Sidney Zisook1, Ilanit Tal2, Kimberly Weingart2, Paul Hicks3, Lori L Davis4, Peijun Chen5, Jean Yoon6, Gary R Johnson7, Julia E Vertrees8, Sanjai Rao2, Patricia D Pilkinton9, James A Wilcox10, Mamta Sapra11, Ali Iranmanesh11, Grant D Huang12, Somaia Mohamed13. 1. VA San Diego Healthcare System and University of California, San Diego, USA. Electronic address: szisook@ucsd.edu. 2. VA San Diego Healthcare System and University of California, San Diego, USA. 3. Central Texas Veterans Healthcare System and Department of Psychiatry and Behavioral Sciences Texas A&M Health Science Center College of Medicine, Temple, TX, USA. 4. Tuscaloosa VA Medical Center, Tuscaloosa, AL, USA; University of Alabama School of Medicine, USA. 5. Louis Stokes VA Medical Center and Case Western Reserve University School of Medicine, Cleveland, OH, USA. 6. Health Economics Resource Center (HERC), VA Palo Alto, Menlo Park, CA, USA. 7. VA Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, West Haven, CT, USA. 8. VA Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, New Mexico VA Healthcare System, Albuquerque, NM, USA. 9. Tuscaloosa VA Medical Center, Tuscaloosa, AL, USA; Capstone College of Community Health Sciences, Tuscaloosa, AL, USA. 10. Tucson VA Medical Center and Department of Psychiatry, University of Arizona, Tucson, AZ, USA. 11. Salem VA Medical Center, Salem, VA, USA; Virginia Tech Carilion School of Medicine, Roanoke, VA, USA. 12. Cooperative Studies Program Central Office, VA Office of Research & Development, Washington DC, USA. 13. VA VISN1 New England Mental Illness Research, Education and Clinical Center (MIRECC), Veterans Health Administration, West Haven, CT, USA; Yale University School of Medicine, USA.
Abstract
OBJECTIVE: Finding effective and lasting treatments for patients with Major Depressive Disorder (MDD) that fail to respond optimally to initial standard treatment is a critical public health imperative. Understanding the nature and characteristics of patients prior to initiating "next-step" treatment is an important component of identifying which specific treatments are best suited for individual patients. We describe clinical features and demographic characteristics of a sample of Veterans who enrolled in a "next-step" clinical trial after failing to achieve an optimal outcome from at least one well-delivered antidepressant trial. METHODS:1522 Veteran outpatients with nonpsychotic MDD completed assessments prior to being randomized to study treatment. Data is summarized and presented in terms of demographic, social, historical and clinical features and compared to a similar, non-Veteran sample. RESULTS:Participants were largely male and white, with about half unmarried and half unemployed. They were moderately severely depressed, with about one-third reporting recent suicidal ideation. More than half had chronic and/or recurrent depression. General medical and psychiatric comorbidities were highly prevalent, particularly PTSD. Many had histories of childhood adversity and bereavement. Participants were impaired in multiple domains of their lives and had negative self-worth. LIMITATIONS: These results may not be generalizable to females, and some characteristics may be specific to Veterans of US military service. There was insufficient data on age of clinical onset and depression subtypes, and three novel measures were not psychometrically validated. CONCLUSIONS: Characterizing VAST-D participants provides important information to help clinicians understand features that may optimize "next-step" MDD treatments. Published by Elsevier B.V.
RCT Entities:
OBJECTIVE: Finding effective and lasting treatments for patients with Major Depressive Disorder (MDD) that fail to respond optimally to initial standard treatment is a critical public health imperative. Understanding the nature and characteristics of patients prior to initiating "next-step" treatment is an important component of identifying which specific treatments are best suited for individual patients. We describe clinical features and demographic characteristics of a sample of Veterans who enrolled in a "next-step" clinical trial after failing to achieve an optimal outcome from at least one well-delivered antidepressant trial. METHODS: 1522 Veteran outpatients with nonpsychotic MDD completed assessments prior to being randomized to study treatment. Data is summarized and presented in terms of demographic, social, historical and clinical features and compared to a similar, non-Veteran sample. RESULTS:Participants were largely male and white, with about half unmarried and half unemployed. They were moderately severely depressed, with about one-third reporting recent suicidal ideation. More than half had chronic and/or recurrent depression. General medical and psychiatric comorbidities were highly prevalent, particularly PTSD. Many had histories of childhood adversity and bereavement. Participants were impaired in multiple domains of their lives and had negative self-worth. LIMITATIONS: These results may not be generalizable to females, and some characteristics may be specific to Veterans of US military service. There was insufficient data on age of clinical onset and depression subtypes, and three novel measures were not psychometrically validated. CONCLUSIONS: Characterizing VAST-D participants provides important information to help clinicians understand features that may optimize "next-step" MDD treatments. Published by Elsevier B.V.
Entities:
Keywords:
Major Depressive Disorder; Treatment-resistant depression; Veterans
Authors: Paul B Hicks; Varadan Sevilimedu; Gary R Johnson; Ilanit Tal; Peijun Chen; Lori L Davis; Julia E Vertrees; Somaia Mohamed; Sidney Zisook Journal: Psychiatr Res Clin Pract Date: 2019-10-03
Authors: Somaia Mohamed; Gary R Johnson; Peijun Chen; Paul B Hicks; Lori L Davis; Jean Yoon; Theresa C Gleason; Julia E Vertrees; Kimberly Weingart; Ilanit Tal; Alexandra Scrymgeour; David D Lawrence; Beata Planeta; Michael E Thase; Grant D Huang; Sidney Zisook; Sanjai D Rao; Patricia D Pilkinton; James A Wilcox; Ali Iranmanesh; Mamta Sapra; George Jurjus; James P Michalets; Muhammed Aslam; Thomas Beresford; Keith D Anderson; Ronald Fernando; Sriram Ramaswamy; John Kasckow; Joseph Westermeyer; Gihyun Yoon; D Cyril D'Souza; Gunnar Larson; William G Anderson; Mary Klatt; Ayman Fareed; Shabnam I Thompson; Carlos J Carrera; Solomon S Williams; Timothy M Juergens; Lawrence J Albers; Clifford S Nasdahl; Gerardo Villarreal; Julia L Winston; Cristobal A Nogues; K Ryan Connolly; Andre Tapp; Kari A Jones; Gauri Khatkhate; Sheetal Marri; Trisha Suppes; Joseph LaMotte; Robin Hurley; Aimee R Mayeda; Alexander B Niculescu; Bernard A Fischer; David J Loreck; Nicholas Rosenlicht; Steven Lieske; Mitchell S Finkel; John T Little Journal: JAMA Date: 2017-07-11 Impact factor: 56.272