.

P 112. Treatment of major depression with bilateral theta burst stimulation: A randomized controlled pilot trial

Current efforts to improve clinical effectiveness and utility of repetitive transcranial magnetic stimulation (rTMS) in the treatment of major depression (MD) include theta burst stimulation (TBS), a patterned form of rTMS. This study was performed to investigate the efficacy of bilateral TBS to the dorsolateral prefrontal cortex (dlPFC) in patients with major depressive disorder in addition to ongoing medication and psychotherapy. In this randomized-controlled trial, thirty-two patients with MD were treated for six weeks (thirty sessions) with either successively intermittent, activity enhancing TBS to the left and continuous, inhibiting TBS to the right dlPFC or with bilateral sham stimulation. Primary outcome measure was the proportion of treatment response defined as a Montgomery-Asberg Depression Rating Scale (MADRS) <50% compared to baseline. Secondary outcomes comprised response and remission rates of the Hamilton Depression Rating Scale (HAMD) and the Beck Depression Inventory (BDI). Logistic regression analysis with the factors treatment condition, duration of the current episode age and therapy resistance revealed a significantly larger number of responders in the cTBS ( n = 9) compared to the sham-stimulation ( n = 4) group (Wald χ 2 = 3.9, p = 0.048). Response to cTBS was predicted by a shorter duration of the current episode (Wald χ 2 = 3.77, p = 0.052). Patient-reported outcome as assessed by the BDI indicated a higher rate of remitters in the cTBS ( n = 6) than in the sham ( n = 1) group (Wald χ 2 = 3.6, p = 0.058). These findings indicate that a six weeks treatment of MDD with iTBS to the left and cTBS to the right dlPFC for six weeks is safe, feasible and superior to sham stimulation applied add-on to pharmacological and psychotherapeutic treatment.