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Efficacy of depression treatments, including adjunctive antipsychotic treatment, has not been explored for patients with worsening symptoms after antidepressant therapy (ADT).
This post-hoc analysis utilized pooled data from 3 similarly designed, randomized, double-blind, placebo-controlled trials that assessed the efficacy, safety, and tolerability of adjunctive aripiprazole in patients with major depressive disorder with inadequate response to ADT. The studies had 2 phases: an 8-week prospective ADT phase and 6-week adjunctive (aripiprazole or placebo) treatment phase. This analysis focused on patients whose symptoms worsened during the prospective 8-week ADT phase (worsening defined as >0% increase in Montgomery–Åsberg Depressive Rating Scale [MADRS] Total score). During the 6-week, double-blind, adjunctive phase, response was defined as ≥50% reduction in MADRS Total score and remission as ≥50% reduction in MADRS Total score and MADRS score ≤10.
Of 1065 patients who failed to achieve a response during the prospective phase, 160 exhibited worsening of symptoms (ADT-Worseners), and 905 exhibited no change/reduction in MADRS scores (ADT-Non-worseners). Response rates for ADT-Worseners at endpoint were 36.6% (adjunctive aripiprazole) and 22.5% (placebo). Similarly, response rates at endpoint for ADT-Non-worseners were 37.5% (adjunctive aripiprazole) and 22.5% (placebo). Remission rates at endpoint for ADT-Worseners were 25.4% (adjunctive aripiprazole) and 12.4% (placebo). For ADT-Non-worseners, remission rates were 29.9% (adjunctive aripiprazole) and 17.4% (placebo).
These results suggest that adjunctive aripiprazole is an effective intervention for patients whose symptoms worsen during antidepressant monotherapy. The results challenge the view that benefits of adjunctive therapy with aripiprazole are limited to partial responders to ADT.
Within the past five years, the scholarly literature on the U.S. Senate has been immeasurably enriched by the appearance of a half-dozen books that are noteworthy, not merely for the quality of the research involved but for the perspective they share. Directing their attention to different features of the institution, all emphasize what is truly distinctive about the Senate. In spite of powerful evidence that the hardedged partisanship that has long been a feature of the House has made strong inroads in the Senate, and in the face of evidence provided by Barbara Sinclair's Unorthodox Lawmaking (1997) and others that Senate leadership, at least in the postcommittee phase of legislation, has gotten more muscular in the manner of party leaders in the House, the two chambers are in no danger of becoming indistinguishable one from the other anytime soon.
A public philosophy is the ectoplasm of a political party. Candidates represent die party, but, in a larger sense, they are epiphenomenal; if die parry's principles and organizing concepts are shopworn, even die most presentable candidate will have difficulty transcending diem. In such cases victory is not impossible, just unwarranted.
The Democratic party is like an estranged married couple that tries to make a go of it again. However great its resolve to play up the things held in common and to minimize those causing strife, it soon finds that the matters that tear at the relationship are of equal or greater importance than those that cement it. One might say that on many issues the Democratic party is divided between those who squeeze the toothpaste tube in the middle and those who roll it up from the end.
For openers, there are elements in the party who are distinctly uncomfortable with many of the constituencies that traditionally have lent it support. For another thing, the party itself is divided between vintage free-traders and born-again protectionists. Although Democrats want government to have more than the limited role Ronald Reagan would consign to it, many in the party fear that the voters are unsympathetic to its statist proclivities.
An abiding criticism of the Reagan administration in the first six months of its life was that it had no foreign policy. In a global sense this criticism was certainly well taken: Nothing resembling Kissinger's detente policy or Carter's human rights doctrine seemed even in the works. Yet without the essential dimensions of a universal foreign policy, regional policies were taking shape.
Shortly after Reagan's election and well before his inauguration, those who saw themselves as both the authors and legatees of the Reagan landslide made a move to dismantle the Carter African policy and to ensure that its like would not soon emerge. Reagan's conservative allies in Congress—most notably Senator Jesse Helms of North Carolina—put the new administration on notice that henceforth South Africa would be dropped from this country's enemies list and that the United States no longer would be counted in the ranks of Pretoria's antagonists at the United Nations.
It hardly seems possible that two decades have elapsed since the floodtide of African independence. We have become so accustomed to associating Africa with newness that we are apt to forget that the premier states of independent Africa—Ghana and Sudan—are coming up on their twenty-fifth anniversaries of freedom from colonial rule. The scant score of years has seen some remarkable transformations. Nigeria, whose first decade was blighted by Africa's bloodiest civil war, has emerged not merely as a regional power but a major world actor. Second only to Saudi Arabia as a supplier of oil to the United States, Nigeria is able to exert a degree of influence on this country unequaled among the states of the African continent.
In 1913, when Woodrow Wilson was assuming the duties of President of the United States, Joseph Stalin was in exile in Siberia and Lenin in Galicia. When Union and Confederate veterans were meeting to commemorate the fiftieth anniversary of the Battle of Gettysburg and Henry Ford was about to set up the first modern assembly line, the newly established Union of South Africa promulgated the Natives Land Act. A world preoccupied with the decay of great empires and apprehensive about the onset of world conflict was only dimly aware of this law enacted in a distant corner of a remote continent. The law prescribed the apportionment of territory of the Union into areas of exclusive settlement by whites and blacks.