Utilizing the &lt;em&gt;DSM-5&lt;/em&gt; Anxious Distress Specifier to Develop Treatment Strategies for Patients With Major Depressive Disorder

Thase, Michael E.; Weisler, Richard H.; Manning, J. Sloan; Trivedi, Madhukar H.

doi:10.4088/jcp.ot17015ah1

Cited by 8 publications

(5 citation statements)

References 58 publications

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“…Moreover, we expected to gain insights into the temporal dynamics of DR by assessing neural mediators 13,27,28,33 along treatment. Previous clinical 37–39 and imaging studies 40–42 provide compelling evidence that highly persistent cognitive symptoms such as memory deficits or rumination are related to unfavorable illness course in terms of onset, DR, chronicity and future relapse. However, a more direct cognitive measure is required for a clinical application 41 .…”

Section: Introductionmentioning

confidence: 99%

Prefrontal networks dynamically related to recovery from major depressive disorder: a longitudinal pharmacological fMRI study

et al. 2019

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Due to lacking predictors of depression recovery, successful treatment of major depressive disorder (MDD) is frequently only achieved after therapeutic optimization leading to a prolonged suffering of patients. This study aimed to determine neural prognostic predictors identifying non-remitters prior or early after treatment initiation. Moreover, it intended to detect time-sensitive neural mediators indicating depression recovery. This longitudinal, interventional, single-arm, open-label, phase IV, pharmacological functional magnetic resonance imaging (fMRI) study comprised four scans at important stages prior (day 0) and after escitalopram treatment initiation (day 1, 28, and 56). Totally, 22 treatment-free MDD patients (age mean ± SD: 31.5 ± 7.7; females: 50%) suffering from a concurrent major depressive episode without any comorbid DSM-IV axis I diagnosis completed the study protocol. Primary outcome were neural prognostic predictors of depression recovery. Enhanced de-activation of anterior medial prefrontal cortex (amPFC, single neural mediator) indicated depression recovery correlating with MADRS score and working memory improvements. Strong dorsolateral PFC (dlPFC) activation and weak dlPFC-amPFC, dlPFC-posterior cingulate cortex (PCC), dlPFC-parietal lobe (PL) coupling (three prognostic predictors) hinted at depression recovery at day 0 and 1. Preresponse prediction of continuous (dlPFC-PL: R2day1 = 55.9%, 95% CI: 22.6–79%, P < 0.005) and dichotomous (specificity/sensitivity: SP/SNday1 = 0.91/0.82) recovery definitions remained significant after leave-one-out cross-validation. Identified prefrontal neural predictors might propel the future development of fMRI markers for clinical decision making, which could lead to increased response rates and adherence during acute phase treatment periods. Moreover, this study underscores the importance of the amPFC in depression recovery.

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Section: Introductionmentioning

confidence: 99%

Prefrontal networks dynamically related to recovery from major depressive disorder: a longitudinal pharmacological fMRI study

et al. 2019

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“…Since the publication of the DSM‐5 (2013), it has been recognized that anxious distress might characterize many patients diagnosed with major depressive disorder. For example, the prevalence of this type of depression seems to range between 40% and 78% (Thase et al, 2017). Also, agitation seems to be present during depression episodes in 32.2% of bipolar patients (Serra et al, 2019).…”

Section: Discussionmentioning

confidence: 99%

“…Also, agitation seems to be present during depression episodes in 32.2% of bipolar patients (Serra et al, 2019). Moreover, anxious depression is associated with poorer functioning, limited response to treatment and greater suicidality (Thase et al, 2017). It has also been noted that depression tends to be episodic, while anxious symptoms tend to linger and hardly remit completely (Thase et al, 2017).…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, anxious depression is associated with poorer functioning, limited response to treatment and greater suicidality (Thase et al, 2017). It has also been noted that depression tends to be episodic, while anxious symptoms tend to linger and hardly remit completely (Thase et al, 2017). Finally, some studies suggested that in 57% of cases, anxiety disorders preceded comorbid depressive disorders, whereas in only 18% of cases, depression disorder preceded anxiety disorders (Lamers et al, 2011).…”

Section: Discussionmentioning

confidence: 99%

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Comorbidity among depression, anxiety and stress symptoms in naturalistic clinical samples: A cross‐cultural network analysis

Mihić,

Janičić,

Marchetti

et al. 2023

Clin Psychology and Psychoth

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Comorbidity between depression and anxiety is well‐established across various settings and cultures. We approached comorbidity from the network psychopathology perspective and examined the depression, anxiety/autonomic arousal and stress/tension symptoms in naturalistic clinical samples from Serbia, Italy and Croatia. This was a multisite study in which regularized partial correlation networks of the symptoms, obtained via self‐reports on the Depression Anxiety and Stress Scales‐21 (DASS‐21) in three cross‐cultural, clinical samples (total N = 874), were compared with respect to centrality, edge weights, community structure and bridge centrality. A moderate degree of similarity in a number of network indices across the three networks was observed. While negative mood emerged to be the most central node, stress/tension nodes were the most likely bridge symptoms between depressive and anxiety/autonomic arousal symptoms. We demonstrated that the network structure and features in mixed clinical samples were similar across three different languages and cultures. The symptoms such as agitation, restlessness and inability to relax functioned as bridges across the three symptom communities explored in this study. Important theoretical and clinical implications were derived.

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“…Major depressive disorder with anxious distress exerts a significant impact on the healthcare system To emphasize the importance and impact of the concurrence of anxiety and depressive disorders, the Diagnostic and Statistical Manual of Mental Disorders-5th edition (DSM-5) has added the anxious distress specifier (ADS) [1]. The diagnostic criteria for ADS require the presence of at least two of the following symptoms: (1) feeling keyed up or tense, (2) restlessness, (3) difficulty concentrating due to worry, (4) feeling that something awful may happen, and (5) feeling that one may lose control of oneself.…”

Section: Introductionmentioning

confidence: 99%

High-definition transcranial direct current stimulation (HD-tDCS) in major depressive disorder with anxious distress—a study protocol for a double-blinded randomized sham-controlled trial

Zhang,

Zhao,

Sun

et al. 2024

Trials

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Background Comorbid anxiety disorders and anxious distress are highly prevalent among individuals with major depressive disorder (MDD). The presence of the DSM-5 anxious distress specifier (ADS) has been associated with worse treatment outcomes and chronic disease course. Few studies have evaluated the therapeutic effects of High-definition transcranial direct current stimulation (HD-tDCS) on depressive and anxiety symptoms among MDD patients with ADS. The current randomized controlled trial aims to assess the efficacy of HD-tDCS as an augmentation therapy with antidepressants compared to sham-control in subjects of MDD with ADS. Methods MDD patients with ADS will be recruited and randomly assigned to the active HD-tDCS or sham HD-tDCS group. In both groups, patients will receive the active or sham intervention in addition to their pre-existing antidepressant therapy, for 2 weeks with 5 sessions per week, each lasting 30 min. The primary outcome measures will be the change of depressive symptoms, clinical response, and the remission rate as measured with the 17-item Hamilton Depression Rating Scale (HDRS-17) before and after the intervention and at the 2nd and 6th week after the completed intervention. Secondary outcome measures include anxiety symptoms, cognitive symptoms, disability assessment, and adverse effects. Discussion The HD-tDCS applied in this trial may have treatment effects on MDD with ADS and have minimal side effects. Trial registration The trial protocol is registered with www.chictr.org.cn under protocol registration number ChiCTR2300071726. Registered 23 May 2023.

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Utilizing the <em>DSM-5</em> Anxious Distress Specifier to Develop Treatment Strategies for Patients With Major Depressive Disorder

Cited by 8 publications

References 58 publications

Prefrontal networks dynamically related to recovery from major depressive disorder: a longitudinal pharmacological fMRI study

Prefrontal networks dynamically related to recovery from major depressive disorder: a longitudinal pharmacological fMRI study

Comorbidity among depression, anxiety and stress symptoms in naturalistic clinical samples: A cross‐cultural network analysis

High-definition transcranial direct current stimulation (HD-tDCS) in major depressive disorder with anxious distress—a study protocol for a double-blinded randomized sham-controlled trial

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