title: Characteristics of U.S. Veteran Patients with Major Depressive Disorder who require "next-step" treatments: A VAST-D report.
abstract: Finding effective and lasting treatments for patients with Major Depressive Disorder (MDD) that fail to respond optimally to initial standard treatment is a critical public health imperative. Understanding the nature and characteristics of patients prior to initiating "next-step" treatment is an important component of identifying which specific treatments are best suited for individual patients. We describe clinical features and demographic characteristics of a sample of Veterans who enrolled in a "next-step" clinical trial after failing to achieve an optimal outcome from at least one well-delivered antidepressant trial.
  
  
  
  1522 Veteran outpatients with nonpsychotic MDD completed assessments prior to being randomized to study treatment. Data is summarized and presented in terms of demographic, social, historical and clinical features and compared to a similar, non-Veteran sample.
  
  
  
  Participants were largely male and white, with about half unmarried and half unemployed. They were moderately severely depressed, with about one-third reporting recent suicidal ideation. More than half had chronic and/or recurrent depression. General medical and psychiatric comorbidities were highly prevalent, particularly PTSD. Many had histories of childhood adversity and bereavement. Participants were impaired in multiple domains of their lives and had negative self-worth.
  
  
  
  These results may not be generalizable to females, and some characteristics may be specific to Veterans of US military service. There was insufficient data on age of clinical onset and depression subtypes, and three novel measures were not psychometrically validated.
  
  
  
  Characterizing VAST-D participants provides important information to help clinicians understand features that may optimize "next-step" MDD treatments.
authors.affiliation: VA San Diego Healthcare System and University of California, San Diego, USA. Electronic address: szisook@ucsd.edu.
authors.forename: Sidney
authors.initials: S
authors.lastname: Zisook
authors.affiliation: VA San Diego Healthcare System and University of California, San Diego, USA.
authors.forename: Ilanit
authors.initials: I
authors.lastname: Tal
authors.affiliation: VA San Diego Healthcare System and University of California, San Diego, USA.
authors.forename: Kimberly
authors.initials: K
authors.lastname: Weingart
authors.affiliation: Central Texas Veterans Healthcare System and Department of Psychiatry and Behavioral Sciences Texas A&M Health Science Center College of Medicine, Temple, TX, USA.
authors.forename: Paul
authors.initials: P
authors.lastname: Hicks
authors.affiliation: Tuscaloosa VA Medical Center, Tuscaloosa, AL, USA; University of Alabama School of Medicine, USA.
authors.forename: Lori L
authors.initials: LL
authors.lastname: Davis
authors.affiliation: Louis Stokes VA Medical Center and Case Western Reserve University School of Medicine, Cleveland, OH, USA.
authors.forename: Peijun
authors.initials: P
authors.lastname: Chen
authors.affiliation: Health Economics Resource Center (HERC), VA Palo Alto, Menlo Park, CA, USA.
authors.forename: Jean
authors.initials: J
authors.lastname: Yoon
authors.affiliation: VA Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, West Haven, CT, USA.
authors.forename: Gary R
authors.initials: GR
authors.lastname: Johnson
authors.affiliation: VA Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, New Mexico VA Healthcare System, Albuquerque, NM, USA.
authors.forename: Julia E
authors.initials: JE
authors.lastname: Vertrees
authors.affiliation: VA San Diego Healthcare System and University of California, San Diego, USA.
authors.forename: Sanjai
authors.initials: S
authors.lastname: Rao
authors.affiliation: Tuscaloosa VA Medical Center, Tuscaloosa, AL, USA; Capstone College of Community Health Sciences, Tuscaloosa, AL, USA.
authors.forename: Patricia D
authors.initials: PD
authors.lastname: Pilkinton
authors.affiliation: Tucson VA Medical Center and Department of Psychiatry, University of Arizona, Tucson, AZ, USA.
authors.forename: James A
authors.initials: JA
authors.lastname: Wilcox
authors.affiliation: Salem VA Medical Center, Salem, VA, USA; Virginia Tech Carilion School of Medicine, Roanoke, VA, USA.
authors.forename: Mamta
authors.initials: M
authors.lastname: Sapra
authors.affiliation: Salem VA Medical Center, Salem, VA, USA; Virginia Tech Carilion School of Medicine, Roanoke, VA, USA.
authors.forename: Ali
authors.initials: A
authors.lastname: Iranmanesh
authors.affiliation: Cooperative Studies Program Central Office, VA Office of Research & Development, Washington DC, USA.
authors.forename: Grant D
authors.initials: GD
authors.lastname: Huang
authors.affiliation: VA VISN1 New England Mental Illness Research, Education and Clinical Center (MIRECC), Veterans Health Administration, West Haven, CT, USA; Yale University School of Medicine, USA.
authors.forename: Somaia
authors.initials: S
authors.lastname: Mohamed
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000928:Antidepressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D000068180:Aripiprazole / Q000627:therapeutic use; D016642:Bupropion / Q000627:therapeutic use; D015897:Comorbidity; D003865:Major Depressive Disorder / Q000188:drug therapy* / Q000523:psychology*; D061218:Depressive Disorder, Treatment-Resistant / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D014481:United States; D014728:Veterans / Q000523:psychology*; D055815:Young Adult
chemical_list: D000928:Antidepressive Agents; D016642:Bupropion; D000068180:Aripiprazole
keywords: Major Depressive Disorder; Treatment-resistant depression; Veterans