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P.2.a.025 Exploratory study of actigraphic and psychometric measures in depressed patients treated with agomelatine or sertraline
S326
P.2.a Affective disorders and antidepressants – Affective disorders (clinical)
Results: – In our research there is not any “Superadaptation” case between anxious and depressive outpatients samples. – Women have a more pathological social support than men but these differences are not significant. – A smaller number of depressive outpatients are included in “Normal” category than anxiety disorder outpatients; although statistically significant differences among them do not exist. – Outpatients included in “Normal” social support category present an average age significantly greater than in the rest of the categories. (p = 0.048). – Disorders frequently included in “Patent Social Mismacht” are Panic Disorder and Agoraphobia followed by Dysthymia (p = 0.005). – Depressive Adapted Disorder and Anxiety Adapted Disorder are more frequently included in “Normal” category (p = 0.005). Conclusion: 1. Outpatients who suffer from Anxiety Disorder or Depressive Disorder are not in “Superadaptation” category from a social support point of view. 2. Outpatients of older age represent a better social support. 3. Panic Disorders and Agoraphobia are the most socially support unadaptable in psychiatric diagnosis followed by Distimic disorder. Depressive and Anxiety Adapted Disorder have less pathological social support than others. 4. Posstraumatic stress disorder is the only psychiatric disorder which does not have any case included in “Normal” category. References [1] Hays RD, Wells KB, Sherbourne CD, et al, 1995, Functioning and well-being outcomes of patients with depression compared with chronic general medical illnesses. Arch Gen Psychiatry 52: 11−9. [2] Hirschfeld RM, Montgomery SA, Keller MB, et al, 2000, Social functioning in depression: a review. J Clin Psychiatry Apr, 61(4), 268−75. [3] Weissman MM, 2000, Social functioning and the treatment of depression. J Clin Psychiatry 61(Suppl 1), 31−8.
P.2.a.025 Exploratory study of actigraphic and psychometric measures in depressed patients treated with agomelatine or sertraline K. Wulff1 ° , F. Bayle2 , G. Hajak3 , A.L. Montejo Gonzales4 , E. Smeraldi5 , J. Rybakowski6 , L. Laigle7 , S. Kasper8 . 1 University of Oxford, Circadian and Visual Neuroscience Group, Oxford, United Kingdom; 2 University Paris-Descartes, Centre Hospitalier Sainte-Anne, Paris, France; 3 Universitaet Regensburg, Klinik fuer Psychiatrie, Regensburg, Germany; 4 Hospital de Salamanca, Hospital de Salamanca, Salamanca, Spain; 5 Universita VitaSalute San Raffaele, Divisione di Neuropsichiatria, Milano, Italy; 6 Akademii Medycznej w Posnaniu, Klinika Psychiatrii Doroslych, Poznan, Poland; 7 IRIS, Neuropsychiatry Division, Courbevoie, France; 8 Universitaetsklinik fuer Psychiatrie und Psychotherapie, Klinische Abteilung fuer Allgemeine Psychiatrie, Wien, Austria Major Depressive Disorder is regarded a heterogeneous syndrome with patients usually having a combination of symptoms very likely to stem from distinct neurobiological process in the brain, with more than one system being responsible for the abnormal regulation associated with Major Depressive Disorder. Depressed patients most often suffer from low daytime activity and sleep disturbances (flattening of rhythms). Actigraphy has been extensively used in both research and clinical settings to objectively
measure the pattern of activity and rest, including patients with Major Depressive Disorder [1]. Actigraphy may be a valuable tool to explore differential treatment effects in regard to the restactivity cycle and between clinical subtypes of depression. In our present exploratory work we aim to develop a characterisation of subtypes of Major Depressive Disorder defined by their circadian and sleep-related patterns using wrist actigraphy that allows ambulatory measurements in the patients’ natural environment. The Relative Amplitude, which is calculated as the ratio of average activity at night over average daytime activity, was used as a key-parameter. Actigraphy data (Cambridge Neurotechnology Ltd., UK) and clinical information on 300 patients diagnosed for Major Depressive Disorder according to the DSM-IV TR were collected for seven weeks across six European countries within a randomised, double-blind parallel group design in 2005 and 2006. Patients underwent one baseline week (no medication) and were then treated with efficient doses of agomelatine (25 to 50 mg per day) or sertraline (50 to 100 mg per day) for six weeks. Agomelatine has a new pharmacological profile as an antidepressant acting as a melatonergic agonist and an antagonist at 5-HT2C receptors. Agomelatine has demonstrated antidepressant efficacy [2] and also regulates biological circadian rhythms. The currently still blinded actigraphy data from 70 patients analysed so far, allow differentiation of circadian subtypes at baseline and over the treatment course into those with low, medium and high basal Relative Amplitude when setting the thresholds at the 20th and 80th percentile of the population’s Relative Amplitude values. A monophasic activity/rest pattern with a high level of daytime activity and little activity at night is regarded as optimal (high basal Relative Amplitude subgroup). Separate analyses of activity levels recorded during the day and at night, and according to clinical response to antidepressant treatment, may provide predictive factors of the treatment outcome. In particular, there could be relationships between nocturnal activity, sleep-related variables and symptom improvement. To the best of our knowledge, this is the largest and longest systematic collection of actigraphy data in patients with Major Depressive Disorder. Obviously, the analysis of all 300 patients and further stratification of the data, e.g. for gender, age, Hamilton Depression Rating Scale (HAM-D) sub-items, and a comparison with healthy controls, will generate a more refined insight into what variables may mirror the quality of the treatment outcome. References [1] Ancoli-Israel, et al, 2003, The role of actigraphy in the study of sleep and circadian rhythms. SLEEP 26(3), 342–392. [2] Montgomery SA, 2006, Major depressive disorders: clinical efficacy and tolerability of agomelatine, a new melatonergic agonist. Eur Neuropsychopharmacol Sep, 16(Suppl 5), S633−8.
P.2.a.026 Predicting treatment outcome in difficult-totreat depressed patients G. Camardese ° , L. Mosca, A. Picello, C. Morelli, F. Adamo, L. Pucci, B. Mattioli, P. Bria. University of the Sacred Heart, Institute of Psychiatry, Rome, Italy Introduction: The treatment of depression has a very high rate of non-responding patients. The recurrence of the disorder and a poor response to the treatment configure difficult-to-treat depression. This is a widespread subgroup, which should be detected earlier for a better formulation of the therapeutic project. The efficacy
P.2.a Affective disorders and antidepressants – Affective disorders (clinical)
Results: – In our research there is not any “Superadaptation” case between anxious and depressive outpatients samples. – Women have a more pathological social support than men but these differences are not significant. – A smaller number of depressive outpatients are included in “Normal” category than anxiety disorder outpatients; although statistically significant differences among them do not exist. – Outpatients included in “Normal” social support category present an average age significantly greater than in the rest of the categories. (p = 0.048). – Disorders frequently included in “Patent Social Mismacht” are Panic Disorder and Agoraphobia followed by Dysthymia (p = 0.005). – Depressive Adapted Disorder and Anxiety Adapted Disorder are more frequently included in “Normal” category (p = 0.005). Conclusion: 1. Outpatients who suffer from Anxiety Disorder or Depressive Disorder are not in “Superadaptation” category from a social support point of view. 2. Outpatients of older age represent a better social support. 3. Panic Disorders and Agoraphobia are the most socially support unadaptable in psychiatric diagnosis followed by Distimic disorder. Depressive and Anxiety Adapted Disorder have less pathological social support than others. 4. Posstraumatic stress disorder is the only psychiatric disorder which does not have any case included in “Normal” category. References [1] Hays RD, Wells KB, Sherbourne CD, et al, 1995, Functioning and well-being outcomes of patients with depression compared with chronic general medical illnesses. Arch Gen Psychiatry 52: 11−9. [2] Hirschfeld RM, Montgomery SA, Keller MB, et al, 2000, Social functioning in depression: a review. J Clin Psychiatry Apr, 61(4), 268−75. [3] Weissman MM, 2000, Social functioning and the treatment of depression. J Clin Psychiatry 61(Suppl 1), 31−8.
P.2.a.025 Exploratory study of actigraphic and psychometric measures in depressed patients treated with agomelatine or sertraline K. Wulff1 ° , F. Bayle2 , G. Hajak3 , A.L. Montejo Gonzales4 , E. Smeraldi5 , J. Rybakowski6 , L. Laigle7 , S. Kasper8 . 1 University of Oxford, Circadian and Visual Neuroscience Group, Oxford, United Kingdom; 2 University Paris-Descartes, Centre Hospitalier Sainte-Anne, Paris, France; 3 Universitaet Regensburg, Klinik fuer Psychiatrie, Regensburg, Germany; 4 Hospital de Salamanca, Hospital de Salamanca, Salamanca, Spain; 5 Universita VitaSalute San Raffaele, Divisione di Neuropsichiatria, Milano, Italy; 6 Akademii Medycznej w Posnaniu, Klinika Psychiatrii Doroslych, Poznan, Poland; 7 IRIS, Neuropsychiatry Division, Courbevoie, France; 8 Universitaetsklinik fuer Psychiatrie und Psychotherapie, Klinische Abteilung fuer Allgemeine Psychiatrie, Wien, Austria Major Depressive Disorder is regarded a heterogeneous syndrome with patients usually having a combination of symptoms very likely to stem from distinct neurobiological process in the brain, with more than one system being responsible for the abnormal regulation associated with Major Depressive Disorder. Depressed patients most often suffer from low daytime activity and sleep disturbances (flattening of rhythms). Actigraphy has been extensively used in both research and clinical settings to objectively
measure the pattern of activity and rest, including patients with Major Depressive Disorder [1]. Actigraphy may be a valuable tool to explore differential treatment effects in regard to the restactivity cycle and between clinical subtypes of depression. In our present exploratory work we aim to develop a characterisation of subtypes of Major Depressive Disorder defined by their circadian and sleep-related patterns using wrist actigraphy that allows ambulatory measurements in the patients’ natural environment. The Relative Amplitude, which is calculated as the ratio of average activity at night over average daytime activity, was used as a key-parameter. Actigraphy data (Cambridge Neurotechnology Ltd., UK) and clinical information on 300 patients diagnosed for Major Depressive Disorder according to the DSM-IV TR were collected for seven weeks across six European countries within a randomised, double-blind parallel group design in 2005 and 2006. Patients underwent one baseline week (no medication) and were then treated with efficient doses of agomelatine (25 to 50 mg per day) or sertraline (50 to 100 mg per day) for six weeks. Agomelatine has a new pharmacological profile as an antidepressant acting as a melatonergic agonist and an antagonist at 5-HT2C receptors. Agomelatine has demonstrated antidepressant efficacy [2] and also regulates biological circadian rhythms. The currently still blinded actigraphy data from 70 patients analysed so far, allow differentiation of circadian subtypes at baseline and over the treatment course into those with low, medium and high basal Relative Amplitude when setting the thresholds at the 20th and 80th percentile of the population’s Relative Amplitude values. A monophasic activity/rest pattern with a high level of daytime activity and little activity at night is regarded as optimal (high basal Relative Amplitude subgroup). Separate analyses of activity levels recorded during the day and at night, and according to clinical response to antidepressant treatment, may provide predictive factors of the treatment outcome. In particular, there could be relationships between nocturnal activity, sleep-related variables and symptom improvement. To the best of our knowledge, this is the largest and longest systematic collection of actigraphy data in patients with Major Depressive Disorder. Obviously, the analysis of all 300 patients and further stratification of the data, e.g. for gender, age, Hamilton Depression Rating Scale (HAM-D) sub-items, and a comparison with healthy controls, will generate a more refined insight into what variables may mirror the quality of the treatment outcome. References [1] Ancoli-Israel, et al, 2003, The role of actigraphy in the study of sleep and circadian rhythms. SLEEP 26(3), 342–392. [2] Montgomery SA, 2006, Major depressive disorders: clinical efficacy and tolerability of agomelatine, a new melatonergic agonist. Eur Neuropsychopharmacol Sep, 16(Suppl 5), S633−8.
P.2.a.026 Predicting treatment outcome in difficult-totreat depressed patients G. Camardese ° , L. Mosca, A. Picello, C. Morelli, F. Adamo, L. Pucci, B. Mattioli, P. Bria. University of the Sacred Heart, Institute of Psychiatry, Rome, Italy Introduction: The treatment of depression has a very high rate of non-responding patients. The recurrence of the disorder and a poor response to the treatment configure difficult-to-treat depression. This is a widespread subgroup, which should be detected earlier for a better formulation of the therapeutic project. The efficacy