Antidepressant resistance in adolescents with major depressive disorder: A nationwide longitudinal study

Comparative analysis of the risk of severe bacterial infection and septicemia in adolescents and young adults with treatment-resistant depression and treatment-responsive depression - a nationwide cohort study in Taiwan

Previous studies have shown an association between depression and increased susceptibility to infection in the general population. However, there has been no prior research specifically examining the relationship between treatment-resistant depression (TRD) and severe bacterial infections (SBI) in adolescents and young adults. This retrospective observational cohort study utilized the Taiwan National Health Insurance Research Database (NHIRD) from 2001 to 2010. It included adolescents (12-19 years of age) and young adults (20-29 years of age) diagnosed with major depressive disorder (MDD), comprising 6958 cases of TRD and 27,832 cases of antidepressant-responsive depression (ARPD). The TRD and ARPD groups were further matched (4:1) by chronological age, age at diagnosis of depression, sex, residence, and family income. The primary outcomes were severe bacterial infections (SBI) and septicemia. Cox regression analysis was conducted to identify the risk of hospitalization due to SBI or septicemia during the follow-up period. Compared with controls, the ARPD group had increased risks of SBI (hazard ratio [HR] with 95% confidence interval [CI]: 3.90, 2.73-5.57) and septicemia (HR, 95% CI: 2.56, 1.34-4.91). Notably, the risks of SBI and septicemia appeared to be further elevated in the TRD group. The TRD group exhibited higher incidences of SBI (HR, 95% CI: 6.99, 4.73-10.34) and septicemia (HR, 95% CI: 2.85, 1.28-6.36) than the control group. Adolescents and young adults with TRD had 6.99-fold and 3.90-fold increased risks of SBI and septicemia compared to individuals without MDD, respectively. Therefore, healthcare providers need to be vigilant when monitoring and implementing preventive measures in this population.

Edge-centric connectome-genetic markers of bridging factor to comorbidity between depression and anxiety

Depression-anxiety comorbidity is commonly attributed to the occurrence of specific symptoms bridging the two disorders. However, the significant heterogeneity of most bridging symptoms presents challenges for psychopathological interpretation and clinical applicability. Here, we conceptually established a common bridging factor (cb factor) to characterize a general structure of these bridging symptoms, analogous to the general psychopathological p factor. We identified a cb factor from 12 bridging symptoms in depression-anxiety comorbidity network. Moreover, this cb factor could be predicted using edge-centric connectomes with robust generalizability, and was characterized by connectome patterns in attention and frontoparietal networks. In an independent twin cohort, we found that these patterns were moderately heritable, and identified their genetic connectome-transcriptional markers that were associated with the neurobiological enrichment of vasculature and cerebellar development, particularly during late-childhood-to-young-adulthood periods. Our findings revealed a general factor of bridging symptoms and its neurobiological architectures, which enriched neurogenetic understanding of depression-anxiety comorbidity.

Comorbidity among depression, anxiety and stress symptoms in naturalistic clinical samples: A cross-cultural network analysis

Comorbidity between depression and anxiety is well-established across various settings and cultures. We approached comorbidity from the network psychopathology perspective and examined the depression, anxiety/autonomic arousal and stress/tension symptoms in naturalistic clinical samples from Serbia, Italy and Croatia. This was a multisite study in which regularized partial correlation networks of the symptoms, obtained via self-reports on the Depression Anxiety and Stress Scales-21 (DASS-21) in three cross-cultural, clinical samples (total N = 874), were compared with respect to centrality, edge weights, community structure and bridge centrality. A moderate degree of similarity in a number of network indices across the three networks was observed. While negative mood emerged to be the most central node, stress/tension nodes were the most likely bridge symptoms between depressive and anxiety/autonomic arousal symptoms. We demonstrated that the network structure and features in mixed clinical samples were similar across three different languages and cultures. The symptoms such as agitation, restlessness and inability to relax functioned as bridges across the three symptom communities explored in this study. Important theoretical and clinical implications were derived.

Risk of parental psychiatric disorders among adolescents with major depressive disorder according to response to antidepressant treatment: does the type of antidepressant matter?

BACKGROUND

The genetic load for major depressive disorder (MDD) may be higher in people who develop MDD earlier in life. This study aimed to investigate whether the parents of adolescents with MDD were more likely to have MDD, bipolar disorder (BD), schizophrenic disorder (SZ), alcohol use disorder, or substance use disorder than the parents of adolescents without MDD. We also examined whether the response to antidepressant treatment predicted the likelihood of parental psychiatric disorders.

METHODS

In all, 1,758 adolescents aged 12-19 years with antidepressant-resistant depression, 7,032 (1:4) age-/sex-matched adolescents with antidepressant-responsive depression and 7,032 (1:4) age-/sex-matched controls were included. Parental psychiatric disorders of individuals enrolled were assessed.

RESULTS

The parents of the adolescents with MDD were more likely to be diagnosed with MDD, BD, SZ, alcohol use disorder, or substance use disorder than the parents of the control group. The parents of adolescents who were antidepressant resistant and the mothers of adolescents who were either treatment resistant or treatment responsive were more likely to be diagnosed with a psychiatric disorder.

DISCUSSION

Our study demonstrated that parents of adolescents with MDD may be more likely to be diagnosed with MDD, BD, SZ, alcohol use disorder, or substance use disorder than parents of adolescents without MDD, suggesting the within-disorder transmission and cross-disorder transmission of these psychiatric disorders. Furthermore, the parent's sex and the response to antidepressant treatment may affect the within-disorder transmission of MDD.

Disease progression to bipolar disorder among adolescents and young adults with antidepressant-resistant and antidepressant-responsive depression: Does antidepressant class matter?

Studies have demonstrated a positive relationship between antidepressant resistance and the progression of bipolar disorder. However, the influence of antidepressant classes such as selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs) in this context has yet to be investigated. A total of 5,285 adolescents and young adults with antidepressant-resistant depression and 21,140 with antidepressant-responsive depression were recruited in the present study. The antidepressant-resistant depression group was divided into two subgroups: only resistant to SSRIs (n = 2,242, 42.4%) and additionally resistant to non-SSRIs (n = 3,043, 57.6%) groups. The status of bipolar disorder progression was monitored from the date of depression diagnosis to the end of 2011. Patients with antidepressant-resistant depression were more likely to develop bipolar disorder during the follow-up (hazard ratio [HR]: 2.88, 95% confidence interval [CI]: 2.67-3.09) than those with antidepressant-responsive depression. Furthermore, the group that was additionally resistant to non-SSRIs were at the highest risk of bipolar disorder (HR: 3.02, 95% CI: 2.76-3.29), followed by the group that was only resistant to SSRIs (2.70, 2.44-2.98). Adolescents and young adults with antidepressant-resistant depression, especially those who responded poorly to both SSRIs and SNRIs, were at increased risk of subsequent bipolar disorder compared with those with antidepressant-responsive depression. Further studies are warranted to elucidate the molecular pathomechanisms underlying the resistance to SSRIs and SNRIs and subsequent bipolar disorder.

Treatment-resistant depression in children and adolescents

Major depressive disorder (MDD) in children and adolescents is a significant health problem, causing profound impairments in social, academic, and family functioning and substantial morbidity and mortality. Up to 15% of children and adolescents suffer from MDD, and a proportion, around 30 to 40% of them, failed to respond to initial selective serotonin reuptake inhibitor (SSRI) treatment. The only evidence-based recommendation is medication switching to another SSRI and augmentation with cognitive behavioral therapy. Newly developing treatment, including ketamine, transcranial magnetic stimulation, psychotherapy other than cognitive behavioral therapy, and combined pharmacotherapy with other interventions, requires further longitudinal controlled trials regarding efficacy and safety in this vulnerable population.

Risk of type 2 diabetes mellitus between adolescents with antidepressant-resistant and antidepressant-responsive depression: A cohort study of 15,651 adolescents

BACKGROUND

Whether response to antidepressants is related to the risk of developing type 2 diabetes mellitus (T2DM) in adolescents with depression remains unknown.

METHODS

This study used the Taiwan National Health Insurance Research Database to enroll 1739 adolescents with antidepressant-resistant depression, 6956 with antidepressant-responsive depression, and 6956 controls between 2001 and 2010, with an end-of-2011 follow-up. Physician-diagnosed T2DM was identified at follow-up. T2DM-related risk factors, namely hypertension, dyslipidemia, and obesity, were assessed and controlled for as confounding factors.

RESULTS

Adolescents with antidepressant-resistant depression (hazard ratio [HR], 95 % confidence interval [CI]: 4.62, 2.75-7.75) and those with antidepressant-responsive depression (HR, 95 % CI: 3.06, 1.98-4.72) had a higher risk of developing T2DM at follow-up than did the control group. Those with antidepressant-resistant depression were more likely to receive a diagnosis of T2DM (HR, 95 % CI: 1.51, 1.04-2.19) later in life than were those with antidepressant-responsive depression.

DISCUSSION

Clinicians should closely monitor factors related to T2DM, such as fasting blood sugar, in high-risk populations, especially in adolescents with antidepressant-resistant depression.

Abnormal amplitude of low-frequency fluctuation values as a neuroimaging biomarker for major depressive disorder with suicidal attempts in adolescents: A resting-state fMRI and support vector machine analysis

Objective

Major depressive disorder (MDD) is associated with suicidal attempts (SAs) among adolescents, with suicide being the most common cause of mortality in this age group. This study explored the predictive utility of support vector machine (SVM)-based analyses of amplitude of low-frequency fluctuation (ALFF) results as a neuroimaging biomarker for aiding the diagnosis of MDD with SA in adolescents.

Methods

Resting-state functional magnetic resonance imaging (rs-fMRI) analyses of 71 first-episode, drug-naive adolescent MDD patients with SA and 54 healthy control individuals were conducted. ALFF and SVM methods were used to analyze the imaging data.

Results

Relative to healthy control individuals, adolescent MDD patients with a history of SAs showed reduced ALFF values in the bilateral medial superior frontal gyrus (mSFG) and bilateral precuneus. These lower ALFF values were also negatively correlated with child depression inventory (CDI) scores while reduced bilateral precuneus ALFF values were negatively correlated with Suicidal Ideation Questionnaire Junior (SIQ-JR) scores. SVM analyses showed that reduced ALFF values in the bilateral mSFG and bilateral precuneus had diagnostic accuracy levels of 76.8% (96/125) and 82.4% (103/125), respectively.

Conclusion

Adolescent MDD patients with a history of SA exhibited abnormal ALFF. The identified abnormalities in specific brain regions may be involved in the pathogenesis of this condition and may help identify at-risk adolescents. Specifically, reductions in the ALFF in the bilateral mSFG and bilateral precuneus may be indicative of MDD and SA in adolescent patients.

The comparative effectiveness of antidepressants for youths with major depressive disorder: a nationwide population-based study in Taiwan

Background:

Guidelines recommend fluoxetine as a first-line medication for youths diagnosed with major depressive disorder (MDD). However, little is known about the long-term effectiveness of different antidepressants in juveniles in the real world. This study aimed to compare the effectiveness of antidepressants in youths with MDD.

Methods:

Youths (<20 years old) with a diagnosis of MDD who were new users of antidepressants were selected from a nationwide population-based cohort in Taiwan between 1997 and 2013. We divided a total of 16,981 users (39.9% male; mean age: 16.6 years) into 10 different antidepressant groups (fluoxetine, sertraline, paroxetine, venlafaxine, citalopram, escitalopram, bupropion, fluvoxamine, mirtazapine and moclobemide). Regarding treatment outcomes (hospitalisation and medication discontinuation), Cox proportional hazards regression models were applied to estimate the hazards of such outcomes.

Results:

Compared with the youths treated with fluoxetine, the bupropion-treated group demonstrated lower rates of hospitalisation and discontinuation. Mirtazapine-treated group demonstrated a higher hospitalisation risk mainly when administered for single depressive episodes. Furthermore, patients treated with sertraline and fluvoxamine had higher discontinuation rates. Among the younger teenage subgroups (< 16 years), significantly higher rates of discontinuation were observed in those treated with sertraline, escitalopram and fluvoxamine. Among the older teenage subgroups (⩾ 16 years), bupropion was superior to fluoxetine in preventing hospitalisation and discontinuation.

Conclusion:

We concluded that bupropion might surpass fluoxetine with regard to hospitalisation prevention and drug therapy maintenance among youths with MDD, while mirtazapine users demonstrated a higher hospitalisation risk. Our findings might serve as a reference for clinicians in future studies.

Comparison between Atomoxetine and OROS Methylphenidate as an Adjunctive to SSRIs in Attention-deficit/Hyperactivity Disorder Adults with Comorbid Partially Responsive Major Depressive Disorder: A Head-to-head, 12-week, Randomized, Rater-blinded Clinical Trial

Objective

This study aimed to compare the efficacy and safety of atomoxetine (ATX) and OROS methylphenidate (MPH) as adjunctive to selective serotonin reuptake inhibitors (SSRIs) in adults with attention-deficit hyperactivity disorder (ADHD) with comorbid partially responsive major depressive disorder (MDD).

Methods

Sixty Korean adults with ADHD and comorbid partially responsive MDD were recruited in a 12-week, randomized, rater-blinded, active-controlled trial and were evenly randomized to ATX or OROS MPH treatment.

Results

Depressive symptoms measured using the Hamilton Depression Rating Scale and Clinically Useful Depression Outcome Scale, and ADHD symptoms measured using the Adult ADHD Self-Report Scale, as well as the Clinical Global Impression-Severity, Clinical Global Impression-Improvement, and the Sheehan Disability Scale scores were significantly improved in both groups during the 12 weeks of treatment. The changes in all outcome measures during the 12-week treatment were not significantly different between the two groups (all p > 0.05). No serious adverse events were reported and there were no significant differences in systolic and diastolic blood pressure, pulse rate, weight, or body mass index between the ATX and MPH groups.

Conclusion

Our findings suggest that ATX and MPH can be used as adjunctive treatments in adults with ADHD and comorbid partially responsive MDD. The efficacy and tolerability of ATX and MPH in adults with ADHD did not differ significantly. Further studies should be conducted to draw a definitive conclusion.

Unraveling the comorbidity of depression and anxiety in a large inpatient sample: Network analysis to examine bridge symptoms

BACKGROUND

Comorbidities in mental disorders are often understood by assuming a common cause. The network theory of mental disorders offers an alternative to this assumption by understanding comorbidities as mutually reinforced problems. In this study, we used network analysis to examine bridge symptoms between anxiety and depression in a large sample.

METHOD

Using data from a sample of patients diagnosed with both depression and an anxiety disorder before and after inpatient treatment (N = 5,614, mean age: 42.24, 63.59% female, average treatment duration: 48.12 days), network models of depression and anxiety symptoms are estimated. Topology, the centrality of nodes, stability, and changes in network structure are analyzed. Symptoms that drive comorbidity are determined by bridge node analysis. As an alternative to network communities based on categorical diagnosis, we performed a community analysis and propose empirically derived symptom subsets.

RESULTS

The obtained network models are highly stable. Sad mood and the inability to control worry are the most central. Psychomotor agitation or retardation is the strongest bridge node between anxiety and depression, followed by concentration problems and restlessness. Changes in appetite and suicidality were unique to depression. Community analysis revealed four symptom groups.

CONCLUSION

The estimated network structure of depression and anxiety symptoms proves to be highly accurate. Results indicate that some symptoms are considerably more influential than others and that only a small number of predominantly physical symptoms are strong candidates for explaining comorbidity. Future studies should include physiological measures in network models to provide a more accurate understanding.