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Valerio MP, Szmulewicz AG, Lomastro J, Martino DJ. Neurocognitive performance in melancholic and non-melancholic major depressive disorder: A meta-analysis of comparative studies. Psychiatry Res 2021; 303:114078. [PMID: 34246007 DOI: 10.1016/j.psychres.2021.114078] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 05/20/2021] [Accepted: 06/25/2021] [Indexed: 01/28/2023]
Affiliation(s)
- Marina P Valerio
- National Council of Scientific and Technical Research (CONICET), Ciudad Autónoma de Buenos Aires, Godoy Cruz 2290 (C1425FQB), Argentina; Psychiatric Emergencies Hospital Torcuato de Alvear, Ciudad Autónoma de Buenos Aires, Warnes 2630 (C1427DPS), Argentina
| | - Alejandro G Szmulewicz
- Harvard TH Chan School of Public Health, Epidemiology Department. Huntington Av 677, Boston, MA 02115, United States; Pharmacology Department, University of Buenos Aires School of Medicine, Paraguay 2155 8th Floor M1 (C1121ABG), Ciudad Autónoma de Buenos Aires, Argentina
| | - Julieta Lomastro
- Psychiatric Emergencies Hospital Torcuato de Alvear, Ciudad Autónoma de Buenos Aires, Warnes 2630 (C1427DPS), Argentina
| | - Diego J Martino
- National Council of Scientific and Technical Research (CONICET), Ciudad Autónoma de Buenos Aires, Godoy Cruz 2290 (C1425FQB), Argentina; Institute of Cognitive and Translational Neuroscience (INCyT), INECO Foundation, Favaloro University, Pacheco de Melo 1854 (C1126AAB), Ciudad Autónoma de Buenos Aires, Argentina.
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Nobis A, Zalewski D, Waszkiewicz N. Peripheral Markers of Depression. J Clin Med 2020; 9:E3793. [PMID: 33255237 PMCID: PMC7760788 DOI: 10.3390/jcm9123793] [Citation(s) in RCA: 98] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 11/09/2020] [Accepted: 11/19/2020] [Indexed: 12/22/2022] Open
Abstract
Major Depressive Disorder (MDD) is a leading cause of disability worldwide, creating a high medical and socioeconomic burden. There is a growing interest in the biological underpinnings of depression, which are reflected by altered levels of biological markers. Among others, enhanced inflammation has been reported in MDD, as reflected by increased concentrations of inflammatory markers-C-reactive protein, interleukin-6, tumor necrosis factor-α and soluble interleukin-2 receptor. Oxidative and nitrosative stress also plays a role in the pathophysiology of MDD. Notably, increased levels of lipid peroxidation markers are characteristic of MDD. Dysregulation of the stress axis, along with increased cortisol levels, have also been reported in MDD. Alterations in growth factors, with a significant decrease in brain-derived neurotrophic factor and an increase in fibroblast growth factor-2 and insulin-like growth factor-1 concentrations have also been found in MDD. Finally, kynurenine metabolites, increased glutamate and decreased total cholesterol also hold promise as reliable biomarkers for MDD. Research in the field of MDD biomarkers is hindered by insufficient understanding of MDD etiopathogenesis, substantial heterogeneity of the disorder, common co-morbidities and low specificity of biomarkers. The construction of biomarker panels and their evaluation with use of new technologies may have the potential to overcome the above mentioned obstacles.
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Affiliation(s)
- Aleksander Nobis
- Department of Psychiatry, Medical University of Bialystok, pl. Brodowicza 1, 16-070 Choroszcz, Poland; (D.Z.); (N.W.)
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Lee HS, Baik SY, Kim YW, Kim JY, Lee SH. Prediction of Antidepressant Treatment Outcome Using Event-Related Potential in Patients with Major Depressive Disorder. Diagnostics (Basel) 2020; 10:diagnostics10050276. [PMID: 32375213 PMCID: PMC7277962 DOI: 10.3390/diagnostics10050276] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 04/23/2020] [Accepted: 05/01/2020] [Indexed: 12/22/2022] Open
Abstract
(1) Background: Prediction of treatment outcome has been one of the core objectives in clinical research of patients with major depressive disorder (MDD). This study explored the possibility of event-related potential (ERP) markers to predict antidepressant treatment outcomes among MDD patients; (2) Methods: Fifty-two patients with MDD were recruited and evaluated through Hamilton depression (HAM-D), Hamilton anxiety rating scale (HAM-A), and CORE. Patients underwent a battery of ERP measures including frontal alpha symmetry (FAA) in the low alpha band (8–10 Hz), mismatch negativity (MMN), and loudness-dependent auditory evoked potentials (LDAEP); (3) Results: During the eight weeks of study, 61% of patients achieved remission, and 77% showed successful treatment responsiveness. Patients with low FAA in F5/F6 demonstrated a significantly higher remission/response ratio and better treatment responsiveness (F (2.560, 117.755) = 3.84, p = 0.016) compared to patients with high FAA. In addition, greater FAA in F7/F8 EEG channels was significantly associated with greater melancholia scores (r = 0.34, p = 0.018). Other ERP markers lacked any significant effect; (4) Conclusions: Our results suggested low FAA (i.e., greater left frontal activity) could reflect a good treatment response in MDD patients. These findings support that FAA could be a promising index in understanding both MDD and melancholic subtype.
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Affiliation(s)
- Hyun Seo Lee
- Clinical Emotion and Cognition Research Laboratory, Inje University, Goyang 50834, Korea; (H.S.L.); (S.Y.B.); (Y.-W.K.); (J.-Y.K.)
| | - Seung Yeon Baik
- Clinical Emotion and Cognition Research Laboratory, Inje University, Goyang 50834, Korea; (H.S.L.); (S.Y.B.); (Y.-W.K.); (J.-Y.K.)
| | - Yong-Wook Kim
- Clinical Emotion and Cognition Research Laboratory, Inje University, Goyang 50834, Korea; (H.S.L.); (S.Y.B.); (Y.-W.K.); (J.-Y.K.)
- Department of Biomedical Engineering, Hanyang University, Seoul 04763, Korea
| | - Jeong-Youn Kim
- Clinical Emotion and Cognition Research Laboratory, Inje University, Goyang 50834, Korea; (H.S.L.); (S.Y.B.); (Y.-W.K.); (J.-Y.K.)
| | - Seung-Hwan Lee
- Clinical Emotion and Cognition Research Laboratory, Inje University, Goyang 50834, Korea; (H.S.L.); (S.Y.B.); (Y.-W.K.); (J.-Y.K.)
- Department of Psychiatry, Inje University, Ilsan-Paik Hospital, Goyang 50834, Korea
- Correspondence: or ; Tel.: +82-31-910-7260; Fax: +82-31-910-7268
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Esposito CM, Buoli M. The biological face of melancholia: Are there any reliable biomarkers for this depression subtype? J Affect Disord 2020; 266:802-809. [PMID: 32217262 DOI: 10.1016/j.jad.2020.02.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 01/24/2020] [Accepted: 02/18/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Melancholic depression (MD) is a subtype of Major Depression associated with more clinical severity and poorer prognosis that non-melancholic depression (NMD). The differentiation between depression subtypes is still clinical, although the identification of specific biomarkers could be useful for diagnosis and the development of new treatments. Purpose of the present manuscript is to review the biomarkers that have been associated with MD. METHODS We performed a bibliographic research on the main databases (PubMed, Embase, PsycInfo, Isi Web of Knowledge, Medscape, The Cochrane Library), in order to find studies that proposed biological markers for melancholic depression. A total of 14 studies met our inclusion criteria. RESULTS Most of studies focused on immune dysregulation. Subjects with MD show biological abnormalities than healthy controls (HC). MD might be characterized by specific biological changes and it could be associated to more severe abnormalities with respect to NMD; however especially about this latter point the available data are preliminary. LIMITATIONS Most available data have not been replicated; the studies focused on different biomarkers. In addition, many articles report results on a limited sample size. CONCLUSIONS Melancholic depression is a subtype of major depression that seems to be associated with specific alterations of different biological systems. Future studies with larger sample can confirm the results and hypothesis presented in this review.
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Affiliation(s)
- Cecilia Maria Esposito
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, Milan 20122, Italy.
| | - Massimiliano Buoli
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, Milan 20122, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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Arias JA, Williams C, Raghvani R, Aghajani M, Baez S, Belzung C, Booij L, Busatto G, Chiarella J, Fu CH, Ibanez A, Liddell BJ, Lowe L, Penninx BWJH, Rosa P, Kemp AH. The neuroscience of sadness: A multidisciplinary synthesis and collaborative review. Neurosci Biobehav Rev 2020; 111:199-228. [PMID: 32001274 DOI: 10.1016/j.neubiorev.2020.01.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 12/17/2019] [Accepted: 01/05/2020] [Indexed: 02/06/2023]
Abstract
Sadness is typically characterized by raised inner eyebrows, lowered corners of the mouth, reduced walking speed, and slumped posture. Ancient subcortical circuitry provides a neuroanatomical foundation, extending from dorsal periaqueductal grey to subgenual anterior cingulate, the latter of which is now a treatment target in disorders of sadness. Electrophysiological studies further emphasize a role for reduced left relative to right frontal asymmetry in sadness, underpinning interest in the transcranial stimulation of left dorsolateral prefrontal cortex as an antidepressant target. Neuroimaging studies - including meta-analyses - indicate that sadness is associated with reduced cortical activation, which may contribute to reduced parasympathetic inhibitory control over medullary cardioacceleratory circuits. Reduced cardiac control may - in part - contribute to epidemiological reports of reduced life expectancy in affective disorders, effects equivalent to heavy smoking. We suggest that the field may be moving toward a theoretical consensus, in which different models relating to basic emotion theory and psychological constructionism may be considered as complementary, working at different levels of the phylogenetic hierarchy.
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Affiliation(s)
- Juan A Arias
- Department of Psychology, Swansea University, United Kingdom; Department of Statistics, Mathematical Analysis, and Operational Research, Universidade de Santiago de Compostela, Spain
| | - Claire Williams
- Department of Psychology, Swansea University, United Kingdom
| | - Rashmi Raghvani
- Department of Psychology, Swansea University, United Kingdom
| | - Moji Aghajani
- Department of Psychiatry, Amsterdam UMC, Location VUMC, GGZ InGeest Research & Innovation, Amsterdam Neuroscience, the Netherlands
| | | | | | - Linda Booij
- Department of Psychology, Concordia University Montreal, Canada; CHU Sainte-Justine, University of Montreal, Montreal, Canada
| | | | - Julian Chiarella
- Department of Psychology, Concordia University Montreal, Canada; CHU Sainte-Justine, University of Montreal, Montreal, Canada
| | - Cynthia Hy Fu
- School of Psychology, University of East London, United Kingdom; Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
| | - Agustin Ibanez
- Institute of Cognitive and Translational Neuroscience (INCYT), INECO Foundation, Favaloro University, Buenos Aires, Argentina; National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina; Center for Social and Cognitive Neuroscience (CSCN), School of Psychology, Universidad Adolfo Ibáñez, Santiago, Chile; Universidad Autonoma del Caribe, Barranquilla, Colombia; Centre of Excellence in Cognition and its Disorders, Australian Research Council (ARC), New South Wales, Australia
| | | | - Leroy Lowe
- Neuroqualia (NGO), Turo, Nova Scotia, Canada
| | - Brenda W J H Penninx
- Department of Psychiatry, Amsterdam UMC, Location VUMC, GGZ InGeest Research & Innovation, Amsterdam Neuroscience, the Netherlands
| | - Pedro Rosa
- Department of Psychiatry, University of Sao Paulo, Brazil
| | - Andrew H Kemp
- Department of Psychology, Swansea University, United Kingdom; Department of Psychiatry, University of Sao Paulo, Brazil; Discipline of Psychiatry, and School of Psychology, University of Sydney, Sydney, Australia.
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Su H, Zuo C, Zhang H, Jiao F, Zhang B, Tang W, Geng D, Guan Y, Shi S. Regional cerebral metabolism alterations affect resting-state functional connectivity in major depressive disorder. Quant Imaging Med Surg 2018; 8:910-924. [PMID: 30505720 DOI: 10.21037/qims.2018.10.05] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background 18F-FDG positron emission tomography (PET) is a reliable technique to quantify regional neural glucose metabolism even with major depressive disorder (MDD) heterogeneous features. Previous study proposed that in the resting-state (RS), pairs of brain regions whose regional glucose metabolic rates were significantly correlated were functionally associated. This synchronicity indicates a neuronal metabolic and functional interaction in high energy efficient brain regions. In this study, a multimode method was used to identify the RS-FC patterns based on regional metabolism changes, and to observe its relationship with the severity of depressive symptoms in MDD patients. Methods The study enrolled 11 medication-naive MDD patients and 14 healthy subjects. All participants received a static 18F-FDG PET brain scan and a resting-state functional magnetic resonance imaging (RS-fMRI) scan. SPM5 software was used to compare brain metabolism in MDD patients with that in healthy controls, and designated regions with a change in metabolism as regions of interest (ROIs). The glucose metabolism-based regional RS-FC Z values were compared between groups. Then group independent component analysis (ICA) was used to identify the abnormal connectivity nodes in the intrinsic function networks. Finally, the correlation between abnormal RS-FC Z values and the severity of depressive symptoms was evaluated. Results Patients with MDD had reduced glucose metabolism in the putamen, claustrum, insular, inferior frontal gyrus, and supramarginal gyrus. The metabolic reduction regions impaired functional connectivity (FC) to key hubs, such as the Inferior frontal gyrus (pars triangular), angular gyrus, calcarine sulcus, middle frontal gyrus (MFG), located in dorsolateral prefrontal cortex (DLPFC)/parietal lobe, salience network (SN), primary visual cortex (V1), and language network respectively. There was no correlation between aberrant connectivity and the severity of clinical symptoms. Conclusions This research puts forward a possibility that focal neural activity alteration may share RS-FC dysfunction and be susceptible to hubs in the functional network in MDD. In particular, the metabolism and function profiles of the Inferior frontal gyrus (pars triangularis) should be emphasized in future MDD studies.
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Affiliation(s)
- Hui Su
- Department of Psychiatry, Shanghai Mental Health Center, Shanghai 200030, China.,Department of Psychiatry, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Chuantao Zuo
- PET Center, Huashan Hospital, Fudan University, Shanghai 200235, China
| | - Huiwei Zhang
- PET Center, Huashan Hospital, Fudan University, Shanghai 200235, China
| | - Fangyang Jiao
- PET Center, Huashan Hospital, Fudan University, Shanghai 200235, China
| | - Bin Zhang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai 200030, China
| | - Weijun Tang
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Daoyin Geng
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Yihui Guan
- PET Center, Huashan Hospital, Fudan University, Shanghai 200235, China
| | - Shenxun Shi
- Department of Psychiatry, Huashan Hospital, Fudan University, Shanghai 200040, China
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From psychological moments to mortality: A multidisciplinary synthesis on heart rate variability spanning the continuum of time. Neurosci Biobehav Rev 2017; 83:547-567. [PMID: 28888535 DOI: 10.1016/j.neubiorev.2017.09.006] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 09/04/2017] [Indexed: 02/05/2023]
Abstract
Heart rate variability (HRV) indexes functioning of the vagus nerve, arguably the most important nerve in the human body. The Neurovisceral Integration Model has provided a structural framework for understanding brain-body integration, highlighting the role of the vagus in adaptation to the environment. In the present paper, we emphasise a temporal framework in which HRV may be considered a missing, structural link between psychological moments and mortality, a proposal we label as Neurovisceral Integration Across a Continuum of Time (or NIACT). This new framework places neurovisceral integration on a dimension of time, highlighting implications for lifespan development and healthy aging, and helping to bridge the gap between clearly demarcated disciplines such as psychology and epidemiology. The NIACT provides a novel framework, which conceptualizes how everyday psychological moments both affect and are affected by the vagus in ways that have long-term effects on mortality risk. We further emphasize that a longitudinal approach to understanding change in vagal function over time may yield novel scientific insights and important public health outcomes.
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D'Urso G, Dell'Osso B, Rossi R, Brunoni AR, Bortolomasi M, Ferrucci R, Priori A, de Bartolomeis A, Altamura AC. Clinical predictors of acute response to transcranial direct current stimulation (tDCS) in major depression. J Affect Disord 2017; 219:25-30. [PMID: 28505499 DOI: 10.1016/j.jad.2017.05.019] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Revised: 04/01/2017] [Accepted: 05/06/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND Transcranial direct current stimulation (tDCS) is a promising neuromodulation intervention for poor-responding or refractory depressed patients. However, little is known about predictors of response to this therapy. The present study aimed to analyze clinical predictors of response to tDCS in depressed patients. METHODS Clinical data from 3 independent tDCS trials on 171 depressed patients (including unipolar and bipolar depression), were pooled and analyzed to assess predictors of response. Depression severity and the underlying clinical dimensions were measured using the Hamilton Depression Rating Scale (HDRS) at baseline and after the tDCS treatment. Age, gender and diagnosis (bipolar/unipolar depression) were also investigated as predictors of response. Linear mixed models were fitted in order to ascertain which HDRS factors were associated with response to tDCS. RESULTS Age, gender and diagnosis did not show any association with response to treatment. The reduction in HDRS scores after tDCS was strongly associated with the baseline values of "Cognitive Disturbances" and "Retardation" factors, whilst the "Anxiety/Somatization" factor showed a mild association with the response. LIMITATIONS Open-label design, the lack of control group, and minor differences in stimulation protocols. CONCLUSIONS No differences in response to tDCS were found between unipolar and bipolar patients, suggesting that tDCS is effective for both conditions. "Cognitive disturbance", "Retardation", and "Anxiety/Somatization", were identified as potential clinical predictors of response to tDCS. These findings point to the pre-selection of the potential responders to tDCS, therefore optimizing the clinical use of this technique and the overall cost-effectiveness of the psychiatric intervention for depressed patients.
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Affiliation(s)
- Giordano D'Urso
- Unit of Psychiatry, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy
| | - Bernardo Dell'Osso
- Department of Psychiatry, University of Milan, Milan, Italy; Fondazione IRCCS Ca' Granda, Policlinico, Milan, Italy; Department of Psychiatry and Behavioral Sciences, Stanford University, CA, USA
| | - Rodolfo Rossi
- Unit of Psychiatry, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy.
| | - Andre Russowsky Brunoni
- Service of Interdisciplinary Neuromodulation, Department and Institute of Psychiatry, Laboratory of Neurosciences (LIM-27), University of São Paulo, São Paulo, Brazil; Interdisciplinary Center for Applied Neuromodulation, University Hospital of São Paulo, São Paulo, Brazil
| | - Marco Bortolomasi
- Casa di cura Villa Santa Chiara, Quinto di Valpantena, Verona, Italy
| | - Roberta Ferrucci
- Fondazione IRCCS Ca' Granda, Policlinico, Milan, Italy; Department of Health Sciences, University of Milan, Italy
| | - Alberto Priori
- Department of Health Sciences, University of Milan, Italy; III Clinica Neurologica, Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan, Italy
| | - Andrea de Bartolomeis
- Unit of Psychiatry, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy
| | - Alfredo Carlo Altamura
- Department of Psychiatry, University of Milan, Milan, Italy; Fondazione IRCCS Ca' Granda, Policlinico, Milan, Italy
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Bosaipo NB, Foss MP, Young AH, Juruena MF. Neuropsychological changes in melancholic and atypical depression: A systematic review. Neurosci Biobehav Rev 2017; 73:309-325. [PMID: 28027956 DOI: 10.1016/j.neubiorev.2016.12.014] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 10/28/2016] [Accepted: 12/09/2016] [Indexed: 02/05/2023]
Abstract
There is not a consensus as to whether neuropsychological profiling can distinguish depressive subtypes. We aimed to systematically review and critically analyse the literature on cognitive function in patients with melancholic and atypical depression. We searched in databases PubMed, SCOPUS, Web of Knowledge and PsycInfo for papers comparing the neuropsychological performance of melancholic patients (MEL) to non-melancholic depressive patients (NMEL), including atypical depressives, and healthy controls (HC). All studies were scrutinised to determine the main methodological characteristics and particularly possible sources of bias influencing the results reported, using the STROBE statement checklist. We also provide effect size of the results reported for contrasts between MEL; patients and NMEL patients. Seventeen studies were included; most of them demonstrated higher neuropsychological impairments of MEL patients compared to both NMEL patients and HC on tasks requiring memory, executive function, attention and reaction time. Detailed analysis of the methodologies used in the studies revealed significant variability especially regarding the participants' sociodemographic characteristics, clinical characteristics of patients and differences in neuropsychological assessment. These findings suggest that MEL may have a distinct and impaired cognitive performance compared to NMEL depressive patients on tasks involving verbal and visual memory, executive function, sustained attention and span, as well as psychomotor speed, this last especially when cognitive load is increased. Additional studies with adequate control of potentially confounding variables will help to clarify further differences in the neuropsychological functioning of depressive subtypes.
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Affiliation(s)
- Nayanne Beckmann Bosaipo
- Section of Movement Disorders and Behavioral Neurology, Ribeirao Preto General Hospital of the University of Sao Paulo SP, Brazil
| | - Maria Paula Foss
- Section of Movement Disorders and Behavioral Neurology, Ribeirao Preto General Hospital of the University of Sao Paulo SP, Brazil
| | - Allan H Young
- Centre for Affective Disorders-Department of Psychological Medicine Institute of Psychiatry, Psychology and Neuroscience-King's College London, UK
| | - Mario Francisco Juruena
- Department of Neuroscience and Behavior, School of Medicine of Ribeirao Preto, University of Sao Paulo, Brazil; Centre for Affective Disorders-Department of Psychological Medicine Institute of Psychiatry, Psychology and Neuroscience-King's College London, UK.
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Parker G, McCraw S. The properties and utility of the CORE measure of melancholia. J Affect Disord 2017; 207:128-135. [PMID: 27721186 DOI: 10.1016/j.jad.2016.09.029] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 09/20/2016] [Accepted: 09/24/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND The CORE measure was designed to assess a central feature of melancholia - signs of psychomotor disturbance (PMD) - and so provide an alternate non-symptom based measure of melancholia or of its probability. This review evaluates development and application studies undertaken over the last 25 years to consider how well it has met its original objectives. METHODS All studies published using the CORE measure as either the only or an adjunctive measure of melancholia were obtained and are considered in this review. RESULTS Findings suggest high reliability in quantifying CORE scores can be achieved and that it has construct validity as a measure of PMD. A number of application studies assessing socio-demographic factors, cognitive and motor impairment, dexamethasone suppression and thyrotropin-releasing hormone, response to psychotherapy and to electroconvulsive therapy support its validity as a measure of melancholia, while functional brain imaging studies suggest that the measure identifies regions of decreased connectivity. LIMITATIONS Use of the CORE benefits from rater training and for subjects to be assessed at or near nadir of their depressive episode. There have been insufficient studies evaluating genetic factors, and the treatment response of CORE-defined melancholic patients to antidepressant drugs of differing classes. CONCLUSIONS The CORE, either as a proxy or direct measure of melancholia, provides a strategy for assigning depressed subjects a diagnosis or melancholic or non-melancholic depression or for estimating the probability of melancholia.
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Affiliation(s)
- Gordon Parker
- School of Psychiatry, the University of New South Wales, Sydney, NSW, Australia; The Black Dog Institute, Sydney, NSW, Australia.
| | - Stacey McCraw
- School of Psychiatry, the University of New South Wales, Sydney, NSW, Australia; The Black Dog Institute, Sydney, NSW, Australia
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A meta-analysis of cognitive performance in melancholic versus non-melancholic unipolar depression. J Affect Disord 2016; 201:15-24. [PMID: 27156095 DOI: 10.1016/j.jad.2016.04.039] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 04/16/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Recently there is increasing recognition of cognitive dysfunction as a core feature of Major Depressive Disorder (MDD). The goal of the current meta-analysis was to review and examine in detail the specific features of cognitive dysfunction in Melancholic (MEL) versus Non-Melancholic (NMEL) MDD. METHODS An electronic literature search was performed to find studies comparing cognitive performance in MEL versus NMEL. A meta-analysis of broad cognitive domains (processing speed, reasoning/problem solving, verbal learning, visual learning, attention/working memory) was conducted on all included studies (n=9). Sensitivity and meta-regression analyses were also conducted to detect possible effects of moderator variables (age, gender, education, symptom severity and presence of treatments). RESULTS MEL patients were older and more severly depressed than NMEL subjects. The MEL group was characterized by a worse cognitive performance in attention/working memory (ES=-0.31), visual learning (ES=-0.35) and reasoning/problem solving (ES=-0.46). No difference was detected in drug-free patients by sensitivity analyses. No effect was found for any of our moderators on the cognitive performance in MEL vs NMEL. CONCLUSION Our findings seem to support a moderate but specific effect of melancholic features in affecting the cognitive performance of MDD, in particular as regards visual learning and executive functions.
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Beblo T. Die Bedeutung kognitiver Beeinträchtigungen bei depressiven Patienten. ZEITSCHRIFT FUR NEUROPSYCHOLOGIE 2016. [DOI: 10.1024/1016-264x/a000174] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Zusammenfassung. Beeinträchtigungen der Exekutivfunktionen, der Aufmerksamkeit und des Gedächtnisses sind einige der häufigsten und hartnäckigsten Symptome depressiver Störungen. Bisher konnte allerdings kein eindeutiges Profil dieser Defizite identifiziert werden, wahrscheinlich auch deshalb, weil die Defizite von verschiedenen klinischen und demografischen Faktoren, wie dem Depressionssubtypus, Grübeln, Komorbiditäten und Alter beeinflusst werden. Die kognitiven Beeinträchtigungen verbessern sich mit der Remission der Störung, häufig findet jedoch keine vollständige Rückbildung statt. Sie sind klinisch sehr relevant und gehen einher mit Suizidalität, reduzierten Therapieeffekten und negativen Auswirkungen auf Alltagsaktivitäten. Aus diesen Gründen ergibt sich für betroffene Patienten die Notwendigkeit einer neuropsychologischen Behandlung. Erste Ergebnisse lassen hoffen, dass die kognitiven Beeinträchtigungen mithilfe neuropsychologischer Therapie, Achtsamkeitstraining, psychopharmakologischer Therapie und weiteren neurobiologischen Behandlungen, wie z. B. der repetitiven transkraniellen Magnetstimulation, erfolgreich behandelt werden können.
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Affiliation(s)
- Thomas Beblo
- Klinik für Psychiatrie und Psychotherapie Bethel, Evangelisches Krankenhaus Bielefeld, Bielefeld
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Day CV, Gatt JM, Etkin A, DeBattista C, Schatzberg AF, Williams LM. Cognitive and emotional biomarkers of melancholic depression: An iSPOT-D report. J Affect Disord 2015; 176:141-50. [PMID: 25710095 DOI: 10.1016/j.jad.2015.01.061] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Revised: 01/28/2015] [Accepted: 01/29/2015] [Indexed: 11/15/2022]
Abstract
BACKGROUND Depressed patients with melancholic features have distinct impairments in cognition and anhedonia, but it remains unknown whether these impairments can be quantified on neurocognitive biomarker tests of behavioral performance. We compared melancholic major depressive disorder (MDD) patients to non-melancholic MDD patients and controls on a neurocognitive test battery that assesses eight general and emotional cognitive domains including the hypothesized decision-making and reward-threat perception. METHODS MDD outpatients (n=1008) were assessed using a computerized battery of tests. MDD participants met DSM-IV criteria for MDD and had a score ≥16 on the 17-item Hamilton Rating Scale for Depression. Melancholic MDD was defined using the Mini-International Neuropsychiatric Interview and a psychomotor disturbance observer-rated CORE measure score >7. Controls were age- and gender-matched with no previous DSM-IV or significant medical history. RESULTS Melancholic participants (33.7% of the MDD sample) exhibited significantly poorer performance than controls across each domain of cognitive function and for speed of emotion identification and implicit emotion priming. Compared to the non-melancholic group, specific disturbances were seen on tests of information speed, decision speed, and reward-relevant emotional processing of happy expressions, even after co-varying for symptom severity. LIMITATIONS Assessments were taken at only one medication-free time point. Reward was investigated using an emotional faces task. CONCLUSIONS Melancholic MDD is distinguished by a specific neurocognitive marker profile consistent with reduced decision-making capacity under time demands and loss of reward sensitivity. This profile suggests an underlying deficit in mesolimbic-cortical circuitry for motivationally-directed behavior.
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Affiliation(s)
- Claire V Day
- The Brain Dynamics Centre, Discipline of Psychiatry, Sydney Medical School, University of Sydney, Sydney 2006, NSW, Australia; Westmead Millennium Institute, Westmead 2145, NSW, Australia; Brain Resource Ltd., 235 Jones Street, Sydney, NSW, Australia; Brain Resource Inc., 1000 Sansome Street, San Francisco, CA 94111, USA
| | - Justine M Gatt
- The Brain Dynamics Centre, Discipline of Psychiatry, Sydney Medical School, University of Sydney, Sydney 2006, NSW, Australia; Westmead Millennium Institute, Westmead 2145, NSW, Australia; Neuroscience Research Australia, Randwick 2031, NSW, Australia; School of Psychology, University of New South Wales, Sydney 2052, NSW, Australia
| | - Amit Etkin
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA; Sierra-Pacific Mental Illness Research, Education and Clinical Center (MIRECC) Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304, USA
| | - Charles DeBattista
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Alan F Schatzberg
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Leanne M Williams
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA; Sierra-Pacific Mental Illness Research, Education and Clinical Center (MIRECC) Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304, USA.
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Lener MS, Iosifescu DV. In pursuit of neuroimaging biomarkers to guide treatment selection in major depressive disorder: a review of the literature. Ann N Y Acad Sci 2015; 1344:50-65. [DOI: 10.1111/nyas.12759] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Marc S. Lener
- Department of Psychiatry; Icahn School of Medicine at Mount Sinai; New York New York
| | - Dan V. Iosifescu
- Department of Psychiatry; Icahn School of Medicine at Mount Sinai; New York New York
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15
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Day CV, John Rush A, Harris AWF, Boyce PM, Rekshan W, Etkin A, DeBattista C, Schatzberg AF, Arnow BA, Williams LM. Impairment and distress patterns distinguishing the melancholic depression subtype: an iSPOT-D report. J Affect Disord 2015; 174:493-502. [PMID: 25554994 DOI: 10.1016/j.jad.2014.10.046] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Revised: 10/23/2014] [Accepted: 10/24/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND This study seeks to provide a comprehensive and systematic evaluation of baseline clinical and psychological features and treatment response characteristics that differentiate Major Depressive Disorder (MDD) outpatients with and without melancholic features. Reflecting the emphasis in DSM-5, we also include impairment and distress. METHODS Participants were assessed pre-treatment on clinical features (severity, risk factors, comorbid conditions, illness course), psychological profile (personality, emotion regulation), functional capacity (social and occupational function, quality of life) and distress/coping (negativity bias, emotional resilience, social skills, satisfaction with life). Participants were randomized to sertraline, escitalopram or venlafaxine extended-release and re-assessed post-treatment at 8 weeks regarding remission, response, and change in impairment and distress. RESULTS Patients with melancholic features (n=339; 33.7%) were distinguished clinically from non-melancholics by more severe depressive symptoms and greater exposure to abuse in childhood. Psychologically, melancholic patients were defined by introversion, and a greater use of suppression to regulate negative emotion. Melancholics also had poorer capacity for social and occupational function, and physical and psychological quality of life, along with poorer coping, reflected in less emotional resilience and capacity for social skills. Post-treatment, melancholic patients had lower remission and response, but some of this effect was due to the more severe symptoms pre-treatment. The distress/coping outcome measure of capacity for social skills remained significantly lower for melancholic participants. LIMITATIONS Due to the cross-sectional nature of this study, causal pathways cannot be concluded. CONCLUSIONS Findings provide new insights into a melancholic profile of reduced ability to function interpersonally or effectively deal with one׳s emotions. This distinctly poorer capacity for social skills remained post-treatment. The pre-treatment profile may account for some of the difficulty in achieving remission or response with treatment.
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Affiliation(s)
- Claire V Day
- Brain Dynamics Center, Psychiatry, University of Sydney Medical School, Sydney, NSW 2145 Australia; Discipline of Psychiatry, Sydney Medical School, University of Sydney, Westmead Clinical School, Australia; Brain Resource Ltd., 235 Jones Street, Sydney, NSW, Australia; Brain Resource Inc., 1000 Sansome Street, San Francisco, CA 94111, USA.
| | - A John Rush
- Duke-National University of Singapore, Graduate Medical School Singapore, 8 College Road, Singapore 169857, Singapore
| | - Anthony W F Harris
- Brain Dynamics Center, Psychiatry, University of Sydney Medical School, Sydney, NSW 2145 Australia; Discipline of Psychiatry, Sydney Medical School, University of Sydney, Westmead Clinical School, Australia
| | - Philip M Boyce
- Discipline of Psychiatry, Sydney Medical School, University of Sydney, Westmead Clinical School, Australia
| | - William Rekshan
- Brain Resource Ltd., 235 Jones Street, Sydney, NSW, Australia; Brain Resource Inc., 1000 Sansome Street, San Francisco, CA 94111, USA
| | - Amit Etkin
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA; Sierra-Pacific Mental Illness Research, Education, and Clinical Center (MIRECC) Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304, USA
| | - Charles DeBattista
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Alan F Schatzberg
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Bruce A Arnow
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Leanne M Williams
- Brain Dynamics Center, Psychiatry, University of Sydney Medical School, Sydney, NSW 2145 Australia; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA; Sierra-Pacific Mental Illness Research, Education, and Clinical Center (MIRECC) Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304, USA
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Abstract
The fifth version of the Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 defines mental disorders as syndromes and also introduced disorder "specifiers" with the aim of providing increased diagnostic specificity by defining more homogeneous subgroups of those with the disorder and who share certain features. While the majority of specifiers in DSM-5 define a specific aspect of the disorder such as age at onset or severity, some define syndromes that appear to meet the DSM-5 definition of a mental disorder. Specifically, melancholia is positioned in DSM-5 as a major depressive disorder (non-coded) specifier, while catatonia is listed as both a disorder secondary to a medical condition and as a specifier associated with other mental disorders such as schizophrenia, major depressive disorder, and bipolar disorder. Despite decades of research supporting melancholia's status as a categorical "disorder" (a higher-order construct than a specifier), failure to provide convincing support for its disorder status has contributed to its current positioning in DSM-5. As DSM-5 has similar symptom criteria for major depression and for its melancholia specifier, research seeking to differentiate melancholic and non-melancholic depression according to DSM-5 criteria will have limited capacity to demonstrate "melancholia" as a separate disorder and risks melancholia continuing to be reified as a low-order specifier and thus clinical marginalization. There have been few advances in catatonia research in recent years with its positioning largely relying on opinion and clinical observation rather than on empirical studies.
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Affiliation(s)
- Gordon Parker
- University of New South Wales, Randwick, Sydney, Australia,
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Kemp AH, Quintana DS, Quinn CR, Hopkinson P, Harris AWF. Major depressive disorder with melancholia displays robust alterations in resting state heart rate and its variability: implications for future morbidity and mortality. Front Psychol 2014; 5:1387. [PMID: 25505893 PMCID: PMC4245890 DOI: 10.3389/fpsyg.2014.01387] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 11/13/2014] [Indexed: 01/09/2023] Open
Abstract
Background: Major depressive disorder (MDD) is associated with increased heart rate and reductions in its variability (heart rate variability, HRV) – markers of future morbidity and mortality – yet prior studies have reported contradictory effects. We hypothesized that increases in heart rate and reductions in HRV would be more robust in melancholia relative to controls, than in patients with non-melancholia. Methods: A total of 72 patients with a primary diagnosis of MDD (age M: 36.26, SE: 1.34; 42 females) and 94 controls (age M: 35.69, SE: 1.16; 52 females) were included in this study. Heart rate and measures of its variability (HRV) were calculated from two 2-min electrocardiogram recordings during resting state. Propensity score matching controlled imbalance on potential confounds between patients with melancholia (n = 40) and non-melancholia (n = 32) including age, gender, disorder severity, and comorbid anxiety disorders. Results: MDD patients with melancholia displayed significantly increased heart rate and lower resting-state HRV (including the square root of the mean squared differences between successive N–N intervals, the absolute power of high frequency and standard deviation of the Poincaré plot perpendicular to the line of identity measures of HRV) relative to controls, findings associated with a moderate effect size (Cohens d’s = 0.56–0.58). Patients with melancholia also displayed an increased heart rate relative to those with non-melancholia (Cohen’s d = 0.20). Conclusion: MDD patients with melancholia – but not non-melancholia – display robust increases in heart rate and decreases in HRV. These findings may underpin a variety of behavioral impairments in patients with melancholia including somatic symptoms, cognitive impairment, reduced responsiveness to the environment, and over the longer-term, morbidity and mortality.
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Affiliation(s)
- Andrew H Kemp
- Discipline of Psychiatry, Sydney Medical School, University of Sydney Sydney, NSW, Australia ; School of Psychology, Faculty of Science, University of Sydney Sydney, NSW, Australia ; Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário - Universidade de São Paulo São Paulo, Brazil
| | - Daniel S Quintana
- School of Psychology, Faculty of Science, University of Sydney Sydney, NSW, Australia ; NORMENT, K.G. Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo Oslo, Norway ; Division of Mental Health and Addiction, Oslo University Hospital Oslo, Norway
| | - Candice R Quinn
- Discipline of Psychiatry, Sydney Medical School, University of Sydney Sydney, NSW, Australia
| | - Patrick Hopkinson
- Discipline of Psychiatry, Sydney Medical School, University of Sydney Sydney, NSW, Australia
| | - Anthony W F Harris
- Discipline of Psychiatry, Sydney Medical School, University of Sydney Sydney, NSW, Australia ; Brain Dynamics Centre, Westmead Millennium Institute, University of Sydney - Westmead Hospital Sydney, NSW, Australia
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18
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Lin K, Xu G, Lu W, Ouyang H, Dang Y, Lorenzo-Seva U, Guo Y, Bessonov D, Akiskal HS, So KF, Lee TMC. Neuropsychological performance in melancholic, atypical and undifferentiated major depression during depressed and remitted states: a prospective longitudinal study. J Affect Disord 2014; 168:184-91. [PMID: 25061955 DOI: 10.1016/j.jad.2014.06.032] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Revised: 06/05/2014] [Accepted: 06/24/2014] [Indexed: 01/26/2023]
Abstract
BACKGROUND Considerable evidence has demonstrated that melancholic and atypical major depression have distinct biological correlates relative to undifferentiated major depression, but few studies have specifically delineated neuropsychological performance for them. METHOD In a six-week prospective longitudinal study, we simultaneously compared neuropsychological performance among melancholic depression (n=142), atypical depression (n=76), undifferentiated major depression (n=91), and healthy controls (n=200) during a major depressive episode and a clinically remitted state, respectively. We administered neuropsychological tests assessing processing speed, attention, shifting, planning, verbal fluency, visual spatial memory, and verbal working memory to all participants. RESULTS During the depressive state, the three subtypes displayed extensive cognitive impairment, except for attention, when compared with the healthy controls. Melancholic depression significantly differed from atypical depression in processing speed and verbal fluency. In the remitted state, the three subtypes recovered their visual spatial memory and verbal working memory functions to the healthy control level. The recovery of the other domains (processing speed, set shifting, planning, and verbal fluency), however, was different across the subtypes. No predictive relationship existed between neuropsychological performance and the treatment outcome. LIMITATIONS The drop-out rate in the six-week longitudinal study was relatively high. CONCLUSION Our data provide preliminary evidence that during depressed states the three major depressive subtypes display similar cognitive deficits in some domains but differ in such domains as processing speed and verbal fluency. The recovery of the cognitive deficits following clinical remission from depression may be associated with subtypes of major depressive disorder.
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Affiliation(s)
- Kangguang Lin
- Department of Psychiatry, Guangzhou Psychiatric Hospital, 36 Mingxin Road, Fangcun district, Affiliated Hospital of Guangzhou Medical University, Guangdong Province, Guangzhou 510370, China; Laboratory of Neuropsychology, The University of Hong Kong, Hong Kong; Laboratory of Cognitive Affective Neuroscience, The University of Hong Kong, Hong Kong
| | - Guiyun Xu
- Department of Psychiatry, Guangzhou Psychiatric Hospital, 36 Mingxin Road, Fangcun district, Affiliated Hospital of Guangzhou Medical University, Guangdong Province, Guangzhou 510370, China.
| | - Weicong Lu
- Department of Psychiatry, Guangzhou Psychiatric Hospital, 36 Mingxin Road, Fangcun district, Affiliated Hospital of Guangzhou Medical University, Guangdong Province, Guangzhou 510370, China
| | - Huiyi Ouyang
- Department of Psychiatry, Guangzhou Psychiatric Hospital, 36 Mingxin Road, Fangcun district, Affiliated Hospital of Guangzhou Medical University, Guangdong Province, Guangzhou 510370, China
| | - Yamei Dang
- Department of Psychiatry, Guangzhou Psychiatric Hospital, 36 Mingxin Road, Fangcun district, Affiliated Hospital of Guangzhou Medical University, Guangdong Province, Guangzhou 510370, China
| | - Urbano Lorenzo-Seva
- Research Centre for Behavioral Assessment, Department of Psychology, Rovira i Virgili University, Tarragona, Spain
| | - Yangbo Guo
- Department of Psychiatry, Guangzhou Psychiatric Hospital, 36 Mingxin Road, Fangcun district, Affiliated Hospital of Guangzhou Medical University, Guangdong Province, Guangzhou 510370, China
| | - Daniel Bessonov
- International Mood Center, University of California at San Diego, La Jolla, USA
| | - Hagop S Akiskal
- International Mood Center, University of California at San Diego, La Jolla, USA
| | - Kwok-Fai So
- Department of Ophthalmology, The University of Hong Kong, Hong Kong; The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong; GMH Institute of CNS Regeneration, Jinan University, Guangzhou, China
| | - Tatia M C Lee
- Laboratory of Neuropsychology, The University of Hong Kong, Hong Kong; Laboratory of Cognitive Affective Neuroscience, The University of Hong Kong, Hong Kong; The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong; Institute of Clinical Neuropsychology, The University of Hong Kong, Hong Kong.
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19
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Day CVA, Williams LM. Finding a biosignature for melancholic depression. Expert Rev Neurother 2014; 12:835-47. [DOI: 10.1586/ern.12.72] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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20
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Abstract
PURPOSE OF REVIEW To overview historical ascriptions and the current nosological status of melancholia, before reporting diagnostic strategy, biological marker and treatment studies. RECENT FINDINGS As melancholia has never been satisfactorily differentiated by reliance on symptoms, strategies that adopt a more prototypic approach and incorporate illness correlates in conjunction with symptoms appear to provide greater precision in differentiating melancholic and nonmelancholic depression. An early indicative biological marker--hyperactive Hypothalamic-Pituitary-Adrenal axis functioning--remains supported, whereas a number of other recently proposed candidate markers require clarification. Implications for treatment from recent clinical trials are also discussed. SUMMARY We note that the Diagnostic and Statistical Manual 5 (DSM-5) definition of melancholia [as for Diagnostic and Statistical Manual IV (DSM-IV)] may be limited in its differentiating capacity and so compromise research into melancholia's causes and treatments. Clarifying melancholia's status, primary causes and differential treatment responsiveness awaits more precise definition of this depressive condition.
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