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Depressant drugs, including alcohol and sedative-hypnotics, diminish central nervous system activity by enhancing the action of gamma-aminobutyric acid (GABA), a neurotransmitter that reduces brain activity and promotes relaxation. These substances can have various therapeutic uses but also pose significant risks, especially when misused or combined.
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General Predictors and Moderators of Depression Remission: A VAST-D Report.

Sidney Zisook1, Gary R Johnson1, Ilanit Tal1

  • 1VA San Diego Healthcare System (Zisook, Tal); the Department of Psychiatry, University of California San Diego (Zisook); Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, West Haven (Johnson, Zhao); the Department of Psychiatry, Texas A&M College of Medicine, Temple (Hicks); Louis Stokes VA Medical Center and the Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland (Chen); Tuscaloosa VA Medical Center, Tuscaloosa, Ala. (Davis); University of Alabama School of Medicine, Birmingham (Davis); Philadelphia VA Medical Center (Thase); Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, N.Mex. (Vertrees); and the VA New England Mental Illness Research, Education, and Clinical Center, VA Connecticut Healthcare System, West Haven (Mohamed).

The American Journal of Psychiatry
|April 6, 2019
PubMed
Summary

Many patients with major depressive disorder need further treatment. This study identified patient characteristics to guide clinicians in selecting the best next-step depression treatment, like switching or augmenting antidepressants.

Keywords:
AntidepressantsMajor Depressive DisorderMood Disorders–UnipolarTreatment-Resistant Depression

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Area of Science:

  • Psychiatry and Mental Health
  • Clinical Research
  • Pharmacotherapy

Background:

  • Major depressive disorder (MDD) often requires multiple treatment attempts for remission.
  • Identifying effective next-step treatments is crucial for managing treatment-resistant depression.
  • Current treatment selection lacks personalized predictive factors.

Purpose of the Study:

  • To identify patient baseline characteristics that predict remission in MDD.
  • To explore how these characteristics moderate the effectiveness of different next-step treatments.
  • To guide personalized treatment selection for patients with depression.

Main Methods:

  • Utilized data from the VAST-D study (n=1,522) involving patients with inadequate response to initial antidepressant therapy.
  • Compared three next-step strategies: switching to bupropion, combining with bupropion, or augmenting with aripiprazole over 12 weeks.
  • Employed life table regression models to identify predictors and moderators of remission.

Main Results:

  • Remission was associated with employment, lower depression severity/chronicity, less anxiety, absence of complicated grief, no childhood adversity, and better mental health.
  • Age ≥65 favored aripiprazole augmentation over switching.
  • Severe mixed hypomanic symptoms favored aripiprazole augmentation or bupropion combination over switching.

Conclusions:

  • Baseline patient features can inform the selection of next-step depression treatments.
  • Specific patient profiles may benefit more from augmentation or switching strategies.
  • Findings suggest potential for personalized pharmacotherapy in MDD management.