How Does Positive Mental Health Affect Next-Step Treatment Outcomes in Treatment-Resistant Depression? A VAST-D Report.

IF 2.8 3区医学 Q2 PHARMACOLOGY & PHARMACY

Journal of Clinical Psychopharmacology Pub Date : 2025-09-01 Epub Date: 2025-07-31 DOI:10.1097/JCP.0000000000002051

Sidney Zisook, Gary R Johnson, Beata Planeta, Somaia Mohamed

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引用次数: 0

Abstract

Background: Many patients view the return of "positive mental health" (PMH) to be their most important goal of treatment for major depressive disorder (MDD). However, few studies have systematically measured PMH or prospectively examined the added value of considering PMH as a treatment predictor of outcome. This report aims to fill those gaps by determining features associated with PMH and their contributions to outcomes in outpatients with treatment-resistant depression.

Methods: The VA Augmentation and Switching Treatments for Depression trial randomized 1522 participants to 1 of 3 next-step treatments: switching to bupropion (S-BUP), combining with bupropion (C-BUP), or augmenting with aripiprazole (A-ARI). PMH was measured by a novel, 7-item, self-rated questionnaire. The features and outcomes associated with PMH at baseline and during 12 weeks of treatment were explored.

Results: Low PMH scores at baseline were associated with greater severity and chronicity of depression, suicidal ideation, increased anxiety, comorbid PTSD, grief, and lower quality of life. High PMH scores were associated with a greater likelihood of remission. PMH scores improved with treatment, especially if the next-step treatment was A-AUG as opposed to S-BUP. Improvement in PMH was associated with higher remission and response rates.

Conclusions: Targeting deficiencies in PMH could help optimize outcomes in patients with MDD.

Clinical trial registration: ClinicalTrials.gov identifier NCT01421342.

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积极的心理健康如何影响难治性抑郁症的下一步治疗结果？一份长篇报告。

背景：许多患者认为“积极心理健康”（PMH）的回归是他们治疗重度抑郁症（MDD）最重要的目标。然而，很少有研究系统地测量PMH或前瞻性地检查将PMH作为治疗预后预测因子的附加价值。本报告旨在通过确定与PMH相关的特征及其对难治性抑郁症门诊患者预后的贡献来填补这些空白。方法：抑郁症的VA增强和转换治疗试验将1522名参与者随机分配到3种下一步治疗中的一种：切换到安非他酮（S-BUP），联合安非他酮（C-BUP），或增加阿立哌唑（A-ARI）。PMH通过一份新颖的7项自评问卷进行测量。在基线和12周治疗期间探讨PMH相关的特征和结果。结果：基线PMH评分低与抑郁症的严重程度和慢性程度、自杀意念、焦虑增加、PTSD合并症、悲伤和生活质量较低相关。高PMH评分与更大的缓解可能性相关。PMH评分随着治疗而提高，特别是如果下一步治疗是A-AUG而不是S-BUP。PMH的改善与更高的缓解率和反应率相关。结论：针对PMH缺陷可以帮助优化重度抑郁症患者的预后。临床试验注册：ClinicalTrials.gov识别码NCT01421342。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Clinical Psychopharmacology 医学-精神病学

CiteScore

4.00

自引率

3.40%

发文量

231

审稿时长

4-8 weeks

期刊介绍： Journal of Clinical Psychopharmacology, a leading publication in psychopharmacology, offers a wide range of articles reporting on clinical trials and studies, side effects, drug interactions, overdose management, pharmacogenetics, pharmacokinetics, and psychiatric effects of non-psychiatric drugs. The journal keeps clinician-scientists and trainees up-to-date on the latest clinical developments in psychopharmacologic agents, presenting the extensive coverage needed to keep up with every development in this fast-growing field.