101
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Popovic D, Schiltz K, Falkai P, Koutsouleris N. Präzisionspsychiatrie und der Beitrag von Brain Imaging und anderen Biomarkern. FORTSCHRITTE DER NEUROLOGIE-PSYCHIATRIE 2020; 88:778-785. [PMID: 33307561 DOI: 10.1055/a-1300-2162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
'Precision Psychiatry' as the psychiatric variant of 'Precision Medicine' aims to provide high-level diagnosis and treatment based on robust biomarkers and tailored to the individual clinical, neurobiological, and genetic constitution of the patient. The specific peculiarity of psychiatry, in which disease entities are normatively defined based on clinical experience and are also significantly influenced by contemporary history, society and philosophy, has so far made the search for valid and reliable psychobiological connections difficult. Nevertheless, considerable progress has now been made in all areas of psychiatric research, made possible above all by the critical review and renewal of previous concepts of disease and psychopathology, the increased orientation towards neurobiology and genetics, and in particular the use of machine learning methods. Notably, modern machine learning methods make it possible to integrate high-dimensional and multimodal data sets and generate models which provide new psychobiological insights and offer the possibility of individualized, biomarker-driven single-subject prediction of diagnosis, therapy response and prognosis. The aim of the present review is therefore to introduce the concept of 'Precision Psychiatry' to the interested reader, to concisely present modern, machine learning methods required for this, and to clearly present the current state and future of biomarker-based 'precision psychiatry'.
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Affiliation(s)
- David Popovic
- Klinikum der Universität München, Klinik und Poliklinik für Psychiatrie und Psychotherapie.,International Max Planck Research School for Translational Psychiatry
| | - Kolja Schiltz
- Klinikum der Universität München, Klinik und Poliklinik für Psychiatrie und Psychotherapie
| | - Peter Falkai
- Klinikum der Universität München, Klinik und Poliklinik für Psychiatrie und Psychotherapie.,International Max Planck Research School for Translational Psychiatry
| | - Nikolaos Koutsouleris
- Klinikum der Universität München, Klinik und Poliklinik für Psychiatrie und Psychotherapie.,International Max Planck Research School for Translational Psychiatry
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102
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Nussbaum AM. Questionable Agreement: The Experience of Depression and DSM-5 Major Depressive Disorder Criteria. THE JOURNAL OF MEDICINE AND PHILOSOPHY 2020; 45:623-643. [PMID: 33206179 DOI: 10.1093/jmp/jhaa025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Immediately before the release of DSM-5, a group of psychiatric thought leaders published the results of field tests of DSM-5 diagnostic criteria. They characterized the interrater reliability for diagnosing major depressive disorder by two trained mental health practitioners as of "questionable agreement." These field tests confirmed an open secret among psychiatrists that our current diagnostic criteria for diagnosing major depressive disorder are unreliable and neglect essential experiences of persons in depressive episodes. Alternative diagnostic criteria exist, but psychiatrists rarely encounter them, forestalling the discipline's epistemological crisis. In Alsadair MacIntyre's classic essay, such crises occur in science when a person encounters a rival schemata that is incompatible with their current schemata and subsequently constructs a narrative that allows them to reconstruct their own tradition. In search of rival schemata that are in conversation with their own tradition, psychiatric practitioners can utilize alternative diagnostic criteria like the Cultural Formulation Interview, embrace an epistemologically humble psychiatry, and attend to the narrative experience of a person experiencing a depressive episode.
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103
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Chen Y, Zeng D, Wang Y. Learning Individualized Treatment Rules for Multiple-Domain Latent Outcomes. J Am Stat Assoc 2020; 116:269-282. [PMID: 34776561 PMCID: PMC8589272 DOI: 10.1080/01621459.2020.1817751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Revised: 03/15/2020] [Accepted: 04/04/2020] [Indexed: 10/23/2022]
Abstract
For many mental disorders, latent mental status from multiple-domain psychological or clinical symptoms may perform as a better characterization of the underlying disorder status than a simple summary score of the symptoms, and they may also serve as more reliable and representative features to differentiate treatment responses. Therefore, in order to address the complexity and heterogeneity of treatment responses for mental disorders, we provide a new paradigm for learning optimal individualized treatment rules (ITRs) by modeling patients' latent mental status. We first learn the multi-domain latent states at baseline from the observed symptoms under a restricted Boltzmann machine (RBM) model, through which patients' heterogeneous symptoms are represented using an economical number of latent variables and yet remains flexible. We then optimize a value function defined by the latent states after treatment by exploiting a transformation of the observed symptoms based on the RBM without modeling the relationship between the latent mental states before and after treatment. The optimal treatment rules are derived using a weighted large margin classifier. We derive the convergence rate of the proposed estimator under the latent models. Simulation studies are conducted to test the performance of the proposed method. Finally, we apply the developed method to real world studies and we demonstrate the utility and advantage of our method in tailoring treatments for patients with major depression, and identify patient subgroups informative for treatment recommendations.
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Affiliation(s)
- Yuan Chen
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY 10032
| | - Donglin Zeng
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27516
| | - Yuanjia Wang
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY 10032
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104
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Kato M, Asami Y, Wajsbrot DB, Wang X, Boucher M, Prieto R, Pappadopulos E. Clustering patients by depression symptoms to predict venlafaxine ER antidepressant efficacy: Individual patient data analysis. J Psychiatr Res 2020; 129:160-167. [PMID: 32912597 DOI: 10.1016/j.jpsychires.2020.06.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 05/19/2020] [Accepted: 06/10/2020] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To identify clusters of patients with major depressive disorder (MDD) based on the baseline 17-item Hamilton Rating Scale for Depression (HAM-D17) items and to evaluate the efficacy of venlafaxine extended release (VEN) vs placebo, and the potential effect of dose on efficacy, in each cluster. METHODS Cluster analysis was performed to identify clusters based on standardized HAM-D17 item scores of individual patient data at baseline from 9 double-blind, placebo-controlled studies of VEN for MDD. Change from baseline in HAM-D17 total score was analyzed using a mixed-effects model for repeated measures for each cluster; response and remission rates at week 8 were analyzed using logistic regression. Discontinuation rates were also evaluated in each cluster. RESULTS In 2599 patients, 3 patient clusters were identified, characterized as High modified Core (mCore) Symptoms/High Anxiety (cluster 1), High mCore Symptoms/Medium Anxiety (cluster 2), and Medium mCore Symptoms/Medium Anxiety (cluster 3). Significant effects of VEN vs placebo were observed on change from baseline in HAM-D17 total score at week 8 for both clusters 1 and 2 (both P < 0.001), but not for cluster 3. In cluster 3, a significant treatment effect of VEN was observed at week 8 in the lower-dose subgroup but not in the higher-dose subgroup. All-cause discontinuation rates were significantly higher in placebo than VEN in each cluster. CONCLUSIONS Three unique clusters of patients were identified differing in baseline mCore symptoms and anxiety. Cluster membership may predict efficacy outcomes and contribute to dose effects in patients treated with VEN. CLINICAL TRIALS REGISTRATION NCT01441440; other studies included in this analysis were conducted before the requirement to register clinical studies took effect.
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Affiliation(s)
- Masaki Kato
- Department of Neuropsychiatry, Kansai Medical University, Osaka, Japan.
| | - Yuko Asami
- Upjohn Medical Affairs, Pfizer Japan Inc., Tokyo, Japan
| | | | | | - Matthieu Boucher
- Pfizer Canada Inc, Kirkland, Canada; McGill University, Montréal, QC, Canada
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105
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Maj M, Stein DJ, Parker G, Zimmerman M, Fava GA, De Hert M, Demyttenaere K, McIntyre RS, Widiger T, Wittchen HU. The clinical characterization of the adult patient with depression aimed at personalization of management. World Psychiatry 2020; 19:269-293. [PMID: 32931110 PMCID: PMC7491646 DOI: 10.1002/wps.20771] [Citation(s) in RCA: 173] [Impact Index Per Article: 43.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Depression is widely acknowledged to be a heterogeneous entity, and the need to further characterize the individual patient who has received this diagnosis in order to personalize the management plan has been repeatedly emphasized. However, the research evidence that should guide this personalization is at present fragmentary, and the selection of treatment is usually based on the clinician's and/or the patient's preference and on safety issues, in a trial-and-error fashion, paying little attention to the particular features of the specific case. This may be one of the reasons why the majority of patients with a diagnosis of depression do not achieve remission with the first treatment they receive. The predominant pessimism about the actual feasibility of the personalization of treatment of depression in routine clinical practice has recently been tempered by some secondary analyses of databases from clinical trials, using approaches such as individual patient data meta-analysis and machine learning, which indicate that some variables may indeed contribute to the identification of patients who are likely to respond differently to various antidepressant drugs or to antidepressant medication vs. specific psychotherapies. The need to develop decision support tools guiding the personalization of treatment of depression has been recently reaffirmed, and the point made that these tools should be developed through large observational studies using a comprehensive battery of self-report and clinical measures. The present paper aims to describe systematically the salient domains that should be considered in this effort to personalize depression treatment. For each domain, the available research evidence is summarized, and the relevant assessment instruments are reviewed, with special attention to their suitability for use in routine clinical practice, also in view of their possible inclusion in the above-mentioned comprehensive battery of measures. The main unmet needs that research should address in this area are emphasized. Where the available evidence allows providing the clinician with specific advice that can already be used today to make the management of depression more personalized, this advice is highlighted. Indeed, some sections of the paper, such as those on neurocognition and on physical comorbidities, indicate that the modern management of depression is becoming increasingly complex, with several components other than simply the choice of an antidepressant and/or a psychotherapy, some of which can already be reliably personalized.
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Affiliation(s)
- Mario Maj
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | - Dan J Stein
- South African Medical Research Council Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry and Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Gordon Parker
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Mark Zimmerman
- Department of Psychiatry and Human Behavior, Brown University School of Medicine, Rhode Island Hospital, Providence, RI, USA
| | - Giovanni A Fava
- Department of Psychiatry, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Marc De Hert
- University Psychiatric Centre KU Leuven, Kortenberg, Belgium
- KU Leuven Department of Neurosciences, Leuven, Belgium
| | - Koen Demyttenaere
- University Psychiatric Centre, University of Leuven, Leuven, Belgium
| | - Roger S McIntyre
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Thomas Widiger
- Department of Psychology, University of Kentucky, Lexington, KY, USA
| | - Hans-Ulrich Wittchen
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
- Department of Psychiatry and Psychotherapy, Ludwig Maximilans Universität Munich, Munich, Germany
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106
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Milaneschi Y, Lamers F, Berk M, Penninx BWJH. Depression Heterogeneity and Its Biological Underpinnings: Toward Immunometabolic Depression. Biol Psychiatry 2020; 88:369-380. [PMID: 32247527 DOI: 10.1016/j.biopsych.2020.01.014] [Citation(s) in RCA: 186] [Impact Index Per Article: 46.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 12/03/2019] [Accepted: 01/18/2020] [Indexed: 12/14/2022]
Abstract
Epidemiological evidence indicates the presence of dysregulated homeostatic biological pathways in depressed patients, such as increased inflammation and disrupted energy-regulating neuroendocrine signaling (e.g., leptin, insulin). Alterations in these biological pathways may explain the considerable comorbidity between depression and cardiometabolic conditions (e.g., obesity, metabolic syndrome, diabetes) and represent a promising target for intervention. This review describes how immunometabolic dysregulations vary as a function of depression heterogeneity by illustrating that such biological dysregulations map more consistently to atypical behavioral symptoms reflecting altered energy intake/expenditure balance (hyperphagia, weight gain, hypersomnia, fatigue, and leaden paralysis) and may moderate the antidepressant effects of standard or novel (e.g., anti-inflammatory) therapeutic approaches. These lines of evidence are integrated in a conceptual model of immunometabolic depression emerging from the clustering of immunometabolic biological dysregulations and specific behavioral symptoms. The review finally elicits questions to be answered by future research and describes how the immunometabolic depression dimension could be used to dissect the heterogeneity of depression and potentially to match subgroups of patients to specific treatments with higher likelihood of clinical success.
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Affiliation(s)
- Yuri Milaneschi
- Department of Psychiatry, Amsterdam Public Health and Amsterdam Neuroscience, Amsterdam University Medical Center/Vrije Universiteit & GGZinGeest, Amsterdam, The Netherlands.
| | - Femke Lamers
- Department of Psychiatry, Amsterdam Public Health and Amsterdam Neuroscience, Amsterdam University Medical Center/Vrije Universiteit & GGZinGeest, Amsterdam, The Netherlands
| | - Michael Berk
- Institute for Mental and Physical Health and Clinical Treatment, School of Medicine, Deakin University and Barwon Health, Geelong, Victoria, Australia; Orygen, The National Centre of Excellence in Youth Mental Health, Department of Psychiatry, University of Melbourne, Melbourne, Victoria, Australia; Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Brenda W J H Penninx
- Department of Psychiatry, Amsterdam Public Health and Amsterdam Neuroscience, Amsterdam University Medical Center/Vrije Universiteit & GGZinGeest, Amsterdam, The Netherlands
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107
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Jiang T, Gradus JL, Rosellini AJ. Supervised Machine Learning: A Brief Primer. Behav Ther 2020; 51:675-687. [PMID: 32800297 PMCID: PMC7431677 DOI: 10.1016/j.beth.2020.05.002] [Citation(s) in RCA: 164] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 05/13/2020] [Accepted: 05/13/2020] [Indexed: 12/23/2022]
Abstract
Machine learning is increasingly used in mental health research and has the potential to advance our understanding of how to characterize, predict, and treat mental disorders and associated adverse health outcomes (e.g., suicidal behavior). Machine learning offers new tools to overcome challenges for which traditional statistical methods are not well-suited. This paper provides an overview of machine learning with a specific focus on supervised learning (i.e., methods that are designed to predict or classify an outcome of interest). Several common supervised learning methods are described, along with applied examples from the published literature. We also provide an overview of supervised learning model building, validation, and performance evaluation. Finally, challenges in creating robust and generalizable machine learning algorithms are discussed.
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Affiliation(s)
| | - Jaimie L Gradus
- Boston University School of Public Health; Boston University School of Medicine
| | - Anthony J Rosellini
- Center for Anxiety and Related Disorders, Boston University; Department of Psychological and Brain Sciences, Boston University.
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108
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Meyer AE, Curry JF. Moderators of Treatment for Adolescent Depression. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2020; 50:486-497. [DOI: 10.1080/15374416.2020.1796683] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
| | - John F. Curry
- Department of Psychology and Neuroscience, Duke University
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center
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109
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Nunes A, Trappenberg T, Alda M. The definition and measurement of heterogeneity. Transl Psychiatry 2020; 10:299. [PMID: 32839448 PMCID: PMC7445182 DOI: 10.1038/s41398-020-00986-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 07/21/2020] [Accepted: 08/10/2020] [Indexed: 12/31/2022] Open
Abstract
Heterogeneity is an important concept in psychiatric research and science more broadly. It negatively impacts effect size estimates under case-control paradigms, and it exposes important flaws in our existing categorical nosology. Yet, our field has no precise definition of heterogeneity proper. We tend to quantify heterogeneity by measuring associated correlates such as entropy or variance: practices which are akin to accepting the radius of a sphere as a measure of its volume. Under a definition of heterogeneity as the degree to which a system deviates from perfect conformity, this paper argues that its proper measure roughly corresponds to the size of a system's event/sample space, and has units known as numbers equivalent. We arrive at this conclusion through focused review of more than 100 years of (re)discoveries of indices by ecologists, economists, statistical physicists, and others. In parallel, we review psychiatric approaches for quantifying heterogeneity, including but not limited to studies of symptom heterogeneity, microbiome biodiversity, cluster-counting, and time-series analyses. We argue that using numbers equivalent heterogeneity measures could improve the interpretability and synthesis of psychiatric research on heterogeneity. However, significant limitations must be overcome for these measures-largely developed for economic and ecological research-to be useful in modern translational psychiatric science.
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Affiliation(s)
- Abraham Nunes
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
- Faculty of Computer Science, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Thomas Trappenberg
- Faculty of Computer Science, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Martin Alda
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada.
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110
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Phua DY, Chen H, Chong YS, Gluckman PD, Broekman BFP, Meaney MJ. Network Analyses of Maternal Pre- and Post-Partum Symptoms of Depression and Anxiety. Front Psychiatry 2020; 11:785. [PMID: 32848949 PMCID: PMC7424069 DOI: 10.3389/fpsyt.2020.00785] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 07/22/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Maternal mental health problems often develop prenatally and predict post-partum mental health. However, the circumstances before and following childbirth differ considerably. We currently lack an understanding of dynamic variation in the profiles of depressive and anxiety symptoms over the perinatal period. METHODS Depressive and anxiety symptoms were self-reported by 980 women at 26-week pregnancy and 3 months post-partum. We used network analysis of depressive and anxiety symptoms to investigate if the symptoms network changed during and after pregnancy. The pre- and post-partum depressive-anxiety symptom networks were assessed for changes in structure, unique symptom-symptom interactions, central and bridging symptoms. We also assessed if central symptoms had stronger predictive effect on offspring's developmental outcomes outcomes at birth and 24, 54, and 72 months old than non-central symptoms. Bridging symptoms between negative and positive mental health were also assessed. RESULTS Though the depressive-anxiety network structures were stable during and after pregnancy, the post-partum network was more strongly connected. The central depressive-anxiety symptoms were also different between prenatal and post-partum networks. During pregnancy, central symptoms were mostly related to feeling worthless or useless; after pregnancy, central symptoms were mostly related to feeling overwhelmed or being punished. Central symptoms during pregnancy were associated with poorer developmental outcomes for the child. Anxiety symptoms were strongest bridging symptoms during and after pregnancy. The interactions between negative and positive mental health symptoms were also different during and after pregnancy. CONCLUSIONS The differences between pre- and post-partum networks suggest that the presentation of maternal mental health problems varies over the peripartum period. This variation is not captured by traditional symptom scale scores. The bridging symptoms also suggest that anxiety symptoms may precede the development of maternal depression. Interventions and public health policies should thus be tailored to specific pre- and post-partum symptom profiles.
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Affiliation(s)
- Desiree Y. Phua
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (ASTAR), Singapore, Singapore
| | - Helen Chen
- Department of Psychological Medicine, KK Women’s and Children’s Hospital, Singapore, Singapore
| | - Yap Seng Chong
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (ASTAR), Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Peter D. Gluckman
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (ASTAR), Singapore, Singapore
- Centre for Human Evolution, Adaptation and Disease, Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Birit F. P. Broekman
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (ASTAR), Singapore, Singapore
- Amsterdam UMC and OLVG, VU University, Amsterdam, Netherlands
| | - Michael J. Meaney
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (ASTAR), Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Sackler Program for Epigenetics & Psychobiology, McGill University, Montreal, QC, Canada
- Department of Psychiatry, Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada
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111
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Nemeroff CB. The State of Our Understanding of the Pathophysiology and Optimal Treatment of Depression: Glass Half Full or Half Empty? Am J Psychiatry 2020; 177:671-685. [PMID: 32741287 DOI: 10.1176/appi.ajp.2020.20060845] [Citation(s) in RCA: 80] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Major depressive disorder is a remarkably common and often severe psychiatric disorder associated with high levels of morbidity and mortality. Patients with major depression are prone to several comorbid psychiatric conditions, including posttraumatic stress disorder, anxiety disorders, obsessive-compulsive disorder, and substance use disorders, and medical conditions, including cardiovascular disease, diabetes, stroke, cancer, which, coupled with the risk of suicide, result in a shortened life expectancy. The goal of this review is to provide an overview of our current understanding of major depression, from pathophysiology to treatment. In spite of decades of research, relatively little is known about its pathogenesis, other than that risk is largely defined by a combination of ill-defined genetic and environmental factors. Although we know that female sex, a history of childhood maltreatment, and family history as well as more recent stressors are risk factors, precisely how these environmental influences interact with genetic vulnerability remains obscure. In recent years, considerable advances have been made in beginning to understand the genetic substrates that underlie disease vulnerability, and the interaction of genes, early-life adversity, and the epigenome in influencing gene expression is now being intensively studied. The role of inflammation and other immune system dysfunction in the pathogenesis of major depression is also being intensively investigated. Brain imaging studies have provided a firmer understanding of the circuitry involved in major depression, providing potential new therapeutic targets. Despite a broad armamentarium for major depression, including antidepressants, evidence-based psychotherapies, nonpharmacological somatic treatments, and a host of augmentation strategies, a sizable percentage of patients remain nonresponsive or poorly responsive to available treatments. Investigational agents with novel mechanisms of action are under active study. Personalized medicine in psychiatry provides the hope of escape from the current standard trial-and-error approach to treatment, moving to a more refined method that augurs a new era for patients and clinicians alike.
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Affiliation(s)
- Charles B Nemeroff
- Department of Psychiatry and Behavioral Sciences, University of Texas Dell Medical School in Austin, and Mulva Clinic for the Neurosciences, UT Health Austin
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112
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Predicting second-generation antidepressant effectiveness in treating sadness using demographic and clinical information: A machine learning approach. J Affect Disord 2020; 272:295-304. [PMID: 32553371 DOI: 10.1016/j.jad.2020.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 03/24/2020] [Accepted: 04/17/2020] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Current guidelines for choosing antidepressant medications involve a trial-and-error process. Most patients try multiple antidepressants before finding an effective antidepressant. This study uses demographic and clinical information to create models predicting effectiveness of different antidepressants in treating sadness in a nationally representative sample of US adults. METHODS A secondary analysis of the Collaborative Psychiatric Epidemiology Survey (CPES) was performed. Participants with or without a mental health diagnosis who reported sadness as a symptom, and were taking fluoxetine (n=156), sertraline (n=224), citalopram (n=91), paroxetine (n=156), venlafaxine (n=69), bupropion (n=92), or trazadone (n=26) within the past year were included. Two sets of principal component analyses (PCAs) and logistic regressions were performed: one determined associations between symptom clusters and antidepressant effectiveness for sadness, and the other created models to predict effectiveness. Both PCAs controlled for psychiatric and medical diagnoses, substance use, psychiatric medications, alternative treatments, and demographics. RESULTS Anxiety was associated with ineffectiveness of fluoxetine in treating sadness. Low mood scores were associated with ineffectiveness of paroxetine and venlafaxine, and fatigue was associated with ineffectiveness of sertraline. The models for predicting drug effectiveness had a mean accuracy of 83% and internal validity of 72%. LIMITATIONS CPES data were collected from 2001-2003, so newer drugs were not included. Effectiveness was for sadness, so results are not directly comparable to studies using overall depressive symptom reductions as outcomes. CONCLUSION Since fewer than 50% of patients currently respond to their first antidepressant, this model could provide modest improvement to choosing starting antidepressants in treating sadness.
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113
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Yuan Y, Min HS, Lapane KL, Rothschild AJ, Ulbricht CM. Depression symptoms and cognitive impairment in older nursing home residents in the USA: A latent class analysis. Int J Geriatr Psychiatry 2020; 35:769-778. [PMID: 32250496 PMCID: PMC7552436 DOI: 10.1002/gps.5301] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 03/12/2020] [Accepted: 03/28/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVES To identify subgroups of nursing home (NH) residents in the USA experiencing homogenous depression symptoms and evaluate if subgroups vary by cognitive impairment. METHODS We identified 104 465 newly admitted, long-stay residents with depression diagnosis at NH admission in 2014 using the Minimum Data Set 3.0. The Patient Health Questionnaire-9 was used to measure depression symptoms and the Brief Interview of Mental Status for cognitive impairment (intact; moderately impaired; severely impaired). Latent class analysis (LCA) with logistic regression was used to: (a) construct the depression subgroups and (b) estimate adjusted odds ratios (aOR) and 95% confidence intervals (CI) of the associations between the subgroups and cognitive impairment level, adjusting for demographic and clinical characteristics. RESULTS The best-fitted LCA model suggested four subgroups of depression: minimal symptoms (latent class prevalence: 42.4%), fatigue (32.0%), depressed mood (14.5%), and multiple symptoms (11.2%). Odds of subgroup membership varied by cognitive impairment. Compared to residents with intact cognition, those with moderate or severe cognitive impairment were less likely to belong to the fatigue subgroup [aOR(95% CI): moderate: 0.75 (0.71-0.80); severe: 0.26 (0.23-0.29)] and more likely to belong to the depressed mood subgroup [aOR (95% CI): moderate: 4.54 (3.55-5.81); severe: 6.41 (4.86-8.44)]. Residents with moderate cognitive impairment had increased odds [aOR (95% CI): 1.19 (1.12-1.27)] while those with severe impairment had reduced odds of being in the multiple symptoms subgroup [aOR (95% CI): 0.63 (0.58-0.68)]. CONCLUSIONS Findings provide a basis for improving depression management with consideration of both subgroups of depression symptoms and levels of cognitive function.
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Affiliation(s)
- Yiyang Yuan
- Clinical and Population Health Research PhD Program,
Graduate School of Biomedical Sciences, University of Massachusetts Medical School,
Worcester, MA, USA,Department of Population and Quantitative Health Sciences,
University of Massachusetts Medical School, Worcester, MA, USA
| | - Hye Sung Min
- Department of Population and Quantitative Health Sciences,
University of Massachusetts Medical School, Worcester, MA, USA
| | - Kate L. Lapane
- Department of Population and Quantitative Health Sciences,
University of Massachusetts Medical School, Worcester, MA, USA
| | - Anthony J. Rothschild
- Department of Psychiatry, University of Massachusetts
Medical School and UMass Memorial Healthcare, Worcester, MA, USA
| | - Christine M. Ulbricht
- Department of Population and Quantitative Health Sciences,
University of Massachusetts Medical School, Worcester, MA, USA
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114
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Maslej MM, Furukawa TA, Cipriani A, Andrews PW, Mulsant BH. Individual Differences in Response to Antidepressants: A Meta-analysis of Placebo-Controlled Randomized Clinical Trials. JAMA Psychiatry 2020; 77:607-617. [PMID: 32074273 PMCID: PMC7042922 DOI: 10.1001/jamapsychiatry.2019.4815] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
IMPORTANCE Antidepressants are commonly used worldwide to treat major depressive disorder. Symptomatic response to antidepressants can vary depending on differences between individuals; however, this variability may reflect nonspecific or random factors. OBJECTIVES To investigate the assumption of systematic variability in symptomatic response to antidepressants and to assess whether this variability is associated with severity of major depressive disorder, antidepressant class, or year of study publication. DATA SOURCES Data used were from a recent network meta-analysis of acute treatment with licensed antidepressants in adults with major depressive disorder. The following databases were searched from inception to January 8, 2016: the Cochrane Central Register of Controlled Trials, CINAHL, Embase, LILACS database, MEDLINE, MEDLINE In-Process, and PsycINFO. Additional sources were international trial registries, drug approval agency websites, and key scientific journals. STUDY SELECTION Analysis was restricted to double-blind, randomized placebo-controlled trials with available data at the study's end point. DATA EXTRACTION AND SYNTHESIS Baseline and end point means, SDs, number of participants in each group, antidepressant class, and publication year were extracted. The data were analyzed between August 14 and November 18, 2019. MAIN OUTCOMES AND MEASURES With the use of validated methods, coefficients of variation were derived for antidepressants and placebo, and their ratios were calculated to compare outcome variability between antidepressant and placebo. Ratios were entered into a random-effects model, with the expectation that response to antidepressants would be more variable than response to placebo. Analysis was repeated after stratifying by baseline severity of depression, antidepressant class (selective serotonin reuptake inhibitors: citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline, and vilazodone; serotonin and norepinephrine reuptake inhibitors: desvenlafaxine and venlafaxine; norepinephrine-dopamine reuptake inhibitor: bupropion; noradrenergic agents: amitriptyline and reboxetine; and other antidepressants: agomelatine, mirtazapine, and trazodone), and publication year. RESULTS In the 87 eligible randomized placebo-controlled trials (17 540 unique participants), there was significantly more variability in response to antidepressants than to placebo (coefficients of variation ratio, 1.14; 95% CI, 1.11-1.17; P < .001). Baseline severity of depression did not moderate variability in response to antidepressants. Variability in response to selective serotonin reuptake inhibitors was lower than variability in response to noradrenergic agents (coefficients of variation ratio, 0.88; 95% CI, 0.80-0.97; P = .01), as was the variability in response to other antidepressants compared with noradrenergic agents (coefficients of variation ratio, 0.87; 95% CI, 0.79-0.97; P = .001). Variability also tended to be lower in studies that were published more recently, with coefficients of variation changing by a value of 0.005 (95% CI, 0.002-0.008; P = .003) for every year a study is more recent. CONCLUSIONS AND RELEVANCE Individual differences may be systematically associated with responses to antidepressants in major depressive disorder beyond placebo effects or statistical factors. This study provides empirical support for identifying moderators and personalizing antidepressant treatment.
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Affiliation(s)
- Marta M. Maslej
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Toshiaki A. Furukawa
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine, School of Public Health, Yoshida-Konoe, Sakyo, Kyoto, Japan,Department of Clinical Epidemiology, Kyoto University Graduate School of Medicine, Kyoto University School of Public Health, Yoshida-Konoe, Sakyo, Kyoto, Japan
| | - Andrea Cipriani
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom,Warneford Hospital, Oxford Health National Health Service Foundation Trust, Oxford, United Kingdom
| | - Paul W. Andrews
- Department of Psychology, Neuroscience & Behaviour, McMaster University, Hamilton, Ontario, Canada
| | - Benoit H. Mulsant
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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Schmaal L, Pozzi E, C Ho T, van Velzen LS, Veer IM, Opel N, Van Someren EJW, Han LKM, Aftanas L, Aleman A, Baune BT, Berger K, Blanken TF, Capitão L, Couvy-Duchesne B, R Cullen K, Dannlowski U, Davey C, Erwin-Grabner T, Evans J, Frodl T, Fu CHY, Godlewska B, Gotlib IH, Goya-Maldonado R, Grabe HJ, Groenewold NA, Grotegerd D, Gruber O, Gutman BA, Hall GB, Harrison BJ, Hatton SN, Hermesdorf M, Hickie IB, Hilland E, Irungu B, Jonassen R, Kelly S, Kircher T, Klimes-Dougan B, Krug A, Landrø NI, Lagopoulos J, Leerssen J, Li M, Linden DEJ, MacMaster FP, M McIntosh A, Mehler DMA, Nenadić I, Penninx BWJH, Portella MJ, Reneman L, Rentería ME, Sacchet MD, G Sämann P, Schrantee A, Sim K, Soares JC, Stein DJ, Tozzi L, van Der Wee NJA, van Tol MJ, Vermeiren R, Vives-Gilabert Y, Walter H, Walter M, Whalley HC, Wittfeld K, Whittle S, Wright MJ, Yang TT, Zarate C, Thomopoulos SI, Jahanshad N, Thompson PM, Veltman DJ. ENIGMA MDD: seven years of global neuroimaging studies of major depression through worldwide data sharing. Transl Psychiatry 2020; 10:172. [PMID: 32472038 PMCID: PMC7260219 DOI: 10.1038/s41398-020-0842-6] [Citation(s) in RCA: 111] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 04/09/2020] [Accepted: 05/07/2020] [Indexed: 02/06/2023] Open
Abstract
A key objective in the field of translational psychiatry over the past few decades has been to identify the brain correlates of major depressive disorder (MDD). Identifying measurable indicators of brain processes associated with MDD could facilitate the detection of individuals at risk, and the development of novel treatments, the monitoring of treatment effects, and predicting who might benefit most from treatments that target specific brain mechanisms. However, despite intensive neuroimaging research towards this effort, underpowered studies and a lack of reproducible findings have hindered progress. Here, we discuss the work of the ENIGMA Major Depressive Disorder (MDD) Consortium, which was established to address issues of poor replication, unreliable results, and overestimation of effect sizes in previous studies. The ENIGMA MDD Consortium currently includes data from 45 MDD study cohorts from 14 countries across six continents. The primary aim of ENIGMA MDD is to identify structural and functional brain alterations associated with MDD that can be reliably detected and replicated across cohorts worldwide. A secondary goal is to investigate how demographic, genetic, clinical, psychological, and environmental factors affect these associations. In this review, we summarize findings of the ENIGMA MDD disease working group to date and discuss future directions. We also highlight the challenges and benefits of large-scale data sharing for mental health research.
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Affiliation(s)
- Lianne Schmaal
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia.
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia.
| | - Elena Pozzi
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Tiffany C Ho
- Department of Psychology, Stanford University, Stanford, CA, USA
- Department of Psychiatry & Behavioral Sciences, Stanford University, Stanford, CA, USA
- Department of Psychiatry & Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Laura S van Velzen
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Ilya M Veer
- Division of Mind and Brain Research, Department of Psychiatry and Psychotherapy CCM, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Nils Opel
- Department of Psychiatry, University of Münster, Münster, Germany
| | - Eus J W Van Someren
- Department of Sleep and Cognition, Netherlands Institute for Neuroscience (NIN), an institute of the Royal Netherlands Academy of Arts and Sciences, Amsterdam, Netherlands
- Department of Integrative Neurophysiology, Center for Neurogenomics and Cognitive Research (CNCR), Amsterdam Neuroscience, VU University Amsterdam, Amsterdam, The Netherlands
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Laura K M Han
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Lybomir Aftanas
- FSSBI Scientific Research Institute of Physiology & Basic Medicine, Laboratory of Affective, Cognitive & Translational Neuroscience, Novosibirsk, Russia
- Department of Neuroscience, Novosibirsk State University, Novosibirsk, Russia
| | - André Aleman
- Department of Biomedical Sciences of Cells and Systems, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Bernhard T Baune
- Department of Psychiatry, University of Münster, Münster, Germany
- Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Klaus Berger
- Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany
| | - Tessa F Blanken
- Department of Sleep and Cognition, Netherlands Institute for Neuroscience (NIN), an institute of the Royal Netherlands Academy of Arts and Sciences, Amsterdam, Netherlands
- Department of Integrative Neurophysiology, Center for Neurogenomics and Cognitive Research (CNCR), Amsterdam Neuroscience, VU University Amsterdam, Amsterdam, The Netherlands
| | - Liliana Capitão
- Department of Psychiatry, Oxford University, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
| | | | - Kathryn R Cullen
- Department of Psychology, University of Minnesota, Minneapolis, MN, USA
| | - Udo Dannlowski
- Department of Psychiatry, University of Münster, Münster, Germany
| | - Christopher Davey
- Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia
| | - Tracy Erwin-Grabner
- Laboratory of Systems Neuroscience and Imaging in Psychiatry (SNIP-Lab), University Medical Center Göttingen, Göttingen, Germany
| | - Jennifer Evans
- Experimental Therapeutics Branch, NIMH, NIH, Bethesda, MD, USA
| | - Thomas Frodl
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany
| | - Cynthia H Y Fu
- School of Psychology, University of East London, London, UK
- Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | - Ian H Gotlib
- Department of Psychology, Stanford University, Stanford, CA, USA
| | - Roberto Goya-Maldonado
- Laboratory of Systems Neuroscience and Imaging in Psychiatry (SNIP-Lab), University Medical Center Göttingen, Göttingen, Germany
| | - Hans J Grabe
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Germany
| | - Nynke A Groenewold
- Department of Psychiatry & Mental Health, University of Cape Town, Cape Town, South Africa
| | | | - Oliver Gruber
- Section for Experimental Psychopathology and Neuroimaging, Department of General Psychiatry, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Geoffrey B Hall
- Department of Psychology, Neuroscience & Behaviour, McMaster University, Hamilton, ON, Canada
| | - Ben J Harrison
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne & Melbourne Health, Melbourne, VIC, Australia
| | - Sean N Hatton
- Brain and Mind Centre, University of Sydney, Camperdown, NSW, Australia
| | - Marco Hermesdorf
- Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany
| | - Ian B Hickie
- Brain and Mind Centre, University of Sydney, Camperdown, NSW, Australia
| | - Eva Hilland
- Clinical Neuroscience Research Group, Department of Psychology, University of Oslo, Oslo, Norway
- Department of Psychiatry, Diakonhjemmet Hospital, Oslo, Norway
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Benson Irungu
- Department of Psychiatry & Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Rune Jonassen
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Sinead Kelly
- Beth Israel Deaconess Medical Centre, Harvard Medical School, Boston, MA, USA
| | - Tilo Kircher
- Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany
| | | | - Axel Krug
- Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany
| | - Nils Inge Landrø
- Clinical Neuroscience Research Group, Department of Psychology, University of Oslo, Oslo, Norway
- Department of Psychiatry, Diakonhjemmet Hospital, Oslo, Norway
| | - Jim Lagopoulos
- Sunshine Coast Mind and Neuroscience Thompson Institute, University of the Sunshine Coast, Birtinya, QLD, Australia
| | - Jeanne Leerssen
- Department of Sleep and Cognition, Netherlands Institute for Neuroscience (NIN), an institute of the Royal Netherlands Academy of Arts and Sciences, Amsterdam, Netherlands
- Department of Integrative Neurophysiology, Center for Neurogenomics and Cognitive Research (CNCR), Amsterdam Neuroscience, VU University Amsterdam, Amsterdam, The Netherlands
| | - Meng Li
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany
| | - David E J Linden
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
- MRC Center for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
- Cardiff University Brain Research Imaging Center, Cardiff University, Cardiff, UK
| | - Frank P MacMaster
- Psychiatry and Pediatrics, University of Calgary, Addictions and Mental Health Strategic Clinical Network, Calgary, AB, Canada
| | - Andrew M McIntosh
- Centre for Clinical Brain Science, University of Edinburgh, Edinburgh, UK
| | - David M A Mehler
- Department of Psychiatry, University of Münster, Münster, Germany
- MRC Center for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
- Cardiff University Brain Research Imaging Center, Cardiff University, Cardiff, UK
| | - Igor Nenadić
- Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany
- Marburg University Hospital UKGM, Marburg, Germany
| | - Brenda W J H Penninx
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Maria J Portella
- Institut d'Investigació Biomèdica-Sant Pau, Barcelona, Spain
- CIBERSAM, Madrid, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Liesbeth Reneman
- Department of Radiology and Nuclear Medicine, location AMC, Amsterdam UMC, Amsterdam, The Netherlands
| | - Miguel E Rentería
- Department of Genetics & Computational Biology, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Matthew D Sacchet
- Center for Depression, Anxiety, and Stress Research, McLean Hospital, Harvard Medical School, Belmont, MA, USA
| | | | - Anouk Schrantee
- Department of Radiology and Nuclear Medicine, location AMC, Amsterdam UMC, Amsterdam, The Netherlands
| | - Kang Sim
- West Region/Institute of Mental Health, Singapore, Singapore
- Yong Loo Lin School of Medicine/National University of Singapore, Singapore, Singapore
| | - Jair C Soares
- Department of Psychiatry & Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Dan J Stein
- SA MRC Research Unit on Risk & Resilience in Mental Disorders, Department of Psychiatry & Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Leonardo Tozzi
- Department of Psychiatry & Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Nic J A van Der Wee
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
- Leiden Institute for Brain and Cognition, Leiden University Medical Center, Leiden, The Netherlands
| | - Marie-José van Tol
- Department of Biomedical Sciences of Cells and Systems, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Robert Vermeiren
- Curium-LUMC, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Henrik Walter
- Division of Mind and Brain Research, Department of Psychiatry and Psychotherapy CCM, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Martin Walter
- Department of Psychiatry and Psychotherapy, Jena, Germany
- Clinical Affective Neuroimaging Laboratory, Leibniz Institute for Neurobiology, Magdeburg, Germany
| | - Heather C Whalley
- Centre for Clinical Brain Science, University of Edinburgh, Edinburgh, UK
| | - Katharina Wittfeld
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Germany
| | - Sarah Whittle
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne & Melbourne Health, Melbourne, VIC, Australia
| | - Margaret J Wright
- Queensland Brain Institute, The University of Queensland, Brisbane, QLD, Australia
- Centre for Advanced Imaging, The University of Queensland, Brisbane, QLD, Australia
| | - Tony T Yang
- Department of Psychiatry & Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Carlos Zarate
- Section on the Neurobiology and Treatment of Mood Disorders, National Institute of Mental Health, Bethesda, MD, USA
| | - Sophia I Thomopoulos
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey, CA, USA
| | - Neda Jahanshad
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey, CA, USA
| | - Paul M Thompson
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey, CA, USA
| | - Dick J Veltman
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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116
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Ermers NJ, Hagoort K, Scheepers FE. The Predictive Validity of Machine Learning Models in the Classification and Treatment of Major Depressive Disorder: State of the Art and Future Directions. Front Psychiatry 2020; 11:472. [PMID: 32523557 PMCID: PMC7261928 DOI: 10.3389/fpsyt.2020.00472] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 05/07/2020] [Indexed: 11/13/2022] Open
Abstract
Major depressive disorder imposes a substantial disease burden worldwide, ranking as the third leading contributor to global disability. In spite of its ubiquity, classifying and treating depression has proven troublesome. One argument put forward to explain this predicament is the heterogeneity of patients diagnosed with the disorder. Recently, many areas of daily life have witnessed the surge of machine learning techniques, computational approaches to elucidate complex patterns in large datasets, which can be employed to make predictions and detect relevant clusters. Due to the multidimensionality at play in the pathogenesis of depression, it is suggested that machine learning could contribute to improving classification and treatment. In this paper, we investigated literature focusing on the use of machine learning models on datasets with clinical variables of patients diagnosed with depression to predict treatment outcomes or find more homogeneous subgroups. Identified studies based on best practices in the field are evaluated. We found 16 studies predicting outcomes (such as remission) and identifying clusters in patients with depression. The identified studies are mostly still in proof-of-concept phase, with small datasets, lack of external validation, and providing single performance metrics. Larger datasets, and models with similar variables present across these datasets, are needed to develop accurate and generalizable models. We hypothesize that harnessing natural language processing to obtain data 'hidden' in clinical texts might prove useful in improving prediction models. Besides, researchers will need to focus on the conditions to feasibly implement these models to support psychiatrists and patients in their decision-making in practice. Only then we can enter the realm of precision psychiatry.
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Affiliation(s)
- Nick J. Ermers
- Department of Psychiatry, University Medical Center Utrecht, Utrecht, Netherlands
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117
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Predicting treatment effects in unipolar depression: A meta-review. Pharmacol Ther 2020; 212:107557. [PMID: 32437828 DOI: 10.1016/j.pharmthera.2020.107557] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 04/23/2020] [Indexed: 12/23/2022]
Abstract
There is increasing interest in clinical prediction models in psychiatry, which focus on developing multivariate algorithms to guide personalized diagnostic or management decisions. The main target of these models is the prediction of treatment response to different antidepressant therapies. This is because the ability to predict response based on patients' personal data may allow clinicians to make improved treatment decisions, and to provide more efficacious or more tolerable medications to the right patient. We searched the literature for systematic reviews about treatment prediction in the context of existing treatment modalities for adult unipolar depression, until July 2019. Treatment effect is defined broadly to include efficacy, safety, tolerability and acceptability outcomes. We first focused on the identification of individual predictor variables that might predict treatment response, and second, we considered multivariate clinical prediction models. Our meta-review included a total of 10 systematic reviews; seven (from 2014 to 2018) focusing on individual predictor variables and three focusing on clinical prediction models. These identified a number of sociodemographic, phenomenological, clinical, neuroimaging, remote monitoring, genetic and serum marker variables as possible predictor variables for treatment response, alongside statistical and machine-learning approaches to clinical prediction model development. Effect sizes for individual predictor variables were generally small and clinical prediction models had generally not been validated in external populations. There is a need for rigorous model validation in large external data-sets to prove the clinical utility of models. We also discuss potential future avenues in the field of personalized psychiatry, particularly the combination of multiple sources of data and the emerging field of artificial intelligence and digital mental health to identify new individual predictor variables.
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118
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Neurovegetative symptom subtypes in young people with major depressive disorder and their structural brain correlates. Transl Psychiatry 2020; 10:108. [PMID: 32312958 PMCID: PMC7170873 DOI: 10.1038/s41398-020-0787-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 02/17/2020] [Accepted: 02/26/2020] [Indexed: 01/29/2023] Open
Abstract
Depression is a leading cause of burden of disease among young people. Current treatments are not uniformly effective, in part due to the heterogeneous nature of major depressive disorder (MDD). Refining MDD into more homogeneous subtypes is an important step towards identifying underlying pathophysiological mechanisms and improving treatment of young people. In adults, symptom-based subtypes of depression identified using data-driven methods mainly differed in patterns of neurovegetative symptoms (sleep and appetite/weight). These subtypes have been associated with differential biological mechanisms, including immuno-metabolic markers, genetics and brain alterations (mainly in the ventral striatum, medial orbitofrontal cortex, insular cortex, anterior cingulate cortex amygdala and hippocampus). K-means clustering was applied to individual depressive symptoms from the Quick Inventory of Depressive Symptoms (QIDS) in 275 young people (15-25 years old) with MDD to identify symptom-based subtypes, and in 244 young people from an independent dataset (a subsample of the STAR*D dataset). Cortical surface area and thickness and subcortical volume were compared between the subtypes and 100 healthy controls using structural MRI. Three subtypes were identified in the discovery dataset and replicated in the independent dataset; severe depression with increased appetite, severe depression with decreased appetite and severe insomnia, and moderate depression. The severe increased appetite subtype showed lower surface area in the anterior insula compared to both healthy controls. Our findings in young people replicate the previously identified symptom-based depression subtypes in adults. The structural alterations of the anterior insular cortex add to the existing evidence of different pathophysiological mechanisms involved in this subtype.
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Abstract
Most evidence-based pharmacological guidelines recommend selective serotonin reuptake inhibitors, serotoninnorepinephrine reuptake inhibitors, norepinephrine-dopamine reuptake inhibitors or norepinephrine and specific serotonin antidepressants as the first-line treatment for major depression. Since the clinical factors associated with treating patients with depression are relatively complex, it can be challenging to apply the recommendations of evidence-based medicine verbatim. Furthermore, the diagnostic criteria of major depressive disorders, which are defined in a polythetic and operational manner, inevitably result in their heterogeneity. Studies have inferred that depressive syndrome may be connected with “family resemblance” rather than being shared with a neurobiological essence. Therefore, the symptom-based selection of antidepressants can be supported by a network analysis that provides a novel perspective on the symptom structure of major depression. The symptom-based treatment algorithm suggests treatment options that can be applied to the symptoms that are included in and excluded from the diagnosis criteria of major depressive disorder. The symptom-based selection of antidepressants and other psychotropic agents involves matching the deconstructed symptoms of depression to the specific neuroanatomical regions and neurotransmitters. This ensures timely and optimized treatment options for patients with depression.
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120
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Furukawa TA. Adolescent depression: from symptoms to individualised treatment? Lancet Psychiatry 2020; 7:295-296. [PMID: 32199497 DOI: 10.1016/s2215-0366(20)30080-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 02/12/2020] [Indexed: 11/15/2022]
Affiliation(s)
- Toshi A Furukawa
- Department of Health Promotion and Human Behavior and Department of Clinical Epidemiology, Kyoto University Graduate School of Medicine and School of Public Health Kyoto 606-8501, Japan.
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121
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Sakurai H, Uchida H, Kato M, Suzuki T, Baba H, Watanabe K, Inada K, Kikuchi T, Katsuki A, Kishida I, Sugawara Kikuchi Y, Yasui-Furukori N. Pharmacological management of depression: Japanese expert consensus. J Affect Disord 2020; 266:626-632. [PMID: 32056937 DOI: 10.1016/j.jad.2020.01.149] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 12/13/2019] [Accepted: 01/26/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Clinically relevant issues in the real-world treatment of depression have not always been captured by conventional treatment guidelines. METHODS Certified psychiatrists of the Japanese Society of Clinical Neuropsychopharmacology were asked to evaluate treatment options regarding 23 clinical situations in the treatment of depression using a 9-point Likert scale (1="disagree" and 9="agree"). According to the responses of 114 experts, the options were categorized into first-, second-, and third-line treatments. RESULTS First-line antidepressants varied depending on predominant symptoms: escitalopram (mean ± standard deviation score, 7.8 ± 1.7) and sertraline (7.3 ± 1.7) were likely selected for anxiety; duloxetine (7.6 ± 1.9) and venlafaxine (7.2 ± 2.1) for loss of interest; mirtazapine for insomnia (8.2 ± 1.6), loss of appetite (7.9 ± 1.9), agitation and severe irritation (7.4 ± 2.0), and suicidal ideation (7.5 ± 1.9). While first-line treatment was switched to either an SNRI (7.7 ± 1.9) or mirtazapine (7.4 ± 2.0) in the case of non-response to an SSRI, switching to mirtazapine (7.1 ± 2.2) was recommended in the case of non-response to an SNRI, and vice versa (switching to an SNRI (7.0 ± 2.0) in the case of non-response to mirtazapine). Augmentation with aripiprazole was considered the first-line treatment for partial response to an SSRI (7.1 ± 2.3) or SNRI (7.0 ± 2.5). LIMITATIONS The evidence level of expert consensus is considered low. All included experts were Japanese. CONCLUSIONS Recommendations made by experts in the field are useful and can supplement guidelines and informed decision making in real-world clinical practice. We suggest that pharmacological strategies for depression be flexible and that each patient's situational needs as well as the pharmacotherapeutic profile of medications be considered.
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Affiliation(s)
- Hitoshi Sakurai
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States; Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Hiroyuki Uchida
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Masaki Kato
- Department of Neuropsychiatry, Kansai Medical University, Osaka, Japan
| | - Takefumi Suzuki
- Department of Neuropsychiatry, University of Yamanashi Faculty of Medicine, Yamanashi, Japan
| | - Hajime Baba
- Department of Psychiatry & Behavioral Science, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Koichiro Watanabe
- Department of Neuropsychiatry, Kyorin University School of Medicine, Tokyo, Japan
| | - Ken Inada
- Department of Psychiatry, Tokyo Women's Medical University School of Medicine, Tokyo Japan
| | - Toshiaki Kikuchi
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Asuka Katsuki
- Department of Psychiatry, University of Occupational and Environmental Health, Fukuoka, Japan
| | - Ikuko Kishida
- Fujisawa Hospital, Kanagawa, Japan; Department of Psychiatry, Yokohama City University School of Medicine, Kanagawa, Japan
| | | | - Norio Yasui-Furukori
- Department of Psychiatry, Dokkyo Medical University School of Medicine, Tochigi, Japan.
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Bondar J, Caye A, Chekroud AM, Kieling C. Symptom clusters in adolescent depression and differential response to treatment: a secondary analysis of the Treatment for Adolescents with Depression Study randomised trial. Lancet Psychiatry 2020; 7:337-343. [PMID: 32199509 DOI: 10.1016/s2215-0366(20)30060-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 01/31/2020] [Accepted: 02/06/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Better understanding of the heterogeneity of treatment responses could help to improve care for adolescents with depression. We analysed data from a clinical trial to assess whether specific symptom clusters responded differently to various treatments. METHODS For this secondary analysis, we used data from the Treatment for Adolescents with Depression Study (TADS), in which 439 US adolescents aged 12-17 with a DSM-IV diagnosis of major depressive disorder and a minimum score of 45 on the Children's Depression Rating Scale-Revised (CDRS-R) were randomly assigned (1:1:1:1) to treatment with fluoxetine, cognitive behavioural therapy (CBT), fluoxetine plus CBT, or pill placebo. Our analysis focuses on the acute phase of the trial (ie, the first 12 weeks). Groups of co-occurring symptoms were established by clustering scores for each CDRS-R item at baseline with Ward's method, with Euclidean distances for hierarchical agglomerative clustering. We then used a linear mixed-effects model to investigate the relationship between symptom clusters and treatment efficacy, with the sum of symptom scores within each cluster as the dependent measure. As fixed effects, we entered cluster, time, and treatment assignment, with all two-way and three-way interactions, into the model. The random effect providing better fit was established to be a by-subject random slope for cluster based on improvement in the Schwarz-Bayesian information criterion. OUTCOMES We identified two symptom clusters: cluster 1 comprised depressed mood, difficulty having fun, irritability, social withdrawal, sleep disturbance, impaired schoolwork, excessive fatigue, and low self-esteem, and cluster 2 comprised increased appetite, physical complaints, excessive weeping, decreased appetite, excessive guilt, morbid ideation, and suicidal ideation. For cluster 1 symptoms, CDRS-R scores were reduced by 5·8 points (95% CI 2·8-8·9) in adolescents treated with fluoxetine plus CBT, and by 4·1 points (1·1-7·1) in those treated with fluoxetine, compared with those given placebo. For cluster 2 symptoms, no significant differences in improvements in CDRS-R scores were detected between the active treatment and placebo groups. INTERPRETATION Response to fluoxetine and CBT among adolescents with depression is heterogeneous. Clinicians should consider clinical profile when selecting therapeutic modality. The contrast in response patterns between symptom clusters could provide opportunities to improve treatment efficacy by gearing the development of new therapies towards the resolution of specific symptoms. FUNDING Conselho Nacional de Desenvolvimento Científico e Tecnológico.
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Affiliation(s)
- Julia Bondar
- Department of Psychiatry, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Child & Adolescent Psychiatry Division, Hospital de Clínicas de Porto Alegre, Brazil, Porto Alegre, Brazil
| | - Arthur Caye
- Department of Psychiatry, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Child & Adolescent Psychiatry Division, Hospital de Clínicas de Porto Alegre, Brazil, Porto Alegre, Brazil
| | - Adam M Chekroud
- Spring Health, New York, NY, USA; Department of Psychiatry, Yale University, New Haven, CT, USA
| | - Christian Kieling
- Department of Psychiatry, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Child & Adolescent Psychiatry Division, Hospital de Clínicas de Porto Alegre, Brazil, Porto Alegre, Brazil.
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Borrione L, Bellini H, Razza LB, Avila AG, Baeken C, Brem AK, Busatto G, Carvalho AF, Chekroud A, Daskalakis ZJ, Deng ZD, Downar J, Gattaz W, Loo C, Lotufo PA, Martin MDGM, McClintock SM, O'Shea J, Padberg F, Passos IC, Salum GA, Vanderhasselt MA, Fraguas R, Benseñor I, Valiengo L, Brunoni AR. Precision non-implantable neuromodulation therapies: a perspective for the depressed brain. ACTA ACUST UNITED AC 2020; 42:403-419. [PMID: 32187319 PMCID: PMC7430385 DOI: 10.1590/1516-4446-2019-0741] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 12/10/2019] [Indexed: 12/13/2022]
Abstract
Current first-line treatments for major depressive disorder (MDD) include pharmacotherapy and cognitive-behavioral therapy. However, one-third of depressed patients do not achieve remission after multiple medication trials, and psychotherapy can be costly and time-consuming. Although non-implantable neuromodulation (NIN) techniques such as transcranial magnetic stimulation, transcranial direct current stimulation, electroconvulsive therapy, and magnetic seizure therapy are gaining momentum for treating MDD, the efficacy of non-convulsive techniques is still modest, whereas use of convulsive modalities is limited by their cognitive side effects. In this context, we propose that NIN techniques could benefit from a precision-oriented approach. In this review, we discuss the challenges and opportunities in implementing such a framework, focusing on enhancing NIN effects via a combination of individualized cognitive interventions, using closed-loop approaches, identifying multimodal biomarkers, using computer electric field modeling to guide targeting and quantify dosage, and using machine learning algorithms to integrate data collected at multiple biological levels and identify clinical responders. Though promising, this framework is currently limited, as previous studies have employed small samples and did not sufficiently explore pathophysiological mechanisms associated with NIN response and side effects. Moreover, cost-effectiveness analyses have not been performed. Nevertheless, further advancements in clinical trials of NIN could shift the field toward a more “precision-oriented” practice.
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Affiliation(s)
- Lucas Borrione
- Serviço Interdisciplinar de Neuromodulação, Laboratório de Neurociências (LIM-27), Departamento e Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Helena Bellini
- Serviço Interdisciplinar de Neuromodulação, Laboratório de Neurociências (LIM-27), Departamento e Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Lais Boralli Razza
- Serviço Interdisciplinar de Neuromodulação, Laboratório de Neurociências (LIM-27), Departamento e Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Ana G Avila
- Centro de Neuropsicologia e Intervenção Cognitivo-Comportamental, Faculdade de Psicologia e Ciências da Educação, Universidade de Coimbra, Coimbra, Portugal
| | - Chris Baeken
- Department of Head and Skin, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Department of Psychiatry, University Hospital (UZ Brussel), Brussels, Belgium.,Ghent Experimental Psychiatry (GHEP) Lab, Ghent University, Ghent, Belgium.,Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Anna-Katharine Brem
- Max Planck Institute of Psychiatry, Munich, Germany.,Division of Interventional Cognitive Neurology, Department of Neurology, Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Geraldo Busatto
- Laboratório de Neuroimagem em Psiquiatria (LIM-21), Departamento e Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, USP, São Paulo, SP, Brazil
| | - Andre F Carvalho
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Adam Chekroud
- Spring Health, New York, NY, USA.,Department of Psychiatry, Yale University, New Haven, CT, USA
| | - Zafiris J Daskalakis
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Zhi-De Deng
- Noninvasive Neuromodulation Unit, Experimental Therapeutic & Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA.,Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke University, Durham, NC, USA
| | - Jonathan Downar
- Department of Psychiatry and Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Centre for Mental Health and Krembil Research Institute, University Health Network, Toronto, ON, Canada
| | - Wagner Gattaz
- Laboratório de Neurociências (LIM-27), Departamento e Instituto de Psiquiatria, Hospital das Clínicas,
Faculdade de Medicina, USP, São Paulo, SP, Brazil.,Instituto Nacional de Biomarcadores em Neuropsiquiatria (INBioN), Departamento e Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, USP, São Paulo, SP, Brazil
| | - Colleen Loo
- School of Psychiatry and Black Dog Institute, University of New South Wales, Sydney, Australia
| | - Paulo A Lotufo
- Estudo Longitudinal de Saúde do Adulto (ELSA), Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário, USP, São Paulo, SP, Brazil
| | - Maria da Graça M Martin
- Laboratório de Ressonância Magnética em Neurorradiologia (LIM-44) and Instituto de Radiologia, Hospital das Clínicas, Faculdade de Medicina, USP, São Paulo, SP, Brazil
| | - Shawn M McClintock
- Neurocognitive Research Laboratory, Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA
| | - Jacinta O'Shea
- Wellcome Centre for Integrative Neuroimaging, Oxford Centre for Human Brain Activity, Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom
| | - Frank Padberg
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Ives C Passos
- Laboratório de Psiquiatria Molecular e Programa de
Transtorno Bipolar, Hospital de Clínicas de Porto Alegre (HCPA), Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Giovanni A Salum
- Departamento de Psiquiatria, Seção de Afeto Negativo e Processos Sociais (SANPS), HCPA, UFRGS, Porto Alegre, RS, Brazil
| | - Marie-Anne Vanderhasselt
- Department of Head and Skin, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Ghent Experimental Psychiatry (GHEP) Lab, Ghent University, Ghent, Belgium.,Department of Experimental Clinical and Health Psychology, Psychopathology and Affective Neuroscience Lab, Ghent University, Ghent, Belgium
| | - Renerio Fraguas
- Laboratório de Neuroimagem em Psiquiatria (LIM-21), Departamento e Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, USP, São Paulo, SP, Brazil.,Hospital Universitário, USP, São Paulo, SP, Brazil
| | - Isabela Benseñor
- Estudo Longitudinal de Saúde do Adulto (ELSA), Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário, USP, São Paulo, SP, Brazil
| | - Leandro Valiengo
- Serviço Interdisciplinar de Neuromodulação, Laboratório de Neurociências (LIM-27), Departamento e Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Andre R Brunoni
- Serviço Interdisciplinar de Neuromodulação, Laboratório de Neurociências (LIM-27), Departamento e Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil.,Laboratório de Neurociências (LIM-27), Departamento e Instituto de Psiquiatria, Hospital das Clínicas,
Faculdade de Medicina, USP, São Paulo, SP, Brazil.,Instituto Nacional de Biomarcadores em Neuropsiquiatria (INBioN), Departamento e Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, USP, São Paulo, SP, Brazil.,Hospital Universitário, USP, São Paulo, SP, Brazil
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Kambeitz J, Goerigk S, Gattaz W, Falkai P, Benseñor IM, Lotufo PA, Bühner M, Koutsouleris N, Padberg F, Brunoni AR. Clinical patterns differentially predict response to transcranial direct current stimulation (tDCS) and escitalopram in major depression: A machine learning analysis of the ELECT-TDCS study. J Affect Disord 2020; 265:460-467. [PMID: 32090773 DOI: 10.1016/j.jad.2020.01.118] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 12/02/2019] [Accepted: 01/20/2020] [Indexed: 12/17/2022]
Affiliation(s)
- Joseph Kambeitz
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Nußbaumstraße 7, Munich 80336, Germany; Department of Psychiatry, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Straße 62, Cologne 50937, Germany
| | - Stephan Goerigk
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Nußbaumstraße 7, Munich 80336, Germany; Department of Psychological Methodology and Assessment, Ludwig-Maximilians-University, Leopoldstraße 13, Munich 80802, Germany; Hochschule Fresenius, University of Applied Sciences, Infanteriestraße 11A, Munich 80797, Germany
| | - Wagner Gattaz
- Laboratory of Neurosciences (LIM-27), Department and Institute of Psychiatry, Faculdade de Medicina da Universidade de São Paulo, R Dr Ovidio Pires de Campos 785, 2o andar, São Paulo 05403-000, Brazil
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Nußbaumstraße 7, Munich 80336, Germany
| | - Isabela M Benseñor
- Department of Internal Medicine, Faculdade de Medicina da Universidade de São Paulo & Hospital Universitário, Universidade de São Paulo, Av. Prof Lineu Prestes 2565, São Paulo 05508-000, Brazil
| | - Paulo A Lotufo
- Department of Internal Medicine, Faculdade de Medicina da Universidade de São Paulo & Hospital Universitário, Universidade de São Paulo, Av. Prof Lineu Prestes 2565, São Paulo 05508-000, Brazil
| | - Markus Bühner
- Department of Psychological Methodology and Assessment, Ludwig-Maximilians-University, Leopoldstraße 13, Munich 80802, Germany
| | - Nikolaos Koutsouleris
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Nußbaumstraße 7, Munich 80336, Germany
| | - Frank Padberg
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Nußbaumstraße 7, Munich 80336, Germany
| | - Andre R Brunoni
- Laboratory of Neurosciences (LIM-27), Department and Institute of Psychiatry, Faculdade de Medicina da Universidade de São Paulo, R Dr Ovidio Pires de Campos 785, 2o andar, São Paulo 05403-000, Brazil; Department of Internal Medicine, Faculdade de Medicina da Universidade de São Paulo & Hospital Universitário, Universidade de São Paulo, Av. Prof Lineu Prestes 2565, São Paulo 05508-000, Brazil.
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Katzman MA, Wang X, Wajsbrot DB, Boucher M. Effects of desvenlafaxine versus placebo on MDD symptom clusters: A pooled analysis. J Psychopharmacol 2020; 34:280-292. [PMID: 31913085 DOI: 10.1177/0269881119896066] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Major depressive disorder is characterized by the presence of at least five of nine specific symptoms that contribute to clinically significant functional impairment. This analysis examined the effect of desvenlafaxine (50 or 100 mg) versus placebo on symptom cluster scores and the association between early improvement in symptom clusters and symptomatic or functional remission at week 8. METHODS Using data from nine double-blind, placebo-controlled studies of desvenlafaxine for the treatment of major depressive disorder (N=4317), the effect of desvenlafaxine 50 or 100 mg versus placebo on scores for symptom clusters based on 17-item Hamilton Rating Scale for Depression items was assessed using analysis of covariance. Association between early improvement in symptom clusters (⩾20% improvement from baseline at week 2) and symptomatic and functional remission (17-item Hamilton Rating Scale for Depression total score ⩽7; Sheehan Disability Scale score <7) at week 8 was analyzed using logistic regression. Symptom clusters based on Montgomery-Åsberg Depression Rating Scale were also examined. RESULTS Desvenlafaxine 50 or 100 mg was associated with significant improvement from baseline compared to placebo for all symptom clusters (p<0.001), except a sleep cluster for desvenlafaxine 100 mg. For all symptom clusters, early improvement was significantly associated with achievement of symptomatic and functional remission at week 8 for all treatment groups (p⩽0.0254). CONCLUSION Early improvement in symptom clusters significantly predicts symptomatic or functional remission at week 8 in patients with depression receiving desvenlafaxine (50 or 100 mg) or placebo. Importantly, patients without early improvement were less likely to remit.
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Affiliation(s)
- Martin A Katzman
- START Clinic for Mood and Anxiety Disorders, Toronto, ON, Canada.,Adler Graduate Professional School, Toronto, ON, Canada.,Northern Ontario School of Medicine, Thunder Bay, ON, Canada.,Department of Psychology, Lakehead University, Thunder Bay, ON, Canada
| | | | | | - Matthieu Boucher
- Pfizer Canada, Inc., Kirkland, QC, Canada.,McGill University, Montréal, QC, Canada
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Chekroud A. How founding a company compares to graduate school. Nature 2020:10.1038/d41586-020-00219-w. [PMID: 33495608 DOI: 10.1038/d41586-020-00219-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Tajika A, Furukawa TA, Inagaki M, Kato T, Mantani A, Kurata K, Ogawa Y, Takeshima N, Hayasaka Y, Noma H, Maruo K. Trajectory of criterion symptoms of major depression under newly started antidepressant treatment: sleep disturbances and anergia linger on while suicidal ideas and psychomotor symptoms disappear early. Acta Psychiatr Scand 2019; 140:532-540. [PMID: 31618446 DOI: 10.1111/acps.13115] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/13/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE In modern psychiatry, depression is diagnosed with the diagnostic criteria; however, the trajectory of each of the criterion symptoms is unknown. This study aims to examine this. METHODS We made repeated assessments of the nine diagnostic criterion symptoms with the Patient Health Questionnaire-9 (PHQ-9) among 2011 participants of a 25-week pragmatic randomised controlled trial of sertraline and/or mirtazapine for hitherto untreated major depressive episodes. The changes from baseline were estimated with the mixed-effects model with repeated measures. The time to disappearance of each symptom was modeled using the Kaplan-Meier survival analysis. RESULTS The total score on PHQ-9 was 18.5 (SD = 3.9, n = 2011) at baseline, which decreased to 15.3 (5.2, n = 2011) at week 1, to 11.5 (5.9, n = 1953) at week 3, to 7.8 (6.0, n = 1927) at week 9, and to 6.0 (5.9, n = 1910) at week 25. Suicidal ideas, psychomotor symptoms decreased rapidly, while anergia and sleep disturbance also decreased but only slowly. The survival analyses confirmed the primary analyses. CONCLUSIONS Upon initiation of antidepressant treatment, patients with newly treated major depressive episodes can expect their suicidal ideas and psychomotor symptoms to disappear first but sleep disturbances and anergia to linger on.
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Affiliation(s)
- A Tajika
- Department of Neurosychiatry, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - T A Furukawa
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - M Inagaki
- Department of Psychiatry, Shimane University Faculty of Medicine, Izumo, Japan
| | - T Kato
- Aratama Kokorono Clinic, Nagoya, Japan
| | - A Mantani
- Mantani Mental Clinic, Hiroshima, Japan
| | - K Kurata
- Kabe Mental Health Clinic, Hiroshima, Japan
| | - Y Ogawa
- Department of Healthcare Epidemiology, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - N Takeshima
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - Y Hayasaka
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - H Noma
- Department of Data Science, The Institute of Statistical Mathematics, Tokyo, Japan
| | - K Maruo
- Department of Biostatistics, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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Predicting rehospitalization within 2 years of initial patient admission for a major depressive episode: a multimodal machine learning approach. Transl Psychiatry 2019; 9:285. [PMID: 31712550 PMCID: PMC6848135 DOI: 10.1038/s41398-019-0615-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 10/08/2019] [Accepted: 10/20/2019] [Indexed: 01/12/2023] Open
Abstract
Machine learning methods show promise to translate univariate biomarker findings into clinically useful multivariate decision support systems. At current, works in major depressive disorder have predominantly focused on neuroimaging and clinical predictor modalities, with genetic, blood-biomarker, and cardiovascular modalities lacking. In addition, the prediction of rehospitalization after an initial inpatient major depressive episode is yet to be explored, despite its clinical importance. To address this gap in the literature, we have used baseline clinical, structural imaging, blood-biomarker, genetic (polygenic risk scores), bioelectrical impedance and electrocardiography predictors to predict rehospitalization within 2 years of an initial inpatient episode of major depression. Three hundred and eighty patients from the ongoing 12-year Bidirect study were included in the analysis (rehospitalized: yes = 102, no = 278). Inclusion criteria was age ≥35 and <66 years, a current or recent hospitalisation for a major depressive episode and complete structural imaging and genetic data. Optimal performance was achieved with a multimodal panel containing structural imaging, blood-biomarker, clinical, medication type, and sleep quality predictors, attaining a test AUC of 67.74 (p = 9.99-05). This multimodal solution outperformed models based on clinical variables alone, combined biomarkers, and individual data modality prognostication for rehospitalization prediction. This finding points to the potential of predictive models that combine multimodal clinical and biomarker data in the development of clinical decision support systems.
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Abstract
PURPOSE OF REVIEW Artificial intelligence (AI) technology holds both great promise to transform mental healthcare and potential pitfalls. This article provides an overview of AI and current applications in healthcare, a review of recent original research on AI specific to mental health, and a discussion of how AI can supplement clinical practice while considering its current limitations, areas needing additional research, and ethical implications regarding AI technology. RECENT FINDINGS We reviewed 28 studies of AI and mental health that used electronic health records (EHRs), mood rating scales, brain imaging data, novel monitoring systems (e.g., smartphone, video), and social media platforms to predict, classify, or subgroup mental health illnesses including depression, schizophrenia or other psychiatric illnesses, and suicide ideation and attempts. Collectively, these studies revealed high accuracies and provided excellent examples of AI's potential in mental healthcare, but most should be considered early proof-of-concept works demonstrating the potential of using machine learning (ML) algorithms to address mental health questions, and which types of algorithms yield the best performance. As AI techniques continue to be refined and improved, it will be possible to help mental health practitioners re-define mental illnesses more objectively than currently done in the DSM-5, identify these illnesses at an earlier or prodromal stage when interventions may be more effective, and personalize treatments based on an individual's unique characteristics. However, caution is necessary in order to avoid over-interpreting preliminary results, and more work is required to bridge the gap between AI in mental health research and clinical care.
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Tomlinson A, Furukawa TA, Efthimiou O, Salanti G, De Crescenzo F, Singh I, Cipriani A. Personalise antidepressant treatment for unipolar depression combining individual choices, risks and big data (PETRUSHKA): rationale and protocol. EVIDENCE-BASED MENTAL HEALTH 2019; 23:52-56. [PMID: 31645364 PMCID: PMC7229905 DOI: 10.1136/ebmental-2019-300118] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Introduction Matching treatment to specific patients is too often a matter of trial and error, while treatment efficacy should be optimised by limiting risks and costs and by incorporating patients’ preferences. Factors influencing an individual’s drug response in major depressive disorder may include a number of clinical variables (such as previous treatments, severity of illness, concomitant anxiety etc) as well demographics (for instance, age, weight, social support and family history). Our project, funded by the National Institute of Health Research, is aimed at developing and subsequently testing a precision medicine approach to the pharmacological treatment of major depressive disorder in adults, which can be used in everyday clinical settings. Methods and analysis We will jointly synthesise data from patients with major depressive disorder, obtained from diverse datasets, including randomised trials as well as observational, real-world studies. We will summarise the highest quality and most up-to-date scientific evidence about comparative effectiveness and tolerability (adverse effects) of antidepressants for major depressive disorder, develop and externally validate prediction models to produce stratified treatment recommendations. Results from this analysis will subsequently inform a web-based platform and build a decision support tool combining the stratified recommendations with clinicians and patients’ preferences, to adapt the tool, increase its’ reliability and tailor treatment indications to the individual-patient level. We will then test whether use of the tool relative to treatment as usual in real-world clinical settings leads to enhanced treatment adherence and response, is acceptable to clinicians and patients, and is economically viable in the UK National Health Service. Discussion This is a clinically oriented study, coordinated by an international team of experts, with important implications for patients treated in real-world setting. This project will form a test-case that, if effective, will be extended to non-pharmacological treatments (either face-to-face or internet-delivered), to other populations and disorders in psychiatry (for instance, children and adolescents, or schizophrenia and treatment-resistant depression) and to other fields of medicine.
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Affiliation(s)
| | - Toshi A Furukawa
- Graduate School of Medicine Faculty of Medicine, Kyoto University, Kyoto, Japan
| | - Orestis Efthimiou
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Georgia Salanti
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | | | - Ilina Singh
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Andrea Cipriani
- Department of Psychiatry, University of Oxford, Oxford, UK .,Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
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131
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Recommendations and future directions for supervised machine learning in psychiatry. Transl Psychiatry 2019; 9:271. [PMID: 31641106 PMCID: PMC6805872 DOI: 10.1038/s41398-019-0607-2] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 07/05/2019] [Accepted: 07/30/2019] [Indexed: 12/22/2022] Open
Abstract
Machine learning methods hold promise for personalized care in psychiatry, demonstrating the potential to tailor treatment decisions and stratify patients into clinically meaningful taxonomies. Subsequently, publication counts applying machine learning methods have risen, with different data modalities, mathematically distinct models, and samples of varying size being used to train and test models with the promise of clinical translation. Consequently, and in part due to the preliminary nature of such works, many studies have reported largely varying degrees of accuracy, raising concerns over systematic overestimation and methodological inconsistencies. Furthermore, a lack of procedural evaluation guidelines for non-expert medical professionals and funding bodies leaves many in the field with no means to systematically evaluate the claims, maturity, and clinical readiness of a project. Given the potential of machine learning methods to transform patient care, albeit, contingent on the rigor of employed methods and their dissemination, we deem it necessary to provide a review of current methods, recommendations, and future directions for applied machine learning in psychiatry. In this review we will cover issues of best practice for model training and evaluation, sources of systematic error and overestimation, model explainability vs. trust, the clinical implementation of AI systems, and finally, future directions for our field.
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Gruskin DC, Rosenberg MD, Holmes AJ. Relationships between depressive symptoms and brain responses during emotional movie viewing emerge in adolescence. Neuroimage 2019; 216:116217. [PMID: 31628982 DOI: 10.1016/j.neuroimage.2019.116217] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 08/14/2019] [Accepted: 09/19/2019] [Indexed: 02/06/2023] Open
Abstract
Affective disorders such as major depression are common but serious illnesses characterized by altered processing of emotional information. Although the frequency and severity of depressive symptoms increase dramatically over the course of childhood and adolescence, much of our understanding of their neurobiological bases comes from work characterizing adults' responses to static emotional information. As a consequence, relationships between depressive brain phenotypes and naturalistic emotional processing, as well as the manner in which these associations emerge over the lifespan, remain poorly understood. Here, we apply static and dynamic inter-subject correlation analyses to examine how brain function is associated with clinical and non-clinical depressive symptom severity in 112 children and adolescents (7-21 years old) who viewed an emotionally evocative clip from the film Despicable Me during functional MRI. Our results reveal that adolescents with greater depressive symptom severity exhibit atypical fMRI responses during movie viewing, and that this effect is stronger during less emotional moments of the movie. Furthermore, adolescents with more similar item-level depressive symptom profiles showed more similar brain responses during movie viewing. In contrast, children's depressive symptom severity and profiles were unrelated to their brain response typicality or similarity. Together, these results indicate a developmental change in the relationships between brain function and depressive symptoms from childhood through adolescence. Our findings suggest that depressive symptoms may shape how the brain responds to complex emotional information in a dynamic manner sensitive to both developmental stage and affective context.
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Affiliation(s)
- David C Gruskin
- Department of Psychology, Yale University, New Haven, CT, 06520, USA.
| | - Monica D Rosenberg
- Department of Psychology, Yale University, New Haven, CT, 06520, USA; Department of Psychology, University of Chicago, Chicago, IL, 60637, USA.
| | - Avram J Holmes
- Department of Psychology, Yale University, New Haven, CT, 06520, USA; Department of Psychiatry, Yale University, New Haven, CT, 06520, USA.
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133
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Ramkumar PN, Karnuta JM, Navarro SM, Haeberle HS, Scuderi GR, Mont MA, Krebs VE, Patterson BM. Deep Learning Preoperatively Predicts Value Metrics for Primary Total Knee Arthroplasty: Development and Validation of an Artificial Neural Network Model. J Arthroplasty 2019; 34:2220-2227.e1. [PMID: 31285089 DOI: 10.1016/j.arth.2019.05.034] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 05/08/2019] [Accepted: 05/20/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The objective is to develop and validate an artificial neural network (ANN) that learns and predicts length of stay (LOS), inpatient charges, and discharge disposition before primary total knee arthroplasty (TKA). The secondary objective applied the ANN to propose a risk-based, patient-specific payment model (PSPM) commensurate with case complexity. METHODS Using data from 175,042 primary TKAs from the National Inpatient Sample and an institutional database, an ANN was developed to predict LOS, charges, and disposition using 15 preoperative variables. Outcome metrics included accuracy and area under the curve for a receiver operating characteristic curve. Model uncertainty was stratified by All Patient Refined comorbidity indices in establishing a risk-based PSPM. RESULTS The dynamic model demonstrated "learning" in the first 30 training rounds with areas under the curve of 74.8%, 82.8%, and 76.1% for LOS, charges, and discharge disposition, respectively. The PSPM demonstrated that as patient comorbidity increased, risk increased by 2.0%, 21.8%, and 82.6% for moderate, major, and severe comorbidities, respectively. CONCLUSION Our deep learning model demonstrated "learning" with acceptable validity, reliability, and responsiveness in predicting value metrics, offering the ability to preoperatively plan for TKA episodes of care. This model may be applied to a PSPM proposing tiered reimbursements reflecting case complexity.
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Affiliation(s)
- Prem N Ramkumar
- Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, OH
| | - Jaret M Karnuta
- Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, OH
| | - Sergio M Navarro
- Said Business School, University of Oxford, Oxford, United Kingdom
| | - Heather S Haeberle
- Department of Orthopaedic Surgery, Baylor College of Medicine, Houston, TX
| | | | - Michael A Mont
- Department of Orthopaedic Surgery, Lenox Hill, New York, NY
| | - Viktor E Krebs
- Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, OH
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Zuidersma M, Chua KC, Hellier J, Voshaar RO, Banerjee S. Sertraline and Mirtazapine Versus Placebo in Subgroups of Depression in Dementia: Findings From the HTA-SADD Randomized Controlled Trial. Am J Geriatr Psychiatry 2019; 27:920-931. [PMID: 31084994 DOI: 10.1016/j.jagp.2019.03.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 03/29/2019] [Accepted: 03/29/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Studies have shown that antidepressants are no better than placebo in treating depression in dementia. The authors examined antidepressant efficacy in subgroups of depression in dementia with different depressive symptom profiles. METHODS This study focuses on exploratory secondary analyses on the randomized, parallel-group, double-blind, placebo-controlled Health Technology Assessment Study of the Use of Antidepressants for Depression in Dementia (HTA-SADD) trial. The setting included old-age psychiatry services in nine centers in England. The participants included 326 patients meeting National Institute of Neurological and Communicative Disorders and Stroke/Alzheimer's Disease and Related Disorders Association probable/possible Alzheimer disease criteria, and Cornell Scale for Depression in Dementia (CSDD) scores of 8 or more. Intervention was placebo (n = 111), sertraline (n = 107), or mirtazapine (n = 108). Latent class analyses (LCA) on baseline CSDD items clustered participants into symptom-based subgroups. Mixed-model analysis evaluated CSDD improvement at 13 and 39 weeks by randomization in each subgroup. RESULTS LCA yielded 4 subgroups: severe (n = 34), psychological (n = 86), affective (n = 129), and somatic (n = 77). Mirtazapine, but not sertraline, outperformed placebo in the psychological subgroup at week 13 (adjusted estimate: -2.77 [standard error (SE) 1.16; 95% confidence interval: -5.09 to -0.46]), which remained, but lost statistical significance at week 39 (adjusted estimate: -2.97 [SE 1.59; 95% confidence interval: -6.15 to 0.20]). Neither sertraline nor mirtazapine outperformed placebo in the other subgroups. CONCLUSION Because of the exploratory nature of the analyses and the small sample sizes for subgroup analysis there is the need for caution in interpreting these data. Replication of the potential effects of mirtazapine in the subgroup of those with depression in dementia with "psychological" symptoms would be valuable. These data should not change clinical practice, but future trials should consider stratifying types of depression in dementia in secondary analyses.
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Affiliation(s)
- Marij Zuidersma
- University Center of Psychiatry & Interdisciplinary Center of Psychopathology and Emotion Regulation (MZ, ROV), University of Groningen, University Medical Center Groningen, the Netherlands
| | - Kia-Chong Chua
- Health Service and Population Research Department (KCC), Institute of Psychiatry, Psychology & Neuroscience, King's College London, London
| | - Jennifer Hellier
- Biostatistics & Health Informatics Department (JH), Institute of Psychiatry, Psychology & Neuroscience, King's College London, London
| | - Richard Oude Voshaar
- University Center of Psychiatry & Interdisciplinary Center of Psychopathology and Emotion Regulation (MZ, ROV), University of Groningen, University Medical Center Groningen, the Netherlands
| | - Sube Banerjee
- Centre for Dementia Studies (SB), Brighton & Sussex Medical School, University of Sussex, Brighton, East Sussex, United Kingdom.
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135
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Mihalik A, Ferreira FS, Rosa MJ, Moutoussis M, Ziegler G, Monteiro JM, Portugal L, Adams RA, Romero-Garcia R, Vértes PE, Kitzbichler MG, Váša F, Vaghi MM, Bullmore ET, Fonagy P, Goodyer IM, Jones PB, Dolan R, Mourão-Miranda J. Brain-behaviour modes of covariation in healthy and clinically depressed young people. Sci Rep 2019; 9:11536. [PMID: 31395894 PMCID: PMC6687746 DOI: 10.1038/s41598-019-47277-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 07/11/2019] [Indexed: 12/29/2022] Open
Abstract
Understanding how variations in dimensions of psychometrics, IQ and demographics relate to changes in brain connectivity during the critical developmental period of adolescence and early adulthood is a major challenge. This has particular relevance for mental health disorders where a failure to understand these links might hinder the development of better diagnostic approaches and therapeutics. Here, we investigated this question in 306 adolescents and young adults (14-24 y, 25 clinically depressed) using a multivariate statistical framework, based on canonical correlation analysis (CCA). By linking individual functional brain connectivity profiles to self-report questionnaires, IQ and demographic data we identified two distinct modes of covariation. The first mode mapped onto an externalization/internalization axis and showed a strong association with sex. The second mode mapped onto a well-being/distress axis independent of sex. Interestingly, both modes showed an association with age. Crucially, the changes in functional brain connectivity associated with changes in these phenotypes showed marked developmental effects. The findings point to a role for the default mode, frontoparietal and limbic networks in psychopathology and depression.
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Affiliation(s)
- Agoston Mihalik
- Centre for Medical Image Computing, Department of Computer Science, University College London, London, United Kingdom.
- Max Planck University College London Centre for Computational Psychiatry and Ageing Research, University College London, London, United Kingdom.
| | - Fabio S Ferreira
- Centre for Medical Image Computing, Department of Computer Science, University College London, London, United Kingdom
- Max Planck University College London Centre for Computational Psychiatry and Ageing Research, University College London, London, United Kingdom
| | - Maria J Rosa
- Centre for Medical Image Computing, Department of Computer Science, University College London, London, United Kingdom
- Max Planck University College London Centre for Computational Psychiatry and Ageing Research, University College London, London, United Kingdom
| | - Michael Moutoussis
- Max Planck University College London Centre for Computational Psychiatry and Ageing Research, University College London, London, United Kingdom
- Wellcome Centre for Human Neuroimaging, University College London, London, United Kingdom
| | - Gabriel Ziegler
- Institute of Cognitive Neurology and Dementia Research, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany
| | - Joao M Monteiro
- Centre for Medical Image Computing, Department of Computer Science, University College London, London, United Kingdom
- Max Planck University College London Centre for Computational Psychiatry and Ageing Research, University College London, London, United Kingdom
| | - Liana Portugal
- Centre for Medical Image Computing, Department of Computer Science, University College London, London, United Kingdom
- Department of Physiology and Pharmacology, Federal Fluminense University, Niteroi, Brazil
| | - Rick A Adams
- Centre for Medical Image Computing, Department of Computer Science, University College London, London, United Kingdom
- Max Planck University College London Centre for Computational Psychiatry and Ageing Research, University College London, London, United Kingdom
- Wellcome Centre for Human Neuroimaging, University College London, London, United Kingdom
| | - Rafael Romero-Garcia
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, United Kingdom
| | - Petra E Vértes
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, United Kingdom
| | - Manfred G Kitzbichler
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, United Kingdom
| | - František Váša
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, United Kingdom
| | - Matilde M Vaghi
- Max Planck University College London Centre for Computational Psychiatry and Ageing Research, University College London, London, United Kingdom
- Wellcome Centre for Human Neuroimaging, University College London, London, United Kingdom
| | - Edward T Bullmore
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
- Cambridgeshire and Peterborough National Health Service Foundation Trust, Cambridge, United Kingdom
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, United Kingdom
- ImmunoPsychiatry, GlaxoSmithKline Research and Development, Stevenage, United Kingdom
| | - Peter Fonagy
- Research Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
| | - Ian M Goodyer
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
- Cambridgeshire and Peterborough National Health Service Foundation Trust, Cambridge, United Kingdom
| | - Peter B Jones
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
- Cambridgeshire and Peterborough National Health Service Foundation Trust, Cambridge, United Kingdom
| | - Raymond Dolan
- Max Planck University College London Centre for Computational Psychiatry and Ageing Research, University College London, London, United Kingdom
- Wellcome Centre for Human Neuroimaging, University College London, London, United Kingdom
| | - Janaina Mourão-Miranda
- Centre for Medical Image Computing, Department of Computer Science, University College London, London, United Kingdom
- Max Planck University College London Centre for Computational Psychiatry and Ageing Research, University College London, London, United Kingdom
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136
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Kalman JL, Bresnahan M, Schulze TG, Susser E. Predictors of persisting psychotic like experiences in children and adolescents: A scoping review. Schizophr Res 2019; 209:32-39. [PMID: 31109737 DOI: 10.1016/j.schres.2019.05.012] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 02/22/2019] [Accepted: 05/05/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND Subclinical psychotic experiences (PLEs) are among the frequently reported mental health problems in children/adolescents. PLEs identified in cross sectional studies of children/adolescents are associated with current and future mental health problems. These associations are stronger for PLEs that persist over time. Hence, it could be useful to examine which children/adolescents with PLEs at a first assessment (baseline) are more likely to have PLEs at subsequent assessments. METHODS We conducted a scoping review of studies that examined whether characteristics of children/adolescents (≤18 years) with PLEs at baseline predict whether PLEs are likely to be persistent or remittent at subsequent assessments. We included studies published between January 2002 and December 2017, conducted on general child/adolescent populations of ≥300 individuals, that provided data on PLEs for at least 2 time points, had available follow-up data for ≥50% of those assessed for PLEs at baseline and targeted for follow-up examination, and reported the differences between individuals with PLEs that persisted or remitted during the study period. RESULTS Six studies met our criteria. Each of them investigated a wide range of baseline characteristics but no predictor of persistence was replicated. CONCLUSIONS Our knowledge about which children/adolescents with PLEs at an initial assessment are likely to have persistent PLEs at subsequent assessments is sparse. A handful of predictors of persistent PLEs have been investigated so far, and none replicated. A better understanding of these predictors would be an important complement to investigations examining the evolution of PLEs and of mental health problems in children/adolescents.
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Affiliation(s)
- Janos L Kalman
- Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, LMU Munich, Munich, Germany; Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University Munich, Munich, Germany; International Max Planck Research School for Translational Psychiatry (IMPRS-TP), Munich, Germany.
| | - Michaeline Bresnahan
- Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Thomas G Schulze
- Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, LMU Munich, Munich, Germany; Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD, United States; Department of Psychiatry and Psychotherapy, University Medical Center, Georg-August University Göttingen, Göttingen, Germany; Department of Genetic Epidemiology in Psychiatry, Medical Faculty Mannheim, Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany
| | - Ezra Susser
- Mailman School of Public Health, Columbia University, New York, NY, United States; New York State Psychiatric Institute, New York, New York, United States
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137
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Athreya AP, Neavin D, Carrillo-Roa T, Skime M, Biernacka J, Frye MA, Rush AJ, Wang L, Binder EB, Iyer RK, Weinshilboum RM, Bobo WV. Pharmacogenomics-Driven Prediction of Antidepressant Treatment Outcomes: A Machine-Learning Approach With Multi-trial Replication. Clin Pharmacol Ther 2019; 106:855-865. [PMID: 31012492 PMCID: PMC6739122 DOI: 10.1002/cpt.1482] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 04/09/2019] [Indexed: 02/06/2023]
Abstract
We set out to determine whether machine learning–based algorithms that included functionally validated pharmacogenomic biomarkers joined with clinical measures could predict selective serotonin reuptake inhibitor (SSRI) remission/response in patients with major depressive disorder (MDD). We studied 1,030 white outpatients with MDD treated with citalopram/escitalopram in the Mayo Clinic Pharmacogenomics Research Network Antidepressant Medication Pharmacogenomic Study (PGRN‐AMPS; n = 398), Sequenced Treatment Alternatives to Relieve Depression (STAR*D; n = 467), and International SSRI Pharmacogenomics Consortium (ISPC; n = 165) trials. A genomewide association study for PGRN‐AMPS plasma metabolites associated with SSRI response (serotonin) and baseline MDD severity (kynurenine) identified single nucleotide polymorphisms (SNPs) in DEFB1,ERICH3,AHR, and TSPAN5 that we tested as predictors. Supervised machine‐learning methods trained using SNPs and total baseline depression scores predicted remission and response at 8 weeks with area under the receiver operating curve (AUC) > 0.7 (P < 0.04) in PGRN‐AMPS patients, with comparable prediction accuracies > 69% (P ≤ 0.07) in STAR*D and ISPC. These results demonstrate that machine learning can achieve accurate and, importantly, replicable prediction of SSRI therapy response using total baseline depression severity combined with pharmacogenomic biomarkers.
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Affiliation(s)
- Arjun P Athreya
- Department of Electrical & Computer Engineering, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA.,Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, Minnesota, USA
| | - Drew Neavin
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, Minnesota, USA
| | - Tania Carrillo-Roa
- Department of Translational Research in Psychiatry, Max Planck Institute of Psychiatry, Munich, Germany
| | - Michelle Skime
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | - Joanna Biernacka
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | - Mark A Frye
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | - A John Rush
- Department of Psychiatry & Behavioral Sciences, Department of Medicine, Duke Institute of Brain Sciences, Duke University School of Medicine, Durham, North Carolina, USA.,Texas Tech University Health Sciences Center, Permian Basin, Texas, USA.,Duke-National University of Singapore Medical School, Singapore, Singapore
| | - Liewei Wang
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, Minnesota, USA
| | - Elisabeth B Binder
- Department of Translational Research in Psychiatry, Max Planck Institute of Psychiatry, Munich, Germany.,Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Ravishankar K Iyer
- Department of Electrical & Computer Engineering, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Richard M Weinshilboum
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, Minnesota, USA
| | - William V Bobo
- Department of Psychiatry & Psychology, Mayo Clinic, Jacksonville, Florida, USA
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138
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Badamasi IM, Lye MS, Ibrahim N, Stanslas J. Genetic endophenotypes for insomnia of major depressive disorder and treatment-induced insomnia. J Neural Transm (Vienna) 2019; 126:711-722. [PMID: 31111219 DOI: 10.1007/s00702-019-02014-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 05/11/2019] [Indexed: 12/12/2022]
Abstract
Major depressive disorder (MDD) is primarily hinged on the presence of either low mood and/or anhedonia to previously pleasurable events for a minimum of 2 weeks. Other clinical features that characterize MDD include disturbances in sleep, appetite, concentration and thoughts. The combination of any/both of the primary MDD symptoms as well as any four of the other clinical features has been referred to as MDD. The challenge for replicating gene association findings with phenotypes of MDD as well as its treatment outcome is putatively due to stratification of MDD patients. Likelihood for replication of gene association findings is hypothesized with specificity in symptoms profile (homogenous clusters of symptom/individual symptoms) evaluated. The current review elucidates the genetic factors that have been associated with insomnia symptom of MDD phenotype, insomnia symptom as a constellation of neuro-vegetative cluster of MDD symptom, insomnia symptom of MDD as an individual entity and insomnia feature of treatment outcome. Homozygous CC genotype of 3111T/C, GSK3B-AT/TT genotype of rs33458 and haplotype of TPH1 218A/C were associated with insomnia symptom of MDD. Insomnia symptom of MDD was not resolved in patients with the A/A genotype of HTR2A-rs6311 when treated with SSRI. Homozygous short (SS) genotype-HTTLPR, GG genotype of HTR2A-rs6311 and CC genotype of HTR2A-rs6313 were associated with AD treatment-induced insomnia, while val/met genotype of BDNF-rs6265 and the TT genotype of GSK-3beta-rs5443 reduced it. Dearth of association studies may remain the bane for the identification of robust genetic endophenotypes in line with findings for genotypes of HTR2A-rs6311.
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Affiliation(s)
- Ibrahim Mohammed Badamasi
- Pharmacotherapeutics Unit, Department of Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Munn Sann Lye
- Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Normala Ibrahim
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Johnson Stanslas
- Pharmacotherapeutics Unit, Department of Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia.
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139
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Carland MA, Thura D, Cisek P. The Urge to Decide and Act: Implications for Brain Function and Dysfunction. Neuroscientist 2019; 25:491-511. [DOI: 10.1177/1073858419841553] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Humans and other animals are motivated to act so as to maximize their subjective reward rate. Here, we propose that reward rate maximization is accomplished by adjusting a context-dependent “urgency signal,” which influences both the commitment to a developing action choice and the vigor with which the ensuing action is performed. We review behavioral and neurophysiological data suggesting that urgency is controlled by projections from the basal ganglia to cerebral cortical regions, influencing neural activity related to decision making as well as activity related to action execution. We also review evidence suggesting that different individuals possess specific policies for adjusting their urgency signal to particular contextual variables, such that urgency constitutes an individual trait which jointly influences a wide range of behavioral measures commonly related to the overall quality and hastiness of one’s decisions and actions. Consequently, we argue that a central mechanism for reward rate maximization provides a potential link between personality traits such as impulsivity, as well as some of the motivation-related symptomology of clinical disorders such as depression and Parkinson’s disease.
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Affiliation(s)
- Matthew A. Carland
- Department of Neuroscience, University of Montreal, Montreal, Quebec, Canada
| | - David Thura
- Department of Neuroscience, University of Montreal, Montreal, Quebec, Canada
| | - Paul Cisek
- Department of Neuroscience, University of Montreal, Montreal, Quebec, Canada
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140
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Jog MV, Wang DJJ, Narr KL. A review of transcranial direct current stimulation (tDCS) for the individualized treatment of depressive symptoms. ACTA ACUST UNITED AC 2019; 17-18:17-22. [PMID: 31938757 DOI: 10.1016/j.pmip.2019.03.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Transcranial direct current stimulation (tDCS) is a low intensity neuromodulation technique shown to elicit therapeutic effects in a number of neuropsychological conditions. Independent randomized sham-controlled trials and meta- and mega-analyses demonstrate that tDCS targeted to the left dorsolateral prefrontal cortex can produce a clinically meaningful response in patients with major depressive disorder (MDD), but effects are small to moderate in size. However, the heterogeneous presentation, and the neurobiology underlying particular features of depression suggest clinical outcomes might benefit from empirically informed patient selection. In this review, we summarize the status of tDCS research in MDD with focus on the clinical, biological, and intrinsic and extrinsic factors shown to enhance or predict antidepressant response. We also discuss research strategies for optimizing tDCS to improve patient-specific clinical outcomes. TDCS appears suited for both bipolar and unipolar depression, but is less effective in treatment resistant depression. TDCS may also better target core aspects of depressed mood over vegetative symptoms, while pretreatment patient characteristics might inform subsequent response. Peripheral blood markers of gene and immune system function have not yet proven useful as predictors or correlates of tDCS response. Though further research is needed, several lines of evidence suggest that tDCS administered in combination with pharmacological and cognitive behavioral interventions can improve outcomes. Tailoring stimulation to the functional and structural anatomy and/or connectivity of individual patients can maximize physiological response in targeted networks, which in turn could translate to therapeutic benefits.
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Affiliation(s)
- Mayank V Jog
- Ahmanson-Lovelace Brain Mapping Center, University of California Los Angeles, Los Angeles, California.,Laboratory of FMRI Technology (LOFT), Mark & Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Danny J J Wang
- Laboratory of FMRI Technology (LOFT), Mark & Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Katherine L Narr
- Ahmanson-Lovelace Brain Mapping Center, University of California Los Angeles, Los Angeles, California.,Department of Neurology, and Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, California
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141
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Zisook S, Johnson GR, Tal I, Hicks P, Chen P, Davis L, Thase M, Zhao Y, Vertrees J, Mohamed S. General Predictors and Moderators of Depression Remission: A VAST-D Report. Am J Psychiatry 2019; 176:348-357. [PMID: 30947531 DOI: 10.1176/appi.ajp.2018.18091079] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Almost two-thirds of patients with major depressive disorder do not achieve remission with initial treatments. Thus, identifying and providing effective, feasible, and safe "next-step" treatments are clinical imperatives. This study explores patient baseline features that might help clinicians select between commonly used next-step treatments. METHODS The authors used data from the U.S. Department of Veterans Affairs (VA) Augmentation and Switching Treatments for Improving Depression Outcomes (VAST-D) study, a multisite, randomized, single-blind trial of 1,522 Veterans Health Administration patients who did not have an adequate response to at least one course of antidepressant treatment meeting minimal standards for dosage and duration. For 12 weeks, participants received one of three possible next-step treatments: switch to another antidepressant-sustained-release bupropion; combination with another antidepressant-sustained-release bupropion; or augmentation with an antipsychotic-aripiprazole. Life table regression models were used to identify baseline characteristics associated with remission overall (general predictors) and their interaction with remission among the three treatment groups (moderators). RESULTS Remission was more likely for individuals who were employed, less severely and chronically depressed, less anxious, not experiencing complicated grief symptoms, did not experience childhood adversity, and had better quality of life and positive mental health. Two features suggested specific next-step treatment selections: age ≥65 years (for whom augmentation with aripiprazole was more effective than switch to bupropion) and severe mixed hypomanic symptoms (for which augmentation with aripiprazole and combination with bupropion were more effective than switch to bupropion). CONCLUSIONS If replicated, these preliminary findings could help clinicians determine which patients with depression requiring next-step treatment will benefit most from a specific augmentation, combination, or switching strategy.
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Affiliation(s)
- Sidney Zisook
- VA San Diego Healthcare System (Zisook, Tal); the Department of Psychiatry, University of California San Diego (Zisook); Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, West Haven (Johnson, Zhao); the Department of Psychiatry, Texas A&M College of Medicine, Temple (Hicks); Louis Stokes VA Medical Center and the Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland (Chen); Tuscaloosa VA Medical Center, Tuscaloosa, Ala. (Davis); University of Alabama School of Medicine, Birmingham (Davis); Philadelphia VA Medical Center (Thase); Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, N.Mex. (Vertrees); and the VA New England Mental Illness Research, Education, and Clinical Center, VA Connecticut Healthcare System, West Haven (Mohamed)
| | - Gary R Johnson
- VA San Diego Healthcare System (Zisook, Tal); the Department of Psychiatry, University of California San Diego (Zisook); Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, West Haven (Johnson, Zhao); the Department of Psychiatry, Texas A&M College of Medicine, Temple (Hicks); Louis Stokes VA Medical Center and the Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland (Chen); Tuscaloosa VA Medical Center, Tuscaloosa, Ala. (Davis); University of Alabama School of Medicine, Birmingham (Davis); Philadelphia VA Medical Center (Thase); Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, N.Mex. (Vertrees); and the VA New England Mental Illness Research, Education, and Clinical Center, VA Connecticut Healthcare System, West Haven (Mohamed)
| | - Ilanit Tal
- VA San Diego Healthcare System (Zisook, Tal); the Department of Psychiatry, University of California San Diego (Zisook); Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, West Haven (Johnson, Zhao); the Department of Psychiatry, Texas A&M College of Medicine, Temple (Hicks); Louis Stokes VA Medical Center and the Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland (Chen); Tuscaloosa VA Medical Center, Tuscaloosa, Ala. (Davis); University of Alabama School of Medicine, Birmingham (Davis); Philadelphia VA Medical Center (Thase); Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, N.Mex. (Vertrees); and the VA New England Mental Illness Research, Education, and Clinical Center, VA Connecticut Healthcare System, West Haven (Mohamed)
| | - Paul Hicks
- VA San Diego Healthcare System (Zisook, Tal); the Department of Psychiatry, University of California San Diego (Zisook); Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, West Haven (Johnson, Zhao); the Department of Psychiatry, Texas A&M College of Medicine, Temple (Hicks); Louis Stokes VA Medical Center and the Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland (Chen); Tuscaloosa VA Medical Center, Tuscaloosa, Ala. (Davis); University of Alabama School of Medicine, Birmingham (Davis); Philadelphia VA Medical Center (Thase); Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, N.Mex. (Vertrees); and the VA New England Mental Illness Research, Education, and Clinical Center, VA Connecticut Healthcare System, West Haven (Mohamed)
| | - Peijun Chen
- VA San Diego Healthcare System (Zisook, Tal); the Department of Psychiatry, University of California San Diego (Zisook); Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, West Haven (Johnson, Zhao); the Department of Psychiatry, Texas A&M College of Medicine, Temple (Hicks); Louis Stokes VA Medical Center and the Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland (Chen); Tuscaloosa VA Medical Center, Tuscaloosa, Ala. (Davis); University of Alabama School of Medicine, Birmingham (Davis); Philadelphia VA Medical Center (Thase); Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, N.Mex. (Vertrees); and the VA New England Mental Illness Research, Education, and Clinical Center, VA Connecticut Healthcare System, West Haven (Mohamed)
| | - Lori Davis
- VA San Diego Healthcare System (Zisook, Tal); the Department of Psychiatry, University of California San Diego (Zisook); Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, West Haven (Johnson, Zhao); the Department of Psychiatry, Texas A&M College of Medicine, Temple (Hicks); Louis Stokes VA Medical Center and the Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland (Chen); Tuscaloosa VA Medical Center, Tuscaloosa, Ala. (Davis); University of Alabama School of Medicine, Birmingham (Davis); Philadelphia VA Medical Center (Thase); Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, N.Mex. (Vertrees); and the VA New England Mental Illness Research, Education, and Clinical Center, VA Connecticut Healthcare System, West Haven (Mohamed)
| | - Michael Thase
- VA San Diego Healthcare System (Zisook, Tal); the Department of Psychiatry, University of California San Diego (Zisook); Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, West Haven (Johnson, Zhao); the Department of Psychiatry, Texas A&M College of Medicine, Temple (Hicks); Louis Stokes VA Medical Center and the Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland (Chen); Tuscaloosa VA Medical Center, Tuscaloosa, Ala. (Davis); University of Alabama School of Medicine, Birmingham (Davis); Philadelphia VA Medical Center (Thase); Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, N.Mex. (Vertrees); and the VA New England Mental Illness Research, Education, and Clinical Center, VA Connecticut Healthcare System, West Haven (Mohamed)
| | - Yinjun Zhao
- VA San Diego Healthcare System (Zisook, Tal); the Department of Psychiatry, University of California San Diego (Zisook); Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, West Haven (Johnson, Zhao); the Department of Psychiatry, Texas A&M College of Medicine, Temple (Hicks); Louis Stokes VA Medical Center and the Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland (Chen); Tuscaloosa VA Medical Center, Tuscaloosa, Ala. (Davis); University of Alabama School of Medicine, Birmingham (Davis); Philadelphia VA Medical Center (Thase); Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, N.Mex. (Vertrees); and the VA New England Mental Illness Research, Education, and Clinical Center, VA Connecticut Healthcare System, West Haven (Mohamed)
| | - Julia Vertrees
- VA San Diego Healthcare System (Zisook, Tal); the Department of Psychiatry, University of California San Diego (Zisook); Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, West Haven (Johnson, Zhao); the Department of Psychiatry, Texas A&M College of Medicine, Temple (Hicks); Louis Stokes VA Medical Center and the Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland (Chen); Tuscaloosa VA Medical Center, Tuscaloosa, Ala. (Davis); University of Alabama School of Medicine, Birmingham (Davis); Philadelphia VA Medical Center (Thase); Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, N.Mex. (Vertrees); and the VA New England Mental Illness Research, Education, and Clinical Center, VA Connecticut Healthcare System, West Haven (Mohamed)
| | - Somaia Mohamed
- VA San Diego Healthcare System (Zisook, Tal); the Department of Psychiatry, University of California San Diego (Zisook); Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, West Haven (Johnson, Zhao); the Department of Psychiatry, Texas A&M College of Medicine, Temple (Hicks); Louis Stokes VA Medical Center and the Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland (Chen); Tuscaloosa VA Medical Center, Tuscaloosa, Ala. (Davis); University of Alabama School of Medicine, Birmingham (Davis); Philadelphia VA Medical Center (Thase); Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, N.Mex. (Vertrees); and the VA New England Mental Illness Research, Education, and Clinical Center, VA Connecticut Healthcare System, West Haven (Mohamed)
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142
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Mofsen AM, Rodebaugh TL, Nicol GE, Depp CA, Miller JP, Lenze EJ. When All Else Fails, Listen to the Patient: A Viewpoint on the Use of Ecological Momentary Assessment in Clinical Trials. JMIR Ment Health 2019; 6:e11845. [PMID: 31066701 PMCID: PMC6524455 DOI: 10.2196/11845] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 02/05/2019] [Accepted: 04/03/2019] [Indexed: 01/09/2023] Open
Abstract
A major problem in mental health clinical trials, such as depression, is low assay sensitivity in primary outcome measures. This has contributed to clinical trial failures, resulting in the exodus of the pharmaceutical industry from the Central Nervous System space. This reduced assay sensitivity in psychiatry outcome measures stems from inappropriately broad measures, recall bias, and poor interrater reliability. Limitations in the ability of traditional measures to differentiate between the trait versus state-like nature of individual depressive symptoms also contributes to measurement error in clinical trials. In this viewpoint, we argue that ecological momentary assessment (EMA)-frequent, real time, in-the-moment assessments of outcomes, delivered via smartphone-can both overcome these psychometric challenges and reduce clinical trial failures by increasing assay sensitivity and minimizing recall and rater bias. Used in this manner, EMA has the potential to further our understanding of treatment response by allowing for the assessment of dynamic interactions between treatment and distinct symptom response.
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Affiliation(s)
- Aaron M Mofsen
- Department of Psychiatry, School of Medicine, Washington University in St Louis, St Louis, MO, United States
| | - Thomas L Rodebaugh
- Department of Psychological and Brain Sciences, Washington University in St Louis, St Louis, MO, United States
| | - Ginger E Nicol
- Department of Psychiatry, School of Medicine, Washington University in St Louis, St Louis, MO, United States
| | - Colin A Depp
- Department of Psychiatry, University of California - San Diego, San Diego, CA, United States
| | - J Philip Miller
- Division of Biostatistics, School of Medicine, Washington University in St Louis, St Louis, MO, United States
| | - Eric J Lenze
- Department of Psychiatry, School of Medicine, Washington University in St Louis, St Louis, MO, United States
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143
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Rutledge RB, Chekroud AM, Huys QJ. Machine learning and big data in psychiatry: toward clinical applications. Curr Opin Neurobiol 2019; 55:152-159. [PMID: 30999271 DOI: 10.1016/j.conb.2019.02.006] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 01/29/2019] [Accepted: 02/07/2019] [Indexed: 12/21/2022]
Abstract
Psychiatry is a medical field concerned with the treatment of mental illness. Psychiatric disorders broadly relate to higher functions of the brain, and as such are richly intertwined with social, cultural, and experiential factors. This makes them exquisitely complex phenomena that depend on and interact with a large number of variables. Computational psychiatry provides two ways of approaching this complexity. Theory-driven computational approaches employ mechanistic models to make explicit hypotheses at multiple levels of analysis. Data-driven machine-learning approaches can make predictions from high-dimensional data and are generally agnostic as to the underlying mechanisms. Here, we review recent advances in the use of big data and machine-learning approaches toward the aim of alleviating the suffering that arises from psychiatric disorders.
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Affiliation(s)
- Robb B Rutledge
- Max Planck UCL Centre for Computational Psychiatry and Ageing Research, University College London, London, England, United Kingdom; Wellcome Centre for Human Neuroimaging, University College London, London, England, United Kingdom
| | - Adam M Chekroud
- Department of Psychiatry, Yale University, New Haven, CT, United States; Spring Health, New York, NY, United States
| | - Quentin Jm Huys
- Max Planck UCL Centre for Computational Psychiatry and Ageing Research, University College London, London, England, United Kingdom; Division of Psychiatry, University College London, London, England, United Kingdom; Camden and Islington NHS Foundation Trust, London, England, United Kingdom.
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144
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Abstract
The biological mechanisms underlying psychiatric diagnoses are not well defined. Clinical diagnosis based on categorical systems exhibit high levels of heterogeneity and co-morbidity. The Research Domain Criteria (RDoC) attempts to reconceptualize psychiatric disorders into transdiagnostic functional dimensional constructs based on neurobiological measures and observable behaviour. By understanding the underlying neurobiology and pathophysiology of the relevant processes, the RDoC aims to advance biomarker development for disease prediction and treatment response. This important evolving dimensional framework must also consider environmental factors. Emerging evidence suggests that gut microbes (microbiome) play a physiological role in brain diseases by modulating neuroimmune, neuroendocrine and neural signalling pathways between the gut and the brain. The integration of the gut microbiome signature as an additional dimensional component of the RDoC may enhance precision psychiatry.
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145
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Affiliation(s)
- Gregory E Simon
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
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146
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Dinga R, Schmaal L, Penninx BWJH, van Tol MJ, Veltman DJ, van Velzen L, Mennes M, van der Wee NJA, Marquand AF. Evaluating the evidence for biotypes of depression: Methodological replication and extension of. NEUROIMAGE-CLINICAL 2019; 22:101796. [PMID: 30935858 PMCID: PMC6543446 DOI: 10.1016/j.nicl.2019.101796] [Citation(s) in RCA: 175] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 03/22/2019] [Accepted: 03/25/2019] [Indexed: 10/29/2022]
Abstract
BACKGROUND Psychiatric disorders are highly heterogeneous, defined based on symptoms with little connection to potential underlying biological mechanisms. A possible approach to dissect biological heterogeneity is to look for biologically meaningful subtypes. A recent study Drysdale et al. (2017) showed promising results along this line by simultaneously using resting state fMRI and clinical data and identified four distinct subtypes of depression with different clinical profiles and abnormal resting state fMRI connectivity. These subtypes were predictive of treatment response to transcranial magnetic stimulation therapy. OBJECTIVE Here, we attempted to replicate the procedure followed in the Drysdale et al. study and their findings in a different clinical population and a more heterogeneous sample of 187 participants with depression and anxiety. We aimed to answer the following questions: 1) Using the same procedure, can we find a statistically significant and reliable relationship between brain connectivity and clinical symptoms? 2) Is the observed relationship similar to the one found in the original study? 3) Can we identify distinct and reliable subtypes? 4) Do they have similar clinical profiles as the subtypes identified in the original study? METHODS We followed the original procedure as closely as possible, including a canonical correlation analysis to find a low dimensional representation of clinically relevant resting state fMRI features, followed by hierarchical clustering to identify subtypes. We extended the original procedure using additional statistical tests, to test the statistical significance of the relationship between resting state fMRI and clinical data, and the existence of distinct subtypes. Furthermore, we examined the stability of the whole procedure using resampling. RESULTS AND CONCLUSION As in the original study, we found extremely high canonical correlations between functional connectivity and clinical symptoms, and an optimal three-cluster solution. However, neither canonical correlations nor clusters were statistically significant. On the basis of our extensive evaluations of the analysis methodology used and within the limits of comparison of our sample relative to the sample used in Drysdale et al., we argue that the evidence for the existence of the distinct resting state connectivity-based subtypes of depression should be interpreted with caution.
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Affiliation(s)
- Richard Dinga
- Department of Psychiatry, Amsterdam UMC, Amsterdam, the Netherlands.
| | - Lianne Schmaal
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Australia; Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | | | - Marie Jose van Tol
- Cognitive Neuroscience Center, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Dick J Veltman
- Department of Psychiatry, Amsterdam UMC, Amsterdam, the Netherlands
| | - Laura van Velzen
- Department of Psychiatry, Amsterdam UMC, Amsterdam, the Netherlands
| | - Maarten Mennes
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, the Netherlands
| | - Nic J A van der Wee
- Department of Psychiatry, Leiden University Medical Center, Leiden, the Netherlands
| | - Andre F Marquand
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, the Netherlands
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147
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Abstract
OBJECTIVE We consider how to choose an antidepressant (AD) medication for the treatment of clinical depression. METHOD A narrative review was undertaken addressing antidepressant 'choice' considering a range of parameters either weighted by patients and clinicians or suggested in the scientific literature. Findings were synthesised and incorporated with clinical experience into a model to assist AD choice. RESULTS Efficacy studies comparing ADs offer indicative guidance, while precision psychiatry prediction based on genetics, developmental trauma, neuroimaging, behavioural and cognitive biomarkers, currently has limited clinical utility. Our model offers guidance for AD choice by assessing first for the presence of a depressive subtype or symptom cluster and matching choice of AD class accordingly. Failing this, an AD can be chosen based on depression severity. Within-class choice can be determined by reference to personality style, patient preference, medical or psychiatric comorbidities and side-effect profile. CONCLUSION Clarification of AD choice would occur if medications are trialled in specific depressive subtypes rather than using the generic diagnosis of major depressive disorder (MDD). Such 'top-down' methods could be enhanced by 'bottom-up' studies to classify individuals according to symptom clusters and biomarkers with AD efficacy tested in these categories. Both methods could be utilised for personalised AD choice.
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Affiliation(s)
- A Bayes
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia.,Black Dog Institute, Randwick, NSW, Australia
| | - G Parker
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia.,Black Dog Institute, Randwick, NSW, Australia
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148
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Predicting antidepressant treatment outcome based on socioeconomic status and citalopram dose. THE PHARMACOGENOMICS JOURNAL 2019; 19:538-546. [DOI: 10.1038/s41397-019-0080-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 10/01/2018] [Accepted: 12/20/2018] [Indexed: 12/30/2022]
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149
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Meyer BM, Rabl U, Huemer J, Bartova L, Kalcher K, Provenzano J, Brandner C, Sezen P, Kasper S, Schatzberg AF, Moser E, Chen G, Pezawas L. Prefrontal networks dynamically related to recovery from major depressive disorder: a longitudinal pharmacological fMRI study. Transl Psychiatry 2019; 9:64. [PMID: 30718459 PMCID: PMC6362173 DOI: 10.1038/s41398-019-0395-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 01/03/2019] [Accepted: 01/10/2019] [Indexed: 12/28/2022] Open
Abstract
Due to lacking predictors of depression recovery, successful treatment of major depressive disorder (MDD) is frequently only achieved after therapeutic optimization leading to a prolonged suffering of patients. This study aimed to determine neural prognostic predictors identifying non-remitters prior or early after treatment initiation. Moreover, it intended to detect time-sensitive neural mediators indicating depression recovery. This longitudinal, interventional, single-arm, open-label, phase IV, pharmacological functional magnetic resonance imaging (fMRI) study comprised four scans at important stages prior (day 0) and after escitalopram treatment initiation (day 1, 28, and 56). Totally, 22 treatment-free MDD patients (age mean ± SD: 31.5 ± 7.7; females: 50%) suffering from a concurrent major depressive episode without any comorbid DSM-IV axis I diagnosis completed the study protocol. Primary outcome were neural prognostic predictors of depression recovery. Enhanced de-activation of anterior medial prefrontal cortex (amPFC, single neural mediator) indicated depression recovery correlating with MADRS score and working memory improvements. Strong dorsolateral PFC (dlPFC) activation and weak dlPFC-amPFC, dlPFC-posterior cingulate cortex (PCC), dlPFC-parietal lobe (PL) coupling (three prognostic predictors) hinted at depression recovery at day 0 and 1. Preresponse prediction of continuous (dlPFC-PL: R2day1 = 55.9%, 95% CI: 22.6-79%, P < 0.005) and dichotomous (specificity/sensitivity: SP/SNday1 = 0.91/0.82) recovery definitions remained significant after leave-one-out cross-validation. Identified prefrontal neural predictors might propel the future development of fMRI markers for clinical decision making, which could lead to increased response rates and adherence during acute phase treatment periods. Moreover, this study underscores the importance of the amPFC in depression recovery.
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Affiliation(s)
- Bernhard M. Meyer
- 0000 0000 9259 8492grid.22937.3dDivision of General Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Ulrich Rabl
- 0000 0000 9259 8492grid.22937.3dDivision of General Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Julia Huemer
- 0000 0000 9259 8492grid.22937.3dDepartment of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Lucie Bartova
- 0000 0000 9259 8492grid.22937.3dDivision of General Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Klaudius Kalcher
- 0000 0000 9259 8492grid.22937.3dMR Centre of Excellence, Medical University of Vienna, Vienna, Austria ,0000 0000 9259 8492grid.22937.3dCenter for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Julian Provenzano
- 0000 0000 9259 8492grid.22937.3dDivision of General Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Christoph Brandner
- 0000 0000 9259 8492grid.22937.3dDivision of General Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Patrick Sezen
- 0000 0000 9259 8492grid.22937.3dDivision of General Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Siegfried Kasper
- 0000 0000 9259 8492grid.22937.3dDivision of General Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Alan F. Schatzberg
- 0000000419368956grid.168010.eDepartment of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA USA
| | - Ewald Moser
- 0000 0000 9259 8492grid.22937.3dMR Centre of Excellence, Medical University of Vienna, Vienna, Austria ,0000 0000 9259 8492grid.22937.3dCenter for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Gang Chen
- 0000 0004 0464 0574grid.416868.5Scientific and Statistical Computational Core, National Institute of Mental Health, Bethesda, MA USA
| | - Lukas Pezawas
- Division of General Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria.
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150
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van Eeden WA, van Hemert AM, Carlier IVE, Penninx BW, Giltay EJ. Severity, course trajectory, and within-person variability of individual symptoms in patients with major depressive disorder. Acta Psychiatr Scand 2019; 139:194-205. [PMID: 30447008 PMCID: PMC6587785 DOI: 10.1111/acps.12987] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/12/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND Depression shows a large heterogeneity of symptoms between and within persons over time. However, most outcome studies have assessed depression as a single underlying latent construct, using the sum score on psychometric scales as an indicator for severity. This study assesses longitudinal symptom-specific trajectories and within-person variability of major depressive disorder over a 9-year period. METHODS Data were derived from the Netherlands Study of Depression and Anxiety (NESDA). This study included 783 participants with a current major depressive disorder at baseline. The Inventory Depressive Symptomatology-Self-Report (IDS-SR) was used to analyze 28 depressive symptoms at up to six time points during the 9-year follow-up. RESULTS The highest baseline severity scores were found for the items regarding energy and mood states. The core symptoms depressed mood and anhedonia had the most favorable course, whereas sleeping problems and (psycho-)somatic symptoms were more persistent over 9-year follow-up. Within-person variability was highest for symptoms related to energy and lowest for suicidal ideation. CONCLUSIONS The severity, course, and within-person variability differed markedly between depressive symptoms. Our findings strengthen the idea that employing a symptom-focused approach in both clinical care and research is of value.
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Affiliation(s)
- W. A. van Eeden
- Department of PsychiatryLeiden University Medical CenterLeidenThe Netherlands
| | - A. M. van Hemert
- Department of PsychiatryLeiden University Medical CenterLeidenThe Netherlands
| | - I. V. E. Carlier
- Department of PsychiatryLeiden University Medical CenterLeidenThe Netherlands
| | - B. W. Penninx
- Department of PsychiatryAmsterdam Public Health Research Institute and Amsterdam NeuroscienceVU University Medical CenterGGZ inGeestAmsterdamThe Netherlands
| | - E. J. Giltay
- Department of PsychiatryLeiden University Medical CenterLeidenThe Netherlands
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