Elsevier

Journal of Affective Disorders

Volume 200, August 2016, Pages 156-158
Journal of Affective Disorders

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Atypical depressive symptoms as a predictor of treatment response to exercise in Major Depressive Disorder

https://doi.org/10.1016/j.jad.2016.01.052Get rights and content

Highlights

  • We examine atypical depressive symptoms as a predictor of treatment response to exercise in MDD.

  • The presence of atypical depressive symptoms is related to greater treatment response.

  • This effect appears driven by a blunted treatment response to high dose exercise for those without atypical symptoms.

Abstract

Effective treatment of Major Depressive Disorder (MDD) will require the development of alternative treatments and the ability for clinicians to match patients with the treatment likely to produce the greatest effect. We examined atypical depression subtype as a predictor of treatment response to aerobic exercise augmentation in persons with non-remitted MDD. Our results revealed a small-to-moderate effect, particularly in a group assigned to high-dose exercise (semi-partial eta-squared =0.0335, p=0.0735), indicating that those with atypical depression tended to have larger treatment response to exercise. Through this hypothesis-generating analysis, we indicate the need for research to examine depression subtype, along with other demographic, clinical and biological factors as predictors of treatment response to exercise.

Introduction

Approximately 30% of patients with MDD achieve remission following initial treatment with an antidepressant medication and a third of patients have significant depressive symptoms even after multiple treatment attempts (Rush et al., 2006, Thase et al., 2005). These data highlight the need for alternative treatments for MDD and have led to the study of exercise as a potential treatment alternative. Meta-analyses of exercise as a treatment for MDD indicate a significant treatment effect on par with that of antidepressant medication and psychotherapy (Cooney et al., 2014, Ekkekakis, 2015, Josefsson et al., 2014, Rethorst et al., 2009, Silveira et al., 2013).

The effective implementation of alternative treatments also requires identification of subgroups of patients with MDD that will benefit from these alternative treatments. One such subgroup is patients with atypical depression. Atypical depression is characterized by mood reactivity along with symptoms increased appetite and/or weight gain, hypersomnia, leaden paralysis, and interpersonal sensitivity. Results from the STAR*D trial indicate poorer treatment response to SSRIs in those with atypical depression (Stewart et al., 2010).

The purpose of this analysis is to examine the atypical depression as a predictor of treatment response to exercise. Previous analyses indicate that hypersomnia and elevations in BMI are associated with better treatment outcomes to exercise (Rethorst et al., 2013, Toups et al., 2011). Furthermore, it has been hypothesized that treatment response to exercise may vary based on depressive subtypes (Schuch and de Almeida Fleck, 2013). Based on those findings, we hypothesize that those with atypical depression will have a greater treatment response to exercise.

Section snippets

Methods

TREAD was a randomized controlled trial designed to compare the efficacy of two doses of exercise augmentation in reducing depressive symptoms in patients with non-remitted MDD. Complete details regarding the TREAD study design have been published elsewhere (Trivedi et al., 2011); specific details pertinent to the current analysis are presented below.

Results

Of the 122 evaluable subjects, 35 were classified as having atypical depression. Those with atypical depression did not differ from those without atypical depression by age, gender, family history of mental illness, BMI, years of education, race/ethnicity, or marital status (p>0.05). The atypical group did demonstrate greater baseline scores on the IDS-C (p<0.001), which is expected since atypical depression was classified by affirmative responses to five IDS-C items. The median adherence rate

Discussion

The purpose of this paper was to examine atypical depression as a potential predictor of antidepressant response to exercise. Our results indicate a small-to-moderate effect of atypical depression, with a greater reduction in depressive symptoms among those with atypical depression. Examination of the atypical×exercise group effect indicates that this effect appears to be driven by a reduced treatment effect observed in the non-atypical depression group assigned to high dose exercise.

These

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    Although our atypical group does not exactly matches the DSM definition of atypical depression, we found similar symptoms (increased weight and appetite), characteristics (higher prevalence of female, lower mean age, lower age-of-onset) and co-occurring pathophysiology (higher prevalence of metabolic syndrome). Furthermore, previous data-driven studies have found similar classes, labeling them atypical, with similar characteristics (Novick et al., 2005; Lamers et al., 2010; Li et al., 2014; Rodgers et al., 2014a, 2014b; Alexandrino et al., 2013) and biological disturbances (Lamers et al., 2013; Lasserre et al., 2016; Rethorst et al., 2016), that largely correspond with the DSM-based atypical depression. This underlines the idea both approaches distinguish the same atypical subtype.

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