Abstract Objective To investigate whether subtypes of depression predict differential outcomes of treatment with selective serotonin-reuptake inhibitor (SSRI) and a tricyclic antidepressant in major ...depression. Method Among 811 adults with moderate-to-severe depression, melancholic, atypical, anxious and anxious-somatizing depression subtypes established at baseline were evaluated as predictors of outcome of treatment with flexible dosage of the SSRI escitalopram or the tricyclic antidepressant nortriptyline. The primary outcome measure was the Montgomery–Åsberg Depression Rating Scale (MADRS). Secondary outcome measures were the 17-item Hamilton Rating Scale for Depression (HRSD-17) and the Beck Depression Inventory (BDI). Results Melancholic depression was associated with slightly worse outcomes among individuals treated with escitalopram, but did not affect outcome of treatment with nortriptyline. The interaction between melancholic depression and drug did not reach statistical significance for the primary outcome measure and significant results for secondary outcome measures were not robust in sensitivity analyses. Atypical depression was unrelated to outcome of treatment with either antidepressant. Anxious and anxious-somatizing depression did not predict outcome on the primary measure, but inconsistently predicted worse outcome in some secondary analyses. Limitations Some participants were non-randomly allocated to drug. Therefore, drug-by-predictor interactions had to be validated in sensitivity analyses restricted to the 468 randomly allocated individuals. Conclusions Melancholic, atypical or anxious depression, are not sufficiently robust differential predictors of outcome to help clinician choose between SSRI and tricyclic antidepressants. There is a need to investigate other predictors of outcome.
A diagnosis of psychosis has tended to discount the considerable degree of emotional disorder associated with it, in a manner that may also inform psychological treatment options. Depression and ...anxiety are often associated with schizophrenia. Up to 40% of people have clinical levels of depression and anxiety symptoms could occur in 60% of patients with chronic psychotic disorder. Among emotional problems depression and depressive symptoms are well recognised and treated with success, whereas anxiety is a less known phenomenon and has not been studied as much as depression. Comorbid anxiety disorders or symptoms (social phobia, panic disorder, obsessive compulsive disorder, and post-traumatic stress disorder) occur in patients with psychosis in the same way as in patients who have only anxiety disorder. This comorbidity adversely affects outcome, and it may also reflect on processes underlying the development of psychotic symptoms. The present review highlights some major characteristics of anxiety and psychosis and also some aspects of coping and treatment strategies for anxiety in patients with psychosis.
Major depressive disorder has been linked with inflammatory processes, but it is unclear whether individual differences in levels of inflammatory biomarkers could help match patients to treatments ...that are most likely to be beneficial. The authors tested the hypothesis that C-reactive protein (CRP), a commonly available marker of systemic inflammation, predicts differential response to escitalopram (a serotonin reuptake inhibitor) and nortriptyline (a norepinephrine reuptake inhibitor).
The hypothesis was tested in the Genome-Based Therapeutic Drugs for Depression (GENDEP) study, a multicenter open-label randomized clinical trial. CRP was measured with a high-sensitivity method in serum samples from 241 adult men and women with major depressive disorder randomly allocated to 12-week treatment with escitalopram (N=115) or nortriptyline (N=126). The primary outcome measure was the score on the Montgomery-Åsberg Depression Rating Scale (MADRS), administered weekly.
CRP level at baseline differentially predicted treatment outcome with the two antidepressants (CRP-drug interaction: β=3.27, 95% CI=1.65, 4.89). For patients with low levels of CRP (<1 mg/L), improvement on the MADRS score was 3 points higher with escitalopram than with nortriptyline. For patients with higher CRP levels, improvement on the MADRS score was 3 points higher with nortriptyline than with escitalopram. CRP and its interaction with medication explained more than 10% of individual-level variance in treatment outcome.
An easily accessible peripheral blood biomarker may contribute to improvement in outcomes of major depressive disorder by personalizing treatment choice.
To implement and evaluate an educational program for primary care physicians on recognition and treatment of depression and suicide prevention.
The study was conducted in 3 Slovenian neighboring ...regions (Celje, Ravne na Koroskem, and Podravska) with similar suicide rates and other health indicators. All primary care physicians from Celje (N=155) and Ravne na Koroskem (N=35) were invited to participate in the educational program on depression treatment and suicide risk recognition. From January to March 2003, approximately half of them (82 out of 190; educational group) attended the program, whereas the other half (108 out of 190; control group 1) and physicians from the Podravska region (N=164; control group 2) did not attend the program. The prescription rates of antidepressants and anxiolytics before and after the intervention were compared between the studied regions. Also, suicide rates three-years before and after the intervention were compared.
From 2002 to 2003, there was a 2.33-fold increase in the rate of antidepressant prescriptions in the educational group (P<0.05) and only 1.28-fold (P<0.05) and 1.34-fold (P<0.05) increase in control groups 1 and 2, respectively. However, the 12% decrease in suicide rate in the intervention regions was not significantly greater than the 4% decrease in the non-intervention region (P>0.05).
Our training program was beneficial for primary care physicians' ability to recognize and manage depression. However, there was no significant decrease in local suicide rates.
The aim of our study was to examine availability and utilization of mental health services in the 12 Slovenian statistical regions by using the The European Service Mapping Schedule (ESMS) ...methodology. 251 mental health services were mapped according to their type as presented in schema of ESMS service tree. Marked differences between regions were noticed in patterns of service provision and utilization. In contrast with the scarcity of mental health services in the Zasavska and Notranjsko-kraska region, the Central-Slovenian region offered the most diverse and abundant choice of services of all statistical regions. We lack day and structured activity services offering work or work-related activities. Out-patient and community services are mainly medium intensity non-mobile services that offer continuing care.
Mental health promotion and mental disorder prevention can reduce the risk for mental and behavioural disorders and decreased social welfare and health costs. The aim of the present study was to map ...and analyse prevention and promotion activities and programmes in the mental health area in Slovenia.
The selection of services for a study was performed using the database of the Agency of the Republic of Slovenia for Public Legal Records and Related Services, internet and other accessible sources
The Slovenian translation of ESMS was used for mapping the services in the mental health area.
The initial sample from above mentioned sources contained 84 services working in the mental health area in 12 Slovenian statistical regions. At present 516 services were contacted and 172 did not comply with inclusion criteria. The 162 services from all 12 Slovenian statistical geographical regions have been mapped and their activities and characteristics analysed.
The analysis of the approaches to mental disorder prevention revealed that the most frequent approaches were selective primary prevention in 27.9% and tertiary prevention in 28.2% of cases.
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