Short-term Antidepressant Treatment Research Articles

Short-term antidepressant treatment and facial processing

We used functional magnetic resonance imaging to investigate the effects of short-term treatment with reboxetine, a selective noradrenaline reuptake inhibitor, on emotional facial processing in healthy volunteers. Reboxetine was associated with a reduced amygdala response to fearful faces and increased activation to happy v. neutral facial expressions in the right fusiform gyrus, relative to placebo treatment and in the absence of changes in mood. Our results show that reboxetine modulates the neural substrates of emotional processing, highlighting a mechanism by which drug treatment could normalise negative bias in depression and anxiety.

Association Between Treatment-Emergent Suicidal Ideation With Citalopram and Polymorphisms Near Cyclic Adenosine Monophosphate Response Element Binding Protein in the STAR*D Study

A small subset of patients with depression exhibit new or worsening suicidal thoughts or behavior during short-term treatment with antidepressants. Because cyclic adenosine monophosphate response element binding (CREB) protein has been implicated in both antidepressant mechanisms and suicide, the CREB1 gene represents a gene that possibly influences the risk for treatment-emergent suicidality. To examine polymorphisms that span CREB1, which was previously associated with anger expression in men with major depressive disorder, for association with new or worsening suicidality. Nested case-control study derived from the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study, a multicenter, prospective, open, 12-week effectiveness trial from July 1, 2001, to September 30, 2006. Outpatient primary care and psychiatric clinics. Patients Individuals with nonpsychotic major depressive disorder for whom DNA was available and who did not report suicidal ideation at study entry were subsequently treated with citalopram hydrobromide for up to 12 weeks. Emergent suicidal ideation, defined as a score of 2 or higher on any postbaseline visit for participants whose baseline score was 0 or 1 on the 16-item Quick Inventory of Depressive Symptomatology-Clinician Rated suicide item. Of 1447 participants, 124 (8.6%) subsequently reported suicidality on at least 1 visit; these individuals were compared with the remaining 1324 participants. Of 5 single nucleotide polymorphisms (SNPs) examined, none were significantly associated with treatment-emergent suicidality overall. However, 2 SNPs revealed a gene-by-sex interaction with suicidality. Among the 539 men, these 2 SNPs and 2 of the 5 SNP haplotypes were significantly associated with new-onset suicidality. Polymorphisms that span CREB1 were associated with treatment-emergent suicidality among men with depression, extending an observation of association with male anger expression in a prior independent cohort. If replicated, this finding would suggest that pharmacogenetic testing could facilitate the identification of the small subset of individuals at greater risk during short-term antidepressant treatment.

Short-term antidepressant treatment of comorbid dental anxiety in patients with panic disorder

Objectives. The aims of this study were to determine the frequency of dental anxiety (DA) and dental phobia (DP) in panic disorder, and to follow the changes in DA levels during antidepressant treatment of panic disorder. Methods. Fifty-three controls and 102 panic disorder patients were assessed using the Structured Clinical Interview (SCID), the Panic-Agoraphobia Scale (PAS), and the Corah Dental Anxiety Scale (DAS). Oral health status was defined by the number of decayed, missing, and filled teeth (DMFT) index. The patients were classified into three groups: (1) those without dental anxiety (WDA), (2) those with dental anxiety (DA), and (3) those with dental phobia (DP). All patients were treated with antidepressants for 3 months and the response rates were assessed. Results. At baseline, DAS was significantly higher in both the DA and the DP groups than in the control group. Ten (9.8%) of the panic disorder patients fulfilled the diagnostic criteria for DP; 31 (30.4%) had severe DA. In the control group, none of the patients was diagnosed as DP, whereas 7 (13.5%) had severe DA. Panic disorder and DA both responded to the antidepressant treatment, but DAS scores remained significantly higher in the DP group than in the DA group and the control group at the end of the third month. Conclusions. Our data suggest that both DA and DP are more frequent in panic disorder than in healthy controls. Antidepressant treatment may have been helpful in decreasing DA levels in the DA group but not in the DP group.

Implications of using different cut-offs on symptom severity scales to define remission from depression.

A fundamental question in the medical management of disease is how well treatment works. Although there are many ways of defining improvement, one endpoint of definite interest is the resolution or remission of the disorder. In short-term antidepressant treatment trials, remission is usually defined according to post-treatment scores on symptom severity measures, such as the Hamilton Rating Scale for Depression (HRSD) or the Montgomery-Asberg Depression Rating Scale (MADRS). However, there is uncertainty as to what cut-offs should be used on these measures to define remission. During the past 2 years, as part of the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project, our laboratory has examined the question of how to define remission on the HRSD and MADRS. In the present report from the MIDAS project, we examined the impact of the cut-off score used to define remission on the percentage of depressed outpatients in ongoing treatment who are considered to be in remission. In addition, we examined the association between remission status and psychosocial impairment for different cut-off scores. Three hundred and three depressed psychiatric outpatients were rated on the MADRS, 17-item HRSD, and an index of DSM-IV remission status. Approximately one-third of patients completed a measure of psychosocial impairment. For both the HRSD and the MADRS, we examined four cut-off scores for remission. For each cut-off, we determined the percentage of patients who met the definition of remission, the percentage of patients who continued to meet DSM-IV criteria for major depressive disorder (MDD), and the percentage of patients without any self-reported impairment from depression. For both scales, the range of cut-off scores was associated with more than a two-fold difference in prevalence of remission. Based on higher thresholds to define remission, a small percentage of patients met criteria for MDD, whereas no patients scoring below the low thresholds had MDD. The threshold to define remission was associated with psychosocial impairment: higher cut-off scores were associated with lower rates of no impairment. The cut-offs used to define remission from depression considerably influence the percentage of patients considered to be in remission. Lower cut-off scores than those most commonly used to define remission appear to be more valid.

Acute response of social functioning in dysthymic patients with desipramine

Despite some evidence that short-term antidepressant treatment improves social dysfunction in depressed patients, little is known about the response of specific social impairments in dysthymic patients to antidepressant medication. We examined the effect of acute (10 weeks), open-label desipramine (DMI) treatment on social functioning in subjects with DSM-III-R dysthymia. Social functioning was assessed with the social adjustment scale self-report (SAS-SR) at baseline and at week 10. Compared with DMI nonresponders, DMI responders showed significantly greater improvement in overall social functioning ( F 2,45 = 5.46, P < 0.0001) and in enjoyment of leisure time ( F 2,45 = 14.38, P < 0.0001) on the SAS-SR. Dysthymic patients who respond to DMI improve significantly in social functioning. Diminished capacity to enjoy leisure time may be a state marker of depression in some chronically depressed patients.

Effects of antidepressants on thinking styles in depressed inpatients

Telner, J.I., W.R.P. Surphlis, Y.D. Lapierre and G. Mehta: Effects of antidepressants on thinking styles in depressed inpatients. Prog. Neuro-Psychopharmacol. Biol. Psychiat. 1988, 12 :277–284 1. 1. Clinical and empirical evidence point to distorted negative thinking during depressive episodes. 2. 2. The present study, utilizing the Cognitions Questionnaire, examined the thinking styles in depressed inpatients prior to antidepressant pharmacotherapy and again 3–4 weeks after treatment. 3. 3. Across the 5 dimensions of thinking assessed, only generalization across situation changed significantly in the drug-respondent group. 4. 4. While clinically, short-term antidepressant treatment was shown to be efficacious, it only changed cognitions in a limited way.

Changes occurring in appetite and weight during short-term antidepressant treatment.

Changes in appetite and weight were recorded in mild to moderately depressed out-patients during the course of clinical trials of various antidepressant drugs. After six weeks, differences due to treatment regimes were minimal. Patients who on becoming depressed experienced severe changes in appetite and weight in either direction, tended to return to normal. The significant associations of appetite and weight change during treatment were with weight, appetite, and carbohydrate preference at presentation, and also with the 'appetite history' and 'weight history'. The associations with the degree of depression were relatively minor.