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Strakowski SM. Applying Functional Imaging to Clinical Practice: Are We Making Progress Toward Its Promise? Am J Psychiatry 2023; 180:182-184. [PMID: 36855873 DOI: 10.1176/appi.ajp.20230013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Affiliation(s)
- Stephen M Strakowski
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis; Mary O'Daniel and Bill Stone Center for Child and Adolescent Psychiatry, Evansville, Ind
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2
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Primo de Carvalho Alves L, Sica da Rocha N. Lower levels of brain-derived neurotrophic factor are associated with melancholic psychomotor retardation among depressed inpatients. Bipolar Disord 2018. [PMID: 29516593 DOI: 10.1111/bdi.12636] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVES Melancholic depression is a type of depression which is closely related to biological variables than are other types of depression. Its clinical features can be assessed using six items on the Hamilton Depression Rating Scale (HAM-D6 ). Previous studies have shown, using item response theory, that the symptom depressed mood is the least severe melancholic feature; work and activities, somatic symptoms and psychic anxiety are of moderate severity; and feelings of guilt and psychomotor retardation are the most severe. We aimed to evaluate whether the more severe melancholic signs or symptoms were associated with decreases in brain-derived neurotrophic factor (BDNF) levels. METHODS A total of 151 severely depressed inpatients had their BDNF levels analyzed by comparing those who presented with each HAM-D6 melancholic feature to those for whom the HAM-D6 feature was absent, using multiple linear regressions. The levels of BDNF of patients who presented with each melancholic feature were also compared with those of 100 healthy controls. RESULTS Depressed patients' median BDNF level was 44.06 ng/mL (interquartile range [IQR]: 33.99-62.4 ng/mL), and controls' median BDNF level was 65.22 ng/mL (IQR: 49.87-76.08 ng/mL) (P < .001). The presence of depressed mood, work and activities, somatic symptoms, psychic anxiety, and guilty feelings was not associated with BDNF levels. However, the presence of psychomotor retardation was associated with reduced BDNF (median reduction -10.07 ng/mL; 95% confidence interval [CI]: -19.43 to -0.71; P = .03). CONCLUSIONS To the best of our knowledge, this study is the first to associate BDNF levels with melancholic features in a sample of severely depressed inpatients. The main finding of this study was that severely depressed inpatients who presented the most severe melancholic feature, psychomotor retardation, had significantly reduced BDNF levels in the blood.
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Affiliation(s)
- Lucas Primo de Carvalho Alves
- Federal University of Rio Grande do Sul, Porto Alegre, Brazil.,Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, Porto Alegre, Brazil
| | - Neusa Sica da Rocha
- Federal University of Rio Grande do Sul, Porto Alegre, Brazil.,Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, Porto Alegre, Brazil
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Translocator protein (18kDa TSPO) binding, a marker of microglia, is reduced in major depression during cognitive-behavioral therapy. Prog Neuropsychopharmacol Biol Psychiatry 2018; 83:1-7. [PMID: 29269262 DOI: 10.1016/j.pnpbp.2017.12.011] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 11/27/2017] [Accepted: 12/18/2017] [Indexed: 12/27/2022]
Abstract
Prior studies indicated that neuroinflammation might play a role in the pathophysiology of major depressive disorder (MDD). The purpose of this study was to examine changes in a microglial marker in the brain of patients with MDD during cognitive-behavioral therapy (CBT) and supportive psychotherapy (SPT). Participants were newly diagnosed patients with MDD receiving CBT (n=20) or SPT (n=20) who were compared with 20 healthy control subjects. We used [18F]-FEPPA positron emission tomography (PET) to examine translocator protein total distribution volume (TSPO VT), a marker of microglial density and inflammation. Patients were scanned before and after CBT and SPT. Before therapy, TSPO VT was significantly elevated in neocortical grey matter, frontal cortex, temporal cortex, and hippocampus in MDD relative to the control subjects. In the CBT group, but not in the SPT group, TSPO VT was significantly reduced during the treatment period. Reductions in TSPO VT were correlated with the amelioration of depressive symptoms. This correlation was consistent in the hippocampus in both CBT and SPT groups. In conclusion, CBT, when it reduced symptoms, also decreased TSPO VT. Efficient psychosocial interventions were accompanied by the normalization of a glial marker in the brain of patients with MDD, which may indicate reduced pro-inflammatory activity.
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Juengst SB, Kumar RG, Wagner AK. A narrative literature review of depression following traumatic brain injury: prevalence, impact, and management challenges. Psychol Res Behav Manag 2017; 10:175-186. [PMID: 28652833 PMCID: PMC5476717 DOI: 10.2147/prbm.s113264] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Depression is one of the most common conditions to emerge after traumatic brain injury (TBI), and despite its potentially serious consequences it remains undertreated. Treatment for post-traumatic depression (PTD) is complicated due to the multifactorial etiology of PTD, ranging from biological pathways to psychosocial adjustment. Identifying the unique, personalized factors contributing to the development of PTD could improve long-term treatment and management for individuals with TBI. The purpose of this narrative literature review was to summarize the prevalence and impact of PTD among those with moderate to severe TBI and to discuss current challenges in its management. Overall, PTD has an estimated point prevalence of 30%, with 50% of individuals with moderate to severe TBI experiencing an episode of PTD in the first year after injury alone. PTD has significant implications for health, leading to more hospitalizations and greater caregiver burden, for participation, reducing rates of return to work and affecting social relationships, and for quality of life. PTD may develop directly or indirectly as a result of biological changes after injury, most notably post-injury inflammation, or through psychological and psychosocial factors, including pre injury personal characteristics and post-injury adjustment to disability. Current evidence for effective treatments is limited, although the strongest evidence supports antidepressants and cognitive behavioral interventions. More personalized approaches to treatment and further research into unique therapy combinations may improve the management of PTD and improve the health, functioning, and quality of life for individuals with TBI.
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Affiliation(s)
- Shannon B Juengst
- Department of Physical Medicine and Rehabilitation
- Department of Rehabilitation Counseling, University of Texas Southwestern Medical Center, Dallas, TX
| | - Raj G Kumar
- Department of Physical Medicine and Rehabilitation
| | - Amy K Wagner
- Department of Physical Medicine and Rehabilitation
- Department of Neuroscience
- Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA, USA
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Rive MM, Redlich R, Schmaal L, Marquand AF, Dannlowski U, Grotegerd D, Veltman DJ, Schene AH, Ruhé HG. Distinguishing medication-free subjects with unipolar disorder from subjects with bipolar disorder: state matters. Bipolar Disord 2016; 18:612-623. [PMID: 27870505 DOI: 10.1111/bdi.12446] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 10/01/2016] [Indexed: 01/24/2023]
Abstract
OBJECTIVES Recent studies have indicated that pattern recognition techniques of functional magnetic resonance imaging (fMRI) data for individual classification may be valuable for distinguishing between major depressive disorder (MDD) and bipolar disorder (BD). Importantly, medication may have affected previous classification results as subjects with MDD and BD use different classes of medication. Furthermore, almost all studies have investigated only depressed subjects. Therefore, we focused on medication-free subjects. We additionally investigated whether classification would be mood state independent by including depressed and remitted subjects alike. METHODS We applied Gaussian process classifiers to investigate the discriminatory power of structural MRI (gray matter volumes of emotion regulation areas) and resting-state fMRI (resting-state networks implicated in mood disorders: default mode network [DMN], salience network [SN], and lateralized frontoparietal networks [FPNs]) in depressed (n=42) and remitted (n=49) medication-free subjects with MDD and BD. RESULTS Depressed subjects with MDD and BD could be classified based on the gray matter volumes of emotion regulation areas as well as DMN functional connectivity with 69.1% prediction accuracy. Prediction accuracy using the FPNs and SN did not exceed chance level. It was not possible to discriminate between remitted subjects with MDD and BD. CONCLUSIONS For the first time, we showed that medication-free subjects with MDD and BD can be differentiated based on structural MRI as well as resting-state functional connectivity. Importantly, the results indicated that research concerning diagnostic neuroimaging tools distinguishing between MDD and BD should consider mood state as only depressed subjects with MDD and BD could be correctly classified. Future studies, in larger samples are needed to investigate whether the results can be generalized to medication-naïve or first-episode subjects.
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Affiliation(s)
- Maria M Rive
- Program for Mood Disorders, Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Ronny Redlich
- Department of Psychiatry, University of Münster, Münster, Germany
| | - Lianne Schmaal
- Department of Psychiatry and Neuroscience, Campus Amsterdam, VU University Medical Center, Amsterdam, the Netherlands
| | - André F Marquand
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, the Netherlands
| | - Udo Dannlowski
- Department of Psychiatry, University of Münster, Münster, Germany
| | | | - Dick J Veltman
- Department of Psychiatry, VU University Medical Center, Amsterdam, the Netherlands
| | - Aart H Schene
- Program for Mood Disorders, Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.,Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, the Netherlands.,Department of Psychiatry, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Henricus G Ruhé
- Program for Mood Disorders, Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.,Department of Psychiatry, Mood and Anxiety Disorders, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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Association of thalamic hyperactivity with treatment-resistant depression and poor response in early treatment for major depression: a resting-state fMRI study using fractional amplitude of low-frequency fluctuations. Transl Psychiatry 2016; 6:e754. [PMID: 26954981 PMCID: PMC4872444 DOI: 10.1038/tp.2016.18] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Revised: 01/16/2016] [Accepted: 01/24/2016] [Indexed: 12/13/2022] Open
Abstract
Despite novel antidepressant development, 10-30% of patients with major depressive disorder (MDD) have antidepressant treatment-resistant depression (TRD). Although new therapies are needed, lack of knowledge regarding the neural mechanisms underlying TRD hinders development of new therapeutic options. We aimed to identify brain regions in which spontaneous neural activity is not only altered in TRD but also associated with early treatment resistance in MDD. Sixteen patients with TRD, 16 patients with early-phase non-TRD and 26 healthy control (HC) subjects underwent resting-state functional magnetic resonance imaging. To identify brain region differences in spontaneous neural activity between patients with and without TRD, we assessed fractional amplitude of low-frequency fluctuations (fALFF). We also calculated correlations between the percent change in the Hamilton Rating Scale for Depression (HRSD17) scores and fALFF values in brain regions with differing activity for patients with and without TRD. Patients with TRD had increased right-thalamic fALFF values compared with patients without TRD. The percent change in HRSD17 scores negatively correlated with fALFF values in patients with non-TRD. In addition, patients with TRD showed increased fALFF values in the right inferior frontal gyrus (IFG), inferior parietal lobule (IPL) and vermis, compared with patients with non-TRD and HC subjects. Our results show that spontaneous activity in the right thalamus correlates with antidepressant treatment response. We also demonstrate that spontaneous activity in the right IFG, IPL and vermis may be specifically implicated in the neural pathophysiology of TRD.
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Almeida OP, Hankey GJ, Yeap BB, Golledge J, Flicker L. Prevalence, associated factors, mood and cognitive outcomes of traumatic brain injury in later life: the health in men study (HIMS). Int J Geriatr Psychiatry 2015; 30:1215-23. [PMID: 25703581 DOI: 10.1002/gps.4276] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Revised: 01/21/2015] [Accepted: 01/23/2015] [Indexed: 11/06/2022]
Abstract
BACKGROUND The incidence of traumatic brain injury (TBI) is rising, as are its neuropsychiatric complications. This study aims to determine (1) the prevalence of TBI, (2) the association between history of past TBI and sociodemographic, lifestyle and clinical factors, and (3) the risk of depression and cognitive impairment in later life associated with exposure to TBI. METHODS Cross-sectional study of a community-derived sample of 5486 Australian men aged 70-89 years. Information on TBI was retrieved from the Western Australian Data Linkage System (WADLS) and via self-report. We used the WADLS and self-report to ascertain history of past depression, and the Geriatric Depression Scale 15-items to assess current clinically significant symptoms of depression, defined by score ≥7. We defined cognitive impairment by a mini-mental state examination score <24 or a WADLS diagnosis of dementia. RESULTS Nine hundred fifty-three men had history of TBI (17.4%). Factors associated with TBI included coronary heart disease, stroke, poor self-perceived physical health and falls. TBI increased the odds ratio of past (odds ratio (OR) = 1.55, 95% confidence interval (CI) = 1.21, 1.99) and current depression (OR = 1.77, 95% CI = 1.36, 2.32), as well as of cognitive impairment (OR = 1.23, 95% CI = 1.00, 1.51). The population fractions of depression and cognitive impairment attributable to TBI were 6.9% (95% CI = 3.3%, 10.3%) and 3.4% (95% CI = 0.0%, 6.9%). CONCLUSIONS History of TBI is common in older men, and is associated with increased risk of depression and cognitive impairment. If this association is truly causal, then the effective reduction of events leading to TBI (e.g., motor vehicle accidents and falls) may also decrease the prevalence of depression and cognitive impairment in later life.
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Affiliation(s)
- Osvaldo P Almeida
- School of Psychiatry & Clinical Neurosciences, University of Western Australia, Perth, Australia.,WA Centre for Health & Ageing, Centre for Medical Research, Perth, Australia.,Department of Psychiatry, Royal Perth Hospital, Perth, Australia
| | - Graeme J Hankey
- School of Medicine and Pharmacology, University of Western Australia, Perth, Australia.,Department of Neurology, Sir Charles Gairdner Hospital, Perth, Australia
| | - Bu B Yeap
- School of Medicine and Pharmacology, University of Western Australia, Perth, Australia.,Department of Endocrinology and Diabetes, Fiona Stanley Hospital, Perth, Australia.,Department of Endocrinology and Diabetes, Fremantle Hospital, Perth, Australia
| | - Jonathan Golledge
- Queensland Research Centre for Periral Vascular Disease, School of Medicine and Dentistry, James Cook University, Townsville, Australia.,Department of Vascular and Endovascular Surgery, The Townsville Hospital, Townsville, Australia
| | - Leon Flicker
- WA Centre for Health & Ageing, Centre for Medical Research, Perth, Australia.,School of Medicine and Pharmacology, University of Western Australia, Perth, Australia.,Department of Geriatric Medicine, Royal Perth Hospital, Perth, Australia
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Cerullo MA, Eliassen JC, Smith CT, Fleck DE, Nelson EB, Strawn JR, Lamy M, DelBello MP, Adler CM, Strakowski SM. Bipolar I disorder and major depressive disorder show similar brain activation during depression. Bipolar Disord 2014; 16:703-12. [PMID: 24990479 PMCID: PMC4213254 DOI: 10.1111/bdi.12225] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Accepted: 02/27/2014] [Indexed: 01/03/2023]
Abstract
OBJECTIVES Despite different treatments and courses of illness, depressive symptoms appear similar in major depressive disorder (MDD) and bipolar I disorder (BP-I). This similarity of depressive symptoms suggests significant overlap in brain pathways underlying neurovegetative, mood, and cognitive symptoms of depression. These shared brain regions might be expected to exhibit similar activation in individuals with MDD and BP-I during functional magnetic resonance imaging (fMRI). METHODS fMRI was used to compare regional brain activation in participants with BP-I (n = 25) and MDD (n = 25) during a depressive episode as well as 25 healthy comparison (HC) participants. During the scans, participants performed an attentional task that incorporated emotional pictures. RESULTS During the viewing of emotional images, subjects with BP-I showed decreased activation in the middle occipital gyrus, lingual gyrus, and middle temporal gyrus compared to both subjects with MDD and HC participants. During attentional processing, participants with MDD had increased activation in the parahippocampus, parietal lobe, and postcentral gyrus. However, among these regions, only the postcentral gyrus also showed differences between MDD and HC participants. CONCLUSIONS No differences in cortico-limbic regions were found between participants with BP-I and MDD during depression. Instead, the major differences occurred in primary and secondary visual processing regions, with decreased activation in these regions in BP-I compared to major depression. These differences were driven by abnormal decreases in activation seen in the participants with BP-I. Posterior activation changes are a common finding in studies across mood states in participants with BP-I.
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Affiliation(s)
- Michael A Cerullo
- Department of Psychiatry, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - James C Eliassen
- Center for Imaging Research, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Christopher T Smith
- Department of Psychiatry, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - David E Fleck
- Department of Psychiatry, University of Cincinnati College of Medicine, Cincinnati, OH, USA,Center for Imaging Research, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Erik B Nelson
- Department of Psychiatry, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Jeffrey R Strawn
- Department of Psychiatry, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Martine Lamy
- Department of Psychiatry, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Melissa P DelBello
- Department of Psychiatry, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Caleb M Adler
- Department of Psychiatry, University of Cincinnati College of Medicine, Cincinnati, OH, USA,Center for Imaging Research, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Stephen M Strakowski
- Department of Psychiatry, University of Cincinnati College of Medicine, Cincinnati, OH, USA,Center for Imaging Research, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Ellis MJ, Leddy JJ, Willer B. Physiological, vestibulo-ocular and cervicogenic post-concussion disorders: An evidence-based classification system with directions for treatment. Brain Inj 2014; 29:238-48. [DOI: 10.3109/02699052.2014.965207] [Citation(s) in RCA: 194] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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