Potential efficacy of dopaminergic antidepressants in treatment resistant anergic-anhedonic depression results of the chronic anergic-anhedonic depression open trial - CADOT

Ludovic Christophe Dormegny-Jeanjean; Clément de Billy; Olivier Mainberger; Sébastien Weibel; Benoit Schorr; Alexandre Obrecht; Lionel Landré; Fabrice Berna; Jean-Baptiste Causin; Frederic Blanc; Vlad Danila; Mihaela Tomsa; Geraldine Pfleger; Camille Meyer; Ilia Humbert; Hervé Javelot; Guillaume Meyer; Gilles Bertschy; Jack Rene Foucher

doi:10.3389/fpsyt.2023.1194090

Potential efficacy of dopaminergic antidepressants in treatment resistant anergic-anhedonic depression results of the chronic anergic-anhedonic depression open trial - CADOT

Front Psychiatry. 2023 Sep 27:14:1194090. doi: 10.3389/fpsyt.2023.1194090. eCollection 2023.

Authors

Ludovic Christophe Dormegny-Jeanjean^{1

2

3}, Clément de Billy^{1

2

3}, Olivier Mainberger^{1

2

3}, Sébastien Weibel^{1

4

5}, Benoit Schorr^{4

5

6}, Alexandre Obrecht^{1

2}, Lionel Landré³, Fabrice Berna^{4

5}, Jean-Baptiste Causin^{1

4

5}, Frederic Blanc^{3

6}, Vlad Danila^{1

7}, Mihaela Tomsa^{1

7}, Geraldine Pfleger^{1

8}, Camille Meyer^{1

2

4}, Ilia Humbert^{1

2

4}, Hervé Javelot^{1

9}, Guillaume Meyer^{1

10}, Gilles Bertschy^{1

4

5}, Jack Rene Foucher^{1

2

3

4}

Affiliations

¹ Treatment resistant depression expert center of Alsace (CEDRA), Strasbourg-Rouffach-Erstein-Brumath, Rouffach, France.
² Non-Invasive neuroModulation Center of Strasbourg (CEMNIS), University Hospital of Strasbourg, Strasbourg, France.
³ CNRS UMR 7357 iCube, neurophysiology, FMTS, University of Strasbourg, Strasbourg, France.
⁴ Department of Psychiatry and Mental Health - University Hospital of Strasbourg, University of Strasbourg, Strasbourg, France.
⁵ INSERM UMR 1114, Physiopathology and Cognitive Psychopathology of Schizophrenia, University of Strasbourg, Strasbourg, France.
⁶ Geriatrics Department and Expert Center for Neurocognitive Disorders, University Hospital of Strasbourg, Strasbourg, France.
⁷ Department of Psychiatry "Pole 8/9", Rouffach Psychiatric Hospital, Rouffach, France.
⁸ Department of Integrated Psychiatric Care, Centre Hospitalier d'Erstein, Erstein, France.
⁹ Expert center in Psychopharmacology, Etablissement public de santé Alsace nord (EPSAN), Bischwiller, France.
¹⁰ Department of Psychopharmacology, Centre Hospitalier d'Erstein, Lingolsheim, France.

Abstract

Introduction: Among treatment-resistant depression (TRD), we identified anergic-anhedonic clinical presentations (TRAD) as putatively responsive to pro-dopaminergic strategies. Based on the literature, non-selective monoamine oxidase inhibitors (MAOI) and dopamine D2 receptor agonists (D2RAG) were sequentially introduced, frequently under the coverage of a mood stabilizer. This two-step therapeutic strategy will be referred to as the Dopaminergic Antidepressant Therapy Algorithm (DATA). We describe the short and long-term outcomes of TRAD managed according to DATA guidelines.

Method: Out of 52 outpatients with TRAD treated with DATA in a single expert center, 48 were included in the analysis [severity - QIDS (Quick Inventory of Depressive Symptomatology) = 16 ± 3; episode duration = 4.1 ± 2.7 years; Thase and Rush resistance stage = 2.9 ± 0.6; functioning - GAF (Global Assessment of Functioning) = 41 ± 8]. These were followed-up for a median (1st - 3rd quartile) of 4 (1-9) months before being prescribed the first dopaminergic treatment and remitters were followed up 21 (11-33) months after remission.

Results: At the end of DATA step 1, 25 patients were in remission (QIDS <6; 52% [38-66%]). After DATA step 2, 37 patients were in remission (77% [65-89%]) to whom 5 patients with a QIDS score = 6 could be added (88% [78-97%]). Many of these patients felt subjectively remitted (GAF = 74 ± 10). There was a significant benefit to combining MAOI with D2RAG which was maintained for at least 18 months in 30 patients (79% [62-95%]).

Conclusion: These results support TRAD sensitivity to pro-dopaminergic interventions. However, some clinical heterogeneities remain in our sample and suggest some improvement in the description of dopamine-sensitive form(s).

Keywords: anergia; anhedonia; apathy; atypical depression; dopamine D2 receptor agonists; hypodopaminergic mesencephalic syndrome; monoamine oxidase inhibitors; treatment resistant depression.