D L Ackerman

County of Los Angeles Public Health, Los Angeles, California, United States

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Publications (11)32.7 Total impact

  • Deborah L Ackerman, Sander Greenland
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    ABSTRACT: Meta-analytic reviews of placebo-controlled studies for obsessive-compulsive disorder have found that clomipramine is more effective than drugs with more selective actions on serotonin reuptake, whereas in most direct comparisons, clomipramine's superiority has been less obvious. The authors used metaregression to identify sources of he-terogeneity in placebo-controlled trials of clomipramine, fluvoxamine, sertraline, and paroxetine. They evaluated such patient characteristics as age, gender, age of obsessive-compulsive disorder (OCD) onset, and baseline severity of OCD and depression, and such study characteristics as exclusion or inclusion criteria, length of single-blind prerandomization period, length of trial, number of subjects, and publication year. We found considerable heterogeneity across studies that was associated, in part, with publication year, length of single-blind prerandomization period, length of trial, and severity of patients' OCD. The apparent superiority of clomipramine persisted after controlling for these factors. The authors also confirmed previous reports that placebo response is higher in more recent studies. Meta-analyses can help characterize responders and nonresponders. The authors urge investigators to provide summaries of patient characteristics, especially baseline severity, age at onset, and duration of OCD, by patients' response.
    Journal of Clinical Psychopharmacology 07/2002; 22(3):309-17. · 3.51 Impact Factor
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    ABSTRACT: We evaluated inpatient treatment of depression, prescribing patterns for antidepressants, and associated hospital charges. We reviewed administrative data of the UCLA Neuropsychiatric Hospital between July 1994 and July 1997 for all 1698 hospitalizations for mood disorders. We evaluated drug utilization patterns and hospital charges by analysis of variance and multiple regression, and by stratifying on diagnosis, severity, age, and other factors. Length of stay was the major contributor to total charges, which included room charges and charges for services, procedures, supplies, and tests. The selective serotonin reuptake inhibitors (SSRIs) were prescribed most often (to 47% of patients), followed by the atypicals (heterocyclics, 12%), the tricyclics (TCAs, 7%), venlafaxine (7%) and the monoamine oxidase inhibitors (MAOIs, < 1%). The atypicals were given to the oldest patients. After controlling for length of stay, patient age, genders and comorbidity, the atypicals were associated with the highest total inpatient charges: $2000 more than MAOIs, $600 more than SSRIs, and $600 more than venlafaxine. Higher charges were the result of more expensive procedures, especially ECT. The SSRIs were the most commonly used antidepressant. Charges for antidepressant medications contributed only 0.5% of total inpatient charges. Patients receiving atypicals had among the highest total charges, partly because of the higher use of ECT. They may represent a more severely depressed group who have not responded to other antidepressants.
    Pharmacoepidemiology and Drug Safety 03/2002; 11(3):219-27. · 2.90 Impact Factor
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    ABSTRACT: A high rate of improvement among patients who receive placebo in controlled trials of antidepressants can complicate the evaluation of true drug effect. Placebo response may be a reaction to the psychosocial factors of study participation or a function of changes in the natural course of depression. Drug side effects may also influence patients' expectations, and they should be distinguished from the somatic symptoms associated with major depression. The authors reanalyzed data from a large, multicenter, placebo-controlled clinical trial of fluoxetine treatment of geriatric depression to evaluate similarities and differences between responders and nonresponders in both treatment groups. Specifically, the authors examined weekly somatic complaints as possible predictors of response and of dropout, as well as the time course and onset of response. Fluoxetine was superior to placebo on all outcome measures. Among somatic complaints associated with fluoxetine response, headache before and after randomization was associated with a good response and anxiety after randomization was associated with a poor response. Somnolence before and after randomization was associated with a good placebo response. Early and persistent improvement occurred among similar proportions of responders in both groups. The difference between fluoxetine and placebo seemed to be a persistent response beginning during the 4th week. Pretreatment somnolence was associated with early, persistent improvement in both groups and may serve as a marker for placebo response.
    Journal of Clinical Psychopharmacology 01/2001; 20(6):658-65. · 3.51 Impact Factor
  • D L Ackerman, S Greenland, A Bystritsky
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    ABSTRACT: Differences between the side effect profiles of clomipramine (CMI) and the selective serotonin reuptake inhibitors may be important factors in both treatment outcome and patient selection in obsessive-compulsive disorder (OCD). Safety and efficacy data from an industry-sponsored, multicenter clinical trial of CMI were analyzed previously using tabular and multiple regression methods. Good response, defined as at least a 35% drop in final scores on the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), was associated with a later age of OCD onset and certain early side effects that may reflect a sensitivity of responders to CMI's serotonergic actions. The authors conducted a similar analysis of data from an industry-sponsored clinical trial of fluoxetine in OCD. Fluoxetine response did not seem to be associated with age of OCD onset. Good response to both drugs was associated with initial nervousness and sexual complaints. The common side effects of fluoxetine (headache, nausea, and gastrointestinal complaints) did not seem to be associated with treatment response. Slight differences in the protocols of the two clinical trials yielded patient populations that were different in factors found to be associated with treatment outcome: subjects in the fluoxetine study had lower scores on the Y-BOCS, higher scores on the Hamilton Rating Scale for Depression, and an earlier age of OCD onset.
    Journal of Clinical Psychopharmacology 11/1999; 19(5):459-65. · 3.51 Impact Factor
  • D L Ackerman, S Greenland, A Bystritsky
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    ABSTRACT: Fluoxetine is effective in treating obsessive-compulsive disorder (OCD). Nonetheless, a substantial number of patients do not respond or have only partial improvement. Data generated by a multicenter, placebo-controlled, fixed-dose trial of fluoxetine were reanalyzed to identify characteristics of responders. Multiple regression methods were used to evaluate the relationship between therapeutic response and baseline measures such as severity of symptoms, type of symptoms (obsessions, compulsions, depression), course of illness, previous treatment, age of onset, and other demographic factors (age, race, and sex). Fluoxetine was more effective than placebo on all outcome measures. A 60-mg dosage was associated with a greater drop in Yale-Brown Obsessive-Compulsive Scale total score and a greater drop in Compulsion items than a 20-mg dosage. Response rates and overall improvement were greatest for patients with a history of remissions, with no previous drug treatment or with only prior behavior therapy, with more severe OCD (especially with greater interference and distress from obsessions), or with either low or high Hamilton Rating Scale for Depression scores. This study did not detect any associations between response and current age, age of OCD onset, gender, and race. None of the demographic or clinical factors evaluated was found to be related to improvement in the placebo group.
    Journal of Clinical Psychopharmacology 07/1998; 18(3):185-92. · 3.51 Impact Factor
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    ABSTRACT: Results from placebo-controlled trials of antidepressants can be used to identify patients most likely to benefit from medication. Using data from a randomized clinical trial of fluoxetine versus placebo for 671 elderly outpatients with major depression, we evaluated characteristics of those who improved with and without active medication. We found that the choice of outcome measure made a difference when evaluating the effectiveness of fluoxetine relative to placebo and determining the accuracy of predictive variables in both treatment groups. Generally, less severe depression predicted favorable response (greater than 50% improvement on the 21-item Hamilton Rating Scale for Depression [HAM-D-21], less than 3 on the Clinical Global Impressions [CGI] and Patient Global Impressions [PGI] improvement scales) and remission (less than 9 on 6-week HAM-D-21) with both fluoxetine and placebo. Less anxiety/somatization was associated with favorable fluoxetine response, and lower levels of cognitive and sleep disturbance were associated with remission in the placebo group. By contrast, higher levels of psychomotor retardation in the placebo group were associated with clinician and patient ratings of much or very much improved. The similarities among responders in both groups may indicate that some in the fluoxetine group would have improved with placebo.
    Psychopharmacology bulletin 02/1997; 33(4):707-14. · 1.35 Impact Factor
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    ABSTRACT: Early adverse effects of a drug may be a manifestation of individual differences in drug metabolism or of different pathologic processes. These differences may influence therapeutic responsiveness. Using data from Ciba-Geigy's multicenter 10-week clinical trial, we studied the relationship between early side effects and subsequent therapeutic response to clomipramine (CMI) in obsessive-compulsive disorder. We used tabular analyses and multiple regression to evaluate associations between early complaints and change in score on the Yale-Brown Obsessive-Compulsive Scale. We also evaluated whether early complaints were drug related (i.e., true side effects). It appeared that dry mouth, constipation, dizziness, insomnia, male impotence, nervousness, palpitation, and tremor reported during the first 4 weeks were predictive of good response to CMI. Myoclonus and tinnitus appeared weakly associated with treatment success. Most of these complaints were reported more by the CMI group than the placebo group, and more during CMI treatment than before. The more common complaints may reflect an individual's ability to metabolize CMI appropriately so that adequate therapeutic blood levels are attained. The less common complaints may reflect a sensitivity to CMI's serotonergic actions.
    Journal of Clinical Psychopharmacology 09/1996; 16(4):324-8. · 3.51 Impact Factor
  • D L Ackerman, S Greenland, A Bystritsky
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    ABSTRACT: We used receiver-operator characteristic (ROC) curve analysis to evaluate predictors of response to clomipramine in obsessive-compulsive disorder (OCD). Previously, we identified response predictors among 230 OCD patients who received clomipramine in a placebo-controlled, multicenter clinical trail. We found that at baseline a later age of OCD onset, low scores on the Hamilton Depression scale, and high scores on items 3 and 8 of the Yale-Brown Obsessive Compulsive Scale predicted good response. Certain early side effects also predicted outcome. We fitted a logistic regression model containing baseline information and then calculated each patient's estimated response probability by substituting individuals' values in the regression equation. Next we compared the estimated response risks with each patient's known outcome. Finally, we produced a ROC curve by plotting the true positive and false positive rates for various cutoff points of the risk scores. The same steps were followed for Weeks 1 through 4, adding information about early side effects and weekly response. We found that baseline information predicted outcome better than chance, and predictive ability increased with data on side effects and early response.
    Psychopharmacology bulletin 02/1996; 32(1):157-65. · 1.35 Impact Factor
  • S Greenland, D L Ackerman
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    ABSTRACT: To estimate the degree to which neural tube defects (NTDs) are associated with periconceptional clomiphene citrate (CC) exposure in controlled epidemiologic studies, to investigate the consistency of study findings with respect to this association, and to identify key problems that future studies should address. Pooled analysis of 10 epidemiologic studies. Hospitals and clinics. Women undergoing treatment for infertility. Oral administration of CC. Prevalence ratio for NTDs. Ten controlled epidemiologic studies were identified that supplied sufficient data on CC and NTDs for inclusion. The estimated ratio of NTD prevalence among CC-exposed versus unexposed pregnancies ranged from 0.55 to 5.73 among the studies, but the variation was compatible with random fluctuation. The estimated summary prevalence ratio was 1.08, with 95% confidence limits of 0.76 and 1.51. This analysis indicates that an elevation in NTD risk due to CC cannot be ruled out, but any such elevation seems likely to be less than twofold, and there may be no elevation at all. Future studies should be designed to avoid several methodological problems not addressed in studies to date.
    Fertility and Sterility 12/1995; 64(5):936-41. · 4.17 Impact Factor
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    ABSTRACT: There have been many attempts to find predictors of the therapeutic response to the clomipramine treatment of obsessive-compulsive disorder. The majority of studies have failed to identify such predictors. Possible reasons for this failure include the small sample size of most studies, samples homogeneous with respect to the study factors of interest, and the use of statistical procedures that are insensitive to individual differences or that inadequately control for confounding. We have reanalyzed data from Ciba-Geigy's large, multicenter clinical trial of clomipramine for obsessive-compulsive disorder, using stratification and regression techniques to identify multiple prognostic factors and control for confounders. We assessed the relationship between therapeutic response and baseline measures such as severity of symptoms, type of symptoms (obsessions, compulsions, depression), length of illness, age of onset, and other demographic factors (age, race, and sex). We found age of onset to be a strong predictor of response to clomipramine: people who develop obsessive-compulsive disorder later in life have a better chance of responding than do those who become ill earlier, independent of length of illness. We also found that baseline depression is associated with response, but the association appears to be nonlinear.
    Journal of Clinical Psychopharmacology 09/1994; 14(4):247-54. · 3.51 Impact Factor
  • A Bystritsky, D L Ackerman, R O Pasnau
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    ABSTRACT: Thirteen patients meeting DSM-III-R criteria for panic disorder with or without agoraphobia that started during or shortly after cocaine exposure were treated in the UCLA Anxiety Disorders Program (Los Angeles, CA). Low starting doses (ranging from 2.5 to 10 mg/day) of desipramine were used. Doses were then slowly increased to an average daily dose of 25 mg. Eleven patients who were able to tolerate an initial increase in panic anxiety responded to this treatment strategy with almost full resolution of panic attacks. The authors discuss the possible value and mechanisms of low dose treatment of cocaine-related panic attacks.
    Journal of Nervous & Mental Disease 01/1992; 179(12):755-8. · 1.84 Impact Factor