Potential efficacy of dopaminergic antidepressants in treatment resistant anergic-anhedonic depression results of the chronic anergic-anhedonic depression open trial – CADOT
oleh: Ludovic Christophe Dormegny-Jeanjean, Ludovic Christophe Dormegny-Jeanjean, Ludovic Christophe Dormegny-Jeanjean, Clément de Billy, Clément de Billy, Clément de Billy, Olivier Mainberger, Olivier Mainberger, Olivier Mainberger, Sébastien Weibel, Sébastien Weibel, Sébastien Weibel, Benoit Schorr, Benoit Schorr, Benoit Schorr, Alexandre Obrecht, Alexandre Obrecht, Lionel Landré, Fabrice Berna, Fabrice Berna, Jean-Baptiste Causin, Jean-Baptiste Causin, Jean-Baptiste Causin, Frederic Blanc, Frederic Blanc, Vlad Danila, Vlad Danila, Mihaela Tomsa, Mihaela Tomsa, Geraldine Pfleger, Geraldine Pfleger, Camille Meyer, Camille Meyer, Camille Meyer, Ilia Humbert, Ilia Humbert, Ilia Humbert, Hervé Javelot, Hervé Javelot, Guillaume Meyer, Guillaume Meyer, Gilles Bertschy, Gilles Bertschy, Gilles Bertschy, Jack Rene Foucher, Jack Rene Foucher, Jack Rene Foucher, Jack Rene Foucher
| Format: | Article |
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| Diterbitkan: | Frontiers Media S.A. 2023-09-01 |
Deskripsi
IntroductionAmong treatment-resistant depression (TRD), we identified anergic-anhedonic clinical presentations (TRAD) as putatively responsive to pro-dopaminergic strategies. Based on the literature, non-selective monoamine oxidase inhibitors (MAOI) and dopamine D2 receptor agonists (D2RAG) were sequentially introduced, frequently under the coverage of a mood stabilizer. This two-step therapeutic strategy will be referred to as the Dopaminergic Antidepressant Therapy Algorithm (DATA). We describe the short and long-term outcomes of TRAD managed according to DATA guidelines.MethodOut of 52 outpatients with TRAD treated with DATA in a single expert center, 48 were included in the analysis [severity – QIDS (Quick Inventory of Depressive Symptomatology) = 16 ± 3; episode duration = 4.1 ± 2.7 years; Thase and Rush resistance stage = 2.9 ± 0.6; functioning – GAF (Global Assessment of Functioning) = 41 ± 8]. These were followed-up for a median (1st – 3rd quartile) of 4 (1–9) months before being prescribed the first dopaminergic treatment and remitters were followed up 21 (11–33) months after remission.ResultsAt the end of DATA step 1, 25 patients were in remission (QIDS <6; 52% [38–66%]). After DATA step 2, 37 patients were in remission (77% [65–89%]) to whom 5 patients with a QIDS score = 6 could be added (88% [78–97%]). Many of these patients felt subjectively remitted (GAF = 74 ± 10). There was a significant benefit to combining MAOI with D2RAG which was maintained for at least 18 months in 30 patients (79% [62–95%]).ConclusionThese results support TRAD sensitivity to pro-dopaminergic interventions. However, some clinical heterogeneities remain in our sample and suggest some improvement in the description of dopamine-sensitive form(s).