Frontiers in Psychiatry (Sep 2023)

Potential efficacy of dopaminergic antidepressants in treatment resistant anergic-anhedonic depression results of the chronic anergic-anhedonic depression open trial – CADOT

  • Ludovic Christophe Dormegny-Jeanjean,
  • Ludovic Christophe Dormegny-Jeanjean,
  • Ludovic Christophe Dormegny-Jeanjean,
  • Clément de Billy,
  • Clément de Billy,
  • Clément de Billy,
  • Olivier Mainberger,
  • Olivier Mainberger,
  • Olivier Mainberger,
  • Sébastien Weibel,
  • Sébastien Weibel,
  • Sébastien Weibel,
  • Benoit Schorr,
  • Benoit Schorr,
  • Benoit Schorr,
  • Alexandre Obrecht,
  • Alexandre Obrecht,
  • Lionel Landré,
  • Fabrice Berna,
  • Fabrice Berna,
  • Jean-Baptiste Causin,
  • Jean-Baptiste Causin,
  • Jean-Baptiste Causin,
  • Frederic Blanc,
  • Frederic Blanc,
  • Vlad Danila,
  • Vlad Danila,
  • Mihaela Tomsa,
  • Mihaela Tomsa,
  • Geraldine Pfleger,
  • Geraldine Pfleger,
  • Camille Meyer,
  • Camille Meyer,
  • Camille Meyer,
  • Ilia Humbert,
  • Ilia Humbert,
  • Ilia Humbert,
  • Hervé Javelot,
  • Hervé Javelot,
  • Guillaume Meyer,
  • Guillaume Meyer,
  • Gilles Bertschy,
  • Gilles Bertschy,
  • Gilles Bertschy,
  • Jack Rene Foucher,
  • Jack Rene Foucher,
  • Jack Rene Foucher,
  • Jack Rene Foucher

DOI
https://doi.org/10.3389/fpsyt.2023.1194090
Journal volume & issue
Vol. 14

Abstract

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IntroductionAmong treatment-resistant depression (TRD), we identified anergic-anhedonic clinical presentations (TRAD) as putatively responsive to pro-dopaminergic strategies. Based on the literature, non-selective monoamine oxidase inhibitors (MAOI) and dopamine D2 receptor agonists (D2RAG) were sequentially introduced, frequently under the coverage of a mood stabilizer. This two-step therapeutic strategy will be referred to as the Dopaminergic Antidepressant Therapy Algorithm (DATA). We describe the short and long-term outcomes of TRAD managed according to DATA guidelines.MethodOut of 52 outpatients with TRAD treated with DATA in a single expert center, 48 were included in the analysis [severity – QIDS (Quick Inventory of Depressive Symptomatology) = 16 ± 3; episode duration = 4.1 ± 2.7 years; Thase and Rush resistance stage = 2.9 ± 0.6; functioning – GAF (Global Assessment of Functioning) = 41 ± 8]. These were followed-up for a median (1st – 3rd quartile) of 4 (1–9) months before being prescribed the first dopaminergic treatment and remitters were followed up 21 (11–33) months after remission.ResultsAt the end of DATA step 1, 25 patients were in remission (QIDS <6; 52% [38–66%]). After DATA step 2, 37 patients were in remission (77% [65–89%]) to whom 5 patients with a QIDS score = 6 could be added (88% [78–97%]). Many of these patients felt subjectively remitted (GAF = 74 ± 10). There was a significant benefit to combining MAOI with D2RAG which was maintained for at least 18 months in 30 patients (79% [62–95%]).ConclusionThese results support TRAD sensitivity to pro-dopaminergic interventions. However, some clinical heterogeneities remain in our sample and suggest some improvement in the description of dopamine-sensitive form(s).

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