Résumé
Objective:We previously reported that morning bright light therapy is efficacious in adults with nonseasonal major depressive disorder (MDD), both on its own and in combination with fluoxetine. Given that appetitive symptoms predict response to bright light therapy in seasonal depression, we examined, in this secondary analysis, whether the same held true in these nonseasonal MDD patients. Methods:Data were collected from October 7, 2009, to March 11, 2014. One hundred twenty-two patients who met DSM-IV-TRcriteria for MDD without a seasonal pattern were randomly assigned to light monotherapy, fluoxetine, combination light and fluoxetine, or double-placebo (inactivated negative ion generator plus placebo pill). Multiple regression assessed the percentage change in Montgomery-Asberg Depression Rating Scale (MADRS) scores based on treatment condition, appetitive symptom score at baseline (sum of 4 items on the Structured Interview Guide for the Hamilton Depression Rating Scale, Seasonal Affective Disorders version), and the condition-by-appetitive score interaction. Sex was considered as a possible moderator of these effects. Results:The overall regression model predicting treatment response was highly significant (P<.001), and the treatment condition-by-appetitive score interaction was a strong predictor of MADRS change scores (t=2.65, P=.009). For individuals in the placebo group, more appetitive symptoms at baseline predicted less decrease in MADRS scores at 8 weeks (r=-0.37; large effect size). In contrast, for individuals in the active treatment groups, more appetitive symptoms at baseline predicted more of a decrease in depression scores at 8 weeks (fluoxetine group r=+0.23, medium effect size; light therapy group r=+0.11, small effect size; combination group r=+0.32, medium to large effect size). No moderation effect of sex was found. Conclusions:More severe appetitive symptoms at baseline predicted treatment response differentially across the 4 treatment groups. Contrary to prior findings in seasonal depression, this association was not robust for MDD patients receiving light therapy alone, although it was stronger in patients receiving fluoxetine with or without light. As the group sample sizes were modest, the current findings should be considered as preliminary only.
| Langue d'origine | English |
|---|---|
| Numéro d'article | 17m11856 |
| Journal | Journal of Clinical Psychiatry |
| Volume | 79 |
| Numéro de publication | 4 |
| DOI | |
| Statut de publication | Published - juill. 1 2018 |
Note bibliographique
Funding Information:analysis and interpretation of the findings, or the writing of this report. Acknowledgments: The authors thank Ms Cindy Woo, BA, and Ms Tanya Poitras, BA, University of British Columbia, and Ms Jessica Grummitt, MSc, University of Toronto, for coordinating the study. The acknowledged individuals report no conflicts of interest. Dr Levitan acknowledges the support of the CAMH Foundation.
Funding Information:
Submitted: August 9, 2017; accepted January 17, 2018. Published online: July 24, 2018. Potential conflicts of interest: Dr Levitan has received speaker honoraria from Shire Canada. Dr Lam has received research funds from Brain Canada, Bristol-Myers Squibb, Canadian Institutes of Health Research, Canadian Network for Mood and Anxiety Treatments, Coast Capital Savings, Lundbeck, Pfizer, St Jude Medical, University Health Network Foundation, and Vancouver Coastal Health Research Institute; consulted to and/or received speaker honoraria from AstraZeneca, Bristol-Myers Squibb, Canadian Psychiatric Association, Canadian Network for Mood and Anxiety Treatments, Eli Lilly, Johnson & Johnson, Lundbeck, Lundbeck Institute, Mochida, Otsuka, Pfizer, Servier, and Takeda; received royalties from Cambridge University Press, Informa Press, and Oxford University Press; and holds a copyright on the Lam Employment Absence and Productivity Scale (LEAPS). Dr Levitt receives unrestricted salary support from Eli Lilly Canada Inc. Dr Michalak has received consulting honoraria from Lundbeck. Dr Ramasubbu has received research grants from AstraZeneca. Dr Yatham has been an advisory board member for and received honoraria and grant/research support from AstraZeneca, Bristol-Myers Squibb, Eli Lilly, GlaxoSmithKline, Johnson & Johnson, Novartis, Pfizer, Abbott, Servier, and Wyeth; has been on an advisory board member for Forest; and has received grant/research support from the Stanley Foundation, the National Alliance for Research on Schizophrenia and Depression, Canadian Institutes of Health Research, and the Canadian Psychiatric Foundation. Drs Morehouse and Tam have no disclosures. Funding/support: The primary study that was the basis for the current secondary analysis was funded by the Canadian Institutes of Health Research (CIHR, MCT-94832). Dr Levitan also received support for the current study from the Cameron Parker Holcombe Wilson Chair in Depression Studies at the Centre for Addiction and Mental Health (CAMH) and University of Toronto, Toronto, Ontario, Canada. Role of the sponsor: The funding sources had no role in the design and conduct of the study, the
Publisher Copyright:
© Copyright 2018 Physicians Postgraduate Press, Inc.
ASJC Scopus Subject Areas
- Psychiatry and Mental health
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