1
|
Shao J, Qin J, Wang H, Sun Y, Zhang W, Wang X, Wang T, Xue L, Yao Z, Lu Q. Capturing the Individual Deviations From Normative Models of Brain Structure for Depression Diagnosis and Treatment. Biol Psychiatry 2024; 95:403-413. [PMID: 37579934 DOI: 10.1016/j.biopsych.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 07/20/2023] [Accepted: 08/03/2023] [Indexed: 08/16/2023]
Abstract
BACKGROUND The high heterogeneity of depression prevents us from obtaining reproducible and definite anatomical maps of brain structural changes associated with the disorder, which limits the individualized diagnosis and treatment of patients. In this study, we investigated the clinical issues related to depression according to individual deviations from normative ranges of gray matter volume. METHODS We enrolled 1092 participants, including 187 patients with depression and 905 healthy control participants. Structural magnetic resonance imaging data of healthy control participants from the Human Connectome Project (n = 510) and REST-meta-MDD Project (n = 229) were used to establish a normative model across the life span in adults 18 to 65 years old for each brain region. Deviations from the normative range for 187 patients and 166 healthy control participants recruited from two local hospitals were captured as normative probability maps, which were used to identify the disease risk and treatment-related latent factors. RESULTS In contrast to case-control results, our normative modeling approach revealed highly individualized patterns of anatomic abnormalities in depressed patients (less than 11% extreme deviation overlapping for any regions). Based on our classification framework, models trained with individual normative probability maps (area under the receiver operating characteristic curve range, 0.7146-0.7836) showed better performance than models trained with original gray matter volume values (area under the receiver operating characteristic curve range, 0.6800-0.7036), which was verified in an independent external test set. Furthermore, different latent brain structural factors in relation to antidepressant treatment were revealed by a Bayesian model based on normative probability maps, suggesting distinct treatment response and inclination. CONCLUSIONS Capturing personalized deviations from a normative range could help in understanding the heterogeneous neurobiology of depression and thus guide clinical diagnosis and treatment of depression.
Collapse
Affiliation(s)
- Junneng Shao
- School of Biological Sciences & Medical Engineering, Southeast University, Nanjing, China; Key Laboratory of Child Development and Learning Science, Ministry of Education, Southeast University, Nanjing, China
| | - Jiaolong Qin
- School of Computer Science and Engineering, Nanjing University of Science and Technology, Nanjing, China
| | - Huan Wang
- School of Biological Sciences & Medical Engineering, Southeast University, Nanjing, China; Key Laboratory of Child Development and Learning Science, Ministry of Education, Southeast University, Nanjing, China
| | - Yurong Sun
- School of Biological Sciences & Medical Engineering, Southeast University, Nanjing, China; Key Laboratory of Child Development and Learning Science, Ministry of Education, Southeast University, Nanjing, China
| | - Wei Zhang
- School of Biological Sciences & Medical Engineering, Southeast University, Nanjing, China; Key Laboratory of Child Development and Learning Science, Ministry of Education, Southeast University, Nanjing, China
| | - Xinyi Wang
- School of Biological Sciences & Medical Engineering, Southeast University, Nanjing, China; Key Laboratory of Child Development and Learning Science, Ministry of Education, Southeast University, Nanjing, China
| | - Ting Wang
- School of Biological Sciences & Medical Engineering, Southeast University, Nanjing, China; Key Laboratory of Child Development and Learning Science, Ministry of Education, Southeast University, Nanjing, China
| | - Li Xue
- School of Biological Sciences & Medical Engineering, Southeast University, Nanjing, China; Key Laboratory of Child Development and Learning Science, Ministry of Education, Southeast University, Nanjing, China
| | - Zhijian Yao
- Department of Psychiatry, the Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China; Nanjing Brain Hospital, Medical School of Nanjing University, Nanjing, China.
| | - Qing Lu
- School of Biological Sciences & Medical Engineering, Southeast University, Nanjing, China; Key Laboratory of Child Development and Learning Science, Ministry of Education, Southeast University, Nanjing, China.
| |
Collapse
|
2
|
Quagliato LA, Primavera D, Fornaro M, Preti A, Carta MG, Nardi AE. An update on the pharmacotherapeutic strategies for the treatment of dysthymic disorder: a systematic review. Expert Opin Pharmacother 2023; 24:2035-2040. [PMID: 37787056 DOI: 10.1080/14656566.2023.2265809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 09/28/2023] [Indexed: 10/04/2023]
Abstract
INTRODUCTION Longer treatment times, more comorbidity, more severe impairments in social, psychological, and emotional functioning, increased healthcare use, and more hospitalizations are all factors that are related to dysthymia. Given the significant prevalence of dysthymia (including persistent depressive disorder) worldwide, its comorbidity with several mental disorders, and the detrimental effects of these comorbidities, it is important to conduct a systematic review to compare the effects of pharmacological acute and maintenance treatments for dysthymia with placebo and standard care in the last 10 years, based on the publication of DSM5. AREAS COVERED This systematic review was performed according to PRISMA guidelines. Databases, including PubMed and Cochrane Central Register of Controlled Trials, were searched to assess the effects of pharmacological acute and maintenance treatments for dysthymia in comparison with placebo and treatment as usual. EXPERT OPINION Our review shows that SSRIs and SNRIs present efficacy for dysthymia treatment, and L-Acetylcarnitine should be investigated further for this condition in elderly patients. The comparison of antidepressant medication versus placebo showed coherent results based on three studies favoring pharmacotherapy as an effective treatment for participants with dysthymia. However, the scarcity of research on continuation and maintenance therapy in people with dysthymia highlights the need for more primary research.
Collapse
Affiliation(s)
- Laiana A Quagliato
- Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Diego Primavera
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Michele Fornaro
- Neuroscience, Reproductive Science and Dentistry, Federico II University of Naples, Naples, Italy
| | - Antonio Preti
- Department of Neuroscience, University of Turin, Turin, Italy
| | - Mauro G Carta
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Antonio E Nardi
- Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| |
Collapse
|
3
|
Killgore WDS, Vanuk JR, Dailey NS. Treatment with morning blue light increases left amygdala volume and sleep duration among individuals with posttraumatic stress disorder. Front Behav Neurosci 2022; 16:910239. [PMID: 36172470 PMCID: PMC9510679 DOI: 10.3389/fnbeh.2022.910239] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 08/24/2022] [Indexed: 01/18/2023] Open
Abstract
BackgroundPosttraumatic stress disorder (PTSD) is associated with numerous cognitive, affective, and psychophysiological outcomes, including problems with sleep and circadian rhythms. We tested the effectiveness of a daily morning blue-light exposure treatment (BLT) versus a matched amber light treatment (ALT) to regulate sleep in individuals diagnosed with PTSD. Moreover, PTSD is also associated with reliable findings on structural neuroimaging scans, including reduced amygdala volumes and other differences in cortical gray matter volume (GMV) that may be indicative of underlying neurobehavioral dysfunctions. We examined the effect of BLT versus ALT on GMV and its association with sleep outcomes.MethodsSeventy-six individuals (25 male; 51 female) meeting DSM-V criteria for PTSD (Age = 31.45 years, SD = 8.83) completed sleep assessments and structural neuroimaging scans, followed by random assignment one of two light groups, including BLT (469 nm; n = 39) or placebo ALT (578 nm; n = 37) light therapy daily for 30-min over 6-weeks. Participants wore a wrist actigraph for the duration of the study. After treatment, participants returned to complete sleep assessments and a structural neuroimaging scan. Neuroimaging data were analyzed using the Computational Anatomy Toolbox (CAT12) and Voxel-Based Morphometry (VBM) modules within the Statistical Parametric Mapping (SPM12) software.ResultsThe BLT condition produced significant increases in total time in bed and total sleep time from actigraphy compared to the ALT condition, while ALT improved wake after sleep onset and sleep efficiency compared to BLT. Additionally, BLT led to an increase in left amygdala volume compared to ALT but did not affect hypothesized medial prefrontal regions. Finally, within group correlations showed that improvements in sleep quality and nightmare severity were correlated with increases in left amygdala volume over the course of treatment for the BLT group but not the ALT group.ConclusionIn individuals with PTSD, daily exposure to morning blue light treatment was associated with improvements in objective sleep duration and increased volume of the left amygdala compared to amber placebo light treatment, and changes in amygdala volume correlated with subjective improvement in sleep. These findings suggest that daily morning BLT may provide an important non-pharmacologic adjunctive approach for facilitating sleep and neurobehavioral recovery from PTSD.
Collapse
|
4
|
Yang J, Hellerstein DJ, Chen Y, McGrath PJ, Stewart JW, Peterson BS, Wang Z. Serotonin-norepinephrine reuptake inhibitor antidepressant effects on regional connectivity of the thalamus in persistent depressive disorder: evidence from two randomized, double-blind, placebo-controlled clinical trials. Brain Commun 2022; 4:fcac100. [PMID: 35592490 PMCID: PMC9113244 DOI: 10.1093/braincomms/fcac100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 02/02/2022] [Accepted: 04/12/2022] [Indexed: 11/13/2022] Open
Abstract
Previous neuroimaging studies have shown that serotonin-norepinephrine reuptake inhibitor antidepressants alter functional activity in large expanses of brain regions. However, it is not clear how these regions are systemically organized on a connectome level with specific topological properties, which may be crucial to revealing neural mechanisms underlying serotonin-norepinephrine reuptake inhibitor treatment of persistent depressive disorder. To investigate the effect of serotonin-norepinephrine reuptake inhibitor antidepressants on brain functional connectome reconfiguration in persistent depressive disorder and whether this reconfiguration promotes the improvement of clinical symptoms, we combined resting-state functional magnetic resonance imaging (fMRI) scans acquired in two randomized, double-blind, placebo-controlled trial studies of serotonin-norepinephrine reuptake inhibitor antidepressant treatment of patients with persistent depressive disorder. One was a randomized, double-blind, placebo-controlled trial of 10-week duloxetine medication treatment, which included 17 patients in duloxetine group and 17 patients in placebo group (ClinicalTrials.gov Identifier: NCT00360724); the other one was a randomized, double-blind, placebo-controlled trial of 12-week desvenlafaxine medication treatment, which included 16 patients in desvenlafaxine group and 15 patients in placebo group (ClinicalTrials.gov Identifier: NCT01537068). The 24-item Hamilton Depression Rating Scale was used to measure clinical symptoms, and graph theory was employed to examine serotonin-norepinephrine reuptake inhibitor antidepressant treatment effects on the topological properties of whole-brain functional connectome of patients with persistent depressive disorder. We adopted a hierarchical strategy to examine the topological property changes caused by serotonin-norepinephrine reuptake inhibitor antidepressant treatment, calculated their small-worldness, global integration, local segregation and nodal clustering coefficient in turn. Linear regression analysis was used to test associations of treatment, graph properties changes and clinical symptom response. Symptom scores were more significantly reduced after antidepressant than placebo administration (η 2 = 0.18). There was a treatment-by-time effect that optimized the functional connectome in a small-world manner, with increased global integration and increased nodal clustering coefficient in the bilateral thalamus (left thalamus η 2 = 0.21; right thalamus η 2 = 0.23). The nodal clustering coefficient increment of the right thalamus (ratio = 29.86; 95% confidence interval, -4.007 to -0.207) partially mediated the relationship between treatment and symptom improvement, and symptom improvement partially mediated (ratio = 21.21; 95% confidence interval, 0.0243-0.444) the relationship between treatment and nodal clustering coefficient increments of the right thalamus. Our study may indicate a putative mutually reinforcing association between nodal clustering coefficient increment of the right thalamus and symptom improvement from serotonin-norepinephrine reuptake inhibitor antidepressant treatments with duloxetine or desvenlafaxine.
Collapse
Affiliation(s)
- Jie Yang
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
- Department of Depression Evaluation Service, New York State Psychiatric Institute, 1051 Riverside Drive, Unit #51, New York, NY 10032, USA
| | - David J. Hellerstein
- Department of Depression Evaluation Service, New York State Psychiatric Institute, 1051 Riverside Drive, Unit #51, New York, NY 10032, USA
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
| | - Ying Chen
- Department of Depression Evaluation Service, New York State Psychiatric Institute, 1051 Riverside Drive, Unit #51, New York, NY 10032, USA
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
- Mailman School of Public Health, Columbia University, New York, NY 10032, USA
| | - Patrick J. McGrath
- Department of Depression Evaluation Service, New York State Psychiatric Institute, 1051 Riverside Drive, Unit #51, New York, NY 10032, USA
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
| | - Jonathan W. Stewart
- Department of Depression Evaluation Service, New York State Psychiatric Institute, 1051 Riverside Drive, Unit #51, New York, NY 10032, USA
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
| | - Bradley S. Peterson
- Institute for the Developing Mind, Children’s Hospital Los Angeles, Los Angeles, CA 90027, USA
- Keck School of Medicine, University of Southern California, Los Angeles, CA 90089-9021, USA
| | - Zhishun Wang
- Department of Depression Evaluation Service, New York State Psychiatric Institute, 1051 Riverside Drive, Unit #51, New York, NY 10032, USA
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
| |
Collapse
|