Speed of Improvement in Sleep Disturbance and Anxiety Compared With Core Mood Symptoms During Acute Treatment of Depression in Old Age

Dombrovski, Alexandre Y.; Blakesley-Ball, Richard; Mulsant, Benoit H.; Mazumdar, Sati; Houck, Patricia R.; Szántó, Katalin; Reynolds, Charles F.

doi:10.1097/01.jgp.0000218325.76196.d1

Cited by 27 publications

(25 citation statements)

References 16 publications

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“…This grouping is consistent with a recent meta-analysis of the HAM-D factor structure (Shafer, 2006). As we found previously, HAM-D factors, from which these subscales were derived, explain s imilar proportions of overall symptom variability; the subscales possess high interrater reliability and moderate internal consistency (Dombrovski et al, 2006). These subscales were only weakly inter-correlated; thus, we examined them as independent variables.…”

Section: Measures Of Outcome and Residual Symptomssupporting

confidence: 63%

Residual symptoms and recurrence during maintenance treatment of late-life depression

Dombrovski

Mulsant

Houck

et al. 2007

Journal of Affective Disorders

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138

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Section: Measures Of Outcome and Residual Symptomssupporting

confidence: 63%

Residual symptoms and recurrence during maintenance treatment of late-life depression

Dombrovski

Mulsant

Houck

et al. 2007

Journal of Affective Disorders

Self Cite

138

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show abstract

“…Persistent anxiety was defined as a score of ≥2 on the HRSD-17 anxiety subscale including the agitation (item 9), psychic (item 10) and somatic (item 11) anxiety, and hypochondriasis (item 15). These factor-analytically derived subscales have been shown to explain similar proportions of overall symptom variability (Dombrovski et al 2006). Their construction was confirmed by the results of a recent meta-analysis of the HRSD-17 factor structure (Shafer 2006).…”

Section: Methodsmentioning

confidence: 50%

Which symptoms predict recurrence of depression in women treated with maintenance interpersonal psychotherapy?

Dombrovski¹,

Cyranowski²,

Mulsant³

et al. 2008

Depress. Anxiety

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104

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Background-Even low levels of residual symptoms are known to increase the risk of relapse and early recurrence of major depression. It is not known if ongoing psychotherapy lessens this risk. We therefore examined the impact of persistent symptoms, including mood, insomnia, and anxiety symptoms, on time to recurrence in women receiving maintenance interpersonal psychotherapy (IPT-M) for recurrent depression.

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“…Based on our previous work, we defined core HAM-D symptoms as HAM-D items 1, 2, 3, and 7 (depressed mood, guilt, suicide, and work/activities); anxiety HAM-D symptoms as items 9, 10, 11, and 15 (agitation, psychic anxiety, somatic anxiety, and hypochondriasis); and sleep HAM-D symptoms as items 4, 5, and 6 (early, middle, and late insomnia) (28). We initially performed a univariate logistic regression on the demographic and clinical variables to identify potential predictors of treatment response.…”

Section: Acute Treatment Protocolsmentioning

confidence: 99%

Empirically Derived Decision Trees for the Treatment of Late-Life Depression

Andreescu

Mulsant²,

Houck³

et al. 2008

AJP

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Objective-Several predictors of treatment response in late-life depression have been reported in the literature. The aim of this analysis was to develop a clinically useful algorithm that would allow clinicians to predict which patients will likely respond to treatment and thereby guide clinical decision making.Method-A total of 461 patients with late-life depression were treated under structured conditions for up to 12 weeks and assessed weekly with the 17-item Hamilton Rating Scale for Depression . The authors developed a hierarchy of predictors of treatment response using signaldetection theory. The authors developed two models, one minimizing false predictions of future response and one minimizing false predictions of future nonresponse, to offer clinicians two clinically useful treatment algorithms.Results-In the first model, early symptom improvement (defined by the relative change in HAM-D-17 total score from baseline to week 4), lower baseline anxiety, and an older age of onset predict response at 12 weeks. In the second model, early symptom improvement represents the principal guide in tailoring treatment, followed by baseline anxiety level, baseline sleep disturbance, and-for a minority of patients-the adequacy of previous antidepressant treatment.Conclusions-Our two models, developed to help clinicians in different clinical circumstances, illustrate the possibility of tailoring the treatment of late-life depression based on clinical characteristics and confirm the importance of early observed changes in clinical status.Late-life major depression is associated with emotional suffering, disability, caregiver strain, suicide, and poor compliance with other medical treatments (1). Successful antidepressant treatment is one of the most effective ways to reduce disability, prevent morbidity, and improve quality of life in an older depressed patient (2,3). In many cases, patients appear to be resistant to treatment because their antidepressants are switched prematurely (4,5). If treating clinicians knew the probability of treatment response earlier in the course of treatment, they would be in a better position to advise patients about various treatment options. These options could include continuing the current medication, augmenting current pharmacotherapy, or switching to another approach (6,7). Previously, our group has shown that a patient's clinical status after 4 weeks of treatment predicts reliably their response status at week 12 (6). Furthermore, we have identified several biological, clinical, and psychosocial characteristics as predictors of treatment response in latelife major depression: allelic variation in the serotonin transporter promoter, REM sleep latency, cerebral glucose metabolism, age at onset of first episode, sleep disturbances at baseline, baseline Hamilton Depression Rating Scale (HAM-D) scores, baseline anxiety levels, suicidal ideation, response and adherence to previous antidepressant treatment, family support, and social inequalities (7-17). To our knowledge, there is n...

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Speed of Improvement in Sleep Disturbance and Anxiety Compared With Core Mood Symptoms During Acute Treatment of Depression in Old Age

Cited by 27 publications

References 16 publications

Residual symptoms and recurrence during maintenance treatment of late-life depression

Residual symptoms and recurrence during maintenance treatment of late-life depression

Which symptoms predict recurrence of depression in women treated with maintenance interpersonal psychotherapy?

Empirically Derived Decision Trees for the Treatment of Late-Life Depression

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