Person:

Hock, Rebecca

Background: Maternal depressive symptoms are negatively associated with early child growth in developing countries; however, few studies have examined this relation in developed countries or used a longitudinal design with data past the second year of the child’s life. We investigated if and when early maternal depressive symptoms affect average growth in young children up to age 6 in a nationally representative sample of US children. Methods: Using data from 6,550 singleton births from the Early Childhood Longitudinal Study -- Birth Cohort (ECLS-B), we fit growth trajectory models with random effects to examine the relation between maternal depressive symptoms at 9 months based on the twelve-item version of the Center for Epidemiologic Studies Depression Scale (CES-D) and child height and body mass index (BMI) to age 6 years. Results: Mothers with moderate/severe depressive symptoms at 9 months postpartum had children with shorter stature at this same point in time [average 0.26 cm shorter; 95% CI: 5 cm, 48 cm] than mothers without depressive symptoms; children whose mothers reported postpartum depressive symptoms remained significantly shorter throughout the child’s first 6 years. Conclusions: Results suggest that the first year postpartum is a critical window for addressing maternal depressive symptoms in order to optimize child growth. Future studies should investigate the role of caregiving and feeding practices as potential mechanisms linking maternal depressive symptoms and child growth trajectories.

Objective: Esketamine, the s-enantiomer of ketamine, was recently approved as a rapid-acting intranasal therapy for depression and is currently under development for suicidality. The authors sought to determine the efficacy of adjunctive intranasal esketamine in major depressive disorder (MDD). Data Sources: A systematic search of Pubmed/Medline was conducted up to January 2019, in addition to abstracts of major psychiatric meetings held since 2010. Where necessary, authors and/or study sponsors were contacted in order to obtain a copy of the presentation as well as any pertinent study details. Study Selection: 241 study abstracts were initially identified and reviewed. Selected studies were randomized, double-blind clinical trials comparing adjunctive intranasal esketamine to adjunctive placebo for MDD. Data Extration: Data were extracted independently by two of the authors. A random effects model was used to calculate the standardized mean difference (SMD) between esketamine and placebo (intranasal saline) in the MADRS score change from baseline to endpoint, serving as the primary outcome of the study. Results: Five trials with 774 patients were pooled. Adjunctive esketamine was significantly more effective than placebo for MADRS score change, response, and remission (N=774, SMD = 0.36, 95% CI = 0.24 - 0.49, p < .0001; response: RR = 1.40, 95% CI: 1.22 - 1.61, p < .0001; remission: RR = 1.45, 95% CI: 1.20 - 1.75, p < .0001). Results remained statistically significant regardless of differences in the study sample, fixed vs. new/optimized baseline antidepressants, or duration of the study. Conclusions: Adjunctive intranasal esketamine for patients with MDD who are either treatment-resistant or acutely suicidal appears to be an effective treatment strategy.

Objective: A meta-analysis of studies of vortioxetine in adults with major depressive disorder (MDD). Data Sources: Abstracts were identified using PubMed by cross-referencing “vortioxetine” with “placebo” and “randomized.” No language or publication year restrictions were used. Study Selection: Randomized, double-blind, placebo-controlled clinical trials comparing oral vortioxetine monotherapy with placebo for acute treatment of MDD. Data Extraction: Data were extracted with a pre-coded form, as follows: number of patients randomized, treatment group, Montgomery-Asberg Depression Rating Scale (MADRS) response and remission rates, mean change in scores from baseline and standard errors for the MADRS, Hamilton Anxiety Rating Scale (HAM-A), and Digit Symbol Substitution Test (DSST). Results: 7,269 subjects randomized to vortioxetine (n=3,630) or placebo (n=3,639) from 17 studies were included. The probability of receiving placebo did not predict difference in change in MADRS scores between vortioxetine and placebo (estimate 4.1, p=0.54). The standardized mean difference (SMD) (95% CI) for change in MADRS versus placebo was 0.33 (0.24 - 0.41), and was 0.25 (0.08 - 0.39), 0.33 (0.19 - 0.47), 0.26 (-0.06 to 0.58), and 0.44 (0.27 - 0.62) for 5mg, 10 mg, 15 mg, and 20 mg doses respectively. Greater difference in efficacy between drug and placebo was observed in studies with a low than a high placebo response rate. Conclusion: Vortioxetine is more effective than placebo in improving depression, anxiety and cognition. Less informative or uninformative studies obscured the true treatment effect.