Jay D Amsterdam1, Justine Shults. 1. Depression Research Unit, University Science Center-3rd Floor, 3535 Market Street, Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, PA 19104-3309, United States. jamsterd@mail.med.upenn.edu
Abstract
OBJECTIVE: Evidence-based data suggest that MAOI therapy may be effective in up to 50% of patients with treatment-resistant depression (TRD). We hypothesized that MAOI therapy is similarly effective in patients with advanced stage TRD who are unresponsive to > or = 4 prior antidepressant drug (AD) trials compared to patients with early stage TRD who are unresponsive to < or = 3 prior AD trials. METHODS: To test this hypothesis, data were harvested from 400 patient charts. Of these, 59 patients received a total of 75 MAOI treatment trials. 50 patients had 1 MAOI trial and 9 patients had 2 or more MAOI trials. Response was assessed using the Clinical Global Impressions Change (CGI/C) scale. RESULTS: 56% of MAOI trials resulted in a CGI/C score of 1 ("very much better") or 2 ("much better"). Only 25% resulted in a CGI/C score of 4 or more ("no change" or "worse"). 32.5% of MAOI trials resulted in a CGI/C score of 1 in patients with early stage TRD, while only 12.1% of MAOI trials resulted in a CGI/C score of 1 in patients with advanced stage TRD (p=0.04). There was a significant negative correlation between the number of prior, failed AD trials and the final CGI/C score (p=0.03). The odds associated with attaining a CGI/C score of 1 diminished by a factor of 30% with each prior failed AD trial. We observed only 1 case of acute hypertension which responded to sublingual nifedipine therapy. LIMITATIONS: The sample size was limited, and MAOI outcome was not compared with other AD therapy. The adequacy of prior AD trials could not always be verified. CONCLUSION: These data suggest that MAOI therapy may be beneficial in patients with early stage TRD who are unresponsive to < or = 3 prior treatments. However, the relative efficacy of MAOI therapy in advanced stage TRD remains uncertain.
OBJECTIVE: Evidence-based data suggest that MAOI therapy may be effective in up to 50% of patients with treatment-resistant depression (TRD). We hypothesized that MAOI therapy is similarly effective in patients with advanced stage TRD who are unresponsive to > or = 4 prior antidepressant drug (AD) trials compared to patients with early stage TRD who are unresponsive to < or = 3 prior AD trials. METHODS: To test this hypothesis, data were harvested from 400 patient charts. Of these, 59 patients received a total of 75 MAOI treatment trials. 50 patients had 1 MAOI trial and 9 patients had 2 or more MAOI trials. Response was assessed using the Clinical Global Impressions Change (CGI/C) scale. RESULTS: 56% of MAOI trials resulted in a CGI/C score of 1 ("very much better") or 2 ("much better"). Only 25% resulted in a CGI/C score of 4 or more ("no change" or "worse"). 32.5% of MAOI trials resulted in a CGI/C score of 1 in patients with early stage TRD, while only 12.1% of MAOI trials resulted in a CGI/C score of 1 in patients with advanced stage TRD (p=0.04). There was a significant negative correlation between the number of prior, failed AD trials and the final CGI/C score (p=0.03). The odds associated with attaining a CGI/C score of 1 diminished by a factor of 30% with each prior failed AD trial. We observed only 1 case of acute hypertension which responded to sublingual nifedipine therapy. LIMITATIONS: The sample size was limited, and MAOI outcome was not compared with other AD therapy. The adequacy of prior AD trials could not always be verified. CONCLUSION: These data suggest that MAOI therapy may be beneficial in patients with early stage TRD who are unresponsive to < or = 3 prior treatments. However, the relative efficacy of MAOI therapy in advanced stage TRD remains uncertain.
Authors: Aimee M Hunter; Ian A Cook; Molly Tartter; Simi K Sharma; Gregory D Disse; Andrew F Leuchter Journal: Psychopharmacology (Berl) Date: 2015-08-29 Impact factor: 4.530
Authors: Jiayu Ye; Lauren A E Erland; Sandeep K Gill; Stephanie L Bishop; Andrea Verdugo-Meza; Susan J Murch; Deanna L Gibson Journal: Biomolecules Date: 2021-05-15