Patients with major depression often suffer from excessive interpersonal sensitivity, although it is not typically measured in antidepressant clinical trials. Preliminary evidence suggests selective ...serotonin reuptake inhibitors have the capacity to reduce interpersonal sensitivity.
This was a pooled analysis of data from 1709 patients in three randomized, double-blind, placebo-controlled trials of fluoxetine and paroxetine for acute major depressive disorder. Depressive symptoms were assessed with the Hamilton Depression Rating Scale. A factor from the Symptom Checklist was used to assess interpersonal sensitivity. Our outcome of interest was change from baseline scores at the last assessment (up to 8 or 12 weeks, depending on the trial).
Both medications produced significantly greater reductions in interpersonal sensitivity relative to placebo. The effect of medication remained significant after controlling for depression improvement, which explained 18.5% of the variation in interpersonal sensitivity improvement among those treated with active medication. The effect of medication on depressive symptoms, relative to placebo, was not influenced by baseline interpersonal sensitivity.
The outcome measured interpersonal sensitivity over the last week, and the results do not necessarily reflect changes in long-standing, trait-like patterns of interpersonal sensitivity. Only two medications were studied.
Selective serotonin reuptake inhibitors are effective at treating interpersonal sensitivity in acutely depressed patients. This appears to be a unique drug effect that is not only the result of depression improvement. Future clinical trials might benefit from assessing interpersonal sensitivity more routinely.
•Paroxetine and fluoxetine reduced interpersonal sensitivity more than placebo.•This effect could not be fully explained by concurrent depression improvement.•Baseline interpersonal sensitivity did not moderate the depression treatment effect.
•Quetiapine response rates did not differ markedly by melancholic status.•The melancholic subgroup demonstrated lower placebo response rates.•Subgroup-treatment interactions did not reach statistical ...significance.
Melancholic depression may preferentially respond to certain treatments. This study examined the efficacy of extended-release quetiapine monotherapy in patients with melancholic and nonmelancholic major depressive disorder.
Data from four randomized placebo-controlled trials was pooled. Melancholic features were assessed with baseline depression scale items according to DSM criteria. The outcome measure was response on the Montgomery–Åsberg Depression Rating Scale. Cox regression models predicting response over time with interactions between treatment condition and melancholic status were used to test for treatment effect heterogeneity.
The 6-week response rate difference between quetiapine and placebo was roughly 10% greater in the melancholic subgroup, primarily due to a lower placebo response, although the subgroup-treatment interactions did not reach statistical significance. The main effect of quetiapine was significant in every model.
The main limitations were the retrospective analysis and the post-hoc designation of melancholic depression based on scale items not designed for that purpose. Results should be considered preliminary and exploratory until replicated.
The lower placebo response rate in the melancholic subgroup is consistent with past research and reinforces the benefit of pharmacotherapy for these patients.
This article presents the results of 2 studies that investigated mood instability in the Eysenck neuroticism scales and its relationship to trait impulsivity and risk taking. In Study 1 we examined ...the relationship between a mood instability factor in the Eysenck Personality Inventory and impulsivity (i.e., rapid unplanned behavior) in a general population sample of 6,066 adults. The mood instability factor was positively correlated with impulsivity. The remaining factors, largely reflecting trait anxiety, were also positively correlated with impulsivity, although these correlations disappeared when mood instability was included in the same regression model. In Study 2 we factor analyzed the short form of the revised Eysenck Personality Questionnaire to isolate mood instability and trait anxiety factors and explore their associations with risk taking in a general population sample of 394,170 adults 40 to 69 years old. The mood instability factor was positively associated with risk taking, whereas the association for the trait anxiety factor was negative. Taken together, the results suggest that mood instability and trait anxiety are separable components of Eysenckian neuroticism and that mood instability is the main component that is positively associated with trait impulsivity and risk taking. Further research is needed to clarify the factor structure of Eysenckian neuroticism.
BACKGROUNDEmotional blunting is theorized to be an adverse effect of antidepressants, particularly serotonin reuptake inhibitors, but this has not been firmly established. Another possibility is that ...emotional blunting represents a residual depressive symptom. METHODSWe analyzed data from adult outpatients with acute major depressive disorder who participated in three 8-week randomized controlled trials. Trials 1 and 2 were pooled (venlafaxine, n = 378; bupropion, n = 389; placebo, n = 383) and Trial 3 (escitalopram, n = 254; bupropion, n = 260) was analyzed separately. Emotional blunting was measured with the "inability to feel" item from the Montgomery-Åsberg Depression Rating Scale. RESULTSEmotional responsiveness improved, on average, in all treatment groups. Only a minority of participants (≤6 %) experienced more emotional blunting post-treatment, compared to baseline, with no significant differences between treatment groups, although roughly 20-25 % continued to report an inability to feel normal emotions at the final assessment. In Trials 1 and 2, emotional blunting was associated with poorer outcomes in terms of depressive symptoms, suicidal ideation, and sexual function, but these correlations were nearly identical in the placebo group. LIMITATIONSThe trials were short and cannot speak to the possibility of emotional blunting from long-term treatment. Emotional blunting was measured with a single item. CONCLUSIONSThe study medications did not significantly decrease emotional responsiveness, and there was no evidence that emotional blunting mediated treatment response. In acute treatment, emotional blunting may be better conceptualized as a residual symptom than as an adverse drug effect.
Most research describing ketamine as a treatment for depression has relied on intravenous dosing. There remains a need for more research to support this treatment with other routes of administration. ...This was a retrospective chart review of 30 patients hospitalized with unipolar or bipolar treatment-resistant depression who were treated with up to four doses of compounded intranasal racemic ketamine (50 mg or 75 mg). Treatment courses lasted up to 7 days. Symptom improvement was measured with either the Hamilton Depression Rating Scale or the Montgomery-Åsberg Depression Rating Scale. Ketamine was well tolerated with no severe adverse events or treatment discontinuations due to adverse effects. Blood pressures increased by 4-6 mmHg on average with no patients requiring medication to lower blood pressure. Twenty patients (66.7%) were classified as treatment responders based on depression scores decreasing by more than 50%. Among the 27 patients with moderate to severe suicidal ideation scores at baseline, these decreased by 68.5% on average. Overall, the results suggest that compounded intranasal racemic ketamine was safe and effective in the treatment of depressive symptoms and suicidal ideation in a real-world sample of patients hospitalized with treatment-resistant depression. Additional research comparing intranasal ketamine to esketamine and intravenous racemic ketamine is warranted.
Public Health Significance
This study found that a novel intranasal ketamine treatment protocol was able to safely treat depressive symptoms and suicidal ideation in a sample of patients hospitalized with treatment-resistant depression. Intravenous ketamine and esketamine currently have more research supporting their use as a treatment for depression, but these results suggest that intranasal ketamine is also likely a suitable and less expensive treatment option.
In this exploratory pilot study we reanalyzed data from a previous randomized, double-blind, placebo-controlled trial of lamotrigine for bipolar II depression in which lamotrigine was not superior to ...placebo to determine if splitting the sample into melancholic and nonmelancholic subgroups revealed a significant treatment effect.
Adult outpatients (n = 150) in an acute bipolar II depressive episode completed 8 weeks of treatment with lamotrigine (titrated to 200 mg/d) or placebo. Depressive symptoms were assessed at baseline and weekly with the 17-item Hamilton Depression Rating Scale (HAMD-17) and the Montgomery-Åsberg Depression Rating Scale (MADRS). The presence of melancholic depression was determined by baseline responses to the HAMD-17 and MADRS according to the Diagnostic and Statistical Manual of Mental Disorders criteria. Cox regression models stratified by melancholic status were used to predict HAMD-17 and MADRS treatment response. Analysis-of-variance models were used to compare HAMD-17 and MADRS change scores between lamotrigine and placebo groups while testing for interactions by melancholic status.
Lamotrigine was associated with higher odds of treatment response compared with placebo in the melancholic subgroup but not in the nonmelancholic subgroup. However, the melancholic subgroup-treatment interactions from the analysis-of-variance models were nonsignificant.
Further research is warranted to test the hypothesis that bipolar depression with melancholic symptoms is more responsive to lamotrigine over placebo than nonmelancholic bipolar depression.
Objective
There is a well‐established inverse relationship between age and positive psychotic symptoms, both in patients with psychotic disorders and in general population samples with psychotic ...experiences. The reason for this inverse relationship is unclear. We hypothesized that life‐course developmental changes in borderline personality traits, which also typically decline with age, might explain the inverse relationship between age and positive psychotic symptoms.
Methods
We tested this hypothesis with data from 19,980 adults who completed 2000, 2007, and 2014 UK Adult Psychiatric Morbidity Survey studies. Hallucinations and delusions were assessed with the Psychosis Screening Questionnaire. Borderline features were assessed with the Structured Clinical Interview for DSM‐IV Axis II Personality Disorders Screening Questionnaire. Logistic regression models with effect decompositions were used to conduct the analyses.
Results
As expected, age was negatively associated with hallucinations and delusions. These effects were wholly or mostly reduced after controlling for borderline features. Similar results were found in a subgroup of participants with a probable psychotic disorder. Repeating the analysis with a broad index of psychopathology severity instead of borderline features did not produce comparable results. Borderline factor scores reflecting identity/relationship disturbance, mood instability/anger, and self‐harm/suicidality were created, all of which appeared to explain part of the inverse relationship between age and psychotic experiences.
Conclusion
Declining borderline traits throughout adulthood may account for the reduced prevalence of positive psychotic symptoms in both clinical and non‐clinical populations. Future research might evaluate the impact of treatments that target borderline traits on positive psychotic symptoms.
Objectives
The purpose of this study was to determine whether mood instability in people with anxiety disorders contributes to trait impulsivity, non‐suicidal self‐injury, and binge eating/purging.
...Methods
Data were analysed from a general population sample of 7,221 adults (Mage = 51.0 years; 56.9% female). Logistic regression analyses with effect decompositions were used to establish the associations of five anxiety disorders (generalized anxiety disorder, social phobia, panic disorder, agoraphobia, and obsessive–compulsive disorder) with impulsivity, non‐suicidal self‐injury, and binge eating/purging, and then to determine the extent that adding mood instability to each model reduced these relationships.
Results
Participants with an anxiety disorder were more likely to report impulsivity compared to participants without an anxiety disorder (ORs = 2.40–3.92, all p < .001), but these relationships reduced by 59–78% and became non‐significant when mood instability was added to the models. Participants with an anxiety disorder were also more likely to report non‐suicidal self‐injury (ORs = 3.86–18.9, all p < .001) and binge eating/purging (ORs = 4.05–14.9, all p < .01); adding mood instability to the models reduced these relationships by at least 30%.
Conclusions
Mood instability and impulsivity are common in people with anxiety disorders. Anxiety disorders are associated with impulsivity largely because of the association between mood instability and impulsivity. Mood instability may contribute to non‐suicidal self‐injury and binge eating/purging in people with anxiety disorders. Treatments for mood instability in addition to standard anxiety disorder treatment may reduce impulsivity, non‐suicidal self‐injury, and binge eating/purging in people with anxiety disorders.
Practitioner points
Many patients with anxiety disorders experience mood instability, which is associated with impulsivity, non‐suicidal self‐injury, and binge eating/purging.
Treating mood instability alongside anxiety may help reduce impulsivity, non‐suicidal self‐injury, and binge eating/purging in people with anxiety disorders.
Community studies have found a relatively high prevalence of hallucinations, which are associated with a range of (psychotic and non-psychotic) mental disorders, as well as with suicidal ideation and ...behaviour. The literature on hallucinations in the general population has largely focused on adolescents and young adults.
We aimed to explore the prevalence and psychopathologic significance of hallucinations across the adult lifespan.
Using the 1993, 2000, 2007 and 2014 cross-sectional Adult Psychiatric Morbidity Survey series (N = 33 637), we calculated the prevalence of past-year hallucinations in the general population ages 16 to ≥90 years. We used logistic regression to examine the relationship between hallucinations and a range of mental disorders, suicidal ideation and suicide attempts.
The prevalence of past-year hallucinations varied across the adult lifespan, from a high of 7% in individuals aged 16-19 years, to a low of 3% in individuals aged ≥70 years. In all age groups, hallucinations were associated with increased risk for mental disorders, suicidal ideation and suicide attempts, but there was also evidence of significant age-related variation. In particular, hallucinations in older adults were less likely to be associated with a cooccurring mental disorder, suicidal ideation or suicide attempt compared with early adulthood and middle age.
Our findings highlight important life-course developmental features of hallucinations from early adulthood to old age.
This study used ecological momentary assessment (EMA) to explore the correlates of suicidal ideation (SI) instability in patients hospitalized for depression and SI. Thirty-nine adult inpatients were ...given smartphones with visual analogue scales to rate current depressed mood, anger/irritability, feeling socially connected, and SI three times a day throughout hospitalization. Affective Lability Scales (ALS) were also completed at baseline. SI instability was correlated with SI intensity, depressed mood instability, and social connection instability. Social connection instability was not associated with SI instability after controlling for depressed mood instability. ALS scores were not associated with EMA-derived SI instability. Participants with multiple past suicide attempts experienced greater SI instability. More research examining the clinical significance of SI instability is warranted.
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