Clinical Edge Journal Scan

Key clinical point: Vitamin D supplementation may reduce negative emotions in patients with major depressive disorder (MDD).

Major finding: Vitamin D supplementation reduced negative emotions at doses of ≤4,000 IU/day (Hedges' g = −0.2311; P = .0008). In the sub-group analysis, the effects were significant in patients with serum levels of 25(OH)D ≤50 nmol/L (P = .0028), but not in those with levels >50 nmol/L (P = .0507).

Study details: Systematic review and meta-analysis of 25 randomized controlled trials (n = 7,534) comparing the effects of vitamin D and the placebo on negative emotions in patients with MDD.

Disclosures: No funding information was identified. The authors declared no conflicts of interest.

Citation: Cheng YC et al. Depress Anxiety. 2020 May 04. doi: 10.1002/da.23025.

Key clinical point: Vitamin D supplementation may reduce negative emotions in patients with major depressive disorder (MDD).

Major finding: Vitamin D supplementation reduced negative emotions at doses of ≤4,000 IU/day (Hedges' g = −0.2311; P = .0008). In the sub-group analysis, the effects were significant in patients with serum levels of 25(OH)D ≤50 nmol/L (P = .0028), but not in those with levels >50 nmol/L (P = .0507).

Study details: Systematic review and meta-analysis of 25 randomized controlled trials (n = 7,534) comparing the effects of vitamin D and the placebo on negative emotions in patients with MDD.

Disclosures: No funding information was identified. The authors declared no conflicts of interest.

Citation: Cheng YC et al. Depress Anxiety. 2020 May 04. doi: 10.1002/da.23025.

Key clinical point: Vitamin D supplementation may reduce negative emotions in patients with major depressive disorder (MDD).

Major finding: Vitamin D supplementation reduced negative emotions at doses of ≤4,000 IU/day (Hedges' g = −0.2311; P = .0008). In the sub-group analysis, the effects were significant in patients with serum levels of 25(OH)D ≤50 nmol/L (P = .0028), but not in those with levels >50 nmol/L (P = .0507).

Study details: Systematic review and meta-analysis of 25 randomized controlled trials (n = 7,534) comparing the effects of vitamin D and the placebo on negative emotions in patients with MDD.

Disclosures: No funding information was identified. The authors declared no conflicts of interest.

Citation: Cheng YC et al. Depress Anxiety. 2020 May 04. doi: 10.1002/da.23025.

Key clinical point: Patients with major depressive disorder (MDD) having suicidal ideation (SI) show poorer performance in verbal learning domain.

Major finding: The SI vs. non-SI group performed worse in the domain of verbal learning at baseline (mean verbal learning scores, 39.7 vs. 42.2; P = .036). Other cognitive domains had no significant differences between the groups (speed of processing, working memory, and visual learning; P greater than .005 for all).

Study details: The data come from a longitudinal, 4-week open-label trial of patients with MDD (SI group, n = 130 and non-SI group, n = 175).

Disclosures: This study was funded by the National Natural Science Foundation of China, the National Key Research and Development Program of China, Guangdong Basic and Applied Basic Research Foundation, Science and Technology Department of Guangdong Province major science and technology, the International Communication Foundation Science and Technology Commission of Shanghai Municipality, Guangzhou Municipal Psychiatric Disease Clinical Transformation Laboratory, and Key Laboratory for Innovation platform Plan, Science, and Technology Program of Guangzhou, China. The authors declared no conflicts of interest.

Citation: Lan X et al. J Affect Disord. 2020 Apr 30. doi: 10.1016/j.jad.2020.03.141.

Key clinical point: Patients with major depressive disorder (MDD) having suicidal ideation (SI) show poorer performance in verbal learning domain.

Major finding: The SI vs. non-SI group performed worse in the domain of verbal learning at baseline (mean verbal learning scores, 39.7 vs. 42.2; P = .036). Other cognitive domains had no significant differences between the groups (speed of processing, working memory, and visual learning; P greater than .005 for all).

Study details: The data come from a longitudinal, 4-week open-label trial of patients with MDD (SI group, n = 130 and non-SI group, n = 175).

Disclosures: This study was funded by the National Natural Science Foundation of China, the National Key Research and Development Program of China, Guangdong Basic and Applied Basic Research Foundation, Science and Technology Department of Guangdong Province major science and technology, the International Communication Foundation Science and Technology Commission of Shanghai Municipality, Guangzhou Municipal Psychiatric Disease Clinical Transformation Laboratory, and Key Laboratory for Innovation platform Plan, Science, and Technology Program of Guangzhou, China. The authors declared no conflicts of interest.

Citation: Lan X et al. J Affect Disord. 2020 Apr 30. doi: 10.1016/j.jad.2020.03.141.

Key clinical point: Patients with major depressive disorder (MDD) having suicidal ideation (SI) show poorer performance in verbal learning domain.

Major finding: The SI vs. non-SI group performed worse in the domain of verbal learning at baseline (mean verbal learning scores, 39.7 vs. 42.2; P = .036). Other cognitive domains had no significant differences between the groups (speed of processing, working memory, and visual learning; P greater than .005 for all).

Study details: The data come from a longitudinal, 4-week open-label trial of patients with MDD (SI group, n = 130 and non-SI group, n = 175).

Disclosures: This study was funded by the National Natural Science Foundation of China, the National Key Research and Development Program of China, Guangdong Basic and Applied Basic Research Foundation, Science and Technology Department of Guangdong Province major science and technology, the International Communication Foundation Science and Technology Commission of Shanghai Municipality, Guangzhou Municipal Psychiatric Disease Clinical Transformation Laboratory, and Key Laboratory for Innovation platform Plan, Science, and Technology Program of Guangzhou, China. The authors declared no conflicts of interest.

Citation: Lan X et al. J Affect Disord. 2020 Apr 30. doi: 10.1016/j.jad.2020.03.141.

Key clinical point: Depressogenic excess eating and weight gain are common in patients with major depressive disorder (MDD) and linked with peripheral dopamine levels.

Major finding: The Yale Food Addiction Scale (YFAS) criteria were met by 29% of patients with MDD vs. 3% of control group individuals. Patients with MDD who met the YFAS criteria showed a significantly higher weight (P = .003), body mass index (P = .001), and waist circumference (P less than .001) than those with MDD not meeting YFAS criteria and control individuals. A positive correlation was observed between plasma dopamine levels and disordered eating behaviors in women.

Study details: The study evaluated patients with MDD (n = 80) and control individuals (n = 60) aged 18-63 years.

Disclosures: No study sponsor was identified. The authors declared no conflicts of interest.

Citation: Mills JG et al. Appetite. 2020 May 01. doi: 10.1016/j.appet.2020.104586.

Key clinical point: Depressogenic excess eating and weight gain are common in patients with major depressive disorder (MDD) and linked with peripheral dopamine levels.

Major finding: The Yale Food Addiction Scale (YFAS) criteria were met by 29% of patients with MDD vs. 3% of control group individuals. Patients with MDD who met the YFAS criteria showed a significantly higher weight (P = .003), body mass index (P = .001), and waist circumference (P less than .001) than those with MDD not meeting YFAS criteria and control individuals. A positive correlation was observed between plasma dopamine levels and disordered eating behaviors in women.

Study details: The study evaluated patients with MDD (n = 80) and control individuals (n = 60) aged 18-63 years.

Disclosures: No study sponsor was identified. The authors declared no conflicts of interest.

Citation: Mills JG et al. Appetite. 2020 May 01. doi: 10.1016/j.appet.2020.104586.

Key clinical point: Depressogenic excess eating and weight gain are common in patients with major depressive disorder (MDD) and linked with peripheral dopamine levels.

Major finding: The Yale Food Addiction Scale (YFAS) criteria were met by 29% of patients with MDD vs. 3% of control group individuals. Patients with MDD who met the YFAS criteria showed a significantly higher weight (P = .003), body mass index (P = .001), and waist circumference (P less than .001) than those with MDD not meeting YFAS criteria and control individuals. A positive correlation was observed between plasma dopamine levels and disordered eating behaviors in women.

Study details: The study evaluated patients with MDD (n = 80) and control individuals (n = 60) aged 18-63 years.

Disclosures: No study sponsor was identified. The authors declared no conflicts of interest.

Citation: Mills JG et al. Appetite. 2020 May 01. doi: 10.1016/j.appet.2020.104586.

Key clinical point: Neuronavigation-guided high-dose repetitive transcranial magnetic stimulation (rTMS) may be a novel method to rapidly reduce suicidal ideation in patients with major depressive disorder (MDD).

Major finding: The rTMS vs. sham group demonstrated a significantly greater reduction in the Beck Scale for Suicide Ideation (−14.76 vs. −4.71), 24-item Hamilton Depression rating scale (−19.19 vs. −4.48), and Montgomery-Asberg Depression Rating Scale scores (−19.67 vs. −4.33) on day 7 (P less than .001 for all).

Study details: A total of 42 treatment-naïve patients with MDD with suicidal ideation were randomly assigned to receive escitalopram oxalate in combination with rTMS via either active (n = 21) or sham coil (n = 21) for 1 week.

Disclosures: This study was supported by the National Natural Science Foundation of China. The authors declared no conflict of interest.

Citation: Pan F et al. Clin Pharmacol Ther. 2020 Apr 22. doi: 10.1002/cpt.1858.

Key clinical point: Neuronavigation-guided high-dose repetitive transcranial magnetic stimulation (rTMS) may be a novel method to rapidly reduce suicidal ideation in patients with major depressive disorder (MDD).

Major finding: The rTMS vs. sham group demonstrated a significantly greater reduction in the Beck Scale for Suicide Ideation (−14.76 vs. −4.71), 24-item Hamilton Depression rating scale (−19.19 vs. −4.48), and Montgomery-Asberg Depression Rating Scale scores (−19.67 vs. −4.33) on day 7 (P less than .001 for all).

Study details: A total of 42 treatment-naïve patients with MDD with suicidal ideation were randomly assigned to receive escitalopram oxalate in combination with rTMS via either active (n = 21) or sham coil (n = 21) for 1 week.

Disclosures: This study was supported by the National Natural Science Foundation of China. The authors declared no conflict of interest.

Citation: Pan F et al. Clin Pharmacol Ther. 2020 Apr 22. doi: 10.1002/cpt.1858.

Key clinical point: Neuronavigation-guided high-dose repetitive transcranial magnetic stimulation (rTMS) may be a novel method to rapidly reduce suicidal ideation in patients with major depressive disorder (MDD).

Major finding: The rTMS vs. sham group demonstrated a significantly greater reduction in the Beck Scale for Suicide Ideation (−14.76 vs. −4.71), 24-item Hamilton Depression rating scale (−19.19 vs. −4.48), and Montgomery-Asberg Depression Rating Scale scores (−19.67 vs. −4.33) on day 7 (P less than .001 for all).

Study details: A total of 42 treatment-naïve patients with MDD with suicidal ideation were randomly assigned to receive escitalopram oxalate in combination with rTMS via either active (n = 21) or sham coil (n = 21) for 1 week.

Disclosures: This study was supported by the National Natural Science Foundation of China. The authors declared no conflict of interest.

Citation: Pan F et al. Clin Pharmacol Ther. 2020 Apr 22. doi: 10.1002/cpt.1858.

Key clinical point: The addition of pimavanserin to ongoing treatment improves sexual function in patients with major depressive disorder (MDD).

Major finding: Pimavanserin vs. placebo significantly improved the Massachusetts General Hospital Sexual Functioning Index mean scores from baseline to week 5 (least square mean difference, −0.634; P = .0002). Item 14 scores (sexual interest) on the 17-item Hamilton Depression Rating Scale improved significantly with pimavanserin vs. placebo (P less than .05).

Study details: This secondary analysis of the CLARITY study included 203 patients with MDD randomly assigned to either pimavanserin (n = 51) or placebo (n = 152) in addition to their current treatment.

Disclosures: This study was funded by ACADIA Pharmaceuticals, Inc. Dr. Marlene Freeman: Investigator Initiated Trials/Research: Takeda, JayMac, Sage; Advisory boards: Otsuka, Alkermes, Janssen, Sage; Sunovion; Independent Data Safety and Monitoring Committee: Janssen (Johnson & Johnson); Medical Editing: GOED newsletter. Speaking/honoraria: U.S. Psychiatric Congress, Medscape. He is an employee of Massachusetts General Hospital and works with the MGH National Pregnancy Registry.

Citation: Freeman MP et al. Depress Anxiety. 2020 Apr 17. doi: 10.1002/da.23017.

Key clinical point: The addition of pimavanserin to ongoing treatment improves sexual function in patients with major depressive disorder (MDD).

Major finding: Pimavanserin vs. placebo significantly improved the Massachusetts General Hospital Sexual Functioning Index mean scores from baseline to week 5 (least square mean difference, −0.634; P = .0002). Item 14 scores (sexual interest) on the 17-item Hamilton Depression Rating Scale improved significantly with pimavanserin vs. placebo (P less than .05).

Study details: This secondary analysis of the CLARITY study included 203 patients with MDD randomly assigned to either pimavanserin (n = 51) or placebo (n = 152) in addition to their current treatment.

Disclosures: This study was funded by ACADIA Pharmaceuticals, Inc. Dr. Marlene Freeman: Investigator Initiated Trials/Research: Takeda, JayMac, Sage; Advisory boards: Otsuka, Alkermes, Janssen, Sage; Sunovion; Independent Data Safety and Monitoring Committee: Janssen (Johnson & Johnson); Medical Editing: GOED newsletter. Speaking/honoraria: U.S. Psychiatric Congress, Medscape. He is an employee of Massachusetts General Hospital and works with the MGH National Pregnancy Registry.

Citation: Freeman MP et al. Depress Anxiety. 2020 Apr 17. doi: 10.1002/da.23017.

Key clinical point: The addition of pimavanserin to ongoing treatment improves sexual function in patients with major depressive disorder (MDD).

Major finding: Pimavanserin vs. placebo significantly improved the Massachusetts General Hospital Sexual Functioning Index mean scores from baseline to week 5 (least square mean difference, −0.634; P = .0002). Item 14 scores (sexual interest) on the 17-item Hamilton Depression Rating Scale improved significantly with pimavanserin vs. placebo (P less than .05).

Study details: This secondary analysis of the CLARITY study included 203 patients with MDD randomly assigned to either pimavanserin (n = 51) or placebo (n = 152) in addition to their current treatment.

Disclosures: This study was funded by ACADIA Pharmaceuticals, Inc. Dr. Marlene Freeman: Investigator Initiated Trials/Research: Takeda, JayMac, Sage; Advisory boards: Otsuka, Alkermes, Janssen, Sage; Sunovion; Independent Data Safety and Monitoring Committee: Janssen (Johnson & Johnson); Medical Editing: GOED newsletter. Speaking/honoraria: U.S. Psychiatric Congress, Medscape. He is an employee of Massachusetts General Hospital and works with the MGH National Pregnancy Registry.

Citation: Freeman MP et al. Depress Anxiety. 2020 Apr 17. doi: 10.1002/da.23017.

This study by Sinyor et al. reviewed 56 studies of antidepressants versus placebo and found that active drugs physiologically generated more neurological, sexual and anticholinergic side effects. No differences between drug and placebo were found for generating more psychic symptoms, pain symptoms, or weight gain suggesting that if remarkable complaints exist post dosing that these may be nocebo in origin. A nocebo effect occurs when negative expectations in the patient’s mindset creates artificial or psychic-based side effects.

Interestingly in large psychotropic trials, up to a quarter of subject will discontinue the placebo treatment due to side effects. In clinical practice, this also means that many of our patients may quit their medications early or we may discontinue them early allowing for poor dosing and likely poor outcomes. More interventional research about anti-nocebo interventions (identifying those at nocebo risk, tailoring information during informed consent, positive framing of side effect percentages, etc.) are warranted and could lead to more days on drug per patient and ideally better outcomes for them as well.

Thomas L. Schwartz, MD

Senior Associate Dean of Education

Interim Chair/Professor of Psychiatry

SUNY Upstate Medical University

This study by Sinyor et al. reviewed 56 studies of antidepressants versus placebo and found that active drugs physiologically generated more neurological, sexual and anticholinergic side effects. No differences between drug and placebo were found for generating more psychic symptoms, pain symptoms, or weight gain suggesting that if remarkable complaints exist post dosing that these may be nocebo in origin. A nocebo effect occurs when negative expectations in the patient’s mindset creates artificial or psychic-based side effects.

Interestingly in large psychotropic trials, up to a quarter of subject will discontinue the placebo treatment due to side effects. In clinical practice, this also means that many of our patients may quit their medications early or we may discontinue them early allowing for poor dosing and likely poor outcomes. More interventional research about anti-nocebo interventions (identifying those at nocebo risk, tailoring information during informed consent, positive framing of side effect percentages, etc.) are warranted and could lead to more days on drug per patient and ideally better outcomes for them as well.

Thomas L. Schwartz, MD

Senior Associate Dean of Education

Interim Chair/Professor of Psychiatry

SUNY Upstate Medical University

This study by Sinyor et al. reviewed 56 studies of antidepressants versus placebo and found that active drugs physiologically generated more neurological, sexual and anticholinergic side effects. No differences between drug and placebo were found for generating more psychic symptoms, pain symptoms, or weight gain suggesting that if remarkable complaints exist post dosing that these may be nocebo in origin. A nocebo effect occurs when negative expectations in the patient’s mindset creates artificial or psychic-based side effects.

Interestingly in large psychotropic trials, up to a quarter of subject will discontinue the placebo treatment due to side effects. In clinical practice, this also means that many of our patients may quit their medications early or we may discontinue them early allowing for poor dosing and likely poor outcomes. More interventional research about anti-nocebo interventions (identifying those at nocebo risk, tailoring information during informed consent, positive framing of side effect percentages, etc.) are warranted and could lead to more days on drug per patient and ideally better outcomes for them as well.

Thomas L. Schwartz, MD

Senior Associate Dean of Education

Interim Chair/Professor of Psychiatry

SUNY Upstate Medical University