1
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Adams MJ, Thorp JG, Jermy BS, Kwong ASF, Kõiv K, Grotzinger AD, Nivard MG, Marshall S, Milaneschi Y, Baune BT, Müller-Myhsok B, Penninx BWJH, Boomsma DI, Levinson DF, Breen G, Pistis G, Grabe HJ, Tiemeier H, Berger K, Rietschel M, Magnusson PK, Uher R, Hamilton SP, Lucae S, Lehto K, Li QS, Byrne EM, Hickie IB, Martin NG, Medland SE, Wray NR, Tucker-Drob EM, Lewis CM, McIntosh AM, Derks EM. Genome-wide meta-analysis of ascertainment and symptom structures of major depression in case-enriched and community cohorts. Psychol Med 2024:1-10. [PMID: 39324397 DOI: 10.1017/s0033291724001880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/27/2024]
Abstract
BACKGROUND Diagnostic criteria for major depressive disorder allow for heterogeneous symptom profiles but genetic analysis of major depressive symptoms has the potential to identify clinical and etiological subtypes. There are several challenges to integrating symptom data from genetically informative cohorts, such as sample size differences between clinical and community cohorts and various patterns of missing data. METHODS We conducted genome-wide association studies of major depressive symptoms in three cohorts that were enriched for participants with a diagnosis of depression (Psychiatric Genomics Consortium, Australian Genetics of Depression Study, Generation Scotland) and three community cohorts who were not recruited on the basis of diagnosis (Avon Longitudinal Study of Parents and Children, Estonian Biobank, and UK Biobank). We fit a series of confirmatory factor models with factors that accounted for how symptom data was sampled and then compared alternative models with different symptom factors. RESULTS The best fitting model had a distinct factor for Appetite/Weight symptoms and an additional measurement factor that accounted for the skip-structure in community cohorts (use of Depression and Anhedonia as gating symptoms). CONCLUSION The results show the importance of assessing the directionality of symptoms (such as hypersomnia versus insomnia) and of accounting for study and measurement design when meta-analyzing genetic association data.
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Affiliation(s)
- Mark J Adams
- Division of Psychiatry, University of Edinburgh, Edinburgh, UK
| | - Jackson G Thorp
- Mental Health and Neuroscience, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Bradley S Jermy
- Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland
| | - Alex S F Kwong
- Division of Psychiatry, University of Edinburgh, Edinburgh, UK
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Kadri Kõiv
- Estonian Genome Centre, Institute of Genomics, University of Tartu, Tartu, Estonia
| | - Andrew D Grotzinger
- Department of Psychology and Neuroscience, University of Colorado at Boulder, Boulder, CO, USA
- Institute for Behavioral Genetics, University of Colorado at Boulder, Boulder, CO, USA
| | - Michel G Nivard
- Department of Biological Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Sally Marshall
- Centre for Genomic & Experimental Medicine, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
| | - Yuri Milaneschi
- Department of Psychiatry, Amsterdam Public Health and Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Bernhard T Baune
- Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, VIC, Australia
- Department of Psychiatry, University of Münster, Münster, NRW, Germany
| | - Bertram Müller-Myhsok
- Department of Translational Research in Psychiatry, Max Planck Institute of Psychiatry, Munich, BY, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, BY, Germany
- Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Brenda W J H Penninx
- Department of Psychiatry, Amsterdam Public Health and Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Dorret I Boomsma
- Department of Biological Psychology & Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Douglas F Levinson
- Department of Psychiatry & Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Gerome Breen
- Social, Genetic and Developmental Psychiatry Centre, King's College London, London, UK
- NIHR Maudsley Biomedical Research Centre, King's College London, London, UK
| | - Giorgio Pistis
- Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Prilly, VD, Switzerland
| | - Hans J Grabe
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, MV, Germany
| | - Henning Tiemeier
- Child and Adolescent Psychiatry, Erasmus University Medical Center Rotterdam, Rotterdam, Netherlands
- Social and Behavioral Science, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Klaus Berger
- Institute of Epidemiology and Social Medicine, University of Münster, Münster, NRW, Germany
| | - Marcella Rietschel
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, BW, Germany
| | - Patrik K Magnusson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Rudolf Uher
- Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Steven P Hamilton
- Psychiatry, Kaiser Permanente Northern California, San Francisco, CA, USA
| | - Susanne Lucae
- Max Planck Institute of Psychiatry, Munich, BY, Germany
| | - Kelli Lehto
- Estonian Genome Centre, Institute of Genomics, University of Tartu, Tartu, Estonia
| | - Qingqin S Li
- Neuroscience Therapeutic Area, Janssen Research and Development, LLC, Titusville, NJ, USA
| | - Enda M Byrne
- Child Health Research Centre, University of Queensland, Brisbane, QLD, Australia
| | - Ian B Hickie
- Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
| | - Nicholas G Martin
- Mental Health and Neuroscience, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Sarah E Medland
- Mental Health and Neuroscience, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Naomi R Wray
- Institute for Molecular Bioscience, University of Queensland, Brisbane, QLD, Australia
- Queensland Brain Institute, University of Queensland, Brisbane, QLD, Australia
| | - Elliot M Tucker-Drob
- Department of Psychology, University of Texas at Austin, Austin, TX, USA
- Population Research Center, University of Texas at Austin, Austin, TX, USA
| | - Cathryn M Lewis
- Social, Genetic and Developmental Psychiatry Centre, King's College London, London, UK
- Department of Medical & Molecular Genetics, King's College London, London, UK
| | - Andrew M McIntosh
- Division of Psychiatry, University of Edinburgh, Edinburgh, UK
- Institute for Genomics and Cancer, University of Edinburgh, Edinburgh, UK
| | - Eske M Derks
- Mental Health and Neuroscience, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
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2
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Chaves AR, Cuda J, Shim S, Drodge J, Nasr Y, Brender R, Antochi R, McMurray L, Pilutti LA, Tremblay S. Optimizing antidepressant benefits: Effect of theta burst stimulation treatment in physically active people with treatment-resistant depression. J Affect Disord 2024; 367:876-885. [PMID: 39260582 DOI: 10.1016/j.jad.2024.09.024] [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: 06/06/2024] [Revised: 07/16/2024] [Accepted: 09/08/2024] [Indexed: 09/13/2024]
Abstract
Theta burst stimulation (TBS) is a promising therapy for treatment-resistant major depressive disorder (MDD), but a significant proportion of individuals do not respond adequately, necessitating alternative approaches. This study explores whether individuals meeting minimum recommended physical activity levels demonstrate better responses to TBS compared to physically inactive individuals. Using data from a randomized controlled trial (n = 43), participants were categorized as physically active or inactive based on baseline International Physical Activity Questionnaire (IPAQ) scores. Depression scores (Hamilton Rating Scale for Depression, 17-item; HRSD-17) were assessed at baseline, 4, and 6 weeks of TBS treatment. A significant Time X Group effect adjusted for age and baseline depression was observed. Physically active individuals consistently exhibited lower depression scores across time points. At 4 and 6 weeks, there was a significant increase in between-group differences, indicating that the physically active group derived greater benefits from treatment. At 6 weeks, a significantly higher proportion of responders (≥50 % HRSD-17 reduction) were observed in the physically active compared to inactive group. Physical activity significantly contributed to regression and logistic models predicting treatment response. These findings support the potential role of baseline physical activity in enhancing TBS therapy for MDD.
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Affiliation(s)
- Arthur R Chaves
- Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, 200 Lees Ave Building FHS, Ottawa, ON K1S 5S9, Canada; The Royal's Institute of Mental Health Research, 1145 Carling Ave, Ottawa, ON K1Z 7K4, Canada
| | - Jennifer Cuda
- The Royal's Institute of Mental Health Research, 1145 Carling Ave, Ottawa, ON K1Z 7K4, Canada
| | - Stacey Shim
- The Royal's Institute of Mental Health Research, 1145 Carling Ave, Ottawa, ON K1Z 7K4, Canada
| | - Jessica Drodge
- The Royal's Institute of Mental Health Research, 1145 Carling Ave, Ottawa, ON K1Z 7K4, Canada
| | - Youssef Nasr
- The Royal's Institute of Mental Health Research, 1145 Carling Ave, Ottawa, ON K1Z 7K4, Canada
| | - Ram Brender
- Department of Psychiatry, University of Ottawa, Roger Guindon Hall, 451 Smyth Rd #2044, Ottawa, ON K1H 8M5, Canada; Royal Ottawa Mental Health Centre, 1145 Carling Ave, Ottawa, ON K1Z 7K4, Canada
| | - Ruxandra Antochi
- Department of Psychiatry, University of Ottawa, Roger Guindon Hall, 451 Smyth Rd #2044, Ottawa, ON K1H 8M5, Canada; Royal Ottawa Mental Health Centre, 1145 Carling Ave, Ottawa, ON K1Z 7K4, Canada
| | - Lisa McMurray
- Department of Psychiatry, University of Ottawa, Roger Guindon Hall, 451 Smyth Rd #2044, Ottawa, ON K1H 8M5, Canada; Royal Ottawa Mental Health Centre, 1145 Carling Ave, Ottawa, ON K1Z 7K4, Canada
| | - Lara A Pilutti
- Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, 200 Lees Ave Building FHS, Ottawa, ON K1S 5S9, Canada; The University of Ottawa Brain and Mind Research Institute, Roger Guindon Hall, 451 Smyth Rd #2044, Ottawa, ON K1H 8M5, Canada
| | - Sara Tremblay
- The Royal's Institute of Mental Health Research, 1145 Carling Ave, Ottawa, ON K1Z 7K4, Canada; The University of Ottawa Brain and Mind Research Institute, Roger Guindon Hall, 451 Smyth Rd #2044, Ottawa, ON K1H 8M5, Canada; Département de psychoéducation et de psychologie, Université du Québec en Outaouais, 283 Alexandre-Taché Boul, Gatineau, QC J8X 3X7, Canada; Department of Neuroscience, Carleton University, 1125 Colonel By Dr, Ottawa, ON K1S 5B6, Canada; Department of Cellular and Molecular Medicine, University of Ottawa, Roger Guindon Hall, 451 Smyth Rd #2044, Ottawa, ON K1H 8M5, Canada.
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3
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Huang L, Tang S, Rietkerk J, Appadurai V, Krebs MD, Schork AJ, Werge T, Zuber V, Kendler K, Cai N. Polygenic Analyses Show Important Differences Between Major Depressive Disorder Symptoms Measured Using Various Instruments. Biol Psychiatry 2024; 95:1110-1121. [PMID: 38056704 PMCID: PMC11139567 DOI: 10.1016/j.biopsych.2023.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 11/06/2023] [Accepted: 11/26/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND Symptoms of major depressive disorder (MDD) are commonly assessed using self-rating instruments like the Patient Health Questionnaire-9 (PHQ-9) (current symptoms) and the Composite International Diagnostic Interview Short-Form (CIDI-SF) (worst-episode symptoms). We performed a systematic comparison between them for their genetic architecture and utility in investigating MDD heterogeneity. METHODS Using data from the UK Biobank (n = 41,948-109,417), we assessed the single nucleotide polymorphism heritability and genetic correlation (rg) of both sets of MDD symptoms. We further compared their rg with non-MDD traits and used Mendelian randomization to assess whether either set of symptoms has more genetic sharing with non-MDD traits. We also assessed how specific each set of symptoms is to MDD using the metric polygenic risk score pleiotropy. Finally, we used genomic structural equation modeling to identify factors that explain the genetic covariance between each set of symptoms. RESULTS Corresponding symptoms reported through the PHQ-9 and CIDI-SF have low to moderate genetic correlations (rg = 0.43-0.87), and this cannot be fully attributed to different severity thresholds or the use of a skip structure in the CIDI-SF. Both Mendelian randomization and polygenic risk score pleiotropy analyses showed that PHQ-9 symptoms are more associated with traits that reflect general dysphoria, whereas the skip structure in the CIDI-SF allows for the identification of heterogeneity among likely MDD cases. Finally, the 2 sets of symptoms showed different factor structures in genomic structural equation modeling, reflective of their genetic differences. CONCLUSIONS MDD symptoms assessed using the PHQ-9 and CIDI-SF are not interchangeable; the former better indexes general dysphoria, while the latter is more informative about within-MDD heterogeneity.
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Affiliation(s)
- Lianyun Huang
- Helmholtz Pioneer Campus, Helmholtz Zentrum München, Neuherberg, Germany; Computational Health Centre, Helmholtz Zentrum München, Neuherberg, Germany; School of Medicine, Technical University of Munich, Munich, Germany
| | - Sonja Tang
- School of Public Health, Imperial College London, London, United Kingdom; MRC Centre for Environment and Health, Imperial College London, London, United Kingdom
| | - Jolien Rietkerk
- Helmholtz Pioneer Campus, Helmholtz Zentrum München, Neuherberg, Germany; Computational Health Centre, Helmholtz Zentrum München, Neuherberg, Germany; School of Medicine, Technical University of Munich, Munich, Germany
| | - Vivek Appadurai
- Institute of Biological Psychiatry, Mental Health Center, Sct Hans, Copenhagen University Hospital, Mental Health Services CPH, Copenhagen, Denmark
| | - Morten Dybdahl Krebs
- Institute of Biological Psychiatry, Mental Health Center, Sct Hans, Copenhagen University Hospital, Mental Health Services CPH, Copenhagen, Denmark
| | - Andrew J Schork
- Institute of Biological Psychiatry, Mental Health Center, Sct Hans, Copenhagen University Hospital, Mental Health Services CPH, Copenhagen, Denmark; Neurogenomics Division, The Translational Genomics Research Institute, Phoenix, Arizona; Section for Geogenetics, GLOBE Institute, Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen, Denmark
| | - Thomas Werge
- Institute of Biological Psychiatry, Mental Health Center, Sct Hans, Copenhagen University Hospital, Mental Health Services CPH, Copenhagen, Denmark; Lundbeck Foundation GeoGenetics Centre, Natural History Museum of Denmark, University of Copenhagen, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Verena Zuber
- School of Public Health, Imperial College London, London, United Kingdom; MRC Centre for Environment and Health, Imperial College London, London, United Kingdom
| | - Kenneth Kendler
- Virginia Institute for Psychiatric and Behavioral Genetics and Department of Psychiatry, Virginia Commonwealth University, Richmond, Virginia
| | - Na Cai
- Helmholtz Pioneer Campus, Helmholtz Zentrum München, Neuherberg, Germany; Computational Health Centre, Helmholtz Zentrum München, Neuherberg, Germany; School of Medicine, Technical University of Munich, Munich, Germany.
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4
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Huider F, Milaneschi Y, Hottenga JJ, Bot M, Rietman ML, Kok AAL, Galesloot TE, 't Hart LM, Rutters F, Blom MT, Rhebergen D, Visser M, Brouwer I, Feskens E, Hartman CA, Oldehinkel AJ, de Geus EJC, Kiemeney LA, Huisman M, Picavet HSJ, Verschuren WMM, van Loo HM, Penninx BWJH, Boomsma DI. Genomics Research of Lifetime Depression in the Netherlands: The BIObanks Netherlands Internet Collaboration (BIONIC) Project. Twin Res Hum Genet 2024; 27:1-11. [PMID: 38497097 DOI: 10.1017/thg.2024.4] [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] [Indexed: 03/19/2024]
Abstract
In this cohort profile article we describe the lifetime major depressive disorder (MDD) database that has been established as part of the BIObanks Netherlands Internet Collaboration (BIONIC). Across the Netherlands we collected data on Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) lifetime MDD diagnosis in 132,850 Dutch individuals. Currently, N = 66,684 of these also have genomewide single nucleotide polymorphism (SNP) data. We initiated this project because the complex genetic basis of MDD requires large population-wide studies with uniform in-depth phenotyping. For standardized phenotyping we developed the LIDAS (LIfetime Depression Assessment Survey), which then was used to measure MDD in 11 Dutch cohorts. Data from these cohorts were combined with diagnostic interview depression data from 5 clinical cohorts to create a dataset of N = 29,650 lifetime MDD cases (22%) meeting DSM-5 criteria and 94,300 screened controls. In addition, genomewide genotype data from the cohorts were assembled into a genomewide association study (GWAS) dataset of N = 66,684 Dutch individuals (25.3% cases). Phenotype data include DSM-5-based MDD diagnoses, sociodemographic variables, information on lifestyle and BMI, characteristics of depressive symptoms and episodes, and psychiatric diagnosis and treatment history. We describe the establishment and harmonization of the BIONIC phenotype and GWAS datasets and provide an overview of the available information and sample characteristics. Our next step is the GWAS of lifetime MDD in the Netherlands, with future plans including fine-grained genetic analyses of depression characteristics, international collaborations and multi-omics studies.
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Affiliation(s)
- Floris Huider
- Department of Biological Psychology, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, 1081 Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, 1105 Amsterdam, the Netherlands
| | - Yuri Milaneschi
- Amsterdam Public Health Research Institute, 1105 Amsterdam, the Netherlands
- Department of Psychiatry, Amsterdam UMC location Vrije Universiteit Amsterdam, 1081 Amsterdam, the Netherlands
| | - Jouke-Jan Hottenga
- Department of Biological Psychology, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, 1081 Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, 1105 Amsterdam, the Netherlands
| | - Mariska Bot
- Amsterdam Public Health Research Institute, 1105 Amsterdam, the Netherlands
- Department of Psychiatry, Amsterdam UMC location Vrije Universiteit Amsterdam, 1081 Amsterdam, the Netherlands
| | - M Liset Rietman
- Center for Prevention, Lifestyle and Health, Dutch National Institute for Public Health and the Environment, 3721 Bilthoven, the Netherlands
| | - Almar A L Kok
- Amsterdam Public Health Research Institute, 1105 Amsterdam, the Netherlands
- Department of Epidemiology and Data Science, Amsterdam UMC location Vrije Universiteit, 1081 Amsterdam, the Netherlands
| | | | | | | | | | - Didi Rhebergen
- Amsterdam Public Health Research Institute, 1105 Amsterdam, the Netherlands
- Department of Psychiatry, Amsterdam UMC location Vrije Universiteit Amsterdam, 1081 Amsterdam, the Netherlands
- Mental health Institute GGZ Centraal, Amersfoort, the Netherlands
| | - Marjolein Visser
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, 1081 Amsterdam, the Netherlands
| | - Ingeborg Brouwer
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, 1081 Amsterdam, the Netherlands
| | - Edith Feskens
- Division of Human Nutrition and Health, Wageningen University & Research, 6700 Wageningen, the Netherlands
| | - Catharina A Hartman
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, 9713 Groningen, the Netherlands
| | - Albertine J Oldehinkel
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, 9713 Groningen, the Netherlands
| | - Eco J C de Geus
- Department of Biological Psychology, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, 1081 Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, 1105 Amsterdam, the Netherlands
| | | | - Martijn Huisman
- Amsterdam Public Health Research Institute, 1105 Amsterdam, the Netherlands
- Department of Epidemiology and Data Science, Amsterdam UMC location Vrije Universiteit, 1081 Amsterdam, the Netherlands
- Department of Sociology, Vrije Universiteit Amsterdam, 1081 Amsterdam, the Netherlands
| | - H Susan J Picavet
- Center for Prevention, Lifestyle and Health, Dutch National Institute for Public Health and the Environment, 3721 Bilthoven, the Netherlands
| | - W M Monique Verschuren
- Center for Prevention, Lifestyle and Health, Dutch National Institute for Public Health and the Environment, 3721 Bilthoven, the Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, 3584 Utrecht, the Netherlands
| | - Hanna M van Loo
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, 9713 Groningen, the Netherlands
| | - Brenda W J H Penninx
- Amsterdam Public Health Research Institute, 1105 Amsterdam, the Netherlands
- Department of Psychiatry, Amsterdam UMC location Vrije Universiteit Amsterdam, 1081 Amsterdam, the Netherlands
| | - Dorret I Boomsma
- Department of Biological Psychology, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, 1081 Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, 1105 Amsterdam, the Netherlands
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Watson M, Chaves AR, Gebara A, Desforges M, Broomfield A, Landry N, Lemoyne A, Shim S, Drodge J, Cuda J, Kiaee N, Nasr Y, Carleton C, Daskalakis ZJ, Taylor R, Tuominen L, Brender R, Antochi R, McMurray L, Tremblay S. A naturalistic study comparing the efficacy of unilateral and bilateral sequential theta burst stimulation in treating major depression - the U-B-D study protocol. BMC Psychiatry 2023; 23:739. [PMID: 37817124 PMCID: PMC10566125 DOI: 10.1186/s12888-023-05243-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 10/01/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND Major depressive disorder (MDD) is a prevalent mental health condition affecting millions worldwide, leading to disability and reduced quality of life. MDD poses a global health priority due to its early onset and association with other disabling conditions. Available treatments for MDD exhibit varying effectiveness, and a substantial portion of individuals remain resistant to treatment. Repetitive transcranial magnetic stimulation (rTMS), applied to the left and/or right dorsolateral prefrontal cortex (DLPFC), is an alternative treatment strategy for those experiencing treatment-resistant MDD. The objective of this study is to investigate whether this newer form of rTMS, namely theta burst stimulation (TBS), when performed unilaterally or bilaterally, is efficacious in treatment-resistant MDD. METHODS In this naturalistic, randomized double-blinded non-inferiority trial, participants with a major depressive episode will be randomized to receive either unilateral (i.e., continuous TBS [cTBS] to the right and sham TBS to the left DLPFC) or bilateral sequential TBS (i.e., cTBS to the right and intermittent TBS [iTBS] to the left DLPFC) delivered 5 days a week for 4-6 weeks. Responders will move onto a 6-month flexible maintenance phase where TBS treatment will be delivered at a decreasing frequency depending on degree of symptom mitigation. Several clinical assessments and neuroimaging and neurophysiological biomarkers will be collected to investigate treatment response and potential associated biomarkers. A non-inferiority analysis will investigate whether bilateral sequential TBS is non-inferior to unilateral TBS and regression analyses will investigate biomarkers of treatment response. We expect to recruit a maximal of 256 participants. This trial is approved by the Research Ethics Board of The Royal's Institute of Mental Health Research (REB# 2,019,071) and will follow the Declaration of Helsinki. Findings will be published in peer-reviewed journals. DISCUSSION Comprehensive assessment of symptoms and neurophysiological biomarkers will contribute to understanding the differential efficacy of the tested treatment protocols, identifying biomarkers for treatment response, and shedding light into underlying mechanisms of TBS. Our findings will inform future clinical trials and aid in personalizing treatment selection and scheduling for individuals with MDD. TRIAL REGISTRATION The trial is registered on https://clinicaltrials.gov/ct2/home (#NCT04142996).
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Affiliation(s)
- Molly Watson
- University of Ottawa Institute of Mental Health Research at The Royal, 1145 Carling Ave, Ottawa, ON, K1Z 7K4, Canada
- Department of Neuroscience, Carleton University, 1125 Colonel By Drive, Ottawa, ON, K1S 5B6, Canada
| | - Arthur R Chaves
- University of Ottawa Institute of Mental Health Research at The Royal, 1145 Carling Ave, Ottawa, ON, K1Z 7K4, Canada
- Faculty of Health Sciences, University of Ottawa, 125 University, Ottawa, ON, K1N6N5, Canada
| | - Abir Gebara
- School of Medicine, Stanford University, 300 Pasteur Drive, Stanford, CA, 94305, USA
| | - Manon Desforges
- University of Ottawa Institute of Mental Health Research at The Royal, 1145 Carling Ave, Ottawa, ON, K1Z 7K4, Canada
- Département de Psychoéducation Et Psychologie, Université du Québec en Outaouais, 283 Alexandre-Taché Boul, Gatineau, QC, J8X 3X7, Canada
| | - Antoinette Broomfield
- University of Ottawa Institute of Mental Health Research at The Royal, 1145 Carling Ave, Ottawa, ON, K1Z 7K4, Canada
| | - Noémie Landry
- University of Ottawa Institute of Mental Health Research at The Royal, 1145 Carling Ave, Ottawa, ON, K1Z 7K4, Canada
- Département de Psychoéducation Et Psychologie, Université du Québec en Outaouais, 283 Alexandre-Taché Boul, Gatineau, QC, J8X 3X7, Canada
| | - Alexandra Lemoyne
- University of Ottawa Institute of Mental Health Research at The Royal, 1145 Carling Ave, Ottawa, ON, K1Z 7K4, Canada
- Département de Psychoéducation Et Psychologie, Université du Québec en Outaouais, 283 Alexandre-Taché Boul, Gatineau, QC, J8X 3X7, Canada
| | - Stacey Shim
- University of Ottawa Institute of Mental Health Research at The Royal, 1145 Carling Ave, Ottawa, ON, K1Z 7K4, Canada
| | - Jessica Drodge
- University of Ottawa Institute of Mental Health Research at The Royal, 1145 Carling Ave, Ottawa, ON, K1Z 7K4, Canada
| | - Jennifer Cuda
- University of Ottawa Institute of Mental Health Research at The Royal, 1145 Carling Ave, Ottawa, ON, K1Z 7K4, Canada
| | - Nasim Kiaee
- University of Ottawa Institute of Mental Health Research at The Royal, 1145 Carling Ave, Ottawa, ON, K1Z 7K4, Canada
- Department of Neuroscience, Carleton University, 1125 Colonel By Drive, Ottawa, ON, K1S 5B6, Canada
| | - Youssef Nasr
- University of Ottawa Institute of Mental Health Research at The Royal, 1145 Carling Ave, Ottawa, ON, K1Z 7K4, Canada
| | - Christophe Carleton
- University of Ottawa Institute of Mental Health Research at The Royal, 1145 Carling Ave, Ottawa, ON, K1Z 7K4, Canada
- Département de Psychoéducation Et Psychologie, Université du Québec en Outaouais, 283 Alexandre-Taché Boul, Gatineau, QC, J8X 3X7, Canada
| | - Zafiris J Daskalakis
- Department of Psychiatry, University California San Diego, 9500 Gilman Dr, La Jolla, CA, 92093, USA
| | - Reggie Taylor
- University of Ottawa Institute of Mental Health Research at The Royal, 1145 Carling Ave, Ottawa, ON, K1Z 7K4, Canada
- Department of Physics, Carleton University, 1125 Colonel By Drive, Ottawa, ON, K1S 5B6, Canada
| | - Lauri Tuominen
- University of Ottawa Institute of Mental Health Research at The Royal, 1145 Carling Ave, Ottawa, ON, K1Z 7K4, Canada
- Department of Psychiatry, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada
| | - Ram Brender
- Department of Psychiatry, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada
- Royal Ottawa Mental Health Centre, 1145 Carling Ave, Ottawa, ON, K1Z 7K4, Canada
| | - Ruxandra Antochi
- Department of Psychiatry, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada
- Royal Ottawa Mental Health Centre, 1145 Carling Ave, Ottawa, ON, K1Z 7K4, Canada
| | - Lisa McMurray
- Department of Psychiatry, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada
- Royal Ottawa Mental Health Centre, 1145 Carling Ave, Ottawa, ON, K1Z 7K4, Canada
| | - Sara Tremblay
- University of Ottawa Institute of Mental Health Research at The Royal, 1145 Carling Ave, Ottawa, ON, K1Z 7K4, Canada.
- Department of Neuroscience, Carleton University, 1125 Colonel By Drive, Ottawa, ON, K1S 5B6, Canada.
- Département de Psychoéducation Et Psychologie, Université du Québec en Outaouais, 283 Alexandre-Taché Boul, Gatineau, QC, J8X 3X7, Canada.
- Department of Cellular and Molecular Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada.
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Adams MJ, Thorp JG, Jermy BS, Kwong ASF, Kõiv K, Grotzinger AD, Nivard MG, Marshall S, Milaneschi Y, Baune BT, Müller-Myhsok B, Penninx BW, Boomsma DI, Levinson DF, Breen G, Pistis G, Grabe HJ, Tiemeier H, Berger K, Rietschel M, Magnusson PK, Uher R, Hamilton SP, Lucae S, Lehto K, Li QS, Byrne EM, Hickie IB, Martin NG, Medland SE, Wray NR, Tucker-Drob EM, Lewis CM, McIntosh AM, Derks EM. Genetic structure of major depression symptoms across clinical and community cohorts. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.07.05.23292214. [PMID: 37461564 PMCID: PMC10350129 DOI: 10.1101/2023.07.05.23292214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
Diagnostic criteria for major depressive disorder allow for heterogeneous symptom profiles but genetic analysis of major depressive symptoms has the potential to identify clinical and aetiological subtypes. There are several challenges to integrating symptom data from genetically-informative cohorts, such as sample size differences between clinical and community cohorts and various patterns of missing data. We conducted genome-wide association studies of major depressive symptoms in three clinical cohorts that were enriched for affected participants (Psychiatric Genomics Consortium, Australian Genetics of Depression Study, Generation Scotland) and three community cohorts (Avon Longitudinal Study of Parents and Children, Estonian Biobank, and UK Biobank). We fit a series of confirmatory factor models with factors that accounted for how symptom data was sampled and then compared alternative models with different symptom factors. The best fitting model had a distinct factor for Appetite/Weight symptoms and an additional measurement factor that accounted for missing data patterns in the community cohorts (use of Depression and Anhedonia as gating symptoms). The results show the importance of assessing the directionality of symptoms (such as hypersomnia versus insomnia) and of accounting for study and measurement design when meta-analysing genetic association data.
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Affiliation(s)
- Mark J Adams
- Division of Psychiatry, University of Edinburgh, Edinburgh, UK
| | - Jackson G Thorp
- Mental Health and Neuroscience, QIMR Berghofer Medical Research Institute, Brisbane, QLD, AU
| | - Bradley S Jermy
- Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, FI
| | - Alex S F Kwong
- Division of Psychiatry, University of Edinburgh, Edinburgh, UK
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Kadri Kõiv
- Estonian Genome Centre, Institute of Genomics, University of Tartu, Tartu, EE
| | - Andrew D Grotzinger
- Department of Psychology and Neuroscience, University of Colorado at Boulder, Boulder, CO, US
- Institute for Behavioral Genetics, University of Colorado at Boulder, Boulder, CO, US
| | - Michel G Nivard
- Department of Biological Psychology, Vrije Universiteit Amsterdam, Amsterdam, NL
| | - Sally Marshall
- Centre for Genomic & Experimental Medicine, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
| | - Yuri Milaneschi
- Department of Psychiatry, Amsterdam Public Health and Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, NL
| | - Bernhard T Baune
- Department of Psychiatry, University of Melbourne, Melbourne, VIC, AU
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, VIC, AU
- Department of Psychiatry, University of Münster, Münster, NRW, DE
| | - Bertram Müller-Myhsok
- Department of Translational Research in Psychiatry, Max Planck Institute of Psychiatry, Munich, BY, DE
- Munich Cluster for Systems Neurology (SyNergy), Munich, BY, DE
- Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Brenda Wjh Penninx
- Department of Psychiatry, Amsterdam Public Health and Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, NL
| | - Dorret I Boomsma
- Department of Biological Psychology & Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, NL
| | - Douglas F Levinson
- Department of Psychiatry & Behavioral Sciences, Stanford University, Stanford, CA, US
| | - Gerome Breen
- Social, Genetic and Developmental Psychiatry Centre, King's College London, London, UK
- NIHR Maudsley Biomedical Research Centre, King's College London, London, UK
| | - Giorgio Pistis
- Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Prilly, VD, CH
| | - Hans J Grabe
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald MV, DE
| | - Henning Tiemeier
- Child and Adolescent Psychiatry, Erasmus University Medical Center Rotterdam, Rotterdam, NL
- Social and Behavioral Science, Harvard T.H. Chan School of Public Health, Boston, MA, US
| | - Klaus Berger
- Institute of Epidemiology and Social Medicine, University of Münster, Münster, NRW, DE
| | - Marcella Rietschel
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, BW, DE
| | - Patrik K Magnusson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, SE
| | - Rudolf Uher
- Psychiatry, Dalhousie University, Halifax, NS, CA
| | - Steven P Hamilton
- Psychiatry, Kaiser Permanente Northern California, San Francisco, CA, US
| | | | - Kelli Lehto
- Estonian Genome Centre, Institute of Genomics, University of Tartu, Tartu, EE
| | - Qingqin S Li
- Neuroscience Therapeutic Area, Janssen Research and Development, LLC, Titusville, NJ, US
| | - Enda M Byrne
- Child Health Research Centre, University of Queensland, Brisbane, QLD, AU
| | - Ian B Hickie
- Brain and Mind Centre, University of Sydney, Sydney, NSW, AU
| | - Nicholas G Martin
- Mental Health and Neuroscience, QIMR Berghofer Medical Research Institute, Brisbane, QLD, AU
| | - Sarah E Medland
- Mental Health and Neuroscience, QIMR Berghofer Medical Research Institute, Brisbane, QLD, AU
| | - Naomi R Wray
- Institute for Molecular Bioscience, University of Queensland, Brisbane, QLD, AU
- Queensland Brain Institute, University of Queensland, Brisbane, QLD, AU
| | - Elliot M Tucker-Drob
- Department of Psychology, University of Texas at Austin, Austin, TX, US
- Population Research Center, University of Texas at Austin, Austin, TX, US
| | - Cathryn M Lewis
- Social, Genetic and Developmental Psychiatry Centre, King's College London, London, UK
- Department of Medical & Molecular Genetics, King's College London, London, UK
| | - Andrew M McIntosh
- Division of Psychiatry, University of Edinburgh, Edinburgh, UK
- Institute for Genomics and Cancer, University of Edinburgh, Edinburgh, UK
| | - Eske M Derks
- Mental Health and Neuroscience, QIMR Berghofer Medical Research Institute, Brisbane, QLD, AU
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Huang L, Tang S, Rietkerk J, Appadurai V, Krebs MD, Schork AJ, Werge T, Zuber V, Kendler K, Cai N. Polygenic analyses show important differences between MDD symptoms collected using PHQ9 and CIDI-SF. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.02.27.23286527. [PMID: 36909638 PMCID: PMC10002792 DOI: 10.1101/2023.02.27.23286527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Symptoms of Major Depressive Disorder (MDD) are commonly assessed using self-rating instruments like the Patient Health Questionnaire 9 (PHQ9, for current symptoms), and the Composite International Diagnostic Interview Short-Form (CIDI-SF, for lifetime worst-episode symptoms). Using data from the UKBiobank, we show that corresponding symptoms endorsed through PHQ9 and CIDI-SF have low to moderate genetic correlations (rG=0.43-0.87), and this cannot be fully attributed to different severity thresholds or the use of a skip-structure in CIDI-SF. Through a combination of Mendelian Randomization (MR) and polygenic prediction analyses, we find that PHQ9 symptoms are more associated with traits which reflect general dysphoria, while the skip-structure in CIDI-SF allows for the identification of heterogeneity among likely MDD cases. This has important implications on factor analyses performed on their respective genetic covariance matrices for the purpose of identification of genetic factors behind MDD symptom dimensions and heterogeneity.
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Affiliation(s)
- Lianyun Huang
- Helmholtz Pioneer Campus, Helmholtz Zentrum München, Neuherberg, Germany
- Computational Health Centre, Helmholtz Zentrum München, Neuherberg, Germany
- School of Medicine, Technical University of Munich, Munich, Germany
| | - Sonja Tang
- School of Public Health, Imperial College London, UK
- MRC Centre for Environment and Health, Imperial College London, UK
| | - Jolien Rietkerk
- Helmholtz Pioneer Campus, Helmholtz Zentrum München, Neuherberg, Germany
- Computational Health Centre, Helmholtz Zentrum München, Neuherberg, Germany
- School of Medicine, Technical University of Munich, Munich, Germany
| | - Vivek Appadurai
- Institute of Biological Psychiatry, Mental Health Center - Sct Hans, Copenhagen University Hospital – Mental Health Services CPH, Copenhagen, Denmark
| | - Morten Dybdahl Krebs
- Institute of Biological Psychiatry, Mental Health Center - Sct Hans, Copenhagen University Hospital – Mental Health Services CPH, Copenhagen, Denmark
| | - Andrew J. Schork
- Institute of Biological Psychiatry, Mental Health Center - Sct Hans, Copenhagen University Hospital – Mental Health Services CPH, Copenhagen, Denmark
- Neurogenomics Division, The Translational Genomics Research Institute (TGEN), Phoenix, AZ, USA
- Section for Geogenetics, GLOBE Institute, Faculty of Health and Medical Sciences, Copenhagen University
| | - Thomas Werge
- Institute of Biological Psychiatry, Mental Health Center - Sct Hans, Copenhagen University Hospital – Mental Health Services CPH, Copenhagen, Denmark
- Lundbeck Foundation GeoGenetics Centre, Natural History Museum of Denmark, University of Copenhagen, Copenhagen 1350, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen 2200, Denmark
| | - Verena Zuber
- School of Public Health, Imperial College London, UK
- MRC Centre for Environment and Health, Imperial College London, UK
| | - Kenneth Kendler
- Virginia Institute for Psychiatric and Behavioral Genetics and Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, USA
| | - Na Cai
- Helmholtz Pioneer Campus, Helmholtz Zentrum München, Neuherberg, Germany
- Computational Health Centre, Helmholtz Zentrum München, Neuherberg, Germany
- School of Medicine, Technical University of Munich, Munich, Germany
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Rabelo-da-Ponte FD, Verdolini N, Goularte JF, Serafim SD, Caldieraro MAK, Vieta E, Ramos-Quiroga JA, Amoretti S, Rosa AR. Identifying pathways between psychiatric symptoms and psychosocial functioning in the general population. Eur Neuropsychopharmacol 2023; 67:86-94. [PMID: 36640692 DOI: 10.1016/j.euroneuro.2022.11.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 11/07/2022] [Accepted: 11/08/2022] [Indexed: 01/15/2023]
Abstract
The present study aims to identify pathways between psychiatric network symptoms and psychosocial functioning and their associated variables among functioning clusters in the general population. A cross-sectional web-based survey was administered in a total of 3,023 individuals in Brazil. The functioning clusters were derived by a previous study identifying three different groups based on the online Functioning Assessment Short Test. Networking analysis was fitted with all items of the Patient-Reported Outcomes Measurement Information System for depression and for anxiety (PROMIS) using the mixed graphical model. A decision tree model was used to identify the demographic and clinical characteristics of good and low functioning. A total of 926 (30.63%) subjects showed good functioning, 1,436 (47.50%) participants intermediate functioning, and 661 (21.86%) individuals low functioning. Anxiety and uneasy symptoms were the most important nodes for good and intermediate clusters but anxiety, feeling of failure, and depression were the most relevant symptoms for low functioning. The decision tree model was applied to identify variables capable to discriminate individuals with good and low functioning. The algorithm achieved balanced accuracy 0.75, sensitivity 0.87, specificity 0.63, positive predictive value 0.63 negative predictive value 0.87 (p<0.001), and an area under the curve of 0.83 (95%CI:0.79-0.86, p<0.01). Our results show that individuals who present psychological distress are more likely to experience poor functional status, suggesting that this subgroup should receive a more comprehensive psychiatric assessment and mental health care.
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Affiliation(s)
- Francisco Diego Rabelo-da-Ponte
- Department of Social, Genetic & Developmental Psychiatry, Institute of Psychology, Psychiatry and Neurosciences, King's College London, London, United Kingdom
| | - Norma Verdolini
- Bipolar and Depressive Disorders Unit, Hospìtal Clinic de Barcelona, Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Institute of Neurosciences (UBNeuro), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Barcelona, Catalonia, Spain
| | - Jeferson Ferraz Goularte
- Laboratory of Molecular Psychiatry, Centro de Pesquisa Experimental (CPE) and Centro de Pesquisa Clínica (CPC), Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil; Instituto Nacional de Ciência e Tecnologia Translacional em Medicina (INCT-TM), Porto Alegre, RS, Brazil; Universidade Federal do Rio Grande do Sul, School of Medicine, Graduate Program in Psychiatry and Behavioral Sciences, Department of Psychiatry, Porto Alegre, RS, Brazil
| | - Silvia Dubou Serafim
- Laboratory of Molecular Psychiatry, Centro de Pesquisa Experimental (CPE) and Centro de Pesquisa Clínica (CPC), Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil; Instituto Nacional de Ciência e Tecnologia Translacional em Medicina (INCT-TM), Porto Alegre, RS, Brazil; Universidade Federal do Rio Grande do Sul, School of Medicine, Graduate Program in Psychiatry and Behavioral Sciences, Department of Psychiatry, Porto Alegre, RS, Brazil
| | - Marco Antonio Knob Caldieraro
- Laboratory of Molecular Psychiatry, Centro de Pesquisa Experimental (CPE) and Centro de Pesquisa Clínica (CPC), Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil; Instituto Nacional de Ciência e Tecnologia Translacional em Medicina (INCT-TM), Porto Alegre, RS, Brazil; Universidade Federal do Rio Grande do Sul, School of Medicine, Graduate Program in Psychiatry and Behavioral Sciences, Department of Psychiatry, Porto Alegre, RS, Brazil
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Hospìtal Clinic de Barcelona, Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Institute of Neurosciences (UBNeuro), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Barcelona, Catalonia, Spain
| | - J Antoni Ramos-Quiroga
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain; Department of Psychiatry and Forensic Medicine, Universitat Autonoma de Barcelona, Barcelona, Catalonia, Spain; Psychiatric Genetics Unit, Group of Psychiatry, Mental Health and Addictions, Vall d'Hebron Research Institute (VHIR), Universitat Autonoma de Barcelona, CIBERSAM, Instituto de Salud Carlos III, Barcelona, Catalonia, Spain
| | - Silvia Amoretti
- Bipolar and Depressive Disorders Unit, Hospìtal Clinic de Barcelona, Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Institute of Neurosciences (UBNeuro), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Barcelona, Catalonia, Spain; Psychiatric Genetics Unit, Group of Psychiatry, Mental Health and Addictions, Vall d'Hebron Research Institute (VHIR), Universitat Autonoma de Barcelona, CIBERSAM, Instituto de Salud Carlos III, Barcelona, Catalonia, Spain.
| | - Adriane R Rosa
- Laboratory of Molecular Psychiatry, Centro de Pesquisa Experimental (CPE) and Centro de Pesquisa Clínica (CPC), Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil; Instituto Nacional de Ciência e Tecnologia Translacional em Medicina (INCT-TM), Porto Alegre, RS, Brazil; Universidade Federal do Rio Grande do Sul, School of Medicine, Graduate Program in Psychiatry and Behavioral Sciences, Department of Psychiatry, Porto Alegre, RS, Brazil; Department of Pharmacology, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.
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