Does somatosensory amplification decrease with antidepressant treatment?

Somatosensory amplification refers to a tendency to experience somatic and visceral sensations as unusually intense, noxious, and disturbing. The authors wanted to determine whether somatosensory amplification is a stable construct or whether it might change with antidepressant therapy. Fifteen patients with fibromyalgia and 17 patients with major depressive disorder received antidepressant treatment and were assessed after 6 and 12 weeks of treatment. Amplification scores responded to antidepressant treatment in patients with major depression but not in patients with fibromyalgia, despite a decrease in the levels of depression in both groups. When change in depression and anxiety scores was partialled out from change in somatosensory amplification scores, the amplification scores did not change significantly in either the depressed or the fibromyalgia groups. Given the small numbers and the marginal significance of the results, the authors are unable to say definitely just how independent of depression somatosensory amplification is. Whether somatosensory amplification is a measure of depression per se should be tested in a more definitive and larger future study.     

Gender differences in response to antidepressant treatment prescribed in primary care. Does menopause make a difference?

BACKGROUND: Epidemiological surveys have consistently reported that the prevalence of major depression in women is almost twice as high as it is in men. While it seems that no major gender differences have been observed in the severity and symptomatology of depression, results regarding differences in antidepressant treatment response are controversial, especially when considering menopause in treatment response. METHODS: A total of 242 women (95 in their menopause), and 59 men beginning antidepressant treatment with a selective serotonin reuptake inhibitor (SSRI; Citalopram, Fluoxetine, Paroxetine or Sertraline) from 16 primary care (PC) centres were followed up during 6 months. Menopause effect and gender differences in antidepressant treatment response were evaluated. Additionally, severity and symptomatology of depression were compared among genders. RESULTS: Overall results suggest that menopause is related to a worse treatment response and to a poorer self-evaluation of global health status. No gender differences were observed in treatment response, depression severity, and symptomatology. LIMITATIONS: Since our sample included PC participants, a wide spectrum of depression severity was considered. Additionally, menopause was assessed by means of participants' self-report. CONCLUSIONS: Menopause seems to negatively affect SSRI treatment response of depressed women treated in PC.     

How accurate are patients in reporting their antidepressant treatment history?

BACKGROUND: A patient's report of their antidepressant treatment history is one of the most important pieces of information used in selecting an antidepressant regimen. It is currently unknown how accurate patients are in describing and characterizing their antidepressant treatment history. METHODS: Seventy-three patients receiving treatment for depression at our outpatient psychiatric practice were interviewed by an independent evaluator who was blind to each patient's treatment history. Information was obtained regarding which antidepressant and augmentation regimens patients had undergone, antidepressant doses, duration of trials, and the nature of response to each trial. The results of these interviews were then compared with patients' actual treatment history as elicited from an independent chart review. RESULTS: Patients recalled 85 of the 104 (81.7%) monotherapy trials they had undergone in the past 5 years, but only recalled 12 of 46 (26.1%) augmentation trials (P<0.001). Patients were found to be very reliable in distinguishing between those trials that were of adequate dose and duration and those that were not. Patients were also generally reliable in depicting the quality of response to past trials, though patient report of a past negative trial was significantly more reliable than a report of a past positive trial. The presence of current depressive symptomatology did not adversely affect patients' ability to recall past trials or accurately describe their responses to past regimens. LIMITATIONS: All patients were treated by a single psychiatrist, and all trials occurred within the last 5 years. CONCLUSION: Patients are able to recall the majority of monotherapy trials they have undergone, but have great difficulty remembering when two medications were taken concurrently, i.e. augmentation trials. Patient report appears to be a satisfactory method to obtain information regarding trial adequacy and response in most, but not all instances.     

Does treatment delay in first-episode psychosis really matter?

BACKGROUND: Relatively few predictors of outcome in first-episode psychosis are potentially malleable and duration of untreated psychosis (DUP) is one. However, the degree to which DUP is mediated by other predictors of outcome is unclear. This study examines the specific effects of DUP on 12-month outcome after adjusting for effects of potential confounders and moderating variables. METHOD: The sample comprised 354 first-episode psychosis patients followed up 12-months after remission/stabilization of their psychotic symptoms. Outcome measures included functional outcome, severity of positive symptoms and negative symptoms. Hierarchical multiple regression assessed whether DUP significantly predicted 12-month outcome after adjusting for other predictors. Contrast analysis further clarified the differential effects of DUP on 12-month outcome. RESULTS: DUP remained a significant predictor of outcome after adjusting for the effects of other variables. This finding remained robust for the subset of patients with schizophrenia or schizophreniform disorder. Functional outcome appeared to decline substantially even after very short treatment delays (> 7 days), with more gradual deterioration in functioning until very long DUP (> 1 year). Good outcome was variably associated with good pre-morbid adjustment, female gender, diagnosis of affective disorder, short duration of prodromal symptoms, and treatment within the Early Psychosis Prevention and Intervention model in contrast to other models of care. CONCLUSIONS: DUP consistently predicts outcome independently of other variables, and is not simply a proxy for other factors. As one of the few potentially malleable factors influencing outcome, DUP could prove to be a target for secondary preventive efforts in early psychosis.     

Does illness attribution affect treatment assignment in depression?

Objective: Little is known about depressed individuals' illness attributions and how these influence treatment assignment in clinical practice. The aim of the present study was to examine whether illness attribution across the domains of intraindividual, interpersonal and biological reasons was associated with treatment assignment in a naturalistic treatment setting. Method: Illness attribution was assessed with the Reasons for Depression Questionnaire in 221 depressed individuals. Participants were assigned to either cognitive–behavioural therapy (CBT), interpersonal therapy (IPT) or psychopharmacological treatment (PHT). Results: Depressed individuals who strongly attributed their illness to intraindividual factors were more likely to be assigned to CBT, and depressed individuals attributing their depression to biological reasons were more likely to receive in PHT. In contrast, interpersonal illness attribution was not associated with treatment assignment. Conclusions: Illness attribution influences treatment assignment to CBT and PHT. However, factors other than illness attribution for depression affect a treatment choice of IPT. Copyright © 2009 John Wiley & Sons, Ltd. Key Practitioner Message:

• Intraindividual and biological illness attributions affected depressed individuals' treatment assignment, making these individuals more likely to receive CBT and PHT, respectively.
• Interpersonal illness attribution was not found to be associated with treatment assignment.
• There were significant gender differences in illness attribution. Men were more likely to endorse in achievement‐related causes, and women attributed their depressive illnesses to more interpersonal reasons (i.e., relationship, childhood and intimacy).

     

Does osteopenia warrant treatment?

The progressive loss of bone mass that leads to osteoporosis in postmenopausal women is known to result in substantial morbidity and mortality. Underdiagnosed and undertreated, osteoporosis jeopardizes the health of an estimated 8 million American women 50 years of age or older who are at high risk for hip, vertebral, and other fractures. Because osteopenia is generally a subclinical condition that results in a lower fracture rate than osteoporosis, its potential impact is more difficult to recognize, although it is nearly three times more prevalent than osteoporosis. The question arises as to whether osteopenia should be diagnosed and treated before it transitions into osteoporosis. Because the number of postmenopausal women is projected to increase substantially in the near future and the number of postmenopausal women who will or who have discontinued their use of hormone therapy has increased sharply, the consequences of failing to identify and treat women at increased fracture risk are considerable. Moreover, the rate of bone loss in the first year after discontinuation of hormone therapy is especially rapid and similar to the rate that occurs early after menopause. Accordingly, fracture risk is substantially increased at this time in relation to the magnitude of bone loss. The goal of nonpharmacologic and pharmacologic therapy is to prevent the first fracture in any woman at risk for fracture. Initiation of antiresorptive therapy known to provide rapid efficacy can be particularly important in achieving the treatment goal in appropriate osteopenic women.     

Does estrogen enhance the antidepressant effects of fluoxetine?

BACKGROUND: While hormone replacement therapy (HRT) has not been shown to be an effective treatment for major depression, preliminary studies suggest that estrogen may potentiate the effect of selective serotonin reuptake inhibitors. METHOD: In an ongoing study, perimenopausal women diagnosed with major depression were randomly assigned to one of three treatment conditions: (1) fluoxetine 10-20 mg alone, (2) estradiol patch 0.1-0.2 mg alone or (3) the combination of fluoxetine 10-20 mg and estradiol patch 0.1-0.2 mg. RESULTS: In the five cases presented here, the combination of fluoxetine and estradiol was most effective, followed by fluoxetine alone and then estradiol alone. LIMITATIONS: These are selected cases from an ongoing study and do not represent statistically significant data. CONCLUSIONS: These preliminary cases suggest that estrogen can enhance the efficacy of antidepressant medication in menopausal women and this adjunctive treatment strategy may be superior to antidepressant or estrogen alone. Further research is needed in elucidating the mechanisms by which estrogen may enhance antidepressant action in perimenopausal women.     

Does psychotherapy research inform treatment decisions in private practice?

Psychologists in independent practice (N = 591) were surveyed regarding their approach to treatment decisions, specifically the use of research on empirically supported treatments (ESTs) to inform practice. All participants received a case study of a patient with panic disorder, and half were randomly assigned to receive a research summary on evidence-based treatments for panic disorder (cognitive-behavioral therapy and pharmacotherapy). Practitioners reported that they rely primarily on clinical experiences to inform treatment decisions, although they often consult EST literature. Those who received the research summary were significantly more likely to report they would use an EST. These results indicate that providing information about ESTs can impact practice. Although this sample was more positive about EST research than clinicians are often depicted to be, this study indicates an enduring research-practice gap in clinical psychology.     

Is methoxydine a new rapid acting antidepressant for the treatment of depression in alcoholics?

Methoxydine is a dissociative anaesthetic belonging to the arylcyclohexylamine class. This substance shows pharmacodynamic similarities with ketamine, a medication with demonstrated rapid-acting antidepressant effects. Like ketamine, results of binding assays have shown that methoxydine is an uncompetitive antagonist of NMDA receptor approximately as potent as ketamine, but less potent than PCP. Furthermore, unlike ketamine, it acts as a dopamine, serotonin, and noradrenaline reuptake inhibitor as well as an agonist at sigma-1, sigma-2, and opioid receptors. The hypothesis is that methoxydine can produce rapid antidepressant effects in depressed patients with high risk of suicide, including depressed alcoholics.     

Does higher cardiovascular response to ECT predict early antidepressant effect?

BACKGROUND: Effects of diencephalic seizure generalization during ECT, e.g., cardiovascular response, may be relevant in indexing its therapeutic potency. A trend for greater rate pressure product (RPP=heart rate x systolic blood pressure) response to modified ECT in responders than in nonresponders is reported. Atropine used in modified ECT is known to increase RPP. This study examined if cardiovascular response during ECT with or without atropine predicts antidepressant effect. METHODS: Twenty nine consenting, major depressive disorder patients received ECTs. Atropine premedication was randomly withheld in the second or third ECT session. RPP was recorded during ECT. Severity of depression was measured at twice weekly intervals. RESULTS: Fifteen patients remitted at the end of 2 weeks. These early remitters had significantly higher poststimulus RPP than the rest in the ECT session without atropine but not so in the session with atropine. Cumulative poststimulus RPP predicted the early antidepressant response. Corresponding motor or EEG seizure durations were not associated with antidepressant effect. LIMITATIONS: Most patients continued to receive antidepressants. ECT stimulus laterality was not controlled. The study focussed on only short term antidepressant effects. CONCLUSIONS: RPP response to ECT recorded under no-atropine condition may reflect its physiological effects relevant to therapeusis and may have the potential to index seizure adequacy.     

Can HCV affect the efficacy of anti-HIV treatment?

Summary.  To evaluate the impact of new antiretroviral combinations (HAART: Highly Active Anti Retroviral Therapy) on HCV replication and liver enzyme levels, we analysed the changes in HCV viremia and aminotransferase levels in HIV and HCV co-infected patients. Moreover, to evaluate the influence of HCV infection on the efficacy of HAART, we compared the virological, immunological and biochemical response to antiretroviral combinations in anti-HIV positive subjects with or without HCV infection. We enrolled eight consecutive outpatients with HIV-HCV coinfection and with indications for HAART (Group A). For each patient in group A, we selected an anti-HIV negative patient with indications for HAART, pair-matched for age, sex, risk factor for HIV infection, presumed duration of infection, number of CD4 cells, HIV viremia and treatment schedule (Group B). A statistically significant increase in CD4 in both groups was found at 1^st, 3^rd and 6^th month of antiretroviral therapy. A decrease in HIV-RNA in both groups was observed at 1^st and 6^th month of treatment. The percentage of patients with undetectable HIV-RNA at the 1^st month was higher in Group B than in Group A (8/8 vs. 3/8, p = 0.025). Basal HCV-RNA viremia was very high in each case and no variations during treatment were observed. During therapy the aminotransferase levels slightly decreased in Group A and consistently increased in Group B. In Group A the differences were not significant to the statistical analysis; in Group B the aminotransferase levels at 3^st and 6^th month were significantly higher than those observed at the baseline. Received September 28, 1999/Accepted December 7, 1999     

Does problem-solving treatment work through resolving problems?

BACKGROUND: A randomized controlled trial of problem-solving treatment, antidepressant medication and the combination of the two treatments found no difference in treatment efficacy for major depressive disorders in primary care. In addition to treatment outcome, the trial sought to determine possible mechanisms of action of the problem-solving intervention. METHOD: Two potential mechanisms of action of problem-solving treatment were evaluated by comparison with drug treatment. First, did problem-solving treatment work by achieving problem resolution and secondly, did problem-solving treatment work by increasing the patients' sense of mastery and self-control? RESULTS: Problem-solving treatment did not achieve a greater resolution in the patients' perception of their problem severity by comparison with drug treatment, neither did problem-solving treatment result in a greater sense of mastery or self-control. CONCLUSIONS: The results from this study did not support the hypotheses that for patients with major depression, by comparison with antidepressant medication: problem-solving treatment would result in better problem resolution; or that problem-solving treatment would increase the patients' sense of mastery and self-control.     

Does batterers' treatment work? A meta-analytic review of domestic violence treatment

This meta-analytic review examines the findings of 22 studies evaluating treatment efficacy for domestically violent males. The outcome literature of controlled quasi-experimental and experimental studies was reviewed to test the relative impact of Duluth model, cognitive-behavioral therapy (CBT), and other types of treatment on subsequent recidivism of violence. Study design and type of treatment were tested as moderators. Treatment design tended to have a small influence on effect size. There were no differences in effect sizes in comparing Duluth model vs. CBT-type interventions. Overall, effects due to treatment were in the small range, meaning that the current interventions have a minimal impact on reducing recidivism beyond the effect of being arrested. Analogies to treatment for other populations are presented for comparison. Implications for policy decisions and future research are discussed.     

Is there a role for hemoperfusion/hemodialysis as a treatment option in severe tricyclic antidepressant intoxication?

OBJECTIVE: Suicidal self-poisoning with tricyclic antidepressants like doxepin is a major therapeutic problem in emergency medicine with a high fatality rate. Deaths are mainly caused by cardiotoxicity with arrhythmias, intraventricular conduction disturbances and myocardial depression. For treatment, alkalinization and hypertonic saline are recommended. The role of extracorporeal, treatment procedures is not clear. The possible benefit of hemoperfusion/hemodialysis is discussed in a case report with respect to the published literature. CASE REPORT: After ingestion of an amount of at least 5000 mg doxepin a 37-year-old man with endogenous depression developed cardiac arrest. After preclinical resuscitation with prolonged external cardiac massage, he was admitted to the intensive care unit with persistently severe hypotension and wide QRS complexes (230-260 ms). Despite fluid load, alkalinization, hypertonic saline and high-dose vasoactive substances the patient's condition did not improve. Hemoperfusion over hemoresin combined with hemodialysis led to an impressive clinical improvement with shortening of QRS duration (from 230 to 120 ms) and hemodynamic stabilization. The patient fully recovered without neurologic deficits. CONCLUSION: We report a successful treatment with hemoperfusion over hemoresin and hemodialysis in a patient with life-threatening doxepin poisoning intractable with the generally recommended treatment. In such acute TCA intoxication with severe cardiotoxicity, hemoperfusion/hemodialysis should be considered a potential treatment option, as the "toxicokinetics" of drugs may totally differ from their usual pharmacokinetic behaviour. Experimental and clinical studies are needed to clarify the toxicokinetics of TCA in order to improve the therapeutic approach.