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Journal Article 2009; 30(6): 723-728 PubMed PMID: 20038931 Citation  Keywords:  Adult, Antidepressive Agents:administration & dosage, Depressive Disorder, Major:diagnosis, Drug Resistance, Drug Therapy, Combination, Female, Humans, Male, Middle Aged, Psychiatric Status Rating Scales, Retrospective Studies, Secondary Prevention, Sever.   

OBJECTIVE: The aim of this retrospective study was to compare the efficacy of combination therapy (combinations of antidepressants and various augmentations) and antidepressant monotherapy in the treatment of patients, who failed to respond at least to one previous antidepressant trial in the routine clinical practice.

METHODS: We reviewed chart documents of patients hospitalized at Prague Psychiatric Center for depressive disorder from June 2005 to June 2007 and finished at least 4 weeks of new treatment. Depressive symptoms and overall clinical status were assessed using Montgomery and Asberg Depression Rating Scale, Clinical Global Impression and Beck Depression Inventory - Short Form at the baseline and in the end of treatment.

RESULTS: We identified 49 inpatients (24-combined treatment, 25-monotherapy), who were suitable for analyses. Both groups were equal in baseline characteristics and in the duration of index episode treatment. The combined treatment was superior to the monotherapy switch in the MADRS median score reduction (16 vs. 9 points, p=0.01). The combined group achieved higher response rate compared to monotherapy group (67% vs. 36%, p=0.05). Number need to treat for response was 3.3 (95% CI, 1.85-37.3).

CONCLUSION: The findings of this study suggest that combined treatment is more efficacious than switch to monotherapy in the treatment of resistant depression....

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Journal Article 2009; 30(5): 564-573 PubMed PMID: 20035251 Citation  Keywords:  Adult, Cluster Analysis, Depressive Disorder:diagnosis, Depressive Disorder, Major:diagnosis, Fatigue:diagnosis, Female, Humans, Male, Middle Aged, Pain:diagnosis,.   

BACKGROUND: Major depression is characterized by multifarious symptoms and symptoms clusters, such as the melancholic and anxiety symptom clusters. There is a strong comorbidity and a biological similarity between major depression and myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS).

OBJECTIVE: The aim of the present study was to examine "psychosomatic" symptoms reminiscent of ME/CFS in major depression.

METHODS: Toward this end, we examined the 12-item Fibromyalgia and Chronic Fatigue Syndrome Rating (FF) Scale and the Hamilton Depression Rating Scale (HDRS) in 103 major depressed patients by means of multivariate pattern recognition methods. results: Our findings support the existence of two factors, i.e. a fatigue and somatic (F&S) factor, i.e aches and pain, muscular tension, fatigue, concentration difficulties, failing memory, irritability, irritable bowel, headache, and a subjective experience of infection; and a depression factor, i.e. sadness, irritability, sleep disorders, autonomic symptoms, and a subjective experience of infection. Cluster analysis performed on the 12 FF items found two different clusters, which were separated by highly significant differences in the F&S items, the most significant being a subjective experience of infection, aches and pain, muscular tension, fatigue, concentration difficulties and failing memory. Multivariate analyses showed that the differences between both clusters were quantitatively, and not qualitatively, and reflected the severity of the F&S dimension. There was a strong association between the F&S symptoms and melancholia and chronic depression. Treatment resistant depression was characterized by higher scores on the depression factor score. There was a strong correlation between the HDRS score and the FF items, fatigue, a subjective experience of infection, and sadness. Our findings show that F&S symptoms are a major feature of depression and largely predict severity of illness, and chronic and melancholic depression.

CONCLUSIONS: It is concluded that the diagnostic criteria of depression and melancholia and rating scales to measure severity of illness should be modified to include the F&S symptom profile....

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