1,721,303 research outputs found
Effectiveness and tolerability of pregabalin in patients with generalized anxiety disorders in routine clinical care
No full textEffectiveness and tolerability of pregabalin in patients with generalized anxiety disorders in routine clinical care In a comprehensive clinical trial program, pregabalin, an alpha(2) delta-ligand of voltage-gated calcium channels, has shown efficacy and safety in treatment of generalized anxiety disorder (GAD). The present open-label, non-interventional, observational trial aimed to prospectively investigate the efficacy and tolerability in a real life setting. 331 psychiatrists recruited 578 adult patients with GAD and documented treatment with pregabalin over four weeks. GAD severity was rated at baseline, after one week and at study end by the Hospital Anxiety and Depression Scale (HADS) and on a daily basis, with a visual analogue scale (VAS anxiety). Response to treatment was measured with the Patient Global Impression of Change scale (PGIC). Dosing was flexible and at the discretion of the treating physician. Most patients received an initial daily dose of 150 mg pregabalin, which was then increased to 300 mg/day. Mean HADS scores decreased significantly from 15.4 (95% CI: 15.1-15.6) at baseline to 9.5 (9.1-9.8) at the final visit. VAS anxiety scores significantly decreased from 62.3 (59.9-64.7) to 26.5 (23.6-29.4) with 74% and 63% of subjects achieving a >30% and >50% reduction, respectively. Regarding the PGIC, 90.4% of patients reported improvement. A total of 26 adverse events (AEs) occurred during the trial, mostly rated mild to moderate in severity, with no treatment related serious events. Only 1.2% of subjects discontinued treatment due to AEs. Under clinical practice conditions, pregabalin in unselected patients with GAD was effective, with a rapid onset of action, and well tolerated. These results are in line with those from randomized, controlled clinical trials
Attrition in treatment-resistant depression: predictors and clinical impact
No full textThe aim of this study was to investigate attrition (dropout) during a second antidepressant trial in treatment-resistant depression. Three hundred forty-two outpatients with major depressive disorder and lack of response to a prior antidepressant were treated with venlafaxine for 6 weeks. Sociodemographic and clinical characteristics were compared between the attrition and non-attrition groups. Attrition was reported in 65 patients (19%), of whom 30 patients (46%) dropped out within week 4. The characteristics of dropout patients included a longer duration of depressive episode (P = 0.011) and lower antidepressant doses (P < 0.0001) as a consequence of a faster decrease (week 2) in depressive symptoms (P = 0.028). However, by controlling for early improvement, dropout subjects were associated with a smaller probability of antidepressant response (odds ratio = 0.16▪.83). A decrease of at least 30% in Montgomery Asberg Depression Rating Scale on day 14 predicted subsequent dropout with high specificity (81.9%▪1.0%) but lower sensitivity (19.6%▪2.8%) for clinical use. Patients who have been depressed for a longer period and show an initial improvement of symptoms after changing their antidepressant may be at increased risk for drop out. Further studies are necessary to ascertain the usefulness of these characteristics for predicting attrition.SCOPUS: ar.jDecretOANoAutActifinfo:eu-repo/semantics/publishe
High occupational level is associated with poor response to treatment of depression
No full textDepression may be complicated by work-related stress and, in turn, depression is a leading cause of disability in workplaces. Though available effective treatments, only one third of patients reach full remission after a first treatment trial and nearly half of the patients are non-responders. Occupational level has been found to be a reliable predictor of health outcome in the general population. In the present study we tested the potential association of occupational level of those in work with response to treatment of depression in a large multinational sample. Major depressive disorder patients (n=654) stratified in three occupational levels (high, middle, low) were considered for the present study. Response to last treatment for current episode and treatment resistant depression, defined as non-response to 2 or more previous adequate treatment trials, were considered the outcome variables. Depressed patients from the high occupational level had a higher level of educational achievement. They showed a significantly poorer response to the last treatment with lower remission rates and more treatment resistance than the other occupational level groups. They were treated less with Serotonin Reuptake Inhibitors (SRIs). Potential confounding factors did not influence the main effect. The present findings indicate that those working at a high occupational level may be a risk factor for poor response to medication for depression and this has potential implications for clinicians and their patients, for future research, for employers and for public policy.SCOPUS: ar.jinfo:eu-repo/semantics/publishe
Superiority of escitalopram to paroxetine in the treatment of depression
No full textPost-hoc pooled analysis of data from two 6-month randomised controlled trials in patients with major depressive disorder (MDD) revealed superior efficacy and tolerability of escitalopram when compared with paroxetine. Escitalopram (n = 394) produced a significantly (p < 0.01) greater mean treatment difference of 2.0 points in primary endpoints, judged using the Montgomery–Åsberg Depression Rating Scale (MADRS) total score, compared with paroxetine (n = 383). Significant differences were also observed in Clinical Global Impression (CGI) — severity (escitalopram, 2.1; paroxetine, 2.4; p < 0.01) and CGI — improvement (escitalopram, 1.8; paroxetine, 2.0: p < 0.01). In the sub-group of severely depressed patients (baseline MADRS ? 30), escitalopram showed further improved efficacy compared with paroxetine in all scores. This analysis supports previous observations of superior efficacy and tolerability of long-term escitalopram treatment (10 to 20 mg/day) compared with paroxetine (20 to 40 mg/day). Escitalopram is a good therapeutic option for the long-term treatment of MDD, particularly in severely depressed patients
Bipolar II disorder as a risk factor for postpartum depression
No full textObjectives There is evidence for a bipolar diathesis in postpartum depression (PPD) and women presenting with a first PPD frequently receive a diagnosis of bipolar type II disorder (BD-II). However formal evidence for an association between BD-II and PPD has not yet been reported. In the present study we tested a potential association between BD-II and PPD. Methods Parous women with a diagnosis of bipolar type I disorder (BD-I) (n=93), BD-II (n=36) or major depressive disorder (MDD) (n=444) were considered in the present study. All women were retrospectively evaluated for history of PPD (DSM-IV criteria) and other clinical and socio-demographic features. Results Women with a history of PDD (n=139, 24%) were younger, younger at illness onset and had more family history for BD compared to women without history of PPD (n=436, 75.9%). Half of BD-II women reported PPD (50%), compared to less than one-third of BD-I and MDD women (respectively 27.5% and 21.6%) (p=0.004). Limitations Limitations include the retrospective assessment of PPD and no available data about the timing of postpartum episodes, illness onset or psychiatric care before or after childbirth, and the number of postpartum episodes. Conclusions BD-II may confer a remarkable risk for PPD, which may be even higher than that of women affected by BD-I disorder. Careful monitoring of BD-II women during the pregnancy and postpartum period, as well as assessment of bipolar features in women with a PPD without a current diagnosis of BD are recommended.SCOPUS: ar.jinfo:eu-repo/semantics/publishe
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