Kronish, I.M., Hampsey, M., Falzon, L. orcid.org/0000-0002-9449-6056 et al. (2 more authors) (2018) Personalized (N-of-1) trials for depression : a systematic review. Journal of Clinical Psychopharmacology, 38 (3). pp. 218-225. ISSN 0271-0749
Abstract
Purpose/Background
Personalized (N-of-1) trials are single-patient, crossover-design trials that may be useful for personalizing the selection of depression treatments. We conducted a systematic review of published N-of-1 trials for depression to determine the feasibility and suitability of this methodology for personalizing depression care.
Methods/Procedures
Electronic databases were searched from database inception through October 2016. Studies were selected if they enrolled depressed patients, included a within-subject crossover design, and systematically assessed depressive symptoms during the N-of-1 trial.
Findings/Results
Five eligible studies reporting on 47 depressed patients (range, 1–18 patients) were identified. Two studies were conducted among adults with treatment-resistant depression, 1 study among depressed inpatients, and 2 studies among patients from special populations (geriatric nursing home, human immunodeficiency virus–associated encephalopathy). All studies evaluated the effects of pharmacologic treatments (methylphenidate, d-amphetamine, ketamine, and sulpiride). Three studies compared an off-label treatment with placebo, 1 study compared 2 off-label treatments, and 1 study compared escalating doses of an off-label treatment with placebo. All 4 studies with more than 1 participant demonstrated heterogeneous treatment effects. All studies produced data that could personalize treatment selection for individual patients. No studies reported on recruitment challenges, compliance with self-tracking, or satisfaction with participation.
Implications/Conclusions
The feasibility of N-of-1 trials for depression was demonstrated for a limited number of second-line pharmacologic treatments in treatment-resistant patients or in patients with comorbidities that would have excluded them from conventional randomized controlled trials. Additional research is needed to determine whether N-of-1 trials are suitable for improving the selection of depression treatments in clinical practice.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | © 2018 Wolters Kluwer Health, Inc. |
Keywords: | depression; N-of-1; personalized medicine |
Dates: |
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Institution: | The University of Sheffield |
Academic Units: | The University of Sheffield > Faculty of Medicine, Dentistry and Health (Sheffield) > School of Health and Related Research (Sheffield) > ScHARR - Sheffield Centre for Health and Related Research |
Depositing User: | Symplectic Sheffield |
Date Deposited: | 31 Jan 2022 14:44 |
Last Modified: | 01 Feb 2022 07:31 |
Status: | Published |
Publisher: | Wolters Kluwer Health |
Refereed: | Yes |
Identification Number: | 10.1097/jcp.0000000000000864 |
Related URLs: | |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:183093 |