Efficacy of Add-on Deep Transcranial Magnetic Stimulation in Comorbid Alcohol Dependence and Dysthymic Disorder: Three Case Reports.

Efficacy of Add-On Deep Transcranial Magnetic Stimulation in Comorbid Alcohol Dependence and Dysthymic Disorder: Three Case Reports.

Prim Care Companion CNS Disord. 2013; 15(1):
Rapinesi C, Kotzalidis GD, Serata D, Casale AD, Bersani FS, Solfanelli A, Scatena P, Raccah RN, Brugnoli R, Digiacomantonio V, Carbonetti P, Fensore C, Tatarelli R, Angeletti G, Ferracuti S, Girardi P

Background: Craving for alcohol is associated with abnormal activation in the dorsolateral prefrontal cortex. Deep transcranial magnetic stimulation (dTMS) has shown promise in the treatment of depression. There are few treatment options for treatment-resistant dysthymic disorder comorbid with alcohol use disorder. Objective: To investigate the possible anticraving efficacy of bilateral dorsolateral prefrontal cortex high-frequency dTMS in 3 patients with comorbid long-term DSM-IV-TR dysthymic disorder and alcohol use disorder. Method: Three patients with alcohol use disorder with dysthymic disorder in their detoxification phase (abstaining for > 1 month) underwent twenty 20-minute sessions of 20 Hz dTMS over the dorsolateral prefrontal cortex over 28 days between 2011 and 2012. Alcohol craving was rated with the Obsessive Compulsive Drinking Scale and depressive symptoms with the Hamilton Depression Rating Scale. Results: All 3 patients responded unsatisfactorily to initial intravenous antidepressant and antianxiety combinations but responded after 10 dTMS sessions, improving on both anxiety-depressive symptoms and craving. This improvement enabled us to reduce antidepressant dosages after dTMS cycle completion. Discussion: High-frequency bilateral dorsolateral prefrontal cortex dTMS with left prevalence was found to produce significant anticraving effects in alcohol use disorder comorbid with dysthymic disorder. The potential of dTMS for reducing craving in patients with substance use disorder deserves to be further investigated. HubMed – depression


The predictive value of the memory impairment screen in patients with subjective memory complaints: a prospective study.

Prim Care Companion CNS Disord. 2013; 15(1):
Modrego PJ, Gazulla J

Objective: The use of biomarkers in early Alzheimer’s disease detection is growing. However, it is not clear whether sophisticated biomarker testing is more efficient than neuropsychological tests focused on memory. The goal of this study was to evaluate the predictive value of the Memory Impairment Screen (MIS), a simple and brief memory test, in elderly subjects with subjective memory loss. Method: A prospective cohort of 105 patients with subjective memory loss was followed up from December 2007 to April 2011 in Zaragoza, Spain. At baseline, the patients underwent neuropsychological examination with Mini-Examen-Cognoscivo (Spanish adaptation of the Mini-Mental State Examination), MIS, Clinical Dementia Rating scale, Blessed Dementia Rating Scale, and Geriatric Depression Scale. The final endpoint of the study was the conversion to dementia, mostly of probable Alzheimer’s disease type according to the National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer’s Disease and Related Disorders Association work group criteria. The patients were reevaluated every 6 months. Results: After a mean follow-up of 2 years (range, 1-4 years), 57 patients developed Alzheimer’s disease and 48 did not. A baseline score of 0 or 1 on the MIS predicted conversion to Alzheimer’s disease, with a sensitivity of 42.9%, a specificity of 98%, and a positive predictive value of 96%. The area under the curve was 0.76 (95% CI, 0.66-0.83). Conclusions: In the clinical setting in patients referred for memory complaints, the MIS score at baseline (0 and 1) is useful to predict who may develop Alzheimer’s disease within at least a year. The MIS would be more useful when combined with a higher sensitivity test. HubMed – depression


Assessment of falls in older patients treated with duloxetine: a secondary analysis of a 24-week randomized, placebo-controlled trial.

Prim Care Companion CNS Disord. 2013; 15(1):
Nelson JC, Oakes TM, Liu P, Ahl J, Bangs ME, Raskin J, Perahia DG, Robinson MJ

Objective: To assess fall events in older depressed patients during treatment with duloxetine. Method: Post hoc analysis of solicited fall events collected at each study visit using a questionnaire during a 24-week, multicenter, randomized, placebo-controlled, double-blind, phase 4 trial (November 2006 to November 2009). Older outpatients (? 65 years) with major depressive disorder (DSM-IV criteria) were randomly assigned to duloxetine 60 mg/d (n = 249) or placebo (n = 121) for the 12-week acute phase, after which the duloxetine dose could be increased to 120 mg/d and nonresponding placebo patients could be switched to duloxetine 60 mg/d. Between-treatment differences in percentages of patients with fall events were compared by Fisher exact test. Exposure-adjusted incidence rates (EAIRs) of falls per patient-year were also estimated. Results: In the acute phase, 17.3% of patients treated with duloxetine 60 mg versus 11.6% treated with placebo (P = .170) experienced a fall event. Over 24 weeks, the percentage of patients with a fall while taking duloxetine 60 mg versus placebo was 24.0% versus 15.7% (P = .078), and the percentage was significantly higher in patients taking duloxetine regardless of dose (25.3%) than with placebo (15.7%, P = .045). Between-treatment differences in EAIRs over 12 weeks (0.26; 95% CI, -0.20 to 0.72) and over 24 weeks (0.27; 95% CI, -0.10 to 0.65) were not significant. Conclusions: Direct assessment of fall events greatly increases the number of falls reported by patients. Although the EAIR of falls per patient-year associated with duloxetine was not significant in this trial, clinicians should remain vigilant about the possibility of falls in older patients with duloxetine or any antidepressant treatment. Trial Registration: ClinicalTrials.gov identifier NCT00406848. HubMed – depression


Selegiline transdermal system: use pattern and adherence in patients with major depressive disorder.

Prim Care Companion CNS Disord. 2013; 15(1):
Sclar DA, Cohen LJ, Portland KB

Objective: To discern the pattern of use of selegiline transdermal system as well as the level of adherence relative to other pharmacotherapies for treatment of major depressive disorder. Method: Deidentified patient-level data (2010-2011; N = 2,985) were abstracted from US longitudinal archives (Medicaid, Medicare, managed care) in this retrospective exploratory claims-based analysis. Major depressive disorder was defined as ICD-9-CM codes 292.2, 296.3, 300.4, or 311. Antidepressant treatment failure was defined as receipt of < 90 days of initial antidepressant. Results: Most patients received selegiline transdermal system as a second or third treatment option following treatment failure, and only 71 patients received it as first-line therapy. Patients were more likely to receive selegiline transdermal system for 60, 90, or 180 days compared to other therapies irrespective of treatment failure (P < .05). Among patients who did not fail treatment in the first 90 days, selegiline transdermal system was associated with a greater probability of receipt compared to selective serotonin reuptake inhibitors or serotonin norepinephrine reuptake inhibitors at 120 days (odds ratio [OR] = 1.21; 95% CI, 1.14-1.47) and 180 days (OR = 1.09; 95% CI, 1.01-1.28). Conclusion: Although limited by the small sample size of patients receiving selegiline transdermal system versus other pharmacotherapies, the results suggest that after antidepressant treatment failure, earlier use of selegiline transdermal system may be warranted. HubMed – depression


Comparative efficacy of seven psychotherapeutic interventions for patients with depression: a network meta-analysis.

PLoS Med. 2013; 10(5): e1001454
Barth J, Munder T, Gerger H, Nüesch E, Trelle S, Znoj H, Jüni P, Cuijpers P

Previous meta-analyses comparing the efficacy of psychotherapeutic interventions for depression were clouded by a limited number of within-study treatment comparisons. This study used network meta-analysis, a novel methodological approach that integrates direct and indirect evidence from randomised controlled studies, to re-examine the comparative efficacy of seven psychotherapeutic interventions for adult depression.We conducted systematic literature searches in PubMed, PsycINFO, and Embase up to November 2012, and identified additional studies through earlier meta-analyses and the references of included studies. We identified 198 studies, including 15,118 adult patients with depression, and coded moderator variables. Each of the seven psychotherapeutic interventions was superior to a waitlist control condition with moderate to large effects (range d?=?-0.62 to d?=?-0.92). Relative effects of different psychotherapeutic interventions on depressive symptoms were absent to small (range d?=?0.01 to d?=?-0.30). Interpersonal therapy was significantly more effective than supportive therapy (d?=?-0.30, 95% credibility interval [CrI] [-0.54 to -0.05]). Moderator analysis showed that patient characteristics had no influence on treatment effects, but identified aspects of study quality and sample size as effect modifiers. Smaller effects were found in studies of at least moderate (?d?=?0.29 [-0.01 to 0.58]; p?=?0.063) and large size (?d?=?0.33 [0.08 to 0.61]; p?=?0.012) and those that had adequate outcome assessment (?d?=?0.38 [-0.06 to 0.87]; p?=?0.100). Stepwise restriction of analyses by sample size showed robust effects for cognitive-behavioural therapy, interpersonal therapy, and problem-solving therapy (all d>0.46) compared to waitlist. Empirical evidence from large studies was unavailable or limited for other psychotherapeutic interventions.Overall our results are consistent with the notion that different psychotherapeutic interventions for depression have comparable benefits. However, the robustness of the evidence varies considerably between different psychotherapeutic treatments. Please see later in the article for the Editors’ Summary. HubMed – depression