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Hiroko Sugawara,1 Takahiro Tsutsumi,2 Ken Inada,2 Jun Ishigooka,2 Mamoru Hashimoto,1 Minoru Takebayashi,1,3 Katsuji Nishimura2 1Department of Neuropsychiatry, Faculty of Life Science, Kumamoto University, Kumamoto, Japan; 2Department of Psychiatry, Tokyo Women’s Medical University Hospital, Tokyo, Japan; 3Division of Psychiatry and Neuroscience, Institute for Clinical Research, National Hospital Organization Kure Medical Center, Hiroshima, Japan Purpose: Mixed features in a major depressive episode (MDE) predict bipolar disorder (BD). The mixed features specifier included in the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) could be restrictive because it excludes the symptoms common to both mania/hypomania and depression, including psychomotor agitation. On the other hand, an anxious distress (ANXD) specifier has also been introduced in the DSM-5, and psychomotor agitation has been defined as a severity of ANXD. In this study, we retrospectively investigated the association between presence of ANXD in an MDE and bipolarity. Patients and methods: The subjects were patients admitted with an MDE to the Department of Psychiatry at Tokyo Women’s Medical University Hospital from December 2014 to March 2016. Eligible patients were older than 20 years of age and met the DSM-5 criteria for major depressive disorder or BD. All data were extracted from medical records. The subjects were grouped according to whether they did or did not have ANXD. The demographics and clinical features of these groups were compared. Severity of illness was evaluated according to the Hamilton Rating Scale for Depression (HRSD) score on admission. Results: ANXD was present in 31 and absent in 33 of 64 patients with MDE. The HRSD score was significantly higher in the group with ANXD than in the group without ANXD (P=0.0041). Mixed features (P=0.0050) and suicide attempts (P=0.0206) were significantly more common in the group with ANXD than in the g

Hiroko Sugawara,1 Takahiro Tsutsumi,2 Ken Inada,2 Jun Ishigooka,2 Mamoru Hashimoto,1 Minoru Takebayashi,1,3 Katsuji Nishimura2 1Department of Neuropsychiatry, Faculty of Life Science, Kumamoto University, Kumamoto, Japan; 2Department of Psychiatry, Tokyo Women’s Medical University Hospital, Tokyo, Japan; 3Division of Psychiatry and Neuroscience, Institute for Clinical Research, National Hospital Organization Kure Medical Center, Hiroshima, Japan Purpose: Mixed features in a major depressive episode (MDE) predict bipolar disorder (BD). The mixed features specifier included in the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) could be restrictive because it excludes the symptoms common to both mania/hypomania and depression, including psychomotor agitation. On the other hand, an anxious distress (ANXD) specifier has also been introduced in the DSM-5, and psychomotor agitation has been defined as a severity of ANXD. In this study, we retrospectively investigated the association between presence of ANXD in an MDE and bipolarity. Patients and methods: The subjects were patients admitted with an MDE to the Department of Psychiatry at Tokyo Women’s Medical University Hospital from December 2014 to March 2016. Eligible patients were older than 20 years of age and met the DSM-5 criteria for major depressive disorder or BD. All data were extracted from medical records. The subjects were grouped according to whether they did or did not have ANXD. The demographics and clinical features of these groups were compared. Severity of illness was evaluated according to the Hamilton Rating Scale for Depression (HRSD) score on admission. Results: ANXD was present in 31 and absent in 33 of 64 patients with MDE. The HRSD score was significantly higher in the group with ANXD than in the group without ANXD (P=0.0041). Mixed features (P=0.0050) and suicide attempts (P=0.0206) were significantly more common in the group with ANXD than in the g

Takahiro Tsutsumi,1 Hiroko Sugawara,1,2 Ryoko Ito,1 Mizuho Asano,1 Satoru Shimizu,3 Jun Ishigooka,1 Katsuji Nishimura1 1Department of Psychiatry, 2Support Center for Women Health Care Professionals and Research, 3Department of Research, Medical Research Institute, Tokyo Women’s Medical University, Tokyo, Japan Background: Mirtazapine, which is classified as a noradrenergic and specific serotonergic antidepressant, is widely prescribed for the treatment of major depressive disorder. The potential predictive factors of the efficacy of mirtazapine and the tolerability based on the incidence of oversedation and jitteriness/anxiety syndrome were evaluated. Patients and methods: Patients with major depressive disorder were retrospectively investigated. Study subjects comprised 68 patients with depression who received mirtazapine as an initial antidepressant at the Department of Psychiatry of the Tokyo Women’s Medical University Hospital from September 2009 to March 2013. The efficacy of mirtazapine monotherapy was evaluated based on the Clinical Global Impression Improvement score. Clinical characteristics were compared between remission and nonremission groups to determine the factors predicting the efficacy. Moreover, discontinuation rates due to adverse effects, including oversedation and jitteriness/anxiety syndrome, were examined, and the effects of confounding factors were evaluated. Results: The remission rate of mirtazapine monotherapy was 36.8% among the 68 enrolled subjects. The mean final doses in the remission and nonremission groups were 27.6±13.5 mg and 26.0±14.1 mg, respectively, and there was no significant difference between them. Multiple logistic analyses revealed that the absence of guilt (odds ratio [OR] =0.15; 95% CI [1.66–37.24], P=0.006) and the presence of psychomotor retardation (OR =4.30; 95% CI [1.30–16.60], P=0.016) were significantly related to the efficacy of mir

Hiroko Sugawara,1,2 Kaoru Sakamoto,1 Tsuyoto Harada,3 Satoru Shimizu,4 Jun Ishigooka1 1Department of Psychiatry, Tokyo Women’s Medical University, 2Support Center for Women Health Care Professionals and Researchers, Tokyo Women’s Medical University, Shinjuku-ku, 3Department of Psychiatry, Tokyo Women’s Medical University Medical Center East, Arakawa-ku, 4Department of Research, Medical Research Institute, Tokyo Women’s Medical University, Shinjuku-ku, Tokyo, Japan Background: Several studies have evaluated the efficacy and tolerability of aripiprazole for augmentation of antidepressant therapy for treatment-resistant depression (TRD). Here, we investigated the efficacy of aripiprazole augmentation for TRD including both major depressive disorder and bipolar disorder and the clinical predictors of treatment efficacy in a Japanese population.  Methods: Eighty-five depressed Japanese patients who underwent aripiprazole augmentation therapy after failing to respond satisfactorily to antidepressant monotherapy were included in the study. Treatment responses were evaluated based on Clinical Global Impression Improvement scores assessed 8 weeks after initiation of aripiprazole administration. We compared demographic and diagnostic variables, psychiatric medication variables, and clinical variables between remission and nonremission groups.  Results: The aripiprazole augmentation remission rate was 36.5%. Multiple logistic regression analysis indicated that aripiprazole augmentation was significantly more effective for bipolar depression than for major depressive disorder, and both absence of comorbid anxiety disorders and current episode duration >3 months were significantly associated with the efficacy of aripiprazole augmentation.  Conclusion: Polarity of depression, comorbidity of anxiety disorders, and current episode duration may predict the efficacy of aripiprazole augmentation for TRD includin