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Depression: HELP
Articles by Jay D. Amsterdam
Based on 24 articles published since 2010
(Why 24 articles?)
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Between 2010 and 2020, J. Amsterdam wrote the following 24 articles about Depression.
 
+ Citations + Abstracts
1 Review Rhodiola rosea L. as a putative botanical antidepressant. 2016

Amsterdam, Jay D / Panossian, Alexander G. ·Depression Research Unit, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania School of Medicine, Philadelphia, PA, USA. Electronic address: jamsterd@mail.med.upenn.edu. · Research and Development Unit, Swedish Herbal Institute, Vallberga, Halland, Sweden. ·Phytomedicine · Pubmed #27013349.

ABSTRACT: BACKGROUND: Rhodiola rosea (R. rosea) is a botanical adaptogen with putative anti-stress and antidepressant properties. Evidence-based data supporting the effectiveness of R. rosea for depression in adults is limited, and therefore a comprehensive review of available animal and human studies suggesting a putative antidepressant action is warranted. PURPOSE: A review of the literature was undertaken to ascertain studies of possible antidepressant mechanisms of action and studies of the safety and effectiveness of R. rosea extracts in animals and adult humans. METHODS: A search of MEDLINE and the Russian state library database was conducted (up to October 2015) on R. rosea. MECHANISM OF ACTION: R. rosea extracts and its purified constituent, salidroside, has been shown to produce a variety of mediator interactions with several molecular networks of neuroendocrine-immune and neurotransmitter receptor systems likely to be involved in the pathophysiology of depression. A wide variety of preclinical in vivo and ex vivo studies with laboratory animals suggests the presence of several biochemical and pharmacological antidepressant-like actions. EFFECTIVENESS: Clinical assessment of R. rosea L. rhizome extracts in humans with various depressive syndromes is based upon results from two randomized, double-blind, placebo-controlled trials of 146 subjects with major depressive disorder and seven open-label studies totaling 714 individuals with stress-induced mild depression (diagnosed as asthenic syndrome or psychoneurosis). Overall, results of these studies suggests a possible antidepressant action for R. rosea extract in adult humans. SAFETY: In contrast to most conventional antidepressants, R. rosea extract appears to be well-tolerated in short-term studies with a favorable safety profile. CONCLUSIONS: R. rosea demonstrates multi-target effects on various levels of the regulation of cell response to stress, affecting various components of the neuroendocrine, neurotransmitter receptor and molecular networks associated with possible beneficial effects on mood.

2 Clinical Trial Rhodiola rosea versus sertraline for major depressive disorder: A randomized placebo-controlled trial. 2015

Mao, Jun J / Xie, Sharon X / Zee, Jarcy / Soeller, Irene / Li, Qing S / Rockwell, Kenneth / Amsterdam, Jay D. ·Department of Family Medicine & Community Health, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States; Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States. Electronic address: jun.mao@uphs.upenn.edu. · Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States. · Department of Family Medicine & Community Health, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States; Depression Research Unit, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States. · Investigational Drug Service, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States. · Depression Research Unit, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States. ·Phytomedicine · Pubmed #25837277.

ABSTRACT: BACKGROUND: We performed a proof of concept trial to evaluate relative safety and efficacy of Rhodiola rosea (R. rosea) versus sertraline for mild to moderate major depressive disorder. HYPOTHESIS: We hypothesize that R. rosea would have similar therapeutic effects as sertraline but with less adverse events. STUDY DESIGN: Phase II randomized placebo controlled clinical trial. METHODS: 57 subjects were randomized to 12 weeks of standardized R. rosea extract, sertraline, or placebo. Changes over time in Hamilton Depression Rating (HAM-D), Beck Depression Inventory (BDI), and Clinical Global Impression Change (CGI/C) scores among groups were examined using mixed-effects models. RESULTS: Modest, albeit statistically non-significant, reductions were observed for HAM-D, BDI, and CGI/C scores for all treatment conditions with no significant difference between groups (p = 0.79, p = 0.28, and p = 0.17, respectively). The decline in HAM-D scores was greater for sertraline (-8.2, 95% confidence interval [CI], -12.7 to -3.6) versus R. rosea (-5.1, 95% CI: -8.8 to -1.3) and placebo (-4.6, 95% CI: -8.6 to -0.6). While the odds of improving (versus placebo) were greater for sertraline (1.90 [0.44-8.20]; odds ratio [95% CI]) than R. rosea (1.39 [0.38-5.04]), more subjects on sertraline reported adverse events (63.2%) than R. rosea (30.0%) or placebo (16.7%) (p = 0.012). CONCLUSIONS: Although R. rosea produced less antidepressant effect versus sertraline, it also resulted in significantly fewer adverse events and was better tolerated. These findings suggest that R. rosea, although less effective than sertraline, may possess a more favorable risk to benefit ratio for individuals with mild to moderate depression.

3 Article Putative Antidepressant Effect of Chamomile ( 2019

Amsterdam, Jay D / Li, Qing S / Xie, Sharon X / Mao, Jun J. ·Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. · Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY. · Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. ·J Altern Complement Med · Pubmed #31808709.

ABSTRACT:

4 Article Relative effectiveness of tricyclic antidepressant versus monoamine oxidase inhibitor monotherapy for treatment-resistant depression. 2019

Kim, Thomas / Xu, Colin / Amsterdam, Jay D. ·Department of Psychology, University of Pennsylvania, Philadelphia, PA, USA. Electronic address: thomastk@sas.upenn.edu. · Department of Psychology, University of Pennsylvania, Philadelphia, PA, USA. · Depression Research Unit, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania School of Medicine, Philadelphia, PA, USA. Electronic address: jamsterd@pennmedicine.upenn.edu. ·J Affect Disord · Pubmed #30861462.

ABSTRACT: OBJECTIVES: Antidepressants may be less effective in treatment-resistant depression (TRD). In this exploratory study, we examined the widely held hypothesis that monoamine oxidase inhibitor (MAOI) therapy may be superior to tricyclic antidepressant (TCA) therapy for TRD. We also examined the influence of the number of prior treatment trials on TCA versus MAOI effectiveness in TRD. METHODS: Data were retrospectively extracted from approximately 2,500 treatment charts of patients with TRD who were attending a university mood disorder clinic between 1983 and 2015. Hierarchical linear modeling was used to examine the efficacy of drug class on outcome as well as the interaction between drug class and the number of prior antidepressant trials. RESULTS: 147 treatment outcome observations were made from 94 unipolar, depressed patients who either received TCA (N = 47) or MAOI (N = 100) monotherapy for TRD. For patients unresponsive to at least one prior trial, drug class significantly predicted end-of-treatment CGI/S scores, with TCAs showing worse (i.e., higher) end-of-treatment CGI/S scores relative to MAOI therapy (b = 1.04, t = 4.98, p < 0.0001). When examining the interaction between drug class and the number of prior antidepressant trials, the interaction effect was significant (b = -0.50, t = -2.43, p = 0.02); however, the advantage for MAOI versus TCA therapy decreases with more prior, failed, antidepressant trials. CONCLUSION: Results suggest that MAOIs may be more effective than TCAs for early stage TRD. This difference in effectiveness between MAOIs and TCAs diminished as the number of prior treatment trials increased. However, the TCA sample size was limited and the analysis was retrospective with non-randomized conditions.

5 Article Residual anxiety may be associated with depressive relapse during continuation therapy of bipolar II depression. 2018

Lorenzo-Luaces, Lorenzo / Amsterdam, Jay D / DeRubeis, Robert J. ·Department of Psychological and Brain Sciences, Indiana University - Bloomington, Bloomington, IN, United States. Electronic address: lolorenz@indiana.edu. · Depression Research Unit, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania School of Medicine, Philadelphia, PA, United States. · Depression Research Unit, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania School of Medicine, Philadelphia, PA, United States; Department of Psychology, University of Pennsylvania, Philadelphia, PA, United States. ·J Affect Disord · Pubmed #29149756.

ABSTRACT: BACKGROUND: Anxiety symptoms are common in bipolar disorder. We explored the effect of anxiety on the outcome of acute and continuation pharmacotherapy of bipolar II depression. METHODS: Data were derived from a randomized double-blind 12-week acute (N = 129) and 6-month continuation (N = 55) comparison of venlafaxine versus lithium monotherapy in bipolar II depression in adults. We distinguished between the items of the Hamilton Rating Scale for Depression (HRSD) that capture depression vs. anxiety (i.e., psychomotor agitation, psychic anxiety, somatic anxiety, hypochondriasis, and obsessive-compulsive concerns) and examined the effect of treatment on depression and anxiety. Additionally, we explored whether baseline anxiety or depression predicted changes over time in depression and anxiety ratings or moderated treatment outcomes. We also explored whether residual depressive and anxious symptoms predicted relapse during continuation therapy. RESULTS: Venlafaxine was superior to lithium in reducing both depression and anxiety, though its effects on anxiety were more modest than those on depression. Baseline anxiety predicted change over time in anxiety, but not depression. By contrast, baseline depression did not predict change over time in depression or anxiety. Residual anxiety, specifically uncontrollable worry, was a stronger predictor of relapse than residual depression. CONCLUSION: Successful treatment of symptoms of anxiety in bipolar depression may protect against depressive relapse.

6 Article Effects of venlafaxine versus lithium monotherapy on quality of life in bipolar II major depressive disorder: Findings from a double-blind randomized controlled trial. 2018

Lorenzo-Luaces, Lorenzo / Amsterdam, Jay D. ·Department of Psychological and Brain Sciences, Indiana University, Bloomington, USA; Depression Research Unit, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania School of Medicine, Philadelphia, USA. Electronic address: lolorenz@indiana.edu. · Depression Research Unit, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania School of Medicine, Philadelphia, USA. ·Psychiatry Res · Pubmed #29136600.

ABSTRACT: Bipolar disorder is associated with decreased quality of life, especially during depressive episodes. There are few studies that have examined whether quality of life improves following pharmacological treatments of bipolar depression. In this exploratory study, we examined the effects of antidepressant versus mood stabilizer monotherapy on quality of life ratings in bipolar II subjects during acute (12 week) treatment. Data were derived from a randomized double-blind comparison of venlafaxine (n = 65) versus lithium (n = 64) monotherapy. The Quality of Life Index (QLI) was administered at baseline (n = 126; 98%) and again at the end of treatment. We explored treatment differences in continuous changes on the QLI using last-observation carried forward. Additionally, we explored the likelihood of experiencing clinically-significant improvements as well as baseline correlates of QLI and changes in QLIe. Venlafaxine was superior to lithium in reducing symptoms of depression during acute treatment. However, there were no significant differences between treatments in QLI ratings. Changes in symptoms of depression were correlated to, but not redundant, with improvements in QLI ratings. These findings suggest that quality of life may be an important secondary outcome to target and measure as a part of comparative clinical trials of pharmacotherapy for bipolar II depression.

7 Article Comparison of treatment outcome using two definitions of rapid cycling in subjects with bipolar II disorder. 2017

Amsterdam, Jay D / Lorenzo-Luaces, Lorenzo / DeRubeis, Robert J. ·Depression Research Unit, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. · Department of Psychology, University of Pennsylvania, Philadelphia, PA, USA. ·Bipolar Disord · Pubmed #28160351.

ABSTRACT: OBJECTIVES: We examined differences in treatment outcome between Diagnostic and Statistical Manual Fourth Edition (DSM-IV)-defined rapid cycling and average lifetime-defined rapid cycling in subjects with bipolar II disorder. We hypothesized that, compared with the DSM-IV definition, the average lifetime definition of rapid cycling may better identify subjects with a history of more mood lability and a greater likelihood of hypomanic symptom induction during long-term treatment. METHODS: Subjects ≥18 years old with a bipolar II major depressive episode (n=129) were categorized into DSM-IV- and average lifetime-defined rapid cycling and prospectively treated with either venlafaxine or lithium monotherapy for 12 weeks. Responders (n=59) received continuation monotherapy for six additional months. RESULTS: These exploratory analyses found moderate agreement between the two rapid-cycling definitions (κ=0.56). The lifetime definition captured subjects with more chronic courses of bipolar II depression, whereas the DSM-IV definition captured subjects with more acute symptoms of hypomania. There was no difference between rapid-cycling definitions with respect to the response to acute venlafaxine or lithium monotherapy. However, the lifetime definition was slightly superior to the DSM-IV definition in identifying subjects who went on to experience hypomanic symptoms during continuation therapy. CONCLUSIONS: Although sample sizes were limited, the findings suggest that the lifetime definition of rapid cycling may identify individuals with a chronic rapid-cycling course and may also be slightly superior to the DSM-IV definition in identifying individuals with hypomania during relapse-prevention therapy. These findings are preliminary in nature and need replication in larger, prospective, bipolar II studies.

8 Article Step-wise loss of antidepressant effectiveness with repeated antidepressant trials in bipolar II depression. 2016

Amsterdam, Jay D / Lorenzo-Luaces, Lorenzo / DeRubeis, Robert J. ·Depression Research Unit, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, USA. · Department of Psychology, University of Pennsylvania, Philadelphia, PA, USA. · Methods to Improve Diagnostic Assessment and Services (MIDAS) Project, Brown University, Providence, RI, USA. ·Bipolar Disord · Pubmed #27805299.

ABSTRACT: OBJECTIVE: This study examined the relationship between the number of prior antidepressant treatment trials and step-wise increase in pharmacodynamic tolerance (or progressive loss of effectiveness) in subjects with bipolar II depression. METHODS: Subjects ≥18 years old with bipolar II depression (n=129) were randomized to double-blind venlafaxine or lithium carbonate monotherapy for 12 weeks. Responders (n=59) received continuation monotherapy for six additional months. RESULTS: After controlling for baseline covariates of prior medications, there was a 25% reduction in the likelihood of response to treatment with each increase in the number of prior antidepressant trials (odds ratio [OR]=0.75, unstandardized coefficient [B]=-0.29, standard error (SE)=0.12; χ CONCLUSIONS: The odds of responding or remitting during venlafaxine or lithium monotherapy were reduced by 25% and 32%, respectively, with each increase in the number of prior antidepressant treatment trials. There was no relationship between prior antidepressant exposure and depressive relapse during continuation therapy of bipolar II disorder.

9 Article Specific Pharmacological Effects of Paroxetine Comprise Psychological but Not Somatic Symptoms of Depression. 2016

Schalet, Benjamin D / Tang, Tony Z / DeRubeis, Robert J / Hollon, Steven D / Amsterdam, Jay D / Shelton, Richard C. ·Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America. · Department of Psychology, University of Pennsylvania, Philadelphia, PA, United States of America. · Department of Psychology, Vanderbilt University, Nashville, TN, United States of America. · Depression Research Unit, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America. · Department of Psychiatry and Behavioral Neurobiology, The University of Alabama at Birmingham, Birmingham, AL, United States of America. ·PLoS One · Pubmed #27438078.

ABSTRACT: BACKGROUND: Meta-analyses of placebo-controlled trials of SSRIs suggest that only a small portion of the observable change in depression may be attributed to "true" pharmacological effects. But depression is a multidimensional construct, so treatment effects may differ by symptom cluster. We tested the hypothesis that SSRIs uniquely alter psychological rather than somatic symptoms of depression and anxiety. METHOD: Outpatients with moderate to severe MDD were randomly assigned to receive paroxetine (n = 120) or placebo (n = 60). RESULTS: Paroxetine significantly outperformed placebo on all psychological subscales of the syndrome measures, but not on any of the somatic subscales. The difference in score reduction between paroxetine and placebo was more than twice as great for the psychological symptoms compared to the somatic symptoms. CONCLUSIONS: Paroxetine appears to have a "true" pharmacological effect on the psychological but not on the somatic symptoms of depression and anxiety. Paroxetine's influence on somatic symptoms appears to be mostly duplicated by placebo.

10 Article The citalopram CIT-MD-18 pediatric depression trial: Deconstruction of medical ghostwriting, data mischaracterisation and academic malfeasance. 2016

Jureidini, Jon N / Amsterdam, Jay D / McHenry, Leemon B. ·Critical and Ethical Mental Health Research Group, University of Adelaide, Adelaide, Australia. · Depression Research Unit, Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, PA, USA. · Department of Philosophy, California State University, Northridge, CA, USA. ·Int J Risk Saf Med · Pubmed #27176755.

ABSTRACT: OBJECTIVE: Deconstruction of a ghostwritten report of a randomized, double-blind, placebo-controlled efficacy and safety trial of citalopram in depressed children and adolescents conducted in the United States. METHODS: Approximately 750 documents from the Celexa and Lexapro Marketing and Sales Practices Litigation: Master Docket 09-MD-2067-(NMG) were deconstructed. RESULTS: The published article contained efficacy and safety data inconsistent with the protocol criteria. Procedural deviations went unreported imparting statistical significance to the primary outcome, and an implausible effect size was claimed; positive post hoc measures were introduced and negative secondary outcomes were not reported; and adverse events were misleadingly analysed. Manuscript drafts were prepared by company employees and outside ghostwriters with academic researchers solicited as 'authors'. CONCLUSION: Deconstruction of court documents revealed that protocol-specified outcome measures showed no statistically significant difference between citalopram and placebo. However, the published article concluded that citalopram was safe and significantly more efficacious than placebo for children and adolescents, with possible adverse effects on patient safety.

11 Article Rapid versus non-rapid cycling bipolar II depression: response to venlafaxine and lithium and hypomanic risk. 2016

Lorenzo-Luaces, L / Amsterdam, J D / Soeller, I / DeRubeis, R J. ·Depression Research Unit, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania School of Medicine, Philadelphia, PA. · Department of Psychology, University of Pennsylvania, Philadelphia, PA. · Department of Family Medicine and Community Health, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA. ·Acta Psychiatr Scand · Pubmed #26803764.

ABSTRACT: OBJECTIVE: To examine the safety and effectiveness of antidepressant versus mood stabilizer monotherapy in rapid versus non-rapid cycling bipolar II disorder. METHOD: Subjects ≥18 years old with bipolar II depression (n = 129) were randomized to double-blind venlafaxine or lithium carbonate monotherapy for 12 weeks. Responders (n = 59) received continuation monotherapy for six additional months. RESULTS: Rapid cycling did not affect frequency of response or change over time in depressive symptoms. Rapid cycling status did not affect frequency of depressive relapse or sustained treatment response. Rapid cyclers were more likely to experience hypomanic symptoms (P = 0.005) during continuation monotherapy; however, rates were similar in venlafaxine (17.6%) and lithium (42.9%) (P = 0.31). CONCLUSION: Rapid cycling status may not be associated with an increased risk of diminished response or greater depressive relapse during venlafaxine, relative to lithium monotherapy, in bipolar II subjects. Additional randomized studies are needed to confirm these findings.

12 Article Safety and effectiveness of continuation antidepressant versus mood stabilizer monotherapy for relapse-prevention of bipolar II depression: A randomized, double-blind, parallel-group, prospective study. 2015

Amsterdam, Jay D / Lorenzo-Luaces, Lorenzo / Soeller, Irene / Li, Susan Qing / Mao, Jun J / DeRubeis, Robert J. ·Depression Research Unit, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania School of Medicine, Philadelphia, PA, USA. Electronic address: jamsterd@mail.med.upenn.edu. · Depression Research Unit, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania School of Medicine, Philadelphia, PA, USA; Department of Psychology, University of Pennsylvania, Philadelphia, PA, USA. · Depression Research Unit, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania School of Medicine, Philadelphia, PA, USA; Department of Family Medicine and Community Health, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA. · Department of Family Medicine and Community Health, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA. ·J Affect Disord · Pubmed #26143402.

ABSTRACT: OBJECTIVE: Compare the safety and effectiveness of continuation antidepressant versus mood stabilizer monotherapy for preventing depressive relapse in bipolar II disorder. METHODS: Subjects ≥18 years old with bipolar II depression (n=129) were randomized to double-blind venlafaxine or lithium monotherapy for 12 weeks. Responders with a ≥50% reduction in depression score were continued for an additional 6 months of relapse-prevention monotherapy. Primary outcome was depressive relapse during continuation monotherapy. Secondary outcomes included sustained response rate from initiation of treatment to study end-point, relapse hazard, time to relapse, change in mania ratings, and frequency of treatment-emergent sub-syndromal hypomania and/or depressive episodes. RESULTS: Venlafaxine produced greater sustained response rate versus lithium (p<0.0001); however, there was no difference in relapse rate for venlafaxine (7.5%) versus lithium (26.7%) (p=0.079); relapse hazard (p=0.073), or time to relapse (p=0.090) between treatment conditions during continuation monotherapy. There were no group differences in mania rating scores over time and no difference in frequency or duration of syndromal or sub-syndromal hypomanic episodes. There were more sub-syndromal depressive episodes during lithium monotherapy (p=0.03). LIMITATIONS: Sample size was limited by the lower sustained response rate for lithium versus venlafaxine; study was not specifically powered to detect differences in treatment-emergent hypomanic or depressive episodes between groups. CONCLUSION: Results suggest that continuation venlafaxine monotherapy may provide similar prophylactic effectiveness relative to lithium, with no difference in treatment-emergent hypomanic episodes and without the need for frequent serum lithium level and metabolic monitoring. Larger, prospective trials are needed to confirm these observations.

13 Article Gains in employment status following antidepressant medication or cognitive therapy for depression. 2015

Fournier, Jay C / DeRubeis, Robert J / Amsterdam, Jay / Shelton, Richard C / Hollon, Steven D. ·Jay C. Fournier, PhD, Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Robert J. DeRubeis, PhD, Department of Psychology, University of Pennsylvania, Philadelphia, Pennsylvania; Jay Amsterdam, MD, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Richard C. Shelton, MD, Department of Psychiatry and Behavioral Neurobiology, The University of Alabama at Birmingham, Birmingham, Alabama; Steven D. Hollon, PhD, Department of Psychology, Vanderbilt University, Nashville, Tennessee, USA. ·Br J Psychiatry · Pubmed #24925985.

ABSTRACT: BACKGROUND: Depression can adversely affect employment status. AIMS: To examine whether there is a relative advantage of cognitive therapy or antidepressant medication in improving employment status following treatment, using data from a previously reported trial. METHOD: Random assignment to cognitive therapy (n = 48) or the selective serotonin reuptake inhibitor paroxetine (n = 93) for 4 months; treatment responders were followed for up to 24 months. Differential effects of treatment on employment status were examined. RESULTS: At the end of 28 months, cognitive therapy led to higher rates of full-time employment (88.9%) than did antidepressant medication among treatment responders (70.8%), χ(2) 1 = 5.78, P = 0.02, odds ratio (OR) = 5.66, 95% CI 1.16-27.69. In the shorter-term, the main effect of treatment on employment status was not significant following acute treatment (χ(2) 1 = 1.74, P = 0.19, OR = 1.77, 95% CI 0.75-4.17); however, we observed a site×treatment interaction (χ(2) 1 = 6.87, P = 0.009) whereby cognitive therapy led to a higher rate of full-time employment at one site but not at the other. CONCLUSIONS: Cognitive therapy may produce greater improvements in employment v. medication, particularly over the longer term.

14 Article Rhodiola rosea therapy for major depressive disorder: a study protocol for a randomized, double-blind, placebo- controlled trial. 2014

Mao, Jun J / Li, Qing S / Soeller, Irene / Xie, Sharon X / Amsterdam, Jay D. ·Department of Family Medicine and Community Health, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA ; Center for Clinical Epidemiology and Biostatistics and Department of Biostatistics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA ; Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA. · Department of Family Medicine and Community Health, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA. · Center for Clinical Epidemiology and Biostatistics and Department of Biostatistics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA. · Depression Research Unit, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA. ·J Clin Trials · Pubmed #25610752.

ABSTRACT: BACKGROUND: Rhodiola rosea ( METHODS / DESIGN: Subjects with MDD not receiving antidepressant therapy will be randomized to either DISCUSSION: This study will provide valuable preliminary information on the safety and efficacy data of

15 Article The effect of postinjury depression on quality of life following minor injury. 2014

Richmond, Therese S / Guo, Wensheng / Ackerson, Theimann / Hollander, Judd / Gracias, Vicente / Robinson, Keith / Amsterdam, Jay. ·Xi, Andrea B. Laporte Professor of Nursing, University of Pennsylvania School of Nursing, Philadelphia, PA, USA. ·J Nurs Scholarsh · Pubmed #24354500.

ABSTRACT: PURPOSE: To describe quality of life (QoL) in the year following minor injury and to test the hypothesis that individuals with depression in the postinjury year experience lower QoL than do individuals with no depression. DESIGN: Prospective, longitudinal, cohort design. A total of 275 adults were randomly selected from injured patients presenting to an urban emergency department. METHODS: All participants underwent structured psychiatric diagnostic interviews immediately after injury and at 3, 6, and 12 months. The primary outcome, QoL, was measured using the Quality of Life Index. Covariates included demographics, injury status, preinjury functional status, preinjury social support, and anticipation of problems postdischarge. The General Estimating Equation was used to compare changes in QoL between participants with and without depression over 3, 6, and 12 months, adjusting for covariates. RESULTS: An 18.1% proportion (95% confidence interval [CI] 13.3, 22.9%) of the sample met criteria for a mood disorder in the postinjury year. The depressed group reported a QoL that was 4.2 points (95% CI 2.8-5.6) lower in the year postinjury compared with that of the nondepressed group. CONCLUSIONS: Depression after minor injury negatively affects QoL even a full year postinjury. CLINICAL RELEVANCE: The findings of this study show that patients who have injuries that are treated and discharged from an emergency department can have significantly lower QoL in the year after that injury that is attributed, in part, to postinjury depression. Nurses should provide anticipatory guidance to patients that they may experience feelings of sadness or being "blue," and that if they do, they should seek care.

16 Article Convergence and divergence in the delivery of cognitive therapy in two randomized clinical trials. 2013

Webb, Christian A / Derubeis, Robert J / Hollon, Steven D / Dimidjian, Sona / Amsterdam, Jay D / Shelton, Richard C. ·University of Pennsylvania, Department of Psychology, 3720 Walnut Street, Solomon Lab Bldg, Philadelphia, PA 19104, USA. cwebb@mclean.harvard.edu ·Behav Res Ther · Pubmed #23792178.

ABSTRACT: OBJECTIVE: Research indicates that cognitive therapy (CT) can be differentiated from other treatment modalities based on in-session therapist behavior. However, to our knowledge, consistency in the implementation of individual CT across clinical trials has not been tested. We compared therapist adherence to CT, as well as the therapeutic alliance, in two randomized clinical trials (RCTs) of depression treatment. METHOD: Data were drawn from two highly cited RCTs of CT for major depression, representing a total of three sites. Trained raters coded sessions for therapist adherence to CT and the therapeutic alliance. RESULTS: Significant differences were obtained between sites in overall level of adherence to CT, therapist emphasis on cognitive vs behavioral strategies, and therapist focus on homework. In contrast, no significant differences emerged in the collaborative structure of CT and in the therapeutic alliance. CONCLUSIONS: Despite efforts to maximize the consistency of CT implementation (e.g., via the use of the same treatment manuals, delivered by carefully-selected and experienced therapists), differences in the implementation of CT can result. Although preliminary, these findings raise questions regarding the uniformity of CT delivery across published clinical trials, and underline the importance of assessing treatment integrity, both across clinical trials and in dissemination research.

17 Article Change over time in brain serotonin transporter binding in major depression: effects of therapy measured with [(123) I]-ADAM SPECT. 2013

Amsterdam, Jay D / Newberg, Andrew B / Newman, Cory F / Shults, Justine / Wintering, Nancy / Soeller, Irene. ·Depression Research Unit, Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, PA. ·J Neuroimaging · Pubmed #23751132.

ABSTRACT: Several studies have reported low brain serotonin transporter (SERT) binding in individuals with major depression. We hypothesized that the SERT standardized uptake ratio (SUR) values using [(123) I]-ADAM single photon emission computed tomography would increase in depressed subjects who responded to cognitive behavior therapy (CBT) compared to CBT nonresponders. [(123) I]-ADAM scans were acquired before and after 12 weeks of CBT from 20 depressed subjects and on two occasions 12 weeks apart from 10 nondepressed, healthy volunteers. The primary outcome measure was change over time in SUR values in the midbrain, medial temporal lobe, and basal ganglia regions. Depressed subjects demonstrated low pretreatment mean SUR values that significantly increased over time in the midbrain (P = .011), right medial temporal lobe (P = .008), and left medial temporal lobe (P = .000) regions. Treatment responders showed a significant increase over time in SUR values in left medial temporal lobe (P = .029) and right medial temporal lobe (P = .007) regions. Partial and nonresponder subjects also showed a significant increase over time in SUR values in the left medial temporal region (P = .040) (vs. healthy volunteers), but to a lesser degree. The findings suggest that low pretreatment SERT binding may increase over time in some depressed individuals who experience symptom improvement.

18 Article Differential change in specific depressive symptoms during antidepressant medication or cognitive therapy. 2013

Fournier, Jay C / DeRubeis, Robert J / Hollon, Steven D / Gallop, Robert / Shelton, Richard C / Amsterdam, Jay D. ·Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O'Hara Street, Pittsburgh, PA 15213, USA. fournierjc@upmc.edu ·Behav Res Ther · Pubmed #23644038.

ABSTRACT: Cognitive therapy and antidepressant medications are effective treatments for depression, but little is known about their relative efficacy in reducing individual depressive symptoms. Using data from a recent clinical trial comparing cognitive therapy, antidepressant medication, and placebo in the treatment of moderate-to-severe depression, we examined whether there was a relative advantage of any treatment in reducing the severity of specific depressive symptom clusters. The sample consisted of 231 depressed outpatients randomly assigned to: cognitive therapy for 16 weeks (n = 58); paroxetine treatment for 16 weeks (n = 116); or pill placebo for 8 weeks (n = 57). Differential change in five subsets of depressive symptoms was examined: mood, cognitive/suicide, anxiety, typical-vegetative, and atypical-vegetative symptoms. Medication led to a greater reduction in cognitive/suicide symptoms relative to placebo by 4 weeks, and both active treatments reduced these symptoms more than did placebo by 8 weeks. Cognitive therapy reduced the atypical-vegetative symptoms more than placebo by 8 weeks and more than medications throughout the trial. These findings suggest that medications and cognitive therapy led to different patterns of response to specific symptoms of depression and that the general efficacy of these two well-validated treatments may be driven in large part by changes in cognitive or atypical-vegetative symptoms.

19 Article Low brain serotonin transporter binding in major depressive disorder. 2012

Newberg, Andrew B / Amsterdam, Jay D / Wintering, Nancy / Shults, Justine. ·Myrna Brind Center of Integrative Medicine, Thomas Jefferson University, Philadelphia, PA 19107, USA. andrew.newberg@jefferson.edu ·Psychiatry Res · Pubmed #22698760.

ABSTRACT: We examined midbrain, medial temporal lobe, and basal ganglia serotonin transporter (SERT) distribution volume ratio (DVR) values in subjects with major depressive disorder versus healthy volunteers using a selective SERT radioligand and single photon emission computed tomography (SPECT). We hypothesized that the DVR value for SERT binding would be lower in depressed versus non-depressed subjects. [(123)I]-ADAM SPECT scans were acquired from 20 drug free, depressed subjects and 20 drug-free depressed subjects and 10 drug-free healthy volunteers. The primary outcome measure was the DVR value for [(123)I]-ADAM uptake in the midbrain, medial temporal lobe, and basal ganglia regions. Depressed subjects demonstrated significantly lower DVR values in the midbrain, right and left medial temporal lobe, and right and left basal ganglia. There was significant probability that lower DVR values could distinguish between depressed and non-depressed subjects in the midbrain, medial temporal lobe, and the right and left basal ganglia. These findings confirm prior observations of lower SERT binding in depression, and suggest that low SERT binding may represent a putative biomarker of depression. Future studies are needed to confirm these observations.

20 Article Greater striatal dopamine transporter density may be associated with major depressive episode. 2012

Amsterdam, Jay D / Newberg, Andrew B / Soeller, Irene / Shults, Justine. ·Depression Research Unit, Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, PA, USA. ·J Affect Disord · Pubmed #22482744.

ABSTRACT: BACKGROUND: We examined striatal dopamine transporter (DAT) distribution volume ratio (DVR) values in subjects with unipolar or bipolar major depressive episode (versus non-depressed healthy volunteers) using the selective DAT radioligand [(99m)Tc]TRODAT-1 and single photon emission computed tomography (SPECT). We hypothesized that striatal DVR values would be greater in depressed versus non-depressed subjects, and that greater DVR values may represent a possible clinical biomarker of depression. METHODS: [(99m)Tc]TRODAT-1 spect images were acquired from 39 depressed and 103 non-depressed drug-free subjects. The primary outcome measure was the DVR value of [(99m)Tc]TRODAT-1 binding for the putamen region and the combined putamen plus caudate region. RESULTS: DVR values were significantly correlated across all striatal regions within both subject groups (p<0.005). Depressed subjects had significantly greater DVR values (versus non-depressed subjects) in the putamen (p<0.0005) and the combined putamen plus caudate (p<0.0005) regions. There was no difference in DVR values between unipolar (n=24) and bipolar (n=15) depressed subjects, and no difference in DVR values for depressed subjects with or without prior antidepressant exposure. The predictive probability of the putamen or combined putamen plus caudate DVR value to distinguish depressed from non-depressed subjects was significant (p<0.0005). LIMITATIONS: DAT values could potentially be influenced by age, gender, diagnosis, prior psychotropic dug exposure, illness length, or symptom severity. CONCLUSION: Results confirm prior observations of greater striatal DAT density in depressed versus non-depressed subjects, and suggest that greater DVR values may possibly represent a potential diagnostic biomarker for distinguish depressed from non-depressed individuals.

21 Article Predictors of patient cognitive therapy skills and symptom change in two randomized clinical trials: the role of therapist adherence and the therapeutic alliance. 2012

Webb, Christian A / Derubeis, Robert J / Dimidjian, Sona / Hollon, Steven D / Amsterdam, Jay D / Shelton, Richard C. ·Department of Psychology, University of Pennsylvania, Philadelphia, PA 19104-1696, USA. webb@sas.upenn.edu ·J Consult Clin Psychol · Pubmed #22468907.

ABSTRACT: OBJECTIVE: Previous research has found that therapist adherence to concrete, problem-focused cognitive therapy (CT) techniques predicts depressive symptom change (e.g., Feeley, DeRubeis, & Gelfand, 1999). More recently, Strunk, DeRubeis, Chui, and Alvarez (2007) demonstrated that in-session evidence of patients' use of CT skills was related to a lower rate of relapse in the year following CT for depression. The current investigation attempts to integrate and extend these findings within 2 separate samples of patients and therapists. METHOD: Drawing from the CT samples (N = 105, mean age = 40 years, female = 62%, White = 82%) of 2 published randomized clinical trials of depression treatment, we conducted analyses to examine whether therapist adherence to concrete CT techniques (Collaborative Study Psychotherapy Rating Scale) and the quality of the therapeutic alliance (Working Alliance Inventory) predict patients' use of CT skills (Performance of Cognitive Therapy Strategies) and subsequent Beck Depression Inventory symptom change. RESULTS: Results indicated a differential pattern of prediction in the 2 samples. In one, CT techniques exhibited a stronger association with patient CT skills and symptom change than did the alliance, whereas the reverse pattern emerged in the second sample. A baseline symptom severity × CT techniques interaction indicated that between-study differences in intake depression severity might in part explain the process-outcome differences. CONCLUSIONS: The present findings suggest that the nature of the therapy sample examined may moderate process-outcome findings in psychotherapy research. The implications of these results and directions for future research are discussed.

22 Article The analysis of binary longitudinal data with time-dependent covariates. 2012

Guerra, Matthew W / Shults, Justine / Amsterdam, Jay / Ten-Have, Thomas. ·Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA. ·Stat Med · Pubmed #22246815.

ABSTRACT: We consider longitudinal studies with binary outcomes that are measured repeatedly on subjects over time. The goal of our analysis was to fit a logistic model that relates the expected value of the outcomes with explanatory variables that are measured on each subject. However, additional care must be taken to adjust for the association between the repeated measurements on each subject. We propose a new maximum likelihood method for covariates that may be fixed or time varying. We also implement and make comparisons with two other approaches: generalized estimating equations, which may be more robust to misspecification of the true correlation structure, and alternating logistic regression, which models association via odds ratios that are subject to less restrictive constraints than are correlations. The proposed estimation procedure will yield consistent and asymptotically normal estimates of the regression and correlation parameters if the correlation on consecutive measurements on a subject is correctly specified. Simulations demonstrate that our approach can yield improved efficiency in estimation of the regression parameter; for equally spaced and complete data, the gains in efficiency were greatest for the parameter associated with a time-by-group interaction term and for stronger values of the correlation. For unequally spaced data and with dropout according to a missing-at-random mechanism, MARK1ML with correctly specified consecutive correlations yielded substantial improvements in terms of both bias and efficiency. We present an analysis to demonstrate application of the methods we consider. We also offer an R function for easy implementation of our approach.

23 Article Two aspects of the therapeutic alliance: differential relations with depressive symptom change. 2011

Webb, Christian A / DeRubeis, Robert J / Amsterdam, Jay D / Shelton, Richard C / Hollon, Steven D / Dimidjian, Sona. ·Department of Psychology, University of Pennsylvania, 3815 Walnut Street, Philadelphia, PA 19104-1696, USA. webb@sas.upenn.edu ·J Consult Clin Psychol · Pubmed #21480694.

ABSTRACT: OBJECTIVE: The therapeutic alliance has been linked to symptom change in numerous investigations. Although the alliance is commonly conceptualized as a multidimensional construct, few studies have examined its components separately. The current study explored which components of the alliance are most highly associated with depressive symptom change in cognitive therapy (CT). METHOD: Data were drawn from 2 published randomized, controlled clinical trials of CT for major depressive disorder (n = 105, mean age = 40 years, female = 62%, White = 82%). We examined the relations of 2 factor-analytically derived components of the Working Alliance Inventory (WAI; Horvath & Greenberg, 1986, 1989) with symptom change on the Beck Depression Inventory-II (BDI-II; Beck, Steer, & Brown, 1996) that occurred either prior to or subsequent to the examined sessions. WAI ratings were obtained at an early and a late session for each therapist-patient dyad. RESULTS: Variation in symptom change subsequent to the early session was significantly related to the WAI factor that assesses therapist-patient agreement on the goals and tasks of therapy but not to a factor assessing the affective bond between therapist and patient. In contrast, both factors, when assessed in a late session, were significantly predicted by prior symptom change. CONCLUSIONS: These findings may reflect the importance, in CT, of therapist-patient agreement on the goals and tasks of therapy. In contrast, the bond between therapist and patient may be more of a consequence than a cause of symptom change in CT. The implications of these results and directions for future research are discussed.

24 Retraction Effect of cognitive therapy with antidepressant medications vs antidepressants alone on the rate of recovery in major depressive disorder: a randomized clinical trial. 2014

Hollon, Steven D / DeRubeis, Robert J / Fawcett, Jan / Amsterdam, Jay D / Shelton, Richard C / Zajecka, John / Young, Paula R / Gallop, Robert. ·Department of Psychology, Vanderbilt University, Nashville, Tennessee. · Department of Psychology, University of Pennsylvania, Philadelphia. · Department of Psychiatry, University of New Mexico, Albuquerque. · Department of Psychiatry, University of Pennsylvania, Philadelphia. · Department of Psychiatry, Vanderbilt University, Nashville, Tennessee6currently at the Department of Psychiatry, University of Alabama, Birmingham. · Department of Psychiatry, Rush University, Chicago, Illinois. · Department of Mathematics and Applied Statistics, West Chester University, West Chester, Pennsylvania. ·JAMA Psychiatry · Pubmed #25142196.

ABSTRACT: IMPORTANCE: Antidepressant medication (ADM) is efficacious in the treatment of depression, but not all patients achieve remission and fewer still achieve recovery with ADM alone. OBJECTIVE: To determine the effects of combining cognitive therapy (CT) with ADM vs ADM alone on remission and recovery in major depressive disorder (MDD). DESIGN, SETTING, AND PARTICIPANTS: A total of 452 adult outpatients with chronic or recurrent MDD participated in a trial conducted in research clinics at 3 university medical centers in the United States. The patients were randomly assigned to ADM treatment alone or CT combined with ADM treatment. Treatment was continued for up to 42 months until recovery was achieved. INTERVENTIONS: Antidepressant medication with or without CT. MAIN OUTCOMES AND MEASURES: Blind evaluations of recovery with a modified version of the 17-item Hamilton Rating Scale for Depression and the Longitudinal Interval Follow-up Evaluation. RESULTS: Combined treatment enhanced the rate of recovery vs treatment with ADM alone (72.6% vs 62.5%; t451 = 2.45; P = .01; hazard ratio [HR], 1.33; 95% CI, 1.06-1.68; number needed to treat [NNT], 10; 95% CI, 5-72). This effect was conditioned on interactions with severity (t451 = 1.97; P = .05; NNT, 5) and chronicity (χ2 = 7.46; P = .02; NNT, 6) such that the advantage for combined treatment was limited to patients with severe, nonchronic MDD (81.3% vs 51.7%; n = 146; t145 = 3.96; P = .001; HR, 2.34; 95% CI, 1.54-3.57; NNT, 3; 95% CI, 2-5). Fewer patients dropped out of combined treatment vs ADM treatment alone (18.9% vs 26.8%; t451 = -2.04; P = .04; HR, 0.66; 95% CI, 0.45-0.98). Remission rates did not differ significantly either as a main effect of treatment or as an interaction with severity or chronicity. Patients with comorbid Axis II disorders took longer to recover than did patients without comorbid Axis II disorders regardless of the condition (P = .01). Patients who received combined treatment reported fewer serious adverse events than did patients who received ADMs alone (49 vs 71; P = .02), largely because they experienced less time in an MDD episode. CONCLUSIONS AND RELEVANCE: Cognitive therapy combined with ADM treatment enhances the rates of recovery from MDD relative to ADMs alone, with the effect limited to patients with severe, nonchronic depression. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00057577.