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AJP CME: May 2019 - Irritability and Its Clinical Utility in Major Depressive Disorder: Prediction of Individual-Level Acute-Phase Outcomes Using Early Changes in Irritability and Depression Severity

Activity Type:

  • Journal CME

Release Date: 5/1/2019

Expiration Date: 4/30/2021

  • AMA PRA Category 1: 1
  • Participation: 1

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Objective: The authors evaluated improvement in irritability with antidepressant treatment and its prognostic utility in treatment-seeking adult outpatients with major depressive disorder.

Methods: Mixed-model analyses were used to assess changes in irritability (as measured with the five-item irritability domain of the Concise Associated Symptom Tracking [CAST-IRR] scale) from baseline to week 4 after controlling for depression severity (as measured with the 16-item Quick Inventory of Depressive Symptomatology–Clinician Rated [QIDS-C]) in the Combining Medications to Enhance Depression Outcomes (CO-MED) trial (N=664). An interactive calculator for remission (QIDS-C score ≤5) and no meaningful benefit (<30% reduction in QIDS-C score from baseline) at week 8 was developed with logistic regression analyses in the CO-MED trial using participants with complete data (N=431) and independently replicated in the Suicide Assessment and Methodology Study (SAMS) (N=163).


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Educational Objective

The participant will recognize the importance of assessing irritability in adult patients with major depressive disorder.

Target Audience

This program is designed for all psychiatrists in clinical practice, residents in Graduate Medical Education programs, medical students interested in psychiatry, and other physicians who wish to advance their current knowledge of clinical medicine.

Estimated Time to Complete

Duration: 1 hour
Begin Date: May 1, 2019
End Date: April 30, 2021

How to Earn Credit

In order to earn CME credit, subscribers should read through the material presented in the article. After reading the article, complete the quiz and submit your evaluation and study hours (up to 1 AMA PRA Category 1 Credit™).  A score of 60% or higher is required to receive credit.

Continuing Education Credit

The American Psychiatric Association (APA) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The APA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Faculty and Planner Disclosures

Title: Irritability and Its Clinical Utility in Major Depressive Disorder: Prediction of Individual-Level Acute-Phase Outcomes Using Early Changes in Irritability and Depression Severity

Authors: Manish K. Jha, M.B.B.S., Abu Minhajuddin, Ph.D., Charles South, Ph.D., A. John Rush, M.D., Madhukar H. Trivedi, M.D.

Affiliations: Center for Depression Research and Clinical Care, UT Southwestern Medical Center, Dallas (M.K.J., A.M., C.S., M.H.T.); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (M.K.J.); Duke-National University of Singapore (A.J.R.); Department of Psychiatry, Duke Medical School, Durham, N.C. (A.J.R.); Texas Tech University-Health Sciences Center, Permian Basin, Midland-Odessa (A.J.R.).

Disclosures: Dr. Jha has received contract research funding from Acadia Pharmaceuticals and Janssen Research and Development. Dr. Rush has received consulting fees from Akili, Brain Resource, Compass, Curbstone Consultant LLC, Eli Lilly, Emmes Corp., LivaNova, MindLinc, Sunovion, Takeda USA, and Taj Medical; he has received speaking fees from LivaNova and SingHealth; he receives royalties from Guilford Press and the University of Texas Southwestern Medical Center, Dallas; and he is co-inventor on two patents (number 7,795,033: Methods to Predict the Outcome of Treatment with Antidepressant Medication; number 7,906,283: Methods to Identify Patients at Risk of Developing Adverse Events During Treatment with Antidepressant Medication). Dr. Trivedi has served as a consultant for or on the advisory board of Alkermes, Akili Interactive, Allergan Pharmaceuticals, Acadia Pharmaceuticals, Avanir Pharmaceuticals, Brintellix Global, Bristol-Myers Squibb, Caudex, Cerecor, Forest Pharmaceuticals, Global Medical Education, Health Research Associates, Insys, Johnson & Johnson Pharmaceutical Research and Development, Lilly Research Laboratories, Lundbeck Research USA, Medscape, Merck, Mitsubishi Pharma, MSI Methylation Sciences, Navitor, One Carbon Therapeutics, Otsuka America Pharmaceutical, Pamlab, Pfizer, and Takeda Global Research; he has received royalties from Janssen Research and Development and has author agreements with Janssen Asia Pacific and Oxford University Press; and he has received grant support from the Agency for Healthcare Research and Quality, the Cancer Prevention and Research Institute of Texas, Johnson & Johnson, NIDA, the National Institute of Diabetes and Digestive and Kidney Diseases, the National Center for Advancing Translational Sciences, NIMH, and the Patient-Centered Outcomes Research Institute. The other authors report no financial relationships with commercial interests.

Discussion of unapproved or investigational use of products*: No.

*APA policy requires disclosure by CME authors of unapproved or investigational use of products discussed in CME programs. Off-label use of medications by individual physicians is permitted and common. Decisions about off-label use can be guided by scientific literature and clinical experience.

Program Planners

Ned H. Kalin, M.D. (Editor-in-Chief, AJP); Carolyn Rodriguez, M.D., Ph.D. (Deputy Editor, AJP); Michael D. Roy (Editorial Director, AJP); Michael A. Pogachar (Online Content Manager, Journals). Dr. Kalin has served as a consultant to the Board of Scientific Advisors, the Pritzker Neuropsychiatric Disorders Research Consortium, and the Skyland Trail Advisory Board and as Councilor, Society of Biological Psychiatry. Dr. Rodriguez has served as a consultant to Allergan, Blackthorn, Epiodyne, and Rugen. Mr. Roy and Mr. Pogachar report no financial relationships with commercial interests.

Hardware/Software Requirements

This internet-based CME activity is best experienced using Internet Explorer 8+, Mozilla Firefox 3+, Safari 4+. This Web site requires that JavaScript and session cookies be enabled. Certain activities may require additional software to view multimedia, presentation, or printable versions of the content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Flash, Adobe Acrobat, Microsoft PowerPoint, and Windows Media Player.
Optimal System Configuration:
  • Flash Player: Adobe Flash Player 10.1+ 
  • Browser: Firefox 3+, Internet Explorer 8.0+, Safari 4.0+, or Google Chrome 7.0+ 
  • Operating System: Windows XP+ or Mac OS X 10.4+ 
  • Internet Connection: 1 Mbps or higher
  • Screen Resolution: 1024 x 768 pixels.

Minimum Requirements:

  • Windows PC:500-MHz Pentium II; Windows XP or higher; 128 MB RAM; Video Card at least 64MB of video memory; Sound Card at least 16-bit; Macromedia Flash Player 10 or higher, audio playback with speakers for programs with video content; Firefox 1.1+, Internet Explorer 7.0+, Safari 1.0+, Google Chrome, or Opera
  • Macintosh: Mac OS X 10.3 or higher with latest updates installed; 1.83MHz Intel Core Duo or faster; RAM: 128MB or more; Video Card: at least 64MB of video memory; Sound Card: at least 16-bit

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