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Xue L, Bocharova M, Young AH, Aarsland D. Cognitive improvement in late-life depression treated with vortioxetine and duloxetine in an eight-week randomized controlled trial: The role of age at first onset and change in depressive symptoms. J Affect Disord 2024; 361:74-81. [PMID: 38838790 DOI: 10.1016/j.jad.2024.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 04/22/2024] [Accepted: 06/02/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND Age at first onset of depression as a clinical factor affecting cognitive improvement in late life depression was investigated. METHODS This is a secondary analysis of an eight-week randomized controlled trial involving 452 elderly patients treated by vortioxetine, duloxetine or placebo (1:1:1). Patients were subcategorized into early-onset (LLD-EO) and late-onset (LLD-LO) groups divided by onset age of 50. Cognitive performance was assessed by composite score of Digit Symbol Substitution Test (DSST) and the Rey Auditory Verbal Learning Test (RAVLT) tasks, while depressive symptoms were assessed by Montgomery-Åsberg Depression Rating Scale (MADRS). RESULTS Vortioxetine and duloxetine exhibited advantages versus placebo in improving cognitive performance in the LLD-LO group, yet not in the LLD-EO group after eight weeks. Patients in the LLD-EO group showed overall advantage to placebo in depressive symptoms before endpoint (week 8) of treatment, while patients in the LLO-LO group showed no advantage until endpoint. Path analysis suggested a direct effect of vortioxetine (B = 0.656, p = .036) and duloxetine (B = 0.726, p = .028) on improving cognition in the LLD-LO group, yet in all-patients treated set both medications improved cognition indirectly through changes of depressive symptoms. LIMITATION Reliability of clinical history could raise caution as it was collected by subjective recall of patients. CONCLUSION Age at first onset might affect cognitive improvement as well as change in depressive symptoms and its mediation towards cognitive improvement in late life depression treated with vortioxetine and duloxetine.
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Affiliation(s)
- Lingfeng Xue
- Centre for Healthy Brain Ageing, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, United Kingdom.
| | - Mariia Bocharova
- Centre for Healthy Brain Ageing, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, United Kingdom
| | - Allan H Young
- Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, United Kingdom
| | - Dag Aarsland
- Centre for Healthy Brain Ageing, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, United Kingdom
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Liang G, Lee YZ, Kow ASF, Lee QL, Cheng Lim LW, Yusof R, Tham CL, Ho YC, Lee MT. Neuroprotective effects of Gypenosides: A review on preclinical studies in neuropsychiatric disorders. Eur J Pharmacol 2024; 978:176766. [PMID: 38908668 DOI: 10.1016/j.ejphar.2024.176766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 05/27/2024] [Accepted: 06/19/2024] [Indexed: 06/24/2024]
Abstract
Gynostemma pentaphyllum (Thunb.) Makino is a perennial creeping herb belonging to the Cucurbitaceae family that has a long history of usage in traditional oriental medicine. Gypenosides are the primary bioactive compounds in Gynostemma pentaphyllum. Because of the medicinal value of gypenosides, functional food and supplements containing gypenosides have been promoted and consumed with popularity, especially among Asian communities. This review presented the progress made in the research of pharmacological properties of gypenosides on diseases of the nervous system and their possible mechanism of action. To date, preclinical studies have demonstrated the therapeutic effects of gypenosides in alleviating neuropsychiatric disorders like depression, Parkinson's disease, Alzheimer's disease, secondary dementia, stroke, optic neuritis, etc. Pharmacological studies have discovered that gypenosides can modulate various major signaling pathways like NF-κB, Nrf2, AKT, ERK1/2, contributing to the neuroprotective properties. However, there is a dearth of clinical research on gypenosides, with current investigations on the compounds being mainly conducted in vitro and on animals. Future studies focusing on isolating and purifying novel gypenosides and investigations on exploring the potential molecular mechanism underlying their biological activities are warranted, which may serve as a foundation for further clinical trials for the betterment of human health.
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Affiliation(s)
- Gengfan Liang
- Faculty of Pharmaceutical Sciences, UCSI University, Kuala Lumpur, 56000, Malaysia.
| | - Yu Zhao Lee
- Office of Postgraduate Studies, UCSI University, Kuala Lumpur, 56000, Malaysia; Faculty of Applied Sciences, UCSI University, Kuala Lumpur, 56000, Malaysia.
| | | | - Qi Long Lee
- School of Health Sciences, International Medical University, Kuala Lumpur, 57000, Malaysia.
| | - Luis Wei Cheng Lim
- School of Health Sciences, International Medical University, Kuala Lumpur, 57000, Malaysia.
| | - Rohana Yusof
- Faculty of Applied Sciences, UCSI University, Kuala Lumpur, 56000, Malaysia.
| | - Chau Ling Tham
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang , 43400, Selangor, Malaysia; Natural Medicine and Product Research Laboratory (NaturMeds), Institute of Bioscience, Universiti Putra Malaysia, Serdang , 43400, Selangor, Malaysia.
| | - Yu-Cheng Ho
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung City, 82445, Taiwan.
| | - Ming Tatt Lee
- Faculty of Pharmaceutical Sciences, UCSI University, Kuala Lumpur, 56000, Malaysia; Centre of Research for Mental Health and Well-being, UCSI University, Kuala Lumpur, 56000, Malaysia.
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Silva RH, Pedro LC, Manosso LM, Gonçalves CL, Réus GZ. Pre- And Post-Synaptic Protein In The Major Depressive Disorder: From Neurobiology To Therapeutic Targets. Neuroscience 2024:S0306-4522(24)00372-5. [PMID: 39103041 DOI: 10.1016/j.neuroscience.2024.07.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 07/22/2024] [Accepted: 07/31/2024] [Indexed: 08/07/2024]
Abstract
Major depressive disorder (MDD) has demonstrated its negative impact on various aspects of the lives of those affected. Although several therapies have been developed over the years, it remains a challenge for mental health professionals. Thus, understanding the pathophysiology of MDD is necessary to improve existing treatment options or seek new therapeutic alternatives. Clinical and preclinical studies in animal models of depression have shown the involvement of synaptic plasticity in both the development of MDD and the response to available drugs. However, synaptic plasticity involves a cascade of events, including the action of presynaptic proteins such as synaptophysin and synapsins and postsynaptic proteins such as postsynaptic density-95 (PSD-95). Additionally, several factors can negatively impact the process of spinogenesis/neurogenesis, which are related to many outcomes, including MDD. Thus, this narrative review aims to deepen the understanding of the involvement of synaptic formations and their components in the pathophysiology and treatment of MDD.
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Affiliation(s)
- Ritele H Silva
- Translational Psychiatry Laboratory, Graduate Program in Health Sciences, University of Southern Santa Catarina (UNESC), Criciúma, SC, Brazil; Department of Health Sciences, Campus Araranguá, Federal University of Santa Catarina, 88906-072 Araranguá, SC, Brazil
| | - Lucas C Pedro
- Translational Psychiatry Laboratory, Graduate Program in Health Sciences, University of Southern Santa Catarina (UNESC), Criciúma, SC, Brazil
| | - Luana M Manosso
- Translational Psychiatry Laboratory, Graduate Program in Health Sciences, University of Southern Santa Catarina (UNESC), Criciúma, SC, Brazil
| | - Cinara L Gonçalves
- Translational Psychiatry Laboratory, Graduate Program in Health Sciences, University of Southern Santa Catarina (UNESC), Criciúma, SC, Brazil
| | - Gislaine Z Réus
- Translational Psychiatry Laboratory, Graduate Program in Health Sciences, University of Southern Santa Catarina (UNESC), Criciúma, SC, Brazil.
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Yuan X, Chai J, Xu W, Zhao Y. Exploring the Potential of Probiotics and Prebiotics in Major Depression: From Molecular Function to Clinical Therapy. Probiotics Antimicrob Proteins 2024:10.1007/s12602-024-10326-z. [PMID: 39078446 DOI: 10.1007/s12602-024-10326-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2024] [Indexed: 07/31/2024]
Abstract
Major depressive disorder (MDD) represents a complex and challenging mental health condition with multifaceted etiology. Recent research exploring the gut-brain axis has shed light on the potential influence of gut microbiota on mental health, offering novel avenues for therapeutic intervention. This paper reviews current evidence on the role of prebiotics and probiotics in the context of MDD treatment. Clinical studies assessing the effects of prebiotic and probiotic interventions have demonstrated promising results, showcasing improvements in depression symptoms and metabolic parameters in certain populations. Notably, prebiotics and probiotics have shown the capacity to modulate inflammatory markers, cortisol levels, and neurotransmitter pathways linked to MDD. However, existing research presents varied outcomes, underscoring the need for further investigation into specific microbial strains, dosage optimization, and long-term effects. Future research should aim at refining personalized interventions, elucidating mechanisms of action, and establishing standardized protocols to integrate these interventions into clinical practice. While prebiotics and probiotics offer potential adjunctive therapies for MDD, continued interdisciplinary efforts are vital to harnessing their full therapeutic potential and reshaping the landscape of depression treatment paradigms.
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Affiliation(s)
- Xin Yuan
- Graduate School of Heilongjiang University of Chinese Medicine, Harbin, 150040, China
- The First Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin, 150040, China
- The Second Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin, 150040, China
| | - Jianbo Chai
- Heilongjiang Mental Hospital, Harbin, 150036, China
| | - Wenqiang Xu
- Harbin Jiarun Hospital, Harbin, 150040, China
| | - Yonghou Zhao
- Heilongjiang Mental Hospital, Harbin, 150036, China.
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Yang X, Fang S, Lyu W, Hu Y, Xu H, Jiang X, Zhao Y, Zhang Y, Li J, Kuang W. Vortioxetine for depression in adults: A systematic review and dose-response meta-analysis of randomized controlled trials. Psychiatry Clin Neurosci 2024. [PMID: 38957929 DOI: 10.1111/pcn.13709] [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] [Received: 05/05/2024] [Revised: 06/10/2024] [Accepted: 06/13/2024] [Indexed: 07/04/2024]
Abstract
AIM Major depressive disorder (MDD) is a prevalent psychiatric condition and vortioxetine offers promising antidepressant effects due to its unique pharmacological profile. However, the dose-response relationships of vortioxetine for MDD is not well established. We aimed to conduct dose-response meta-analyses to fill this gap. METHODS We systematically searched multiple electronic databases for randomized controlled trials of vortioxetine for MDD, with the last search conducted on 08 February, 2024. The dose-response relationship was evaluated using a one-stage random-effects dose-response meta-analysis with restricted cubic spline model. The primary outcome was efficacy (mean change in depression scale score), with secondary outcomes including response, dropout for any reasons (acceptability), dropout for adverse events (tolerability), and any adverse events (safety). RESULTS The dose-response meta-analysis comprised 16 studies, with 4,294 participants allocated to the vortioxetine group and 2,299 participants allocated to the placebo group. The estimated 50% effective dose was 4.37 mg/day, and the near-maximal effective dose (95% effective dose) was 17.93 mg/day. Visual inspection of the dose-efficacy curve suggests that a plateau possibly had not been reached yet at 20 mg/day. Acceptability, tolerability and safety decreased as the dose increased. Subgroup analysis indicated that no significant differences were observed in acceptability, tolerability and safety among the dosage groups. CONCLUSIONS Vortioxetine may potentially provide additional therapeutic benefits when exceeding the current licensed dosage without significantly impacting safety. Conducting clinical trials exceeding the current approved dosage appears necessary to fully comprehend its efficacy and risk.
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Affiliation(s)
- Xin Yang
- Department of Mental Health Center, West China Hospital of Sichuan University, Chengdu, China
| | - Shuping Fang
- Department of Mental Health Center, West China Hospital of Sichuan University, Chengdu, China
| | - Wenqi Lyu
- Department of Mental Health Center, West China Hospital of Sichuan University, Chengdu, China
| | - Yongbo Hu
- Department of Division of Neurology and Psychiatry, West China Xiamen Hospital of Sichuan University, Xiamen, China
- Department of Radiology, Huaxi MR Research Center (HMRRC), West China Hospital of Sichuan University, Chengdu, China
| | - Huifang Xu
- Department of Geriatric Psychiatry, The Fourth People's Hospital of Chengdu, Chengdu, China
| | - Xiao Jiang
- Department of Psychiatry, Ziyang Psychosis Hospital, Ziyang, China
| | - Yurou Zhao
- Department of Mental Health Center, West China Hospital of Sichuan University, Chengdu, China
- Department of Geriatric Psychiatry, The Fourth People's Hospital of Chengdu, Chengdu, China
| | - Yuwei Zhang
- Department of Mental Health Center, West China Hospital of Sichuan University, Chengdu, China
- Department of Geriatric, Chengdu Second People's Hospital, Chengdu, China
| | - Jin Li
- Department of Mental Health Center, West China Hospital of Sichuan University, Chengdu, China
| | - Weihong Kuang
- Department of Mental Health Center, West China Hospital of Sichuan University, Chengdu, China
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Bustamante LA, Barch DM, Solis J, Oshinowo T, Grahek I, Konova AB, Daw ND, Cohen JD. Major depression symptom severity associations with willingness to exert effort and patch foraging strategy. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.02.18.24302985. [PMID: 38947009 PMCID: PMC11213125 DOI: 10.1101/2024.02.18.24302985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
Individuals with major depressive disorder (MDD) can experience reduced motivation and cognitive function, leading to challenges with goal-directed behavior. When selecting goals, people maximize 'expected value' by selecting actions that maximize potential reward while minimizing associated costs, including effort 'costs' and the opportunity cost of time. In MDD, differential weighing of costs and benefits are theorized mechanisms underlying changes in goal-directed cognition and may contribute to symptom heterogeneity. We used the Effort Foraging Task to quantify cognitive and physical effort costs, and patch leaving thresholds in low effort conditions (hypothesized to reflect perceived opportunity cost of time) and investigated their shared versus distinct relationships to clinical features in participants with MDD (N=52, 43 in-episode) and comparisons (N=27). Contrary to our predictions, none of the decision-making measures differed with MDD diagnosis. However, each of the measures were related to symptom severity, over and above effects of ability (i.e., performance). Greater anxiety symptoms were selectively associated with lower cognitive effort cost (i.e. greater willingness to exert effort). Anhedonia symptoms were associated with increased physical effort costs. Finally, greater physical anergia was related to decreased patch leaving thresholds. Markers of effort-based decision-making may inform understanding of MDD heterogeneity. Increased willingness to exert cognitive effort may contribute to anxiety symptoms such as rumination and worry. The association of decreased leaving thresholds with symptom severity is consistent with reward rate-based accounts of reduced vigor in MDD. Future research should address subtypes of depression with or without anxiety, which may relate differentially to cognitive effort decisions.
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Jespersen CP, Pedersen HF, Kleinstäuber M, Fink P, Wellnitz KB, Ørnbøl E, Schröder A, Agger JL, Vase L, Finnerup NB, Gormsen LK. Efficacy of patient education and duloxetine, alone and in combination, for patients with multisystem functional somatic disorder: Study protocol for the EDULOX trial. Contemp Clin Trials 2024; 141:107524. [PMID: 38604496 DOI: 10.1016/j.cct.2024.107524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 03/28/2024] [Accepted: 04/08/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND Multisystem functional somatic disorder is characterized by specific patterns of persistent physical symptoms with a complex biopsychosocial etiology. The disorder can lead to disability and personal suffering. Current treatment options require specialized settings, therefore patients often wait a long time to receive specific treatment. Patient education is considered important in most treatment programs, but has only been investigated sparsely as a stand-alone treatment. Pharmacological treatment is limited to tricyclic antidepressants in low doses with no antidepressant properties. Duloxetine has been found effective in single organ functional disorders. As a treatment for multisystem functional somatic disorder, duloxetine could reduce symptoms and treat comorbid anxiety and depression. It may furthermore enhance the effect of patient education through a hypothesized effect on cognitive functioning. The purpose of the EDULOX trial is to study psycho-EDUcation and duLOXetine alone and in combination. METHODS This is a nested study design. The parent trial "EDULOX1" (n = 424) will compare a patient education program with enhanced usual care in an open-labelled, randomized controlled trial. In addition to this, eligible participants will furthermore receive either duloxetine or active placebo in the nested, double-blinded, randomized controlled trial, "EDULOX2" (n = 212). Patient and clinician reported outcomes will be collected through questionnaires. CONCLUSION The EDULOX trial may establish evidence for treatments applicable for the majority of patients with multisystem functional somatic disorder. If effective, duloxetine would be a more tolerable pharmacological treatment option that can target comorbid depression and anxiety, and potentially boost the effect of patient education. Trial registration number The study is registered at www. CLINICALTRIALS gov (NCT06232473) and the internal list of research projects at the Region of Central Denmark (Case number 1-16-02-305-23). Approval from the Danish Medical Research Ethics Committees (Case number: 2212291) and the Danish Medicines Agency was obtained under EudraCT Number: 2022-002780-30 and Sponsor's Protocol Code Number: 9515.
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Affiliation(s)
- Cecilia Pihl Jespersen
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - Heidi Frølund Pedersen
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Maria Kleinstäuber
- Department of Psychology, Emma Eccles Jones College of Education and Human Services, Utah State University, Logan, UT, USA
| | - Per Fink
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Kaare Bro Wellnitz
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Eva Ørnbøl
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Andreas Schröder
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
| | - Johanne Liv Agger
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
| | - Lene Vase
- Department of Psychology and Behavioral Sciences, School of Business and Social Sciences, Aarhus University, Aarhus, Denmark
| | - Nanna Brix Finnerup
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Lise Kirstine Gormsen
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Cuomo A, Aguglia A, De Berardis D, Ventriglio A, Gesi C, Fagiolini A. Individualized strategies for depression: narrative review of clinical profiles responsive to vortioxetine. Ann Gen Psychiatry 2024; 23:20. [PMID: 38755657 PMCID: PMC11097484 DOI: 10.1186/s12991-024-00505-1] [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: 01/31/2024] [Accepted: 05/03/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Depression is a highly heterogeneous disorder, often resulting in suboptimal response and remission rates. This underscores the need for more nuanced clinical characterization of patients to tailor individualized treatment plans. Emerging evidence highlights the critical role of cognitive and emotional dysfunction in major depression, prompting the exploration of novel therapeutic interventions that target these specific symptom domains. MAIN TEXT Vortioxetine, a multimodal antidepressant, enhances serotonergic activity while also modulating several other neurotransmitter systems involved in depressive symptoms such as emotional blunting, anhedonia, and cognitive dysfunction. Numerous randomized, placebo-controlled trials have demonstrated vortioxetine's efficacy and safety in treating depression, particularly in specific subgroups of depressed patients, including those with cognitive deficits and comorbid anxiety symptoms or disorders. Although not randomized or placebo-controlled, studies have also shown vortioxetine's efficacy in depressed patients with emotional blunting or anhedonia. Vortioxetine's ability to effectively treat a range of depressive symptoms, including anhedonia, emotional blunting, anxiety, and cognitive dysfunction, provides an individualized treatment solution for depressed individuals suffering from these symptoms. The purpose of this paper is to identify clinical profiles of patients who may benefit from vortioxetine, with the goal of optimizing therapeutic outcomes. CONCLUSION Vortioxetine has been shown to be effective for patients with depression and symptoms such as anhedonia, emotional blunting, anxiety, and cognitive dysfunction. Tailoring treatment plans to individual needs and personalizing treatment choices based on the specific symptoms presented by depressed patients improve treatment outcomes.
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Affiliation(s)
- Alessandro Cuomo
- Department of Molecular and Developmental Medicine, University of Siena School of Medicine, Siena, Italy.
| | - Andrea Aguglia
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | | | - Antonio Ventriglio
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Camilla Gesi
- Department of Mental Health and Addiction, ASST Fatebenfratelli-Sacco, Milan, Italy
| | - Andrea Fagiolini
- Department of Molecular and Developmental Medicine, University of Siena School of Medicine, Siena, Italy
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Reuben DB, Kremen S, Maust DT. Dementia Prevention and Treatment: A Narrative Review. JAMA Intern Med 2024; 184:563-572. [PMID: 38436963 DOI: 10.1001/jamainternmed.2023.8522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Abstract
Importance Dementia affects 10% of those 65 years or older and 35% of those 90 years or older, often with profound cognitive, behavioral, and functional consequences. As the baby boomers and subsequent generations age, effective preventive and treatment strategies will assume increasing importance. Observations Preventive measures are aimed at modifiable risk factors, many of which have been identified. To date, no randomized clinical trial data conclusively confirm that interventions of any kind can prevent dementia. Nevertheless, addressing risk factors may have other health benefits and should be considered. Alzheimer disease can be treated with cholinesterase inhibitors, memantine, and antiamyloid immunomodulators, with the last modestly slowing cognitive and functional decline in people with mild cognitive impairment or mild dementia due to Alzheimer disease. Cholinesterase inhibitors and memantine may benefit persons with other types of dementia, including dementia with Lewy bodies, Parkinson disease dementia, vascular dementia, and dementia due to traumatic brain injury. Behavioral and psychological symptoms of dementia are best treated with nonpharmacologic management, including identifying and mitigating the underlying causes and individually tailored behavioral approaches. Psychotropic medications have minimal evidence of efficacy for treating these symptoms and are associated with increased mortality and clinically meaningful risks of falls and cognitive decline. Several emerging prevention and treatment strategies hold promise to improve dementia care in the future. Conclusions and Relevance Although current prevention and treatment approaches to dementia have been less than optimally successful, substantial investments in dementia research will undoubtedly provide new answers to reducing the burden of dementia worldwide.
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Affiliation(s)
- David B Reuben
- Multicampus Program in Geriatric Medicine and Gerontology, David Geffen School of Medicine, University of California, Los Angeles
| | - Sarah Kremen
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, California
- Jona Goldrich Center for Alzheimer's and Memory Disorders, Cedars-Sinai Medical Center, Los Angeles, California
| | - Donovan T Maust
- Department of Psychiatry, University of Michigan, Ann Arbor
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
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Zhang Y, Lai S, Zhang J, Wang Y, Zhao H, He J, Huang D, Chen G, Qi Z, Chen P, Yan S, Huang X, Lu X, Zhong S, Jia Y. The effectiveness of vortioxetine on neurobiochemical metabolites and cognitive of major depressive disorders patients: A 8-week follow-up study. J Affect Disord 2024; 351:799-807. [PMID: 38311073 DOI: 10.1016/j.jad.2024.01.272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 01/22/2024] [Accepted: 01/31/2024] [Indexed: 02/06/2024]
Abstract
OBJECTIVE Vortioxetine has been shown to improve cognitive performance in people with depression. This study will look at the changes in neurobiochemical metabolites that occur when vortioxetine improves cognitive performance in MDD patients, with the goal of determining the neuroimaging mechanism through which vortioxetine improves cognitive function. METHODS 30 depressed patients and 30 demographically matched healthy controls (HC) underwent MCCB cognitive assessment and 1H-MRS. After 8 weeks of vortioxetine medication, MCCB and 1H-MRS tests were retested in the MDD group. Before and after therapy, changes in cognitive performance, NAA/Cr, and Cho/Cr were examined in the MDD group. RESULTS Compared with the HC group, the MDD group had significant reduced in verbal learning, social cognition, and total cognition (all p < 0.05). And the MDD group had lower NAA/Cr in Right thalamus and Left PFC; the Cho/Cr in Right thalamus was lower than HC; the Cho/Cr in Left ACC had significantly increase (all p < 0.05). The MDD group showed significant improvements in the areas of verbal learning, attention/alertness, and total cognitive function before and after Vortioxetine treatment (all p < 0.05). The NAA/Cr ratio of the right PFC before and after treatment (t = 2.338, p = 0.026) showed significant changes. CONCLUSIONS Vortioxetine can enhance not just the depression symptoms of MDD patients in the initial period, but also their verbal learning, social cognition, and general cognitive capacities after 8 weeks of treatment. Furthermore, vortioxetine has been shown to enhance cognitive function in MDD patients by altering NAA/Cr and Cho/Cr levels in the frontal-thalamic-ACC.
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Affiliation(s)
- Yiliang Zhang
- Department of Psychiatry, First Affiliated Hospital of Jinan University, Guangzhou 510630, China
| | - Shunkai Lai
- Department of Psychiatry, First Affiliated Hospital of Jinan University, Guangzhou 510630, China
| | - Jianzhao Zhang
- Department of Psychiatry, First Affiliated Hospital of Jinan University, Guangzhou 510630, China
| | - Ying Wang
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou 510630, China
| | - Hui Zhao
- Department of Psychiatry, First Affiliated Hospital of Jinan University, Guangzhou 510630, China
| | - Jiali He
- Department of Psychiatry, First Affiliated Hospital of Jinan University, Guangzhou 510630, China
| | - Dong Huang
- Department of Psychiatry, First Affiliated Hospital of Jinan University, Guangzhou 510630, China
| | - Guanmao Chen
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou 510630, China
| | - Zhangzhang Qi
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou 510630, China
| | - Pan Chen
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou 510630, China
| | - Shuya Yan
- Department of Psychiatry, First Affiliated Hospital of Jinan University, Guangzhou 510630, China
| | - Xiaosi Huang
- Department of Psychiatry, First Affiliated Hospital of Jinan University, Guangzhou 510630, China
| | - Xiaodan Lu
- Department of Psychiatry, First Affiliated Hospital of Jinan University, Guangzhou 510630, China
| | - Shuming Zhong
- Department of Psychiatry, First Affiliated Hospital of Jinan University, Guangzhou 510630, China.
| | - Yanbin Jia
- Department of Psychiatry, First Affiliated Hospital of Jinan University, Guangzhou 510630, China.
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Ren FF, Hillman CH, Wang WG, Li RH, Zhou WS, Liang WM, Yang Y, Chen FT, Chang YK. Effects of aerobic exercise on cognitive function in adults with major depressive disorder: A systematic review and meta-analysis. Int J Clin Health Psychol 2024; 24:100447. [PMID: 38371396 PMCID: PMC10869919 DOI: 10.1016/j.ijchp.2024.100447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 01/30/2024] [Indexed: 02/20/2024] Open
Abstract
Background Major Depressive Disorder (MDD) is a highly prevalent psychiatric disorder that impairs the cognitive function of individuals. Aerobic exercise stands out as a promising non-pharmacological intervention for enhancing cognitive function and promoting brain health.While positive impacts of aerobic exercise on executive function in adults with depression have been documented, a comprehensive understanding of its benefits on overall cognitive function, including memory, attention, and processing speed, along with key moderating factors in adults with MDD, remains unexplored. The purpose of the systematic review and meta-analysis was to investigate the effects of aerobic exercise on overall cognitive function in adults with MDD, and to explore whether cognitive sub-domains, aerobic exercise characteristics, and study and sample variables modify the effects of aerobic exercise on cognition. Methods Six English electronic databases (Embase, Cochrane Central, Scopus, APA PsycInfo, PubMed, Web of Science) were searched from inception to 2 April 2023. Randomized trials, including adults aged 18 years or above with a diagnosis of clinical depression, of the effects of aerobic exercise on cognitive function in adults with MDD compared to non-aerobic exercise groups were included. A three-level meta-analysis was conducted utilizing a random-effects model in R. The quality of the studies was evaluated using the Physiotherapy Evidence Database (PEDro) scale. The PROSPERO registration number is CRD42022367350. Results Twelve randomized trials including 945 adults with MDD were included. Results indicated that aerobic exercise significantly improved overall cognitive function (g = 0.21; 95 % confidence intervals [CI] = 0.07, 0.34), and the sub-domains of memory (g = 0.25; 95 % CI = 0.06, 0.44) and executive function (g = 0.12; 95 % CI = 0.04, 0.20). Significant benefits in cognitive function were found from moderate-to-vigorous (mixed) intensity (g = 0.19; 95 % CI = 0.02, 0.37), aerobic exercise conducted 3 times per week (g = 0.23; 95 % CI = 0.10, 0.38), in sessions < 45 min (g = 0.59; 95 % CI = 0.28, 0.90), and 45-60 min (g = 0.16; 95 % CI = 0.07, 0.26), in aerobic exercise intervention ≤ 12 weeks (g = 0. 26; 95 % CI = 0.08, 0.44). Limitations This review only included peer-reviewed English-language studies, which may lead to a language bias. The results of the Egger's test suggested a potential publication bias. Conclusions Aerobic exercise is efficacious in improving overall cognitive function and the sub-domains of memory and executive function in adults with major depressive disorder.
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Affiliation(s)
- Fei-Fei Ren
- Department of Physical Education, Beijing Language and Culture University, Beijing, China
| | - Charles H. Hillman
- Department of Psychology, Northeastern University, Boston, MA, USA
- Department of Physical Therapy, Movement, and Rehabilitation, Northeastern University, Boston, MA, USA
| | - Wei-Guang Wang
- Department of Physical Education, Beijing Language and Culture University, Beijing, China
| | - Ruei-Hong Li
- Department of Physical Education and Sport Sciences, National Taiwan Normal University, Taipei, Taiwan
| | - Wen-Sheng Zhou
- Department of Physical Education, Jiangsu Second Normal University, Jiangsu, China
| | - Wen-Ming Liang
- Life Sciences Center, Vilnius University, Vilnius, Lithuania
| | - Yong Yang
- Laboratory of Kinesiology and Rehabilitation, School of Physical Education and Sport, Chaohu University, Anhui, China
| | - Feng-Tzu Chen
- Department of Kinesiology, National Tsing Hua University, Hsinchu, Taiwan
| | - Yu-Kai Chang
- Department of Physical Education and Sport Sciences, National Taiwan Normal University, Taipei, Taiwan
- Social Emotional Education and Development Center, National Taiwan Normal University, Taipei, Taiwan
- Institute for Research Excellence in Learning Science, National Taiwan Normal University, Taipei, Taiwan
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12
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Fahri Aydın E, Güleç M, Oral E, Gökhan Daloğlu A. The Effects of Fluoxetine and Agomelatine on Neurocognitive Functions and Sleep in Patients with Major Depressive Disorder. PSYCHIAT CLIN PSYCH 2024; 34:9-18. [PMID: 38883888 PMCID: PMC11177640 DOI: 10.5152/pcp.2024.22498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 09/21/2023] [Indexed: 06/18/2024] Open
Abstract
Background We aimed to evaluate the effects of 6 weeks of agomelatine versus fluoxetine treatment on cognition and sleep. Methods Agomelatine 25 mg/day and fluoxetine 20 mg/day were administered to major depressive disorder (MDD) patients. Assessments were conducted before the treatment and at the sixth week of treatment via psychometric measures and comprehensive neurocognitive assessments of various functions, including executive skills, attention, memory, verbal fluency, and speed of processing. Results They both improved the evaluated neurocognitive test scores (P < .05), except for the scores of the Digit Span Test (P > .05), but only fluoxetine significantly improved the scores of the Controlled Oral Word Association Test (P = .018). Only in relation to the subjective sleep quality part of the Pittsburgh Sleep Quality Index (P = .035) and the Trail Making Test-B (TMT-B) (P = .046) was there an important difference between the study groups, and agomelatine showed better effects than fluoxetine in these measures. Conclusion Both drugs improved the neurocognitive functioning in the participants. However, the better effect of agomelatine in improving the TMT-B scores suggests that it is a suitable option for MDD patients with noticeable executive disturbances.
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Affiliation(s)
- Esat Fahri Aydın
- Department of Psychiatry, Atatürk University, Faculty of Medicine, Erzurum, Turkey
| | - Mustafa Güleç
- Department of Psychiatry, Izmir Katip Çelebi University, Atatürk Education and Training Hospital, İzmir, Turkey
| | - Elif Oral
- Department of Psychiatry, Izmir Katip Çelebi University, Atatürk Education and Training Hospital, İzmir, Turkey
| | - Ali Gökhan Daloğlu
- Department of Psychiatry, Mersin City Training and Research Hospital, Mersin, Turkey
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13
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Azargoonjahromi A. Role of the SARS-CoV-2 Virus in Brain Cells. Viral Immunol 2024; 37:61-78. [PMID: 38315740 DOI: 10.1089/vim.2023.0116] [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: 02/07/2024] Open
Abstract
COVID-19, caused by the SARS-CoV-2 virus, can have neurological effects, including cognitive symptoms like brain fog and memory problems. Research on the neurological effects of COVID-19 is ongoing, and factors such as inflammation, disrupted blood flow, and damage to blood vessels may contribute to cognitive symptoms. Notably, some authors and existing evidence suggest that the SARS-CoV-2 virus can enter the central nervous system through different routes, including the olfactory nerve and the bloodstream. COVID-19 infection has been associated with neurological symptoms such as altered consciousness, headaches, dizziness, and mental disorders. The exact mechanisms and impact on memory formation and brain shrinkage are still being studied. This review will focus on pathways such as the olfactory nerve and blood-brain barrier disruption, and it will then highlight the interactions of the virus with different cell types in the brain, namely neurons, astrocytes, oligodendrocytes, and microglia.
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Affiliation(s)
- Ali Azargoonjahromi
- Researcher in Neuroscience, Shiraz University of Medical Sciences, Shiraz, Iran
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14
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Ahern E, White J, Slattery E. Change in Cognitive Function over the Course of Major Depressive Disorder: A Systematic Review and Meta-analysis. Neuropsychol Rev 2024:10.1007/s11065-023-09629-9. [PMID: 38315296 DOI: 10.1007/s11065-023-09629-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 11/29/2023] [Indexed: 02/07/2024]
Abstract
Major depressive disorder (MDD) is associated with significant cognitive deficits during the acute and remitted stages. The aim of this systematic review and meta-analysis was to examine the course of cognitive function whilst considering demographic, treatment, or clinical features of MDD that could moderate the extent of cognitive change. Databases were searched to identify studies that reported on cognitive function in MDD with a ≥12-week test-retest interval. Relevant studies were pooled using random effects modelling to generate an inverse-variance, weighted, mean effect size estimate (Hedges' g) of cognitive change for each cognitive variable and for an overall composite cognitive domain. Of 6898 records, 99 eligible studies were identified from which 69 were meta-analysed, consisting of 4639 MDD patients (agemean = 40.25 years, female% = 64.62%) across 44 cognitive variables. In over 95% of cognitive variables, improvements were either of non-significant, negligible, or of a small magnitude, and when compared to matched healthy controls, the possibility of practice effects could not be precluded. Depressive symptom improvement and the number of previous depressive episodes moderated the extent of cognitive change, demonstrating state- and scar-like features for one-quarter of the cognitive domains. Further longitudinal studies are required to elucidate the MDD cognitive trajectory from initial onset. Findings nonetheless suggest that following pharmacological and non-pharmacological treatment, cognitive change in MDD is typically small, but the capacity for change may be less with episode recurrence. Targeting cognition early in the course of illness may facilitate better prognosis and support a more complete functional recovery.
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Affiliation(s)
- Elayne Ahern
- School of Psychology, Dublin City University, Glasnevin, Dublin 9, Ireland.
- Department of Psychology, University of Limerick, Castletroy, Limerick, V94 T9PX, Ireland.
| | - Jessica White
- School of Psychology, Dublin City University, Glasnevin, Dublin 9, Ireland
- School of Psychology, University College Dublin, Belfield, Dublin 4, Ireland
| | - Eadaoin Slattery
- Department of Applied Social Sciences, Technological University of the Shannon Midwest, Limerick, Ireland
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15
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Rhee TG, Shim SR, Manning KJ, Tennen HA, Kaster TS, d’Andrea G, Forester BP, Nierenberg AA, McIntyre RS, Steffens DC. Neuropsychological Assessments of Cognitive Impairment in Major Depressive Disorder: A Systematic Review and Meta-Analysis with Meta-Regression. PSYCHOTHERAPY AND PSYCHOSOMATICS 2024; 93:8-23. [PMID: 38272009 PMCID: PMC10880806 DOI: 10.1159/000535665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 12/01/2023] [Indexed: 01/27/2024]
Abstract
INTRODUCTION Cognitive dysfunction or deficits are common in patients with major depressive disorder (MDD). The current study systematically reviews and meta-analyzes multiple domains of cognitive impairment in patients with MDD. METHODS PubMed/MEDLINE, PsycINFO, Cochrane Library, Embase, Web of Science, and Google Scholar were searched from inception through May 17, 2023, with no language limits. Studies with the following inclusion criteria were included: (1) patients with a diagnosis of MDD using standardized diagnostic criteria; (2) healthy controls (i.e., those without MDD); (3) neuropsychological assessments of cognitive impairment using Cambridge Neuropsychological Test Automated Battery (CANTAB); and (4) reports of sufficient data to quantify standardized effect sizes. Hedges' g standardized mean differences (SMDs) with corresponding 95% confidence intervals (CIs) were used to quantify effect sizes of cognitive impairments in MDD. SMDs were estimated using a fixed- or random-effects models. RESULTS Overall, 33 studies consisting of 2,596 subjects (n = 1,337 for patients with MDD and n = 1,259 for healthy controls) were included. Patients with MDD, when compared to healthy controls, had moderate cognitive deficits (SMD, -0.39 [95% CI, -0.47 to -0.31]). In our subgroup analyses, patients with treatment-resistant depression (SMD, -0.56 [95% CI, -0.78 to -0.34]) and older adults with MDD (SMD, -0.51 [95% CI, -0.66 to -0.36]) had greater cognitive deficits than healthy controls. The effect size was small among unmedicated patients with MDD (SMD, -0.19 [95% CI, -0.37 to -0.00]), and we did not find any statistical difference among children. Cognitive deficits were consistently found in all domains, except the reaction time. No publication bias was reported. CONCLUSION Because cognitive impairment in MDD can persist in remission or increase the risk of major neurodegenerative disorders, remediation of cognitive impairment in addition to alleviation of depressive symptoms should be an important goal when treating patients with MDD.
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Affiliation(s)
- Taeho Greg Rhee
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- VA New England Mental Illness, Research, Education and Clinical Center (MIRECC), VA Connecticut Healthcare System, West Haven, CT, USA
- Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Sung Ryul Shim
- Department of Biomedical Informatics, College of Medicine, Konyang University, Daejeon, Republic of Korea
| | - Kevin J. Manning
- Department of Psychiatry, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Howard A. Tennen
- Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Tyler S. Kaster
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Giacomo d’Andrea
- Department of Neurosciences, Imaging and Clinical Sciences, Università Degli Studi G. D’Annunzio, Chieti, Italy
| | - Brent P. Forester
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Tufts University School of Medicine, Boston, MA, USA
| | - Andrew A. Nierenberg
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Dauten Family Center for Bipolar Treatment Innovation, Massachusetts General Hospital, Boston, MA, USA
| | - Roger S. McIntyre
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Brain and Cognition Discovery Foundation, Toronto, ON, Canada
| | - David C. Steffens
- Department of Psychiatry, University of Connecticut School of Medicine, Farmington, CT, USA
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16
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Belfiori M, Salis F, Demelas G, Mandas A. Association between Depressive Mood, Antidepressant Therapy and Neuropsychological Performances: Results from a Cross-Sectional Study on Elderly Patients. Brain Sci 2024; 14:54. [PMID: 38248269 PMCID: PMC10813455 DOI: 10.3390/brainsci14010054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 12/21/2023] [Accepted: 01/03/2024] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND Currently, the global demographic landscape is undergoing a transformative shift towards an increasingly aging population. This leads to an increase in chronic pathologies, including depression and cognitive impairment. This study aimed to evaluate the association between depressive mood, whether in treatment or not, and cognitive capacities, assessed using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). METHODS This study included 259 subjects, aged 65 years or older, evaluated at the Geriatric Outpatient Service of the University Hospital of Monserrato, Cagliari, between July 2018 and May 2022, who experienced subjective depressive mood and/or cognitive deficits. RESULTS Only 25.1% of the sample showed no cognitive impairment on the RBANS. Education was a significant regressor of the RBANS Total Scale scores (p < 0.0001) and was negatively associated with mood deflection (r = -0.15, p = 0.0161). Subjects with depressive mood had more impaired attention and visuospatial/constructional abilities compared to untreated euthymic patients. Post-hoc analysis, conducted with the Conover test, showed that untreated euthymic patients (GDS-15 ≤ 5, group 2) had a higher score on the RBANS total scale than patients with mood deflection (GDS-15 > 5, group 1), and treated euthymic patients (GDS-15 ≤ 5, group 3). Finally, different logistic regression analyses revealed a significant negative coefficient for GDS as a regressor of the RBANS total scale (coefficient: -0.04, p = 0.0089), visuospatial/constructional abilities (coefficient: -0.03, p = 0.0009), language (coefficient: -0.05, p = 0.0140), and attention (coefficient: -0.05, p < 0.0001). CONCLUSIONS Our analysis demonstrated that "naturally" euthymic people show better cognitive performances than people with depressive mood and subjects with acceptable mood due to antidepressants. Furthermore, the gender-based difference observed in the language domain suggests the potential utility of incorporating an alternative category for male patients in the Semantic Fluency test.
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Affiliation(s)
- Maristella Belfiori
- Department of Medical Sciences, and Public Health, University of Cagliari, SS 554 Bivio Sestu, Monserrato, 09042 Cagliari, Italy; (F.S.); (G.D.); (A.M.)
| | - Francesco Salis
- Department of Medical Sciences, and Public Health, University of Cagliari, SS 554 Bivio Sestu, Monserrato, 09042 Cagliari, Italy; (F.S.); (G.D.); (A.M.)
- Department of Biomedical Sciences, University of Cagliari, 09042 Cagliari, Italy
| | - Giorgia Demelas
- Department of Medical Sciences, and Public Health, University of Cagliari, SS 554 Bivio Sestu, Monserrato, 09042 Cagliari, Italy; (F.S.); (G.D.); (A.M.)
| | - Antonella Mandas
- Department of Medical Sciences, and Public Health, University of Cagliari, SS 554 Bivio Sestu, Monserrato, 09042 Cagliari, Italy; (F.S.); (G.D.); (A.M.)
- University Hospital “Azienda Ospedaliero-Universitaria” of Cagliari, 09127 Cagliari, Italy
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17
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Fox CA, Lee CT, Hanlon AK, Seow TXF, Lynch K, Harty S, Richards D, Palacios J, O'Keane V, Stephan KE, Gillan CM. An observational treatment study of metacognition in anxious-depression. eLife 2023; 12:RP87193. [PMID: 37818942 PMCID: PMC10567110 DOI: 10.7554/elife.87193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023] Open
Abstract
Prior studies have found metacognitive biases are linked to a transdiagnostic dimension of anxious-depression, manifesting as reduced confidence in performance. However, previous work has been cross-sectional and so it is unclear if under-confidence is a trait-like marker of anxious-depression vulnerability, or if it resolves when anxious-depression improves. Data were collected as part of a large-scale transdiagnostic, four-week observational study of individuals initiating internet-based cognitive behavioural therapy (iCBT) or antidepressant medication. Self-reported clinical questionnaires and perceptual task performance were gathered to assess anxious-depression and metacognitive bias at baseline and 4-week follow-up. Primary analyses were conducted for individuals who received iCBT (n=649), with comparisons between smaller samples that received antidepressant medication (n=82) and a control group receiving no intervention (n=88). Prior to receiving treatment, anxious-depression severity was associated with under-confidence in performance in the iCBT arm, replicating previous work. From baseline to follow-up, levels of anxious-depression were significantly reduced, and this was accompanied by a significant increase in metacognitive confidence in the iCBT arm (β=0.17, SE=0.02, p<0.001). These changes were correlated (r(647)=-0.12, p=0.002); those with the greatest reductions in anxious-depression levels had the largest increase in confidence. While the three-way interaction effect of group and time on confidence was not significant (F(2, 1632)=0.60, p=0.550), confidence increased in the antidepressant group (β=0.31, SE = 0.08, p<0.001), but not among controls (β=0.11, SE = 0.07, p=0.103). Metacognitive biases in anxious-depression are state-dependent; when symptoms improve with treatment, so does confidence in performance. Our results suggest this is not specific to the type of intervention.
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Affiliation(s)
- Celine Ann Fox
- School of Psychology, Trinity College DublinDublinIreland
- Trinity College Institute of Neuroscience, Trinity College DublinDublinIreland
| | - Chi Tak Lee
- School of Psychology, Trinity College DublinDublinIreland
- Trinity College Institute of Neuroscience, Trinity College DublinDublinIreland
| | - Anna Kathleen Hanlon
- School of Psychology, Trinity College DublinDublinIreland
- Trinity College Institute of Neuroscience, Trinity College DublinDublinIreland
| | - Tricia XF Seow
- Wellcome Centre for Human Neuroimaging, University College LondonLondonUnited Kingdom
| | - Kevin Lynch
- School of Psychology, Trinity College DublinDublinIreland
| | - Siobhán Harty
- SilverCloud Science, SilverCloud Health LtdDublinIreland
| | - Derek Richards
- School of Psychology, Trinity College DublinDublinIreland
- SilverCloud Science, SilverCloud Health LtdDublinIreland
| | - Jorge Palacios
- School of Psychology, Trinity College DublinDublinIreland
- SilverCloud Science, SilverCloud Health LtdDublinIreland
| | - Veronica O'Keane
- Department of Psychiatry, Trinity College DublinDublinIreland
- Tallaght Hospital, Trinity Centre for Health Sciences, Tallaght University HospitalDublinIreland
| | - Klaas Enno Stephan
- Translational Neuroimaging Unit (TNU), Institute for Biomedical Engineering, University of ZurichZurichSwitzerland
- Max Planck Institute for Metabolism ResearchCologneGermany
| | - Claire M Gillan
- School of Psychology, Trinity College DublinDublinIreland
- Trinity College Institute of Neuroscience, Trinity College DublinDublinIreland
- Global Brain Health Institute, Trinity College DublinDublinIreland
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18
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Malekizadeh H, Saed O, Rashtbari A, Sajjadi M, Ahmadi D, Ronold EH. Deficits in specific executive functions manifest by severity in major depressive disorder: a comparison of antidepressant naïve inpatient, outpatient, subclinical, and healthy control groups. Front Psychiatry 2023; 14:1225062. [PMID: 37854445 PMCID: PMC10580982 DOI: 10.3389/fpsyt.2023.1225062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 09/12/2023] [Indexed: 10/20/2023] Open
Abstract
Introduction Previous research has highlighted the executive function (EF) deficits present in depressed patients; however, conflicting results exist regarding the impact of depression severity on the size of these deficits. This study aimed to compare deficits in EF between antidepressant naïve inpatient and outpatient depressed, a group with subclinical depression symptoms, and a healthy control group while controlling for education, sex, and age. Methods In cross-sectional research, 245 antidepressant naive participants (46 inpatient, 68 outpatient, 65 subclinical, and 67 healthy control individuals) were recruited by convenience sampling. The Structured Clinical Interview for DSM-5 Disorders (SCID-5) and Beck Depression Inventory-II (BDI-II) were used to assess depression. EF was measured using several neuropsychological tests, including the Stroop Color-Word Test, the Wisconsin Card Sorting Test, and the N-back Test, which assessed the components of Inhibition, Shifting, and Updating, respectively. Multivariate analysis of covariance revealed a significant difference between the groups in EF components (p < 0.001). Pairwise comparisons further showed that inpatient and outpatient patients had more depressive symptoms and worse EF performance than subclinical and healthy control groups (p < 0.05). Results In the analysis of EF measures, a significant difference was found among the four groups, with post-hoc tests revealing variations in specific EF components. Overall, patients with more severe depressive symptoms show more deficits in EF. Additionally, correlations between clinical characteristics and EF measures varied across patient groups, but many correlations became non-significant after adjusting for the false discovery rate (FDR). Discussion This study emphasizes the impact of depression severity on deficits in the EF of depressed patients and at-risk populations. Consequently, it is important to consider executive dysfunctions as an underlying vulnerability in the development and persistence of depressive disorder.
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Affiliation(s)
- Hossein Malekizadeh
- Department of Clinical Psychology, Faculty of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Omid Saed
- Department of Clinical Psychology, Faculty of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Alireza Rashtbari
- Department of Clinical Psychology, Faculty of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Mozhdeh Sajjadi
- Faculty of Psychology and Education, University of Tehran, Tehran, Iran
| | - Davoud Ahmadi
- Department of Clinical Psychology, Faculty of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Eivind Haga Ronold
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
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19
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McIntyre RS, Alsuwaidan M, Baune BT, Berk M, Demyttenaere K, Goldberg JF, Gorwood P, Ho R, Kasper S, Kennedy SH, Ly-Uson J, Mansur RB, McAllister-Williams RH, Murrough JW, Nemeroff CB, Nierenberg AA, Rosenblat JD, Sanacora G, Schatzberg AF, Shelton R, Stahl SM, Trivedi MH, Vieta E, Vinberg M, Williams N, Young AH, Maj M. Treatment-resistant depression: definition, prevalence, detection, management, and investigational interventions. World Psychiatry 2023; 22:394-412. [PMID: 37713549 PMCID: PMC10503923 DOI: 10.1002/wps.21120] [Citation(s) in RCA: 83] [Impact Index Per Article: 83.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/17/2023] Open
Abstract
Treatment-resistant depression (TRD) is common and associated with multiple serious public health implications. A consensus definition of TRD with demonstrated predictive utility in terms of clinical decision-making and health outcomes does not currently exist. Instead, a plethora of definitions have been proposed, which vary significantly in their conceptual framework. The absence of a consensus definition hampers precise estimates of the prevalence of TRD, and also belies efforts to identify risk factors, prevention opportunities, and effective interventions. In addition, it results in heterogeneity in clinical practice decision-making, adversely affecting quality of care. The US Food and Drug Administration (FDA) and the European Medicines Agency (EMA) have adopted the most used definition of TRD (i.e., inadequate response to a minimum of two antidepressants despite adequacy of the treatment trial and adherence to treatment). It is currently estimated that at least 30% of persons with depression meet this definition. A significant percentage of persons with TRD are actually pseudo-resistant (e.g., due to inadequacy of treatment trials or non-adherence to treatment). Although multiple sociodemographic, clinical, treatment and contextual factors are known to negatively moderate response in persons with depression, very few factors are regarded as predictive of non-response across multiple modalities of treatment. Intravenous ketamine and intranasal esketamine (co-administered with an antidepressant) are established as efficacious in the management of TRD. Some second-generation antipsychotics (e.g., aripiprazole, brexpiprazole, cariprazine, quetiapine XR) are proven effective as adjunctive treatments to antidepressants in partial responders, but only the olanzapine-fluoxetine combination has been studied in FDA-defined TRD. Repetitive transcranial magnetic stimulation (TMS) is established as effective and FDA-approved for individuals with TRD, with accelerated theta-burst TMS also recently showing efficacy. Electroconvulsive therapy is regarded as an effective acute and maintenance intervention in TRD, with preliminary evidence suggesting non-inferiority to acute intravenous ketamine. Evidence for extending antidepressant trial, medication switching and combining antidepressants is mixed. Manual-based psychotherapies are not established as efficacious on their own in TRD, but offer significant symptomatic relief when added to conventional antidepressants. Digital therapeutics are under study and represent a potential future clinical vista in this population.
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Affiliation(s)
- Roger S McIntyre
- Brain and Cognition Discovery Foundation, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
| | - Mohammad Alsuwaidan
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
| | - Bernhard T Baune
- Department of Psychiatry, University of Münster, Münster, Germany
- Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia
| | - Michael Berk
- Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia
- Deakin University IMPACT Institute, Geelong, VIC, Australia
| | - Koen Demyttenaere
- Department of Psychiatry, Faculty of Medicine, KU Leuven, Leuven, Belgium
| | - Joseph F Goldberg
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Philip Gorwood
- Department of Psychiatry, Sainte-Anne Hospital, Paris, France
| | - Roger Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Institute for Health Innovation and Technology, National University of Singapore, Singapore
| | - Siegfried Kasper
- Department of Psychiatry and Psychotherapy and Center of Brain Research, Molecular Neuroscience Branch, Medical University of Vienna, Vienna, Austria
| | - Sidney H Kennedy
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
| | - Josefina Ly-Uson
- Department of Psychiatry and Behavioral Medicine, University of The Philippines College of Medicine, Manila, The Philippines
| | - Rodrigo B Mansur
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
| | - R Hamish McAllister-Williams
- Northern Center for Mood Disorders, Translational and Clinical Research Institute, Newcastle University, and Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - James W Murrough
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Andrew A Nierenberg
- Dauten Family Center for Bipolar Treatment Innovation, Massachusetts General Hospital, Boston, MA, USA
| | - Joshua D Rosenblat
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
| | - Gerard Sanacora
- Department of Psychiatry, Yale University, New Haven, CT, USA
| | - Alan F Schatzberg
- Department of Psychiatry, Stanford University School of Medicine, Stanford, CA, USA
| | - Richard Shelton
- Department of Psychiatry, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Stephen M Stahl
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - Madhukar H Trivedi
- Department of Psychiatry, University of Illinois Chicago, Chicago, IL, USA
| | - Eduard Vieta
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
| | - Maj Vinberg
- Mental Health Centre, Northern Zealand, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
| | - Nolan Williams
- Department of Psychiatry, Stanford University School of Medicine, Stanford, CA, USA
| | - Allan H Young
- Department of Psychological Medicine, King's College London, London, UK
| | - Mario Maj
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
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20
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Metcalf CA, Duffy KA, Page CE, Novick AM. Cognitive Problems in Perimenopause: A Review of Recent Evidence. Curr Psychiatry Rep 2023; 25:501-511. [PMID: 37755656 PMCID: PMC10842974 DOI: 10.1007/s11920-023-01447-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/08/2023] [Indexed: 09/28/2023]
Abstract
PURPOSE OF REVIEW To review recent research regarding cognitive problems during perimenopause, including which menopause-related symptoms, demographic variables, stress exposures, and neural biomarkers are associated with cognitive problems and which interventions demonstrate efficacy at improving cognitive performance. RECENT FINDINGS Cognitive problems are common during perimenopause and have a significant impact on a substantial proportion of women. Evidence continues to indicate that verbal learning and verbal memory are the cognitive functions that are most negatively affected during perimenopause, and new research suggests that perimenopause may also be associated with deficits in processing speed, attention, and working memory. Recent research suggests that the cognitive profiles of women transitioning through perimenopause are heterogenous - with some showing strengths and others demonstrating weaknesses in particular cognitive domains. Depression, sleep problems, and vasomotor symptoms in perimenopause may be associated with cognitive difficulties. Recent neuroimaging studies are identifying changes in activity patterns within brain regions that correlate with cognitive performance in perimenopause, but future causal studies are needed to understand the neural mechanisms of cognitive problems during this time. Although clinical treatment studies for cognitive concerns have historically focused on postmenopause, some small trials in perimenopausal samples have been conducted recently but are frequently underpowered. Current guidelines from the North American Menopause Society do not support the use of hormone therapy at any age for cognitive problems. Animal research demonstrates that estradiol and levonorgestrel combined may alleviate working memory problems. Much progress has been made in understanding how perimenopause impacts cognition, and more research is needed to better identify who is at highest risk and how to meaningfully prevent and alleviate cognitive problems during this reproductive stage. Larger-scale randomized intervention trials specifically during perimenopause are urgently needed to address cognitive concerns in this population of women. More consistent reproductive staging, inclusion of covariates, and analyses examining perimenopause specifically would improve study quality and the ability to draw clear conclusions from this research.
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Affiliation(s)
- Christina A Metcalf
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, 1890 N. Revere Court MS F546, Aurora, CO, 80045, USA.
| | - Korrina A Duffy
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, 1890 N. Revere Court MS F546, Aurora, CO, 80045, USA
| | - Chloe E Page
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, 1890 N. Revere Court MS F546, Aurora, CO, 80045, USA
| | - Andrew M Novick
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, 1890 N. Revere Court MS F546, Aurora, CO, 80045, USA
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21
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Chokka P, Bender A, Brennan S, Ahmed G, Corbière M, Dozois DJA, Habert J, Harrison J, Katzman MA, McIntyre RS, Liu YS, Nieuwenhuijsen K, Dewa CS. Practical pathway for the management of depression in the workplace: a Canadian perspective. Front Psychiatry 2023; 14:1207653. [PMID: 37732077 PMCID: PMC10508062 DOI: 10.3389/fpsyt.2023.1207653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 08/09/2023] [Indexed: 09/22/2023] Open
Abstract
Major depressive disorder (MDD) and other mental health issues pose a substantial burden on the workforce. Approximately half a million Canadians will not be at work in any week because of a mental health disorder, and more than twice that number will work at a reduced level of productivity (presenteeism). Although it is important to determine whether work plays a role in a mental health condition, at initial presentation, patients should be diagnosed and treated per appropriate clinical guidelines. However, it is also important for patient care to determine the various causes or triggers including work-related factors. Clearly identifying the stressors associated with the mental health disorder can help clinicians to assess functional limitations, develop an appropriate care plan, and interact more effectively with worker's compensation and disability programs, as well as employers. There is currently no widely accepted tool to definitively identify MDD as work-related, but the presence of certain patient and work characteristics may help. This paper seeks to review the evidence specific to depression in the workplace, and provide practical tips to help clinicians to identify and treat work-related MDD, as well as navigate disability issues.
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Affiliation(s)
- Pratap Chokka
- Department of Psychiatry, University of Alberta, Grey Nuns Hospital, Edmonton, AB, Canada
| | - Ash Bender
- Work, Stress and Health Program, The Centre for Addiction and Mental Health, Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Stefan Brennan
- Department of Psychiatry, University of Saskatchewan, Royal University Hospital, Saskatoon, SK, Canada
| | - Ghalib Ahmed
- Department of Family Medicine and Psychiatry, University of Alberta, Edmonton, AB, Canada
| | - Marc Corbière
- Department of Education, Career Counselling, Université du Québec à Montréal, Centre de Recherche de l’Institut Universitaire en Santé Mentale de Montréal, Montréal, QC, Canada
| | - David J. A. Dozois
- Department of Psychology, University of Western Ontario, London, ON, Canada
| | - Jeff Habert
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - John Harrison
- Metis Cognition Ltd., Kilmington, United Kingdom; Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King’s College, London, United Kingdom; Alzheimercentrum, AUmc, Amsterdam, Netherlands
| | - Martin A. Katzman
- START Clinic for the Mood and Anxiety Disorders, Toronto, ON, Canada; Department of Psychiatry, Northern Ontario School of Medicine, and Department of Psychology, Lakehead University, Thunder Bay, ON, Canada
| | - Roger S. McIntyre
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Yang S. Liu
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
| | - Karen Nieuwenhuijsen
- Department of Public and Occupational Health, Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Carolyn S. Dewa
- Department of Psychiatry and Behavioural Sciences, University of California, Davis, Davis, CA, United States
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22
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Nunez JJ, Liu YS, Cao B, Frey BN, Ho K, Milev R, Müller DJ, Rotzinger S, Soares CN, Taylor VH, Uher R, Kennedy SH, Lam RW. Response trajectories during escitalopram treatment of patients with major depressive disorder. Psychiatry Res 2023; 327:115361. [PMID: 37523890 DOI: 10.1016/j.psychres.2023.115361] [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: 05/08/2023] [Revised: 07/17/2023] [Accepted: 07/21/2023] [Indexed: 08/02/2023]
Abstract
Depression is a leading global cause of disability, yet about half of patients do not respond to initial antidepressant treatment. This treatment difficulty may be in part due to the heterogeneity of depression and corresponding response to treatment. Unsupervised machine learning allows underlying patterns to be uncovered, and can be used to understand this heterogeneity by finding groups of patients with similar response trajectories. Prior studies attempting this have clustered patients using a narrow range of data primarily from depression scales. In this work, we used unsupervised machine learning to cluster patients receiving escitalopram therapy using a wide variety of subjective and objective clinical features from the first eight weeks of the Canadian Biomarker Integration Network in Depression-1 trial. We investigated how these clusters responded to treatment by comparing changes in symptoms and symptom categories, and by using Principal Component Analysis (PCA). Our algorithm found three clusters, which broadly represented non-responders, responders, and remitters. Most categories of features followed this response pattern except for objective cognitive features. Using PCA with our clusters, we found that subjective mood state/anhedonia is the core feature of response with escitalopram, but there exists other distinct patterns of response around neurovegetative symptoms, activation, and cognition.
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Affiliation(s)
- John-Jose Nunez
- Department of Psychiatry, University of British Columbia, Vancouver, Canada.
| | - Yang S Liu
- Department of Psychiatry, University of Alberta, Edmonton, Canada
| | - Bo Cao
- Department of Psychiatry, University of Alberta, Edmonton, Canada; Department of Computing Science, University of Alberta, Edmonton, Canada
| | - Benicio N Frey
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada
| | - Keith Ho
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Roumen Milev
- Department of Psychiatry, Queen's University, Providence Care, Kingston, Canada
| | - Daniel J Müller
- Department of Psychiatry, University of Toronto, Toronto, Canada; Centre for Addiction and Mental Health, Toronto, Canada
| | - Susan Rotzinger
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Claudio N Soares
- Department of Psychiatry, Queen's University, Providence Care, Kingston, Canada
| | - Valerie H Taylor
- Department of Psychiatry, University of Calgary, Calgary, Canada
| | - Rudolf Uher
- Department of Psychiatry, Dalhousie University, Halifax, Canada
| | - Sidney H Kennedy
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Raymond W Lam
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
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23
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Ren FF, Alderman BL, Wang WG, Chen FT, Zhou WS, Zong WJ, Liang WM, Chang YK. Effects of Exercise Training on Executive Functioning in Adults with Depression: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Sports Med 2023; 53:1765-1788. [PMID: 37369934 DOI: 10.1007/s40279-023-01869-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2023] [Indexed: 06/29/2023]
Abstract
BACKGROUND Exercise is a promising nonpharmacological intervention to improve executive function (EF). However, results from randomized trials and meta-analyses examining the effects of exercise on working memory in adults with depression are mixed, and the influence of exercise on EF, as well as the key moderators of the relationship, remain inconclusive. OBJECTIVE The present systematic review with meta-analysis examined the influence of exercise interventions on EF in adults with depression, and the influence of key moderating variables. METHODS Electronic searches were conducted using Embase, Cochrane Central, Scopus, Ovid MEDLINE, PubMed, Web of Science, China National Knowledge Infrastructure, Wanfang Database, and Weipu Database up to 25 June 2022, and updated on 16 January 2023. Randomized controlled trials (RCTs) examining the effects of exercise training on EF in adults with depression were included. A three-level meta-analysis based on a random-effects model was applied in R. Study quality was assessed using the Physiotherapy Evidence Database (PEDro) scale. RESULTS A total of 14 RCTs that evaluated 1201 adults with depression were included. The results indicated that exercise significantly improved global EF [g = 0.180; 95% confidence intervals (CI) = 0.038, 0.323], and the subdomains of working memory (g = 0.182; 95% CI = 0.015, 0.350), cognitive flexibility (g = 0.222; 95% CI = 0.048, 0.395), and reasoning/planning (g = 0.889; 95% CI = 0.571, 1.206). In subgroup analyses, significant improvements in EF were only observed for aerobic exercise (g = 0.203; 95% CI = 0.023, 0.382), moderate-to-vigorous intensity exercise (g = 0.200; 95% CI = 0.022, 0.379), exercise performed three or more times per week (g = 0.207; 95% CI = 0.026, 0.388), in sessions ≤ 60 min (g = 0.173; 95% CI = 0.003, 0.343), and in program durations lasting at least 13 weeks (g = 0. 248; 95% CI = 0.034, 0.462). CONCLUSIONS This meta-analysis demonstrates the benefits of exercise training for improving EF and the subdomains of working memory, cognitive flexibility, and reasoning/planning in adults with depression. Future randomized clinical trials are warranted to determine the therapeutic effects of exercise training on EF and cognitive symptoms in depressed patients.
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Affiliation(s)
- Fei-Fei Ren
- Department of Physical Education, Beijing Language and Culture University, Beijing, China
| | - Brandon L Alderman
- Department of Kinesiology and Health, Center of Alcohol and Substance Use Studies, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
| | - Wei-Guang Wang
- Department of Physical Education, Beijing Language and Culture University, Beijing, China
| | - Feng-Tzu Chen
- Department of Sports Medicine, China Medical University, Taichung, Taiwan
| | - Wen-Sheng Zhou
- Department of Physical Education, Nanjing Xiao-Zhuang University, Jiangsu, China
| | - Wei-Jie Zong
- China Wushu School, Beijing Sport University, Beijing, China
| | - Wen-Ming Liang
- Life Sciences Center, Vilnius University, Vilnius, Lithuania
| | - Yu-Kai Chang
- Department of Physical Education and Sport Sciences, National Taiwan Normal University, 162, Section 1, Heping East Road, Daan District, Taipei, 106209, Taiwan.
- Institute for Research Excellence in Learning Science, National Taiwan Normal University, Taipei, Taiwan.
- Social Emotional Education and Development Center, National Taiwan Normal University, Taipei, Taiwan.
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24
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Pedruzo B, Aymerich C, Pacho M, Herrero J, Laborda M, Bordenave M, Giuliano AJ, McCutcheon RA, Gutiérrez-Rojas L, McGuire P, Stone WS, Fusar-Poli P, González-Torres MÁ, Catalan A. Longitudinal change in neurocognitive functioning in children and adolescents at clinical high risk for psychosis: a systematic review. Eur Child Adolesc Psychiatry 2023:10.1007/s00787-023-02221-9. [PMID: 37199754 DOI: 10.1007/s00787-023-02221-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 04/29/2023] [Indexed: 05/19/2023]
Abstract
Clinical high risk of psychosis (CHR-P) population has become an attractive area of interest in preventing transitions to psychosis. The consequences of developing a psychotic disorder may be worse in cases of early onset. Thus, childhood and adolescence represent a critical developmental window, where opportunities to gain social and adaptive abilities depend on the individuals' neurocognitive performance. There have been previous syntheses of the evidence regarding neurocognitive functioning in CHR-P individuals and its longitudinal changes. However, there has been less focus on children and adolescents at CHR-P. A multistep literature search was performed from database inception until July 15th, 2022. PRIMSA/MOOSE compliant systematic review and PROSPERO protocol were used to identify studies reporting on longitudinal changes in neurocognitive functioning in children and adolescents (mean age of sample ≤ 18 years) at CHR-P and matched healthy control (HC) group. A systematic review of identified studies was then undertaken. Three articles were included, resulting in a total sample size of 151 CHR-P patients [mean (SD) age, 16.48 (2.41) years; 32.45% female] and 64 HC individuals [mean (SD) age, 16.79 (2.38) years; 42.18% female]. CHR-P individuals had worse outcomes in verbal learning, sustained attention and executive functioning domains compared to HC. Individuals taking antidepressants had better outcomes in verbal learning in contrast with those taking antipsychotics. In children and adolescents, neurocognition may be already impaired before the psychosis onset, and remains stable during the transition to psychosis. Further study should be performed to obtain more robust evidence.
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Affiliation(s)
- Borja Pedruzo
- Department of Psychiatry, Basurto University Hospital, Bilbao, Spain.
| | - Claudia Aymerich
- Department of Psychiatry, Basurto University Hospital, Bilbao, Spain
| | - Malein Pacho
- Department of Psychiatry, Basurto University Hospital, Bilbao, Spain
| | - Jon Herrero
- Department of Psychiatry, Basurto University Hospital, Bilbao, Spain
| | - María Laborda
- Department of Psychiatry, Basurto University Hospital, Bilbao, Spain
| | - Marta Bordenave
- Department of Psychiatry, Basurto University Hospital, Bilbao, Spain
| | - Anthony J Giuliano
- Worcester Recovery Center and Hospital, Massachusetts Department of Mental Health, Boston, USA
| | - Robert A McCutcheon
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Department of Psychiatry, University of Oxford, Oxford, UK
| | | | - Philip McGuire
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- National Institute for Health Research Biomedical Research Centre, London, UK
- Outreach and Support in South London Service, South London and Maudsley National Health Service Foundation Trust, London, UK
| | - William S Stone
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Paolo Fusar-Poli
- National Institute for Health Research Biomedical Research Centre, London, UK
- Outreach and Support in South London Service, South London and Maudsley National Health Service Foundation Trust, London, UK
- Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Miguel Ángel González-Torres
- Department of Psychiatry, Basurto University Hospital, Bilbao, Spain
- Neuroscience Department, University of Basque Country (UPV/EHU), Leioa, Spain
- Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
- CIBERSAM. Centro Investigación Biomédica en Red de Salud Mental, Madrid, Spain
| | - Ana Catalan
- Department of Psychiatry, Basurto University Hospital, Bilbao, Spain
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Neuroscience Department, University of Basque Country (UPV/EHU), Leioa, Spain
- Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
- CIBERSAM. Centro Investigación Biomédica en Red de Salud Mental, Madrid, Spain
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25
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Gerber M, Cody R, Beck J, Brand S, Donath L, Eckert A, Faude O, Hatzinger M, Imboden C, Kreppke JN, Lang UE, Mans S, Mikoteit T, Oswald A, Schweinfurth-Keck N, Zahner L, Ludyga S. Differences in Selective Attention and Inhibitory Control in Patients with Major Depressive Disorder and Healthy Controls Who Do Not Engage in Sufficient Physical Activity. J Clin Med 2023; 12:jcm12103370. [PMID: 37240475 DOI: 10.3390/jcm12103370] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/03/2023] [Accepted: 05/05/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Patients with major depressive disorder (MDD) are characterized by neurocognitive impairments and show deficits in various cognitive performance indicators, including executive function. We examined whether sustained attention and inhibitory control differ between patients with MDD and healthy controls, and whether differences exist between patients with mild, moderate, and severe depression. METHODS Clinical in-patients (N = 212) aged 18-65 years with a current diagnosis of MDD and 128 healthy controls were recruited. Depression severity was assessed using the Beck Depression Inventory, and sustained attention and inhibitory control were assessed using the oddball and flanker tasks. The use of these tasks promises insights into executive function in depressive patients that are not biased by verbal skills. Group differences were tested via analyses of covariance. RESULTS Patients with MDD showed slower reaction times in both the oddball and flanker task, independent of the executive demands of the trial types. Younger participants achieved shorter reaction times in both inhibitory control tasks. After correcting for age, education, smoking, BMI, and nationality, only differences in reaction times in the oddball task were statistically significant. In contrast, reaction times were not sensitive to the symptom severity of depression. CONCLUSION Our results corroborate deficits in basic information processing and specific impairments in higher-order cognitive processes in MDD patients. As difficulties in executive function underlie problems in planning, initiating, and completing goal-directed activities, they may jeopardize in-patient treatment and contribute to the recurrent nature of depression.
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Affiliation(s)
- Markus Gerber
- Department for Sport, Exercise and Health, University of Basel, 4052 Basel, Switzerland
| | - Robyn Cody
- Department for Sport, Exercise and Health, University of Basel, 4052 Basel, Switzerland
| | - Johannes Beck
- Psychiatric Clinic Sonnenhalde, 4125 Riehen, Switzerland
| | - Serge Brand
- Department for Sport, Exercise and Health, University of Basel, 4052 Basel, Switzerland
- Adult Psychiatric Clinics (UPKE), University of Basel, 4002 Basel, Switzerland
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah 6719851115, Iran
- Substance Abuse Prevention Research Center, Kermanshah University of Medical Sciences, Kermanshah 6715847141, Iran
- School of Medicine, Tehran University of Medical Sciences (TUMS), Tehran 1419733141, Iran
| | - Lars Donath
- Department of Intervention Research in Exercise Training, German Sport University Cologne, 50933 Cologne, Germany
| | - Anne Eckert
- Adult Psychiatric Clinics (UPKE), University of Basel, 4002 Basel, Switzerland
| | - Oliver Faude
- Department for Sport, Exercise and Health, University of Basel, 4052 Basel, Switzerland
| | - Martin Hatzinger
- Psychiatric Services Solothurn, University of Basel, 4503 Solothurn, Switzerland
| | | | - Jan-Niklas Kreppke
- Department for Sport, Exercise and Health, University of Basel, 4052 Basel, Switzerland
| | - Undine E Lang
- Adult Psychiatric Clinics (UPKE), University of Basel, 4002 Basel, Switzerland
| | - Sarah Mans
- Private Clinic Wyss, 3053 Münchenbuchsee, Switzerland
| | - Thorsten Mikoteit
- Psychiatric Services Solothurn, University of Basel, 4503 Solothurn, Switzerland
| | - Anja Oswald
- Psychiatric Clinic Sonnenhalde, 4125 Riehen, Switzerland
| | | | - Lukas Zahner
- Department for Sport, Exercise and Health, University of Basel, 4052 Basel, Switzerland
| | - Sebastian Ludyga
- Department for Sport, Exercise and Health, University of Basel, 4052 Basel, Switzerland
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26
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Ab Latiff HZ, Ariaratnam S, Shuib N, Isa MR. Cognitive Decline and Its Associated Factors in Patients with Major Depressive Disorder. Healthcare (Basel) 2023; 11:healthcare11070950. [PMID: 37046877 PMCID: PMC10094268 DOI: 10.3390/healthcare11070950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 02/20/2023] [Accepted: 03/21/2023] [Indexed: 03/29/2023] Open
Abstract
Background: Major Depressive Disorder (MDD) is a significant and common mental health problem occurring worldwide. Cognitive decline is frequently observed during acute and residual phases of MDD, contributing significantly to functional impairment. The aim of this study was to determine the clinical profile and correlates of cognitive decline amongst adult outpatients with MDD. Methods: The survey was cross-sectional in design. A systematic random sampling method was used to recruit patients. Confirmation of MDD was achieved by using the Mini International Neuropsychiatric Interview (M.I.N.I 7.0). Cognitive decline was measured using the Montreal Cognitive Assessment (MoCA). Descriptive analysis was performed, followed by univariate and multiple logistic regression analyses. Results: Out of 245 patients, 32.7% (n = 80, 95% CI: 26.7, 38.6) had cognitive decline. Multiple logistic regression showed the existence of cognitive decline amongst MDD patients, which was significantly associated with those having secondary and lower levels of education (OR: 6.09; 95% CI: 2.82, 13.16; p < 0.001), five or more depressive episodes (OR: 8.93; 95% CI: 3.24, 24.67; p < 0.001), treatment non-compliance (OR: 3.48; 95% CI: 1.40, 6.59; p = 0.003), and medical comorbidity (OR: 2.74; 95% CI: 1.46, 5.18; p = 0.002). Conclusions: Cognitive decline is a prevalent condition among outpatients with MDD. Clinicians need to be cognizant about measures of cognition and related risk factors. Timely control of both depression and medical comorbidities would be a reasonable approach to improve functional outcomes in MDD patients.
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Affiliation(s)
- Husni Zaim Ab Latiff
- Department of Psychiatry, Faculty of Medicine, Universiti Teknologi MARA (UiTM), Cawangan Selangor, Kampus Sungai Buloh, Sungai Buloh 47000, Selangor, Malaysia
- Psychiatric and Mental Health Department, Hospital Sultanah Nurzahirah, Kuala Terengganu 20400, Terengganu, Malaysia
| | - Suthahar Ariaratnam
- Department of Psychiatry, Faculty of Medicine, Universiti Teknologi MARA (UiTM), Cawangan Selangor, Kampus Sungai Buloh, Sungai Buloh 47000, Selangor, Malaysia
- Correspondence:
| | - Norley Shuib
- Department of Psychiatry, Faculty of Medicine, Universiti Teknologi MARA (UiTM), Cawangan Selangor, Kampus Sungai Buloh, Sungai Buloh 47000, Selangor, Malaysia
| | - Mohamad Rodi Isa
- Department of Public Health Medicine, Faculty of Medicine, Universiti Teknologi MARA (UiTM), Cawangan Selangor, Kampus Sungai Buloh, Sungai Buloh 47000, Selangor, Malaysia
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27
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Cheng CM, Jeng JS. Psychiatric rehabilitation and cognitive deficit for treatment-resistant depression. PROGRESS IN BRAIN RESEARCH 2023; 281:91-113. [PMID: 37806718 DOI: 10.1016/bs.pbr.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2023]
Abstract
Patients with TRD often experience persistent impairment of affective, psychosocial, and cognitive function, which impedes their recovery. The continuation of pharmacotherapy for patients with TRD remains the cornerstone of functional recovery. Cognitive dysfunction is prevalent in patients with MDD and may make patients' depressive symptoms and psychosocial functioning worse, even in the remitted stage of illness. Deficits can manifest not only in specific cognitive domains but also in global cognitive function, which may reflect underlying persistent pathophysiological changes. Compared with nontreatment-resistant patients with MDD, patients with TRD exhibit greater subjective and objective cognitive impairment, which possibly contributes to a greater adverse impact on daily functioning. Cognitive and psychosocial remission should be a goal in treating MDD. How to appropriately and individualized perform pharmacological intervention, psychotherapy, neuromodulation, cognitive remediation or other rehabilitation treatment programs is a critical step to achieve our goal. Integrating multiple interventions that engage multiple physiological systems with a multidisciplinary team warrants increased attention, and personalized therapeutic programs may facilitate the complete restoration of patients' everyday functioning.
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Affiliation(s)
- Chih-Ming Cheng
- Attending Psychiatrist, Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Lecturer, Division of Psychiatry, College of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan.
| | - Jia-Shyun Jeng
- Attending Psychiatrist, Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
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28
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Pagonabarraga J, Álamo C, Castellanos M, Díaz S, Manzano S. Depression in Major Neurodegenerative Diseases and Strokes: A Critical Review of Similarities and Differences among Neurological Disorders. Brain Sci 2023; 13:brainsci13020318. [PMID: 36831861 PMCID: PMC9954482 DOI: 10.3390/brainsci13020318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 02/05/2023] [Accepted: 02/09/2023] [Indexed: 02/16/2023] Open
Abstract
Depression and anxiety are highly prevalent in most neurological disorders and can have a major impact on the patient's disability and quality of life. However, mostly due to the heterogeneity of symptoms and the complexity of the underlying comorbidities, depression can be difficult to diagnose, resulting in limited recognition and in undertreatment. The early detection and treatment of depression simultaneously with the neurological disorder is key to avoiding deterioration and further disability. Although the neurologist should be able to identify and treat depression initially, a neuropsychiatry team should be available for severe cases and those who are unresponsive to treatment. Neurologists should be also aware that in neurodegenerative diseases, such as Alzheimer's or Parkinson's, different depression symptoms could develop at different stages of the disease. The treatment options for depression in neurological diseases include drugs, cognitive-behavioral therapy, and somatic interventions, among others, but often, the evidence-based efficacy is limited and the results are highly variable. Here, we review recent research on the diagnosis and treatment of depression in the context of Alzheimer's disease, Parkinson's disease, and strokes, with the aim of identifying common approaches and solutions for its initial management by the neurologist.
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Affiliation(s)
- Javier Pagonabarraga
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain
- Department of Medicine, Autonomous University of Barcelona, 08193 Barcelona, Spain
- Centro de Investigación en Red sobre Enfermedades Neurodegenerativas (CIBERNED), 28031 Madrid, Spain
- Correspondence:
| | - Cecilio Álamo
- Department of Biomedical Sciences (Pharmacology), Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, 28801 Madrid, Spain
| | - Mar Castellanos
- Department of Neurology, A Coruña University Hospital and Biomedical Research Institute, 15006 La Coruña, Spain
| | - Samuel Díaz
- Headaches Unit, Department of Neurology, Hospital Universitario y Politécnico La Fe, 46026 Valencia, Spain
| | - Sagrario Manzano
- Department of Neurology, Infanta Leonor University Hospital, 28031 Madrid, Spain
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Hasse-Sousa M, Martins DS, Petry-Perin C, Britto MJSD, Remus IB, Lapa CDO, Reckziegel RDFX, Sales SCD, Jesus LSD, Philippsen M, Massuda R, Van Rheenen TE, Gama CS, Czepielewski LS. The role of semantic clustering in the relationship between verbal memory and psychosocial functioning in schizophrenia and bipolar disorder: Possible distinct cognitive pathway compared to healthy controls. J Affect Disord 2023; 320:330-339. [PMID: 36162669 DOI: 10.1016/j.jad.2022.09.077] [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: 11/24/2021] [Revised: 09/02/2022] [Accepted: 09/20/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Verbal memory (VM) is impaired in schizophrenia (SZ) and bipolar disorder (BD), and predicts psychosocial functioning. However, there is a lack of research exploring the role of VM component processes, including semantic clustering, in these disorders. Semantic clustering might impact this association, as effective semantic memory strategies may reflect unimpaired executive control, leading to an adequate functioning. We aimed to investigate VM components in SZ and BD, and the role of semantic clustering in the relationship between VM and functioning. METHODS We included 495 participants (156 SZ, 172 BD, and 167 healthy controls (HC)) that underwent an assessment using the Hopkins Verbal Learning Test - Revised for VM and the Functioning Assessment Short Test for psychosocial functioning. We compared groups through ANOVAs and investigated the effect of semantic clustering in the relationship between VM total immediate free recall and functioning through linear regression models. RESULTS SZ had worse overall VM performance compared to BD, which performed worse than HCs. HCs used more semantic clustering than SZ and BD, but there were no differences between the two clinical groups. In HCs, semantic clustering impacted the relationship between VM performance and functioning, while no interaction was observed in SZ or BD. LIMITATIONS Cross-sectional design; no medication effects or other cognitive functions were assessed. CONCLUSIONS SZ and BD may use an alternative cognitive pathway in which the relationship between VM and functioning is independent of complex cognitive processes such as semantic clustering, supporting the cognitive remediation targeting of VM in these disorders.
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Affiliation(s)
- Mathias Hasse-Sousa
- Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre; Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Programa de Pós Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Programa de Pós-Graduação em Psicologia, Departamento de Psicologia do Desenvolvimento e da Personalidade, Instituto de Psicologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Dayane Santos Martins
- Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre; Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Programa de Pós Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Carolina Petry-Perin
- Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre; Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Programa de Pós Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Maria Julia Silva de Britto
- Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre; Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Programa de Pós Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Isadora Bosini Remus
- Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre; Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Programa de Pós Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Clara de Oliveira Lapa
- Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre; Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Programa de Pós Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Ramiro de Freitas Xavier Reckziegel
- Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre; Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Programa de Pós Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Sarah Corrêa de Sales
- Psychosis Treatment and Research Program, Department of Forensic Medicine and Psychiatry, Universidade Federal do Paraná (UFPR), Curitiba, Brazil
| | - Letícia Stephane de Jesus
- Psychosis Treatment and Research Program, Department of Forensic Medicine and Psychiatry, Universidade Federal do Paraná (UFPR), Curitiba, Brazil
| | - Marielli Philippsen
- Psychosis Treatment and Research Program, Department of Forensic Medicine and Psychiatry, Universidade Federal do Paraná (UFPR), Curitiba, Brazil
| | - Raffael Massuda
- Psychosis Treatment and Research Program, Department of Forensic Medicine and Psychiatry, Universidade Federal do Paraná (UFPR), Curitiba, Brazil
| | - Tamsyn E Van Rheenen
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia; Centre for Mental Health, School of Health Sciences, Swinburne University, Melbourne, VIC, Australia
| | - Clarissa Severino Gama
- Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre; Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Programa de Pós Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Letícia Sanguinetti Czepielewski
- Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre; Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Programa de Pós-Graduação em Psicologia, Departamento de Psicologia do Desenvolvimento e da Personalidade, Instituto de Psicologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
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Oyarzún-González X, Abner EL, Toro P, Ferreccio C. Prevalence and Factors Associated with Subjective Memory Complaint in a Semi-Rural Community in Chile. J Alzheimers Dis 2023; 95:1221-1231. [PMID: 37661887 PMCID: PMC10964110 DOI: 10.3233/jad-230541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
BACKGROUND Subjective memory complaints (SMC) are commonly studied in older adults and have been identified as potentially prodromal to dementia and Alzheimer's disease. Studies among younger adults from South America are lacking. OBJECTIVE To estimate the prevalence of SMC and the factors associated with it among Maule Cohort (MAUCO) participants. METHODS We performed a cross-sectional analysis to estimate the prevalence of SMC and investigated its associated factors from MAUCO baseline data (N = 6,687). Within groups defined by age (38-59, 60-74) and global cognition (Mini-Mental State Examination: ≥26, 25-22, ≤21), multinomial logistic regression models evaluated risk factors for SMC (Yes, Sometimes, No). RESULTS Overall, SMC prevalence was 16.4%; 15.9% (95% CI 14.9-16.9%) among younger and 17.6% (15.8-19.4%) among older participants. Female sex, comorbidities, and bad/fair self-reported health status (SRHS) were generally associated with higher odds of SMC. CONCLUSION Overall prevalence of SMC was 16%. Different factors were associated with the odds of SMC depending on age and global cognitive status. Future SMC studies should include sex-specific assessments, evaluate SRHS as a moderator of SMC reporting, and the influence of the SARS-CoV-2 pandemic on SMC reporting.
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Affiliation(s)
- Ximena Oyarzún-González
- Dr. Donneyong’s Laboratory, Division of Outcomes and Translational Sciences, College of Pharmacy, The Ohio State University
- Advanced Center for Chronic Diseases, ACCDiS
| | - Erin L. Abner
- Sanders-Brown Center on Aging and Alzheimer’s Disease Center, University of Kentucky, Lexington, KY, USA
- Department of Epidemiology and Environmental Health, College of Public Health, University of Kentucky, Lexington, KY, USA
- Department of Biostatistics, College of Public Health, University of Kentucky, Lexington, KY, USA
| | - Pablo Toro
- Advanced Center for Chronic Diseases, ACCDiS
- School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Catterina Ferreccio
- Advanced Center for Chronic Diseases, ACCDiS
- School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
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31
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Liu C, Li L, Pan W, Zhu D, Lian S, Liu Y, Ren L, Mao P, Ren Y, Ma X. Altered topological properties of functional brain networks in patients with first episode, late-life depression before and after antidepressant treatment. Front Aging Neurosci 2023; 15:1107320. [PMID: 36949772 PMCID: PMC10025486 DOI: 10.3389/fnagi.2023.1107320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 02/20/2023] [Indexed: 03/08/2023] Open
Abstract
Objectives To preliminarily explore the functional activity and information integration of the brains under resting state based on graph theory in patients with first-episode, late-life depression (LLD) before and after antidepressant treatment. Methods A total of 50 patients with first-episode LLD and 40 non-depressed controls (NCs) were recruited for the present research. Participants underwent the RBANS test, the 17-item Hamilton depression rating scale (HAMD-17) test, and resting-state functional MRI scans (rs-fMRI). The RBANS test consists of 12 sub-tests that contribute to a total score and index scores across the five domains: immediate memory, visuospatial/constructional, language, attention, and delayed memory. Escitalopram or sertraline was adopted for treating depression, and the dosage of the drug was adjusted by the experienced psychiatrists. Of the 50 LLD patients, 27 cases who completed 6-month follow-ups and 27 NCs matched with age, sex, and education level were included for the final statistical analysis. Results There were significant differences in RBANS total score, immediate memory, visuospatial/constructional, language, attention, and delayed memory between LLD baseline group and NCs group (P < 0.05). Considering the global attribute indicators, the clustering coefficient of global indicators was lower in the LLD baseline group than in the NCs group, and the small-world attribute of functional brain networks existed in all three groups. The degree centrality and node efficiency of some brains were lower in the LLD baseline group than in the NCs group. After 6 months of antidepressant therapy, the scores of HAMD-17, immediate memory, language, and delayed memory in the LLD follow-up group were higher than those in the LLD baseline group. Compared with the LLD baseline group, the degree centrality and node efficiency of some brains in the cognitive control network were decreased in the LLD follow-up group. Conclusions The ability to integrate and divide labor of functional brain networks declines in LLD patients and linked with the depression severity. After the relief of depressive symptoms, the small-world attribute of functional brain networks in LLD patients persists. However, the information transmission efficiency and centrality of some brain regions continue to decline over time, perhaps related to their progressive cognitive impairment.
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Affiliation(s)
- Chaomeng Liu
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders and National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Li Li
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders and National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Weigang Pan
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders and National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Dandi Zhu
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders and National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Siyuan Lian
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders and National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Yi Liu
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders and National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Li Ren
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders and National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Peixian Mao
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders and National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Yanping Ren
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders and National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
- Yanping Ren
| | - Xin Ma
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders and National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
- *Correspondence: Xin Ma
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32
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Choi J, Lee S, Motter JN, Kim H, Andrews H, Doraiswamy PM, Devanand DP, Goldberg TE. Models of depressive pseudoamnestic disorder. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2022; 8:e12335. [PMID: 36523848 PMCID: PMC9746884 DOI: 10.1002/trc2.12335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 06/29/2022] [Accepted: 06/30/2022] [Indexed: 12/15/2022]
Abstract
Objective Little effort has been made in the past to validate depressive pseudodementia based on hypothesis-driven approaches. We extended this concept to individuals with amnestic Mild Cognitive Impairment and Major Depression, that is, pseudodepressive amnestic disorder. We tested two hypotheses consistent with the presentations and mechanisms associated with this potential syndrome: improvements in cognition would be significantly correlated with improvements in depression after treatment (Hypothesis 1), and if not confirmed, the presence of such an association could be identified once moderator variables were taken into account (Hypothesis 2). Methods Within a clinical trial, 61 individuals received open label serotonin reuptake inhibitor (citalopram or venlafaxine) treatment over a 16-week period. Selective Reminding Test and Hamilton Depression scale were conducted serially to measure change in memory and depression, respectively. Magnetic resonance imaging, other cognitive measures (Alzheimer's Disease Assessment Scale-Cognitive and speed of processing tests), and additional depression measure (Beck Depression Inventory [BDI]) were also administered. Results No significant associations between improvement in depression and improvement in cognition were observed. Sensitivity analyses with other cognitive measures, the BDI, and exclusion of possible "placebo" responders were negative as well. There were no significant moderation effects for baseline Hamilton Rating Scale for Depression as a measure of symptom severity or age. APOE ε4 genotype and white matter hyperintensity burden yielded counter-intuitive, albeit marginally significant results. Conclusions Negative findings cast doubt on the frequency of depressive pseudoamnestic disorder in older populations with documented depression and memory impairments.
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Affiliation(s)
- Jongwoo Choi
- Division of Mental Health Data ScienceNew York State Psychiatric InstituteNew YorkNew YorkUSA
| | - Seonjoo Lee
- Division of Mental Health Data ScienceNew York State Psychiatric InstituteNew YorkNew YorkUSA
- Department of BiostatisticsMailman School of Public HealthColumbia UniversityNew YorkNew YorkUSA
- Department of PsychiatryColumbia University Medical CenterNew YorkNew YorkUSA
| | - Jeffrey N. Motter
- Division of Geriatric PsychiatryNew York State Psychiatric InstituteNew YorkNew YorkUSA
| | - Hyun Kim
- Division of Geriatric PsychiatryNew York State Psychiatric InstituteNew YorkNew YorkUSA
| | - Howard Andrews
- Department of BiostatisticsMailman School of Public HealthColumbia UniversityNew YorkNew YorkUSA
- Department of PsychiatryColumbia University Medical CenterNew YorkNew YorkUSA
| | - P. Murali Doraiswamy
- Department of Psychiatry and Behavioral SciencesDuke University School of MedicineDurhamNorth CarolinaUSA
| | - D. P. Devanand
- Division of Geriatric PsychiatryNew York State Psychiatric InstituteNew YorkNew YorkUSA
| | - Terry E. Goldberg
- Department of PsychiatryColumbia University Medical CenterNew YorkNew YorkUSA
- Division of Geriatric PsychiatryNew York State Psychiatric InstituteNew YorkNew YorkUSA
- Department of AnesthesiologyColumbia University Medical CenterNew YorkNew YorkUSA
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Weiner JK, Smith T, Hoy CK, Sarosh C, Madison JA, Ambati A, Tambralli A, Peters N, Packel C, Gockman K, Zuo Y, Briceño EM, Nagaraja V, Knight JS. Predictors and Interrelationship of Patient-Reported Outcomes in Antiphospholipid Syndrome: A Cross-Sectional Study. ACR Open Rheumatol 2022; 5:28-37. [PMID: 36461647 PMCID: PMC9837395 DOI: 10.1002/acr2.11512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 10/20/2022] [Accepted: 10/26/2022] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE This study assessed patient-reported outcomes (PROs) in individuals with persistently positive antiphospholipid antibodies (aPL) to better understand how living with aPL may affect their quality of life. METHODS Patients completed Patient-Reported Outcomes Measurement Information System Physical Function (PF) and Cognitive Function (CF) Short Forms as well as the pain intensity (PI) rating (scale of 1-10). Patients were characterized for demographics, clinical manifestations of antiphospholipid syndrome (APS), cardiovascular risk factors, laboratory test results, and medication usage. Multivariate modeling was done via linear regression. RESULTS Of 139 patients, 89 had primary APS, 21 had secondary APS, and 29 had persistent aPL without meeting clinical criteria for APS. The average T scores (±SD) for PF and CF were 45.4 ± 9.2 and 48.6 ± 11.6, respectively; the average for PI was 3.0 ± 2.6. Approximately half of the patients (47%) endorsed at least mild impairment in PF (T score < 45). Mean PF, CF, and PI did not differ between diagnostic groups. Individuals who endorsed more impairment on one measure also tended to endorse more impairment on another (Pearson r = 0.43-0.59). In the multivariate models, age, smoking, pain medications, and serotonergic medications were associated with impairment in at least one PRO domain. The Damage Index for APS was significantly correlated with both PF and CF. CONCLUSION Individuals living with APS endorsed more impairment in PF (and potentially CF) than expected for the general population. The relationship between certain medications and PROs warrants further study, as does the longitudinal trajectory of these and other PROs.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Yu Zuo
- University of MichiganAnn ArborMichigan
| | | | - Vivek Nagaraja
- University of Michigan, Ann Arbor, and Mayo ClinicScottsdaleArizona
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Perlman G, Cogo-Moreira H, Wu CY, Herrmann N, Swardfager W. Depression interacts with allostatic load to predict cognitive decline in middle age. Psychoneuroendocrinology 2022; 146:105922. [PMID: 36150368 DOI: 10.1016/j.psyneuen.2022.105922] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 09/06/2022] [Accepted: 09/07/2022] [Indexed: 01/29/2023]
Abstract
BACKGROUND Allostatic load (AL) indicates the cumulative impact of stress on homeostatic mechanisms. Depression and AL have been associated with cognitive deficits, but it is unclear if they do so independently. METHODS Using data from middle-aged participants in the observational longitudinal Midlife in the United States (MIDUS) study (n = 704, 57.5 % female, 63.8 ± 10.6 years old in 2014), we assessed whether the effect of prior depression (Composite International Diagnostic Interview Short-Form in 1995) on cognitive decline between 2004 and 2013 (composite Z-scores derived from the Brief Test of Adult Cognition by Telephone and the Stop & Go Switch Task) was moderated by AL Z-scores in 2004 (calculated from biomarkers in blood, urine, and electrocardiography). RESULTS A significant depression × AL interaction predicted a decline in a composite cognitive score (β = -0.066, SE=0.029, p = 0.024) and executive function (β = -0.068, SE=0.025, p = 0.007). Depression predicted a decline in composite cognition among those with AL Z-scores above - 0.055. AL subdomains of inflammation and lipid metabolism showed evidence of moderation. CONCLUSION Middle-aged adults with depression who had higher allostatic load were at greater risk of cognitive decline. Future studies should evaluate whether the interaction predicts incident dementia, and whether interventions targeting depression or elevated AL in people who have both can attenuate cognitive decline.
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Affiliation(s)
- George Perlman
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, 2075 Bayview Avenue, Toronto M4N 3M5, Canada; Department of Pharmacology & Toxicology, University of Toronto, 1 King's College Circle, Toronto M5S 1A8, Canada; Sleep and Cardiopulmonary Program, University Health Network - Toronto Rehabilitation Institute, 347 Rumsey Road, Toronto M4G 2V6, Canada
| | - Hugo Cogo-Moreira
- Department of Education, ICT and Learning, Østfold University College, P.O.Box 700, NO-1757, Halden, Norway
| | - Che-Yuan Wu
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, 2075 Bayview Avenue, Toronto M4N 3M5, Canada; Department of Pharmacology & Toxicology, University of Toronto, 1 King's College Circle, Toronto M5S 1A8, Canada
| | - Nathan Herrmann
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, 2075 Bayview Avenue, Toronto M4N 3M5, Canada; Department of Psychiatry, University of Toronto, 250 College Street, Toronto M5T 1R8, Canada
| | - Walter Swardfager
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, 2075 Bayview Avenue, Toronto M4N 3M5, Canada; Department of Pharmacology & Toxicology, University of Toronto, 1 King's College Circle, Toronto M5S 1A8, Canada; Sleep and Cardiopulmonary Program, University Health Network - Toronto Rehabilitation Institute, 347 Rumsey Road, Toronto M4G 2V6, Canada.
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Colwell MJ, Tagomori H, Chapman S, Gillespie AL, Cowen PJ, Harmer CJ, Murphy SE. Pharmacological targeting of cognitive impairment in depression: recent developments and challenges in human clinical research. Transl Psychiatry 2022; 12:484. [PMID: 36396622 PMCID: PMC9671959 DOI: 10.1038/s41398-022-02249-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 11/01/2022] [Accepted: 11/03/2022] [Indexed: 11/18/2022] Open
Abstract
Impaired cognition is often overlooked in the clinical management of depression, despite its association with poor psychosocial functioning and reduced clinical engagement. There is an outstanding need for new treatments to address this unmet clinical need, highlighted by our consultations with individuals with lived experience of depression. Here we consider the evidence to support different pharmacological approaches for the treatment of impaired cognition in individuals with depression, including treatments that influence primary neurotransmission directly as well as novel targets such as neurosteroid modulation. We also consider potential methodological challenges in establishing a strong evidence base in this area, including the need to disentangle direct effects of treatment on cognition from more generalised symptomatic improvement and the identification of sensitive, reliable and objective measures of cognition.
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Affiliation(s)
- Michael J Colwell
- University Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Hosana Tagomori
- University Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Sarah Chapman
- University Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - Amy L Gillespie
- University Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Philip J Cowen
- University Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Catherine J Harmer
- University Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Susannah E Murphy
- University Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK.
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK.
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Vortioxetine Improves Depressive Symptoms and Cognition in Parkinson's Disease Patients with Major Depression: An Open-Label Prospective Study. Brain Sci 2022; 12:brainsci12111466. [PMID: 36358393 PMCID: PMC9688230 DOI: 10.3390/brainsci12111466] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 10/15/2022] [Accepted: 10/26/2022] [Indexed: 11/17/2022] Open
Abstract
Depression is frequent in Parkinson’s disease (PD) patients, but the evidence for many antidepressant agents to treat it in PD is insufficient. The aim of the present prospective open-label single-arm study (VOPARK, an open-label study of the effectiveness and safety of VOrtioxetine in PARKinson’s disease patients with depression) was to analyze the effectiveness of vortioxetine on depressive symptoms in PD patients with major depression. The primary efficacy outcome was the change from baseline (VB) at the end of the observational period (12 weeks ± 14 days; V12w) in the 17-item Hamilton Depression Rating Scale (HAM-D17) total score. At VB, all patients had a HAM-D17 total score ≥16. A total of 30 patients (age 66.23 ± 10.27; 73.3% males) were included between February 2021 (first patient, 12/FEB/21) and March 2022 (last patient, 14/MAR/22). At 12 weeks, 27 patients completed the follow-up (90%). The total HAM-D17 total score was reduced by 52.7% (from 21.5 ± 4.75 at VB to 10.44 ± 7.54 at V12w; Cohen’s effect size = −2.5; p < 0.0001) and the response and remission rates were 50% and 43.3%, respectively. Apathy (Apathy Scale; p < 0.0001), cognition (PD-Cognitive Rating Scale; p = 0.007), fatigue (Fatigue Severity Scale; p = 0.014), and quality of life (PDQ-39 (p = 0.001) and EUROHIS-QOL8 (p < 0.0001)) improved at 3 weeks as well. A total of 11 adverse events in 10 patients (33.3%) were reported, one of which was severe (vomiting related to vortioxetine with full recovery after drug withdrawal). Vortioxetine was safe and well tolerated and improved depressive symptoms and other non-motor symptoms in PD patients.
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McIntyre RS, Lipsitz O, Rodrigues NB, Subramaniapillai M, Nasri F, Lee Y, Fehnert B, King J, Chrones L, Kratiuk K, Uddin S, Rosenblat JD, Mansur RB, McCue M. An App-Based Digit Symbol Substitution Test for Assessment of Cognitive Deficits in Adults With Major Depressive Disorder: Evaluation Study. JMIR Ment Health 2022; 9:e33871. [PMID: 36301615 PMCID: PMC9650567 DOI: 10.2196/33871] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 06/29/2022] [Accepted: 07/20/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Cognitive dysfunction is an impairing core symptom of depression. Among adults with major depressive disorder (MDD) treated with antidepressants, residual cognitive symptoms interfere with patient-reported outcomes. The foregoing characterization of cognitive symptoms provides the rationale for screening and assessing the severity of cognitive symptoms at point of care. However, clinical neurocognitive assessments are time-consuming and difficult, and they require specialist expertise to interpret them. A smartphone-delivered neurocognitive test may offer an effective and accessible tool that can be readily implemented into a measurement-based care framework. OBJECTIVE We aimed to evaluate the use of a smartphone-delivered app-based version of the established Cognition Kit Digit Symbol Substitution Test (DSST) neurocognitive assessment compared to a traditional paper-and-pencil version. METHODS Convergent validity and test-retest reliability of the 2 versions were evaluated. Patient satisfaction with the app was also assessed. RESULTS Assessments made using the app-based Cognition Kit DSST were highly correlated with the standard paper-and-pencil version of the test, both at the baseline visit (r=0.69, df=27; P<.001) and at the end-of-study visit (r=0.82, df=27; P<.001), and they were positively evaluated by 30 patients as being user-friendly, easy to navigate, and preferable over the paper-and-pencil version of the DSST. However, although the app-based Cognition Kit DSST was validated in patients with MDD, it still needs to be evaluated in healthy controls. CONCLUSIONS App-based DSST may facilitate a more personalized, convenient, and cost-effective method of cognitive assessment, helping to guide measurement-based care and psychotherapeutic and pharmacologic treatment options for patients with MDD. TRIAL REGISTRATION ClinicalTrials.gov NCT03999567; https://tinyurl.com/2p8pnyv7.
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Affiliation(s)
- Roger S McIntyre
- University Health Network, Mood Disorders Psychopharmacology Unit, Toronto, ON, Canada.,Brain and Cognition Discovery Foundation, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Canadian Rapid Treatment Center of Excellence, Mississauga, ON, Canada
| | - Orly Lipsitz
- University Health Network, Mood Disorders Psychopharmacology Unit, Toronto, ON, Canada.,Canadian Rapid Treatment Center of Excellence, Mississauga, ON, Canada
| | - Nelson B Rodrigues
- University Health Network, Mood Disorders Psychopharmacology Unit, Toronto, ON, Canada.,Canadian Rapid Treatment Center of Excellence, Mississauga, ON, Canada
| | - Mehala Subramaniapillai
- University Health Network, Mood Disorders Psychopharmacology Unit, Toronto, ON, Canada.,Canadian Rapid Treatment Center of Excellence, Mississauga, ON, Canada
| | - Flora Nasri
- Canadian Rapid Treatment Center of Excellence, Mississauga, ON, Canada
| | - Yena Lee
- University Health Network, Mood Disorders Psychopharmacology Unit, Toronto, ON, Canada
| | - Ben Fehnert
- Ctrl Group, London, United Kingdom.,Cognition Kit, Cambridge, United Kingdom
| | - James King
- Cognition Kit, Cambridge, United Kingdom
| | - Lambros Chrones
- Takeda Pharmaceuticals U.S.A., Inc., Lexington, MA, United States
| | - Kevin Kratiuk
- Canadian Rapid Treatment Center of Excellence, Mississauga, ON, Canada
| | - Sharif Uddin
- Takeda Pharmaceuticals U.S.A., Inc., Lexington, MA, United States
| | - Joshua D Rosenblat
- University Health Network, Mood Disorders Psychopharmacology Unit, Toronto, ON, Canada.,Brain and Cognition Discovery Foundation, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Canadian Rapid Treatment Center of Excellence, Mississauga, ON, Canada
| | - Rodrigo B Mansur
- University Health Network, Mood Disorders Psychopharmacology Unit, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Maggie McCue
- Takeda Pharmaceuticals U.S.A., Inc., Lexington, MA, United States
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Decreased reward circuit connectivity during reward anticipation in major depression. Neuroimage Clin 2022; 36:103226. [PMID: 36257119 PMCID: PMC9668633 DOI: 10.1016/j.nicl.2022.103226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 09/21/2022] [Accepted: 10/08/2022] [Indexed: 11/11/2022]
Abstract
An important symptom of major depressive disorder (MDD) is the inability to experience pleasure, possibly due to a dysfunction of the reward system. Despite promising insights regarding impaired reward-related processing in MDD, circuit-level abnormalities remain largely unexplored. Furthermore, whereas studies contrasting experimental conditions from incentive tasks have revealed important information about reward processing, temporal difference modeling of reward-related prediction error (PE) signals might give a more accurate representation of the reward system. We used a monetary incentive delay task during functional MRI scanning to explore PE-related striatal and ventral tegmental area (VTA) activation in response to anticipation and delivery of monetary rewards in 24 individuals with MDD versus 24 healthy controls (HCs). Furthermore, we investigated group differences in temporal difference related connectivity with a generalized psychophysiological interaction (gPPI) analysis with the VTA, ventral striatum (VS) and dorsal striatum (DS) as seeds during reward versus neutral, both in anticipation and delivery. Relative to HCs, MDD patients displayed a trend-level (p = 0.052) decrease in temporal difference-related activation in the VS during reward anticipation and delivery combined. Moreover, gPPI analyses revealed that during reward anticipation, MDD patients exhibited decreased functional connectivity between the VS and anterior cingulate cortex / medial prefrontal cortex, anterior cingulate gyrus, angular/middle orbital gyrus, left insula, superior/middle frontal gyrus (SFG/MFG) and precuneus/superior occipital gyrus/cerebellum compared to HC. Moreover, MDD patients showed decreased functional connectivity between the VTA and left insula compared to HC during reward anticipation. Exploratory analysis separating medication free patients from patients using antidepressant revealed that these decreased functional connectivity patterns were mainly apparent in the MDD group that used antidepressants. These results suggest that MDD is characterized by alterations in reward circuit connectivity rather than isolated activation impairments. These findings represent an important extension of the existing literature since improved understanding of neural pathways underlying depression-related reward dysfunctions, may help currently unmet diagnostic and therapeutic efforts.
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The Effects of Tai Chi on the Executive Functions and Physical Fitness in Middle-Aged Adults with Depression: A Randomized Controlled Trial. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:1589106. [PMID: 36147650 PMCID: PMC9489347 DOI: 10.1155/2022/1589106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 08/22/2022] [Indexed: 12/02/2022]
Abstract
Objective The present study examined the effects of Tai Chi exercise on the executive functions (EFs) and physical fitness of middle-aged adults with depression. Methods A total of 39 middle-aged adults with depression (Mage = 50.59, SD = 7.38) were randomly assigned to the Tai Chi group (n = 20) or the waiting-list control group (n = 19). The Tai Chi group engaged in two 90 min sessions of Tai Chi exercise per week for 12 weeks; the waiting-list control group was asked to maintain their usual daily routines for 12 weeks. Depression symptoms, EFs (i.e., inhibitory control, planning, working memory, and cognitive flexibility), and physical fitness (i.e., cardiovascular fitness, muscular strength, muscular endurance, power, and flexibility) were evaluated at the baseline (pretest), 6-week (mid-test), and 12-week (post-test) marks. Results Both groups showed decreased depression symptoms over time. Compared with the control group, the Tai Chi group showed decreased reaction times for incongruent conditions in the Stroop test from pretest to mid- and post-test, and shorter reaction time for incongruent conditions in the Stroop test than the control group at post-test; the Tai Chi group performed significantly better than the control group in overall total move score of Tower of London (TOL). The Tai Chi group also showed increased total correct scores of TOL from pretest to mid- and post-test, and greater total correct scores of TOL than the control group at post-test. Additionally, results indicated that Tai Chi exercise comprehensively improved physical fitness from pretest to mid- and post-test. Greater performance in terms of cardiovascular fitness, muscular strength, and power was also found in the Tai Chi group at post-test than in the control group. Conclusions These findings suggest that the 12-week Tai Chi exercise improved inhibitory control, planning and working memory aspects of executive functions, and physical fitness in middle-aged adults with depression.
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Huang IC, Chang TS, Chen C, Sung JY. Effect of Vortioxetine on Cognitive Impairment in Patients With Major Depressive Disorder: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Int J Neuropsychopharmacol 2022; 25:969-978. [PMID: 35981958 PMCID: PMC9743961 DOI: 10.1093/ijnp/pyac054] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 05/26/2022] [Accepted: 08/17/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Dementia and depression are increasingly common worldwide, and their effective control could ease the burden on economies, public health systems, and support networks. Vortioxetine is a new antidepressant with multipharmacologic actions that elevate the concentration of serotonin and modulate multiple neurotransmitter receptors in the brain. We conducted a meta-analysis to explore whether the cognitive function of patients with major depressive disorder (MDD) treated with vortioxetine would improve. METHODS We systematically reviewed randomized controlled trials (RCTs) in the PubMed, Embase, and Cochrane databases to assess the treatment effects of vortioxetine on the cognitive function of patients with MDD. The outcome measures included the Digit Symbol Substitution Test (DSST), Perceived Deficits Questionnaire (PDQ), and Montgomery-Åsberg Depression Rating Scale (MADRS) scores. Pooled results were calculated using a fixed-effects or random-effects model according to the heterogeneity of the included trials. RESULTS Six RCTs with a total of 1782 patients were included in the meta-analysis, which demonstrated that vortioxetine improved DSST, PDQ, and MADRS scores in patients with MDD. The results were consistent at the 10- and 20-mg doses. In the 20-mg group, the decrease in MADRS scores was more significant than that in the placebo group. CONCLUSIONS Both the 10- and 20-mg doses of vortioxetine can significantly increase DSST scores and decrease PDQ and MADRS scores in patients with MDD and cognitive dysfunction, but further studies with longer follow-up periods to assess mental function are required.
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Affiliation(s)
- I-Chen Huang
- Department of Neurology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Tsui-San Chang
- Department of Neurology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Chiehfeng Chen
- Division of Plastic Surgery, Department of Surgery, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan,Department of Public Health, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan,Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan
| | - Jia-Ying Sung
- Correspondence: Jia-Ying Sung, MD, PhD, Department of Neurology, Wan Fang Hospital, Taipei Medical University, No. 111, Sec. 3, Xinglong Rd, Wenshan Dist, Taipei City 116, Taiwan ()
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Bozzatello P, Giordano B, Montemagni C, Rocca P, Bellino S. Real-World Functioning in Psychiatric Outpatients: Predictive Factors. J Clin Med 2022; 11:jcm11154400. [PMID: 35956015 PMCID: PMC9369214 DOI: 10.3390/jcm11154400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 06/17/2022] [Accepted: 07/27/2022] [Indexed: 02/04/2023] Open
Abstract
Introduction: Investigations on predictors of real-world functioning were mainly performed in patients with schizophrenia, while fewer studies have been conducted in other psychiatric disorders. Objective: Our objective was to identify clinical, socio-demographic, and illness-related predictors of real-world functioning during 12 months of standard treatments in outpatients with different diagnoses. Methods: Outpatients (n = 1019) with schizophrenia (SZ), major depressive disorder (MDD), bipolar disorder (BD), and borderline personality disorder (BPD) were evaluated with the following tools: SCID-5-CV and SCID-5-PD, CGI-S, SAT-P, DAI-10, and PSP. Change of PSP (ΔPSP) between baseline and 12 months was used as the dependent variable in multiple regression analysis. Results: Higher PSP score at baseline and the achievement of main milestones predicted better functioning after follow-up in all subgroups of patients, with the exception of BD. In the total sample, ΔPSP was related to age of onset, treatments, and quality of life, and inversely related to psychiatric anamnesis, antidepressants, and global symptoms. In SZ, ΔPSP was related to adherence and quality of life. In MDD, ΔPSP was related to psychotherapy and quality of life, and inversely related to antidepressants and global symptoms. In BD, ΔPSP was related to age of onset, antipsychotics, and quality of life, while it was inversely related to psychiatric anamnesis. In BPD, antipsychotics, mood stabilizers, psychotherapy, and quality of life were directly related to ΔPSP, while suicidal attempts and global symptoms had an inverse relation. Conclusions: Several socio-demographic and illness-related variables predicted improvement of real-world functioning, besides psychopathology and severity of the disease.
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Yang KC, Hsieh WC, Chou YH. Cognitive factor structure and measurement invariance between healthy controls and patients with major depressive disorder. J Psychiatr Res 2022; 151:598-605. [PMID: 35636038 DOI: 10.1016/j.jpsychires.2022.05.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 05/03/2022] [Accepted: 05/20/2022] [Indexed: 02/01/2023]
Abstract
Cognitive impairments are crucial in functional outcomes of major depressive disorder (MDD). The effectiveness of currently available treatment methods for cognitive deficits is suboptimal. A cognitive test battery is often applied to evaluate cognition with multiple interrelated and difficult-to-interpret outcomes. Generating cognitive factor scores after the confirmation of a common cognitive structure and measurement invariance between healthy controls (HCs) and patients may aid in understanding cognition further. This methodology has been applied for several neuropsychiatric disorders, but not for MDD. Therefore, we conducted a series of exploratory factor analyses (EFA), confirmatory factor analyses (CFA), and multiple groups CFA (MGCFA) for a cognitive test battery in HCs and patients with MDD. The initial EFA of 106 HCs yielded a three-factor model-comprising attention, memory, and executive function. The CFA confirmed the initial model in other 94 HCs with revisions, which reasonably fit the cognitive data of 54 patients with MDD. MGCFA supported the measurement invariance of the determined model between HCs and patients with MDD. The associations of cognitive factor scores with age or education and the effect sizes of group differences in cognitive factor scores externally validated the determined model. In conclusion, this is the first study to demonstrate the measurement invariance of a cognitive model between HCs and patients with MDD using MGCFA. The measurement invariance substantiated valid group comparisons of factor scores and their relationships with other markers. The current results may be applicable for the development of improved treatment strategies for cognitive impairments in MDD.
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Affiliation(s)
- Kai-Chun Yang
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Psychiatry, Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Wen-Chih Hsieh
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yuan-Hwa Chou
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Psychiatry, Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Center for Quality Management, Taipei Veterans General Hospital, Taipei, Taiwan.
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Ronold EH, Joormann J, Hammar Å. Computerized Working Memory Training in Remission From Major Depressive Disorder: Effects on Emotional Working Memory, Processing Speed, Executive Functions, and Associations With Symptoms. Front Behav Neurosci 2022; 16:887596. [PMID: 35832292 PMCID: PMC9272008 DOI: 10.3389/fnbeh.2022.887596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 05/30/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Remission from major depressive disorder (MDD) is associated with residual symptoms related to reduced functioning, quality of life, and relapse risk. Previous studies have raised questions about mechanisms involved-in and affected by cognitive training. This study investigated the associations and changes among depressive symptoms, rumination, processing speed (PS), executive functioning (EF), and emotional working memory (e-WM) pre- post computerized working memory training (CWMT). Method Twenty-nine remitted participants were included in a pre- post pilot study of within-subject effects of online CWMT. A total of 20 participants completed the intervention and pre- post tests of EF and PS, e-WM, in addition to symptom and rumination measures. Associations between changes in symptoms and cognition were investigated pre- post. Associations between improvements in CWMT, depression history, and changes in cognition were explored. Hypotheses and statistics were preregistered before data were analyzed. Results Manipulation of negatively valanced stimuli in e-WM showed an inverse association with rumination pre-intervention, but the association disappeared post-intervention. Cognitive functioning improved in most conditions with largest effects in EF. Symptoms did not change in the remitted sample. CWMT improvements were related to improvements in some aspects of EF and PS, but also to worse self-reported attention. Depression history was related to less improvement in EF. Limitations Sample size was small and there was dropout from the study. There was no control group, thus precluding practice and placebo effects and causal relationships. Conclusions Computerized WM training improves cognitive functions and could influence associations between e-WM and rumination. This could counteract functional impairment following MDD.
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Affiliation(s)
- Eivind Haga Ronold
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
- Division of Psychiatry, Haukeland University Hospital, University of Bergen, Bergen, Norway
| | - Jutta Joormann
- Department of Psychology, Yale University, New Haven, CT, United States
| | - Åsa Hammar
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
- Division of Psychiatry, Haukeland University Hospital, University of Bergen, Bergen, Norway
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Leonhardi J, Barthel H, Speerforck S, Dietzel J, Schroeter ML, Saur D, Tiepolt S, Rullmann M, Patt M, Claßen J, Schomerus G, Sabri O. Differential Diagnosis Between Alzheimer's Disease-Related Depression and Pseudo-Dementia in Depression: A New Indication for Amyloid-β Imaging? J Alzheimers Dis 2022; 88:1029-1035. [PMID: 35723098 DOI: 10.3233/jad-215619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Alzheimer's disease and depression can start with combined cognitive and depressive symptoms [1, 2]. Accurate differential diagnosis is desired to initiate specific treatment. OBJECTIVE We investigated whether amyloid-β PET imaging can discriminate both entities. METHODS This retrospective observational study included 39 patients (20 female, age = 70±11years) with both cognitive and depressive symptoms who underwent amyloid-β PET imaging and in whom clinical follow-up data was available. Amyloid-β PET was carried out applying [18F]Florbetaben or [11C]PiB. The PET images were analyzed by standardized visual and relative-quantitative evaluation. Based on clinical follow-up (median of 2.4 years [range 0.3 to 7.0 years, IQR = 3.7 years] after amyloid PET imaging which was not considered in obtaining a definite diagnosis), discrimination ability between AD-related depression and pseudo-dementia in depression/depression with other comorbidities was determined. RESULTS Visually, all 10 patients with pseudo-dementia in depression and all 15 patients with other depression were rated as amyloid-β-negative; 2 of 14 patients with AD-related depression were rated amyloid-β-negative. ROC curve analysis of the unified composite standardized uptake value ratios (cSUVRs) was able to discriminate pseudo-dementia in depression from AD-related depression with high accuracy (AUC = 0.92). Optimal [18F]Florbetaben discrimination cSUVR threshold was 1.34. In congruence with the visual PET analysis, the resulting sensitivity of the relative-quantitative analysis was 86% with a specificity of 100% . CONCLUSION Amyloid-β PET can differentiate AD-related depression and pseudo-dementia in depression. Prospective clinical studies are warranted to confirm this result and to potentially broaden the spectrum of clinical applications for amyloid-β PET imaging.
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Affiliation(s)
- Jakob Leonhardi
- Department of Nuclear Medicine, University of Leipzig Medical Center, Leipzig, Germany.,Department of Radiology, University of Leipzig Medical Center, Leipzig, Germany
| | - Henryk Barthel
- Department of Nuclear Medicine, University of Leipzig Medical Center, Leipzig, Germany
| | - Sven Speerforck
- Department of Psychiatry and Psychotherapy, University of Leipzig Medical Center, Leipzig, Germany
| | - Jens Dietzel
- Department of Psychiatry and Psychotherapy, University of Leipzig Medical Center, Leipzig, Germany
| | - Matthias L Schroeter
- Clinic for Cognitive Neurology, University of Leipzig Medical Center, Max Planck Institute for Human Cognitive & Brain Sciences, Leipzig, Germany
| | - Dorothee Saur
- Department of Neurology, University of Leipzig Medical Center, Leipzig, Germany
| | - Solveig Tiepolt
- Department of Nuclear Medicine, University of Leipzig Medical Center, Leipzig, Germany
| | - Michael Rullmann
- Department of Nuclear Medicine, University of Leipzig Medical Center, Leipzig, Germany
| | - Marianne Patt
- Department of Nuclear Medicine, University of Leipzig Medical Center, Leipzig, Germany
| | - Joseph Claßen
- Department of Neurology, University of Leipzig Medical Center, Leipzig, Germany
| | - Georg Schomerus
- Department of Psychiatry and Psychotherapy, University of Leipzig Medical Center, Leipzig, Germany
| | - Osama Sabri
- Department of Nuclear Medicine, University of Leipzig Medical Center, Leipzig, Germany
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Luciana M, Collins PF. Neuroplasticity, the Prefrontal Cortex, and Psychopathology-Related Deviations in Cognitive Control. Annu Rev Clin Psychol 2022; 18:443-469. [PMID: 35534121 DOI: 10.1146/annurev-clinpsy-081219-111203] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
A basic survival need is the ability to respond to, and persevere in the midst of, experiential challenges. Mechanisms of neuroplasticity permit this responsivity via functional adaptations (flexibility), as well as more substantial structural modifications following chronic stress or injury. This review focuses on prefrontally based flexibility, expressed throughout large-scale neuronal networks through the actions of excitatory and inhibitory neurotransmitters and neuromodulators. With substance use disorders and stress-related internalizing disorders as exemplars, we review human behavioral and neuroimaging data, considering whether executive control, particularly cognitive flexibility, is impaired premorbidly, enduringly compromised with illness progression, or both. We conclude that deviations in control processes are consistently expressed in the context of active illness but operate through different mechanisms and with distinct longitudinal patterns in externalizing versus internalizing conditions.
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Affiliation(s)
- Monica Luciana
- Department of Psychology, University of Minnesota, Minneapolis, Minnesota, USA; ,
| | - Paul F Collins
- Department of Psychology, University of Minnesota, Minneapolis, Minnesota, USA; ,
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Lee SH, Jeon SW, Shin C, Pae CU, Patkar AA, Masand PS, An H, Han C. Acute Efficacy and Safety of Escitalopram Versus Desvenlafaxine and Vortioxetine in the Treatment of Depression With Cognitive Complaint: A Rater-Blinded Randomized Comparative Study. Psychiatry Investig 2022; 19:268-280. [PMID: 35500900 PMCID: PMC9058271 DOI: 10.30773/pi.2021.0368] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 02/17/2022] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE This study aimed to compare the efficacy and safety of escitalopram, vortioxetine, and desvenlafaxine for acute treatment of major depressive disorder (MDD) with cognitive complaint (CC). METHODS A total of 129 patients with MDD who also complained of CC were randomized evenly to either escitalopram, vortioxetine, or desvenlafaxine group and underwent a multi-center, six-week, rater-blinded, and head-to-head comparative trial. Differences in depressive symptoms following treatment were measured using the Hamilton Depression Rating Scale (HAMD) and the Montgomery-Åsberg Depression Rating Scale (MADRS). Subjective cognitive function and the presence of adverse events were assessed. RESULTS The three antidepressant treatment groups did not show significant differences in the improvement of depressive symptoms as measured by HAMD and MADRS. Desvenlafaxine treatment was associated with a superior treatment response rate in depressive symptoms compared to vortioxetine or escitalopram treatment. However, no significant differences were found in the remission rate of depressive symptoms. The three antidepressant treatment groups did not show significant differences in the improvement of CC. Adverse profiles of each treatment group were tolerable, with no significant differences. CONCLUSION In acute antidepressant treatment for MDD with CC, escitalopram, vortioxetine, and desvenlafaxine presented similar efficacy in relief of depressive symptoms; however, desvenlafaxine was associated with a superior treatment. Further studies are needed to confirm these results by investigating the therapeutic efficacy and safety profile of long-term antidepressant treatment of MDD with CC (Clinical Trial Registry, http://cris.nih.go.kr/cris/en/: KCT0002173).
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Affiliation(s)
- Seung-Hoon Lee
- Department of Psychiatry, Veterans Health Service Medical Center, Seoul, Republic of Korea
| | - Sang Won Jeon
- Department of Psychiatry, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Cheolmin Shin
- Department of Psychiatry, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Republic of Korea
| | - Chi-Un Pae
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ashwin A Patkar
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | | | - Hyonggin An
- Department of Biostatistics, Korea University College of Medicine, Seoul, Republic of Korea
| | - Changsu Han
- Department of Psychiatry, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
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Machado-Santos AR, Loureiro-Campos E, Patrício P, Araújo B, Alves ND, Mateus-Pinheiro A, Correia JS, Morais M, Bessa JM, Sousa N, Rodrigues AJ, Oliveira JF, Pinto L. Beyond New Neurons in the Adult Hippocampus: Imipramine Acts as a Pro-Astrogliogenic Factor and Rescues Cognitive Impairments Induced by Stress Exposure. Cells 2022; 11:cells11030390. [PMID: 35159199 PMCID: PMC8834148 DOI: 10.3390/cells11030390] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 01/13/2022] [Accepted: 01/21/2022] [Indexed: 02/06/2023] Open
Abstract
Depression is a prevalent, socially burdensome disease. Different studies have demonstrated the important role of astrocytes in the pathophysiology of depression as modulators of neurotransmission and neurovascular coupling. This is evidenced by astrocyte impairments observed in brains of depressed patients and the appearance of depressive-like behaviors upon astrocytic dysfunctions in animal models. However, little is known about the importance of de novo generated astrocytes in the mammalian brain and in particular its possible involvement in the precipitation of depression and in the therapeutic actions of current antidepressants (ADs). Therefore, we studied the modulation of astrocytes and adult astrogliogenesis in the hippocampal dentate gyrus (DG) of rats exposed to an unpredictable chronic mild stress (uCMS) protocol, untreated and treated for two weeks with antidepressants—fluoxetine and imipramine. Our results show that adult astrogliogenesis in the DG is modulated by stress and imipramine. This study reveals that distinct classes of ADs impact differently in the astrogliogenic process, showing different cellular mechanisms relevant to the recovery from behavioral deficits induced by chronic stress exposure. As such, in addition to those resident, the newborn astrocytes in the hippocampal DG might also be promising therapeutic targets for future therapies in the neuropsychiatric field.
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Affiliation(s)
- Ana R Machado-Santos
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, 4710-057 Braga, Portugal
- ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Eduardo Loureiro-Campos
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, 4710-057 Braga, Portugal
- ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Patrícia Patrício
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, 4710-057 Braga, Portugal
- ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Bruna Araújo
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, 4710-057 Braga, Portugal
- ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Nuno Dinis Alves
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, 4710-057 Braga, Portugal
- ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - António Mateus-Pinheiro
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, 4710-057 Braga, Portugal
- ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Joana Sofia Correia
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, 4710-057 Braga, Portugal
- ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Mónica Morais
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, 4710-057 Braga, Portugal
- ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - João M Bessa
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, 4710-057 Braga, Portugal
- ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Nuno Sousa
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, 4710-057 Braga, Portugal
- ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Ana J Rodrigues
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, 4710-057 Braga, Portugal
- ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - João Filipe Oliveira
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, 4710-057 Braga, Portugal
- ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
- IPCA-EST-2Ai, Polytechnic Institute of Cávado and Ave, Applied Artificial Intelligence Laboratory, Campus of IPCA, 4750-810 Barcelos, Portugal
| | - Luísa Pinto
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, 4710-057 Braga, Portugal
- ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
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Tournier M, Pambrun E, Maumus-Robert S, Pariente A, Verdoux H. The risk of dementia in patients using psychotropic drugs: Antidepressants, mood stabilizers or antipsychotics. Acta Psychiatr Scand 2022; 145:56-66. [PMID: 34689322 DOI: 10.1111/acps.13380] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 10/12/2021] [Accepted: 10/17/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The risk of dementia associated with the use of psychotropic drugs is not fully understood. A nested case-control study was carried out to assess the risk of dementia broadly defined or Alzheimer's disease associated with antidepressants, mood stabilizers or antipsychotics. METHODS A cohort was formed from healthcare claim databases including all patients aged 50 and over with a first dispensing of the psychotropic drugs concerned between 2006 and 2017. Patients who developed dementia over the study period were considered as cases. The association between drug exposure prior to a five-year lag time and diagnosis of dementia was assessed by conditional logistic regression models. RESULTS No association was found between dementia, either broadly defined or Alzheimer disease, and antidepressant or mood stabilizers. Findings were conflicting with regard to antipsychotics. First- and second-generation antipsychotics (FGA and SGA) were not associated with Alzheimer disease. SGA treatments of more than 3 months were associated with a higher risk of dementia broadly defined than no use of antipsychotics (Odds ratio [OR] 2.00; 95%CI 1.06-3.79; p = 0.03). In a sensitivity analysis using a lag time of 3 years, ever use of SGA and SGA treatments of more than 3 months were associated with a higher risk of dementia broadly defined than no use of antipsychotics (OR 1.71; 1.10-2.67; p = 0.02 and OR 1.84; 1.03-3.32; p = 0.04, respectively). CONCLUSION The association between antipsychotics and dementia should be further investigated to establish patients, specific drugs, and patterns of treatment at risk. Prescribers should remain cautious when prescribing them.
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Affiliation(s)
- Marie Tournier
- Inserm, Bordeaux Population Health Research Centre, Team Pharmacoepidemiology, UMR 1219, Univ. Bordeaux, Bordeaux, France.,Hospital Charles Perrens, Bordeaux, France
| | - Elodie Pambrun
- Inserm, Bordeaux Population Health Research Centre, Team Pharmacoepidemiology, UMR 1219, Univ. Bordeaux, Bordeaux, France
| | - Sandy Maumus-Robert
- Inserm, Bordeaux Population Health Research Centre, Team Pharmacoepidemiology, UMR 1219, Univ. Bordeaux, Bordeaux, France
| | - Antoine Pariente
- Inserm, Bordeaux Population Health Research Centre, Team Pharmacoepidemiology, UMR 1219, Univ. Bordeaux, Bordeaux, France.,Public Health Department, Medical Pharmacology Unit, University Hospital of Bordeaux, Bordeaux, France
| | - Hélène Verdoux
- Inserm, Bordeaux Population Health Research Centre, Team Pharmacoepidemiology, UMR 1219, Univ. Bordeaux, Bordeaux, France.,Hospital Charles Perrens, Bordeaux, France
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Mattingly G, Brunner E, Chrones L, Lawrence DF, Simonsen K, Ren H. Effectiveness of vortioxetine for major depressive disorder in real-world clinical practice: US cohort results from the global RELIEVE study. Front Psychiatry 2022; 13:977560. [PMID: 36683990 PMCID: PMC9845760 DOI: 10.3389/fpsyt.2022.977560] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 11/22/2022] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Effective treatment of major depressive disorder (MDD) involves addressing both depressive and functional symptoms, increasing patients' overall sense of well-being and quality of life (QoL). METHODS RELIEVE was an international observational, prospective study in patients ≥18 years with a current diagnosis of a major depressive episode (MDE) initiating vortioxetine in routine clinical practice; outcomes for the cohort of participants from the United States are presented here. Functioning was assessed at weeks 12 and 24 versus baseline using the Sheehan Disability Scale (SDS). Secondary effectiveness analyses assessed changes from baseline to weeks 12 and 24 in functioning, depression severity, cognitive symptoms, sexual function, and QoL. RESULTS 244 participants had an average of 8.2 previous MDEs; mean duration of their current MDE at baseline was 93.5 weeks. Vortioxetine was used as second- or later-line treatment for 80.5% of participants. Least-squares mean (SE) SDS total score significantly decreased from baseline by 7.19 (0.52) points at week 12 and 8.19 (0.56) points at week 24 (p < 0.0001 for both). Significant improvements were also reflected across SDS subscores, depression severity, cognitive function, sexual function, and QoL. Healthcare resource utilization and productivity parameters also improved. Adverse events were observed in 21.8% of patients, with nausea being the most common (7.3%). CONCLUSION This real-world study demonstrated improvements in functioning, depressive symptoms, and cognitive function in patients with MDD treated with vortioxetine in routine clinical practice in the cohort of patients enrolled in the United States. Outcomes were consistent with the efficacy and safety profile of vortioxetine in randomized controlled trials.
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Affiliation(s)
| | | | - Lambros Chrones
- Takeda Pharmaceuticals U.S.A., Inc., Lexington, MA, United States
| | - Debra F Lawrence
- Takeda Pharmaceuticals U.S.A., Inc., Lexington, MA, United States
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De Diego-Adeliño J, Crespo JM, Mora F, Neyra A, Iborra P, Gutiérrez-Rojas L, Salonia SF. Vortioxetine in major depressive disorder: from mechanisms of action to clinical studies. An updated review. Expert Opin Drug Saf 2021; 21:673-690. [PMID: 34964415 DOI: 10.1080/14740338.2022.2019705] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Vortioxetine is a multimodal-acting antidepressant that provides improvements on cognitive function aside from antidepressants and anxiolytic effects. Vortioxetine has been found to be one of the most effective and best tolerated options for major depressive disorder (MDD) in head-to-head trials. AREAS COVERED The present review intends to gather the most relevant and pragmatic data of vortioxetine in MDD, specially focusing on new studies that emerged between 2015 and 2020. EXPERT OPINION Vortioxetine is the first antidepressant that has shown improvements both in depression and cognitive symptoms, due to the unique multimodal mechanism of action that combine the 5-HT reuptake inhibition with modulations of other key pre- and post-synaptic 5-HT receptors (agonism of 5-HT1A receptor, partial agonism of 5-HT1B receptor, and antagonism of 5-HT3, 5-HT1D and 5-HT7 receptors). This new mechanism of action can explain the dose-dependent effect and can be responsible for its effects on cognitive functioning and improved tolerability profile. Potential analgesic and anti-inflammatory properties observed in preclinical studies as well as interesting efficacy and tolerability results of clinical studies with specific target groups render it a promising therapeutic option for patients with MDD and concomitant conditions (as menopause symptoms, pain, inflammation, apathy, sleep and/or metabolic abnormalities).
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Affiliation(s)
- Javier De Diego-Adeliño
- Department of Psychiatry, Hospital de La Santa Creu I Sant Pau, Institut d'Investigació Biomèdica Sant Pau (Iib-sant Pau), Universitat Autònoma de Barcelona (Uab), Centro de Investigación Biomédica En Red de Salud Mental (Cibersam), Spain
| | - José Manuel Crespo
- Department of Psychiatry, Complejo Hospitalario Universitario de Ferrol, Ferrol, Spain
| | - Fernando Mora
- Department of Psychiatry, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Adrián Neyra
- Department of Psychiatry, Hospital de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain
| | - Pedro Iborra
- Department of Psychiatry, San Juan University Hospital, Alicante, Spain
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