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Linsen F, Broeder C, Sep MSC, Verhoeven JE, Bet PM, Penninx BWJH, Meijer OC, Vinkers CH. Glucocorticoid Receptor (GR) antagonism as disease-modifying treatment for MDD with childhood trauma: protocol of the RESET-medication randomized controlled trial. BMC Psychiatry 2023; 23:331. [PMID: 37170109 PMCID: PMC10173560 DOI: 10.1186/s12888-023-04830-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 04/29/2023] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND Major depressive disorder (MDD) is a heterogeneous psychiatric disorder. Childhood trauma (CT, emotional/physical/sexual abuse or neglect before the age of 18) is one of the largest and most consistent risk factors for development and poor course of MDD. Overactivity of the HPA-axis and the stress hormone cortisol is thought to play a role in the vulnerability for MDD following exposure to CT. Rodent experiments showed that antagonism of the glucocorticoid receptor (GR) at adult age reversed the effects of early life stress. Similarly, we aim to target MDD in individuals with CT exposure using the GR antagonist mifepristone. METHODS The RESET-medication study is a placebo-controlled double-blind randomized controlled trial (RCT) which aims to include 158 adults with MDD and CT. Participants will be randomized (1:1) to a 7-day treatment arm of mifepristone (1200 mg/day) or a control arm (placebo). Participants are allowed to receive usual care for MDD including antidepressants. Measurements include three face-to-face meetings at baseline (T0), day 8 (T1), week 6 (T2), and two online follow-up meetings at 12 weeks (T3) and 6 months (T4). A subgroup of participants (N = 80) are included in a fMRI sub-study (T0, T2). The main study outcome will be depressive symptom severity as measured with the Inventory of Depressive Symptomatology-Self Rated (IDS-SR) at T2. Secondary outcomes include, among others, depressive symptom severity at other time points, disability, anxiety, sleep and subjective stress. To address underlying mechanisms mifepristone plasma levels, cortisol, inflammation, epigenetic regulation and fMRI measurements are obtained. DISCUSSION The RESET-medication study will provide clinical evidence whether GR antagonism is a disease-modifying treatment for MDD in individuals exposed to CT. If effective, this hypothesis-driven approach may extend to other psychiatric disorders where CT plays an important role. TRIAL REGISTRATION The trial protocol has been registered 01-02-2022 on ClinicalTrials.gov with ID "NCT05217758".
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Affiliation(s)
- F Linsen
- Department of Psychiatry, Amsterdam University Medical Center Location Vrije Universiteit Amsterdam, Amsterdam, 1081 HV, The Netherlands.
- Department of Anatomy & Neurosciences, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, 1081 HV, The Netherlands.
| | - C Broeder
- Department of Psychiatry, Amsterdam University Medical Center Location Vrije Universiteit Amsterdam, Amsterdam, 1081 HV, The Netherlands
- Department of Anatomy & Neurosciences, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, 1081 HV, The Netherlands
| | - M S C Sep
- Department of Psychiatry, Amsterdam University Medical Center Location Vrije Universiteit Amsterdam, Amsterdam, 1081 HV, The Netherlands
- GGZ inGeest Mental Health Care, Amsterdam, 1081 HJ, The Netherlands
| | - J E Verhoeven
- Department of Psychiatry, Amsterdam University Medical Center Location Vrije Universiteit Amsterdam, Amsterdam, 1081 HV, The Netherlands
- GGZ inGeest Mental Health Care, Amsterdam, 1081 HJ, The Netherlands
| | - P M Bet
- Department of Clinical Pharmacology and Pharmacy, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, 1081 HV, the Netherlands
| | - B W J H Penninx
- Department of Psychiatry, Amsterdam University Medical Center Location Vrije Universiteit Amsterdam, Amsterdam, 1081 HV, The Netherlands
- Amsterdam Public Health, Mental Health Program and Amsterdam Neuroscience, Mood, Anxiety, Psychosis, Sleep & Stress Program, Amsterdam, The Netherlands
| | - O C Meijer
- Division of Endocrinology, Department of Internal Medicine, Leiden University Medical Center, Leiden University, Leiden, 2333 ZA, the Netherlands
- Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Leiden University, Leiden, 2333 ZA, the Netherlands
| | - C H Vinkers
- Department of Psychiatry, Amsterdam University Medical Center Location Vrije Universiteit Amsterdam, Amsterdam, 1081 HV, The Netherlands
- Department of Anatomy & Neurosciences, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, 1081 HV, The Netherlands
- GGZ inGeest Mental Health Care, Amsterdam, 1081 HJ, The Netherlands
- Amsterdam Public Health, Mental Health Program and Amsterdam Neuroscience, Mood, Anxiety, Psychosis, Sleep & Stress Program, Amsterdam, The Netherlands
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Kaiser A, Broeder C, Cohen JR, Douw L, Reneman L, Schrantee A. Effects of a single-dose methylphenidate challenge on resting-state functional connectivity in stimulant-treatment naive children and adults with ADHD. Hum Brain Mapp 2022; 43:4664-4675. [PMID: 35781371 PMCID: PMC9491277 DOI: 10.1002/hbm.25981] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 05/17/2022] [Accepted: 05/27/2022] [Indexed: 11/09/2022] Open
Abstract
Prior studies suggest that methylphenidate, the primary pharmacological treatment for attention-deficit/hyperactivity disorder (ADHD), alters functional brain connectivity. As the neurotransmitter systems targeted by methylphenidate undergo significant alterations throughout development, the effects of methylphenidate on functional connectivity may also be modulated by age. Therefore, we assessed the effects of a single methylphenidate challenge on brain network connectivity in stimulant-treatment naïve children and adults with ADHD. We obtained resting-state functional MRI from 50 boys (10-12 years of age) and 49 men (23-40 years of age) with ADHD (DSM IV, all subtypes), before and after an oral challenge with 0.5 mg/kg methylphenidate; and from 11 boys and 12 men as typically developing controls. Connectivity strength (CS), eigenvector centrality (EC), and betweenness centrality (BC) were calculated for the striatum, thalamus, dorsal anterior cingulate cortex (dACC), and prefrontal cortex (PFC). In line with our hypotheses, we found that methylphenidate decreased measures of connectivity and centrality in the striatum and thalamus in children with ADHD, but increased the same metrics in adults with ADHD. Surprisingly, we found no major effects of methylphenidate in the dACC and PFC in either children or adults. Interestingly, pre-methylphenidate, participants with ADHD showed aberrant connectivity and centrality compared to controls predominantly in frontal regions. Our findings demonstrate that methylphenidate's effects on connectivity of subcortical regions are age-dependent in stimulant-treatment naïve participants with ADHD, likely due to ongoing maturation of dopamine and noradrenaline systems. These findings highlight the importance for future studies to take a developmental perspective when studying the effects of methylphenidate treatment.
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Affiliation(s)
- Antonia Kaiser
- Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, Amsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | - Caroline Broeder
- Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, Amsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | - Jessica R. Cohen
- Department of Psychology and NeuroscienceUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Linda Douw
- Department of Anatomy and Neurosciences, Amsterdam Neuroscience, Amsterdam UMCVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Liesbeth Reneman
- Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, Amsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | - Anouk Schrantee
- Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, Amsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
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Beentjes KM, Neal DP, Kerkhof YJF, Broeder C, Moeridjan ZDJ, Ettema TP, Pelkmans W, Muller MM, Graff MJL, Dröes RM. Impact of the FindMyApps program on people with mild cognitive impairment or dementia and their caregivers; an exploratory pilot randomised controlled trial. Disabil Rehabil Assist Technol 2020; 18:253-265. [PMID: 33245000 DOI: 10.1080/17483107.2020.1842918] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE FindMyApps is a web-based selection-tool and errorless learning training program to help people with mild dementia/Mild Cognitive Impairment (MCI) and caregivers find user-friendly apps. In preparation of a definitive trial, the impact and feasibility of the FindMyApps intervention on self-management and engagement in meaningful activities, including social participation, was explored. MATERIALS AND METHODS An exploratory pilot randomised controlled trial (trial registration approval number: NL7210) with pre/post measurements was conducted with community-dwelling people with mild dementia/MCI and their caregivers (n = 59) in the Netherlands. Dyads in the experimental group (n = 28) received training to use the tablet and FindMyApps, and the errorless learning method was taught to their caregivers. Control group dyads (n = 31) received a tablet (without FindMyApps), instructions on tablet-use and links to dementia-friendly apps. Validated instruments were used to assess person with dementia's self-management, meaningful activities and social participation, caregiver's sense of competence and both their quality of life. RESULTS AND CONCLUSIONS No statistical significant group differences on the outcomes were found. Small to moderate effect-sizes in favour of the FindMyApps group were found for self-management and social participation. Caregivers tended to have more positive care experiences. Subgroup analyses showed that people older than 70 benefitted more from FindMyApps regarding self-management and higher educated people benefitted more regarding social participation. FindMyApps is feasible for the target group and may have potential to improve self-management and social participation. For a future definitive effectiveness trial a larger sample size is recommended, as well as taking into account the possible impact of education and age.IMPLICATIONS FOR REHABILITATIONThe FindMyApps program is feasible for people with dementia/MCI and may have potential to improve their self-management and social participation.Informal caregivers may develop a more positive care experience when utilizing FindMyApps to find suitable apps for self-management and social participation for the person with dementia/MCI.
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Affiliation(s)
- Kim M Beentjes
- Department of Psychiatry, Amsterdam University Medical Centers, location VUmc, Amsterdam Public Health research institute, Amsterdam, the Netherlands
| | - David P Neal
- Department of Psychiatry, Amsterdam University Medical Centers, location VUmc, Amsterdam Public Health research institute, Amsterdam, the Netherlands
| | - Yvonne J F Kerkhof
- Department of Psychiatry, Amsterdam University Medical Centers, location VUmc, Amsterdam Public Health research institute, Amsterdam, the Netherlands.,Centre for Nursing Research, Sector Health Care, Saxion University of Applied Sciences, Deventer/Enschede, the Netherlands
| | - Caroline Broeder
- Department of Psychiatry, Amsterdam University Medical Centers, location VUmc, Amsterdam Public Health research institute, Amsterdam, the Netherlands.,Faculty of Science, Universiteit van Amsterdam, Amsterdam, the Netherlands
| | - Zaïnah D J Moeridjan
- Department of Psychiatry, Amsterdam University Medical Centers, location VUmc, Amsterdam Public Health research institute, Amsterdam, the Netherlands.,Faculty of Behavior and Movement Sciences, Department of Clinical Psychology, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Teake P Ettema
- Department of Psychiatry, Amsterdam University Medical Centers, location VUmc, Amsterdam Public Health research institute, Amsterdam, the Netherlands
| | - Wiesje Pelkmans
- Alzheimer Center Amsterdam, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Majon M Muller
- Department of Internal Medicine, Section Geriatric Medicine, Center of Geriatric Medicine (COGA), Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Maud J L Graff
- Department of Rehabilitation and Scientific Institute for Quality of Healthcare, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Rose-Marie Dröes
- Department of Psychiatry, Amsterdam University Medical Centers, location VUmc, Amsterdam Public Health research institute, Amsterdam, the Netherlands
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