Clinical Briefs

Early Response to Exercise in Depressed Patients

SOURCE: Suterwala A, Rethorst CD, Carmody TJ, et al. Affect following first exercise session as a predictor of treatment response in depression. J Clin Psychiatry 2016;77:1036-1042.

Although most depressed patients treated with antidepressants note favorable symptom improvement, only about one-third achieve full remission. Selective serotonin reuptake inhibitors are the most common first-line antidepressants used in the United States and, although generally well tolerated, may induce problematic adversities such as sexual dysfunction. Additionally, the response to pharmacotherapy may take several weeks or longer to manifest, during which time clinicians cannot be confident whether any particular antidepressant ultimately will be effective. If the response to a chosen antidepressant treatment turns out to be insufficient, the clinician will have wasted the patient’s time and money, and potentially exposed the patient to unwanted adverse effects.

Exercise has been noted to produce favorable outcomes in depressed patients. Might the early response to exercise predict who would respond favorably over the long term?

Suterwala et al performed a randomized, controlled trial of exercise in depressed patients (n = 126). High-dose exercise (180 minutes/week moderate-vigorous activity) was compared with low-dose activity (45 minutes/week). Exercise was supervised during one session each week for the entire 12-week duration of the trial.

The Positive and Negative Affect Scale (PANAS) was administered to both groups immediately after the very first supervised session in the study’s first week. A favorable PANAS score after the first exercise session proved to be a good predictor of improvement at 12 weeks, as well as likelihood of remission, but only in the high-dose exercise group. We may be better able to capture the potential for beneficial effects of exercise in depression by early identification of responders.

COPD Patients Who May Need Intensified Smoking Cessation

SOURCE: Tottenborg SS, Thomsen RW, Johnsen SP, et al. Determinants of smoking cessation in patients with COPD treated in the outpatient setting. Chest 2016;150:554-562.

Like most other endeavors in medicine, the road to successful smoking cessation is not one-size-fits-all. Prior to end-stage disease for patients with COPD, the only intervention that has been shown to be truly disease-modifying is smoking cessation. How can we best target our efforts to ensure best smoking cessation outcomes? Tottenborg et al studied a large population of smokers suffering from COPD in Denmark (n = 3,233) to see which demographic factors were associated with likelihood of smoking cessation. In this population (in contrast to other data from the United States), clinician encouragement to cease smoking was not statistically significantly associated with likelihood of cessation.

Over a five-year period of observation, factors that were identified as associated with lesser likelihood of smoking cessation included younger age (30-39 years compared to ≥ 70 years), lower income, unemployment, and low severity of COPD. Although we can’t change our patients’ age, income, job status, or COPD severity, Tottenborg et al suggested identifying the characteristics that predict less success with smoking cessation may allow clinicians an opportunity to redouble efforts in these same individuals.

USPSTF Endorses TB Screening for High-risk Individuals

SOURCE: USPSTF. Screening for latent tuberculosis infection in adults: US Preventive Services Task Force recommendation statement. JAMA 2016;316:962-969.

The U.S. Preventive Services Task Force (USPSTF) recently issued a Level B recommendation endorsing screening for latent TB in high-risk populations, meaning, “there is high certainty that the net benefit is moderate, or there is moderate certainty that the net benefit is moderate to substantial.”

Based on screening using either the Mantoux tuberculin skin test or the interferon-gamma release assay, the USPSTF concluded that both are sufficiently sensitive and specific to be considered accurate. Despite the absence of TB screening trials that confirm benefits, since treatment of latent TB prevents progression to active TB, a moderate degree of benefit should be achieved through screening.

However, TB screening is not advocated on a population-wide basis. Instead, USPSTF recommends screening in high-risk populations. Such individuals include persons who have lived in countries of high TB prevalence (e.g., Mexico, Philippines, Vietnam, India, China, Haiti, or Guatemala), have lived in high-risk congregate settings (e.g., homeless/correctional facilities), are immunosuppressed (e.g., HIV or on immunosuppressive meds), or have been in contact with persons suffering from active TB.