Medical Pulse Reading
This analysis of data from randomized controlled studies shows that for the patients with the Big Five personality “neurotic” T-score lower than 62.5 , the clinical cure rate after 4 weeks of mirtazapine treatment was significantly higher than that of SSRI (73.7% vs. 40.0%, p = .048).
However, for “neurotic” T scores For patients above 62.5, the clinical cure rate after 8 weeks of SSRI treatment was significantly higher than that of mirtazapine (74.1 % vs. 35.7 %, p = .017).
In addition, the 4-week clinical cure rate of patients with high “nervousness” score regardless of SSRI or mirtazapine are very low (<30%).
The authors suggest that SSRIs may be more appropriate than mirtazapine for those with a higher degree of neuroticism, although the onset may be slower.
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There are significant individual differences in the response of depressed patients to antidepressant treatment. In addition to biological factors, psychosocial factors including personality traits may also be related to the efficacy of antidepressants, and are expected to become reference factors for clinical drug selection.
However, few previous studies have investigated the relationship between patient personality traits and antidepressant efficacy. Studies have shown that:
▶ “Agreeableness” in the Big Five can better predict the efficacy of fluoxetine, which is more effective than baseline depression Severity.
▶ “Low harm avoidance”, “high self-direction”, “high reward dependence” as defined by the Temperament Personality Inventory (TCI) ” was significantly associated with ideal paroxetine efficacy.
▶ Escitalopram can rapidly reduce depressive symptoms in “high social desirability” individuals.
However, few studies on this topic have used a randomized controlled design and have never explored mirtazapine. In this context, Japanese researchers used data from the “GUNDAM study” to evaluate the potential impact of personality traits in depressed patients on the antidepressant efficacy of SSRI and mirtazapine, aiming to guide clinical medicine and reduce trial and error costs .
< /span>Study Introduction
The Gundam Study was an 8-week randomized controlled, open-label , a flexible-dose study that directly compared the efficacy and tolerability of SSRIs (paroxetine or sertraline) with mirtazapine in the treatment of outpatient depression. Patients were 20-75 years old, required a baseline Hamilton Depression Scale (HAMD17) total score ≥14, and were drug-free for at least 14 days prior to enrollment.
These patients were randomized 1:1 to mirtazapine or SSRI for 4 weeks; treatment response (defined as improvement in symptoms) ≥50%) of the patients continued to use the original drug, and those who failed to achieve an effective response were re-randomized and continued to use the original drug or combined SSRI and mirtazapine for 4 weeks.
This analysis assessed patients’ baseline Big Five personality traits and clinical cure at 4 and 8 weeks (defined as HAMD17 total score) ≤7); for example, whether a score on a personality trait can be used to guide the choice of SSRI or mirtazapine.
Results
The researchers collected baseline and 4-week data from 101 patients, including 55 in the SSRIs group and 46 in the mirtazapine group. Age 46.4 years, female 41.6%, baseline HAMD17 mean total score 20.8. The 8-week single-agent cure rate data were obtained from 67 patients, including 38 in the SSRIs group and 29 in the mirtazapine group.
First of all, the mean T-score (64.57) of these patients was more than one SD higher than that of the healthy population, while the mean T-score of “extroversion” was higher than that of the healthy population. The average T scores of “openness”, “agreeableness”, and “conscientiousness” were slightly lower than those of the healthy people, but the magnitudes were all lower than one SD.
Receiver operating characteristic curve (ROC) showed that the patient’s “nervousness” score significantly affected the patient’s clinical outcomes in the 4th and 8th weeks. Cure rate, the key cutoff for T score was 62.5 (AUC = 0.69, 95%CI = 0.57-0.80, Youden index 0.35, p = .001):
Figure 1 Clinical cure rates of mirtazapine (black) and SSRI (oblique stripes) after 4 and 8 weeks of treatment; * p<0.05; moderate, "nervous" T score lower than 62.5; high, "nervous" T score higher than 62.5
▶ For patients below this threshold (n=34), mirtazapine The clinical cure rate after 4 weeks of treatment was significantly higher than that of SSRI (73.7% vs. 40.0%, χ2 = 3.93, df = 1, p = .048)
▶ For patients above this threshold (n=41), the clinical cure rate after 8 weeks of SSRI treatment was significantly higher than that of mirtazapine (74.1 % vs. 35.7%, χ2 = 5.70, df = 1, p = .017)
It is worth noting that patients with high neuroticism scores did not use SSRI or M With zapine, the 4-week clinical cure rate was very low (<30%).
In addition, for patients in the mirtazapine group, a higher “neurotic” score (OR = 1.27, 95%CI = 1.10- 1.46, p = .001) and a lower “conscientiousness” score (OR = 0.92, 95%CI = 0.84-0.99, p = .033) were both significantly associated with failure to achieve clinical cure after 4 weeks of treatment. For patients in the SSRI group, no personality trait score was found to be significantly associated with clinical cure rates at 4 or 8 weeks.
< /span>Conclusion
In this study, patients with high neuroticism scores were treated with either SSRI or mirtazapine4 The clinical cure rate after 8 weeks was not ideal; after 8 weeks of treatment, the clinical cure rate of the SSRI group was significantly better than that of mirtazapine. According to the authors, this is consistent with the currently approved indications for these drugs – SSRIs have indications for generalized anxiety disorder and social anxiety disorder internationally, but mirtazapine does not. In fact, the majority (63.0%) of patients in this study had scores above the cutoff for “neuroticism”.
Although there are some limitations, including wider confidence intervals for some results due to smaller sample sizes, overall, SSRI may Zapine is more suitable for those with a higher degree of neuroticism, although the onset of action may be slower. Assessing the patient as a “whole” individual before antidepressant treatment, including measuring personality traits where conditions permit, is expected to provide patients with more individualized antidepressant treatment.
Documents Index: Naito M, Kato M, Koshikawa Y, Bandou H, Sakai S, Takekita Y, Nishida K, Kinoshita T. Personality as a basis for antidepressant selection for patients with depression: A two-point outcome study at 4 and 8 weeks. J Affect Disord. 2022 Jul 4;314:27-33. doi: 10.1016/j.jad.2022.07.001. Epub ahead of print. PMID: 35798178.
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