When Should a Patient Be Declared Recovered From a Major Depressive Episode?

Dunlop, Boadie W.; Rapaport, Mark Hyman

doi:10.4088/jcp.15com10437

Cited by 7 publications

(7 citation statements)

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“…Cognitive function that is impaired in depressive disorder is very harmful since cognitive functions are required to handle everyday life. If an impairment occurs, mistakes in decision making may happen, which give rise to suicidal thoughts [32], result in the failure to recognize the individual's state that is in need of help [59], prolong recovery, proceed into a chronic condition, enable a depression relapse to occur [15,18], and eventually lead to low quality of life even if the depression is in remission [60]. This suggests that cognitive function impairment, in this case working memory function and cognitive flexibility, occurred before depressive disorder parameters presented completely.…”

Section: Discussionmentioning

confidence: 99%

Impaired Cognitive Flexibility and Working Memory Precedes Depression: A Rat Model to Study Depression

2020

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Introduction: Depressive disorders are the 4th leading cause of health problems and the 2nd leading cause of burden among all diseases. Almost all depressive disorder patients have cognitive impairments to a certain extend. Studies about cognitive impairments in depression had been conducted, but whether cognitive dysfunctions are the cause or the effect is still not clear. Objectives: To analyze the process of working memory and cognitive flexibility impairments in a rat model of depression. Methods: In this experimental study, chronic unpredictable mild stress (CUMS) was used as a model of depression in 30 rats (Rattus novergicus). Cognitive function was assessed with the Morris water maze and attentional set shifting test. Results: This study found a significant difference on day 21 in working memory (p = 0.002) and cognitive flexibility (p = 0.036), which continued to day 41 in working memory (p = 0.001) and cognitive flexibility (p = 0.020). In the CUMS model of depression, parameters peak on day 41 and reveal parameter changes in weight gain (p = 0.018), food intake (p < 0.001), changes in food intake (p = 0.001), and the sucrose preference (p = 0.005), elevated plus maze (p = 0.001), and light dark box tests (p = 0.020). Conclusion: In a rat model of depression, cognitive impairment preceded depression, but it might be caused by anxiety-like behavior that occurred in early stimulation of chronic unpredictable mild stress.

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Section: Discussionmentioning

confidence: 99%

Impaired Cognitive Flexibility and Working Memory Precedes Depression: A Rat Model to Study Depression

2020

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“…Although the percent differences in response and remission rates were generally similar for HAM-D17 and HAM-D6, the slightly lower difference in remission rate between arms (0.8%) as assessed by the HAM-D6 (∆ = 4.6%) versus the HAM-D17 (∆ = 5.4%) is of interest. A concern in the field is that the standard HAM-D17 remission threshold of ≤7 may be high, capturing many patients who continue to experience impairment or distress from persisting symptoms [35, 36]. Thus, low levels of core symptoms, as determined by the standard HAM-D6 remission threshold (≤4), might comprise a more valid measure for defining the state of clinical remission.…”

Section: Discussionmentioning

confidence: 99%

“…An analysis of scalability was performed using the non-parametric item response theory model developed by Mokken [34]. Using this framework, the deviation of either the HAM-D17 scale or the HAM-D6 scale from a perfectly homogeneous structure was expressed using Loevinger’s scalability coefficient (H) [35], a measure of the extent to which the scale items represented a single dimension. Loevinger’s coefficient was interpreted as follows: ≥0.5, strong scale homogeneity; 0.40–0.49, moderate but acceptable homogeneity; 0.30–0.39, doubtful homogeneity; < 0.30, no homogeneity.…”

Section: Methodsmentioning

confidence: 99%

Comparing sensitivity to change using the 6-item versus the 17-item Hamilton depression rating scale in the GUIDED randomized controlled trial

Dunlop

Parikh²,

Rothschild

et al. 2019

BMC Psychiatry

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BackgroundPrevious research suggests that the 17-item Hamilton Depression Rating Scale (HAM-D17) is less sensitive in detecting differences between active treatment and placebo for major depressive disorder (MDD) than is the HAM-D6 scale, which focuses on six core depression symptoms. Whether HAM-D6 shows greater sensitivity when comparing two active MDD treatment arms is unknown.MethodsThis post hoc analysis used data from the intent-to-treat (ITT) cohort (N = 1541) of the Genomics Used to Improve DEpression Decisions (GUIDED) trial, a rater- and patient-blinded randomized controlled trial. GUIDED compared combinatorial pharmacogenomics-guided care with treatment as usual (TAU) in patients with MDD. Percent of symptom improvement, response rate and remission rate from baseline to week 8 were evaluated using both scales. Analyses were performed for the full cohort and for the subset of patients who at baseline were taking medications predicted by the test to have moderate or significant gene-drug interactions. A Mokken scale analysis was conducted to compare the homogeneity of HAM-D17 with that of HAM-D6.ResultsAt week 8, the guided-care arm demonstrated statistically significant benefit over TAU when the HAM-D6 (∆ = 4.4%, p = 0.023) was used as the continuous measure of symptom improvement, but not when using the HAM-D17 (∆ = 3.2%, p = 0.069). Response rates increased significantly for guided-care compared with TAU when evaluated using both HAM-D6 (∆ = 7.0%, p = 0.004) and HAM-D17 (∆ = 6.3%, p = 0.007). Remission rates also were significantly greater for guided-care versus TAU using both measures (HAM-D6 ∆ = 4.6%, p = 0.031; HAM-D17 ∆ = 5.5%, p = 0.005). Patients in the guided-care arm who at baseline were taking medications predicted to have gene-drug interactions showed further increased benefit over TAU at week 8 for symptom improvement (∆ = 7.3%, p = 0.004) response (∆ = 10.0%, p = 0.001) and remission (∆ = 7.9%, p = 0.005) using HAM-D6. All outcomes showed continued improvement through week 24. Mokken scale analysis demonstrated the homogeneity and unidimensionality of HAM-D6, but not of HAM-D17, across treatment arms.ConclusionsThe HAM-D6 scale identified a statistically significant difference in symptom improvement between combinatorial pharmacogenomics-guided care and TAU, whereas the HAM-D17 did not. The demonstrated utility of pharmacogenomics-guided treatment over TAU as detected by the HAM-D6 highlights its value for future biomarker-guided trials comparing active treatment arms.Trial registrationClinicaltrials.gov: NCT02109939. Registered 10 April 2014.

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“…The concept of 'recovery' in MDD (defined as a persistent state of remission of symptoms; Dunlop & Rapaport, 2016) has gathered interest in recent years. Studies report that recovery from MDD is possible (e.g., Kessler et al, 2003;Simon et al, 2002) even without receiving professional help (Ridge and Ziebland, 2006), but is a complex phenomenon that requires further investigation (Kartalova-O' Doherty and Tedstone, 2010;Skärsäter et al, 2009).…”

mentioning

confidence: 99%

“…The concept of “recovery” in MDD has gathered interest in recent years (Dunlop & Rapaport, 2016). Recovery is defined as a personal process of changing one’s attitudes, values, feelings, goals, skills, and roles (Slade et al, 2014).…”

mentioning

confidence: 99%

Attempting to Restore Integrity of the Self: A Grounded Theory Study of Recovery From Major Depressive Disorder

Amini

Marks

Cheraghi

et al. 2018

J Am Psychiatr Nurses Assoc

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BACKGROUND: The cultural and social background of the individual would seem to be important factors that can affect recovery from major depressive disorder (MDD). Currently, there is little information on the process of recovery from MDD in Middle Eastern countries, such as Iran. AIMS: This study was conducted to explore the process of recovery from MDD in Iran. METHOD: A grounded theory approach by Corbin and Strauss was used to explore recovery from MDD. Twenty patients were recruited using purposive and theoretical sampling methods. RESULTS: Several themes emerged from the data, the primary of which was “Attempting to restore integrity of the self,” which included the two subthemes of “Attempting to restore health,” and “Attempting to reacquire the lost abilities.” Various contextual factors also affected recovery, including poverty, inefficient health care systems, perceived support, feelings of failure, and social stigma. During the recovery process, participants adopted both “effective strategies” and “ineffective strategies.” Following the attempt to restore integrity, participants experienced different levels of integrity, ranging from “complete recovery” to “no recovery/relapse.” CONCLUSIONS: The results from this study contribute to the body of knowledge regarding recovery from MDD in Iran. The data suggest that recovery from depressive disorder is a very personal experience that is affected by different and variable factors and conditions. However, the attempt to restore integrity of the self can result in achieving a higher level of performance and health.

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When Should a Patient Be Declared Recovered From a Major Depressive Episode?

Abstract: Commentary See article by Judd et al

Cited by 7 publications

References 19 publications

Impaired Cognitive Flexibility and Working Memory Precedes Depression: A Rat Model to Study Depression

Impaired Cognitive Flexibility and Working Memory Precedes Depression: A Rat Model to Study Depression

Comparing sensitivity to change using the 6-item versus the 17-item Hamilton depression rating scale in the GUIDED randomized controlled trial

Attempting to Restore Integrity of the Self: A Grounded Theory Study of Recovery From Major Depressive Disorder

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