The Concise Health Risk Tracking-self Report: Psychometrics Within A Placebo-controlled Antidepressant Trial Among Depressed Outpatients

Background/aims: While substantial prior research has evaluated the psychometric properties of the 12-item Concise Health Risk Tracking-Self Report (CHRT-SR12), a measure of suicide propensity and suicidal thoughts, no prior research has investigated its factor structure, sensitivity to change over time, and other psychometric properties in a placebo-controlled trial of antidepressant medication, nor determined whether symptoms change throughout treatment. Methods: Participants in the multi-site Establishing Moderators and Biosignatures of Antidepressant Response in Clinical Care (EMBARC) study (n=278) provided data to evaluate the factor structure and sensitivity to change over time of the CHRT-SR12 through eight weeks of a clinical trial in which participants received either placebo or antidepressant medication (sertraline). Results/Outcomes: Factor analysis confirmed two factors: propensity (comprised of first-order factors including pessimism, helplessness, social support, and despair) and suicidal thoughts. Internal consistency (α’s ranged from 0.69–0.92) and external validity were both acceptable, with the total score and propensity factor scores significantly correlated with total scores and single-item suicidal-thoughts scores on the self-report Quick Inventory of Depressive Symptoms and the clinician-rated 17-item Hamilton Rating Scale for Depression. Through analyzing CHRT-SR12 changes over eight treatment weeks, the total score and both the factors decreased regardless of baseline suicidal thoughts. Change in clinician-rated suicidal thoughts was reflected by change in both the total score and propensity factor score. Conclusions/interpretation: These results confirm the reliability, validity, and applicability of the CHRT-SR12 to a placebo-controlled clinical trial of depressed outpatients receiving antidepressant medication

Efficacy, safety, and indications for tricyclic and newer antidepressants

The availability of several different classes of medication provides practitioners with various alternatives for the treatment of depression and associated disorders. Factors to be considered in the initial choice of an antidepressant include efficacy, side effects (both short and long term), safely in overdose, and range of therapeutic action. These features are reviewed for the standard tricyclic anti‐depressants (TCAs) and monoamine oxidase inhibitors (MAOIs), as well as for the newer selective serotonin reuptake inhibitors (SSRIs) and reversible inhibitors of monoamine oxidase (RIMAs). The SSRIs have demonstrated efficacy equivalent to TCAs, but possess more favorable side effect profiles and are safer in overdose. Additional research is needed to clarify the relative advantages of SSRIs compared with the classical tricyclic antidepressants and monoamine oxidase inhibitors, and to inform clinical decision‐making. Depression 2:127–131 (1994/1995). © 1995 Wiley‐Liss, Inc. Copyright © 1994 Verlag Chemie, GmbHSCOPUS: ar.jinfo:eu-repo/semantics/publishe

Magnetic Resonance Imaging Measures of Brain Structure to Predict Antidepressant Treatment Outcome in Major Depressive Disorder

10.1016/j.ebiom.2014.12.002EBioMedicine2137-4

Impairment and distress patterns distinguishing the melancholic depression subtype: An iSPOT-D report

10.1016/j.jad.2014.10.046Journal of Affective Disorders174493-50

Early Improvement in Psychosocial Function Predicts Longer-Term Symptomatic Remission in Depressed Patients

<div><p>The goal of this study was to evaluate the relationship between early change in psychosocial function independent of depression severity and longer-term symptomatic remission. Participants of Combining Medications to Enhance Depression Outcomes trial were randomly selected for model selection (n = 334) and validation (n = 331). Changes in psychosocial function (Work and Social Adjustment Scale, WSAS) from baseline to week 6 were assessed and two data-driven sub-groups of WSAS change were identified in the randomly selected model selection half. Results of analyses to predict symptomatic remission at 3 and 7 months were validated for these sub-groups in the second half (validation sample). From baseline to week 6, psychosocial function improved significantly even after adjusting for depression severity at each visit and select baseline variables (age, gender, race, ethnicity, education, income, employment, depression onset before age 18, anxious features, and suicidal ideation), treatment-arm, and WSAS score. The WSAS change patterns identified two (early improvement and gradual change) subgroups. After adjusting for baseline variables and remission status at week 6, participants with early improvement in the second half (validation sample) had greater remission rates than those with gradual change at both 3 (3.3 times) and 7 months (2.3 times) following acute treatment initiation. In conclusion, early improvement in psychosocial function provides a clinically meaningful prediction of longer-term symptomatic remission, independent of depression symptom severity.</p></div

Parameters of selected model of change in WSAS during the first 6 weeks of CO-MED trial.

<p>Parameters of selected model of change in WSAS during the first 6 weeks of CO-MED trial.</p

Psychosocial function of validation sample participants (n = 331) during CO-MED trial.

<p>Sub-groups (early improvement and gradual change) of participants with different trajectories of Work and Social Adjustment Scale (WSAS) change were identified using latent class analyses during the first 6 weeks (marked by vertical line). Score of WSAS greater than 10 suggest significant functional impairment [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0167901#pone.0167901.ref038" target="_blank">38</a>] (horizontal line). * Continuation Phase was limited to CO-MED trial participants who had a clinical response.</p

Model fit estimates of latent class analyses of WSAS change in the model selection sample (n = 334).

<p>Model fit estimates of latent class analyses of WSAS change in the model selection sample (n = 334).</p

Baseline sociodemographic and clinical characteristics of participants in CO-MED trial.

<p>Baseline sociodemographic and clinical characteristics of participants in CO-MED trial.</p