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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EResults from the National Institute of Mental Health\u0027s Study of the Pharmacotherapy of Psychotic Depression [STOP-PD] were presented at the American Psychiatric Association\u0027s 2008 Annual Meeting. To investigate the efficacy of a pharmacotherapeutic approach, STOP-PD looked at monotherapy with an antipsychotic versus an antipsychotic\/antidepressant combination.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003Epersonality disorders\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Emood disorders\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Epsychopharmacology clinical trials\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n         \n         \u003Cp id=\u0022p-2\u0022\u003EResults from the National Institute of Mental Health\u0027s Study of the Pharmacotherapy of Psychotic Depression (STOP-PD) were presented at the American Psychiatric Association\u0027s 2008 Annual Meeting by Barnett Meyers, MD, Weill Medical College of Cornell University, New York, NY, on behalf of the collaborative study group. \u201cThere\u0027s a need for alternative treatments to ECT [electroconvulsive therapy]. One of the factors that I don\u0027t think is discussed enough is that there is a significant change in Hamilton scores following the ECT procedure \u2013 scores are found to have drifted upwards at the next assessment.\u201d There are also practical considerations, as ECT is not readily available on an out-patient basis.\u003C\/p\u003E\n         \u003Cp id=\u0022p-3\u0022\u003ETo investigate the efficacy of a pharmacotherapeutic approach, STOP-PD looked at monotherapy with an antipsychotic versus an antipsychotic\/antidepressant combination. In this 12-week, multicenter, placebo-controlled, double-blind trial, 259 patients with unipolar delusional depression were randomized to treatment with olanzapine\/placebo or olanzapine\/sertraline. Dosing regimens were initiated and then escalated as follows: olanzapine 5 mg, 10 mg, then 15 mg\/day on Days 1, 4, and 7; with sertraline at 50 mg, 100 mg, and then 150 mg\/day on the same schedule. Doses of 200 mg\/day sertraline and 20 mg\/day olanzapine were allowed for residual symptoms. Study endpoints included 2 weeks of Hamilton Rating Scale for Depression (HAM-D) 17 \u2264 10 (\u201cremission\u201d) to demonstrate stability, and SADS delusional item measures of \u201cno delusion\u201d at the 2nd or both weeks of the depression remission period.\u003C\/p\u003E\n         \u003Cp id=\u0022p-4\u0022\u003EAll patients in this study were aged 19 years and older, and 142 patients who were randomized were aged \u226560 years. All patients had HAM-D 17 scores of \u226521 at study entry. Patients with suicidal ideation were excluded.\u003C\/p\u003E\n         \u003Cp id=\u0022p-5\u0022\u003EAfter enrollment, subject discontinuations in this trial were high: 53% in the monotherapy arm and 37% in the combination arm. \u201cThe most common reason for both groups is the subject withdrawing consent,\u201d reported Meyers, \u201cfollowed by clinical worsening.\u201d He added that insufficient response leading to discontinuation was higher in the monotherapy arm than for the combination: 10% versus 4.7%, respectively.\u003C\/p\u003E\n         \u003Cp id=\u0022p-6\u0022\u003EAfter 12 weeks, results showed a superior depression remission rate of 67% in the olanzapine\/sertraline arm versus 41.9% for monotherapy (p=0.036). When broken down by age, both older (\u226560) and younger patients had statistically superior results for the combination versus monotherapy (p\u0026lt;0.02), yet within the combination arm, results for the two age groups were not statistically different. \u201cThis did not support our hypothesis that younger patients would do better with the combination. In fact, numerically, older patients had a better response.\u201d SADS scores were reduced equivalently for both groups in both treatment arms.\u003C\/p\u003E\n         \u003Cp id=\u0022p-7\u0022\u003EThe adverse events that were reported for this study did not differ significantly between the age groups, with the exception of more pedal edema seen in older patients and younger patients experiencing more weight gain. As expected, olanzapine-related weight gain was the most common adverse event overall (54.1%) and was dose-related.\u003C\/p\u003E\n         \u003Cp id=\u0022p-8\u0022\u003EWhen asked about weight gain concerns for patients being treated long-term, Meyers suggested that other atypical antipsychotics might be appropriate for use in this setting, cautioning, however, that little is known about the efficacy of these other atypical medications for psychotic depression or their adverse effects.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2008 MD Conference Express\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/8\/3\/17.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzmdxq\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}