Targeting Unmet Needs in the Treatment of Major Depressive Disorder
EXPIRED
Roger S. McIntyre, MD, FRCPC
BOTTOM LINE:Targeting Unmet Needs in the Treatment of Major Depressive Disorder |
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Many of the unmet needs in Major Depressive Disorder are modifiable, including improving diagnostic accuracy, offering treatments with faster onset of action, treatments with greater overall efficacy, and treatments that can improve patient functioning. Measurement based care guiding treatment wherein the aim is to achieve remission, improve cognitive function, and general functioning, are key therapeutic objectives. |
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Introduction
Major depressive disorder (MDD) is a common and severe disorder that is estimated to affect approximately 350 million people globally.1 It is predicted that MDD debases human capital more than most other non-communicable disorders.2 In addition to substantial illness-associated morbidity, MDD is associated with the loss of 10 years of life.3 The implications of MDD on other organ systems is demonstrated by mortality studies indicating that cardiovascular disease is the most common cause of excess mortality.4 Significant unmet needs exist in the management of MDD, which, if addressed successfully, would be expected to reduce overall illness-associated morbidity. Herein, we succinctly review and summarize key unmet needs in MDD (Table 1).
Major Depressive Disorder: Unmet Needs and Innovative Treatments
This activity is intended for physicians, physician assistants, nurse practitioners and registered nurses engaged in the care of patients with major depression.
Supported by an educational grant from:
Allergan
Activity Information
EXPIRED
Release date: September 1, 2019
Expiration date: August 31, 2020
EXPIRED
Available at www.mdedge.com/MDD
EDUCATIONAL OBJECTIVES
After completing this activity, the participant should be better able to:
- Treat major depression within 2 weeks.
- Use evidence based treatments to achieve remission in major depression.
- Discuss novel targets including glutamate for treating major depression.
- Utilize treatments with innovative mechanisms to treat major depression.
FACULTY
 | Roger S. McIntyre, MD, FRCPC | |
 | Michael E. Thase, MD |
JOINT ACCREDITATION STATEMENT
In support of improving patient care, this activity has been planned and implemented by the Postgraduate Institute for Medicine and Global Medical Education. Postgraduate Institute for Medicine is jointly accredited by the American Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
PHYSICIAN CONTINUING MEDICAL EDUCATION
The Postgraduate Institute for Medicine designates this enduring material for a maximum of 1 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
CONTINUING NURSING EDUCATION
The maximum number of hours awarded for this Continuing Nursing Education activity is 1 contact hour. Designated for 0.4 contact hours of pharmacotherapy credit for Advance Practice Registered Nurses.
DISCLOSURE OF CONFLICTS OF INTEREST
Postgraduate Institute for Medicine (PIM) requires instructors, planners, managers and other individuals who are in a position to control the content of this activity to disclose any real or apparent conflict of interest (COI) they may have as related to the content of this activity. All identified COI are thoroughly vetted and resolved according to PIM policy. PIM is committed to providing its learners with high quality CME activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of a commercial interest.
Faculty
Roger S. Mcintyre, MD, FRCPC
Consulting Fees: AstraZeneca, Bristol-Myers Squibb, Eli-Lilly, Forest, JanssenOrtho, Johnson & Johnson, Lundbeck, Mitsubishi, Moksha8, Otsuka, Pfizer, Purdue, Shire, Sunovion, Takeda
Speakers’ Bureau: AstraZeneca, Bristol-Myers Squibb, Elli-Lilly, Forest, JanssenOrtho, Johnson & Johnson, Lundbeck, Mitsubishi, Moksha8, Otsuka, Pfizer, Purdue, Shire, Sunovion, Takeda
Research Grants: Allergan, AstraZeneca, JanssenOrtho, Lundbeck, Otsuka, Pfizer, Purdue, Shire,
Michael Thase, MD
Consulting Fees: Acadia, Akili, Alkermes, Allergan, Cerecor, Fabre-Kramer, Gerson Lehrman Group, Guidepoint Global, Johnson & Johnson, Moksha8, Nestlé, Neuralstrim, Novartis, Otsuka, Pfizer, Sunovion
Contracted Research: Acadia, Agency for Healthcare
Research and Quality (AHRQ), Alkermes, Allergan, AssureRX Health, Avanir, Axome, Intracellular, Johnson & Johnson, National Institutes of Health / National Institute of Mental Health (NIMH), Otsuka, Patient-Centered Outcomes
Research Institute (PCORI), Takeda
Royalties: American Psychiatric Foundation, Guilford Publications, Herald House, W.W. Norton & Company
Spouse: Peloton Advantage
PLANNERS AND MANAGERS
The PIM planners and managers have nothing to disclose.
The Global Medical Education planner and manager, Prakash Masand, MD, has disclosed the following:
Consulting Fees: Allergan, Lundbeck, Sunovion, Takeda
Speakers’ Bureau: Allergan, Lundbeck, Sunovion, Takeda
Contracted Research: Allergan
Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.
The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Disclaimer
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
METHOD OF PARTICIPATION AND INSTRUCTIONS FOR CREDIT
During the period September 1, 2019, through August 31, 2020 participants must read the learning objectives and disclosures, study the educational activity and complete the post-test with a score of 75% or better and the activity evaluation. Please follow the steps below:
Go to www.cmeuniversity.com
Register or Login (will take less than 1 minute)
Type in 14255 at the top of the page, “Find Post-Test/Evaluation by Course”, click enter
Click on activity title when it appears
Choose the type of credit you would like
Complete the activity posttest
Complete online Evaluation
Receive an immediate CME Certificate to download and/or print for your files
References
- Organization WH, Others. Depression and Other Common Mental Disorders: Global Health Estimates. World Health Organization; 2017. https://apps.who.int/iris/bitstream/handle/10665/254610/WHOMSD-MER-2017.2-eng.pdf.
- McIntyre RS, Lee Y. Cognition in major depressive disorder: a “Systemically Important Functional Index” (SIFI). Curr Opin Psychiatry. 2016;29(1):48-55.
- Walker ER, McGee RE, Druss BG. Mortality in mental disorders and global disease burden implications: a systematic review and meta-analysis. JAMA Psychiatry. 2015;72(4):334-341.
- Goldstein BI, Carnethon MR, Matthews KA, et al. Major depressive disorder and bipolar disorder predispose youth to accelerated atherosclerosis and early cardiovascular disease: a scientific statement from the American Heart Association. Circulation. 2015;132(10):965-986.
- Rosenblat JD, Lee Y, McIntyre RS. The effect of pharmacogenomic testing on response and remission rates in the acute treatment of major depressive disorder: A meta-analysis. J Affect Disord. 2018;241:484-491.
- Fabbri C, Porcelli S, Serretti A. From pharmacogenetics to pharmacogenomics: the way toward the personalization of antidepressant treatment. Can J Psychiatry. 2014;59(2):62-75.
- Rosenblat JD, Goldberg JF, McIntyre RS. Consumer warning for genetic tests claiming to predict response to medications: implications for psychiatry. A J Psychiatry. 2019;176(5):412-413.
- Integrating Pharmacogenomics in Practice: One GIFT at a Time or a Package Deal? | | Blogs | CDC. https://blogs-origin.cdc.gov/genomics/2017/11/06/integrating-pharmacogen.... Accessed June 12, 2019.
- McIntyre RS, Lee Y, Mansur RB. Treating to target in major depressive disorder: response to remission to functional recovery. CNS Spectr. 2015;20 Suppl 1:20-30; quiz 31.
- Preskorn SH. Drug-drug Interactions in Psychiatric Practice, Part 1: Reasons, Importance, and Strategies to Avoid and Recognize Them. J Psychiatr Pract. 2018;24(4):261-268.
- Rong C, Carmona NE, Lee YL, et al. Drug-drug interactions as a result of co-administering Δ9-THC and CBD with other psychotropic agents. Expert Opin Drug Saf. 2018;17(1):51-54.
- Rush AJ, Trivedi MH, Wisniewski SR, et al. Acute and longer-term outcomes in depressed outpatients requiring one or several treatment steps: a STAR*D report. Am J Psychiatry. 2006;163(11):1905-1917.
- Lee Y, Rosenblat JD, Lee J, et al. Efficacy of antidepressants on measures of workplace functioning in major depressive disorder: a systematic review. J Affect Disord. 2018;227:406-415.
- Ishak WW, Greenberg JM, Cohen RM. Predicting relapse in major depressive disorder using patient-reported outcomes of depressive symptom severity, functioning, and quality of life in the Individual Burden of Illness Index for Depression (IBI-D). J Affect Disord. 2013;151(1):59-65.
- Carroll FI, Blough BE, Mascarella SW, et al. Bupropion and bupropion analogs as treatments for CNS disorders. Adv Pharmacol. 2014;69:177-216.
- McIntyre RS, Lophaven S, Olsen CK. A randomized, double-blind, placebo- controlled study of vortioxetine on cognitive function in depressed adults. Int J Neuropsychopharmacol. 2014;17(10):1557-1567.
- Liu X, Ye W, Watson P, et al. Use of benzodiazepines, hypnotics, and anxiolytics in major depressive disorder: association with chronic pain diseases. J Nerv Ment Dis. 2010;198(8):544-550.
- Boschloo L, Bekhuis E, Weitz ES, et al. The symptom-specific efficacy of antidepressant medication vs. cognitive behavioral therapy in the treatment of depression: results from an individual patient data meta-analysis. World Psychiatry. 2019;18(2):183-191.
- Henssler J, Kurschus M, Franklin J, et al. Trajectories of acute Antidepressant efficacy: how long to wait for response? A systematic review and metaanalysis of long-term, placebo-controlled acute treatment trials. J Clin Psychiatry. 2018;79(3).
- Mathew SJ, Zarate CA Jr. Ketamine for Treatment-Resistant Depression: The First Decade of Progress. Springer; 2016.
- Rosenblat JD, Carvalho AF, Li M, et al. Oral Ketamine for Depression: a Systematic Review. J Clin Psychiatry. 2019;80(3).
- Post RM, Uhde TW, Rubinow DR, et al. Differential time course of antidepressant effects after sleep deprivation, ECT, and carbamazepine: clinical and theoretical implications. Psychiatry Res. 1987;22(1):11-19.
- McIntyre RS, Filteau M-J, Martin L, et al. Treatment-resistant depression: definitions, review of the evidence, and algorithmic approach. J Affect Disord. 2014;156:1-7.
- Kudlow P, Cha DS, Carvalho AF, et al. Nitric oxide and major depressive disorder: pathophysiology and treatment implications. Curr Mol Med. 2016;16(2):206-215.