Predicting Remission in Late-Life Major Depression: A Clinical Algorithm Based Upon Past Treatment History

Instructions

Click the red REGISTER button to pay the $10 fee and take the posttest
Click here to return to the JCP CME article,

Overview

Rates of treatment resistance in randomized controlled trials in patients with late-life depression are as high as 77% using SSRIs, yet SSRIs are often used as first-line treatment. This CME article helps to optimize the selection of the next step in treating late-life depression.


Read the whole article at psychiatrist.com here:
Predicting Remission in Late-Life Major Depression: A Clinical Algorithm Based Upon Past Treatment History

© Copyright 2019 Physicians Postgraduate Press, Inc.

Target Audience

Psychiatrists

Learning Objectives

Evaluate the number and class of prior adequate medication trials to optimize the selection of next-step depression treatment for older patients

Activity summary
Available credit: 
  • 1.00 AMA PRA Category 1 Credit™
  • 1.00 Participation
Activity opens: 
12/10/2019
Activity expires: 
12/31/2021
Cost:
$10.00
Rating: 
0

CME Background

Articles are selected for credit designation based on an assessment of the educational needs of CME participants, with the purpose of providing readers with a curriculum of CME articles on a variety of topics throughout each volume. Activities are planned using a process that links identified needs with desired results.

To obtain credit, read the article, correctly answer the questions in the Posttest, and complete the Evaluation. A $10 processing fee will apply.

CME Objective

After studying this article, you should be able to:

  • Evaluate patients’ psychiatric history to identify women at increased risk for postpartum depression

Statement of Need and Purpose

Many patients with depression, especially geriatric individuals, do not respond to first-line treatment, even when given a trial of adequate dosage and duration. Providers need additional information to guide treatment planning. Education about research into whether the number and class of prior medication trials affect response would be beneficial.

Release, Expiration, and Review Dates

This educational activity was published in December 2019 and is eligible for AMA PRA Category 1 Credit™ through December 31, 2021. The latest review of this material was November 2019.

Disclosure of off-label usage

The authors have determined that, to the best of their knowledge, ketamine and nitrous oxide are not approved by the US Food and Drug Administration for the treatment of depression.

Author contributions

Drs Lenze, Reynolds, and Mulsant designed the parent study and wrote the protocol. Drs Buchalter, Oughli, Lenze, Dixon, and Mulsant and Mr Miller developed the hypothesis and secondary data analytic plan, had access to all the data, and analyzed the data. Drs Buchalter, Oughli, Lenze, and Mulsant were responsible for the decision to submit the report and drafted it. All authors read, critically revised, edited, and approved the report.

Funding/support

This study was supported primarily by the National Institute of Mental Health (R01 MH083660 and P30 MH90333 to University of Pittsburgh, R01 MH083648 to Washington University, and R01 MH083643 and R34 MH101365 to the Centre for Addiction and Mental Health at the University of Toronto). Additional funding was provided by the UPMC Endowment in Geriatric Psychiatry, the Taylor Family Institute for Innovative Psychiatric Research (at Washington University), the Washington University Institute of Clinical and Translational Sciences grant UL1 TR000448 from the National Center for Advancing Translational Sciences, and the Campbell Family Mental Health Research Institute at the Centre for Addiction and Mental Health, Toronto. Bristol-Myers Squibb contributed aripiprazole and placebo tablets, and Pfizer contributed venlafaxine extended release capsules for this study.

Role of the sponsor

Funding sources for this study had no role in the design or conduct of the research, including the collection, management, analysis, and interpretation of the data; the preparation, review, or approval of the manuscript; or the decision to submit the manuscript for publication.

Disclaimer

Dr Karp, JCP Focus on Geriatric Psychiatry Section Editor, was not involved in the editorial review or decision to publish this article.

Acknowledgments

The authors thank the clinical and data management staff and the patient participants of the IRL GREY (Incomplete Response in Late-Life Depression: Getting to Remission) study and the Data and Safety Monitoring Board members: Joel Streim, MD, University of Pennsylvania; Jeff Williamson, MD, Wake Forest University; J. Craig Nelson, MD, University of California San Francisco; Joel Greenhouse, PhD, Carnegie Mellon University; and Steven Roose, MD, Columbia University.

Faculty Affiliation

Erica L. F. Buchalter, MD
Department of Psychiatry, Washington University School of Medicine, Saint Louis, Missouri

Hanadi Ajam Oughli, MD
Department of Psychiatry, Washington University School of Medicine, Saint Louis, Missouri

Eric J. Lenze, MD
Department of Psychiatry, Washington University School of Medicine, Saint Louis, Missouri

David Dixon, PhD
Department of Psychiatry, Washington University School of Medicine, Saint Louis, Missouri

J. Philip Miller
Department of Psychiatry, Washington University School of Medicine, Saint Louis, Missouri

Daniel M. Blumberger, MD, MSc
Centre for Addiction and Mental Health and Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada

Jordan F. Karp, MD
Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania

Charles F. Reynolds III, MD
Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania

Benoit H. Mulsant, MD, MS*
Centre for Addiction and Mental Health and Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada

‡Both first authors contributed equally to the work.

*Corresponding author: Benoit H. Mulsant, MD, MS, Department of Psychiatry, CAMH, 250 College St, Toronto, ON, M5T 1R8 Canada (benoit.mulsant@utoronto.ca).

Financial Disclosure

All individuals in a position to influence the content of this activity were asked to complete a statement regarding all relevant personal financial relationships between themselves or their spouse/partner and any commercial interest. The CME Institute has resolved any conflicts of interest that were identified. In the past year, Marlene P. Freeman, MD, Editor in Chief of The Journal of Clinical Psychiatry, has received research funding from JayMac and Sage; has been a member of the advisory boards for Otsuka, Alkermes, and Sunovion; has been a member of the Independent Data Safety and Monitoring Committee for Janssen; and, as a Massachusetts General Hospital (MGH) employee, works with the MGH National Pregnancy Registry, which is sponsored by Teva, Alkermes, Otsuka, Actavis, and Sunovion, and works with the MGH Clinical Trials Network and Institute, which receives research funding from multiple pharmaceutical companies and the National Institute of Mental Health. No member of the CME Institute staff reported any relevant personal financial relationships. 

Drs BuchalterOughliLenzeDixonBlumbergerKarpReynolds, and Mulsant and Mr Miller have no personal affiliations or financial relationships with any commercial interest to disclose relative to the article.

Accreditation Statement

The CME Institute of Physicians Postgraduate Press, Inc., is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

 

 

Credit Designation

The CME Institute of Physicians Postgraduate Press, Inc., designates this journal-based CME activity for a maximum of 1.00 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Note: The American Nurses Credentialing Center (ANCC) and the American Academy of Physician Assistants (AAPA) accept certificates of participation for educational activities certified for AMA PRA Category 1 Credit™ from organizations accredited by the ACCME.

Available Credit

  • 1.00 AMA PRA Category 1 Credit™
  • 1.00 Participation

Price

Cost:
$10.00
Please login or register to take this activity.

Register for free on our site to participate in this and many free CME courses. There is a $10 processing fee for this activity.