Deborah L. Ackerman

University of California, Los Angeles, Los Angeles, CA, United States

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Publications (6)21.41 Total impact

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    ABSTRACT: The purpose of this study was to explore the efficacy of adding an atypical antipsychotic, olanzapine, to a serotonin reuptake inhibitor (SRI) in treatment-refractory obsessive-compulsive disorder (OCD). Twenty-six patients aged between 18 and 65 (mean = 41.2, SD = 11.9) years meeting DSM-IV criteria for OCD, who had not responded to SRIs, were treated for 6 weeks in a double-blind, placebo-controlled augmentation study with either olanzapine (up to 20 mg/day) or placebo. Severity of illness was assessed biweekly by the Yale-Brown Obsessive Compulsive Scale (Y-BOCS). Analysis of covariance with baseline Y-BOCS score included as a covariate was used to compare improvement in Y-BOCS scores in the 2 groups. Response was defined as a 25% or greater improvement in Y-BOCS score. Data were collected between April 2001 and May 2003. Outcome was assessed for all patients using the last observation carried forward. Subjects in the olanzapine group had a mean decrease of 4.2 (SD = 7.9) in Y-BOCS score compared with a mean increase in score of 0.54 (SD = 1.31) for subjects in the placebo group (F = 4.85, df = 2,23; p =.04). Six (46%) of 13 subjects in the olanzapine group showed a 25% or greater improvement in Y-BOCS score compared with none in the placebo group. The final mean dose of olanzapine was 11.2 (SD = 6.5) mg/day. Medication was well tolerated. Only 2 (15%) of 13 subjects who received olanzapine discontinued because of side effects: sedation (N = 1) or weight gain (N = 1). These results provide preliminary evidence that adding olanzapine to SRIs is potentially efficacious and well tolerated in the short-term treatment of patients with refractory OCD. Controlled studies with larger sample sizes are necessary to more definitively address this treatment strategy.
    The Journal of Clinical Psychiatry 05/2004; 65(4):565-8. DOI:10.4088/JCP.v65n0418 · 5.50 Impact Factor
  • 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. DOI:10.1097/00004714-200206000-00012 · 3.24 Impact Factor
  • Deborah L Ackerman · Jürgen Unützer · Sander Greenland · Michael Gitlin
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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. DOI:10.1002/pds.694 · 2.94 Impact Factor
  • Deborah L. Ackerman · Sander Greenland · Alexander Bystritsky · Gary W. Small
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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. DOI:10.1097/00004714-200012000-00012 · 3.24 Impact Factor
  • Deborah L. Ackerman · Sander Greenland · Alexander 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. DOI:10.1097/00004714-199910000-00010 · 3.24 Impact Factor
  • Deborah L. Ackerman · Sander Greenland · Alexander 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. DOI:10.1097/00004714-199806000-00002 · 3.24 Impact Factor