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Targeting Unmet Needs in the Treatment of Major Depressive Disorder

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SUPPLEMENT TO Release date: September 1, 2019 Expiration date: August 31, 2020 Estimated time to complete activity: FREE 1 CME 1 AMA Category 1 Credit™ CREDIT 1 ANCC contact hours SEPTEMBER 2019 | VOL 18, NO 9 Available at www.mdedge.com/MDD Jointly provided by Postgraduate Institute for Medicine and Global Medical Education. This activity is supported by an independent Targeting Unmet Needs educational grant from Allergan. TARGET AUDIENCE in the Treatment of Major This activity is intended for physicians, physician assistants, nurse practitioners and Depressive Disorder registered nurses engaged in the care of patients with major depression. Roger S. McIntyre, MD, FRCPC EDUCATIONAL OBJECTIVES After completing this activity, the participant should be better able to: BOTTOM LINE: Targeting Unmet Needs in • Treat major depression within 2 weeks. the Treatment of Major Depressive Disorder • Use evidence based treatments to achieve remission in major depression. Many of the unmet needs in Major Depressive Disorder are • Discuss novel targets including glutamate modifiable, including improving diagnostic accuracy, offering for treating major depression. treatments with faster onset of action, treatments with greater • Utilize treatments with innovative overall efficacy, and treatments that can improve patient mechanisms to treat major depression. functioning. Measurement based care guiding treatment wherein FACULTY the aim is to achieve remission, improve cognitive function, and Roger S. McIntyre, MD, general functioning, are key therapeutic objectives. FRCPC Professor of Psychiatry and Pharmacology, Introduction University of Toronto Major depressive disorder (MDD) is a common and severe disorder that is estimated to affect approximately 350 million people glob- ally.1 It is predicted that MDD debases human capital more than most other non-communicable disorders.2 In addition to substan- Michael E. Thase, MD tial illness-associated morbidity, MDD is associated with the loss of Professor of Psychiatry, 10 years of life.3 The implications of MDD on other organ systems Perelman School is demonstrated by mortality studies indicating that cardiovascular of Medicine, disease is the most common cause of excess mortality.4 Significant University of Pennsylvania unmet needs exist in the management of MDD, which, if addressed successfully, would be expected to reduce overall illness-associated morbidity. Herein, we succinctly review and summarize key unmet needs in MDD (Table 1). JOINT ACCREDITATION STATEMENT In support of improving Identifying which patients will respond to which treatments patient care, this activity The inability to identify a priori which individuals will (and will has been planned and implemented by the not) respond to and tolerate a chosen antidepressant often leads to Postgraduate Institute for Medicine and multiple trials of futility, adverse therapeutic outcomes, and unnec- Global Medical Education. Postgraduate essary prolongation of MDD disease activity. The promise of phar- Institute for Medicine is jointly accredited macogenetics/pharmacogenomics brings the possibility of closing by the American Council for Continuing the gap between the current practice of iteratively selecting antide- Medical Education (ACCME), the Accreditation pressants toward a bespoke selection of antidepressants in MDD.5 Council for Pharmacy Education (ACPE), and Pharmacogenetics testing refers to evaluating a single allelic varia- the American Nurses Credentialing Center tion, while pharmacogenomic testing integrates allelic variance for (ANCC), to provide continuing education for proteins that participate in both pharmacokinetic and/or pharmaco- the healthcare team. dynamic processes.5 The rationale for considering a given patient’s CONTINUED ON PAGE S2 CONTINUED ON PAGE S3 Supplement to Current Psychiatry | Vol 18, No 9 | September 2019 S1 TARGETING UNMET NEEDS IN THE TREATMENT OF MAJOR DEPRESSIVE DISORDER CONTINUED FROM PAGE S1 PHYSICIAN CONTINUING MEDICAL EDUCATION PLANNERS AND MANAGERS The Postgraduate Institute for Medicine designates The PIM planners and managers have nothing to disclose. this enduring material for a maximum of 1 AMA PRA The Global Medical Education planner and manager, Category 1 Credit™. Physicians should claim only the credit Prakash Masand, MD, has disclosed the following: commensurate with the extent of their participation in Consulting Fees: Allergan, Lundbeck, Sunovion, Takeda the activity. Speakers’ Bureau: Allergan, Lundbeck, Sunovion, Takeda CONTINUING NURSING EDUCATION Contracted Research: Allergan The maximum number of hours awarded for this Continuing Disclosure of Unlabeled Use Nursing Education activity is 1 contact hour. This educational activity may contain discussion of Designated for 0.4 contact hours of pharmacotherapy credit published and/or investigational uses of agents that are for Advance Practice Registered Nurses. not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled DISCLOSURE OF CONFLICTS OF INTEREST indications. Postgraduate Institute for Medicine (PIM) requires instructors, planners, managers and other individuals The opinions expressed in the educational activity are who are in a position to control the content of this activity those of the faculty and do not necessarily represent the to disclose any real or apparent conflict of interest (COI) views of the planners. Please refer to the official prescribing they may have as related to the content of this activity. information for each product for discussion of approved All identified COI are thoroughly vetted and resolved indications, contraindications, and warnings. according to PIM policy. PIM is committed to providing its learners with high quality CME activities and related Disclaimer materials that promote improvements or quality in Participants have an implied responsibility to use the healthcare and not a specific proprietary business interest newly acquired information to enhance patient outcomes of a commercial interest. and their own professional development. The information presented in this activity is not meant to serve as a guideline Faculty for patient management. Any procedures, medications, Roger S. Mcintyre, MD, FRCPC or other courses of diagnosis or treatment discussed or Consulting Fees: AstraZeneca, Bristol-Myers Squibb, suggested in this activity should not be used by clinicians Eli-Lilly, Forest, JanssenOrtho, Johnson & Johnson, without evaluation of their patient’s conditions and Lundbeck, Mitsubishi, Moksha8, Otsuka, Pfizer, Purdue, possible contraindications and/or dangers in use, review Shire, Sunovion, Takeda of any applicable manufacturer’s product information, and Speakers’ Bureau: AstraZeneca, Bristol-Myers Squibb, comparison with recommendations of other authorities. Elli-Lilly, Forest, JanssenOrtho, Johnson & Johnson, METHOD OF PARTICIPATION AND INSTRUCTIONS Lundbeck, Mitsubishi, Moksha8, Otsuka, Pfizer, Purdue, FOR CREDIT Shire, Sunovion, Takeda During the period September 1, 2019, through Research Grants: Allergan, AstraZeneca, JanssenOrtho, August 31, 2020 participants must read the learning Lundbeck, Otsuka, Pfizer, Purdue, Shire, objectives and disclosures, study the educational activity Michael Thase, MD and complete the post-test with a score of 75% or better Consulting Fees: Acadia, Akili, Alkermes, Allergan, Cerecor, and the activity evaluation. Please follow the steps below: Fabre-Kramer, Gerson Lehrman Group, Guidepoint Global, Johnson & Johnson, Moksha8, Nestlé, Neuralstrim, Novartis, Go to www.cmeuniversity.com Otsuka, Pfizer, Sunovion 1) Register or Login (will take less than 1 minute) Contracted Research: Acadia, Agency for Healthcare 2) Type in 14255 at the top of the page, Research and Quality (AHRQ), Alkermes, Allergan, AssureRX “Find Post-Test/Evaluation by Course”, click enter Health, Avanir, Axome, Intracellular, Johnson & Johnson, 3) Click on activity title when it appears National Institutes of Health / National Institute of Mental 4) Choose the type of credit you would like Health (NIMH), Otsuka, Patient-Centered Outcomes 5) Complete the activity posttest Research Institute (PCORI), Takeda 6) Complete online Evaluation Royalties: American Psychiatric Foundation, Guilford 7) Receive an immediate CME Certificate to Publications, Herald House, W.W. Norton & Company download and/or print for your files Spouse: Peloton Advantage S2 September 2019 | Vol 18, No 9 | Supplement to Current Psychiatry CONTINUED FROM PAGE S1 TABLE 1 to suboptimal symptomatic outcomes in the short- Unmet needs in major depressive disorder and long-term, replicated and convergent evidence indicates that most adults with MDD do not achieve 1) Need to identify which patients with MDD will respond to/ tolerate (or not) antidepressant therapies (ie, personalized patient-reported outcomes (PROs). For example, most medicine). individuals with MDD, despite achieving symptom- 2) Treatments that are more (or less) likely to achieve atic remission, do not achieve full functional recov- 13 provider- and patient-desired outcomes (PROs) in MDD. ery. The implications for treatment acceptability and 3) Treatments capable of attenuating critical dimension/ health outcomes of PROs in MDD were underscored domain-based outcomes in MDD (eg, cognition). by a post-hoc analysis of the STAR*D study, wherein 4) Treatments that can rapidly attenuate depressive investigators sought to determine the impact of a single symptoms. multidimensional measure (ie, Individual
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