3 results on '"Little, John T."'
Search Results
2. Effect of Antidepressant Switching vs Augmentation on Remission Among Patients With Major Depressive Disorder Unresponsive to Antidepressant Treatment: The VAST-D Randomized Clinical Trial.
- Author
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Mohamed, Somaia, Johnson, Gary R, Chen, Peijun, Hicks, Paul B, Davis, Lori L, Yoon, Jean, Gleason, Theresa C, Vertrees, Julia E, Weingart, Kimberly, Tal, Ilanit, Scrymgeour, Alexandra, Lawrence, David D, Planeta, Beata, Thase, Michael E, Huang, Grant D, Zisook, Sidney, and the VAST-D Investigators, Rao, Sanjai D, Pilkinton, Patricia D, Wilcox, James A, Iranmanesh, Ali, Sapra, Mamta, Jurjus, George, Michalets, James P, Aslam, Muhammed, Beresford, Thomas, Anderson, Keith D, Fernando, Ronald, Ramaswamy, Sriram, Kasckow, John, Westermeyer, Joseph, Yoon, Gihyun, D'Souza, D Cyril, Larson, Gunnar, Anderson, William G, Klatt, Mary, Fareed, Ayman, Thompson, Shabnam I, Carrera, Carlos J, Williams, Solomon S, Juergens, Timothy M, Albers, Lawrence J, Nasdahl, Clifford S, Villarreal, Gerardo, Winston, Julia L, Nogues, Cristobal A, Connolly, K Ryan, Tapp, Andre, Jones, Kari A, Khatkhate, Gauri, Marri, Sheetal, Suppes, Trisha, LaMotte, Joseph, Hurley, Robin, Mayeda, Aimee R, Niculescu, Alexander B, Fischer, Bernard A, Loreck, David J, Rosenlicht, Nicholas, Lieske, Steven, Finkel, Mitchell S, and Little, John T
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and the VAST-D Investigators ,Humans ,Bupropion ,Antipsychotic Agents ,Antidepressive Agents ,Drug Therapy ,Combination ,Remission Induction ,Depressive Disorder ,Major ,Drug Synergism ,Drug Resistance ,Adult ,Middle Aged ,Veterans ,United States ,Female ,Male ,Drug Substitution ,Aripiprazole ,Depression ,Brain Disorders ,Clinical Trials and Supportive Activities ,Serious Mental Illness ,Mental Health ,Clinical Research ,Comparative Effectiveness Research ,Evaluation of treatments and therapeutic interventions ,6.1 Pharmaceuticals ,Mental health ,Medical and Health Sciences ,General & Internal Medicine - Abstract
ImportanceLess than one-third of patients with major depressive disorder (MDD) achieve remission with their first antidepressant.ObjectiveTo determine the relative effectiveness and safety of 3 common alternate treatments for MDD.Design, setting, and participantsFrom December 2012 to May 2015, 1522 patients at 35 US Veterans Health Administration medical centers who were diagnosed with nonpsychotic MDD, unresponsive to at least 1 antidepressant course meeting minimal standards for treatment dose and duration, participated in the study. Patients were randomly assigned (1:1:1) to 1 of 3 treatments and evaluated for up to 36 weeks.InterventionsSwitch to a different antidepressant, bupropion (switch group, n = 511); augment current treatment with bupropion (augment-bupropion group, n = 506); or augment with an atypical antipsychotic, aripiprazole (augment-aripiprazole group, n = 505) for 12 weeks (acute treatment phase) and up to 36 weeks for longer-term follow-up (continuation phase).Main outcomes and measuresThe primary outcome was remission during the acute treatment phase (16-item Quick Inventory of Depressive Symptomatology-Clinician Rated [QIDS-C16] score ≤5 at 2 consecutive visits). Secondary outcomes included response (≥50% reduction in QIDS-C16 score or improvement on the Clinical Global Impression Improvement scale), relapse, and adverse effects.ResultsAmong 1522 randomized patients (mean age, 54.4 years; men, 1296 [85.2%]), 1137 (74.7%) completed the acute treatment phase. Remission rates at 12 weeks were 22.3% (n = 114) for the switch group, 26.9% (n = 136)for the augment-bupropion group, and 28.9% (n = 146) for the augment-aripiprazole group. The augment-aripiprazole group exceeded the switch group in remission (relative risk [RR], 1.30 [95% CI, 1.05-1.60]; P = .02), but other remission comparisons were not significant. Response was greater for the augment-aripiprazole group (74.3%) than for either the switch group (62.4%; RR, 1.19 [95% CI, 1.09-1.29]) or the augment-bupropion group (65.6%; RR, 1.13 [95% CI, 1.04-1.23]). No significant treatment differences were observed for relapse. Anxiety was more frequent in the 2 bupropion groups (24.3% in the switch group [n = 124] vs 16.6% in the augment-aripiprazole group [n = 84]; and 22.5% in augment-bupropion group [n = 114]). Adverse effects more frequent in the augment-aripiprazole group included somnolence, akathisia, and weight gain.Conclusions and relevanceAmong a predominantly male population with major depressive disorder unresponsive to antidepressant treatment, augmentation with aripiprazole resulted in a statistically significant but only modestly increased likelihood of remission during 12 weeks of treatment compared with switching to bupropion monotherapy. Given the small effect size and adverse effects associated with aripiprazole, further analysis including cost-effectiveness is needed to understand the net utility of this approach.Trial registrationclinicaltrials.gov Identifier: NCT01421342.
- Published
- 2017
3. Association Between Antipsychotics and All-Cause Mortality Among Community-Dwelling Older Adults.
- Author
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Kheirbek, Raya Elfadel, Fokar, Ali, Little, John T, Balish, Marshall, Shara, Nawar M, Boustani, Malaz A, and Llorente, Maria
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NEUROLEPTIC malignant syndrome ,ANTIPSYCHOTIC agents ,OLDER people ,MORTALITY ,ADULTS ,DEMENTIA patients ,COMPARATIVE studies ,CAUSES of death ,VETERANS ,RESEARCH methodology ,MEDICAL cooperation ,MEDICAL prescriptions ,RESEARCH ,EVALUATION research ,INDEPENDENT living ,RETROSPECTIVE studies - Abstract
Background: Antipsychotics are prescribed to treat various symptoms in older adults, however, their safety in this context has not been fully evaluated. The objective was to evaluate mortality risks associated with off-label use of antipsychotics among older adults with no preexisting mental illness or dementia relative to those with diagnosis of dementia.Methods: Data (2007-2015) were derived from Department of Veterans Affairs registries for 730,226 patients (≥65 years) with no baseline serious mental illness, dementia). We estimated the cumulative incidence of antipsychotics prescription and 10-year all-cause mortality. The extended Cox models were used to estimate Hazard Ratios (HRs) associated with antipsychotics prescription, adjusted for time-varying covariates, dementia diagnosis, comorbidity index score, and age at time of first exposure to antipsychotics.Results: The study included 98% males, 13% African Americans, and 81% Caucasian. Patients with dementia and antipsychotics had the highest risk of mortality (78.0%), followed by (73.0%) for patients with dementia alone and compared with patients without dementia or antipsychotics exposure who had the lowest mortality risk (42.0%). Exposure to typical antipsychotics was associated with (HR: 2.1, confidence interval [CI] 2.0-2.2) compared with atypical antipsychotics (HR: 1.5, CI 1.4-1.5, p = <.0001).Conclusion: In a large cohort of older adults, antipsychotics were associated with an increased risk of all-cause mortality. While significant increase in mortality was attributable to the diagnosis of dementia, the addition of antipsychotics resulted in added mortality risk among all patients. Antipsychotic medications should be used cautiously in all older adults, not only those with dementia. [ABSTRACT FROM AUTHOR]- Published
- 2019
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