Depression Treatment: Type D Personality and Patient-Perceived Health in Nonsignificant Coronary Artery Disease: The TWeesteden mIld STenosis (TWIST) Study.

Type D personality and patient-perceived health in nonsignificant coronary artery disease: the TWeesteden mIld STenosis (TWIST) study.

Filed under: Depression Treatment

Qual Life Res. 2012 Dec 21;
Mommersteeg PM, Pot I, Aarnoudse W, Denollet J, Widdershoven JW

PURPOSE: To examine whether Type D-distressed-personality is independently associated with patient reported health outcomes, such as chest pain, health status and emotional distress, in patients with angiographically nonsignificant coronary abnormalities. Psychosocial factors, such as Type D personality, are risk factors for established coronary artery disease (CAD), but are unknown for patients with non-obstructive CAD. METHODS: A total of 273 patients (62 years, SD 10, 49 % male) participated in the cross-sectional part of the ‘TWeesteden mIld STenosis’ study. Inclusion was based on coronary angiography or CT-scan. Type D personality was examined in relation to chest pain, disease-specific (Seattle Angina Questionnaire) and generic health status (Short Form 12), and emotional distress (Hospital Anxiety and Depression Scale, Fatigue), adjusted for confounders and potential explanatory lifestyle factors. RESULTS: Patients with Type D personality (30 %) had an increased prevalence of chest pain (57 vs. 40 %). When adjusted for confounder’s age, gender, comorbidity, and medication use, Type D personality was significantly associated with increased chest pain, poorer disease-specific and generic health status and increased emotional distress. After further adjustment for explanatory lifestyle factors such as smoking, physical activity, and metabolic syndrome, Type D personality was associated with worse disease perception, lower treatment satisfaction, poor physical and mental health status, and higher emotional distress, but no longer with chest pain, angina stability, or physical limitations. CONCLUSION: Type D personality was significantly associated with poor patient-perceived symptoms in patients with mild coronary abnormalities, which can be hypothesized to be detrimental in the long run.
HubMed – depression


Use of Antidepressant Medications To Improve Outcomes After Stroke.

Filed under: Depression Treatment

Curr Neurol Neurosci Rep. 2013 Jan; 13(1): 318
Chollet F, Acket B, Raposo N, Albucher JF, Loubinoux I, Pariente J

Interest in the use of antidepressants after stroke has been renewed by better knowledge of poststroke depression, but mainly by the capacity of some of them to promote functional recovery of nondepressed subjects. Recombinant tissue plasminogen activator thrombolysis within the first few hours after the stroke is currently the only validated treatment able to improve the spontaneous-and most of the time incomplete-recovery of neurological functions after stroke. However, we have learned from research over the last decade, in part based on the considerable improvement of neuroimaging techniques, that spontaneous recovery of neurological functions is associated with a large intracerebral reorganization of the damaged human brain. The question of whether lesioned-brain plasticity can be modulated by external factors such as pharmacological antidepressant agents is now being addressed with the aim of improving recovery and reducing the final disability of patients. Poststroke depression is known to be frequent and deleterious for patient outcome. We review the interest in the use of antidepressants after stroke in classic but often neglected poststroke depression and we strongly underline the action of some antidepressants in promoting functional recovery of nondepressed patients after stroke.
HubMed – depression


Exposure-Response modeling of anti-depressant treatments: the confounding role of placebo effect.

Filed under: Depression Treatment

J Pharmacokinet Pharmacodyn. 2012 Dec 21;
Goyal N, Gomeni R

Emerging evidence indicates that the selection of patients and the selection of recruitment centers in placebo-controlled, randomized clinical trials (RCTs) in depression have a substantial impact on the probability of observing a treatment effect of a novel medication. The objective of this work was to evaluate the role of placebo in characterizing the exposure-response relationship and proposes a new methodology based on band-pass filtering for assessing the relationship between drug exposure, level of clinical response conditioned to the level of placebo response, and the potency of the antidepressant drug evaluated. Clinical trial simulation (CTS) was used to demonstrate that the conventional analyses of data generated in multi-centre RCTs including centres exhibiting heterogeneous placebo response can lead to contradictory and inappropriate assessment of the exposure-response relationship. To address this issue, a novel modelling approach has been developed for establishing the exposure-response relationship by using a pharmacodynamic model accounting for the placebo effect. The proposed model demonstrated that the expected drug related treatment effect in a placebo-controlled RCT can be predicted as a function of the dose, the drug potency and the level of placebo response when data from informative recruitment centres are considered. With this novel approach, a more accurate estimate of the dose/exposure response can be derived and more informed go/no-go decisions can be made in developing drugs for psychiatric disorders.
HubMed – depression



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