5 results
Features of immunometabolic depression as predictors of antidepressant treatment outcomes: pooled analysis of four clinical trials
- Sarah R. Vreijling, Cherise R. Chin Fatt, Leanne M. Williams, Alan F. Schatzberg, Tim Usherwood, Charles B. Nemeroff, A. John Rush, Rudolf Uher, Katherine J. Aitchison, Ole Köhler-Forsberg, Marcella Rietschel, Madhukar H. Trivedi, Manish K. Jha, Brenda W. J. H. Penninx, Aartjan T. F. Beekman, Rick Jansen, Femke Lamers
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- Journal:
- The British Journal of Psychiatry / Volume 224 / Issue 3 / March 2024
- Published online by Cambridge University Press:
- 22 December 2023, pp. 89-97
- Print publication:
- March 2024
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Background
Profiling patients on a proposed ‘immunometabolic depression’ (IMD) dimension, described as a cluster of atypical depressive symptoms related to energy regulation and immunometabolic dysregulations, may optimise personalised treatment.
AimsTo test the hypothesis that baseline IMD features predict poorer treatment outcomes with antidepressants.
MethodData on 2551 individuals with depression across the iSPOT-D (n = 967), CO-MED (n = 665), GENDEP (n = 773) and EMBARC (n = 146) clinical trials were used. Predictors included baseline severity of atypical energy-related symptoms (AES), body mass index (BMI) and C-reactive protein levels (CRP, three trials only) separately and aggregated into an IMD index. Mixed models on the primary outcome (change in depressive symptom severity) and logistic regressions on secondary outcomes (response and remission) were conducted for the individual trial data-sets and pooled using random-effects meta-analyses.
ResultsAlthough AES severity and BMI did not predict changes in depressive symptom severity, higher baseline CRP predicted smaller reductions in depressive symptoms (n = 376, βpooled = 0.06, P = 0.049, 95% CI 0.0001–0.12, I2 = 3.61%); this was also found for an IMD index combining these features (n = 372, βpooled = 0.12, s.e. = 0.12, P = 0.031, 95% CI 0.01–0.22, I2 = 23.91%), with a higher – but still small – effect size compared with CRP. Confining analyses to selective serotonin reuptake inhibitor users indicated larger effects of CRP (βpooled = 0.16) and the IMD index (βpooled = 0.20). Baseline IMD features, both separately and combined, did not predict response or remission.
ConclusionsDepressive symptoms of people with more IMD features improved less when treated with antidepressants. However, clinical relevance is limited owing to small effect sizes in inconsistent associations. Whether these patients would benefit more from treatments targeting immunometabolic pathways remains to be investigated.
180 Improvement of Sexual Function Observed During Treatment of Major Depressive Disorder with Adjunctive Pimavanserin
- Marlene P. Freeman, Maurizio Fava, Bryan Dirks, Manish K. Jha, Richard C. Shelton, Michael E. Thase, Madhukar H. Trivedi, George I. Papakostas, Keith Liu, Troy Whitworth, Srdjan Stankovic
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- Journal:
- CNS Spectrums / Volume 25 / Issue 2 / April 2020
- Published online by Cambridge University Press:
- 24 April 2020, pp. 313-314
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Study Objectives:
Sexual dysfunction occurs in 40%-60% of patients with major depressive disorder (MDD), due to either the illness itself and/or the effects of antidepressant treatment. The phase-2 CLARITY trial recently demonstrated the efficacy of adjunctive pimavanserin (PIM) for MDD when added to ongoing selective serotonin or serotonin–norepinephrine reuptake inhibitor (SSRI/SNRI) treatment. No new safety observations were reported in this study. This post-hoc analysis examines the potential impact of PIM treatment on sexual function.
Method:Study methodology has been presented previously (APA 2019). Adult male and female patients with moderate-to-severe MDD were randomized to PIM 34 mg/day (n=51) or placebo (PBO, n=152) added to ongoing SSRI/SNRI treatment. Massachusetts General Hospital–Sexual Functioning Inventory (MGH-SFI) and Hamilton Depression Rating Scale, 17-item version (HAMD-17) item 14 (sexual interest) scores were examined by analysis of covariance.
Results:Adjunctive PIM resulted in significantly greater 5-week reduction (improvement) relative to SSRI/SNRI treatment plus placebo on mean MGH-SFI scores (difference –0.634, SE 0.167; P<0.001; effect size [ES], Cohen’s d 0.614). Similarly, PIM resulted in greater improvement compared with placebo on individual MGH-SFI items that applied to both males and females: Interest in Sex (P=0.006; ES=0.483), Ability to Get Sexually Aroused/Excited (P=0.001; ES=0.560), Ability to Achieve Orgasm (P<0.001; ES=0.609), Overall Sexual Satisfaction (P=0.003; ES=0.524). HAMD-17 item 14 scores were also significantly more reduced (improved) with PIM (P<0.001; ES=0.574).
Conclusions:These results underscore the potential of adjunctive PIM for improving sexual function in patients with MDD and inadequate response to SSRIs/SNRIs. Potential benefits should be confirmed in further studies.
Funding Acknowledgements:ACADIA Pharmaceuticals Inc.
Anger attacks are associated with persistently elevated irritability in MDD: findings from the EMBARC study
- Manish K. Jha, Maurizio Fava, Abu Minhajuddin, Cherise Chin Fatt, David Mischoulon, Nausheen Wakhlu, Joseph M. Trombello, Cristina Cusin, Madhukar H. Trivedi
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- Journal:
- Psychological Medicine / Volume 51 / Issue 8 / June 2021
- Published online by Cambridge University Press:
- 06 March 2020, pp. 1355-1363
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Background
This report tests the association of self-reported symptoms of irritability with overt behavior of anger attacks (uncharacteristic sudden bouts of anger that are disproportionate to situation and associated with autonomic activation).
MethodsParticipants of the Establishing Moderators and Biosignatures of Antidepressant Response in Clinical Care study who completed Massachusetts General Hospital Anger Attacks questionnaire were included (n = 293). At each visit, the 17-item Hamilton Depression Rating Scale and the 16-item Concise Associated Symptom Tracking scale were used to measure depression, anxiety, and irritability. In those with anger attacks present v. those without anger attacks, separate t tests and mixed model analyses compared afore-mentioned symptoms at baseline and changes with treatment respectively. As anger attacks may occur without aggressive behaviors, analyses were repeated based only on the presence of aggressive behaviors.
ResultsAt baseline, those with anger attacks (n = 109) v. those without anger attacks (n = 184) had similar levels of depression but higher levels of irritability [effect size (d) = 0.80] and anxiety (d = 0.32). With acute-phase treatment, participants with anger attacks experienced a greater reduction in irritability (p < 0.001) but not in depression (p = 0.813) or anxiety (p = 0.771) as compared to those without anger attacks. Yet, irritability levels at week-8 were higher in those with anger attacks (d = 0.32) than those without anger attacks. Similar results were found in participants with aggressive behaviors.
ConclusionsThe presence of anger attacks in outpatients with major depressive disorder may identify a sub-group of patients with persistently elevated irritability.
Six - Community development practice in India: Interrogating caste and common sense
- Edited by Mae Shaw, Marjorie Mayo, Goldsmiths, University of London
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- Book:
- Class, Inequality and Community Development
- Published by:
- Bristol University Press
- Published online:
- 05 April 2022
- Print publication:
- 06 September 2016, pp 93-106
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Summary
Introduction
A textbook much referred to by social work educators and community development practitioners in India contains the following passage, which reflects on the process of community building in a village near New Delhi, the capital of India:
A meeting of all the villagers was called with the help of the student worker. All the male members, especially the adults, were personally requested to attend the meeting. The meeting was attended by all the leaders. There was no preferential order of sitting except for the fact that the lower caste people belonging to Jhimer, Chamar and Bhangi did not sit on the carpet. (Gangrade, 1971, p.59; emphasis added)
Thus, what is stated as a matter of fact – that ‘there was no preferential order of sitting’ – makes manifest a blatant case of untouchability and indignity for some of the most marginalised caste groups in India. While the usage of derogatory ‘call names’ like Chamar and Bhangi for these marginalised caste groups now constitutes a criminal offence punishable by law in India, the institution of caste nonetheless continues to provide a common cultural idiom to Indians: ‘wherever one may be in India one is in a universe of caste’ (Mandelbaum, 2005, p. 228). As Srinivas (2010, p.3) puts it:
Caste is undoubtedly an all India phenomena in the sense that there are everywhere hereditary, endogamous groups which form a hierarchy and that each of these groups has a traditional association with one or two occupations. … Relations between castes are invariably expressed in terms of pollution and purity.
It is these notions of ‘pollution and purity’ that govern the nature and extent of social interaction between different caste groups. Thus caste is more than an occupational category or an income-based class; rather, it represents a system of rigid social stratification. This is why Ambedkar called caste a ‘closed class’ (cited in Rodrigues, 2002, p.257). In other words, caste-related subdivisions of society are not based upon the comparatively open character of the class system but rather have become self-enclosed units: beyond class in any traditional sense.
Historically, castes at the lower end of the caste hierarchy have experienced the worst forms of exploitation.
Four - Community organising and political agency: changing community development subjects in India
- Edited by Rosie Meade, University College Cork, Mae Shaw, Sarah Banks, Durham University
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- Book:
- Politics, Power and Community Development
- Published by:
- Bristol University Press
- Published online:
- 01 September 2022
- Print publication:
- 13 January 2016, pp 65-82
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Summary
Introduction
The trajectory of community development has been a tumultuous one: a path defined by radical potentialities yet able to claim only limited success. Even during those phases when radical philosophies were less prominent in community development, it stood for relatively ‘fair’ and ‘just’ processes and outcomes. Arguably, we have witnessed a simultaneous expansion and constriction in our understandings of the transformative potential of ‘community’ over several decades, and this in turn necessitates a closer examination of the changing expectations and make-up of community development's subjects. This chapter highlights the evolution and maturation of community development in India. It attempts to explain how ‘community’ has been variously construed in India's processes of community development and how those constructions have been challenged, revised and improvised by practitioners and activists. The chapter thus emphasises that community development's subjects have shown a potential for transformation and agency. For example, subjects have questioned the idea of ‘community development’ itself and, through self- and collective organising, they have become more ‘political’. This phenomenon is referred to here as ‘community organising’ (CO) and by that I mean organising and collectivising processes that redefine power relationships in society. In India, the conception of CO has evolved away from a model of community development that was critiqued as statist, and that mainly referred to government- and/or NGO-guided or facilitated development programmes. CO, on the other hand, has been regarded as far more progressive, with mobilisation and collectivisation generating strategies of contestation, along with the potential for collaboration with the state and its agencies.
The chapter analyses community development from the standpoint of its constituents, that is its subjects. By ‘subject’, I am referring to two contrasting situations: the first, where the ‘subject’ is seen as dissolving into a non-sovereign product of social and discursive construction, devoid of any stability, autonomy or unity of self; the second, where the ‘subject’ can be regarded as self-sufficient, enduring and sovereign, from which all consciousness and action springs. Since ‘subject’ implies both an actor and one who is acted on, this chapter traces movements from one situation to another. More specifically, it is interested in the processes that have led to the emergence of ‘political subjects’ who demonstrate a capacity to influence their lives and circumstances. Communities, acting as ‘political subjects’, consciously challenge the situations whereby they are made subjects of power, asserting their rights, entitlements, freedom and dignity instead.