Sex differences in responses to antidepressant augmentations in treatment-resistant depression
- ”Women are nearly twice as likely as men to suffer from major depressive disorder. Yet, there is a dearth of studies comparing the clinical outcomes of women and men with treatment-resistant depression (TRD) treated with similar augmentation strategies
- ”Methods: We reviewed health records of 76 patients (42 women, 34 men) with TRD, treated with augmentation strategies including antidepressants with mood stabilizers (AD+MS) or antipsychotics (AD+AP) or in combination (AD+AP+MS). Clinical outcomes were determined by comparing changes on the HAMD-17, MADRS, QIDS-C16 and CGI-S at the beginning (T0) and after three months of an unchanged treatment (T3). Changes in individual items of the HAMD-17 were also compared between the groups.
- “Women and men improved from T0 to T3 on all scales (p<0.001,ηp2 ≥0.68). There was also a significant sex x time interaction for all scales (p<0.05, ηp2≥0.06), reflecting a greater improvement in women compared to men. Specifically, women exhibited greater improvement in early (p=0.03, ηp2=0.08) and middle of the night insomnia (p=0.01, ηp2=0.09), as well as psychomotor retardation (p<0.001 ηp2=0.16), psychic (p=0.02, ηp2=0.07) and somatic anxiety (p=0.01, ηp2=0.10).”
- “The combination of AD+AP/MS generates a significantly greater clinical response in women compared to men with TRD supporting the existence of distinct pharmacological profiles between sexes in our sample. Moreover, they emphasize the benefit of augmentation strategies in women, underscoring the benefit of addressing symptoms such as insomnia and anxiety with AP and MS.”
The Potential of Polygenic Risk Scores to Predict Antidepressant Treatment Response in Major Depression: a systematic review
- “Understanding the genetic underpinnings of antidepressant treatment response in unipolar major depressive disorder (MDD) can be useful in identifying patients at risk for poor treatment response or treatment resistant depression. A polygenic risk score (PRS) is a useful tool to explore genetic liability of a complex trait such as antidepressant treatment response.
- The researchers conducted a systematic review of, “studies examining associations between PRSs of psychiatric as well as non-psychiatric traits and antidepressant treatment response in patients with unipolar MDD. A quality assessment of the included studies was performed.
- “Overall, PRSs for attention-deficit hyperactivity disorder, the personality trait openness, coronary artery disease, obesity, and stroke have been associated with antidepressant treatment response in patients with unipolar MDD.”
- “PRSs could be informative to predict antidepressant treatment response in this population, given advances in the field. Most importantly, there is a need for larger study cohorts and the use of standardized outcome measures.”
Neurotrophic Factor Levels and Cognitive Functions before and after the Repetitive Transcranial Magnetic Stimulation in Treatment Resistant Depression
- Ther researchers’ objective was, “To determine relationship between the therapeutic effect of repetitive transcranial magnetic stimulation (rTMS) on cognitive impairment and brain derived neurotrophic factor (BDNF), glial cell derived neurotrophic factor (GDNF) levels in treatment resistant depression (TRD).
- “The study included 33 TRD patients and 33 healthy subjects. Patients received a total of 20 sessions of rTMS treatment. Serum BDNF and GDNF levels were measured before and after rTMS treatment. Additionally, the severity of depression as well as cognitive functions were assessed at the baseline and after the treatment.”
- “The rTMS treatment significantly improved depressive and cognitive symptoms in patients with TRD. Although the level of serum BDNF and GDNF increased after rTMS treatment, it was associated with the improvement in symptoms, but not significantly.”
- The researchers concluded, “rTMS treatment contributes to the antidepressant effect by normalising serum BDNF and GDNF levels in patients with TRD. Adding rTMS to antidepressants is, therefore, an appropriate treatment option for depressive patients with cognitive impairment.”
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