Melancholic/endogenous depression and response to somatic treatment and placebo

Peselow, Eric D.; Sanfilipo, Michael; Difiglia, Constance; Fieve, Ronald R.

doi:10.1176/ajp.149.10.1324

Cited by 72 publications

(7 citation statements)

References 43 publications

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“…The naturalistic design of the study gives a special significance to this result as the majority of previous evidence comes from clinical trials comparing few antidepressant options and restricted inclusion criteria. The available data on melancholic depression favors tricyclic than narrow-action antidepressants [7], [38], [39]. A meta-analysis of 38 double-blind studies concluded that the reversible MAOI moclobemide have higher response rates in depressed patients with melancholic features[40].…”

Section: Discussionmentioning

confidence: 99%

Clinical Patterns and Treatment Outcome in Patients with Melancholic, Atypical and Non-Melancholic Depressions

et al. 2012

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ObjectiveTo assess sociodemographic, clinical and treatment factors as well as depression outcome in a large representative clinical sample of psychiatric depressive outpatients and to determine if melancholic and atypical depression can be differentiated from residual non-melancholic depressive conditions.Subjects/Materials and MethodA prospective, naturalistic, multicentre, nationwide epidemiological study of 1455 depressive outpatients was undertaken. Severity of depressive symptoms was assessed by the Hamilton Depression Rating Scale (HDRS) and the Self Rated Inventory of Depressive Symptomatology (IDS-SR30). IDS-SR30 defines melancholic and atypical depression according to DSM-IV criteria. Assessments were carried out after 6–8 weeks of antidepressant treatment and after 14–20 weeks of continuation treatment.ResultsMelancholic patients (16.2%) were more severely depressed, had more depressive episodes and shorter episode duration than atypical (24.7%) and non-melancholic patients. Atypical depressive patients showed higher rates of co-morbid anxiety disorders and substance abuse. Melancholic patients showed lower rates of remission.ConclusionOur study supports a different clinical pattern and treatment outcome for melancholic and atypical depression subtypes.

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Section: Discussionmentioning

confidence: 99%

Clinical Patterns and Treatment Outcome in Patients with Melancholic, Atypical and Non-Melancholic Depressions

et al. 2012

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“…Researchers have reported differences in response rates based on diagnostic sub-groups, such as patients with melancholic depression showing better response to TCAs versus SSRIs (Roose et al, 1986) or patients with atypical depression responding better to MAOIs than to TCAs (Quitkin et al, 1993). However these findings are generally inconsistent (Peselow et al, 1992; Nelson et al, 1994) and the effects are small (Fava et al, 1997) indicating that treatment strategies based on diagnostic subgroups are unlikely to improve treatment efficacy. These efforts may prove to be more successful if the relative constellation of symptom features were evaluated as potential predictors of response.…”

Section: Discussionmentioning

confidence: 99%

Baseline mood-state measures as predictors of antidepressant response to scopolamine

Furey

Nugent

Speer³

et al. 2012

Psychiatry Research

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Identifying predictors of antidepressant response will facilitate the successful treatment of patients suffering from depression. Scopolamine produces robust antidepressant responses in unipolar and bipolar depression. Here we evaluate the potential for baseline self-ratings to predict treatment response to scopolamine. Fifty-one unipolar and bipolar patients participated in a double-blind, placebo-controlled crossover trial. Following a single-blind placebo session, participants randomly received P/S or S/P (P=3 placebo; S=3 scopolamine (4ug/kg) sessions). Mood-state self-ratings (POMS and VAS) and depression severity (MADRS) were obtained before each infusion. Day 1 (baseline/placebo) self-ratings were used in a discriminant function analysis to identify linear combinations of individual items that predict response. The discriminant analysis separated responders from non-responders in both the unipolar (Chi-square=22.6, p=0.002) and bipolar (Chi-square=11.2, p=0.025) diagnostic subgroups. The discriminant functions accurately classified over 85% of patients as responders/non-responders. The POMS depression subscale correlated with clinical response (r=-.47; p<0.001), as did the VAS restlessness (r=-.49; p<0.001), sad (r=-.49, p<0.0001) and irritated (r=-.40, p=0.004) scales. These results indicate that self-report mood-ratings obtained prior to treatment can predict response outcome to scopolamine, and suggest that a constellation of mood-state features may be related to clinical response.

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“…The diagnostic heterogeneity of most psychiatric disorders raises the possibility that some forms of illness may be more or less responsive to placebo-like interventions. For example, a study by Peselow et al [12]has shown lower placebo response rates in melancholic depression than in non-melancholic depression despite comparable response rates to active treatment in these two groups. However, attempts to restrict clinical trials to populations associated with lower placebo response rates are plagued by the same issues discussed above, in that pressure to enroll may affect some investigators’ diagnostic assessments and inflate the rate of diagnostic misclassification of subtypes of psychiatric disorders.…”

Section: The Search For a Culpritmentioning

confidence: 99%

The Problem of the Placebo Response in Clinical Trials for Psychiatric Disorders: Culprits, Possible Remedies, and a Novel Study Design Approach

Fava¹,

Evins²,

Dorer

et al. 2003

Psychother Psychosom

404

422

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The placebo response is a major issue in clinical trials for psychiatric disorders. Possible contributing factors to this problem include diagnostic misclassification, issues concerning inclusion/exclusion criteria, outcome measures’ lack of sensitivity to change, measurement errors, poor quality of data entry and verification, waxing and waning of the natural course of illness, regression toward the mean phenomenon, patient and clinician expectations about the trial, study design issues, non-specific therapeutic effects, and high attrition. Over the past few decades, researchers have attempted to reduce the placebo effect in a variety of ways. Unfortunately, approaches with very little or no benefit have included restricting enrollment to selected populations, rater training, requirement of same rater, and placebo lead-in phases. Some benefits, although often marginal, have been derived from standardizing diagnostic procedures, managing clinicians’ overestimation of change, simplification of study visits and assessments, minimizing non-specific, therapeutic effects, extending trial duration, reducing number of sites, increasing the sensitivity of outcome measures, and reducing the number of treatment arms. Thus far, there has been no attempt to develop new study designs aimed at reducing the placebo effect. We are proposing a novel study design, called ‘Sequential Parallel Comparison Design’, suitable for double-blind, placebo-controlled trials in psychiatric disorders. This design is aimed at reducing both the overall placebo response rate and the sample size required for such trials. Its usefulness in clinical research needs to be tested empirically. If this study design were to be found to meet its stated goals, this could markedly facilitate the process of clinical development of new compounds for the treatment of psychiatric disorders.

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Melancholic/endogenous depression and response to somatic treatment and placebo

Cited by 72 publications

References 43 publications

Clinical Patterns and Treatment Outcome in Patients with Melancholic, Atypical and Non-Melancholic Depressions

Clinical Patterns and Treatment Outcome in Patients with Melancholic, Atypical and Non-Melancholic Depressions

Baseline mood-state measures as predictors of antidepressant response to scopolamine

The Problem of the Placebo Response in Clinical Trials for Psychiatric Disorders: Culprits, Possible Remedies, and a Novel Study Design Approach

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