Sub‐threshold manic symptoms in recurrent major depressive disorder are a marker for poor outcome

Objective: A small but significant proportion of patients with major depressive disorder (MDD) report mild manic symptoms which are below the diagnostic threshold for a hypomanic episode. Method: We tested for an association between sub‐threshold manic symptoms and clinical outcome in almost 600 patients with recurrent MDD who also had no known family history of bipolar disorder. Results: 9.6% of this large sample had a life‐time history of sub‐threshold manic symptoms. These patients were significantly more likely to have a history of poor response to antidepressants (OR 2.84; 95% CI 1.23–6.56; P < 0.02) and more likely to have experienced psychosis (OR 2.07; 95% CI 1.05–4.09; P < 0.04). They had also experienced more depressive episodes on average (P = 0.006) and were more likely to have been admitted to hospital (P < 0.03). Conclusion: Sub‐threshold manic symptoms in patients with recurrent MDD may be a useful clinical marker for poor response to antidepressants and a more morbid long‐term clinical course.     

Newly diagnosed major depressive disorder and the risk of erectile dysfunction: A population-based cohort study in Taiwan

Introduction

The primary aim of this study was to explore the incidence rate of erectile dysfunction (ED) among major depressive disorder (MDD) patients in an Asian country. The second aim was to compare the risk of ED in MDD patients that were treated using antidepressants with a high risk-ED, antidepressants with a low risk-ED, or without treatment.

Methods

We identified 4339 male patients with newly diagnosed MDD using the National Health Database. Four matched controls per case were selected for the study.

Results

The mean age of the participants was 42.3±16.9. A higher crude HR of 3.6 (95% CI: 2.8–4.6) was seen in the male patients with MDD. After adjusting for obesity, monthly income, urbanization level, and comorbidity, the MDD patients had a 3.2-fold higher HR for an ED diagnosis than the controls. Patients with untreated depression had the highest risk of ED, compared to the control group (HR=3.9). Patients treated with IHiRA had a medium risk of developing ED (HR=3.6), and patients treated with ILoRA had the lowest risk of ED (HR: 2.5).

Conclusion

This prospective cohort study found an association between ED and prior MDD. Patients with untreated depression may have the highest risk of developing ED.     

激越/迟滞型抑郁症首次发作患者的认知功能

目的:探讨激越型和迟滞型抑郁症首次发作患者的认知功能特征及其影响因素。方法:77例抑郁症首次发作患者根据汉密尔顿抑郁量表(HAMD-17)激越项目单项≥3分者进入激越组(n=20例);迟滞项目单项≥3分者进入迟滞组(n=24例);上述2项同时<3分者则进入混合组(n=33例)以及40名正常人(正常对照组)进行威斯康星卡片分类测试(WCST)、持续性操作测验(CPT)、韦氏记忆测验(WMS)测试,记录相应观测指标,并与临床症状、精神药物剂量进行相关性分析。结果:①与正常对照组相比,抑郁症患者存在着广泛的认知功能损害(P<0.05或P<0.01);②激越组和迟滞组在WCST所有指标、CPT舍弃数、误答数、平均反应时间、WMS记忆商数、短时记忆、瞬时记忆上与混合组差异有统计学意义(P<0.05或P<0.01);③激越组与迟滞组在WCST中的非持续性错误答案数、CPT中的误答数、平均反应时间、WMS中的短时记忆方面差异有统计学意义(P<0.05或P<0.01);④大部分观测指标与临床症状以及抗抑郁药丙咪嗪等效剂量、镇静催眠药地西泮等效剂量和抗精神病药氯丙嗪等效剂量之间无显著相关。结论:激越和迟滞型抑郁症患者的认知损害不尽相同,提示抑郁症是一种异源性疾病。     

Adjunctive brexpiprazole for elderly patients with major depressive disorder: An open‐label,long‐term safety and tolerability study

Objectives

The objective of this study was to evaluate the long‐term safety and tolerability of flexible‐dose brexpiprazole adjunct to antidepressant treatment (ADT) in elderly patients with major depressive disorder (MDD).

Methods

Elderly patients (≥65 years) with MDD and inadequate response to ≥1 ADT during the current episode were recruited to a 26‐week, interventional, open‐label study (NCT02400346) at outpatient centers in the USA and Europe. All patients received brexpiprazole 1 to 3 mg/day adjunct to their current ADT. Safety outcomes included adverse events (AEs), movement disorder scales, and standard safety assessments (vital signs, laboratory safety parameters, physical examination, electrocardiograms). Exploratory efficacy outcomes included the Montgomery–Åsberg Depression Rating Scale (MADRS), Clinical Global Impressions‐Severity of Illness (CGI‐S), and Social Adaptation Self‐Evaluation Scale (SASS).

Results

Of the 132 treated patients, 88 (66.7%) completed the study and 44 (33.3%) withdrew, including 24 who withdrew because of AEs (18.2%). Overall, 102 patients (77.3%) experienced ≥1 treatment‐emergent AE (TEAE), which were mostly mild or moderate in severity. Treatment‐emergent AEs with the highest incidence were fatigue (15.2%) and restlessness (12.9%). The most common TEAE leading to withdrawal was fatigue (3.0%). No consistent clinically relevant findings were seen with regard to movement disorder scales or standard safety assessments. Mean (standard error) efficacy score changes from baseline to week 26 were: MADRS total, ?14.5 (0.9); CGI‐S, ?1.8 (0.1); and SASS, 3.2 (0.5).

Conclusions

Long‐term (26‐week) treatment with adjunctive brexpiprazole was generally well tolerated in elderly patients with MDD and inadequate response to prior ADT. Improvements were observed in depressive symptoms and social functioning.

     

Aerobic exercise for adult patients with major depressive disorder in mental health services: A systematic review and meta‐analysis

Although exercise is associated with depression relief, the effects of aerobic exercise (AE) interventions on clinically depressed adult patients have not been clearly supported. The purpose of this meta‐analysis was to examine the antidepressant effects of AE versus nonexercise comparators exclusively for depressed adults (18–65 years) recruited through mental health services with a referral or clinical diagnosis of major depression. Eleven e‐databases and bibliographies of 19 systematic reviews were searched for relevant randomized controlled clinical trials. A random effects meta‐analysis (Hedges’ g criterion) was employed for pooling postintervention scores of depression. Heterogeneity and publication bias were examined. Studies were coded considering characteristics of participants and interventions, outcomes and comparisons made, and study design; accordingly, sensitivity and subgroup analyses were calculated. Across 11 eligible trials (13 comparisons) involving 455 patients, AE was delivered on average for 45 min, at moderate intensity, three times/week, for 9.2 weeks and showed a significantly large overall antidepressant effect (g = –0.79, 95% confidence interval = –1.01, –0.57, P < 0.00) with low and nonstatistically significant heterogeneity (I² = 21%). No publication bias was found. Sensitivity analyses revealed large or moderate to large antidepressant effects for AE (I² ≤ 30%) among trials with lower risk of bias, trials with short‐term interventions (up to 4 weeks), and trials involving individual preferences for exercise. Subgroup analyses revealed comparable effects for AE across various settings and delivery formats, and in both outpatients and inpatients regardless symptom severity. Notwithstanding the small number of trials reviewed, AE emerged as an effective antidepressant intervention.     

Predictors of depressive symptoms at hospital discharge in patients with major depressive disorder

Abstract

Objective. Often patients with major depressive disorder (MDD) leave the hospital with continued significant symptomatology. This study sought to evaluate demographic, clinical, and psychosocial predictors of the presence of clinically significant depressive symptoms, defined as a Modified Hamilton Rating Scale for Depression score of ≥ 14, immediately following hospitalization for MDD. Methods. The study enrolled 135 patients with MDD as part of a larger clinical trial investigating the efficacy of post-hospitalization pharmacologic and psychosocial treatments for depressed inpatients. Structured clinical interview and self-report data were available from 126 patients at hospital admission and discharge. Results. Despite the significant decreases in depressive symptoms over the course of hospitalization, 91 (72%) displayed clinically significant depressive symptoms at discharge. Multivariate logistic regression analysis revealed that female sex, earlier age of onset, and poorer social adjustment were unique predictors of symptom outcome. Conclusions. Results suggest that a large proportion of patients leave the hospital with continued significant symptomatology, and the presence of such symptoms following hospitalization for MDD is likely to be explained by a combination of factors.