Psychische Erkrankungen in der Lebensspanne ... - DGPPN

Topic 15 G Pharmakotherapie // Pharmacotherapy
outcome can be predicted at an early stage by determining the degree
of HPA axis normalization in a second dex / CRH test. In a recent
genome-wide association study, we identified a set of genetic
polymorphisms associated with antidepressant treatment outcome.
Patients with favorable genetic background showed a high rate of remission
independently from HPA axis normaliza tion, while patients
with an unfavorable genetic background showed the worst
treatment outcome in case of a persistent dysregulation of the HPA
axis.
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Algorithm-based decisions in antidepressant treatment – which
patients need stepped care treatment approaches?
Mazda Adli (Charité Campus Mitte, Psychiatrie und Psychotherapie,
Berlin)
Medication algorithms have been proposed as effective means to
offer optimal treatment and improved outcome for patients with
severe mental illness. The randomized controlled phases GAP 2
and GAP 3 demonstrated that an SSTR leads to shorter times to
remission as well as improved treatment performance. GAP3 was a
multicenter randomized clinical trial comparing two different
treatment algorithms (I: SSTR, II: computerized documentation
and expert system, CDES) with treatment as usual (TAU) within
the German Research Network on Depression. 429 participants of
GAP3 were studied with regard to overall outcomes at hospital discharge
after acute treatment of the index episode. Remission was
defined as a Hamilton-Depression Rating Score (HAMD-21)≤9.
Independent from duration of study participation SSTR more likely
resulted in remission at discharge than CDES or TAU (OR = 2,641;
p = .003). Clinical subtyping and interaction analysis showed that
patients with anxious and melancholic subtypes but not psychotic
subtype of depression required significantly longer treatments to
achieve remission but benefited from SSTR irrespective from clinical
phenotype or other sociodemographic variables. Patients with
recurrent depression showed a significantly higher probability of
complying with SSTR than first or single episode patients. With regard
to biomarker-based subtyping GSK3beta genotyping revealed
that carriers of the c-allele (C/C, C/T) who had not sufficiently responded
to antidepressant monotherapy in step 1 showed a significantly
higher probability of achieving remission after subsequent
lithium augmentation than homozygous carriers of the T-allele
(T/T) (HR: 2.70, p=.007). In conclusion, inpatients suffering from
major depression benefit from algorithm-guided treatment following
an SSTR independently from age, gender or number of previous
depressive episodes. Clinical subtype influences the time
need ed to achieve remission or compliance with treatment, but not
responsiveness to the application of SSTR. A genotype-based personalized
approach might be useful to determine the sequence of
treatment steps after an initial antidepressant monotherapy has
failed.
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Rationale and design of the „Randomised clinical trial comparing
early medication change (EMC) strategy with treatment as usual
(TAU) in patients with Major Depressive Disorder – the EMC trial“
Andre Tadic (Universitätsmedizin Mainz, Psychiatrie und Psychotherapie)
S. Gorbulev, N. Dahmen, C. Hiemke, D. F. Braus, J. Röschke, D. van
Calker, D. Wachtlin, K. Lieb
Introduction: In Major Depressive Disorder (MDD), treatment
outcomes with currently available antidepressants and treatment
strategies are insufficient. Reflecting the traditional belief of a delayed
onset of antidepressants‘ effects, current guidelines usually
recommend treatment duration of 3 – 8 weeks until optimisation in
case of insufficient outcome. Challenging this concept, many retro-
spective studies showed that improvement occurs usually within
the first 10 – 14 days of treatment (=early improvement) and that
such improvement (17-item Hamilton Rating Depression Scale
[HAMD-17] decrease ≥20 %) in the early course of treatment has a
substantial predictive value for the final outcome. Most importantly,
non-improvement (HAMD-17 decrease