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Bansal V, McCurry KL, Lisinski J, Kim DY, Goyal S, Wang JM, Lee J, Brown VM, LaConte SM, Casas B, Chiu PH. Reinforcement learning processes as forecasters of depression remission. J Affect Disord 2024:S0165-0327(24)01551-9. [PMID: 39271064 DOI: 10.1016/j.jad.2024.09.066] [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: 12/14/2023] [Revised: 09/06/2024] [Accepted: 09/10/2024] [Indexed: 09/15/2024]
Abstract
BACKGROUND Aspects of reinforcement learning have been associated with specific depression symptoms and may inform the course of depressive illness. METHODS We applied support vector machines to investigate whether blood‑oxygen-level dependent (BOLD) responses linked with neural prediction error (nPE) and neural expected value (nEV) from a probabilistic learning task could forecast depression remission. We investigated whether predictions were moderated by treatment use or symptoms. Participants included 55 individuals (n = 39 female) with a depression diagnosis at baseline; 36 of these individuals completed standard cognitive behavioral therapy and 19 were followed during naturalistic course of illness. All participants were assessed for depression diagnosis at a follow-up visit. RESULTS Both nPE and nEV classifiers forecasted remission significantly better than null classifiers. The nEV classifier performed significantly better than the nPE classifier. We found no main or interaction effects of treatment status on nPE or nEV accuracy. We found a significant interaction between nPE-forecasted remission status and anhedonia, but not for negative affect or anxious arousal, when controlling for nEV-forecasted remission status. LIMITATIONS Our sample size, while comparable to that of other studies, limits options for maximizing and evaluating model performance. We addressed this with two standard methods for optimizing model performance (90:10 train and test scheme and bootstrapped sampling). CONCLUSIONS Results support nEV and nPE as relevant biobehavioral signals for understanding depression outcome independent of treatment status, with nEV being stronger than nPE as a predictor of remission. Reinforcement learning variables may be useful components of an individualized medicine framework for depression healthcare.
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Affiliation(s)
- Vansh Bansal
- Fralin Biomedical Research Institute at VTC, Virginia Tech, Roanoke, VA, United States of America; Department of Psychology, Virginia Tech, Blacksburg, VA, United States of America
| | - Katherine L McCurry
- The Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States of America
| | - Jonathan Lisinski
- Fralin Biomedical Research Institute at VTC, Virginia Tech, Roanoke, VA, United States of America
| | - Dong-Youl Kim
- Fralin Biomedical Research Institute at VTC, Virginia Tech, Roanoke, VA, United States of America
| | - Shivani Goyal
- Fralin Biomedical Research Institute at VTC, Virginia Tech, Roanoke, VA, United States of America; Department of Psychology, Virginia Tech, Blacksburg, VA, United States of America
| | - John M Wang
- Fralin Biomedical Research Institute at VTC, Virginia Tech, Roanoke, VA, United States of America
| | - Jacob Lee
- Fralin Biomedical Research Institute at VTC, Virginia Tech, Roanoke, VA, United States of America
| | - Vanessa M Brown
- Department of Psychology, Emory University, Atlanta, GA, United States of America
| | - Stephen M LaConte
- Fralin Biomedical Research Institute at VTC, Virginia Tech, Roanoke, VA, United States of America; Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA, United States of America; Department of Psychiatry and Behavioral Medicine, Virginia Tech Carilion School of Medicine, Virginia Tech, Roanoke, VA, United States of America
| | - Brooks Casas
- Fralin Biomedical Research Institute at VTC, Virginia Tech, Roanoke, VA, United States of America; Department of Psychology, Virginia Tech, Blacksburg, VA, United States of America; Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA, United States of America; Department of Psychiatry and Behavioral Medicine, Virginia Tech Carilion School of Medicine, Virginia Tech, Roanoke, VA, United States of America
| | - Pearl H Chiu
- Fralin Biomedical Research Institute at VTC, Virginia Tech, Roanoke, VA, United States of America; Department of Psychology, Virginia Tech, Blacksburg, VA, United States of America; Department of Psychiatry and Behavioral Medicine, Virginia Tech Carilion School of Medicine, Virginia Tech, Roanoke, VA, United States of America.
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Gülpen J, Brouwer ME, Geurtsen GJ, van Dis EAM, Denys DAJP, Bockting CL. Treatments for partial remission of major depressive disorder: a systematic review and meta-analysis. BMJ MENTAL HEALTH 2023; 26:1-9. [PMID: 37914347 PMCID: PMC10626872 DOI: 10.1136/bmjment-2023-300827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 10/15/2023] [Indexed: 11/03/2023]
Abstract
QUESTION Partial remission of major depressive disorder (MDD) is a debilitating and distressing clinical state related to chronicity, morbidity and relapse. Although one-third of patients remit partially, evidence for treatment efficacy is unclear. We provide an overview of treatment options and their efficacy. STUDY SELECTION AND ANALYSIS Embase, PsycINFO, Medline and SCOPUS were systematically searched through February 2023. Included were randomised controlled trials (RCTs) examining any treatment in patients with partially remitted MDD aged 13-65 years, reporting data on severity, remission or relapse. FINDINGS Seven RCTs examining psychotherapy including 1024 patients were eligible. There were not enough RCTs to examine effects of pharmacotherapy. Psychotherapy was associated with lower depressive symptom severity at post-treatment (Hedges' g=0.50; 95% CI 0.23 to 0.76), but not at follow-up up to 1 year (Hedges' g=0.36; 95% CI -0.30 to 1.02) or longer (Hedges' g=0.02; 95% CI -0.09 to 0.12). Psychotherapy was associated with superior remission rates at post-treatment (OR 2.57; 95% CI 1.71 to 3.87) and follow-up 6 months or longer (OR 1.75; 95% CI 1.21 to 2.53), although not with improved relapse rates at post-treatment (OR 0.17; 95% CI 0.01 to 4.83) or follow-up 6 months or longer (OR 0.46; 95% CI 0.21 to 1.03). Overall methodological quality was poor. CONCLUSIONS Psychotherapy targeting partial remission may be effective in lowering depressive symptom severity and patients may potentially achieve full remission twice as likely. Yet, long-term and prophylactic effects are lacking. Given the risk of chronicity, more high-quality RCTs are needed. PROSPERO REGISTRATION NUMBER CRD42020188451.
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Affiliation(s)
- Joost Gülpen
- Department of Psychiatry, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
- Mental Health, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Marlies E Brouwer
- Department of Psychiatry, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
- Mental Health, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Gert J Geurtsen
- Department of Medical Psychology, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
- Amsterdam Neuroscience Research Institute, Amsterdam, The Netherlands
| | - Eva A M van Dis
- Department of Psychiatry, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
| | - Damiaan A J P Denys
- Department of Psychiatry, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
- Amsterdam Neuroscience Research Institute, Amsterdam, The Netherlands
| | - Claudi L Bockting
- Department of Psychiatry, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
- Mental Health, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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Bockting C, Legemaat AM, van der Stappen JGJ, Geurtsen GJ, Semkovska M, Burger H, Bergfeld IO, Lous N, Denys DAJP, Brouwer M. Augmenting neurocognitive remediation therapy to Preventive Cognitive Therapy for partially remitted depressed patients: protocol of a pragmatic multicentre randomised controlled trial. BMJ Open 2022; 12:e063407. [PMID: 35738653 PMCID: PMC9226921 DOI: 10.1136/bmjopen-2022-063407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Major depressive disorder (MDD) affects 163 million people globally every year. Individuals who experience subsyndromal depressive symptoms during remission (ie, partial remission of MDD) are especially at risk for a return to a depressive episode within an average of 4 months. Simultaneously, partial remission of MDD is associated with work and (psycho)social impairment and a lower quality of life. Brief psychological interventions such as preventive cognitive therapy (PCT) can reduce depressive symptoms or relapse for patients in partial remission, although achieving full remission with treatment is still a clinical challenge. Treatment might be more effective if cognitive functioning of patients is targeted as well since cognitive problems are the most persisting symptom in partial remission and predict poor treatment response and worse functioning. Studies show that cognitive functioning of patients with (remitted) MDD can be improved by online neurocognitive remediation therapy (oNCRT). Augmenting oNCRT to PCT might improve treatment effects for these patients by strengthening their cognitive functioning alongside a psychological intervention. METHODS AND ANALYSIS This study will examine the effectiveness of augmenting oNCRT to PCT in a pragmatic national multicentre superiority randomised controlled trial. We will include 115 adults partially remitted from MDD with subsyndromal depressive symptoms defined as a Hamilton Depression Rating Scale score between 8 and 15. Participants will be randomly allocated to PCT with oNCRT, or PCT only. Primary outcome measure is the effect on depressive symptomatology over 1 year. Secondary outcomes include time to relapse, cognitive functioning, quality of life and healthcare costs. This first dual approach study of augmenting oNCRT to PCT might facilitate full remission in partially remitted individuals as well as prevent relapse over time. ETHICS AND DISSEMINATION Ethical approval was obtained by Academic Medical Center, Amsterdam. Outcomes will be made publicly available. TRIAL REGISTRATION NUMBER NL9582.
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Affiliation(s)
- Claudi Bockting
- Department of Psychiatry, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
- Centre for Urban Mental Health, University of Amsterdam, Amsterdam, The Netherlands
| | - Amanda M Legemaat
- Department of Psychiatry, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
| | | | - Gert J Geurtsen
- Department of Medical Psychology, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
| | - Maria Semkovska
- Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Huibert Burger
- Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Isidoor O Bergfeld
- Department of Psychiatry, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Brain and Cognition, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Damiaan A J P Denys
- Department of Psychiatry, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
| | - Marlies Brouwer
- Department of Psychiatry, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
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Aluoja A, Tõru I, Raag M, Eller T, Võhma Ü, Maron E. Personality traits and escitalopram treatment outcome in major depression. Nord J Psychiatry 2018; 72:354-360. [PMID: 29688152 DOI: 10.1080/08039488.2018.1465590] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Selective serotonin re-uptake inhibitors (SSRI) have proven to be effective in treatment of depression. Still, treatment efficacy varies significantly from patient to patient and about 40% of patients do not respond to initial treatment. Personality traits have been considered one source of variability in treatment outcome. AIM Current study aimed at identifying specific personality traits that could be predictive of treatment response and/or the dynamics of symptom change in depressive patients. METHOD In a sample of 132 outpatients with major depressive disorder (MDD) treated with an SSRI-group antidepressant escitalopram, the Swedish universities Scales of Personality (SSP) were used in order to find predictive personality traits. For the assessment of the severity of depressive symptoms and the improvement rates, the Hamilton Depression Scale (HAM-D) and Montgomery-Åsberg Depression Rating Scale (MADRS) were used. RESULTS Escitalopram-treated MDD patients with higher social desirability achieved more rapid decrease in symptom severity. None of the studied traits predicted the end result of the treatment. CONCLUSION The findings suggest that specific personality traits may predict the trajectory of symptom change rather than the overall improvement rate.
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Affiliation(s)
- Anu Aluoja
- a Department of Psychiatry , University of Tartu , Tartu , Estonia
| | - Innar Tõru
- a Department of Psychiatry , University of Tartu , Tartu , Estonia
| | - Mait Raag
- b Institute of Family Medicine and Public Health, University of Tartu , Tartu , Estonia
| | - Triin Eller
- a Department of Psychiatry , University of Tartu , Tartu , Estonia
| | - Ülle Võhma
- c Psychiatry Clinic , North Estonia Medical Centre Foundation , Tallinn , Estonia
| | - Eduard Maron
- a Department of Psychiatry , University of Tartu , Tartu , Estonia.,c Psychiatry Clinic , North Estonia Medical Centre Foundation , Tallinn , Estonia.,d Centre for Neuropsychopharmacology , Imperial College London , London , UK
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Hage B, Britton B, Daniels D, Heilman K, Porges SW, Halaris A. Diminution of Heart Rate Variability in Bipolar Depression. Front Public Health 2017; 5:312. [PMID: 29270399 PMCID: PMC5723669 DOI: 10.3389/fpubh.2017.00312] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Accepted: 11/06/2017] [Indexed: 02/06/2023] Open
Abstract
Autonomic nervous system (ANS) dysregulation in depression is associated with symptoms associated with the ANS. The beat-to-beat pattern of heart rate defined as heart rate variability (HRV) provides a noninvasive portal to ANS function and has been proposed to represent a means of quantifying resting vagal tone. We quantified HRV in bipolar depressed (BDD) patients as a measure of ANS dysregulation seeking to establish HRV as a potential diagnostic and prognostic biomarker for treatment outcome. Forty-seven BDD patients were enrolled. They were randomized to receive either escitalopram-celecoxib or escitalopram-placebo over 8 weeks in a double-blind study design. Thirty-five patients completed the HRV studies. Thirty-six healthy subjects served as controls. HRV was assessed at pretreatment and end of study and compared with that of controls. HRV was quantified and corrected for artifacts using an algorithm that incorporates time and frequency domains to address non-stationarity of the beat-to-beat heart rate pattern. Baseline high frequency-HRV (i.e., respiratory sinus arrhythmia) was lower in BDD patients than controls, although the difference did not reach significance. Baseline low-frequency HRV was significantly lower in BDD patients (ln4.20) than controls (ln = 5.50) (p < 0.01). Baseline heart period was significantly shorter (i.e., faster heart rate) in BDD patients than controls. No significant change in HRV parameters were detected over the course of the study with either treatment. These findings suggest that components of HRV may be diminished in BDD patients.
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Affiliation(s)
- Brandon Hage
- Department of Psychiatry and Behavioral Neurosciences, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, United States
| | - Briana Britton
- Department of Psychiatry and Behavioral Neurosciences, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, United States
| | - David Daniels
- Department of Psychiatry and Behavioral Neurosciences, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, United States
| | - Keri Heilman
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, United States
| | - Stephen W Porges
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, United States.,Kinsey Institute, Indiana University Bloomington, Bloomington, IN, United States
| | - Angelos Halaris
- Department of Psychiatry and Behavioral Neurosciences, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, United States
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6
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Differing antidepressant maintenance methodologies. Contemp Clin Trials 2017; 61:87-95. [DOI: 10.1016/j.cct.2017.07.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 07/17/2017] [Accepted: 07/20/2017] [Indexed: 12/28/2022]
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Raising the Minimum Effective Dose of Serotonin Reuptake Inhibitor Antidepressants: Adverse Drug Events. J Clin Psychopharmacol 2016; 36:483-91. [PMID: 27518478 DOI: 10.1097/jcp.0000000000000564] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
This review focuses on the dose-response of serotonin reuptake inhibitor (SRI) antidepressants for efficacy and for adverse drug events (ADEs). Dose-response is identified by placebo-controlled, double-blind, fixed-dose clinical trials comparing various doses for efficacy and for ADEs. Reports from the great majority of clinical trials have consistently found that the minimum SRI effective dose is usually optimal for efficacy in the treatment of depression disorders, even though most American medical practitioners raise the dose when early antidepressant treatment results are negative or partial. To better understand this issue, the medical literature was comprehensively reviewed to ascertain the degree to which SRI medications resulted in a flat dose response for efficacy and then to identify specific ADEs that are dose-dependent. Strong evidence from fixed-dose trial data for the efficacy of nonascendant, minimum effective doses of SRIs was found for the treatment of both major depression and anxiety disorders. Particularly important was the finding that most SRI ADEs have an ascending dose-response curve. These ADEs include sexual dysfunction, hypertension, cardiac conduction risks, hyperglycemia, decreased bone density, sweating, withdrawal symptoms, and agitation. Thus, routinely raising the SRI dose above the minimum effective dose for efficacy can be counter-productive.
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Lopez-Castroman J, Jaussent I, Gorwood P, Courtet P. SUICIDAL DEPRESSED PATIENTS RESPOND LESS WELL TO ANTIDEPRESSANTS IN THE SHORT TERM. Depress Anxiety 2016; 33:483-94. [PMID: 26882201 DOI: 10.1002/da.22473] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Revised: 01/06/2016] [Accepted: 01/11/2016] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Suicidal thoughts and behaviors could be associated to a poor response to antidepressant treatment, but the exclusion of suicidal patients from randomized clinical trials restricts the available knowledge. In this study, we aimed at defining more precisely the response to antidepressants among suicidal patients and the threshold of suicidality that best predicts a poor response. METHOD We investigated the short-term response to a new antidepressant treatment of 4,041 depressed outpatients depending on their suicidal status (passive or active suicidal ideation (SI), history of suicide attempts [SAs]), either self-rated or clinician-rated. Depression outcomes, measured with the Hospital Anxiety and Depression Scale, and remission rates were compared depending on suicidal status at baseline using logistic regression models. RESULTS Using either a qualitative or a quantitative approach to measure SI, we found that suicidal patients were less likely to improve or attain remission, but not more likely to worsen, than nonsuicidal patients. In the multivariate analyses, SI (odds ratio [OR] = 1.40; 95% confidence interval [CI]: 1.18-1.65) and a history of SA (OR = 1.39; 95% CI: 1.16-1.66) were the best predictors of nonremission, independently of the class of antidepressant treatment. CONCLUSION Antidepressant treatment seems to be less effective among those patients that need it most. Clinical trials including suicidal patients are needed to investigate specific treatment options.
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Affiliation(s)
- Jorge Lopez-Castroman
- Department of Psychiatry, CHRU Nimes, Nimes, France.,Inserm, U1061, Université Montpellier, Montpellier, France.,Fondamental Foundation, Créteil, France
| | | | - Philip Gorwood
- Department of Psychiatry, Sainte-Anne Hospital (CMME), Paris, France.,INSERM U894, (Center of Psychiatry and Neurosciences), Paris, France.,Department of Psychiatry, University Paris Descartes, Paris, France
| | - Philippe Courtet
- Inserm, U1061, Université Montpellier, Montpellier, France.,Fondamental Foundation, Créteil, France.,Department of Emergency Psychiatry and Post-Acute Care, CHRU Montpellier, Montpellier, France
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