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Hu C, Ding L, Peng K. Global burden of major depressive disorders attributable to intimate partner violence against women: Magnitude, temporal trends, and regional inequalities. J Affect Disord 2024; 363:182-191. [PMID: 39025448 DOI: 10.1016/j.jad.2024.07.098] [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: 12/11/2023] [Revised: 07/04/2024] [Accepted: 07/15/2024] [Indexed: 07/20/2024]
Abstract
AIMS This study aimed to analyze the temporal trends, spatial heterogeneities, and potential improvements in the burden of major depressive disorders (MDD) attributable to intimate partner violence (IPV) against women across 21 global burden of disease (GBD) regions, and 204 countries and territories from 1990 to 2019. METHODS We evaluated the burden of MDD attributable to IPV against women, as measured in disability-adjusted life years (DALYs) per 100,000 people across 21 GBD regions and 204 GBD countries and territories, using data from the 2019 GBD Study. The average annual percentage change (AAPC) of the DALY age-standardized rates (ASRs) was used to reflect trends over time. LOESS and quantile regression were used to model the relationship between the five GBD sociodemographic index (SDI) categories and DALY ASRs. Frontier analysis determined the minimum achievable DALY ASR associated with developmental status, as measured by the SDI. RESULTS The overall AAPC in age-standardized DALY rates for MDD attributable to IPV declined globally between 1990 and 2019. Despite the overall global decline (AAPC -0.08 [95 % UI -0.2, 0.03]), certain GBD regions, particularly high-income North America and Central Latin America, have experienced increases in DALY ASRs. The relationship between SDI and MDD burden showed a U-shaped variability, with low-SDI regions consistently exhibiting higher and stable DALY rates. Frontier analysis revealed that several countries, regardless of their SDI, have substantial gaps between observed and potentially achievable DALY rates, indicating areas for targeted intervention to reduce the burden of MDD due to IPV. CONCLUSIONS Significant spatial and temporal heterogeneity in MDD due to IPV was observed globally from 1990 to 2019, highlighting the substantial potential for improvement in various countries. Protective measures should be customized to suit the unique cultural contexts, developmental statuses, and regional disparities of each country.
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Affiliation(s)
- Chengxi Hu
- Department of Psychological and Cognitive Sciences, Tsinghua University, Beijing, China
| | - Lin Ding
- Department of Psychological and Cognitive Sciences, Tsinghua University, Beijing, China
| | - Kaiping Peng
- Department of Psychological and Cognitive Sciences, Tsinghua University, Beijing, China.
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Liu Q, Davey D, Jimmy J, Ajilore O, Klumpp H. Network Analysis of Behavioral Activation/Inhibition Systems and Brain Volume in Individuals With and Without Major Depressive Disorder or Social Anxiety Disorder. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2024; 9:551-560. [PMID: 37659443 PMCID: PMC10904669 DOI: 10.1016/j.bpsc.2023.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 08/11/2023] [Accepted: 08/13/2023] [Indexed: 09/04/2023]
Abstract
BACKGROUND Social anxiety disorder (SAD) and major depressive disorder (MDD) are characterized by behavioral abnormalities in motivational systems, namely the behavioral inhibition system (BIS) and behavioral activation system (BAS). Limited studies indicate brain volume in regions that support emotion, learning/memory, reward, and cognitive functions relate to BIS/BAS. To increase understanding of BIS/BAS, the current study used a network approach. METHODS Patients with SAD (n = 59), patients with MDD (n = 64), and healthy control participants (n = 36) completed a BIS/BAS questionnaire and structural magnetic resonance imaging scans; volumetric regions of interest comprised cortical and limbic structures based on previous BIS/BAS studies. A Bayesian Gaussian graphical model was used for each diagnostic group, and groups were compared. Among network metrics, bridge centrality was of primary interest. Analysis of variance evaluated BIS/BAS behaviors between groups. RESULTS Bridge centrality showed hippocampus positively related to BAS, but not to BIS, in the MDD group; no findings were observed in the SAD or control groups. Yet, network density (i.e., overall strength of relationships between variables) and degree centrality (i.e., overall relationship between one variable to all other variables) showed that cortical (e.g., precuneus, medial orbitofrontal) and subcortical (e.g., amygdala, hippocampus) regions differed between diagnostic groups. Analysis of variance results showed BAS was lower in the MDD/SAD groups compared with the control group, while BIS was higher in the SAD group relative to the MDD group, which in turn was higher than the control group. CONCLUSIONS Preliminary findings indicate that network-level aberrations may underlie motivational abnormalities in MDD and SAD. Evidence of BIS/BAS differences builds on previous work that points to shared and distinct motivational differences in internalizing psychopathologies.
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Affiliation(s)
- Qimin Liu
- Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois
| | - Delaney Davey
- Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois.
| | - Jagan Jimmy
- Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, Ohio
| | - Olusola Ajilore
- Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois
| | - Heide Klumpp
- Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois
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Curtiss J, Smoller JW, Pedrelli P. Optimizing precision medicine for second-step depression treatment: a machine learning approach. Psychol Med 2024:1-8. [PMID: 38533794 DOI: 10.1017/s0033291724000497] [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] [Indexed: 03/28/2024]
Abstract
BACKGROUND Less than a third of patients with depression achieve successful remission with standard first-step antidepressant monotherapy. The process for determining appropriate second-step care is often based on clinical intuition and involves a protracted course of trial and error, resulting in substantial patient burden and unnecessary delay in the provision of optimal treatment. To address this problem, we adopt an ensemble machine learning approach to improve prediction accuracy of remission in response to second-step treatments. METHOD Data were derived from the Level 2 stage of the STAR*D dataset, which included 1439 patients who were randomized into one of seven different second-step treatment strategies after failing to achieve remission during first-step antidepressant treatment. Ensemble machine learning models, comprising several individual algorithms, were evaluated using nested cross-validation on 155 predictor variables including clinical and demographic measures. RESULTS The ensemble machine learning algorithms exhibited differential classification performance in predicting remission status across the seven second-step treatments. For the full set of predictors, AUC values ranged from 0.51 to 0.82 depending on the second-step treatment type. Predicting remission was most successful for cognitive therapy (AUC = 0.82) and least successful for other medication and combined treatment options (AUCs = 0.51-0.66). CONCLUSION Ensemble machine learning has potential to predict second-step treatment. In this study, predictive performance varied by type of treatment, with greater accuracy in predicting remission in response to behavioral treatments than to pharmacotherapy interventions. Future directions include considering more informative predictor modalities to enhance prediction of second-step treatment response.
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Affiliation(s)
- Joshua Curtiss
- Depression Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Jordan W Smoller
- Center for Precision Psychiatry, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Paola Pedrelli
- Depression Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
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Serretti A. Modulating factors in mood disorders treatment. Int Clin Psychopharmacol 2024; 39:47-50. [PMID: 38299310 DOI: 10.1097/yic.0000000000000534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
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Moggia D, Bennemann B, Schwartz B, Hehlmann MI, Driver CC, Lutz W. Process-Based psychotherapy personalization: considering causality with continuous-time dynamic modeling. Psychother Res 2023; 33:1076-1095. [PMID: 37306112 DOI: 10.1080/10503307.2023.2222892] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 06/02/2023] [Indexed: 06/13/2023] Open
Abstract
Psychotherapy can be improved by integrating the study of mediators (how it works) and moderators (for whom it works). To demonstrate this integration, we studied the relationship between resource activation, problem-coping experiences and symptoms in cognitive-behavior therapy (CBT) for depression, to obtain preliminary insights on causal inference (which process leads to symptom improvement?) and prediction (which one for whom?). A sample of 715 patients with depression who received CBT was analyzed. Hierarchical Bayesian continuous time dynamic modeling was used to study the temporal dynamics between the variables analyzed within the first ten sessions. Depression and self-efficacy at baseline were examined as predictors of these dynamics. There were significant cross-effects between the processes studied. Under typical assumptions, resource activation had a significant effect on symptom improvement. Problem-coping experience had a significant effect on resource activation. Depression and self-efficacy moderated these effects. However, when system noise was considered, these effects may be affected by other processes. Resource activation was strongly associated with symptom improvement. To the extent of inferring causality, for patients with mild-moderate depression and high self-efficacy, promoting resource activation can be recommended. For patients with severe depression and low self-efficacy, promoting problem-coping experiences can be recommended.
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Kyriacou T, Hodges J, Gould RL. Predictors and moderators of treatment outcome in late-life anxiety: A systematic review. J Affect Disord 2023; 339:454-470. [PMID: 37442444 DOI: 10.1016/j.jad.2023.07.057] [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: 02/17/2023] [Revised: 07/09/2023] [Accepted: 07/10/2023] [Indexed: 07/15/2023]
Abstract
BACKGROUND The aim of this review was to identify and critically appraise predictors and moderators of outcomes of psychological and pharmacological treatments for late-life anxiety disorders. Their identification may guide the development of personalised treatments for older people with anxiety disorders. METHODS Web of Science, PsychINFO, CINAHL, Embase, and Pubmed were searched for studies published up to 12 May 2022. Randomised controlled trials and observational studies reporting treatment predictors and moderators were included. Participants with a diagnosis of any anxiety disorder who were aged over 60 years were included. Treatment outcomes included response, remission, and change in anxiety score. RESULTS Thirteen studies met the inclusion criteria. Twenty-three out of 49 predictors or moderators assessed at post-treatment, and 14 out of 33 predictors or moderators assessed at follow-up were statistically significant. Only one predictor, baseline worry severity at post-treatment, was reported in at least three studies. Most studies were rated as having a low risk of bias in at least three areas and satisfied important quality criteria for predictor and moderator analyses. LIMITATIONS Samples were predominantly white, female and highly educated, and most studies were secondary analyses. CONCLUSIONS There is evidence that baseline worry severity appears to predict treatment outcome in late-life anxiety disorders. However, this was only explored in psychological intervention studies and therefore its predictive ability in pharmacotherapy remains unknown. Future research should explore predictors and moderators in a range of anxiety disorders and design methodologically-strong and adequately-powered studies with the primary aim of assessing predictors of treatment outcomes.
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Affiliation(s)
| | - Jade Hodges
- Division of Psychiatry, University College London, London, UK
| | - Rebecca L Gould
- Division of Psychiatry, University College London, London, UK
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Benarous X, Lahaye H, Pellerin H, Consoli A, Cohen D, Labelle R, Renaud J, Gérardin P, El-Khoury F, van der Waerden J, Guilé JM. Hard-to-treat or hard-to-catch? Clinical features and therapeutic outcomes of help-seeking foster care youths with mood disorders. Front Psychiatry 2023; 14:1211516. [PMID: 37900296 PMCID: PMC10603296 DOI: 10.3389/fpsyt.2023.1211516] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 10/02/2023] [Indexed: 10/29/2023] Open
Abstract
Introduction The high level of emotional problems in youths placed in foster care contrasts with the limited use of evidence-based treatments. This study aims to better characterize the clinical features and therapeutic outcomes of foster care youths with mood disorders. Methods A secondary analysis of data collected in the context of a French-Canadian clinical research network on pediatric mood disorders in four sites was conducted to compare three groups of patients with depressive or bipolar disorder: those without exposure to child welfare intervention (WCWI, n = 181), those who received non-placement psychosocial intervention (NPI, n = 62), and those in placement interventions (PI, n = 41). Results We observed a very high rate of academic problems in patients in the groups NPI/PI compared to those in the WCWI group. Patients in the PI group had more disruptive behavioral disorders (OR = 6.87, 95% CI [3.25-14.52]), trauma-related disorders (OR = 3.78, 95% CI [1.6-8.94]), and any neurodevelopmental disorders (OR = 2.73, 95% CI [1.36-5.49]) compared to the other groups (NPI/WCWI). Among inpatients, the Clinical Global Impression-Improvement scale and the change in the Children Global Assessment Scale during the hospital stay did not differ across the three groups. We observed a higher prescription rate of antipsychotics in the PI group compared to the NPI/WCWI groups, but no significant difference for antidepressants and mood stabilizers. Discussion These findings support the view that, when provided with dedicated support, fostered inpatient youths can improve in a range comparable to other inpatients. Undetected neurodevelopmental disorders and academic problems are likely important contributors of the burden of mood disorders in these youths.
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Affiliation(s)
- Xavier Benarous
- Department of Child and Adolescent Psychopathology, Amiens University Hospital, Amiens, France
- INSERM Unit U1105 Research Group for Analysis of the Multimodal Cerebral Function, University of Picardy Jules Verne (UPJV), Amiens, France
| | - Hélène Lahaye
- Department of Child and Adolescent Psychopathology, Amiens University Hospital, Amiens, France
- INSERM Unit U1105 Research Group for Analysis of the Multimodal Cerebral Function, University of Picardy Jules Verne (UPJV), Amiens, France
| | - Hugues Pellerin
- Department of Child and Adolescent Psychiatry, Pitié-Salpêtrière University Hospital, APHP, Paris, France
| | - Angèle Consoli
- Department of Child and Adolescent Psychiatry, Pitié-Salpêtrière University Hospital, APHP, Paris, France
| | - David Cohen
- Department of Child and Adolescent Psychiatry, Pitié-Salpêtrière University Hospital, APHP, Paris, France
- CNRS UMR 7222, Institute for Intelligent Systems and Robotics, Sorbonne University, Paris, France
| | - Réal Labelle
- Department of Psychology, Université du Québec à Montréal, Montréal, QC, Canada
- Centre for Research and Intervention on Suicide, Ethical Issues and End-of-Life Practices, Université du Québec à Montréal, Montréal, QC, Canada
| | - Johanne Renaud
- Manulife Centre for Breakthroughs in Teen Depression and Suicide Prevention, Douglas Mental Health University Institute, McGill University, Montréal, QC, Canada
- Department of Psychiatry, McGill University, Montréal, QC, Canada
| | - Priscille Gérardin
- Department of Child and Adolescent Psychopathology, Rouen University Hospital, Rouen, France
| | - Fabienne El-Khoury
- Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Equipe de Recherche en Epidémiologie Sociale, Paris, France
| | - Judith van der Waerden
- Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Equipe de Recherche en Epidémiologie Sociale, Paris, France
| | - Jean-Marc Guilé
- Department of Child and Adolescent Psychopathology, Amiens University Hospital, Amiens, France
- INSERM Unit U1105 Research Group for Analysis of the Multimodal Cerebral Function, University of Picardy Jules Verne (UPJV), Amiens, France
- Pôle de psychiatrie de l’enfant et de l’adolescent, Etablissement Publique de Santé Mentale de la Somme, Paris, France
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Vyas CM, Mischoulon D, Chang G, Reynolds CF, Cook NR, Weinberg A, Copeland T, Bubes V, Bradwin G, Lee IM, Buring JE, Mora S, Rifai N, Manson JE, Okereke OI. Relation of serum BDNF to major depression and exploration of mechanistic roles of serum BDNF in a study of vitamin D3 and omega-3 supplements for late-life depression prevention. J Psychiatr Res 2023; 163:357-364. [PMID: 37267732 PMCID: PMC10306120 DOI: 10.1016/j.jpsychires.2023.05.069] [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: 02/07/2023] [Revised: 04/11/2023] [Accepted: 05/25/2023] [Indexed: 06/04/2023]
Abstract
This study: 1) examined cross-sectional and longitudinal relations of serum brain-derived neurotrophic factor (BDNF) to late-life depression (LLD); 2) tested effects of vitamin D3 and omega-3s on change in BDNF; 3) explored modifying or mediating roles of BDNF on effects of vitamin D3 and omega-3s for LLD. We selected 400 adults from a completed trial of vitamin D3 and omega-3 supplements for LLD prevention. BDNF was measured using an enzyme-linked immunosorbent assay. We administered semi-structured diagnostic interviews and Patient Health Questionnaire [PHQ]-9 to ascertain outcomes at baseline (depression caseness vs. non-caseness; PHQ-9) and at 2-year follow-up among baseline non-depressed individuals (incident vs. no incident MDD; change in PHQ-9). At baseline, while there were no significant differences in mean serum BDNF comparing depression cases and non-cases, being in the lowest vs. highest serum BDNF quartile was significantly associated with worse depressive symptoms. There were no significant longitudinal associations between serum BDNF and LLD. Neither supplement significantly affected change in BDNF; serum BDNF did not appear to modify or mediate treatment effects on LLD. In conclusion, we observed significant cross-sectional but not longitudinal associations between serum BDNF levels and LLD. Vitamin D3 or omega-3s did not alter serum BDNF over 2 years.
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Affiliation(s)
- Chirag M Vyas
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
| | - David Mischoulon
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Grace Chang
- Department of Psychiatry, VA Boston Healthcare System and Harvard Medical School, Boston, MA, USA
| | - Charles F Reynolds
- Department of Psychiatry, UPMC and University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Nancy R Cook
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Alison Weinberg
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Trisha Copeland
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Vadim Bubes
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Gary Bradwin
- Department of Laboratory Medicine, Boston Children's Hospital, Boston, MA, USA
| | - I-Min Lee
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Julie E Buring
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Samia Mora
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Nader Rifai
- Department of Laboratory Medicine, Boston Children's Hospital, Boston, MA, USA
| | - JoAnn E Manson
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Olivia I Okereke
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
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Maciaszek J, Pawłowski T, Hadryś T, Misiak B. Baseline depressive symptoms as predictors of efficacy and tolerability of the treatment with duloxetine: a network analysis approach. Front Psychiatry 2023; 14:1210289. [PMID: 37398593 PMCID: PMC10312095 DOI: 10.3389/fpsyt.2023.1210289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 06/02/2023] [Indexed: 07/04/2023] Open
Abstract
Introduction Depression is considered one of the most prevalent and burdensome mental disorders. Only 50-60% of patients respond to first-line treatment. Individuals with depression might benefit from personalized treatment, tailored to the individual needs of the patient. In this study, we aimed to explore the baseline characteristics of depressive symptoms associated with a good response to duloxetine treatment using a network analysis. Additionally, the relationship between baseline psychopathological symptoms and treatment tolerability was assessed. Methods The sample of 88 drug-free patients with active depressive episode, who started monotherapy with increasing doses of duloxetine were evaluated. The Hamilton Depression Rating Scale (HAM-D) was used to assess depression severity and the UKU side effect rating scale to monitor adverse drug reactions (ADRs). A network analysis that explored interactions of specific baseline depression symptoms, treatment efficacy and tolerability was performed. Results The node representing duloxetine treatment efficacy was directly connected to the nodes representing the first HAM-D item ("depressed mood") (edge weight = 0.191) and duloxetine dose (edge weight = 0.144). The node representing ADRs was directly connected to only one node representing the baseline score of the HAM-D anxiety (psychic) item (edge weight = 0.263). Discussion Our findings indicate that individuals with depression presenting greater levels of depressed mood and lower levels of anxiety symptoms might better respond to the treatment with duloxetine in terms of efficacy and tolerability.
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Lundberg J, Cars T, Lööv SÅ, Söderling J, Sundström J, Tiihonen J, Leval A, Gannedahl A, Björkholm C, Själin M, Hellner C. Association of Treatment-Resistant Depression With Patient Outcomes and Health Care Resource Utilization in a Population-Wide Study. JAMA Psychiatry 2023; 80:167-175. [PMID: 36515938 PMCID: PMC9856735 DOI: 10.1001/jamapsychiatry.2022.3860] [Citation(s) in RCA: 30] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Importance The totality of the societal and individual impact of treatment-resistant depression (TRD) is unknown, as is the potential to prognosticate TRD. The generalizability of many observational studies on TRD is limited. Objective To estimate the burden of TRD in a large population-wide cohort in an area with universal health care by including data from both health care types (psychiatric and nonpsychiatric) and, further, to develop a prognostic model for clinical use. Design, Setting, and Participants This cohort study, a population-based observational study, assessed data from the Stockholm MDD Cohort for episodes of major depressive disorder (MDD) between 2010 and 2017 that fulfilled predefined criteria for TRD (≥3 consecutive antidepressant treatments). Data analysis was performed from August 2020 to May 2022. Main Outcomes and Measures Outcomes were psychiatric and nonpsychiatric comorbid conditions, antidepressant treatments, health care resource utilization, lost workdays, all-cause mortality, and intentional self-harm and, in the prognostic model, TRD. Results A total of 158 169 unipolar MDD episodes (in 145 577 patients) were identified between January 1, 2012, and December 31, 2017 (64.7% women; median [IQR] age, 42 years [30-56]). Of these, 12 793 episodes (11%) fulfilled criteria for TRD. The median (IQR) time from the start of MDD episode to TRD was 552 days (294-932). Selective serotonin reuptake inhibitor was the most common class of antidepressant treatment in all treatment steps, and 5907 patients (46.2%) received psychotherapy at some point before initiation of the third pharmacological antidepressant treatment. Compared with matched non-TRD episodes, TRD episodes had more inpatient bed-days (mean, 3.9 days; 95% CI, 3.6-4.1, vs 1.3 days; 95% CI, 1.2-1.4) and more lost workdays (mean, 132.3 days; 95% CI, 129.5-135.1, vs 58.7 days; 95% CI, 56.8-60.6) 12 months after the index date. Anxiety, stress, sleep disorder, and substance use disorder were all more common comorbid conditions in TRD episodes. Intentional self-harm was more than 4 times more common in TRD episodes. The all-cause mortality rate for patients with MDD with TRD episodes was 10.7/1000 person-years at risk, compared with 8.7/1000 person-years at risk for patients with MDD without TRD episodes (hazard ratio, 1.23; 95% CI, 1.07-1.41). Median time from start of the first antidepressant treatment to start of the second, and from start of the second antidepressant treatment to start of the third, was 165 and 197 days, respectively. The severity of MDD, defined using the self-rating Montgomery-Åsberg Depression Rating Scale (MADRS-S) at time of MDD diagnosis, was found to be the most important prognostic factor for TRD (C index = 0.69). Conclusions and Relevance In this cohort study, TRD was a common variant of MDD when including patients from both health care types, which is associated with a high disease burden for both patients and society. The median time between initiation of new antidepressant treatments was longer than recommended in current treatment guidelines, suggesting room for more structured and timely depression care.
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Affiliation(s)
- Johan Lundberg
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden,Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Thomas Cars
- Sence Research, Uppsala, Sweden,Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Sven-Åke Lööv
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Jonas Söderling
- Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Johan Sundström
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden,The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Jari Tiihonen
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden,Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland,Neuroscience Center, University of Helsinki, Helsinki, Finland
| | - Amy Leval
- Janssen-Cilag, Solna, Sweden,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | | | | | | | - Clara Hellner
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden,Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
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Shahini N, Salimi Z, Kiani D, Raftari A, Ziaee M. Relationship of serum estradiol and progesterone with symptoms and sex difference in schizophrenia: A cross-sectional study in Iran. Front Psychiatry 2023; 14:1075780. [PMID: 36970277 PMCID: PMC10030605 DOI: 10.3389/fpsyt.2023.1075780] [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: 10/20/2022] [Accepted: 01/25/2023] [Indexed: 03/29/2023] Open
Abstract
Background Schizophrenia is a devastating disease characterized by frequent relapses, cognitive decline, and emotional and functional disability, with unknown causes. The phenomenology and clinical course of schizophrenic disorders are different between the two genders, which is thought to be related mainly to the effects of steroid sex hormones on the nervous system. Regarding inconsistencies in the studies, we aimed to compare the levels of estradiol and progesterone between schizophrenia patients and healthy individuals. Methods This cross-sectional study was conducted on 66 patients referred to the specialized clinical psychiatric ward of a teaching hospital in the north of Iran, for 5 months in 2021. Thirty-three schizophrenia patients confirmed by a psychiatrist based on DSM5 criteria were included in the case group, and 33 individuals without a psychiatric disease were included in the control group. We completed a demographic information checklist for each patient, along with the Simpson-Angus extrapyramidal side effect scale (SAS) for drug side effects and the positive and negative syndrome scale (PANSS) for the severity of the disease symptoms. Then, a 3-ml blood sample was taken from each participant to determine the serum levels of estradiol and progesterone. The data were analyzed by SPSS16 software. Results Thirty-four (51.5%) and 32 (48.5%) participants in this study were male and female, respectively. The mean serum level of estradiol was 22.33 ± 13.65 pm/dl in schizophrenia patients and 29.36 ± 21.32 pm/dl in the control group, showing no significant difference between the two groups (P = 0.4). However, the mean serum level of progesterone was significantly lower in schizophrenia patients (0.37 ± 1.39 pm/dl) than in control subjects (3.15 ± 5.73 pm/dl) (P < 0.001). The PANSS and SAS scores were not significantly correlated with the level of sex hormones (P > 0.05). Serum estradiol and progesterone levels based on sex significantly differed between the two groups (except for female estradiol). Conclusion Considering the hormonal differences between schizophrenia patients and control subjects, determining hormonal levels in these patients and using complementary hormonal therapies with estradiol or similar compounds can be beneficial as the starting point of schizophrenia treatment, where therapeutic responses can draw the future developmental framework.
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Affiliation(s)
- Najmeh Shahini
- Golestan Research Center of Psychiatry (GRCP), Golestan University of Medical Sciences, Gorgan, Iran
- Clinical Research Development Unit (CRDU), 5 Azar Hospital, Golestan University of Medical Sciences, Gorgan, Iran
| | - Zanireh Salimi
- Psychiatry and Behavioral Sciences Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Dorsa Kiani
- Golestan Research Center of Psychiatry (GRCP), Golestan University of Medical Sciences, Gorgan, Iran
- Dorsa Kiani,
| | - Ahmad Raftari
- Golestan Research Center of Psychiatry (GRCP), Golestan University of Medical Sciences, Gorgan, Iran
| | - Maliheh Ziaee
- Department of Community Medicine, School of Medicine, Social Determinants of Health Research Center, Gonabad University of Medical Sciences, Gonabad, Iran
- *Correspondence: Maliheh Ziaee,
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12
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Rutherford ER, Vandelanotte C, Chapman J, To QG. Associations between depression, domain-specific physical activity, and BMI among US adults: NHANES 2011-2014 cross-sectional data. BMC Public Health 2022; 22:1618. [PMID: 36008859 PMCID: PMC9413906 DOI: 10.1186/s12889-022-14037-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 08/19/2022] [Indexed: 11/29/2022] Open
Abstract
Background Physical activity is associated with depression. However, benefits of physical activity on depression may differ for specific domains of physical activity (i.e., leisure-time, work, and travel). Moreover, the relationship between physical activity and depression could also differ for people in different Body Mass Index (BMI) categories. This study investigated the relationship between domain-specific physical activity and BMI with depression, and the moderation effects of BMI on the relationship between domain physical activity and depression. Methods Complex survey data from the NHANES 2011-2014 was used (N=10,047). Depression was measured using the Patient Health Questionnaire (PHQ-9). Participants reported physical activity minutes in each domain using the Global Physical Activity Questionnaire. Demographic characteristics were self-reported. Weight and height were objectively measured and used for calculating BMI. Survey procedures were used to account for complex survey design. As two survey cycles were used, sampling weights were re-calculated and used for analyses. Taylor series linearisation was chosen as a variance estimation method. Results Participants who engaged in ≥150 minutes/week of total moderate-vigorous physical activity (MVPA) (adjusted B = 0.83, 95% CI [0.50, 1.16]) and leisure-time MVPA (adjusted B = 0.84, 95% CI [0.57, 1.11]) experienced lower levels of depression compared to those engaging in <150 MVPA minutes/week. Work and travel-related physical activity were not associated with depression. Overweight (adjusted B = -0.40, 95% CI [-0.76, -0.04]) and underweight/normal weight participants (adjusted B = -0.60, 95%CI [-0.96, -0.25]) experienced less depressive symptoms compared to obese participants. BMI did not moderate the relationship between domain-specific physical activity and depression. Conclusions Interventions that focus on leisure-time physical activity appear to be best suited to improve depression, however, this needs to be confirmed in purposefully designed intervention studies. Future studies may also examine ways to improve the effectiveness of work and travel physical activity for reducing depression. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-14037-4.
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Affiliation(s)
- Emily R Rutherford
- Central Queensland University, School of Health, Medical and Applied Sciences, Appleton Institute, Rockhampton, Australia
| | - Corneel Vandelanotte
- Central Queensland University, School of Health, Medical and Applied Sciences, Appleton Institute, Rockhampton, Australia
| | - Janine Chapman
- Central Queensland University, School of Health, Medical and Applied Sciences, Appleton Institute, Rockhampton, Australia
| | - Quyen G To
- Central Queensland University, School of Health, Medical and Applied Sciences, Appleton Institute, Rockhampton, Australia.
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Elsaesser M, Herpertz S, Piosczyk H, Jenkner C, Hautzinger M, Schramm E. Modular-based psychotherapy (MoBa) versus cognitive-behavioural therapy (CBT) for patients with depression, comorbidities and a history of childhood maltreatment: study protocol for a randomised controlled feasibility trial. BMJ Open 2022; 12:e057672. [PMID: 35820739 PMCID: PMC9277372 DOI: 10.1136/bmjopen-2021-057672] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 06/08/2022] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION In depression treatment, most patients do not reach response or remission with current psychotherapeutic approaches. Major reasons for individual non-response are interindividual heterogeneity of etiological mechanisms and pathological forms, and a high rate of comorbid disorders. Personalised treatments targeting comorbidities as well as underlying transdiagnostic mechanisms and factors like early childhood maltreatment may lead to better outcomes. A modular-based psychotherapy (MoBa) approach provides a treatment model of independent and flexible therapy elements within a systematic treatment algorithm to combine and integrate existing evidence-based approaches. By optimally tailoring module selection and application to the specific needs of each patient, MoBa has great potential to improve the currently unsatisfying results of psychotherapy as a bridge between disorder-specific and personalised approaches. METHODS AND ANALYSIS In a randomised controlled feasibility trial, N=70 outpatients with episodic or persistent major depression, comorbidity and childhood maltreatment are treated in 20 individual sessions with MoBa or standard cognitive-behavioural therapy for depression. The three modules of MoBa focus on deficits associated with early childhood maltreatment: the systems of negative valence, social processes and arousal. According to a specific questionnaire-based treatment algorithm, elements from cognitive behavioural analysis system of psychotherapy, mentalisation-based psychotherapy and/or mindfulness-based cognitive therapy are integrated for a personalised modular procedure.As a proof of concept, this trial will provide evidence for the feasibility and efficacy (post-treatment and 6-month follow-up) of a modular add-on approach for patients with depression, comorbidities and a history of childhood maltreatment. Crucial feasibility aspects include targeted psychopathological mechanisms, selection (treatment algorithm), sequence and application of modules, as well as training and supervision of the study therapists. ETHICS AND DISSEMINATION This study obtained approval from the independent Ethics Committees of the University of Freiburg and the University of Heidelberg. All findings will be disseminated broadly via peer-reviewed articles in scientific journals and contributions to national and international conferences. TRIAL REGISTRATION NUMBER DRKS00022093.
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Affiliation(s)
- Moritz Elsaesser
- Department of Psychiatry and Psychotherapy, Medical Center and Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Sabine Herpertz
- Department of General Psychiatry, Heidelberg University, Heidelberg, Germany
| | - Hannah Piosczyk
- Department of Psychiatry and Psychotherapy, Medical Center and Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Carolin Jenkner
- Clinical Trials Unit, Universitatsklinikum Freiburg, Freiburg, Germany
| | - Martin Hautzinger
- Department of Psychology, Clinical Psychology, and Psychotherapy, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Elisabeth Schramm
- Department of Psychiatry and Psychotherapy, Medical Center and Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
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Impact of fasting on stress systems and depressive symptoms in patients with major depressive disorder: a cross-sectional study. Sci Rep 2022; 12:7642. [PMID: 35538177 PMCID: PMC9091273 DOI: 10.1038/s41598-022-11639-1] [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: 12/15/2021] [Accepted: 04/22/2022] [Indexed: 11/08/2022] Open
Abstract
Major depressive disorder (MDD) is frequently associated with poor response to treatment. Common antidepressants target neurotransmission and neuronal plasticity, which require adequate energy supply. As imaging studies indicate disturbances in central energy metabolism, and caloric restriction improves neuroplasticity and impacts mood and cognition, correction of energy status might increase the effectiveness of antidepressant treatments and reduce the psychopathological symptoms of depression. Metabolic parameters, stress hormones, and brain-derived neurotrophic factor (BDNF) levels were assessed in serum of depressed inpatients (MDD, N = 21) and healthy volunteers (Ctrl, N = 28) before and after a 72 h fasting period during which only water was consumed. Depression severity was assessed by Beck's Depression Inventory (BDI)-2 sum-score and cognitive-affective and somatic sub-scores. Fasting similarly impacted metabolic parameters and stress systems in both groups. Fasting elevated BDI-2 sum-scores and somatic sub-scores in Ctrl. In MDD, fasting increased somatic-, but decreased cognitive-affective symptoms. Sub-group analyses based on BDI-2 sum-scores pre-fasting showed that cognitive-affective symptoms decreased in patients with moderate/severe but not in those with mild symptoms. This was associated with differential changes in BDNF levels. In conclusion, fasting improved cognitive-affective sub-scores in MDD patients with moderate/severe symptoms that had not responded to prior therapy. Interventions that modulate energy metabolism might directly improve cognitive-affective symptoms and/or augment therapeutic efficacy in moderate-to-severely depressed patients.
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Tan T, Xu Z, Gao C, Shen T, Li L, Chen Z, Chen L, Xu M, Chen B, Liu J, Zhang Z, Yuan Y. Influence and interaction of resting state functional magnetic resonance and tryptophan hydroxylase-2 methylation on short-term antidepressant drug response. BMC Psychiatry 2022; 22:218. [PMID: 35337298 PMCID: PMC8957120 DOI: 10.1186/s12888-022-03860-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 03/11/2022] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Most antidepressants have been developed on the basis of the monoamine deficiency hypothesis of depression, in which neuronal serotonin (5-HT) plays a key role. 5-HT biosynthesis is regulated by the rate-limiting enzyme tryptophan hydroxylase-2 (TPH2). TPH2 methylation is correlated with antidepressant effects. Resting-state functional MRI (rs-fMRI) is applied for detecting abnormal brain functional activity in patients with different antidepressant effects. We will investigate the effect of the interaction between rs-fMRI and TPH2 DNA methylation on the early antidepressant effects. METHODS A total of 300 patients with major depressive disorder (MDD) and 100 healthy controls (HCs) were enrolled, of which 60 patients with MDD were subjected to rs-fMRI. Antidepressant responses was assessed by a 50% reduction in 17-item Hamilton Rating Scale for Depression (HAMD-17) scores at baseline and after two weeks of medication. The RESTPlus software in MATLAB was used to analyze the rs-fMRI data. The amplitude of low-frequency fluctuation (ALFF), regional homogeneity (ReHo), fractional ALFF (fALFF), and functional connectivity (FC) were used, and the above results were used as regions of interest (ROIs) to extract the average value of brain ROIs regions in the RESTPlus software. Generalized linear model analysis was performed to analyze the association between abnormal activity found in rs-fMRI and the effect of TPH2 DNA methylation on antidepressant responses. RESULTS Two hundred ninety-one patients with MDD and 100 HCs were included in the methylation statistical analysis, of which 57 patients were included in the further rs-fMRI analysis (3 patients were excluded due to excessive head movement). 57 patients were divided into the responder group (n = 36) and the non-responder group (n = 21). Rs-fMRI results showed that the ALFF of the left inferior frontal gyrus (IFG) was significantly different between the two groups. The results showed that TPH2-1-43 methylation interacted with ALFF of left IFG to affect the antidepressant responses (p = 0.041, false discovery rate (FDR) corrected p = 0.149). CONCLUSIONS Our study demonstrated that the differences in the ALFF of left IFG between the two groups and its association with TPH2 methylation affect short-term antidepressant drug responses.
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Affiliation(s)
- Tingting Tan
- grid.452290.80000 0004 1760 6316Department of Psychosomatics and Psychiatry, School of Medicine, Zhongda Hospital, Southeast University, Nanjing, 210009 People’s Republic of China ,grid.263826.b0000 0004 1761 0489Key Laboratory of Developmental Genes and Human Diseases, Ministry of Education, School of Medicine, Southeast University, Nanjing, 210009 People’s Republic of China
| | - Zhi Xu
- Department of Psychosomatics and Psychiatry, School of Medicine, Zhongda Hospital, Southeast University, Nanjing, 210009, People's Republic of China. .,Key Laboratory of Developmental Genes and Human Diseases, Ministry of Education, School of Medicine, Southeast University, Nanjing, 210009, People's Republic of China.
| | - Chenjie Gao
- grid.452290.80000 0004 1760 6316Department of Psychosomatics and Psychiatry, School of Medicine, Zhongda Hospital, Southeast University, Nanjing, 210009 People’s Republic of China ,grid.263826.b0000 0004 1761 0489Key Laboratory of Developmental Genes and Human Diseases, Ministry of Education, School of Medicine, Southeast University, Nanjing, 210009 People’s Republic of China
| | - Tian Shen
- grid.452290.80000 0004 1760 6316Department of Psychosomatics and Psychiatry, School of Medicine, Zhongda Hospital, Southeast University, Nanjing, 210009 People’s Republic of China ,grid.89957.3a0000 0000 9255 8984Department of Psychiatric Rehabilitation, Wuxi Mental Health Center, Nanjing Medical University, WuXi, 214123 People’s Republic of China
| | - Lei Li
- grid.263826.b0000 0004 1761 0489School of Medicine, Southeast University, Nanjing, 210009 People’s Republic of China
| | - Zimu Chen
- grid.452290.80000 0004 1760 6316Department of Psychosomatics and Psychiatry, School of Medicine, Zhongda Hospital, Southeast University, Nanjing, 210009 People’s Republic of China ,grid.263826.b0000 0004 1761 0489Key Laboratory of Developmental Genes and Human Diseases, Ministry of Education, School of Medicine, Southeast University, Nanjing, 210009 People’s Republic of China
| | - Lei Chen
- grid.452290.80000 0004 1760 6316Department of Psychosomatics and Psychiatry, School of Medicine, Zhongda Hospital, Southeast University, Nanjing, 210009 People’s Republic of China ,Department of Psychology and Psychiatry, School of Medicine, Jinling Hospital, Nanjing University, Nanjing, 210018 People’s Republic of China
| | - Min Xu
- grid.263826.b0000 0004 1761 0489Department of Anatomy, Medical School, Southeast University, Nanjing, 210009 People’s Republic of China
| | - Bingwei Chen
- grid.263826.b0000 0004 1761 0489Department of Epidemiology and Biostatistics, School of Public Health, Southeast University, Nanjing, 210009 People’s Republic of China
| | - Jiacheng Liu
- grid.452290.80000 0004 1760 6316Department of Nuclear Medicine, School of Medicine, Zhongda Hospital, Southeast University, Nanjing, 210009 People’s Republic of China
| | - Zhijun Zhang
- grid.452290.80000 0004 1760 6316Department of Neurology, School of Medicine, Zhongda Hospital, Southeast University, Nanjing, 210009 People’s Republic of China
| | - Yonggui Yuan
- grid.452290.80000 0004 1760 6316Department of Psychosomatics and Psychiatry, School of Medicine, Zhongda Hospital, Southeast University, Nanjing, 210009 People’s Republic of China ,grid.263826.b0000 0004 1761 0489Key Laboratory of Developmental Genes and Human Diseases, Ministry of Education, School of Medicine, Southeast University, Nanjing, 210009 People’s Republic of China
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De Donatis D, Porcelli S, Zernig G, Mercolini L, Giupponi G, Serretti A, Conca A, Florio V. Venlafaxine and O-desmethylvenlafaxine serum levels are positively associated with antidepressant response in elder depressed out-patients. World J Biol Psychiatry 2022; 23:183-190. [PMID: 34096828 DOI: 10.1080/15622975.2021.1938668] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Therapeutic Drug Monitoring (TDM) represents one of the most promising tools in clinical practice to optimise antidepressant treatment. Nevertheless, little is still known regarding the relationship between clinical efficacy and serum concentration of venlafaxine (VEN). The aim of our study was to investigate the association between serum concentration of venlafaxine + O-desmethylvenlafaxine (SCVO) and antidepressant response (AR). METHODS 52 depressed outpatients treated with VEN were recruited and followed in a naturalistic setting for three months. Hamilton Depression Rating Scale-21 was administered at baseline, at month 1 and at month 3 to assess AR. SCVO was measured at steady state. Linear regression analysis and nonlinear least-squares regression were used to estimate association between SCVO and AR. RESULTS Our results showed an association between AR and SCVO that follows a bell-shaped quadratic function with a progressive increase of AR within the therapeutic reference range of SCVO (i.e. 100-400 ng/mL) and a subsequent decrease of AR at higher serum levels. DISCUSSION This study strongly suggests that TDM could represent a more appropriate tool than the oral dosage to optimise the treatment with VEN. Specifically, highest efficacy might be achieved by titrating patients at SCVO levels around 400 ng/mL.
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Affiliation(s)
- Domenico De Donatis
- Psychiatry Section, Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Stefano Porcelli
- Psychiatry Section, Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Gerald Zernig
- Experimental Psychiatry Unit, Medical University of Innsbruck, Innsbruck, Austria
| | - Laura Mercolini
- Department of Pharmacy and Biotechnology, University of Bologna, Bologna, Italy
| | | | - Alessandro Serretti
- Psychiatry Section, Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
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Wang XY, Tan H, Li X, Dai LQ, Zhang ZW, Lv FJ, Yu RQ. Resting-state functional magnetic resonance imaging-based identification of altered brain the fractional amplitude of low frequency fluctuation in adolescent major depressive disorder patients undergoing electroconvulsive therapy. Front Psychiatry 2022; 13:972968. [PMID: 35958635 PMCID: PMC9357980 DOI: 10.3389/fpsyt.2022.972968] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 07/05/2022] [Indexed: 12/02/2022] Open
Abstract
PURPOSE While electroconvulsive therapy (ECT) has been repeatedly been shown to effectively and efficiently treat the major depressive disorder (MDD), the mechanistic basis for such therapeutic efficacy remains to be firmly established. As such, further research exploring the ECT-based treatment of MDD in an adolescent population is warranted. METHODS This study included 30 treatment-naïve first-episode MDD patients and 30 healthy control (HC) individuals (aged 12-17 years). All participants were scanned using rs-fMRI, and the 30 MDD patients were scanned again after 2 weeks of the ECT treatment period. Intrinsic local activity in each voxel was assessed based on the fractional amplitude of low frequency fluctuation (fALFF) parameter, with all fALFF analyses being completed using the REST application. Correlations between ECT-related changes in fALFF and clinical parameters were additionally examined. RESULTS Relative to HCs, MDD patients exhibited increased fALFF values in the right inferior frontal gyrus (ORBinf), inferior occipital gyrus (IOG), and the left middle frontal gyrus (MFG) at baseline. Following ECT, these patients exhibited significant increases in fALFF values in the right medial superior frontal gyrus (SFGmed), dorsolateral superior frontal gyrus (SFGdor), anterior cingulate, and paracingulate gyrus (ACG), median cingulate and paracingulate gyrus (DCG), and left MFG. MDD patient HAMD scores were negatively correlated with fALFF values when analyzing pre-ECT vs. post-HCT ΔHAMD and fALFF values in the right SFGmed, SFGdor, and the left MFG. CONCLUSION These data suggest that ECT induced altered fALFF in some regions of the brain, suggesting that these alterations may serve as a neurobiological indicator of ECT effectiveness in MDD adolescents.
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Affiliation(s)
- Xing-Yu Wang
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Huan Tan
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiao Li
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Lin-Qi Dai
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhi-Wei Zhang
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Fa-Jin Lv
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ren-Qiang Yu
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Wu CS, Yang AC, Chang SS, Chang CM, Liu YH, Liao SC, Tsai HJ. Validation of Machine Learning-Based Individualized Treatment for Depressive Disorder Using Target Trial Emulation. J Pers Med 2021; 11:jpm11121316. [PMID: 34945788 PMCID: PMC8706481 DOI: 10.3390/jpm11121316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 11/30/2021] [Accepted: 12/01/2021] [Indexed: 12/20/2022] Open
Abstract
This study aims to develop and validate the use of machine learning-based prediction models to select individualized pharmacological treatment for patients with depressive disorder. This study used data from Taiwan’s National Health Insurance Research Database. Patients with incident depressive disorders were included in this study. The study outcome was treatment failure, which was defined as psychiatric hospitalization, self-harm hospitalization, emergency visits, or treatment change. Prediction models based on the Super Learner ensemble were trained separately for the initial and the next-step treatments if the previous treatments failed. An individualized treatment strategy was developed for selecting the drug with the lowest probability of treatment failure for each patient as the model-selected regimen. We emulated clinical trials to estimate the effectiveness of individualized treatments. The area under the curve of the prediction model using Super Learner was 0.627 and 0.751 for the initial treatment and the next-step treatment, respectively. Model-selected regimens were associated with reduced treatment failure rates, with a 0.84-fold (95% confidence interval (CI) 0.82–0.86) decrease for the initial treatment and a 0.82-fold (95% CI 0.80–0.83) decrease for the next-step. In emulation of clinical trials, the model-selected regimen was associated with a reduced treatment failure rate.
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Affiliation(s)
- Chi-Shin Wu
- National Centre for Geriatrics and Welfare Research, National Health Research Institutes, Zhunan 350, Taiwan
- Department of Psychiatry, Yunlin Branch, National Taiwan University Hospital, Yunlin 632, Taiwan
- Correspondence:
| | - Albert C. Yang
- Digital Medicine Center, Institute of Brain Science, National Yang-Ming Chiao-Tung University, Taipei 112, Taiwan;
| | - Shu-Sen Chang
- Institute of Health Behaviours and Community Sciences, College of Public Health, National Taiwan University, Taipei 112, Taiwan;
| | - Chia-Ming Chang
- Department of Psychiatry, Chang Gung Memorial Hospital, Linkou and Chang Gung University, Taoyuan 333, Taiwan;
| | - Yi-Hung Liu
- Department of Mechanical Engineering, National Taiwan University of Science and Technology, Taipei 106, Taiwan;
| | - Shih-Cheng Liao
- Department of Psychiatry, College of Medicine, National Taiwan University Hospital, National Taiwan University, Taipei 100, Taiwan;
| | - Hui-Ju Tsai
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan 350, Taiwan;
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González-Blanch C, Muñoz-Navarro R, Medrano LA, Moriana JA, Ruiz-Rodríguez P, Cano-Vindel A. Moderators and predictors of treatment outcome in transdiagnostic group cognitive-behavioral therapy for primary care patients with emotional disorders. Depress Anxiety 2021; 38:757-767. [PMID: 34043853 DOI: 10.1002/da.23164] [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: 12/31/2020] [Revised: 03/06/2021] [Accepted: 04/17/2021] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE Transdiagnostic group cognitive behavior therapy (TD-GCBT) has shown to be efficacious in the treatment of emotional disorders in primary care. However, little is known about possible moderators or predictors of treatment outcome. We aimed to explore the potential predictors and moderators of outcome in a large multicentre randomized controlled trial comparing TD-GCBT plus treatment as usual (TAU) to TAU alone. METHOD Putative demographic and baseline clinical variables were examined using the PROCESS macro as potential predictors/moderators of depressive and anxiety symptoms at posttreatment and 1-year follow-up. RESULTS Analyses were based on a study completer sample of 1061 participants randomized to TD-CBT + TAU (n = 527) or TAU alone (n = 534), with 631 participants assessed at the posttreatment evaluation and 388 at the 1-year follow-up. Individuals working or with a partner among sociodemographic variables, and higher baseline comorbidities and more severity of symptoms among clinical variables obtained more benefits from adding TDCBT to TAU. Those taking medication before treatment obtained less benefits from the TD-GCBT than those without prescribed antidepressant medications, after controlling for baseline severity of symptoms. Overall, the moderating effect of clinical (but not sociodemographic) variables remained at 1-year follow-up. CONCLUSION Findings support largely the generalization of the TD-GCBT for emotional disorders in primary care to a variety of sociodemographic and clinical groups. However, TD-GCBT seems to work to a greater extent for those individuals with a more severe clinical profile. Providing TD-GCBT before prescribing antidepressant medication and while people are still working may enhance the effects of adding this psychological treatment to TAU in primary care.
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Affiliation(s)
- César González-Blanch
- Mental Health Centre, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - Roger Muñoz-Navarro
- Department of Psychology and Sociology, Faculty of Social and Human Sciences University of Zaragoza, Zaragoza, Spain
| | - Leonardo Adrián Medrano
- Research Secretariat, Faculty of Psychology, Universidad Empresarial Siglo 21, Córdoba, Argentina
| | - Juan Antonio Moriana
- Department of Psychology, Maimónides Institute for Research in Biomedicine of Cordoba-IMIBIC, Reina Sofía University Hospital, University of Córdoba, Córdoba, Spain
| | | | - Antonio Cano-Vindel
- Department of Experimental Psychology, Cognitive Processes and Speech Therapy, Faculty of Psychology, Complutense University of Madrid, Madrid, Spain
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Hughes MC, Pradier MF, Ross AS, McCoy TH, Perlis RH, Doshi-Velez F. Assessment of a Prediction Model for Antidepressant Treatment Stability Using Supervised Topic Models. JAMA Netw Open 2020; 3:e205308. [PMID: 32432711 PMCID: PMC7240354 DOI: 10.1001/jamanetworkopen.2020.5308] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 03/16/2020] [Indexed: 12/28/2022] Open
Abstract
Importance In the absence of readily assessed and clinically validated predictors of treatment response, pharmacologic management of major depressive disorder often relies on trial and error. Objective To assess a model using electronic health records to identify predictors of treatment response in patients with major depressive disorder. Design, Setting, and Participants This retrospective cohort study included data from 81 630 adults with a coded diagnosis of major depressive disorder from 2 academic medical centers in Boston, Massachusetts, including outpatient primary and specialty care clinics from December 1, 1997, to December 31, 2017. Data were analyzed from January 1, 2018, to March 15, 2020. Exposures Treatment with at least 1 of 11 standard antidepressants. Main Outcomes and Measures Stable treatment response, intended as a proxy for treatment effectiveness, defined as continued prescription of an antidepressant for 90 days. Supervised topic models were used to extract 10 interpretable covariates from coded clinical data for stability prediction. With use of data from 1 hospital system (site A), generalized linear models and ensembles of decision trees were trained to predict stability outcomes from topic features that summarize patient history. Held-out patients from site A and individuals from a second hospital system (site B) were evaluated. Results Among the 81 630 adults (56 340 women [69%]; mean [SD] age, 48.46 [14.75] years; range, 18.0-80.0 years), 55 303 reached a stable response to their treatment regimen during follow-up. For held-out patients from site A, the mean area under the receiver operating characteristic curve (AUC) for discrimination of the general stability outcome was 0.627 (95% CI, 0.615-0.639) for the supervised topic model with 10 covariates. In evaluation of site B, the AUC was 0.619 (95% CI, 0.610-0.627). Building models to predict stability specific to a particular drug did not improve prediction of general stability even when using a harder-to-interpret ensemble classifier and 9256 coded covariates (specific AUC, 0.647; 95% CI, 0.635-0.658; general AUC, 0.661; 95% CI, 0.648-0.672). Topics coherently captured clinical concepts associated with treatment response. Conclusions and Relevance The findings suggest that coded clinical data available in electronic health records may facilitate prediction of general treatment response but not response to specific medications. Although greater discrimination is likely required for clinical application, the results provide a transparent baseline for such studies.
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Affiliation(s)
- Michael C. Hughes
- Department of Computer Science, Tufts University, Medford, Massachusetts
| | - Melanie F. Pradier
- John A. Paulson School of Engineering and Applied Sciences, Cambridge, Massachusetts
| | - Andrew Slavin Ross
- John A. Paulson School of Engineering and Applied Sciences, Cambridge, Massachusetts
| | - Thomas H. McCoy
- Center for Quantitative Health, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
| | - Roy H. Perlis
- Center for Quantitative Health, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
| | - Finale Doshi-Velez
- John A. Paulson School of Engineering and Applied Sciences, Cambridge, Massachusetts
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Kitzerow J, Hackbusch M, Jensen K, Kieser M, Noterdaeme M, Fröhlich U, Taurines R, Geißler J, Wolff N, Roessner V, Bast N, Teufel K, Kim Z, Freitag CM. Study protocol of the multi-centre, randomised controlled trial of the Frankfurt Early Intervention Programme A-FFIP versus early intervention as usual for toddlers and preschool children with Autism Spectrum Disorder (A-FFIP study). Trials 2020; 21:217. [PMID: 32093772 PMCID: PMC7038602 DOI: 10.1186/s13063-019-3881-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 11/04/2019] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Naturalistic developmental behavioural interventions (NDBI) have been shown to improve autism-specific symptoms in young children with Autism Spectrum Disorder (ASD). NDBI approaches, such as the ASD-specific Frankfurt Early Intervention Programme for ASD (A-FFIP), are based on ASD-specific developmental and learning aspects. A-FFIP is a low-intensity intervention which can easily be implemented in the local health care/social welfare system. The aim of the present study is to establish 1-year efficacy of the manualised early intervention programme A-FFIP in toddlers and preschool children with ASD. It is hypothesised that A-FFIP will result in improved ASD-specific symptoms compared to early intervention as usual (EIAU). Child- and family-specific secondary outcomes, as well as moderators and mediators of outcome, will be explored. METHODS/DESIGN A prospective, multi-centre, parallel-group, randomised controlled, phase-III trial comparing A-FFIP versus EIAU. A total of 134 children (A-FFIP: 67, EIAU: 67) aged 24-66 months at baseline assessment meeting the criteria for ASD (DSM-5) will be included. The primary outcome is the absolute change of the total score of the Brief Observation of Social Communication Change (BOSCC-AT) between baseline (T2) and 1-year follow-up (T6). The treatment effect will be tested, adjusted for relevant covariates applying a mixed model for repeated measures. Secondary outcomes are BOSCC social communication and repetitive-behaviour scores, single ASD symptoms, language, cognition, psychopathology, parental well-being and family quality of life. Predictors, moderators and mediating mechanisms will be explored. DISCUSSION If efficacy of the manualised A-FFIP early intervention is established, the current study has the potential to change clinical practice strongly towards the implementation of a low-intensity, evidence-based, natural early intervention in ASD. Early intervention in ASD requires specialist training, which subsequently needs to be developed or included into current training curricula. TRIAL REGISTRATION German Registry for Clinical Trials (Deutscher Register Klinischer Studien, DRKS); ID: 00016330. Retrospectively registered on 4 January 2019. URL: https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00016330.
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Affiliation(s)
- Janina Kitzerow
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Autism Therapy and Research Centre of Excellence, University Hospital Frankfurt Goethe University, Deutschordenstr. 50, 60528, Frankfurt am Main, Germany
| | - Matthes Hackbusch
- Institute of Medical Biometry and Informatics (IMBI), University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Katrin Jensen
- Institute of Medical Biometry and Informatics (IMBI), University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Meinhard Kieser
- Institute of Medical Biometry and Informatics (IMBI), University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Michele Noterdaeme
- Department of Child and Adolescent Psychiatry and Psychotherapy, Josefinum Augsburg, Kapellenstrasse 30, 86154, Augsburg, Germany
| | - Ulrike Fröhlich
- Department of Child and Adolescent Psychiatry and Psychotherapy, Josefinum Augsburg, Kapellenstrasse 30, 86154, Augsburg, Germany
| | - Regina Taurines
- Center of Mental Health, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Würzburg, Margarete-Höppel-Platz 1, 97080, Würzburg, Germany
| | - Julia Geißler
- Center of Mental Health, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Würzburg, Margarete-Höppel-Platz 1, 97080, Würzburg, Germany
| | - Nicole Wolff
- Department of Child and Adolescent Psychiatry, Medical Faculty Carl Gustav Carus, Technische Universitaet Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Veit Roessner
- Department of Child and Adolescent Psychiatry, Medical Faculty Carl Gustav Carus, Technische Universitaet Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Nico Bast
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Autism Therapy and Research Centre of Excellence, University Hospital Frankfurt Goethe University, Deutschordenstr. 50, 60528, Frankfurt am Main, Germany
| | - Karoline Teufel
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Autism Therapy and Research Centre of Excellence, University Hospital Frankfurt Goethe University, Deutschordenstr. 50, 60528, Frankfurt am Main, Germany
| | - Ziyon Kim
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Autism Therapy and Research Centre of Excellence, University Hospital Frankfurt Goethe University, Deutschordenstr. 50, 60528, Frankfurt am Main, Germany
| | - Christine M Freitag
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Autism Therapy and Research Centre of Excellence, University Hospital Frankfurt Goethe University, Deutschordenstr. 50, 60528, Frankfurt am Main, Germany.
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Hamadi L, Holliday J. Moderators and mediators of outcome in treatments for anorexia nervosa and bulimia nervosa in adolescents: A systematic review of randomized controlled trials. Int J Eat Disord 2020; 53:3-19. [PMID: 31506978 DOI: 10.1002/eat.23159] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 07/23/2019] [Accepted: 07/23/2019] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To critically appraise papers reporting on moderators and mediators of recommended psychological treatments for anorexia nervosa (AN) and bulimia nervosa (BN) in adolescents. METHOD A systematic search of databases was conducted including PsycINFO, Embase, MEDLINE, AMED, CINAHL, and the Cochrane Library. Studies were included where a randomized controlled trial (RCT) compared therapies for AN or BN and reported on moderators or mediators of treatment effect. Twenty-one eligible papers were included, all based on data from eight RCTs. RESULTS Family therapies were dominant in the literature. Individual or separated treatment appeared superior for families with more difficult relationships, whereas conjoint family treatment appeared to be superior where good family relationships were reported. Where there was greater eating disorder psychopathology in AN, including eating disorder-related obsessions and compulsions, the response was better to a family approach than to individual therapies. There was some evidence that a family treatment was superior for those engaging in purging behaviors in BN. Measures of family relationships, parental self-efficacy, and early change emerged as possible mediators; however, the quality of evidence was mixed and the findings, in some cases, arguably circular. Moderator and mediator analyses were underpowered in all studies, with multiple, and post-hoc, analyses being run, and a broad range of outcome measures used. DISCUSSION This review recommends that emerging findings are explored further in adequately powered trials of the different recommended therapies, with a move toward focusing on effect sizes. A consensus on acceptable definitions of outcome, including remission and recovery, would benefit future research.
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Affiliation(s)
- Layla Hamadi
- Oxford Institute of Clinical Psychology Training, Isis Education Centre, Warneford Hospital, Headington, Oxford.,Eating disorder CAMHS Community Services, Oxford Health NHS Foundation Trust
| | - Joanna Holliday
- Eating disorder CAMHS Community Services, Oxford Health NHS Foundation Trust
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Speech-Language Pathologists' Knowledge and Consideration of Factors That May Predict, Moderate, and Mediate AAC Outcomes. J Autism Dev Disord 2019; 50:238-249. [PMID: 31612373 DOI: 10.1007/s10803-019-04217-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The aims of this study were to examine speech-language pathologists' (SLPs) knowledge and consideration of factors found in research when making clinical decisions regarding AAC for children with Autism Spectrum Disorder (ASD), and to reveal additional factors identified based on SLPs' clinical practice. A 20-question mixed-methods survey was completed internationally by 187 certified SLPs. Overall, SLPs showed some familiarity with the research and considered factors found in research when making clinical decisions. SLPs also identified 20 factors that were not identified in the most recent systematic review that may predict, moderate, and/or mediate outcomes. This information may contribute to advancing clinical services regarding AAC as well as guide future research investigating the mechanisms by which children with ASD respond to AAC interventions.
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McNeal N, Watanasriyakul WT, Normann MC, Akinbo OI, Dagner A, Ihm E, Wardwell J, Grippo AJ. The negative effects of social bond disruption are partially ameliorated by sertraline administration in prairie voles. Auton Neurosci 2019; 219:5-18. [PMID: 31122602 PMCID: PMC6540807 DOI: 10.1016/j.autneu.2019.03.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 03/13/2019] [Accepted: 03/14/2019] [Indexed: 12/11/2022]
Abstract
Negative social experiences influence both depression and cardiovascular dysfunction. Many individuals who experience negative mood states or cardiovascular conditions have limited social support. Therefore, investigation of drug treatments that may protect against the consequences of social stress will aid in designing effective treatment strategies. The current study used an animal model to evaluate the protective effect of sertraline administration on behavioral and cardiovascular consequences of social stress. Specifically, male prairie voles (Microtus ochrogaster), which are socially monogamous rodents that share several behavioral and physiological characteristics with humans, were isolated from a socially-bonded female partner, and treated with sertraline (16 mg/kg/day, ip) or vehicle during isolation. Unexpectedly, sertraline did not protect against depression-relevant behaviors, and it was associated with increased short- and long-term heart rate responses. However, sertraline administration improved heart rate variability recovery following a behavioral stressor, including increased parasympathetic regulation, and altered long-term neuronal activity in brain regions that modulate autonomic control and stress reactivity. These results indicate that sertraline may partially protect against the consequences of social stressors, and suggest a mechanism through which sertraline may beneficially influence neurobiological control of cardiac function.
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Affiliation(s)
- Neal McNeal
- Department of Psychology, Northern Illinois University, DeKalb, IL, USA
| | | | - Marigny C Normann
- Department of Psychology, Northern Illinois University, DeKalb, IL, USA
| | - Oreoluwa I Akinbo
- Department of Psychology, Northern Illinois University, DeKalb, IL, USA
| | - Ashley Dagner
- Department of Psychology, Northern Illinois University, DeKalb, IL, USA
| | - Elliott Ihm
- Department of Psychology, Northern Illinois University, DeKalb, IL, USA
| | - Joshua Wardwell
- Department of Psychology, Northern Illinois University, DeKalb, IL, USA
| | - Angela J Grippo
- Department of Psychology, Northern Illinois University, DeKalb, IL, USA.
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De Donatis D, Florio V, Porcelli S, Saria A, Mercolini L, Serretti A, Conca A. Duloxetine plasma level and antidepressant response. Prog Neuropsychopharmacol Biol Psychiatry 2019; 92:127-132. [PMID: 30611837 DOI: 10.1016/j.pnpbp.2019.01.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 12/11/2018] [Accepted: 01/02/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Major Depressive Disorder (MDD) is associated with a high rate of inadequate treatment response, which is mainly due to the large inter-individual genetic variability in pharmacokinetic and pharmacodynamic targets of antidepressant drugs. Little is still known about the exact association between plasma level of first-line antidepressants and clinical response. This is particularly true for duloxetine, a dual serotonin and norepinephrine reuptake inhibitor recommended as first-line treatment for MDD. The aim of this study was to investigate the association between serum concentration of duloxetine (SCD) and antidepressant response (AR). METHODS 66 MDD patients treated with duloxetine 60 mg/day monotherapy were recruited in an outpatient setting and followed for three months. Hamilton Depression Rating Scale - 21 (HAMD-21) was administrated at baseline, at month 1, and at month 3 to assess AR. SCD was measured at steady state. Linear regression analysis and nonlinear least-squares regression were used to estimate association between SCD and AR. RESULTS SCD showed a high inter-individual variability in our sample, despite the duloxetine fixed oral dosage. We found a strong association between SCD and AR following a bell-shaped function at month 1 and at month 3. Nonetheless, within the recommended SCD range of 30-120 ng/mL a more linear correlation between SCD and AR was observed. DISCUSSION Our results suggest that for duloxetine the association between SCD and AR likely follows a bell-shaped quadratic function with poor AR at subtherapeutic SCD and progressive decrease of AR at higher SCD. The maximum antidepressant efficacy seems to require SCD values next to the highest recommended SCD (30-120 ng/mL), probably because of the optimal saturation of both serotonin and norepinephrine transporters. Thus, taking into account the observed high interindividual variability of SCD, our findings suggest that for MDD patients treated with duloxetine, SCD could be a useful tool to guide the treatment by optimizing the oral dosage in order to increase the AR rate.
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Affiliation(s)
- Domenico De Donatis
- Department of Biomedical and Neuromotor Science, University of Bologna, Bologna, Italy
| | | | - Stefano Porcelli
- Department of Biomedical and Neuromotor Science, University of Bologna, Bologna, Italy
| | - Alois Saria
- Experimental Psychiatry Unit, Medical University of Innsbruck, Innsbruck, Austria
| | - Laura Mercolini
- Department of Pharmacy and Biotechnology, University of Bologna, Bologna, Italy
| | - Alessandro Serretti
- Department of Biomedical and Neuromotor Science, University of Bologna, Bologna, Italy.
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Cristea IA, Karyotaki E, Hollon SD, Cuijpers P, Gentili C. Biological markers evaluated in randomized trials of psychological treatments for depression: a systematic review and meta-analysis. Neurosci Biobehav Rev 2019; 101:32-44. [DOI: 10.1016/j.neubiorev.2019.03.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 03/05/2019] [Accepted: 03/24/2019] [Indexed: 12/15/2022]
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Brain-derived neurotrophic factor as a possible predictor of electroconvulsive therapy outcome. Transl Psychiatry 2019; 9:155. [PMID: 31127089 PMCID: PMC6534549 DOI: 10.1038/s41398-019-0491-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 04/18/2019] [Accepted: 04/29/2019] [Indexed: 12/20/2022] Open
Abstract
While brain-derived neurotrophic factor (BDNF) has been shown to predict response to pharmacotherapy in depression, studies in electroconvulsive therapy (ECT) are small and report conflicting results. This study assesses the association between pre-treatment BDNF levels and ECT outcome in severe late-life unipolar depression (LLD). The potential of BDNF as a clinical predictor of ECT outcome was subsequently evaluated. Characteristics associated with low and high BDNF subgroups were determined as well. Ninety-four patients diagnosed with LDD referred for ECT were included. Fasting serum BDNF levels were determined before ECT. Remission and response, measured with the Montgomery-Åsberg Depression Rating Scale, were the outcomes. The association between BDNF and ECT outcome was analysed with logistic regression and Cox regression. The clinical usefulness of BDNF was evaluated using the receiver operating characteristic (ROC) curve. Associations between clinical characteristics and low versus high BDNF levels were examined with T tests, chi-squared tests and Mann-Whitney tests. The odds of remission decreased with 33% for every five units increase of BDNF levels (OR 0.67, 95% confidence interval 0.47-0.96; p = 0.03); however, neither the association with time to remission nor the associations with response nor the adjusted models were significant. The area under the ROC (0.66) implied a poor accuracy of BDNF as a clinical test. Clinical characteristics associated with BDNF were inclusion site, physical comorbidities and duration of the index episode. To conclude, although there is an association between pre-treatment BDNF levels and ECT outcome, BDNF cannot be considered an eligible biomarker for ECT outcome in clinical practice.
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Zisook S, Johnson GR, Tal I, Hicks P, Chen P, Davis L, Thase M, Zhao Y, Vertrees J, Mohamed S. General Predictors and Moderators of Depression Remission: A VAST-D Report. Am J Psychiatry 2019; 176:348-357. [PMID: 30947531 DOI: 10.1176/appi.ajp.2018.18091079] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Almost two-thirds of patients with major depressive disorder do not achieve remission with initial treatments. Thus, identifying and providing effective, feasible, and safe "next-step" treatments are clinical imperatives. This study explores patient baseline features that might help clinicians select between commonly used next-step treatments. METHODS The authors used data from the U.S. Department of Veterans Affairs (VA) Augmentation and Switching Treatments for Improving Depression Outcomes (VAST-D) study, a multisite, randomized, single-blind trial of 1,522 Veterans Health Administration patients who did not have an adequate response to at least one course of antidepressant treatment meeting minimal standards for dosage and duration. For 12 weeks, participants received one of three possible next-step treatments: switch to another antidepressant-sustained-release bupropion; combination with another antidepressant-sustained-release bupropion; or augmentation with an antipsychotic-aripiprazole. Life table regression models were used to identify baseline characteristics associated with remission overall (general predictors) and their interaction with remission among the three treatment groups (moderators). RESULTS Remission was more likely for individuals who were employed, less severely and chronically depressed, less anxious, not experiencing complicated grief symptoms, did not experience childhood adversity, and had better quality of life and positive mental health. Two features suggested specific next-step treatment selections: age ≥65 years (for whom augmentation with aripiprazole was more effective than switch to bupropion) and severe mixed hypomanic symptoms (for which augmentation with aripiprazole and combination with bupropion were more effective than switch to bupropion). CONCLUSIONS If replicated, these preliminary findings could help clinicians determine which patients with depression requiring next-step treatment will benefit most from a specific augmentation, combination, or switching strategy.
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Affiliation(s)
- Sidney Zisook
- VA San Diego Healthcare System (Zisook, Tal); the Department of Psychiatry, University of California San Diego (Zisook); Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, West Haven (Johnson, Zhao); the Department of Psychiatry, Texas A&M College of Medicine, Temple (Hicks); Louis Stokes VA Medical Center and the Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland (Chen); Tuscaloosa VA Medical Center, Tuscaloosa, Ala. (Davis); University of Alabama School of Medicine, Birmingham (Davis); Philadelphia VA Medical Center (Thase); Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, N.Mex. (Vertrees); and the VA New England Mental Illness Research, Education, and Clinical Center, VA Connecticut Healthcare System, West Haven (Mohamed)
| | - Gary R Johnson
- VA San Diego Healthcare System (Zisook, Tal); the Department of Psychiatry, University of California San Diego (Zisook); Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, West Haven (Johnson, Zhao); the Department of Psychiatry, Texas A&M College of Medicine, Temple (Hicks); Louis Stokes VA Medical Center and the Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland (Chen); Tuscaloosa VA Medical Center, Tuscaloosa, Ala. (Davis); University of Alabama School of Medicine, Birmingham (Davis); Philadelphia VA Medical Center (Thase); Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, N.Mex. (Vertrees); and the VA New England Mental Illness Research, Education, and Clinical Center, VA Connecticut Healthcare System, West Haven (Mohamed)
| | - Ilanit Tal
- VA San Diego Healthcare System (Zisook, Tal); the Department of Psychiatry, University of California San Diego (Zisook); Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, West Haven (Johnson, Zhao); the Department of Psychiatry, Texas A&M College of Medicine, Temple (Hicks); Louis Stokes VA Medical Center and the Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland (Chen); Tuscaloosa VA Medical Center, Tuscaloosa, Ala. (Davis); University of Alabama School of Medicine, Birmingham (Davis); Philadelphia VA Medical Center (Thase); Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, N.Mex. (Vertrees); and the VA New England Mental Illness Research, Education, and Clinical Center, VA Connecticut Healthcare System, West Haven (Mohamed)
| | - Paul Hicks
- VA San Diego Healthcare System (Zisook, Tal); the Department of Psychiatry, University of California San Diego (Zisook); Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, West Haven (Johnson, Zhao); the Department of Psychiatry, Texas A&M College of Medicine, Temple (Hicks); Louis Stokes VA Medical Center and the Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland (Chen); Tuscaloosa VA Medical Center, Tuscaloosa, Ala. (Davis); University of Alabama School of Medicine, Birmingham (Davis); Philadelphia VA Medical Center (Thase); Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, N.Mex. (Vertrees); and the VA New England Mental Illness Research, Education, and Clinical Center, VA Connecticut Healthcare System, West Haven (Mohamed)
| | - Peijun Chen
- VA San Diego Healthcare System (Zisook, Tal); the Department of Psychiatry, University of California San Diego (Zisook); Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, West Haven (Johnson, Zhao); the Department of Psychiatry, Texas A&M College of Medicine, Temple (Hicks); Louis Stokes VA Medical Center and the Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland (Chen); Tuscaloosa VA Medical Center, Tuscaloosa, Ala. (Davis); University of Alabama School of Medicine, Birmingham (Davis); Philadelphia VA Medical Center (Thase); Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, N.Mex. (Vertrees); and the VA New England Mental Illness Research, Education, and Clinical Center, VA Connecticut Healthcare System, West Haven (Mohamed)
| | - Lori Davis
- VA San Diego Healthcare System (Zisook, Tal); the Department of Psychiatry, University of California San Diego (Zisook); Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, West Haven (Johnson, Zhao); the Department of Psychiatry, Texas A&M College of Medicine, Temple (Hicks); Louis Stokes VA Medical Center and the Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland (Chen); Tuscaloosa VA Medical Center, Tuscaloosa, Ala. (Davis); University of Alabama School of Medicine, Birmingham (Davis); Philadelphia VA Medical Center (Thase); Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, N.Mex. (Vertrees); and the VA New England Mental Illness Research, Education, and Clinical Center, VA Connecticut Healthcare System, West Haven (Mohamed)
| | - Michael Thase
- VA San Diego Healthcare System (Zisook, Tal); the Department of Psychiatry, University of California San Diego (Zisook); Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, West Haven (Johnson, Zhao); the Department of Psychiatry, Texas A&M College of Medicine, Temple (Hicks); Louis Stokes VA Medical Center and the Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland (Chen); Tuscaloosa VA Medical Center, Tuscaloosa, Ala. (Davis); University of Alabama School of Medicine, Birmingham (Davis); Philadelphia VA Medical Center (Thase); Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, N.Mex. (Vertrees); and the VA New England Mental Illness Research, Education, and Clinical Center, VA Connecticut Healthcare System, West Haven (Mohamed)
| | - Yinjun Zhao
- VA San Diego Healthcare System (Zisook, Tal); the Department of Psychiatry, University of California San Diego (Zisook); Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, West Haven (Johnson, Zhao); the Department of Psychiatry, Texas A&M College of Medicine, Temple (Hicks); Louis Stokes VA Medical Center and the Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland (Chen); Tuscaloosa VA Medical Center, Tuscaloosa, Ala. (Davis); University of Alabama School of Medicine, Birmingham (Davis); Philadelphia VA Medical Center (Thase); Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, N.Mex. (Vertrees); and the VA New England Mental Illness Research, Education, and Clinical Center, VA Connecticut Healthcare System, West Haven (Mohamed)
| | - Julia Vertrees
- VA San Diego Healthcare System (Zisook, Tal); the Department of Psychiatry, University of California San Diego (Zisook); Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, West Haven (Johnson, Zhao); the Department of Psychiatry, Texas A&M College of Medicine, Temple (Hicks); Louis Stokes VA Medical Center and the Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland (Chen); Tuscaloosa VA Medical Center, Tuscaloosa, Ala. (Davis); University of Alabama School of Medicine, Birmingham (Davis); Philadelphia VA Medical Center (Thase); Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, N.Mex. (Vertrees); and the VA New England Mental Illness Research, Education, and Clinical Center, VA Connecticut Healthcare System, West Haven (Mohamed)
| | - Somaia Mohamed
- VA San Diego Healthcare System (Zisook, Tal); the Department of Psychiatry, University of California San Diego (Zisook); Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, West Haven (Johnson, Zhao); the Department of Psychiatry, Texas A&M College of Medicine, Temple (Hicks); Louis Stokes VA Medical Center and the Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland (Chen); Tuscaloosa VA Medical Center, Tuscaloosa, Ala. (Davis); University of Alabama School of Medicine, Birmingham (Davis); Philadelphia VA Medical Center (Thase); Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, N.Mex. (Vertrees); and the VA New England Mental Illness Research, Education, and Clinical Center, VA Connecticut Healthcare System, West Haven (Mohamed)
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Yacaman-Mendez D, Hallgren M, Forsell Y. Childhood adversities, negative life events and outcomes of non-pharmacological treatments for depression in primary care: A secondary analysis of a randomized controlled trial. J Psychiatr Res 2019; 110:152-158. [PMID: 30641348 DOI: 10.1016/j.jpsychires.2019.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 12/19/2018] [Accepted: 01/03/2019] [Indexed: 11/27/2022]
Abstract
Non-pharmacological treatments for depression are effective and available in primary care, but useful prognostic factors are lacking. Childhood adversities (CA) and negative recent life events (RLE) increase the risk and severity of depression, though their effect on treatment outcomes remains understudied. Using a sample of 737 adult participants of a multicenter randomized controlled trial receiving physical exercise, internet based cognitive-behavioral therapy or treatment as usual, alone or in combination with antidepressants, this prospective study aimed to determine the impact of CA, RLE and their interaction as predictors of outcomes of non-pharmacological treatments for mild-moderate depression in primary care. Outcomes were depression severity (MADRS score) and response to treatment (≥50% reduction in MADRS score) after three months. Linear regression and modified Poisson regression were used, interaction was assessed with a product term (CA*RLE) and epidemiological measures of interaction. The number of CA and RLE were associated with higher depression severity at follow-up (CA: β = 0.79, 95% CI: 0.14 to 1.44 and RLE: β = 0.52, 95% CI: 0.14 to 0.72) and showed a trend towards lower rates of response to treatment (RR = 0.94, 95% CI: 0.86 to 1.03; and RLE: RR = 0.95, 95% CI: 0.90 to 0.99). Interaction between CA and RLE was not significant for depression severity (β = 0.10, 95% CI: -2.12 to 0.41) nor for response to treatment (RERI = -0.05, 95% CI = -0.33 to 0.24). CA and RLE are associated with worse outcomes of non-pharmacological treatments in primary care. Further studies to identify predictors of outcomes of non-pharmaological treatments for depression are needed.
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Affiliation(s)
- Diego Yacaman-Mendez
- Unit of Epidemiology and Public Health Intervention Research (EPHIR), Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
| | - Mats Hallgren
- Unit of Epidemiology of Psychiatric Conditions, Substance Use and Social Environment (EPiCS), Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
| | - Yvonne Forsell
- Unit of Epidemiology and Public Health Intervention Research (EPHIR), Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
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Abstract
OBJECTIVE We consider how to choose an antidepressant (AD) medication for the treatment of clinical depression. METHOD A narrative review was undertaken addressing antidepressant 'choice' considering a range of parameters either weighted by patients and clinicians or suggested in the scientific literature. Findings were synthesised and incorporated with clinical experience into a model to assist AD choice. RESULTS Efficacy studies comparing ADs offer indicative guidance, while precision psychiatry prediction based on genetics, developmental trauma, neuroimaging, behavioural and cognitive biomarkers, currently has limited clinical utility. Our model offers guidance for AD choice by assessing first for the presence of a depressive subtype or symptom cluster and matching choice of AD class accordingly. Failing this, an AD can be chosen based on depression severity. Within-class choice can be determined by reference to personality style, patient preference, medical or psychiatric comorbidities and side-effect profile. CONCLUSION Clarification of AD choice would occur if medications are trialled in specific depressive subtypes rather than using the generic diagnosis of major depressive disorder (MDD). Such 'top-down' methods could be enhanced by 'bottom-up' studies to classify individuals according to symptom clusters and biomarkers with AD efficacy tested in these categories. Both methods could be utilised for personalised AD choice.
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Affiliation(s)
- A Bayes
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia.,Black Dog Institute, Randwick, NSW, Australia
| | - G Parker
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia.,Black Dog Institute, Randwick, NSW, Australia
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Meyer BM, Rabl U, Huemer J, Bartova L, Kalcher K, Provenzano J, Brandner C, Sezen P, Kasper S, Schatzberg AF, Moser E, Chen G, Pezawas L. Prefrontal networks dynamically related to recovery from major depressive disorder: a longitudinal pharmacological fMRI study. Transl Psychiatry 2019; 9:64. [PMID: 30718459 PMCID: PMC6362173 DOI: 10.1038/s41398-019-0395-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 01/03/2019] [Accepted: 01/10/2019] [Indexed: 12/28/2022] Open
Abstract
Due to lacking predictors of depression recovery, successful treatment of major depressive disorder (MDD) is frequently only achieved after therapeutic optimization leading to a prolonged suffering of patients. This study aimed to determine neural prognostic predictors identifying non-remitters prior or early after treatment initiation. Moreover, it intended to detect time-sensitive neural mediators indicating depression recovery. This longitudinal, interventional, single-arm, open-label, phase IV, pharmacological functional magnetic resonance imaging (fMRI) study comprised four scans at important stages prior (day 0) and after escitalopram treatment initiation (day 1, 28, and 56). Totally, 22 treatment-free MDD patients (age mean ± SD: 31.5 ± 7.7; females: 50%) suffering from a concurrent major depressive episode without any comorbid DSM-IV axis I diagnosis completed the study protocol. Primary outcome were neural prognostic predictors of depression recovery. Enhanced de-activation of anterior medial prefrontal cortex (amPFC, single neural mediator) indicated depression recovery correlating with MADRS score and working memory improvements. Strong dorsolateral PFC (dlPFC) activation and weak dlPFC-amPFC, dlPFC-posterior cingulate cortex (PCC), dlPFC-parietal lobe (PL) coupling (three prognostic predictors) hinted at depression recovery at day 0 and 1. Preresponse prediction of continuous (dlPFC-PL: R2day1 = 55.9%, 95% CI: 22.6-79%, P < 0.005) and dichotomous (specificity/sensitivity: SP/SNday1 = 0.91/0.82) recovery definitions remained significant after leave-one-out cross-validation. Identified prefrontal neural predictors might propel the future development of fMRI markers for clinical decision making, which could lead to increased response rates and adherence during acute phase treatment periods. Moreover, this study underscores the importance of the amPFC in depression recovery.
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Affiliation(s)
- Bernhard M. Meyer
- 0000 0000 9259 8492grid.22937.3dDivision of General Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Ulrich Rabl
- 0000 0000 9259 8492grid.22937.3dDivision of General Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Julia Huemer
- 0000 0000 9259 8492grid.22937.3dDepartment of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Lucie Bartova
- 0000 0000 9259 8492grid.22937.3dDivision of General Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Klaudius Kalcher
- 0000 0000 9259 8492grid.22937.3dMR Centre of Excellence, Medical University of Vienna, Vienna, Austria ,0000 0000 9259 8492grid.22937.3dCenter for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Julian Provenzano
- 0000 0000 9259 8492grid.22937.3dDivision of General Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Christoph Brandner
- 0000 0000 9259 8492grid.22937.3dDivision of General Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Patrick Sezen
- 0000 0000 9259 8492grid.22937.3dDivision of General Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Siegfried Kasper
- 0000 0000 9259 8492grid.22937.3dDivision of General Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Alan F. Schatzberg
- 0000000419368956grid.168010.eDepartment of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA USA
| | - Ewald Moser
- 0000 0000 9259 8492grid.22937.3dMR Centre of Excellence, Medical University of Vienna, Vienna, Austria ,0000 0000 9259 8492grid.22937.3dCenter for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Gang Chen
- 0000 0004 0464 0574grid.416868.5Scientific and Statistical Computational Core, National Institute of Mental Health, Bethesda, MA USA
| | - Lukas Pezawas
- Division of General Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria.
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Perlman K, Benrimoh D, Israel S, Rollins C, Brown E, Tunteng JF, You R, You E, Tanguay-Sela M, Snook E, Miresco M, Berlim MT. A systematic meta-review of predictors of antidepressant treatment outcome in major depressive disorder. J Affect Disord 2019; 243:503-515. [PMID: 30286415 DOI: 10.1016/j.jad.2018.09.067] [Citation(s) in RCA: 100] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 07/29/2018] [Accepted: 09/16/2018] [Indexed: 12/16/2022]
Abstract
INTRODUCTION The heterogeneity of symptoms and complex etiology of depression pose a significant challenge to the personalization of treatment. Meanwhile, the current application of generic treatment approaches to patients with vastly differing biological and clinical profiles is far from optimal. Here, we conduct a meta-review to identify predictors of response to antidepressant therapy in order to select robust input features for machine learning models of treatment response. These machine learning models will allow us to learn associations between patient features and treatment response which have predictive value at the individual patient level; this learning can be optimized by selecting high-quality input features for the model. While current research is difficult to directly apply to the clinic, machine learning models built using knowledge gleaned from current research may become useful clinical tools. METHODS The EMBASE and MEDLINE/PubMed online databases were searched from January 1996 to August 2017, using a combination of MeSH terms and keywords to identify relevant literature reviews. We identified a total of 1909 articles, wherein 199 articles met our inclusion criteria. RESULTS An array of genetic, immune, endocrine, neuroimaging, sociodemographic, and symptom-based predictors of treatment response were extracted, varying widely in clinical utility. LIMITATIONS Due to heterogeneous sample sizes, effect sizes, publication biases, and methodological disparities across reviews, we could not accurately assess the strength and directionality of every predictor. CONCLUSION Notwithstanding our cautious interpretation of the results, we have identified a multitude of predictors that can be used to formulate a priori hypotheses regarding the input features for a computational model. We highlight the importance of large-scale research initiatives and clinically accessible biomarkers, as well as the need for replication studies of current findings. In addition, we provide recommendations for future improvement and standardization of research efforts in this field.
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Affiliation(s)
- Kelly Perlman
- Montreal Neurological Institute, McGill University, 3801 Rue Université, Montréal, QC H3A 2B4, Canada.
| | - David Benrimoh
- Department of Psychiatry, McGill University, Montreal, Canada; Faculty of Medicine, McGill University, Montreal, Canada
| | - Sonia Israel
- Department of Psychiatry, McGill University, Montreal, Canada; Douglas Mental Health University Institute, Montreal, Canada
| | - Colleen Rollins
- Department of Psychiatry, University of Cambridge, Cambridge, England, UK
| | - Eleanor Brown
- Montreal Neurological Institute, McGill University, 3801 Rue Université, Montréal, QC H3A 2B4, Canada
| | - Jingla-Fri Tunteng
- Montreal Children's Hospital, McGill University Health Center, Montreal, Canada
| | - Raymond You
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
| | - Eunice You
- Faculty of Medicine, McGill University, Montreal, Canada
| | - Myriam Tanguay-Sela
- Montreal Neurological Institute, McGill University, 3801 Rue Université, Montréal, QC H3A 2B4, Canada
| | - Emily Snook
- Douglas Mental Health University Institute, Montreal, Canada
| | - Marc Miresco
- Department of Psychiatry, Jewish General Hospital, Montreal, Canada
| | - Marcelo T Berlim
- Department of Psychiatry, McGill University, Montreal, Canada; Douglas Mental Health University Institute, Montreal, Canada
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Dreimüller N, Wagner S, Engel A, Braus DF, Roll SC, Elsner S, Tadić A, Lieb K. Predictors of the effectiveness of an early medication change strategy in patients with major depressive disorder. BMC Psychiatry 2019; 19:24. [PMID: 30642308 PMCID: PMC6332626 DOI: 10.1186/s12888-019-2014-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 01/04/2019] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Patients with Major Depressive Disorder (MDD) who are non-improvers after two weeks of antidepressant treatment have a high risk of treatment failure. Recently, we did not find differences in outcomes in non-improvers randomized to an early medication change (EMC) strategy compared to treatment as usual (TAU). This secondary analysis investigated possible predictors of higher remission rates in the EMC strategy. METHODS Of 192 non-improvers (i.e. decrease of ≤20% on the HAMD-17 depression scale) after a two-week treatment with escitalopram, n = 97 were randomized to EMC (immediate switch to high doses of venlafaxine XR) and n = 95 to TAU (continued escitalopram until day 28 with non-responders switched to venlafaxine XR). We first analyzed patient characteristics, psychopathological features and subtypes of MDD by logistic regression analyses as possible predictors of remission rates. In a second investigation, we analyzed the predictors, which showed a significant association in the first analysis before Bonferroni-Holm correction by chi-squared tests separated for treatment groups. All analyses were corrected by Bonferroni-Holm method. RESULTS The first analyses yielded no statistically significant results after correction for multiple testing. In the second analyses, however, patients with prior medication at study entry showed higher remission rates in EMC than in TAU (24.2% versus 8.6%, p = 0.017; Bonferroni-Holm corrected significance level: p = 0.025.). Furthermore, patients with a recurrent course of MDD benefited less from treatment as usual (p = 0.009; Bonferroni-Holm corrected significance level: p = 0.025). Age, sex, age of onset, psychiatric or somatic comorbidities, and other subtypes of MDD did not predict remission rates. CONCLUSIONS Although in our first analysis we found statistically non-significant results, the second analysis showed significant differences in remission rates between patients with or without previous medication and in patients with recurrent MDD or the first depressive episode. It would therefore be valuable to examine in larger and prospective studies whether remission rates can be increased by quick escalation of treatment in certain subgroups of patients. Promising subgroups to be tested are patients who were previously medicated, and who show a recurrent course of MDD. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00974155 . Registered at the 10th of September 2009. Retrospectively registered.
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Affiliation(s)
- Nadine Dreimüller
- Department of Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Untere Zahlbacher Straße 8, D-55131, Mainz, Germany.
| | - Stefanie Wagner
- grid.410607.4Department of Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Untere Zahlbacher Straße 8, D-55131 Mainz, Germany
| | - Alice Engel
- grid.410607.4Department of Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Untere Zahlbacher Straße 8, D-55131 Mainz, Germany
| | - Dieter F. Braus
- grid.491861.3Department for Psychiatry and Psychotherapy, HELIOS Dr. Horst Schmidt Kliniken, Wiesbaden, Germany
| | - Sibylle C. Roll
- Hospital for Psychiatry and Psychotherapy, Vitos Rheingau, Eltville, Germany
| | - Stefan Elsner
- Hospital for Psychiatry and Psychotherapy, Andernach, Germany
| | - André Tadić
- grid.410607.4Department of Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Untere Zahlbacher Straße 8, D-55131 Mainz, Germany ,Agaplesion Elisabethenstift, Department of Psychiatry, Psychosomatics and Psychotherapy, Darmstadt, Germany
| | - Klaus Lieb
- grid.410607.4Department of Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Untere Zahlbacher Straße 8, D-55131 Mainz, Germany
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Jaite C, van Noort BM, Vloet TD, Graf E, Kappel V, Geissler J, Warnke A, Jacob C, Groß-Lesch S, Hennighausen K, Haack-Dees B, Schneider-Momm K, Philipsen A, Matthies S, Rösler M, Retz W, Hänig S, von Gontard A, Sobanski E, Alm B, Hohmann S, Häge A, Poustka L, Colla M, Gentschow L, Freitag CM, Becker K, Jans T. A multicentre randomized controlled trial on trans-generational attention deficit/hyperactivity disorder (ADHD) in mothers and children (AIMAC): an exploratory analysis of predictors and moderators of treatment outcome. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2018; 47:49-65. [PMID: 30084719 DOI: 10.1024/1422-4917/a000602] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE We examined predictors and moderators of treatment outcome in mothers and children diagnosed with ADHD in a large multicentre RCT. METHOD In total, 144 mother-child dyads with ADHD were randomly assigned to either a maternal ADHD treatment (group psychotherapy and open methylphenidate medication, TG) or to a control treatment (individual counselling without psycho- or pharmacotherapy, CG). After maternal ADHD treatment, parent-child training (PCT) for all mother-child dyads was added. The final analysis set was based on 123 dyads with completed primary outcome assessments (TG: n = 67, CG: n = 56). The primary outcome was the change in each child's externalizing symptoms. Multiple linear regression analyses were performed. RESULTS The severity of the child's externalizing problem behaviour in the family at baseline predicted more externalizing symptoms in the child after PCT, independent of maternal treatment. When mothers had a comorbid depression, TG children showed more externalizing symptoms after PCT than CG children of depressive mothers. No differences between the treatment arms were seen in the mothers without comorbid depression. CONCLUSIONS Severely impaired mothers with ADHD and depressive disorder are likely to need additional disorder-specific treatment for their comorbid psychiatric disorders to effectively transfer the contents of the PCT to the home situation (CCTISRCTN73911400).
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Affiliation(s)
- Charlotte Jaite
- 1a aa) Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy
| | - Betteke Maria van Noort
- 1a aa) Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy
| | - Timo D Vloet
- 2b bb) Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy
| | - Erika Graf
- 3 University of Freiburg, Medical Faculty and Medical Center, Freiburg, Germany
| | - Viola Kappel
- 1a aa) Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy
| | - Julia Geissler
- 2b bb) Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy
| | - Andreas Warnke
- 2b bb) Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy
| | - Christian Jacob
- 2a aa) Department of Psychiatry, Psychosomatics and Psychotherapy.,8 Hospital of Nürtingen, Nürtingen, Germany, Department of Psychiatry and Psychotherapy
| | - Silke Groß-Lesch
- 2a aa) Department of Psychiatry, Psychosomatics and Psychotherapy.,12 Schloss Werneck, Werneck, Germany, Department of Psychiatry, Psychotherapy and Psychosomatics
| | - Klaus Hennighausen
- 3b bb) Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics
| | - Barbara Haack-Dees
- 3b bb) Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics
| | - Katja Schneider-Momm
- 3b bb) Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics
| | - Alexandra Philipsen
- 3a aa) Department of Psychiatry and Psychotherapy.,9 University Hospital Bonn, Department of Psychiatry and Psychotherapy
| | | | | | - Wolfgang Retz
- 4a aa) Institute for Forensic Psychology and Psychiatry.,10 University Medical Center Mainz, Mainz, Germany, Department of Psychiatry and Psychotherapy, Germany
| | - Susann Hänig
- 4b bb) Saarland University Hospital, Department of Child and Adolescent Psychiatry and Psychotherapy
| | - Alexander von Gontard
- 4b bb) Saarland University Hospital, Department of Child and Adolescent Psychiatry and Psychotherapy
| | - Esther Sobanski
- 5a aa) Clinic for Psychiatry and Psychotherapy.,13 Johannes Gutenberg University Mainz, Mainz, Germany, Department of Child and Adolescent Psychiatry and Psychotherapy
| | - Barbara Alm
- 5a aa) Clinic for Psychiatry and Psychotherapy
| | - Sarah Hohmann
- 5b bb) Clinic for Child and Adolescent Psychiatry and Psychotherapy
| | - Alexander Häge
- 5b bb) Clinic for Child and Adolescent Psychiatry and Psychotherapy
| | - Luise Poustka
- 5b bb) Clinic for Child and Adolescent Psychiatry and Psychotherapy.,11 Universitätsmedizin Göttingen, Department of Child and Adolescent Psychiatry and Psychotherapy, Germany
| | - Michael Colla
- 14 Universitätsmedizin Rostock, Rostock, Germany, Department of Psychiatry and Psychotherapy
| | - Laura Gentschow
- 1b bb) Campus Benjamin Franklin, Department of Psychiatry and Psychotherapy
| | - Christine M Freitag
- 4b bb) Saarland University Hospital, Department of Child and Adolescent Psychiatry and Psychotherapy.,7 Frankfurt University Hospital, Frankfurt, Germany, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy
| | - Katja Becker
- 5b bb) Clinic for Child and Adolescent Psychiatry and Psychotherapy.,6 Philipps University Marburg, Marburg, Germany, Department of Child and Adolescent Psychiatry and Psychotherapy
| | - Thomas Jans
- 2b bb) Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy
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Benrimoh D, Fratila R, Israel S, Perlman K, Mirchi N, Desai S, Rosenfeld A, Knappe S, Behrmann J, Rollins C, You RP, Aifred Health Team T. Aifred Health, a Deep Learning Powered Clinical Decision Support System for Mental Health. THE NIPS '17 COMPETITION: BUILDING INTELLIGENT SYSTEMS 2018. [DOI: 10.1007/978-3-319-94042-7_13] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Marino P, Schulberg HC, Gildengers AG, Mulsant BH, Sajatovic M, Gyulai L, Aljurdi RK, Evans LD, Banerjee S, Gur RC, Young RC. Assessing bipolar disorder in the older adult: the GERI-BD toolbox. Int J Geriatr Psychiatry 2018; 33:e150-e157. [PMID: 28543407 PMCID: PMC6093209 DOI: 10.1002/gps.4738] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 04/19/2017] [Indexed: 11/11/2022]
Abstract
INTRODUCTION The evidence base regarding characteristics of older adults with bipolar disorder (BD) remains limited. The NIH-funded multicenter study Acute Pharmacotherapy of Late-Life Mania (GERI-BD) assessed various clinical domains before and during mood stabilizer treatment in older adults participating in a 9-week, double-blind randomized controlled trial. We describe the rationale for selecting these instruments. METHODS Domains and instruments were selected on the basis of the study design and the participants. The investigators' experience in clinical trials involving young adults with BD or older adults with major depressive disorder, along with open studies of older adults with BD, contributed to the selection process. RESULTS We identified domains and selected instruments that could be used to assess the participants given their diagnostic, treatment history, and medical and mood state characteristics. They were also intended to measure tolerability and efficacy and permit examination of potential moderating and mediating factors. CONCLUSIONS Decisions regarding the assessment domains to be included in the clinical trial highlight the challenges facing researchers studying drug treatments for older adults with BD, or more generally, mood disorders. We suggest that the domains and instruments selected by GERI-BD investigators constitute a "toolbox" that can be customized for other investigators. Copyright © 2017 John Wiley & Sons, Ltd.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Ruben C Gur
- University of Pennsylvania, Philadelphia, PA, USA
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Rethorst CD, South CC, Rush AJ, Greer TL, Trivedi MH. Prediction of treatment outcomes to exercise in patients with nonremitted major depressive disorder. Depress Anxiety 2017; 34:1116-1122. [PMID: 28672073 PMCID: PMC5718947 DOI: 10.1002/da.22670] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 04/27/2017] [Accepted: 05/20/2017] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Only one-third of patients with major depressive disorder (MDD) achieve remission with initial treatment. Consequently, current clinical practice relies on a "trial-and-error" approach to identify an effective treatment for each patient. The purpose of this report was to determine whether we could identify a set of clinical and biological parameters with potential clinical utility for prescription of exercise for treatment of MDD in a secondary analysis of the Treatment with Exercise Augmentation in Depression (TREAD) trial. METHODS Participants with nonremitted MDD were randomized to one of two exercise doses for 12 weeks. Participants were categorized as "remitters" (≤12 on the IDS-C), nonresponders (<30% drop in IDS-C), or neither. The least absolute shrinkage and selection operator (LASSO) and random forests were used to evaluate 30 variables as predictors of both remission and nonresponse. Predictors were used to model treatment outcomes using logistic regression. RESULTS Of the 122 participants, 36 were categorized as remitters (29.5%), 56 as nonresponders (45.9%), and 30 as neither (24.6%). Predictors of remission were higher levels of brain-derived neurotrophic factor (BDNF) and IL-1B, greater depressive symptom severity, and higher postexercise positive affect. Predictors of treatment nonresponse were low cardiorespiratory fitness, lower levels of IL-6 and BDNF, and lower postexercise positive affect. Models including these predictors resulted in predictive values greater than 70% (true predicted remitters/all predicted remitters) with specificities greater than 25% (true predicted remitters/all remitters). CONCLUSIONS Results indicate feasibility in identifying patients who will either remit or not respond to exercise as a treatment for MDD utilizing a clinical decision model that incorporates multiple patient characteristics.
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Affiliation(s)
- Chad D. Rethorst
- University of Texas Southwestern Medical Center, Center for Depression Research and Clinical Care, Department of Psychiatry
| | - Charles C. South
- University of Texas Southwestern Medical Center, Center for Depression Research and Clinical Care, Department of Psychiatry
| | | | - Tracy L. Greer
- University of Texas Southwestern Medical Center, Center for Depression Research and Clinical Care, Department of Psychiatry
| | - Madhukar H. Trivedi
- University of Texas Southwestern Medical Center, Center for Depression Research and Clinical Care, Department of Psychiatry
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Abstract
Major Depression Disorder (MDD) has a highly variable treatment response due to the large inter-individual variation in the pharmacokinetics and pharmacodynamics of drug treatments. In detail the correlation between plasma level and efficacy has been much debated. Among first-line drugs for MDD, one of the most used is escitalopram. In the present study we investigated the association between serum concentration of escitalopram (SCE) and antidepressant response (AR). 70 MDD patients treated with escitalopram monotherapy were recruited and followed for three months. Hamilton Depression Rating Scale - 21 (HAMD-21) was administrated at baseline, month 1, and month 3 to assess AR. SCE was measured at steady state. Linear regression analysis and nonlinear least-squares regression were used to estimate association between SCE and AR. We found an association between SCE and AR both at month 1 (p<0.001) and month 3 (p=0.0003), which persists also excluding 3 patients with SCE equal to 0. Interestingly, by excluding patients with SCE < 20ng/mL, i.e. with a SCE lower than the putative therapeutic threshold, these associations disappeared. The curvilinear function AR = a + (SCE-SCE2) explained a higher proportion of variance compared to the linear other models (p<0.001). Our results suggest that for escitalopram the association between SCE and AR likely follows a nearly-asymptotic function, with poor AR at sub-therapeutic SCE and stable AR response at therapeutic SCE. Thus, when a patient reaches the therapeutic SCE range, further increase of escitalopram dosage seems to be useless, although further studies are needed to confirm our findings.
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Affiliation(s)
| | - Stefano Porcelli
- Department of Biomedical and Neuromotor Science, University of Bologna, Bologna, Italy
| | - Alois Saria
- Experimental Psychiatry Unit, Medical University of Innsbruck, Innsbruck, Austria
| | - Alessandro Serretti
- Department of Biomedical and Neuromotor Science, University of Bologna, Bologna, Italy.
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Hervé M, Bergon A, Le Guisquet AM, Leman S, Consoloni JL, Fernandez-Nunez N, Lefebvre MN, El-Hage W, Belzeaux R, Belzung C, Ibrahim EC. Translational Identification of Transcriptional Signatures of Major Depression and Antidepressant Response. Front Mol Neurosci 2017; 10:248. [PMID: 28848385 PMCID: PMC5550836 DOI: 10.3389/fnmol.2017.00248] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 07/24/2017] [Indexed: 12/12/2022] Open
Abstract
Major depressive disorder (MDD) is a highly prevalent mental illness whose therapy management remains uncertain, with more than 20% of patients who do not achieve response to antidepressants. Therefore, identification of reliable biomarkers to predict response to treatment will greatly improve MDD patient medical care. Due to the inaccessibility and lack of brain tissues from living MDD patients to study depression, researches using animal models have been useful in improving sensitivity and specificity of identifying biomarkers. In the current study, we used the unpredictable chronic mild stress (UCMS) model and correlated stress-induced depressive-like behavior (n = 8 unstressed vs. 8 stressed mice) as well as the fluoxetine-induced recovery (n = 8 stressed and fluoxetine-treated mice vs. 8 unstressed and fluoxetine-treated mice) with transcriptional signatures obtained by genome-wide microarray profiling from whole blood, dentate gyrus (DG), and the anterior cingulate cortex (ACC). Hierarchical clustering and rank-rank hypergeometric overlap (RRHO) procedures allowed us to identify gene transcripts with variations that correlate with behavioral profiles. As a translational validation, some of those transcripts were assayed by RT-qPCR with blood samples from 10 severe major depressive episode (MDE) patients and 10 healthy controls over the course of 30 weeks and four visits. Repeated-measures ANOVAs revealed candidate trait biomarkers (ARHGEF1, CMAS, IGHMBP2, PABPN1 and TBC1D10C), whereas univariate linear regression analyses uncovered candidates state biomarkers (CENPO, FUS and NUBP1), as well as prediction biomarkers predictive of antidepressant response (CENPO, NUBP1). These data suggest that such a translational approach may offer new leads for clinically valid panels of biomarkers for MDD.
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Affiliation(s)
- Mylène Hervé
- Aix Marseille Univ, CNRS, CRN2M UMR 7286Marseille, France.,FondaMental, Fondation de Recherche et de Soins en Santé MentaleCréteil, France
| | - Aurélie Bergon
- Aix Marseille Univ, INSERM, TAGC UMR_S 1090Marseille, France
| | | | - Samuel Leman
- INSERM U930 Eq 4, UFR Sciences et Techniques, Université François RabelaisTours, France
| | - Julia-Lou Consoloni
- Aix Marseille Univ, CNRS, CRN2M UMR 7286Marseille, France.,FondaMental, Fondation de Recherche et de Soins en Santé MentaleCréteil, France.,AP-HM, Hôpital Sainte Marguerite, Pôle de Psychiatrie Universitaire SolarisMarseille, France
| | | | | | - Wissam El-Hage
- INSERM U930 Eq 4, UFR Sciences et Techniques, Université François RabelaisTours, France.,CHRU de Tours, Clinique Psychiatrique UniversitaireTours, France.,INSERM CIC 1415, Centre d'Investigation Clinique, CHRU de ToursTours, France
| | - Raoul Belzeaux
- Aix Marseille Univ, CNRS, CRN2M UMR 7286Marseille, France.,FondaMental, Fondation de Recherche et de Soins en Santé MentaleCréteil, France.,AP-HM, Hôpital Sainte Marguerite, Pôle de Psychiatrie Universitaire SolarisMarseille, France.,McGill Group for Suicide Studies, Douglas Mental Health University Institute, Department of Psychiatry, McGill UniversityMontreal, QC, Canada
| | - Catherine Belzung
- INSERM U930 Eq 4, UFR Sciences et Techniques, Université François RabelaisTours, France
| | - El Chérif Ibrahim
- Aix Marseille Univ, CNRS, CRN2M UMR 7286Marseille, France.,FondaMental, Fondation de Recherche et de Soins en Santé MentaleCréteil, France.,Aix Marseille Univ, CNRS, INT, Inst Neurosci Timone UMR 7289Marseille, France
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Pharmacogenetics and Imaging-Pharmacogenetics of Antidepressant Response: Towards Translational Strategies. CNS Drugs 2016; 30:1169-1189. [PMID: 27752945 DOI: 10.1007/s40263-016-0385-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Genetic variation underlies both the response to antidepressant treatment and the occurrence of side effects. Over the past two decades, a number of pharmacogenetic variants, among these the SCL6A4, BDNF, FKBP5, GNB3, GRIK4, and ABCB1 genes, have come to the forefront in this regard. However, small effects sizes, mixed results in independent samples, and conflicting meta-analyses results led to inherent difficulties in the field of pharmacogenetics translating these findings into clinical practice. Nearly all antidepressant pharmacogenetic variants have potentially pleiotropic effects in which they are associated with major depressive disorder, intermediate phenotypes involved in emotional processes, and brain areas affected by antidepressant treatment. The purpose of this article is to provide a comprehensive review of the advances made in the field of pharmacogenetics of antidepressant efficacy and side effects, imaging findings of antidepressant response, and the latest results in the expanding field of imaging-pharmacogenetics studies. We suggest there is mounting evidence that genetic factors exert their impact on treatment response by influencing brain structural and functional changes during antidepressant treatment, and combining neuroimaging and genetic methods may be a more powerful way to detect biological mechanisms of response than either method alone. The most promising imaging-pharmacogenetics findings exist for the SCL6A4 gene, with converging associations with antidepressant response, frontolimbic predictors of affective symptoms, and normalization of frontolimbic activity following antidepressant treatment. More research is required before imaging-pharmacogenetics informed personalized medicine can be applied to antidepressant treatment; nevertheless, inroads have been made towards assessing genetic and neuroanatomical liability and potential clinical application.
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Brunoni AR, Tortella G, Benseñor IM, Lotufo PA, Carvalho AF, Fregni F. Cognitive effects of transcranial direct current stimulation in depression: Results from the SELECT-TDCS trial and insights for further clinical trials. J Affect Disord 2016; 202:46-52. [PMID: 27253216 DOI: 10.1016/j.jad.2016.03.066] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 02/29/2016] [Accepted: 03/20/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Cognitive dysfunction treatment remains an unmet clinical need in major depressive disorder (MDD). Transcranial direct current stimulation (tDCS) may improve cognitive symptoms in MDD. Our aim was to investigate the cognitive effects of tDCS in the Sertraline vs. Electric Current Therapy for Treating Depression Clinical Study (SELECT-TDCS). We also explored whether tDCS could have mood-independent cognitive effects. METHODS One hundred twenty MDD patients aged from 18 to 65 years received 12 sessions of active/sham tDCS (2mA for 30min) and real/placebo 50mg/d sertraline over 6 weeks in a factorial trial. We analyzed whether changes in performance of neuropsychological tests (Trail Making, Digit Span, Stroop Task, Mini-Mental Status Exam and Montreal Cognitive Assessment) occurred over time, according to treatment group and depression improvement. Exploratory analyses were carried out to verify the influence of clinical and demographic variables on the outcomes. RESULTS Cognitive improvement was showed in most tests used, although they occurred regardless of intervention type and depression improvement. Further exploratory analyses revealed that clinical response and education level could have mediated pro-cognitive tDCS effects on some of the tests used. LIMITATIONS The neuropsychological battery used might not have been sensitive to detect tDCS-induced effects on cognition. Lack of simultaneous cognitive training during application may have also limited its cognitive effects. CONCLUSIONS We found no evidence of beneficial or deleterious cognitive effects of tDCS as a treatment for depression. We discussed clinical trial design considerations for further tDCS studies assessing cognitive effects, including sample and outcomes considerations.
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Affiliation(s)
- André Russowsky Brunoni
- Center for Clinical and Epidemiological Research & Interdisciplinary Center for Applied Neuromodulation (CINA), University Hospital, University of São Paulo, São Paulo, Brazil; Service of Interdisciplinary Neuromodulation (SIN), Laboratory of Neurosciences (LIM-27), Department and Institute of Psychiatry, Faculty of Medicine of University of São Paulo, São Paulo, Brazil.
| | - Gabriel Tortella
- Center for Clinical and Epidemiological Research & Interdisciplinary Center for Applied Neuromodulation (CINA), University Hospital, University of São Paulo, São Paulo, Brazil; Service of Interdisciplinary Neuromodulation (SIN), Laboratory of Neurosciences (LIM-27), Department and Institute of Psychiatry, Faculty of Medicine of University of São Paulo, São Paulo, Brazil
| | - Isabela Martins Benseñor
- Center for Clinical and Epidemiological Research & Interdisciplinary Center for Applied Neuromodulation (CINA), University Hospital, University of São Paulo, São Paulo, Brazil
| | - Paulo Andrade Lotufo
- Center for Clinical and Epidemiological Research & Interdisciplinary Center for Applied Neuromodulation (CINA), University Hospital, University of São Paulo, São Paulo, Brazil
| | - André Ferrer Carvalho
- Department of Clinical Medicine and Translational Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil
| | - Felipe Fregni
- Laboratory of Neuromodulation, Center for Clinical Research Learning, Department of Physical Medicine and Rehabilitation, Harvard University, USA
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Lv X, Si T, Wang G, Wang H, Liu Q, Hu C, Wang J, Su Y, Huang Y, Jiang H, Yu X. The establishment of the objective diagnostic markers and personalized medical intervention in patients with major depressive disorder: rationale and protocol. BMC Psychiatry 2016; 16:240. [PMID: 27422150 PMCID: PMC4946102 DOI: 10.1186/s12888-016-0953-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 07/01/2016] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Major depressive disorders (MDD) is a common mental disorder with high prevalence, frequent relapse and associated with heavy disease burden. Heritability, environment and their interaction play important roles in the development of MDD. MDD patients usually display a wide variation in clinical symptoms and signs, while the diagnosis of MDD is relatively subjective. The treatment response varies substantially between different subtypes of MDD patients and only half respond adequately to the first antidepressant. This study aims to define subtypes of MDD, develop multi-dimension diagnostic test and combined predictors for improving the diagnostic accuracy and promoting personalized intervention in MDD patients. METHODS/DESIGN This is a multi-center, multi-stage and prospective study. The first stage of this study is a case-control study, aims to explore the risk factors for developing MDD and then define the subtypes of MDD using 1200 MDD patients and 1200 healthy controls with a set of questionnaire. The second stage is a diagnostic test, aims to indentify and replicate the potential indicators to assist MDD diagnosis using 600 MDD patients and 300 healthy controls from the first stage with a set of questionnaire, neuropsychological assessment and a series of biomarkers. The third stage is a 96-week longitudinal study, including 8-week acute period treatment and 88-week stable period treatment, aims to identify overall predictors of treatment effectiveness on MDD at week 8 post treatment and to explore the predictors on MDD prognosis in the following 2 years using 600 MDD patients from the first stage with a set of questionnaire, neuropsychological assessment and a series of biomarkers. The primary outcome measure is the change of the total score of 17-Item Hamilton Rating Scale for Depression. DISCUSSION This study will provide strong and suitable evidence for enhancing the accuracy of MDD diagnosis and promoting personalized treatment for MDD patients in clinical practice. TRIAL REGISTRATION ClinicalTrials.gov: NCT02023567 ; registration date: December 2013.
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Affiliation(s)
- Xiaozhen Lv
- Peking University Sixth Hospital (Institute of Mental Health), Beijing, China ,National Clinical Research Center for Mental Disorders & Key Laboratory for Mental Health, Ministry of Health, Peking University, Beijing, China
| | - Tianmei Si
- Peking University Sixth Hospital (Institute of Mental Health), Beijing, China ,National Clinical Research Center for Mental Disorders & Key Laboratory for Mental Health, Ministry of Health, Peking University, Beijing, China
| | - Gang Wang
- Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Huali Wang
- Peking University Sixth Hospital (Institute of Mental Health), Beijing, China ,National Clinical Research Center for Mental Disorders & Key Laboratory for Mental Health, Ministry of Health, Peking University, Beijing, China
| | - Qi Liu
- Peking University Sixth Hospital (Institute of Mental Health), Beijing, China ,National Clinical Research Center for Mental Disorders & Key Laboratory for Mental Health, Ministry of Health, Peking University, Beijing, China
| | - Changqing Hu
- Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Jing Wang
- Peking University Sixth Hospital (Institute of Mental Health), Beijing, China ,National Clinical Research Center for Mental Disorders & Key Laboratory for Mental Health, Ministry of Health, Peking University, Beijing, China
| | - Yunai Su
- Peking University Sixth Hospital (Institute of Mental Health), Beijing, China ,National Clinical Research Center for Mental Disorders & Key Laboratory for Mental Health, Ministry of Health, Peking University, Beijing, China
| | - Yu Huang
- National Engineering Research Center for Software Engineering, Peking University, Beijing, China
| | - Hui Jiang
- National Engineering Research Center for Software Engineering, Peking University, Beijing, China
| | - Xin Yu
- Peking University Sixth Hospital (Institute of Mental Health), Beijing, China. .,National Clinical Research Center for Mental Disorders & Key Laboratory for Mental Health, Ministry of Health, Peking University, Beijing, China.
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Kent JM, Daly E, Kezic I, Lane R, Lim P, De Smedt H, De Boer P, Van Nueten L, Drevets WC, Ceusters M. Efficacy and safety of an adjunctive mGlu2 receptor positive allosteric modulator to a SSRI/SNRI in anxious depression. Prog Neuropsychopharmacol Biol Psychiatry 2016; 67:66-73. [PMID: 26804646 DOI: 10.1016/j.pnpbp.2016.01.009] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 12/14/2015] [Accepted: 01/19/2016] [Indexed: 12/01/2022]
Abstract
This phase 2a, randomized, multicenter, double-blind, proof-of-concept study was designed to evaluate, efficacy, safety and tolerability of JNJ-40411813/ADX71149, a novel metabotropic glutamate 2 receptor positive allosteric modulator as an adjunctive treatment for major depressive disorder (MDD) with significant anxiety symptoms. Eligible patients (18-64 years) had a DSM-IV diagnosis of MDD, Hamilton Depression Rating Scale-17 (HDRS17) score of ≥ 18, HDRS17 anxiety/somatization factor score of ≥ 7, and an insufficient response to current treatment with a selective serotonin reuptake inhibitor or serotonin-norepinephrine reuptake inhibitor. The doubly-randomized, 8-week double-blind treatment phase was comprised of two 4-week periods, from which a combined test statistic was generated, with pre-determined weights assigned to each of the 2 treatment periods. Period 1: patients (n=121) were randomly assigned (1:1) to JNJ-40411813 (n=62; 50mg to 150 mg b.i.d, flexibly dosed) or placebo (n=59); Period 2: placebo-treated patients (n=22) who continued to meet entry severity criteria were re-randomized (1:1) to JNJ-40411813 or placebo, while other patients underwent sham re-randomization and continued on their same treatment. Of 121 randomized patients, 100 patients (82.6%) were completers. No efficacy signal was detected on the primary endpoint, the 6-item Hamilton Anxiety Subscale (HAM-A6, p=0.51). Efficacy signals (based on prespecified 1-sided p<0.20) were evident on several secondary outcome measures of both depression (HDRS17 total score, 6-item subscale of HDRS17 assessing core depressive symptoms [HAM-D6], and Inventory of Depressive Symptomatology [IDS-C30]) and anxiety (HDRS17 anxiety/somatization factor, IDS-C30 anxiety subscale). Although well-tolerated, the results do not suggest efficacy for JNJ-40411813 as an adjunctive treatment for patients with MDD with significant anxious symptoms in the dose range studied.
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Affiliation(s)
- Justine M Kent
- Janssen Research & Development, LLC, Titusville, NJ, USA.
| | - Ella Daly
- Janssen Research & Development, LLC, Titusville, NJ, USA
| | | | - Rosanne Lane
- Janssen Research & Development, LLC, Titusville, NJ, USA
| | - Pilar Lim
- Janssen Research & Development, LLC, Titusville, NJ, USA
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Saunders R, Cape J, Fearon P, Pilling S. Predicting treatment outcome in psychological treatment services by identifying latent profiles of patients. J Affect Disord 2016; 197:107-15. [PMID: 26991365 DOI: 10.1016/j.jad.2016.03.011] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 02/19/2016] [Accepted: 03/07/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND The outcomes of psychological therapies for anxiety and depression vary across individuals and symptom domains. Being able to predict treatment response from readily available patient data at presentation has potentially important benefits in aiding decisions about the most suitable interventions for a patient. This paper presents a method of identifying subgroups of patients using latent profile analysis, and comparing response to psychological treatments between these profiles. METHODS All outpatients taken into treatment at two psychological treatment services in London, UK and who provided basic demographic information and standardized symptom measures were included in the analysis (n=16636). RESULTS Latent Profile Analysis was performed on intake data to identify statistically different groups of patients, which were then examined in longitudinal analyses to determine their capacity to predict treatment outcomes. Comparison between profiles showed considerable variation in recovery (74-15%), deterioration rates (5-20%), and levels of attrition (17-40%). Further variation in outcomes was found within the profiles when different intensities of psychological intervention were delivered. LIMITATIONS Latent profiles were identified using data from two services, so generalisability to other services should be considered. Routinely collected patient data was included, additional patient information may further enhance utility of the profiles. CONCLUSIONS These results suggest that intake data can be used to reliably classify patients into profiles that are predictive of outcome to different intensities of psychological treatment in routine care. Algorithms based on these kinds of data could be used to optimize decision-making and aid the appropriate matching of patients to treatment.
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Affiliation(s)
- Rob Saunders
- Research Department of Clinical, Educational and Health Psychology, University College London (UCL), 1-19 Torrington Place, London WC1E 7HB, United Kingdom.
| | - John Cape
- Research Department of Clinical, Educational and Health Psychology, University College London (UCL), 1-19 Torrington Place, London WC1E 7HB, United Kingdom
| | - Pasco Fearon
- Research Department of Clinical, Educational and Health Psychology, University College London (UCL), 1-19 Torrington Place, London WC1E 7HB, United Kingdom
| | - Stephen Pilling
- Research Department of Clinical, Educational and Health Psychology, University College London (UCL), 1-19 Torrington Place, London WC1E 7HB, United Kingdom
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Schuch FB, Dunn AL, Kanitz AC, Delevatti RS, Fleck MP. Moderators of response in exercise treatment for depression: A systematic review. J Affect Disord 2016; 195:40-9. [PMID: 26854964 DOI: 10.1016/j.jad.2016.01.014] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 01/05/2016] [Accepted: 01/10/2016] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Exercise have antidepressant effects in people with Major Depressive Disorder (MDD). However, about to half of patients do not respond to exercise. The identification of factors that moderates the antidepressant effects of exercise in people with MDD may help researchers and health professionals to identify sub-groups of patients that would benefit more from exercise. METHODS A systematic review was carried out using Medline(PubMed), EMBASE and psycINFO up to April 2015. Individual and composite moderators were summarized and the strength of the evidence was assessed. RESULTS Eleven studies were included for review resulting in the identification of potential individual (two biological, three clinical, two psychological and two social individual) and two potential composite moderators (the interaction between BDNF and Body Mass Index (BMI) and between family history of mental illness and gender). Only the two biological features and the BDNF x BMI interaction provided confirmatory evidence. LIMITATIONS Due the different statistical approaches used in the studies, it was not possible to perform meta-analyses. The small number of studies and the exploratory nature of the evidence limits a wider generalization of the findings. CONCLUSION Potential clinical, psychological, social or biological moderators were identified. However, the small number of studies and the limited strength of the evidence requires further studies before drawn definitive results. Further trials should consider the inclusion of moderators analysis using an a-priori, theoretical/evidence based hypothesis in order to provide high quality evidence for the use of personalized medicine in exercise for depression.
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Affiliation(s)
- F B Schuch
- Programa de Pós-graduação em ciências médicas: Psiquiatria, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Departamento de Psiquiatria, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil; Grupo de Pesquisa em Atividades Aquáticas e Terrestres, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
| | - A L Dunn
- Klein Buendel Inc., Denver, United States
| | - A C Kanitz
- Grupo de Pesquisa em Atividades Aquáticas e Terrestres, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - R S Delevatti
- Grupo de Pesquisa em Atividades Aquáticas e Terrestres, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - M P Fleck
- Programa de Pós-graduação em ciências médicas: Psiquiatria, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Departamento de Psiquiatria, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
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Baldessarini RJ, Tondo L, Visioli C, Vázquez GH. Illness history: Not associated with remission during treatment of major depression in 515 mood disorder patients. J Affect Disord 2016; 191:118-22. [PMID: 26655121 DOI: 10.1016/j.jad.2015.10.058] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2015] [Revised: 10/20/2015] [Accepted: 10/31/2015] [Indexed: 01/28/2023]
Abstract
BACKGROUND There is suggestive evidence that prior illness history may have little association with response to long-term treatment in bipolar disorder (BD) or recurrent major depressive disorder (MDD), but relationships of illness-history to treatment-response in acute episodes of depression require further testing. METHODS We tested for associations of selected measures of illness history with remission during treatment of an acute index episode of major depression in 515 mood-disorder patients (327 MDD, 188 BD), using bivariate and multivariate methods. RESULTS Remission of depression was more likely with lesser initial symptom-severity and bipolar diagnosis, but not related to years since illness-onset, previous depressions or episodes (based on counts, yearly rates, or %-of months ill), or other indices of illness-severity (hospitalization, co-morbidity, suicide attempt). CONCLUSIONS Likelihood of response to standard treatments for acute major depressive episodes in MDD or BD appeared to be largely independent of prior illness-history.
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Affiliation(s)
- Ross J Baldessarini
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, United States; International Consortium for Psychotic and Mood Disorders Research, Mailman Research Center, McLean Hospital, Belmont, Massachusetts, United States.
| | - Leonardo Tondo
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, United States; International Consortium for Psychotic and Mood Disorders Research, Mailman Research Center, McLean Hospital, Belmont, Massachusetts, United States; Lucio Bini Mood Disorders Center, Cagliari, Sardinia, Italy
| | - Caterina Visioli
- International Consortium for Psychotic and Mood Disorders Research, Mailman Research Center, McLean Hospital, Belmont, Massachusetts, United States; Lucio Bini Mood Disorders Center, Cagliari, Sardinia, Italy
| | - Gustavo H Vázquez
- International Consortium for Psychotic and Mood Disorders Research, Mailman Research Center, McLean Hospital, Belmont, Massachusetts, United States; Department of Neurosciences, Palermo University, Buenos Aires, Argentina
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Sheehan DV, Mancini M, Wang J, Berggren L, Cao H, Dueñas HJ, Yue L. Assessment of functional outcomes by Sheehan Disability Scale in patients with major depressive disorder treated with duloxetine versus selective serotonin reuptake inhibitors. Hum Psychopharmacol 2016; 31:53-63. [PMID: 26331440 PMCID: PMC5049604 DOI: 10.1002/hup.2500] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 05/11/2015] [Accepted: 07/10/2015] [Indexed: 12/03/2022]
Abstract
OBJECTIVE We compared functional impairment outcomes assessed with Sheehan Disability Scale (SDS) after treatment with duloxetine versus selective serotonin reuptake inhibitors (SSRIs) in patients with major depressive disorder. METHODS Data were pooled from four randomized studies comparing treatment with duloxetine and SSRIs (three double blind and one open label). Analysis of covariance, with last-observation-carried-forward approach for missing data, explored treatment differences between duloxetine and SSRIs on SDS changes during 8 to 12 weeks of acute treatment for the intent-to-treat population. Logistic regression analysis examined the predictive capacity of baseline patient characteristics for remission in functional impairment (SDS total score ≤ 6 and SDS item scores ≤ 2) at endpoint. RESULTS Included were 2193 patients (duloxetine n = 1029; SSRIs n = 835; placebo n = 329). Treatment with duloxetine and SSRIs resulted in significantly (p < 0.01) greater improvements in the SDS total score versus treatment with placebo. Higher SDS (p < 0.0001) or 17-item Hamilton Depression Rating Scale baseline scores (p < 0.01) predicted lower probability of functional improvement after treatment with duloxetine or SSRIs. Female gender (p ≤ 0.05) predicted higher probability of functional improvement after treatment with duloxetine or SSRIs. CONCLUSIONS Treatment with SSRIs and duloxetine improved functional impairment in patients with major depressive disorder. Higher SDS or 17-item Hamilton Depression Rating Scale baseline scores predicted less probability of SDS improvement; female gender predicted better improvement in functional impairment at endpoint.
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Affiliation(s)
- David V Sheehan
- Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | | | - Jianing Wang
- Lilly Suzhou Pharmaceutical Company Ltd, Shanghai, China
| | | | - Haijun Cao
- Lilly Suzhou Pharmaceutical Company Ltd, Shanghai, China
| | | | - Li Yue
- Lilly Suzhou Pharmaceutical Company Ltd, Shanghai, China
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Cano M, Cardoner N, Urretavizcaya M, Martínez-Zalacaín I, Goldberg X, Via E, Contreras-Rodríguez O, Camprodon J, de Arriba-Arnau A, Hernández-Ribas R, Pujol J, Soriano-Mas C, Menchón JM. Modulation of Limbic and Prefrontal Connectivity by Electroconvulsive Therapy in Treatment-resistant Depression: A Preliminary Study. Brain Stimul 2015; 9:65-71. [PMID: 26440406 DOI: 10.1016/j.brs.2015.08.016] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 08/11/2015] [Accepted: 08/28/2015] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Although current models of depression suggest that a sequential modulation of limbic and prefrontal connectivity is needed for illness recovery, neuroimaging studies of electroconvulsive therapy (ECT) have focused on assessing functional connectivity (FC) before and after an ECT course, without characterizing functional changes occurring at early treatment phases. OBJECTIVE To assess sequential changes in limbic and prefrontal FC during the course of ECT and their impact on clinical response. METHODS Longitudinal intralimbic and limbic-prefrontal networks connectivity study. We assessed 15 patients with treatment-resistant depression at four different time-points throughout the entire course of an ECT protocol and 10 healthy participants at two functional neuroimaging examinations. Furthermore, a path analysis to test direct and indirect predictive effects of limbic and prefrontal FC changes on clinical response measured with the Hamilton Rating Scale for Depression was also performed. RESULTS An early significant intralimbic FC decrease significantly predicted a later increase in limbic-prefrontal FC, which in turn significantly predicted clinical improvement at the end of an ECT course. CONCLUSIONS Our data support that treatment response involves sequential changes in FC within regions of the intralimbic and limbic-prefrontal networks. This approach may help in identifying potential early biomarkers of treatment response.
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Affiliation(s)
- Marta Cano
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Hospitalet de Llobregat, Barcelona, Spain; Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain
| | - Narcís Cardoner
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Hospitalet de Llobregat, Barcelona, Spain; Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain; Carlos III Health Institute, CIBERSAM, Spain; Mental Health Department, Parc Taulí Sabadell, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Mikel Urretavizcaya
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Hospitalet de Llobregat, Barcelona, Spain; Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain; Carlos III Health Institute, CIBERSAM, Spain
| | - Ignacio Martínez-Zalacaín
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Hospitalet de Llobregat, Barcelona, Spain
| | - Ximena Goldberg
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Hospitalet de Llobregat, Barcelona, Spain; Carlos III Health Institute, CIBERSAM, Spain
| | - Esther Via
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Hospitalet de Llobregat, Barcelona, Spain; Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain
| | - Oren Contreras-Rodríguez
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Hospitalet de Llobregat, Barcelona, Spain; Carlos III Health Institute, CIBERSAM, Spain
| | - Joan Camprodon
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Aida de Arriba-Arnau
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Hospitalet de Llobregat, Barcelona, Spain
| | - Rosa Hernández-Ribas
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Hospitalet de Llobregat, Barcelona, Spain; Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain; Carlos III Health Institute, CIBERSAM, Spain
| | - Jesús Pujol
- Carlos III Health Institute, CIBERSAM, Spain; MRI Research Unit, Hospital del Mar, Barcelona, Spain
| | - Carles Soriano-Mas
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Hospitalet de Llobregat, Barcelona, Spain; Carlos III Health Institute, CIBERSAM, Spain; Department of Psychobiology and Methodology in Health Sciences, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - José M Menchón
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Hospitalet de Llobregat, Barcelona, Spain; Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain; Carlos III Health Institute, CIBERSAM, Spain
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The international Study to Predict Optimized Treatment in Depression (iSPOT-D): outcomes from the acute phase of antidepressant treatment. J Psychiatr Res 2015; 61:1-12. [PMID: 25586212 DOI: 10.1016/j.jpsychires.2014.12.018] [Citation(s) in RCA: 98] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Revised: 12/21/2014] [Accepted: 12/23/2014] [Indexed: 12/28/2022]
Abstract
We aimed to characterize a large international cohort of outpatients with MDD within a practical trial design, in order to identify clinically useful predictors of outcomes with three common antidepressant medications in acute-phase treatment of major depressive disorder (MDD). The international Study to Predict Optimized Treatment in Depression has presently enrolled 1008 treatment-seeking outpatients (18-65 years old) at 17 sites (five countries). At pre-treatment, we characterized participants by symptoms, clinical history, functional status and comorbidity. Participants were randomized to receive escitalopram, sertraline or venlafaxine-extended release and managed by their physician following usual treatment practices. Symptoms, function, quality of life, and side-effect outcomes were assessed 8 weeks later. The relationship of anxiety to response and remission was assessed by comorbid Axis I diagnosis, presence/absence of anxiety symptoms, and dimensionally by anxiety symptom severity. The sample had moderate-to-severe symptoms, but substantial comorbidity and functional impairment. Of completers at week 8, 62.2% responded and 45.4% reached remission on the 17-item Hamilton Rating Scale for Depression; 53.3% and 37.6%, respectively on the 16-item Quick Inventory of Depressive Symptoms. Functional improvements were seen across all domains. Most participants had side effects that occurred with a frequency of 25% or less and were reported as being in the "none" to minimal/mild range for intensity and burden. Outcomes did not differ across medication groups. More severe anxiety symptoms at pre-treatment were associated with lower remission rates across all medications, independent of depressive severity, diagnostic comorbidity or side effects. Across medications, we found consistent and similar improvements in symptoms and function, and a dimensional prognostic effect of comorbid anxiety symptoms. These equivalent outcomes across treatments lay the foundation for identifying potential neurobiological and genetic predictors of treatment outcome in this sample.
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Brunoni AR, Machado-Vieira R, Zarate CA, Vieira ELM, Valiengo L, Benseñor IM, Lotufo PA, Gattaz WF, Teixeira AL. Assessment of non-BDNF neurotrophins and GDNF levels after depression treatment with sertraline and transcranial direct current stimulation in a factorial, randomized, sham-controlled trial (SELECT-TDCS): an exploratory analysis. Prog Neuropsychopharmacol Biol Psychiatry 2015; 56:91-6. [PMID: 25172025 PMCID: PMC4258544 DOI: 10.1016/j.pnpbp.2014.08.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Revised: 07/24/2014] [Accepted: 08/20/2014] [Indexed: 01/07/2023]
Abstract
The neurotrophic hypothesis of depression states that the major depressive episode is associated with lower neurotrophic factors levels, which increase with amelioration of depressive symptoms. However, this hypothesis has not been extended to investigate neurotrophic factors other than the brain-derived neurotrophic factor (BDNF). We therefore explored whether plasma levels of neurotrophins 3 (NT-3) and 4 (NT-4), nerve growth factor (NGF) and glial cell line derived neurotrophic factor (GDNF) changed after antidepressant treatment and correlated with treatment response. Seventy-three patients with moderate-to-severe, antidepressant-free unipolar depression were assigned to a pharmacological (sertraline) and a non-pharmacological (transcranial direct current stimulation, tDCS) intervention in a randomized, 2 × 2, placebo-controlled design. The plasma levels of NT-3, NT-4, NGF and GDNF were determined by enzyme-linked immunosorbent assay before and after a 6-week treatment course and analyzed according to clinical response and allocation group. We found that tDCS and sertraline (separately and combined) produced significant improvement in depressive symptoms. Plasma levels of all neurotrophic factors were similar across groups at baseline and remained significantly unchanged regardless of the intervention and of clinical response. Also, baseline plasma levels were not associated with clinical response. To conclude, in this 6-week placebo-controlled trial, NT-3, NT-4, NGF and GDNF plasma levels did not significantly change with sertraline or tDCS. These data suggest that these neurotrophic factors are not surrogate biomarkers of treatment response or involved in the antidepressant mechanisms of tDCS.
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Affiliation(s)
- André R Brunoni
- Center for Clinical and Epidemiological Research & Interdisciplinary Center for Applied Neuromodulation (CINA), University Hospital, University of São Paulo, São Paulo, Brazil; Service of Interdisciplinary Neuromodulation (SIN), Department and Institute of Psychiatry, Faculty of Medicine of University of São Paulo, São Paulo, Brazil; Laboratory of Neuroscience (LIM27), Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil.
| | - Rodrigo Machado-Vieira
- Laboratory of Neuroscience (LIM27), Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil; Experimental Therapeutics and Pathophysiology Branch, Intramural Research Program, National Institute of Mental Health (NIMH), NIH, Bethesda, MD, USA
| | - Carlos A Zarate
- Experimental Therapeutics and Pathophysiology Branch, Intramural Research Program, National Institute of Mental Health (NIMH), NIH, Bethesda, MD, USA
| | - Erica L M Vieira
- Interdisciplinary Laboratory of Medical Investigation, Faculty of Medicine of Minas Gerais, Belo Horizonte, Brazil
| | - Leandro Valiengo
- Center for Clinical and Epidemiological Research & Interdisciplinary Center for Applied Neuromodulation (CINA), University Hospital, University of São Paulo, São Paulo, Brazil; Service of Interdisciplinary Neuromodulation (SIN), Department and Institute of Psychiatry, Faculty of Medicine of University of São Paulo, São Paulo, Brazil; Laboratory of Neuroscience (LIM27), Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
| | - Isabela M Benseñor
- Center for Clinical and Epidemiological Research & Interdisciplinary Center for Applied Neuromodulation (CINA), University Hospital, University of São Paulo, São Paulo, Brazil
| | - Paulo A Lotufo
- Center for Clinical and Epidemiological Research & Interdisciplinary Center for Applied Neuromodulation (CINA), University Hospital, University of São Paulo, São Paulo, Brazil
| | - Wagner F Gattaz
- Laboratory of Neuroscience (LIM27), Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
| | - Antonio L Teixeira
- Interdisciplinary Laboratory of Medical Investigation, Faculty of Medicine of Minas Gerais, Belo Horizonte, Brazil
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