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Schumacher MM, Santambrogio J. Cortisol and the Dexamethasone Suppression Test as a Biomarker for Melancholic Depression: A Narrative Review. J Pers Med 2023; 13:jpm13050837. [PMID: 37241007 DOI: 10.3390/jpm13050837] [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: 04/14/2023] [Revised: 05/08/2023] [Accepted: 05/09/2023] [Indexed: 05/28/2023] Open
Abstract
The dexamethasone suppression test (DST) assesses the functionality of the HPA axis and can be regarded as the first potential biomarker in psychiatry. In 1981, a group of researchers at the University of Michigan published a groundbreaking paper regarding its use for diagnosing melancholic depression, reporting a diagnostic sensitivity of 67% and a specificity of 95%. While this study generated much enthusiasm and high expectations in the field of biological psychiatry, subsequent studies produced equivocal results, leading to the test being rejected by the American Psychiatric Association. The scientific reasons leading to the rise and fall of the DST are assessed in this review, suggestions are provided as to how the original test can be improved, and its potential applications in clinical psychiatry are discussed. An improved, standardized, and validated version of the DST would be a biologically meaningful and useful biomarker in psychiatry, providing a tool for clinicians caring for depressed patients in the areas of diagnosis, treatment, and prognosis, and predicting the risk of suicide. Additionally, such a test could be a crucial part in the generation of biologically homogenous patient cohorts, necessary for the successful development of new psychotropic medications.
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Affiliation(s)
| | - Jacopo Santambrogio
- Adele Bonolis AS.FRA. Onlus Foundation, 20854 Vedano al Lambro, Italy
- Presidio Corberi, ASST Brianza, 20812 Limbiate, Italy
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Gianfredi V, Dinu M, Nucci D, Eussen SJPM, Amerio A, Schram MT, Schaper N, Odone A. Association between dietary patterns and depression: an umbrella review of meta-analyses of observational studies and intervention trials. Nutr Rev 2023; 81:346-359. [PMID: 36240456 DOI: 10.1093/nutrit/nuac058] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
CONTEXT Depression is the most common causes of disease burden worldwide (GBD 2017 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018;392:1789-1858). OBJECTIVE An umbrella review has been performed to assess the strength and validity of the available observational and trial evidence for the association between a variety of dietary patterns and depression. DATA SOURCES MEDLINE/PubMed, Scopus, Web of Science, EMBASE, PsycINFO, and Cochrane Database were searched. DATA EXTRACTION The Joanna Briggs Institute Umbrella Review Methodology was used. DATA ANALYSIS The review included 19 articles, covering a relatively wide range of dietary patterns: healthy dietary patterns (n = 8), Mediterranean diet (MedDiet) (n = 6), Dietary Inflammatory Index (DII) (n = 5), Western diet (n = 4), Dietary Approaches to Stop Hypertension (DASH) (n = 2), vegetarian diets (n = 4), and other dietary interventions (n = 2). The methodological quality of the included meta-analyses was generally low or critically low. The strength of the evidence was generally weak, although convincing or suggestive evidence was found for an inverse relationship between MedDiet/DII and depression. Higher adherence to the MedDiet and lower DII score were significantly associated with lower risk of depression. CONCLUSION Considering the generally high heterogeneity and low quality of the available evidence, further studies adopting more coherent and uniform methodologies are needed. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration no. CRD42020223376.
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Affiliation(s)
- Vincenza Gianfredi
- are with the Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands.,are with the CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands.,is with the Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Monica Dinu
- is with the Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Daniele Nucci
- is with the Nutritional Support Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Simone J P M Eussen
- are with the Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands.,are with the CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands.,is with the Department of Epidemiology, Maastricht University, Maastricht, The Netherlands
| | - Andrea Amerio
- is with the Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy.,is with the IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,is with the Department of Psychiatry, Tufts University, Boston, MA, USA
| | - Miranda T Schram
- are with the CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands.,are with the Department of Internal Medicine, Maastricht University, Maastricht, The Netherlands.,is with the MHeNS School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands.,is with the Heart and Vascular Center, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Nicolaas Schaper
- are with the Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands.,are with the CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands.,are with the Department of Internal Medicine, Maastricht University, Maastricht, The Netherlands
| | - Anna Odone
- is with the Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
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Costantini L, Pasquarella C, Odone A, Colucci ME, Costanza A, Serafini G, Aguglia A, Belvederi Murri M, Brakoulias V, Amore M, Ghaemi SN, Amerio A. Screening for depression in primary care with Patient Health Questionnaire-9 (PHQ-9): A systematic review. J Affect Disord 2021; 279:473-483. [PMID: 33126078 DOI: 10.1016/j.jad.2020.09.131] [Citation(s) in RCA: 195] [Impact Index Per Article: 65.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 08/17/2020] [Accepted: 09/27/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Depression is a leading cause of disability. International guidelines recommend screening for depression and the Patient Health Questionnaire 9 (PHQ-9) has been identified as the most reliable screening tool. We reviewed the evidence for using it within the primary care setting. METHODS We retrieved studies from MEDLINE, Embase, PsycINFO, CINAHL and the Cochrane Library that carried out primary care-based depression screening using PHQ-9 in populations older than 12, from 1995 to 2018. RESULTS Forty-two studies were included in the systematic review. Most of the studies were cross-sectional (N=40, 95%), conducted in high-income countries (N=27, 71%) and recruited adult populations (N=38, 90%). The accuracy of the PHQ-9 was evaluated in 31 (74%) studies with a two-stage screening system, with structured interview most often carried out by primary care and mental health professionals. Most of the studies employed a cut-off score of 10 (N=24, 57%, total range 5 - 15). The overall sensitivity of PHQ-9 ranged from 0.37 to 0.98, specificity from 0.42 to 0.99, positive predictive value from 0.09 to 0.92, and negative predictive value from 0.8 to 1. LIMITATIONS Lack of longitudinal studies, small sample size, and the heterogeneity of primary-care settings limited the generalizability of our results. CONCLUSIONS PHQ-9 has been widely validated and is recommended in a two-stage screening process. Longitudinal studies are necessary to provide evidence of long-term screening effectiveness.
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Affiliation(s)
- Luigi Costantini
- Department of Medicine and Surgery, University of Parma, Parma, Italy.
| | | | - Anna Odone
- Vita-Salute San Raffaele University, Milan, Italy
| | | | - Alessandra Costanza
- Department of Psychiatry, Faculty of Medicine, University of Geneva (UNIGE), Geneva, Switzerland; Department of Psychiatry, ASO Santi Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy
| | - Gianluca Serafini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Andrea Aguglia
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Martino Belvederi Murri
- Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy
| | - Vlasios Brakoulias
- School of Medicine, Western Sydney University, Blacktown Hospital, Sydney, NSW, Australia
| | - Mario Amore
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - S Nassir Ghaemi
- Department of Psychiatry, Tufts University, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Andrea Amerio
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy; Department of Psychiatry, Tufts University, Boston, MA, USA
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Nucci D, Fatigoni C, Amerio A, Odone A, Gianfredi V. Red and Processed Meat Consumption and Risk of Depression: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E6686. [PMID: 32937855 PMCID: PMC7559491 DOI: 10.3390/ijerph17186686] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 09/08/2020] [Accepted: 09/10/2020] [Indexed: 12/12/2022]
Abstract
Depression is one of the leading causes of disability worldwide, with more than 264 million people affected. On average, depression first appears during the late teens to mid-20s as result of a complex interaction of social, psychological and biological factors. The aim of this systematic review with meta-analysis is to assess the association between red and processed meat intake and depression (both incident and prevalent). This systematic review was conducted according to the methods recommended by the Cochrane Collaboration and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Relevant papers published through March 2020 were identified by searching the electronic databases MEDLINE, Embase and Scopus. All analyses were conducted using ProMeta3 software. A critical appraisal was conducted. Finally, 17 studies met the inclusion criteria. The overall effect size (ES) of depression for red and processed meat intake was 1.08 [(95% CI = 1.04; 1.12), p-value < 0.001], based on 241,738 participants. The results from our meta-analysis showed a significant association between red and processed meat intake and risk of depression. The presented synthesis will be useful for health professionals and policy makers to better consider the effect of diet on mental health status.
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Affiliation(s)
- Daniele Nucci
- Digestive Endoscopy Unit, Veneto Institute of Oncology IOV-IRCCS, Via Gattamelata 64, 35128 Padua, Italy;
| | - Cristina Fatigoni
- Department of Pharmaceutical Science, University of Perugia, Via del Giochetto, 06123 Perugia, Italy;
| | - Andrea Amerio
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, 16132 Genoa, Italy;
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
- Department of Psychiatry, Tufts University, Medford, MA 02111, USA
| | - Anna Odone
- School of Medicine, Vita-Salute San Raffaele University, 20132 Milan, Italy;
| | - Vincenza Gianfredi
- School of Medicine, Vita-Salute San Raffaele University, 20132 Milan, Italy;
- CAPHRI Care and Public Health Research Institute, Maastricht University, 6211 Maastricht, The Netherlands
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Costanza A, Mazzola V, Radomska M, Amerio A, Aguglia A, Prada P, Bondolfi G, Sarasin F, Ambrosetti J. Who Consult an Adult Psychiatric Emergency Department? Pertinence of Admissions and Opportunities for Telepsychiatry. ACTA ACUST UNITED AC 2020; 56:medicina56060295. [PMID: 32545811 PMCID: PMC7353920 DOI: 10.3390/medicina56060295] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 05/27/2020] [Accepted: 06/10/2020] [Indexed: 02/06/2023]
Abstract
Background and Objectives: Psychiatric disorders constitute frequent causes of emergency department (ED) admissions and these rates are increasing. However, referring to ED a whole range of conditions that could or should be dealt with elsewhere is imposing itself as a problematic situation. We aimed: (1) to provide a descriptive picture of the socio-demographic and diagnostic characteristics of the visits among adults at the psychiatric ED; (2) to estimate the clinical pertinence of these visits. Materials and Methods: Retrospective analysis of diagnostic/socio-demographic characteristics and clinical trajectories of patients admitted for a psychiatric condition at the adult psychiatric ED of the University Hospital of Geneva (HUG), Switzerland, during a 6-week timespan. Results: In our sample (n = 763 total admissions for psychiatric conditions; n = 702 for inclusion of patients having received a medical evaluation), depression/anxiety, suicidal behavior (SB), psychotic episode, and substance use disorder (SUD), in descending order, were the most common diagnoses for referral. Patients belonged to younger age groups (≤65 years), had a familial status other than married/in couple, and did not present an unfavorable socio-demographic profile. Concerning the pertinence for a psychiatric ED, primary diagnosis of depression/anxiety is the only variable significantly associated with different grade of degree. By the examination of the patients’ trajectory from admission to discharge, the clinical pertinence for a psychiatric ED admission existed for cases assigned to the Echelle Suisse du Tri (EST®) scale degree 1 (corresponding to most urgent and severe conditions), particularly for diagnoses of depression/anxiety associated with SB, SB as primary or comorbid diagnosis, and psychotic and manic/hypomanic episode. However, diagnoses of depression/anxiety without urgent and severe features (degrees 2, 3, 4) constituted the most frequent mode of presentation. Conclusions: Ambulatory and community-integrated settings could be more appropriate for the majority of patients admitted to adult psychiatric EDs. Moreover, the implementation of telepsychiatry strategies represents a very promising opportunity to offer these patients care continuity, reduce costs and filter the demand for psychiatric ED.
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Affiliation(s)
- Alessandra Costanza
- Department of Psychiatry, Faculty of Medicine, University of Geneva (UNIGE), 1211 Geneva, Switzerland; (P.P.); (G.B.); (F.S.)
- Department of Psychiatry, ASO Santi Antonio e Biagio e Cesare Arrigo Hospital, 15121 Alessandria, Italy
- Correspondence: ; Tel.: +41-22-379-59-00
| | - Viridiana Mazzola
- Department of Psychiatry, Service of Liaison Psychiatry and Crisis Intervention, Geneva University Hospitals (HUG), 1211 Geneva, Switzerland;
| | - Michalina Radomska
- Faculty of Psychology, University of Geneva (UNIGE), 1206 Geneva, Switzerland;
| | - Andrea Amerio
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, 16132 Genoa, Italy; (A.A.); (A.A.)
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
- Mood Disorders Program, Tufts Medical Center, Boston, MA 02111, USA
| | - Andrea Aguglia
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, 16132 Genoa, Italy; (A.A.); (A.A.)
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Paco Prada
- Department of Psychiatry, Faculty of Medicine, University of Geneva (UNIGE), 1211 Geneva, Switzerland; (P.P.); (G.B.); (F.S.)
- Department of Psychiatry, Service of Liaison Psychiatry and Crisis Intervention, Geneva University Hospitals (HUG), 1211 Geneva, Switzerland;
| | - Guido Bondolfi
- Department of Psychiatry, Faculty of Medicine, University of Geneva (UNIGE), 1211 Geneva, Switzerland; (P.P.); (G.B.); (F.S.)
- Department of Psychiatry, Service of Liaison Psychiatry and Crisis Intervention, Geneva University Hospitals (HUG), 1211 Geneva, Switzerland;
| | - François Sarasin
- Department of Psychiatry, Faculty of Medicine, University of Geneva (UNIGE), 1211 Geneva, Switzerland; (P.P.); (G.B.); (F.S.)
- Emergency Department, Emergency Medicine Unit, Geneva University Hospitals, 1211 Geneva, Switzerland
| | - Julia Ambrosetti
- Department of Psychiatry and Emergency Department, Emergency Psychiatric Unit, Geneva University Hospitals, 1211 Geneva, Switzerland;
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Depression and Objectively Measured Physical Activity: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17103738. [PMID: 32466242 PMCID: PMC7277615 DOI: 10.3390/ijerph17103738] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 05/13/2020] [Accepted: 05/15/2020] [Indexed: 12/20/2022]
Abstract
Depression is a major contributor to the overall global burden of disease, with high prevalence and relapse rate. Several factors have been considered in order to reduce the depression burden. Among them, physical activity (PA) showed a potential protective role. However, evidence is contrasting probably because of the differences in PA measurement. The aim of this systematic review with meta-analysis is to assess the association between objectively measured PA and incident and prevalent depression. The systematic review was conducted according to methods recommended by the Cochrane Collaboration and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Relevant papers published through 31 August 2019 were identified searching through the electronic databases PubMed/MEDLINE, Excerpta Medica dataBASE (Embase), PsycINFO, Scopus, Web of Science (WoS), and the Cochrane Library. All analyses were conducted using ProMeta3. Finally, 42 studies met inclusion criteria. The overall Effect size (ES) of depression for the highest vs. the lowest level of PA was −1.16 [(95% CI = −1.41; −0.91), p-value < 0.001] based on 37,408 participants. The results of the meta-analysis showed a potential protective effect of PA on prevalent and incident depression.
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Duffy A, Malhi GS, Grof P. Do the Trajectories of Bipolar Disorder and Schizophrenia Follow a Universal Staging Model? CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2017; 62:115-122. [PMID: 27310243 PMCID: PMC5298521 DOI: 10.1177/0706743716649189] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE The purpose of this study is to address the question of whether a universal staging model of severe psychiatric disorders is a viable direction for future research by examining the extant literature. METHOD A narrative review was conducted of the relevant historical, conceptual, and empirical literature pertaining to the clinical trajectory of bipolar disorder and schizophrenia and issues relevant to staging. RESULTS There is substantive evidence that classic recurrent bipolar disorder is separable from schizophrenia on the basis of family history, developmental and clinical course, treatment response, and neurobiological findings. However, because of the intrinsic heterogeneity of diagnostic categories that has been amplified by recent changes in psychiatric taxonomy, key distinctions between the groups have become obfuscated. While mapping risk and illness markers to emerging psychopathology is a logical approach and may be of value for some psychiatric disorders and/or their clinical subtypes, robust evidence supporting identifiable stages per se is still lacking. Presently, even rudimentary stages such as prodromes cannot be meaningfully applied across different disorders and no commonalities can be found for the basis of universal staging. CONCLUSIONS Advances in the prediction of risk, accurate early illness detection, and tailored intervention will require mapping biomarkers and other risk indicators to reliable clinical phases of illness progression. Given the capricious nature of mood and psychotic disorders, this task is likely to yield success only if conducted in narrowly defined subgroups of individuals at high risk for specific illnesses. This approach is diametrically opposite to that being promulgated by proponents of a universal staging model.
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Affiliation(s)
- Anne Duffy
- 1 Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada.,2 Mood Disorders Centre of Ottawa, Ottawa, Ontario, Canada
| | - Gin S Malhi
- 3 Department of Psychiatry, Royal North Shore Hospital, New South Wales, Australia.,4 Discipline of Psychiatry and Kolling Institute, Sydney Medical School, University of Sydney, New South Wales, Australia
| | - Paul Grof
- 2 Mood Disorders Centre of Ottawa, Ottawa, Ontario, Canada.,5 Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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Amerio A, Odone A, Marchesi C, Ghaemi SN. Are antidepressants mood destabilizers? Psychiatry Res 2015; 227:374-5. [PMID: 25847215 DOI: 10.1016/j.psychres.2015.03.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 03/11/2015] [Accepted: 03/13/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Andrea Amerio
- Department of Neuroscience, Section of Psychiatry, University of Parma, Parma, Italy; Mood Disorders Program, Tufts Medical Center, Boston, MA, USA.
| | - Anna Odone
- School of Medicine-Public Health Unit, University of Parma, Parma, Italy; Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Carlo Marchesi
- Department of Neuroscience, Section of Psychiatry, University of Parma, Parma, Italy
| | - S Nassir Ghaemi
- Mood Disorders Program, Tufts Medical Center, Boston, MA, USA; Department of Psychiatry and Pharmacology, Tufts University Medical School, Boston, MA, USA
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