Antidepressant treatment history as a predictor of response to scopolamine: clinical implications

Jessica S Ellis; Carlos A Zarate Jr; David A Luckenbaugh; Maura L Furey

doi:10.1016/j.jad.2014.03.010

Antidepressant treatment history as a predictor of response to scopolamine: clinical implications

J Affect Disord. 2014 Jun:162:39-42. doi: 10.1016/j.jad.2014.03.010. Epub 2014 Mar 26.

Authors

Jessica S Ellis¹, Carlos A Zarate Jr², David A Luckenbaugh², Maura L Furey²

Affiliations

¹ National Institutes of Health/National Institute of Mental Health,Experimental Therapeutics and Pathophysiology Branch, 10 Center Dr., Building 10/CRC, Room 7-5561, Bethesda, MD 20814-9692, USA. Electronic address: brockmeyerjs@mail.nih.gov.
² National Institutes of Health/National Institute of Mental Health,Experimental Therapeutics and Pathophysiology Branch, 10 Center Dr., Building 10/CRC, Room 7-5561, Bethesda, MD 20814-9692, USA; National Institutes of Health/National Institute of Mental Health, Experimental Therapeutics and Pathophysiology Branch, 10 Center Dr., Building 10/CRC, Bethesda, MD, 20814-9692, USA.

Abstract

Background: The intravenous administration of scopolamine produces rapid antidepressant effects. Generally, failing multiple previous antidepressant trials is associated with a poor prognosis for response to future medications. This study evaluated whether treatment history predicts antidepressant response to scopolamine.

Methods: Treatment resistant patients (2 failed medication trials) (n=31) and treatment naïve patients (no exposure to psychotropic medication) (n=31) with recurrent major depressive or bipolar disorder participated in a double-blind, placebo-controlled, crossover clinical trial. Following a placebo lead-in, participants randomly received P/S or S/P (P=3 placebo; S=3 scopolamine (4ug/kg) sessions 3 to 5 days apart). The Montgomery-Asberg Depression Rating Scale (MADRS) was the primary outcome measure. A linear mixed model was used to examine the interaction between clinical response and treatment history, adjusting for baseline MADRS.

Results: Treatment resistant and treatment naïve subjects combined responded significantly to scopolamine compared to placebo (F=15.06, p<0.001). Reduction in depressive symptoms was significant by the first post-scopolamine session (F=42.75, p<0.001). A treatment history by scopolamine session interaction (F=3.37, p=0.04) indicated treatment naïve subjects had lower MADRS scores than treatment resistant patients; this was significant after the second scopolamine infusion (t=2.15, p=0.03).

Limitations: Post-hoc analysis: Also, we used a single regimen to administer scopolamine, and smokers were excluded from the sample, limiting generalizability.

Conclusions: Treatment naïve and treatment resistant patients showed improved clinical symptoms following scopolamine, while those who were treatment naïve showed greater improvement. Scopolamine rapidly reduces symptoms in both treatment history groups, and demonstrates sustained improvement even in treatment resistant patients.

Keywords: Antidepressant; Depression; Scopolamine; Treatment history; Treatment resistant.

Published by Elsevier B.V.

Publication types

Randomized Controlled Trial
Research Support, N.I.H., Intramural
Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Adult
Antidepressive Agents / therapeutic use*
Bipolar Disorder / drug therapy*
Cross-Over Studies
Depressive Disorder, Major / drug therapy*
Double-Blind Method
Female
Humans
Male
Middle Aged
Psychiatric Status Rating Scales
Research Design
Scopolamine / therapeutic use*
Young Adult

Substances

Antidepressive Agents
Scopolamine

Abstract

Publication types

MeSH terms

Substances

Grants and funding