Effective pharmacologic treatments for psychiatric disorders are available, but their effect is l... more Effective pharmacologic treatments for psychiatric disorders are available, but their effect is limited due to patients’ genetic heterogeneity and low compliance-related to frequent adverse events. Only one third of patients respond to treatment and experience remission. Pharmacogenetics is a relatively young field which focusses on genetic analyses in the context of the metabolism and outcome of drug treatment. These genetic factors can, among other things, lead to differences in the activity of enzymes that metabolize drugs. Recently, a clinical guideline was authorized by the Dutch Clinical Psychiatric Association (NVvP) on the clinical use of pharmacogenetics in psychiatry. The main goal was to provide guidance, based on current evidence, on how to best use genotyping in clinical psychiatric practice. A systematic literature search was performed, and available publications were assessed using the GRADE methodology. General recommendations for psychiatric clinical practice were p...
To compare the efficacy of two antidepressant treatment strategies in severely depressed in-patie... more To compare the efficacy of two antidepressant treatment strategies in severely depressed in-patients, that is, imipramine vs. venlafaxine, both with subsequent lithium addition in non-responders. In-patients (n = 88) with major depressive disorder were randomized to 7-week treatment with imipramine or venlafaxine (phase I). All non-responders (n = 44) received 4-week plasma level-targeted dose lithium addition (phase II). Efficacy was evaluated after 11 weeks of treatment. Analyzing phases I and II combined, non-inferiority was established and the difference in the proportion of responders (HAM-D score reduction ≥50%) by the end of phase II demonstrated the venlafaxine-lithium treatment strategy to be significantly superior to the imipramine-lithium treatment strategy (77% vs. 52%) (χ(2) (1) = 6.03; P = 0.01). Regarding remission (HAM-D score ≤ 7), 15 of 44 (34%) patients in the imipramine-lithium treatment group were remitters compared to 22 of 44 (50%) patients in the venlafaxine-...
Achtergrond: Cultuur kan een belangrijke invloed hebben op de manier waarop een depressie beleefd... more Achtergrond: Cultuur kan een belangrijke invloed hebben op de manier waarop een depressie beleefd, geuit of gepresenteerd wordt. Bevindelijk gereformeerden vormen een orthodoxprotestantse culturele minderheid in Nederland. Mogelijk presenteert deze groepering zich met andere symptomen tijdens een depressie dan niet-kerkelijke patienten. Doel: Nagaan of bevindelijk gereformeerde patienten met een depressie andere symptomen hebben dan niet-kerkelijke patienten. Methode: Aan 70 autochtone volwassenen met een depressie in de ambulante geestelijke gezondheidszorg werd gevraagd een depressie-zelfscorelijst (Beck Depression Inventory II, bdiii) in te vullen. Totaalscore en scores op symptoomclusters bij bevindelijk gereformeerden en nietkerkelijken werden met elkaar vergeleken. Resultaten: Bevindelijk gereformeerden hadden vergeleken met niet-kerkelijken op de bdi-ii een lagere totaalscore en in het bijzonder een lagere score op de symptoomclusters suicidaliteit en beperking in functioneren. Conclusie: Bevindelijk gereformeerden verschillen van niet-kerkelijken in de wijze hoe zij zich presenteren op een depressie-zelfscorelijst tijdens een depressie. Omdat bevindelijk gereformeerden mogelijk dissimuleren en langer doorgaan, lopen ze een verhoogde kans op onderdiagnostiek en -behandeling. Dit onderzoek illustreert dat inzicht in de religieuze achtergrond van (autochtone) patienten van belang kan zijn voor goede psychiatrische diagnostiek.
Antidepressant treatment for major depressive disorder remains suboptimal with response rates of ... more Antidepressant treatment for major depressive disorder remains suboptimal with response rates of just over 50%. Although treatment guidelines, algorithms and clinical keys are available to assist the clinician, the process of finding an effective pharmacotherapy to maximise benefit for the individual patient is largely by "trial and error" and remains challenging. This highlights a clear need to identify biomarkers of treatment response to help guide personalised treatment strategies. We have carried out the largest multiplex immunoassay based longitudinal study to date, examining up to 258 serum markers involved in immune, endocrine and metabolic processes as potential biomarkers associated with treatment response in 332 depression patients recruited from four independent clinical centres. We demonstrated for the first time that circulating Apolipoprotein A-IV, Endoglin, Intercellular Adhesion Molecule 1, Tissue Inhibitor of Metalloproteinases 1, Plasminogen Activator Inh...
Few studies assessing the influence of resistance to antidepressant pharmacotherapy on the respon... more Few studies assessing the influence of resistance to antidepressant pharmacotherapy on the response to subsequent electroconvulsive therapy (ECT) are found in the literature. Results are somewhat conflicting and may not be applicable to the population of depressed patients in The Netherlands. The aim of this study is to assess the influence of medication resistance on the short-term response to ECT in a population of severely depressed inpatients in The Netherlands, where ECT is an exceptional treatment, often used as a final treatment option. We reviewed the records of 41 consecutive inpatients with major depression according to DSM-III-R criteria and rated each patients' antidepressant pharmacotherapy prior to ECT. We examined the extent to which medication resistance was related to short-term response to ECT. When a reduction of at least 50% on the Hamilton Rating Scale for Depression (HRSD) post-ECT compared to pre-ECT (partial remission) is used as response criterion, medication resistant patients and patients without established medication resistance were equally likely to respond to subsequent ECT. When a post-ECT HRSD score < or = 7 (full remission) is used as response criterion, medication resistant patients were less likely to respond to subsequent ECT (8/29=27.6%) than patients who did not receive adequate antidepressant pharmacotherapy prior to ECT (6/12=50.0%), although the difference in response rate was not statistically significant. This study has a retrospective nature and a relatively small sample size. Antidepressant medication resistance does not seem to have an influence on the short-term response to subsequent ECT. However, when the number of patients achieving full remission is concerned, a substantial percentage of antidepressant medication resistant patients respond to ECT, although their response rate was nearly half compared to that of patients without prior adequate treatment with antidepressants. This difference in response rate was not statistically significant. ECT seems to be an effective treatment for both patients with and without prior adequate treatment with antidepressants in this Dutch population.
The British journal of psychiatry : the journal of mental science, 2018
Electroconvulsive therapy (ECT) is considered to be the most effective treatment in severe major ... more Electroconvulsive therapy (ECT) is considered to be the most effective treatment in severe major depression. The identification of reliable predictors of ECT response could contribute to a more targeted patient selection and consequently increased ECT response rates. Aims To investigate the predictive value of age, depression severity, psychotic and melancholic features for ECT response and remission in major depression. A meta-analysis was conducted according to the PRISMA statement. A literature search identified recent studies that reported on at least one of the potential predictors. Of the 2193 articles screened, 34 have been included for meta-analysis. Presence of psychotic features is a predictor of ECT remission (odds ratio (OR) = 1.47, P = 0.001) and response (OR = 1.69, P < 0.001), as is older age (standardised mean difference (SMD) = 0.26 for remission and 0.35 for response (P < 0.001)). The severity of depression predicts response (SMD = 0.19, P = 0.001), but not r...
This report describes a 63-year-old woman, who had experienced 3 previous episodes of severe majo... more This report describes a 63-year-old woman, who had experienced 3 previous episodes of severe major depressive disorder. The first 2 episodes responded to treatment with antidepressants, whereas the third episode was accompanied by psychotic features and responded well to treatment with electroconvulsive therapy (ECT). After a severe relapse, the patient responded very slowly to a second course of ECT and failed to achieve full remission. Within a few weeks, she had another severe relapse and responded very rapidly to a combination of ECT and imipramine. The possible enhancement of the antidepressant efficacy of ECT by combining it with a tricyclic antidepressant (TCA) has received little study, although the literature provides some evidence for a synergy between ECT and TCAs. Combining ECT with a TCA may be a useful strategy in patients who fail to achieve full remission or who experience a rapid relapse.
Effective pharmacologic treatments for psychiatric disorders are available, but their effect is l... more Effective pharmacologic treatments for psychiatric disorders are available, but their effect is limited due to patients’ genetic heterogeneity and low compliance-related to frequent adverse events. Only one third of patients respond to treatment and experience remission. Pharmacogenetics is a relatively young field which focusses on genetic analyses in the context of the metabolism and outcome of drug treatment. These genetic factors can, among other things, lead to differences in the activity of enzymes that metabolize drugs. Recently, a clinical guideline was authorized by the Dutch Clinical Psychiatric Association (NVvP) on the clinical use of pharmacogenetics in psychiatry. The main goal was to provide guidance, based on current evidence, on how to best use genotyping in clinical psychiatric practice. A systematic literature search was performed, and available publications were assessed using the GRADE methodology. General recommendations for psychiatric clinical practice were p...
To compare the efficacy of two antidepressant treatment strategies in severely depressed in-patie... more To compare the efficacy of two antidepressant treatment strategies in severely depressed in-patients, that is, imipramine vs. venlafaxine, both with subsequent lithium addition in non-responders. In-patients (n = 88) with major depressive disorder were randomized to 7-week treatment with imipramine or venlafaxine (phase I). All non-responders (n = 44) received 4-week plasma level-targeted dose lithium addition (phase II). Efficacy was evaluated after 11 weeks of treatment. Analyzing phases I and II combined, non-inferiority was established and the difference in the proportion of responders (HAM-D score reduction ≥50%) by the end of phase II demonstrated the venlafaxine-lithium treatment strategy to be significantly superior to the imipramine-lithium treatment strategy (77% vs. 52%) (χ(2) (1) = 6.03; P = 0.01). Regarding remission (HAM-D score ≤ 7), 15 of 44 (34%) patients in the imipramine-lithium treatment group were remitters compared to 22 of 44 (50%) patients in the venlafaxine-...
Achtergrond: Cultuur kan een belangrijke invloed hebben op de manier waarop een depressie beleefd... more Achtergrond: Cultuur kan een belangrijke invloed hebben op de manier waarop een depressie beleefd, geuit of gepresenteerd wordt. Bevindelijk gereformeerden vormen een orthodoxprotestantse culturele minderheid in Nederland. Mogelijk presenteert deze groepering zich met andere symptomen tijdens een depressie dan niet-kerkelijke patienten. Doel: Nagaan of bevindelijk gereformeerde patienten met een depressie andere symptomen hebben dan niet-kerkelijke patienten. Methode: Aan 70 autochtone volwassenen met een depressie in de ambulante geestelijke gezondheidszorg werd gevraagd een depressie-zelfscorelijst (Beck Depression Inventory II, bdiii) in te vullen. Totaalscore en scores op symptoomclusters bij bevindelijk gereformeerden en nietkerkelijken werden met elkaar vergeleken. Resultaten: Bevindelijk gereformeerden hadden vergeleken met niet-kerkelijken op de bdi-ii een lagere totaalscore en in het bijzonder een lagere score op de symptoomclusters suicidaliteit en beperking in functioneren. Conclusie: Bevindelijk gereformeerden verschillen van niet-kerkelijken in de wijze hoe zij zich presenteren op een depressie-zelfscorelijst tijdens een depressie. Omdat bevindelijk gereformeerden mogelijk dissimuleren en langer doorgaan, lopen ze een verhoogde kans op onderdiagnostiek en -behandeling. Dit onderzoek illustreert dat inzicht in de religieuze achtergrond van (autochtone) patienten van belang kan zijn voor goede psychiatrische diagnostiek.
Antidepressant treatment for major depressive disorder remains suboptimal with response rates of ... more Antidepressant treatment for major depressive disorder remains suboptimal with response rates of just over 50%. Although treatment guidelines, algorithms and clinical keys are available to assist the clinician, the process of finding an effective pharmacotherapy to maximise benefit for the individual patient is largely by "trial and error" and remains challenging. This highlights a clear need to identify biomarkers of treatment response to help guide personalised treatment strategies. We have carried out the largest multiplex immunoassay based longitudinal study to date, examining up to 258 serum markers involved in immune, endocrine and metabolic processes as potential biomarkers associated with treatment response in 332 depression patients recruited from four independent clinical centres. We demonstrated for the first time that circulating Apolipoprotein A-IV, Endoglin, Intercellular Adhesion Molecule 1, Tissue Inhibitor of Metalloproteinases 1, Plasminogen Activator Inh...
Few studies assessing the influence of resistance to antidepressant pharmacotherapy on the respon... more Few studies assessing the influence of resistance to antidepressant pharmacotherapy on the response to subsequent electroconvulsive therapy (ECT) are found in the literature. Results are somewhat conflicting and may not be applicable to the population of depressed patients in The Netherlands. The aim of this study is to assess the influence of medication resistance on the short-term response to ECT in a population of severely depressed inpatients in The Netherlands, where ECT is an exceptional treatment, often used as a final treatment option. We reviewed the records of 41 consecutive inpatients with major depression according to DSM-III-R criteria and rated each patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; antidepressant pharmacotherapy prior to ECT. We examined the extent to which medication resistance was related to short-term response to ECT. When a reduction of at least 50% on the Hamilton Rating Scale for Depression (HRSD) post-ECT compared to pre-ECT (partial remission) is used as response criterion, medication resistant patients and patients without established medication resistance were equally likely to respond to subsequent ECT. When a post-ECT HRSD score &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; or = 7 (full remission) is used as response criterion, medication resistant patients were less likely to respond to subsequent ECT (8/29=27.6%) than patients who did not receive adequate antidepressant pharmacotherapy prior to ECT (6/12=50.0%), although the difference in response rate was not statistically significant. This study has a retrospective nature and a relatively small sample size. Antidepressant medication resistance does not seem to have an influence on the short-term response to subsequent ECT. However, when the number of patients achieving full remission is concerned, a substantial percentage of antidepressant medication resistant patients respond to ECT, although their response rate was nearly half compared to that of patients without prior adequate treatment with antidepressants. This difference in response rate was not statistically significant. ECT seems to be an effective treatment for both patients with and without prior adequate treatment with antidepressants in this Dutch population.
The British journal of psychiatry : the journal of mental science, 2018
Electroconvulsive therapy (ECT) is considered to be the most effective treatment in severe major ... more Electroconvulsive therapy (ECT) is considered to be the most effective treatment in severe major depression. The identification of reliable predictors of ECT response could contribute to a more targeted patient selection and consequently increased ECT response rates. Aims To investigate the predictive value of age, depression severity, psychotic and melancholic features for ECT response and remission in major depression. A meta-analysis was conducted according to the PRISMA statement. A literature search identified recent studies that reported on at least one of the potential predictors. Of the 2193 articles screened, 34 have been included for meta-analysis. Presence of psychotic features is a predictor of ECT remission (odds ratio (OR) = 1.47, P = 0.001) and response (OR = 1.69, P < 0.001), as is older age (standardised mean difference (SMD) = 0.26 for remission and 0.35 for response (P < 0.001)). The severity of depression predicts response (SMD = 0.19, P = 0.001), but not r...
This report describes a 63-year-old woman, who had experienced 3 previous episodes of severe majo... more This report describes a 63-year-old woman, who had experienced 3 previous episodes of severe major depressive disorder. The first 2 episodes responded to treatment with antidepressants, whereas the third episode was accompanied by psychotic features and responded well to treatment with electroconvulsive therapy (ECT). After a severe relapse, the patient responded very slowly to a second course of ECT and failed to achieve full remission. Within a few weeks, she had another severe relapse and responded very rapidly to a combination of ECT and imipramine. The possible enhancement of the antidepressant efficacy of ECT by combining it with a tricyclic antidepressant (TCA) has received little study, although the literature provides some evidence for a synergy between ECT and TCAs. Combining ECT with a TCA may be a useful strategy in patients who fail to achieve full remission or who experience a rapid relapse.
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