Symptomatic remission is the optimal outcome in depression. A brief, validated tool for symptom measurement that can indicate when remission has occurred in mental health and primary care settings is ...unavailable. We evaluated a 7-item abbreviated version (HAMD-7) of the 17-item Hamilton Depression Rating Scale (HAMD-17) in a randomized controlled clinical trial of patients with major depressive disorder being cared for in primary care settings.
We enrolled 454 patients across 47 primary care settings who met DSM-IV-TR criteria for a major depressive disorder. Of these, 410 patients requiring antidepressant medication were randomized to have their symptoms rated with either HAMD-7 (n = 205) or HAMD-17 (n = 205) as the primary measurement tool. The primary outcome was the proportion of patients who achieved a-priori defined responses to 8 weeks of therapy using each instrument.
Of the 205 participants per group, 67% of those evaluated with HAMD-7 were classified as having responded to therapy (defined as a > or = 50% reduction from the pretreatment score), compared with 74% of those evaluated with HAMD-17 (p = 0.43). The difference between the groups' changes in scores from baseline (pretreatment) to endpoint was significant (p < 0.001), without a main effect of group (p = 0.84) or group-by-time (p = 0.83) interaction. The HAMD-7 test was brief to administer (e.g., 3-4 min for 85% of the primary care physicians evaluated), which facilitated the efficient and structured evaluation of salient depressive symptoms.
The abbreviated HAMD-7 depression scale is equivalent to the HAMD-17 in assessing remission in patients with a major depressive disorder undergoing drug therapy.
Objective:
The primary objective was to evaluate sexual function (SF) separately in men and women with major depressive disorder (MDD) before and during treatment with bupropion sustained release ...(SR) or paroxetine. The secondary objectives involved a comparative evaluation of the Sex Effects Scale (Sex FX) and the Investigator-Rated Sexual Desire and Functioning Scale (IRSD-F), as well as a comparison of antidepressant outcomes and an examination of the relation between level of depression and SF over time.
Method:
There were 141 patients (68 women and 73 men) who met DSM-IV criteria for a current major depressive episode. They were randomly assigned to receive bupropion SR (150 to 300 mg daily) or paroxetine (20 to 40 mg daily) under double-blind trial conditions. Patients were assessed at baseline and at 2, 4, 6, and 8 weeks with the 17-item Hamilton Depression Rating Scale (HDRS17), Sex FX, and IRSD-F.
Results:
Prior to treatment, women reported significantly lower SF on both the Sex FX and IRSD-F scales, compared with men. During treatment, there were no significant drug differences on measures of SF over time for women; however, men who were treated with paroxetine reported a worsening of SF, whereas bupropion SR did not significantly alter SF. Both bupropion SR and paroxetine produced clinically and statistically significant reductions in HDRS17 scores as well as comparable rates of response and remission. There was a statistically significant correlation between the 2 measures of SF at all visits. There was also a significant inverse relation between depression and SF in women, but not in men, irrespective of drug.
Conclusion:
According to the Sex FX scale, a significant difference in antidepressant-related sexual dysfunction was detected in men, but not women, during treatment with bupropion SR or paroxetine.
Preliminary data suggest that hormone replacement therapy (HRT) and antidepressant therapy may have overlapping molecular targets.15-20 Moreover, the putative antidepressant effects of HRT have also ...been reported.11,21-29 HRT has been prescribed for climacteric symptoms (e.g., vasomotor symptoms), and some antidepressants (e.g., serotonergic antidepressants) have been shown to alleviate the fall range of climacteric symptoms.19,20,30 Thus, many women who experience depressive symptoms or a major depressive disorder at the time of menopause may find relief of these symptoms and even the disorder by using HRT. Fig. 1: Top: Total estimated prescriptions dispensed in Ontario for hormone replacement therapy (HRT: oral and transdermal estrogen monotherapy and estrogen-progesterone combination therapy) and serotonergic antidepressants (SAs: citalopram, fluoxetine, sertraline, fluvoxamine, paroxetine, venlafaxine, nefazadone and trazadone) to women 45-65 years old, from January 2001 to June 2003. Source: IMS Health Canada. A consistent downward trajectory in the number of HRT prescriptions and a simultaneous increase in the number of SA prescriptions occurred after July 2002, when results indicating potential harmful effects of HRT were published. Bottom: Linear regression models of the number of prescriptions against time, for each prescription type (HRT and SA) and for each time period (11 months before and 11 months after July 2002). The predicted slopes (β ± standard error prescriptions/day) are shown, accompanied by a test of the null hypothesis: β = 0. There was no statistically significant longitudinal trend during the 11 months before July 2002; however, during the period following July 2002, there was a statistically significant decrease in HRT utilization that coincided with an increase in SA utilization. Comparison of the regression models : (HRT v. SA prescriptions) revealed a statistically significant change in the prescription pattern of both agents after the medical scrutiny of HRT usage (β: -25.6 v. 33.2, p < 0.001). *p < 0.001.
Impaired sexual function is associated with major depressive disorder in the untreated state and is often more prevalent during antidepressant therapy, which frequently results in poor treatment ...compliance. In this double-blind, multicenter study, the effects of agomelatine (an MT1 and MT2 agonist and 5HT-2C antagonist) and venlafaxine XR on sexual function were compared using the Sex Effects Scale in depressed patients. A total of 276 male and female patients received either agomelatine (50 mg) or venlafaxine XR (titrated to a target dose of 150 mg/d) for 12 weeks. Those who were sexually active at baseline (n = 193) and those who, in addition, achieved remission (n = 111) were defined a priori for analyses of change in sexual function. Treatment-emergent sexual dysfunction was significantly less prevalent among patients who received agomelatine, and venlafaxine XR was associated with significantly greater deterioration on the Sex Effects Scale domains of desire and orgasm. Both treatments resulted in equivalently high rates of remission (agomelatine, 73%; venlafaxine XR, 66.9%), although fewer patients in the agomelatine group discontinued treatment because of adverse events (agomelatine, 2.2%, vs venlafaxine XR, 8.6%). Agomelatine seems to be an efficacious antidepressant with a superior sexual side effect profile compared with venlafaxine XR, although superiority to placebo was not evaluated in this trial.
Few interventions are proven to reduce total health care costs, and addressing cost-related nonadherence has the potential to do so.
To determine the effect of eliminating out-of-pocket medication ...fees on total health care costs.
This secondary analysis of a multicenter randomized clinical trial using a prespecified outcome took place across 9 primary care sites in Ontario, Canada (6 in Toronto and 3 in rural areas), where health care services are generally publicly funded. Adult patients (≥18 years old) reporting cost-related nonadherence to medicines in the past 12 months were recruited between June 1, 2016, and April 28, 2017, and followed up until April 28, 2020. Data analysis was completed in 2021.
Access to a comprehensive list of 128 medicines commonly prescribed in ambulatory care with no out-of-pocket costs for 3 years vs usual medicine access.
Total publicly funded health care costs over 3 years, including costs of hospitalizations. Health care costs were determined using administrative data from Ontario's single-payer health care system, and all costs are reported in Canadian dollars with adjustments for inflation.
A total of 747 participants from 9 primary care sites were included in the analysis (mean SD age, 51 14 years; 421 56.4% female). Free medicine distribution was associated with a lower median total health care spending over 3 years of $1641 (95% CI, $454-$2792; P = .006). Mean total spending was $4465 (95% CI, -$944 to $9874) lower over the 3-year period.
In this secondary analysis of a randomized clinical trial, eliminating out-of-pocket medication expenses for patients with cost-related nonadherence in primary care was associated with lower health care spending over 3 years. These findings suggest that eliminating out-of-pocket medication costs for patients could reduce overall costs of health care.
ClinicalTrials.gov Identifier: NCT02744963.
Objective:
To investigate the frequency of gambling in people who have been diagnosed with major depressive disorder (MDD) or bipolar disorder (BD). Secondary objectives were to examine: sex ...differences in the rates of gambling behaviour, the temporal relation between onset of mood disorders and problem gambling, psychiatric comorbidities associated with problem gambling, and the influences of problem gambling on quality of life.
Method:
People (aged 18 years and older) who met criteria for lifetime Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision-defined MDD or BD I or II, and were confirmed by the Mini International Neuropsychiatric Interview, were enrolled. Participants were recruited from 5 sites in Canada and 1 in the United States. Prevalence of past-year problem gambling was assessed with the Canadian Problem Gambling Index. Associated comorbidities with problem gambling are presented.
Results:
A total of 579 participants were enrolled (female: n = 379, male: n = 200). Prevalence of problem gambling did not differ significantly between the MDD (12.5%) and the BD (12.3%) groups. There was a significant difference in the prevalence of problem gambling between males (19.5%) and females (7.8%) in the BD group (χ2 = 8.695, df = 1, P = 0.003). Among people meeting criteria for problem gambling, the mood disorder was the primary onset condition in 71% of cases. People with a mood disorder with comorbid current panic disorder (OR = 1.96; 95% CI 1.02 to 3.75), obsessive-compulsive disorder (OR = 1.86; 95% CI 1.01 to 3.45), specific phobia (OR = 2.36; 95% CI 1.17 to 4.76), alcohol dependence (OR = 5.73; 95% CI 3.08 to 10.65), or lifetime substance dependence (OR = 2.05; 95% CI 1.17 to 3.58), had significantly increased odds of problem gambling. Problem gambling across MDD and BD populations was also associated with lower quality of life ratings.
Conclusion:
These results reaffirm a higher prevalence of gambling both in BD and in MDD populations, compared with previously published community samples. Our study also identifies risk factors for gambling behaviours within these populations.
Objectives:
We conducted a preliminary study on the validation of the Psychiatric Diagnostic Screening Questionnaire (PDSQ) among patients seeking treatment for substance use disorders (SUDs).
...Method:
We assessed 76 patients with SUDs, using the PDSQ, followed by the Structured Clinical Interview for DSM-IV. Sensitivity, specificity, positive and negative predictive values, and receiver operating characteristic (ROC) curves were calculated.
Results:
Overall, the psychometric properties identified with the PDSQ in patients with SUDs differed from those found in psychiatric outpatient populations. The ROC curves were calculated for major depressive disorder, posttraumatic stress disorder, and panic disorder. The areas under the curves were 0.86 (95%CI, 0.77 to 0.95; P < 0.001), 0.79 (95%CI, 0.68 to 0.90; P < 0.001), and 0.66 (95%CI, 0.51 to 0.82; P = 0.05), respectively.
Conclusion:
The use of the PDSQ to screen for other psychiatric disorders in populations with SUDs is promising but requires larger validation studies to provide data on its psychometric properties and inform the choice of cut-off scores for this population.
Sexual dysfunction is frequently associated with depression and is often exacerbated by antidepressant treatment. The true prevalence of antidepressant minduced dysfunction during a major depressive ...episode is generally underreported, due to reliance on spontaneous self-report data and the reluctance of physicians to use standardized rating scales. The aim of this study is to validate the Sex Effects scale (SexFX) in a healthy population, addressing internal and inter-rater reliability, test-retest reliability, as well as convergent and divergent validity.
The SexFX is a 13-item scale that assesses severity of sexual dysfunction across the domains of desire, arousal, and orgasm based on the frequency of behaviour. Healthy participants (N = 53) had the SexFX and Changes in Sexual Functioning Questionnaire (CSFQ) administered at two timepoints, two weeks apart.
The Cronbach's a was 0.91 and 0.93 for the male and female scales, respectively, and inter-rater reliability was very high with ICCs of 0.99 for both the male and female scales. Concurrent validity with the CSFQ was adequate.
The SexFX demonstrated satisfactory psychometric properties, providing the results necessary to proceed with further validation trials.
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