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Ayyash S, Davis AD, Alders GL, MacQueen G, Strother SC, Hassel S, Zamyadi M, Arnott SR, Harris JK, Lam RW, Milev R, Müller DJ, Kennedy SH, Rotzinger S, Frey BN, Minuzzi L, Hall GB. Assessing remission in major depressive disorder using a functional-structural data fusion pipeline: A CAN-BIND-1 study. IBRO Neurosci Rep 2024; 16:135-146. [PMID: 38293679 PMCID: PMC10826332 DOI: 10.1016/j.ibneur.2023.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 12/30/2023] [Indexed: 02/01/2024] Open
Abstract
Neural network-level changes underlying symptom remission in major depressive disorder (MDD) are often studied from a single perspective. Multimodal approaches to assess neuropsychiatric disorders are evolving, as they offer richer information about brain networks. A FATCAT-awFC pipeline was developed to integrate a computationally intense data fusion method with a toolbox, to produce a faster and more intuitive pipeline for combining functional connectivity with structural connectivity (denoted as anatomically weighted functional connectivity (awFC)). Ninety-three participants from the Canadian Biomarker Integration Network for Depression study (CAN-BIND-1) were included. Patients with MDD were treated with 8 weeks of escitalopram and adjunctive aripiprazole for another 8 weeks. Between-group connectivity (SC, FC, awFC) comparisons contrasted remitters (REM) with non-remitters (NREM) at baseline and 8 weeks. Additionally, a longitudinal study analysis was performed to compare connectivity changes across time for REM, from baseline to week-8. Association between cognitive variables and connectivity were also assessed. REM were distinguished from NREM by lower awFC within the default mode, frontoparietal, and ventral attention networks. Compared to REM at baseline, REM at week-8 revealed increased awFC within the dorsal attention network and decreased awFC within the frontoparietal network. A medium effect size was observed for most results. AwFC in the frontoparietal network was associated with neurocognitive index and cognitive flexibility for the NREM group at week-8. In conclusion, the FATCAT-awFC pipeline has the benefit of providing insight on the 'full picture' of connectivity changes for REMs and NREMs while making for an easy intuitive approach.
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Affiliation(s)
- Sondos Ayyash
- School of Biomedical Engineering, McMaster University, Hamilton, Ontario, Canada
- Department of Psychology, Neuroscience & Behaviour, McMaster University, Hamilton, Ontario, Canada
| | - Andrew D Davis
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
- Rotman Research Institute, Baycrest, Toronto, Ontario, Canada
| | - Gésine L Alders
- Neuroscience Graduate Program, McMaster University, Hamilton, Ontario, Canada
| | - Glenda MacQueen
- Hotchkiss Brain Institute and Mathison Centre for Mental Health Research and Education, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Stephen C Strother
- Rotman Research Institute, Baycrest, Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
- Department of Medical Biophysics, University of Toronto, Ontario, Canada
| | - Stefanie Hassel
- Hotchkiss Brain Institute and Mathison Centre for Mental Health Research and Education, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Mojdeh Zamyadi
- Rotman Research Institute, Baycrest, Toronto, Ontario, Canada
| | | | - Jacqueline K Harris
- Department of Computer Science, University of Alberta, Edmonton, Alberta, Canada
| | - Raymond W Lam
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Roumen Milev
- Departments of Psychiatry and Psychology, Queen's University, Providence Care Hospital, Kingston, Ontario, Canada
| | - Daniel J Müller
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Sidney H Kennedy
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Centre for Mental Health, University Health Network, Toronto, Ontario, Canada
- Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
- Centre for Depression and Suicide Studies, and Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Susan Rotzinger
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
- Centre for Depression and Suicide Studies, and Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Benicio N Frey
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
- Neuroscience Graduate Program, McMaster University, Hamilton, Ontario, Canada
- Mood Disorders Treatment and Research Centre and Women's Health Concerns Clinic, St. Joseph's Healthcare, Hamilton, Ontario, Canada
| | - Luciano Minuzzi
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
- Neuroscience Graduate Program, McMaster University, Hamilton, Ontario, Canada
- Mood Disorders Treatment and Research Centre and Women's Health Concerns Clinic, St. Joseph's Healthcare, Hamilton, Ontario, Canada
| | - Geoffrey B Hall
- School of Biomedical Engineering, McMaster University, Hamilton, Ontario, Canada
- Department of Psychology, Neuroscience & Behaviour, McMaster University, Hamilton, Ontario, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
- Neuroscience Graduate Program, McMaster University, Hamilton, Ontario, Canada
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Nogovitsyn N, Ballester P, Lasby M, Dunlop K, Ceniti AK, Squires S, Rowe J, Ho K, Suh J, Hassel S, Souza R, Casseb RF, Harris JK, Zamyadi M, Arnott SR, Strother SC, Hall G, Lam RW, Poppenk J, Lebel C, Bray S, Metzak P, MacIntosh BJ, Goldstein BI, Wang J, Rizvi SJ, MacQueen G, Addington J, Harkness KL, Rotzinger S, Kennedy SH, Frey BN. An empirical analysis of structural neuroimaging profiles in a staging model of depression. J Affect Disord 2024; 351:631-640. [PMID: 38290583 DOI: 10.1016/j.jad.2024.01.246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 01/16/2024] [Accepted: 01/26/2024] [Indexed: 02/01/2024]
Abstract
We examine structural brain characteristics across three diagnostic categories: at risk for serious mental illness; first-presenting episode and recurrent major depressive disorder (MDD). We investigate whether the three diagnostic groups display a stepwise pattern of brain changes in the cortico-limbic regions. Integrated clinical and neuroimaging data from three large Canadian studies were pooled (total n = 622 participants, aged 12-66 years). Four clinical profiles were used in the classification of a clinical staging model: healthy comparison individuals with no history of depression (HC, n = 240), individuals at high risk for serious mental illness due to the presence of subclinical symptoms (SC, n = 80), first-episode depression (FD, n = 82), and participants with recurrent MDD in a current major depressive episode (RD, n = 220). Whole-brain volumetric measurements were extracted with FreeSurfer 7.1 and examined using three different types of analyses. Hippocampal volume decrease and cortico-limbic thinning were the most informative features for the RD vs HC comparisons. FD vs HC revealed that FD participants were characterized by a focal decrease in cortical thickness and global enlargement in amygdala volumes. Greater total amygdala volumes were significantly associated with earlier onset of illness in the FD but not the RD group. We did not confirm the construct validity of a tested clinical staging model, as a differential pattern of brain alterations was identified across the three diagnostic groups that did not parallel a stepwise clinical staging approach. The pathological processes during early stages of the illness may fundamentally differ from those that occur at later stages with clinical progression.
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Affiliation(s)
- Nikita Nogovitsyn
- Centre for Depression and Suicide Studies, Unity Health Toronto, Toronto, ON, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.
| | - Pedro Ballester
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Mike Lasby
- Electrical and Software Engineering, Schulich School of Engineering, University of Calgary, Calgary, AB, Canada; Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Katharine Dunlop
- Centre for Depression and Suicide Studies, Unity Health Toronto, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Amanda K Ceniti
- Centre for Depression and Suicide Studies, Unity Health Toronto, Toronto, ON, Canada; Arthur Sommer Rotenberg Suicide & Depression Studies Program, St. Michael's Hospital, Toronto, ON, Canada
| | - Scott Squires
- Department of Psychology, Queen's University, Kingston, ON, Canada
| | - Jessie Rowe
- Department of Psychology, Queen's University, Kingston, ON, Canada
| | - Keith Ho
- Centre for Depression and Suicide Studies, Unity Health Toronto, Toronto, ON, Canada
| | - JeeSu Suh
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Stefanie Hassel
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Roberto Souza
- Electrical and Software Engineering, Schulich School of Engineering, University of Calgary, Calgary, AB, Canada; Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Raphael F Casseb
- Neuroimaging Laboratory, University of Campinas, Campinas, SP, Brazil
| | | | - Mojdeh Zamyadi
- Rotman Research Institute, Baycrest, Toronto, ON, Canada
| | | | - Stephen C Strother
- Rotman Research Institute, Baycrest, Toronto, ON, Canada; Department of Medical Biophysics, University of Toronto, ON, Canada
| | - Geoffrey Hall
- Department of Psychology, Neuroscience & Behaviour, McMaster University, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Raymond W Lam
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Jordan Poppenk
- Department of Psychology, Queen's University, Kingston, ON, Canada
| | - Catherine Lebel
- Department of Radiology, University of Calgary, Calgary, AB, Canada; Alberta Children's Hospital Research Institute, Calgary, AB, Canada; Child & Adolescent Imaging Research (CAIR) Program, Calgary, AB, Canada
| | - Signe Bray
- Department of Radiology, University of Calgary, Calgary, AB, Canada; Alberta Children's Hospital Research Institute, Calgary, AB, Canada; Child & Adolescent Imaging Research (CAIR) Program, Calgary, AB, Canada
| | - Paul Metzak
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Bradley J MacIntosh
- Rotman Research Institute, Baycrest, Toronto, ON, Canada; Hurvitz Brain Sciences Program, Physical Sciences Platform, Sunnybrook Research Institute, Toronto, Ontario, Canada; Computational Radiology & Artificial Intelligence (CRAI) Unit, Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Benjamin I Goldstein
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry and Pharmacology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - JianLi Wang
- Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Sakina J Rizvi
- Centre for Depression and Suicide Studies, Unity Health Toronto, Toronto, ON, Canada; Arthur Sommer Rotenberg Suicide & Depression Studies Program, St. Michael's Hospital, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Glenda MacQueen
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Jean Addington
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Kate L Harkness
- Department of Psychology, Queen's University, Kingston, ON, Canada
| | - Susan Rotzinger
- Centre for Depression and Suicide Studies, Unity Health Toronto, Toronto, ON, Canada; Arthur Sommer Rotenberg Suicide & Depression Studies Program, St. Michael's Hospital, Toronto, ON, Canada; Krembil Research Centre, University Health Network, Toronto, ON, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Sidney H Kennedy
- Centre for Depression and Suicide Studies, Unity Health Toronto, Toronto, ON, Canada; Arthur Sommer Rotenberg Suicide & Depression Studies Program, St. Michael's Hospital, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada; Krembil Research Centre, University Health Network, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Benicio N Frey
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada; Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
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Islam F, Magarbeh L, Elsheikh SSM, Kloiber S, Espinola CW, Bhat V, Frey BN, Milev R, Soares CN, Parikh SV, Placenza F, Hassel S, Taylor VH, Leri F, Blier P, Uher R, Farzan F, Lam RW, Turecki G, Foster JA, Rotzinger S, Kennedy SH, Müller DJ. Influence of CYP2C19, CYP2D6, and ABCB1 Gene Variants and Serum Levels of Escitalopram and Aripiprazole on Treatment-Emergent Sexual Dysfunction: A Canadian Biomarker Integration Network in Depression 1 (CAN-BIND 1) Study. Can J Psychiatry 2024; 69:183-195. [PMID: 37796764 PMCID: PMC10874600 DOI: 10.1177/07067437231203433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Abstract
OBJECTIVES Treatment-emergent sexual dysfunction is frequently reported by individuals with major depressive disorder (MDD) on antidepressants, which negatively impacts treatment adherence and efficacy. We investigated the association of polymorphisms in pharmacokinetic genes encoding cytochrome-P450 drug-metabolizing enzymes, CYP2C19 and CYP2D6, and the transmembrane efflux pump, P-glycoprotein (i.e., ABCB1), on treatment-emergent changes in sexual function (SF) and sexual satisfaction (SS) in the Canadian Biomarker Integration Network in Depression 1 (CAN-BIND-1) sample. METHODS A total of 178 adults with MDD received treatment with escitalopram (ESC) from weeks 0-8 (Phase I). At week 8, nonresponders were augmented with aripiprazole (ARI) (i.e., ESC + ARI, n = 91), while responders continued ESC (i.e., ESC-Only, n = 80) from weeks 8-16 (Phase II). SF and SS were evaluated using the sex effects (SexFX) scale at weeks 0, 8, and 16. We assessed the primary outcomes, SF and SS change for weeks 0-8 and 8-16, using repeated measures mixed-effects models. RESULTS In ESC-Only, CYP2C19 intermediate metabolizer (IM) + poor metabolizers (PMs) showed treatment-related improvements in sexual arousal, a subdomain of SF, from weeks 8-16, relative to CYP2C19 normal metabolizers (NMs) who showed a decline, F(2,54) = 8.00, p < 0.001, q = 0.048. Specifically, CYP2C19 IM + PMs reported less difficulty with having and sustaining vaginal lubrication in females and erection in males, compared to NMs. Furthermore, ESC-Only females with higher concentrations of ESC metabolite, S-desmethylcitalopram (S-DCT), and S-DCT/ESC ratio in serum demonstrated more decline in SF (r = -0.42, p = 0.004, q = 0.034) and SS (r = -0.43, p = 0.003, q = 0.034), respectively, which was not observed in males. ESC-Only females also demonstrated a trend for a correlation between S-DCT and sexual arousal change in the same direction (r = -0.39, p = 0.009, q = 0.052). CONCLUSIONS CYP2C19 metabolizer phenotypes may be influencing changes in sexual arousal related to ESC monotherapy. Thus, preemptive genotyping of CYP2C19 may help to guide selection of treatment that circumvents selective serotonin reuptake inhibitor-related sexual dysfunction thereby improving outcomes for patients. Additionally, further research is warranted to clarify the role of S-DCT in the mechanisms underlying ESC-related changes in SF and SS. This CAN-BIND-1 study was registered on clinicaltrials.gov (Identifier: NCT01655706) on 27 July 2012.
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Affiliation(s)
- Farhana Islam
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
| | - Leen Magarbeh
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
| | - Samar S. M. Elsheikh
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Stefan Kloiber
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Caroline W. Espinola
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Interventional Psychiatry Program, St. Michael's Hospital, Toronto, ON, Canada
| | - Venkat Bhat
- Interventional Psychiatry Program, St. Michael's Hospital, Toronto, ON, Canada
| | - Benicio N. Frey
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
- Mood Disorders Program, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Roumen Milev
- Department of Psychiatry, Queen's University, Providence Care, Kingston, Ontario, Canada
| | - Claudio N. Soares
- Department of Psychiatry, Queen's University, Providence Care, Kingston, Ontario, Canada
| | - Sagar V. Parikh
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Franca Placenza
- Centre for Mental Health, University Health Network, Toronto, Ontario, Canada
| | - Stefanie Hassel
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
- Mathison Centre for Mental Health Research and Education, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Valerie H. Taylor
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
- Mathison Centre for Mental Health Research and Education, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Francesco Leri
- Department of Psychology and Neuroscience, University of Guelph, Guelph, Ontario, Canada
| | - Pierre Blier
- The Royal Institute of Mental Health Research, Ottawa, Ontario, Canada
| | - Rudolf Uher
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Faranak Farzan
- Mechatronic Systems Engineering, Simon Fraser University, Surrey, British Columbia, Canada
| | - Raymond W. Lam
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Gustavo Turecki
- McGill Group for Suicide Studies, Douglas Mental Health University Institute, McGill University, Verdun, Quebec, Canada
| | - Jane A. Foster
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
- Mood Disorders Program, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
- Centre for Mental Health, University Health Network, Toronto, Ontario, Canada
| | - Susan Rotzinger
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Sidney H. Kennedy
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Centre for Mental Health, University Health Network, Toronto, Ontario, Canada
- Department of Psychiatry, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
- Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
| | - Daniel J. Müller
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, Psychosomatics and Psychotherapy, University Clinic of Würzburg, Würzburg, Germany
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Vaccarino SR, Wang S, Rizvi SJ, Lou W, Hassel S, MacQueen GM, Ho K, Frey BN, Lam RW, Milev RV, Rotzinger S, Ravindran AV, Strother SC, Kennedy SH. Functional neuroimaging biomarkers of anhedonia response to escitalopram plus adjunct aripiprazole treatment for major depressive disorder. BJPsych Open 2024; 10:e18. [PMID: 38179598 PMCID: PMC10790221 DOI: 10.1192/bjo.2023.588] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 05/22/2023] [Revised: 08/21/2023] [Accepted: 09/19/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Identifying neuroimaging biomarkers of antidepressant response may help guide treatment decisions and advance precision medicine. AIMS To examine the relationship between anhedonia and functional neurocircuitry in key reward processing brain regions in people with major depressive disorder receiving aripiprazole adjunct therapy with escitalopram. METHOD Data were collected as part of the CAN-BIND-1 study. Participants experiencing a current major depressive episode received escitalopram for 8 weeks; escitalopram non-responders received adjunct aripiprazole for an additional 8 weeks. Functional magnetic resonance imaging (on weeks 0 and 8) and clinical assessment of anhedonia (on weeks 0, 8 and 16) were completed. Seed-based correlational analysis was employed to examine the relationship between baseline resting-state functional connectivity (rsFC), using the nucleus accumbens (NAc) and anterior cingulate cortex (ACC) as key regions of interest, and change in anhedonia severity after adjunct aripiprazole. RESULTS Anhedonia severity significantly improved after treatment with adjunct aripiprazole.There was a positive correlation between anhedonia improvement and rsFC between the ACC and posterior cingulate cortex, ACC and posterior praecuneus, and NAc and posterior praecuneus. There was a negative correlation between anhedonia improvement and rsFC between the ACC and anterior praecuneus and NAc and anterior praecuneus. CONCLUSIONS Eight weeks of aripiprazole, adjunct to escitalopram, was associated with improved anhedonia symptoms. Changes in functional connectivity between key reward regions were associated with anhedonia improvement, suggesting aripiprazole may be an effective treatment for individuals experiencing reward-related deficits. Future studies are required to replicate our findings and explore their generalisability, using other agents with partial dopamine (D2) agonism and/or serotonin (5-HT2A) antagonism.
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Affiliation(s)
- Sophie R. Vaccarino
- Institute of Medical Science, University of Toronto, Canada; Centre for Depression and Suicide Studies, Unity Health Toronto, Canada; and Cumming School of Medicine, University of Calgary, Canada
| | - Shijing Wang
- Institute of Medical Science, University of Toronto, Canada; and Centre for Depression and Suicide Studies, Unity Health Toronto, Canada
| | - Sakina J. Rizvi
- Institute of Medical Science, University of Toronto, Canada; Centre for Depression and Suicide Studies, Unity Health Toronto, Canada; Department of Psychiatry, University of Toronto, Canada; Department of Psychiatry, Unity Health Toronto, Canada; and Li Ka Shing Knowledge Institute, Unity Health Toronto, Canada
| | - Wendy Lou
- Dalla Lana School of Public Health, University of Toronto, Canada; and Department of Biostatistics, University of Toronto, Canada
| | - Stefanie Hassel
- Cumming School of Medicine, University of Calgary, Canada; and Department of Psychiatry, University of Calgary, Canada
| | - Glenda M. MacQueen
- Cumming School of Medicine, University of Calgary, Canada; and Department of Psychiatry, University of Calgary, Canada
| | - Keith Ho
- Centre for Depression and Suicide Studies, Unity Health Toronto, Canada; Department of Psychiatry, Unity Health Toronto, Canada; and Li Ka Shing Knowledge Institute, Unity Health Toronto, Canada
| | - Benicio N. Frey
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Canada
| | - Raymond W. Lam
- Department of Psychiatry, University of British Columbia, Canada
| | - Roumen V. Milev
- Department of Psychiatry, Providence Care, Queen's University, Canada
| | - Susan Rotzinger
- Centre for Depression and Suicide Studies, Unity Health Toronto, Canada
| | | | - Stephen C. Strother
- Institute of Medical Science, University of Toronto, Canada; Rotman Research Institute, Baycrest Centre, Canada; and Department of Medical Biophysics, University of Toronto, Canada
| | - Sidney H. Kennedy
- Institute of Medical Science, University of Toronto, Canada; Centre for Depression and Suicide Studies, Unity Health Toronto, Canada; Department of Psychiatry, University of Toronto, Canada; Department of Psychiatry, Unity Health Toronto, Canada; Li Ka Shing Knowledge Institute, Unity Health Toronto, Canada; and Krembil Research Institute, University Health Network, Toronto, Canada
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5
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Mazurka R, Cunningham S, Hassel S, Foster JA, Nogovitsyn N, Fiori LM, Strother SC, Arnott SR, Frey BN, Lam RW, MacQueen GM, Milev RV, Rotzinger S, Turecki G, Kennedy SH, Harkness KL. Relation of hippocampal volume and SGK1 gene expression to treatment remission in major depression is moderated by childhood maltreatment: A CAN-BIND-1 report. Eur Neuropsychopharmacol 2024; 78:71-80. [PMID: 38128154 DOI: 10.1016/j.euroneuro.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 12/01/2023] [Accepted: 12/14/2023] [Indexed: 12/23/2023]
Abstract
Preclinical research implicates stress-induced upregulation of the enzyme, serum- and glucocorticoid-regulated kinase 1 (SGK1), in reduced hippocampal volume. In the current study, we tested the hypothesis that greater SGK1 mRNA expression in humans would be associated with lower hippocampal volume, but only among those with a history of prolonged stress exposure, operationalized as childhood maltreatment (physical, sexual, and/or emotional abuse). Further, we examined whether baseline levels of SGK1 and hippocampal volume, or changes in these markers over the course of antidepressant treatment, would predict treatment outcomes in adults with major depression [MDD]. We assessed SGK1 mRNA expression from peripheral blood, and left and right hippocampal volume at baseline, as well as change in these markers over the first 8 weeks of a 16-week open-label trial of escitalopram as part of the Canadian Biomarker Integration Network in Depression program (MDD [n = 161] and healthy comparison participants [n = 91]). Childhood maltreatment was assessed via contextual interview with standardized ratings. In the full sample at baseline, greater SGK1 expression was associated with lower hippocampal volume, but only among those with more severe childhood maltreatment. In individuals with MDD, decreases in SGK1 expression predicted lower remission rates at week 16, again only among those with more severe maltreatment. Decreases in hippocampal volume predicted lower week 16 remission for those with low childhood maltreatment. These results suggest that both glucocorticoid-related neurobiological mechanisms of the stress response and history of childhood stress exposure may be critical to understanding differential treatment outcomes in MDD. ClinicalTrials.gov: NCT01655706 Canadian Biomarker Integration Network for Depression Study.
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Affiliation(s)
- Raegan Mazurka
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada.
| | | | - Stefanie Hassel
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Jane A Foster
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Nikita Nogovitsyn
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada; Centre for Depression and Suicide Studies, St. Michael's Hospital, Toronto ON, Canada
| | - Laura M Fiori
- Department of Psychiatry, Douglas Mental Health University Institute, McGill University, Montreal, Canada
| | - Stephen C Strother
- Rotman Research Institute, Baycrest, Toronto, ON, Canada; Department of Medical Biophysics, University of Toronto, Canada
| | | | - Benicio N Frey
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada; Mood Disorders Program, St. Joseph's Healthcare Hamilton, ON, Canada
| | - Raymond W Lam
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Glenda M MacQueen
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Roumen V Milev
- Departments of Psychiatry and Psychology, And Providence Care Hospital, Queen's University, Kingston, ON, Canada
| | - Susan Rotzinger
- Department of Psychiatry, University of Toronto, Canada; Centre for Depression and Suicide Studies, St. Michael's Hospital, Toronto ON, Canada
| | - Gustavo Turecki
- Department of Psychiatry, Douglas Mental Health University Institute, McGill University, Montreal, Canada
| | - Sidney H Kennedy
- Department of Psychiatry, University of Toronto, Canada; Centre for Depression and Suicide Studies, St. Michael's Hospital, Toronto ON, Canada
| | - Kate L Harkness
- Department of Psychology, Queen's University, Kingston, ON, Canada
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Rnic K, LeMoult J, Torres IJ, Chakrabarty T, Foster J, Frey BN, Harkness KL, Ho K, Li QS, Milev R, Quilty LC, Rotzinger S, Soares CN, Uher R, Kennedy SH, Lam RW. Predicting recurrence of major depressive episodes using the Depression Implicit Association Test: A Canadian biomarker integration network in depression (CAN-BIND) report. Psychiatry Res 2023; 330:115606. [PMID: 37979318 DOI: 10.1016/j.psychres.2023.115606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 11/06/2023] [Accepted: 11/11/2023] [Indexed: 11/20/2023]
Abstract
Identifying clinically relevant predictors of depressive recurrence following treatment for Major Depressive Disorder (MDD) is critical for relapse prevention. Implicit self-depressed associations (SDAs), defined as implicit cognitive associations between elements of depression (e.g., sad, miserable) and oneself, often persist following depressive episodes and may represent a cognitive biomarker for future recurrences. Thus, we examined whether SDAs, and changes in SDAs over time, prospectively predict depressive recurrence among treatment responders in the CAN-BIND Wellness Monitoring for MDD Study, a prospective cohort study conducted across 5 clinical centres. A total of 96 patients with MDD responding to various treatments were followed an average of 1.01 years. Participants completed the Depression Implicit Association Test (DIAT) - a computer-based measure of SDAs - every 8 weeks on a tablet device. Survival analyses indicated that greater SDAs at baseline and increases in SDAs over time predicted shorter time to MDD recurrence, even after accounting for depressive symptom severity. The findings show that SDAs are a robust prognostic indicator of risk for MDD recurrence, and that the DIAT may be a feasible and low-cost clinical screening tool. SDAs also represent a potential mechanism underlying the course of recurrent depression and are a promising target for relapse prevention interventions.
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Affiliation(s)
- Katerina Rnic
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada.
| | - Joelle LeMoult
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
| | - Ivan J Torres
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada; British Columbia Mental Health and Substance Use Services, Vancouver, BC, Canada
| | - Trisha Chakrabarty
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Jane Foster
- UT Southwestern Medical Center, Dallas, TX, USA
| | - Benicio N Frey
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Kate L Harkness
- Department of Psychology, Queen's University, Kingston, ON, Canada; Department of Psychiatry, Queen's University, Providence Care, Kingston, ON, Canada
| | - Keith Ho
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Qingqin S Li
- Neuroscience, Janssen Research & Development, LLC, Titusville, NJ, USA
| | - Roumen Milev
- Department of Psychology, Queen's University, Kingston, ON, Canada; Department of Psychiatry, Queen's University, Providence Care, Kingston, ON, Canada
| | - Lena C Quilty
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Susan Rotzinger
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Claudio N Soares
- Department of Psychiatry, Queen's University, Providence Care, Kingston, ON, Canada
| | - Rudolf Uher
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Sidney H Kennedy
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Raymond W Lam
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
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7
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Husain MI, Foster JA, Mason BL, Chen S, Zhao H, Wang W, Rotzinger S, Rizvi S, Ho K, Lam R, MacQueen G, Milev R, Frey BN, Müller D, Turecki G, Jha M, Trivedi M, Kennedy SH. Pro-inflammatory markers are associated with response to sequential pharmacotherapy in major depressive disorder: a CAN-BIND-1 report. CNS Spectr 2023; 28:739-746. [PMID: 37218291 DOI: 10.1017/s109285292300233x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVE There is limited literature on associations between inflammatory tone and response to sequential pharmacotherapies in major depressive disorder (MDD). METHODS In a 16-week open-label clinical trial, 211 participants with MDD were treated with escitalopram 10-20 mg daily for 8 weeks. Responders continued escitalopram while non-responders received adjunctive aripiprazole 2-10 mg daily for 8 weeks. Plasma levels of pro-inflammatory markers-C-reactive protein, interleukin (IL)-1β, IL-6, IL-17, interferon-gamma (IFN)-Γ, tumor necrosis factor (TNF)-α, and Chemokine C-C motif ligand-2 (CCL-2)-measured at baseline, and after 2, 8 and 16 weeks were included in logistic regression analyzes to assess associations between inflammatory markers and treatment response. RESULTS Pre-treatment IFN-Γ and CCL-2 levels were significantly associated with a lower of odds of response to escitalopram at 8 weeks. Increases in CCL-2 levels from weeks 8 to 16 in escitalopram non-responders were significantly associated with higher odds of non-response to adjunctive aripiprazole at week 16. CONCLUSION Higher pre-treatment levels of IFN-Γ and CCL-2 were associated with non-response to escitalopram. Increasing levels of these pro-inflammatory markers may be associated with non-response to adjunctive aripiprazole. These findings require validation in independent clinical populations.
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Affiliation(s)
- M Ishrat Husain
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Jane A Foster
- Centre for Depression and Suicide Studies, Unity Health, Toronto, ON, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
- Mood Disorders Program, St. Joseph's Healthcare Hamilton, ON, Canada
| | - Brittany L Mason
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, United States
| | - Sheng Chen
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Haoyu Zhao
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Wei Wang
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Susan Rotzinger
- Centre for Depression and Suicide Studies, Unity Health, Toronto, ON, Canada
| | - Sakina Rizvi
- Centre for Depression and Suicide Studies, Unity Health, Toronto, ON, Canada
| | - Keith Ho
- Centre for Depression and Suicide Studies, Unity Health, Toronto, ON, Canada
| | - Raymond Lam
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Glenda MacQueen
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Roumen Milev
- Department of Psychiatry, Queen's University, Kingston, ON, Canada
| | - Benicio N Frey
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
- Mood Disorders Program, St. Joseph's Healthcare Hamilton, ON, Canada
| | - Daniel Müller
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Gustavo Turecki
- The Douglas Hospital, Montreal, QC, Canada
- Department of Psychiatry. McGill University, Toronto, ON, Canada
| | - Manish Jha
- Icahn School of Medicine, Mount Sinai Hospital, New York, NY, United States
| | - Madhukar Trivedi
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, United States
| | - Sidney H Kennedy
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Centre for Depression and Suicide Studies, Unity Health, Toronto, ON, Canada
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8
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Phaterpekar T, Nunez JJ, Morton E, Liu YS, Cao B, Frey BN, Milev RV, Müller DJ, Rotzinger S, Soares CN, Taylor VH, Uher R, Kennedy SH, Lam RW. Machine Learning Prediction of Quality of Life Improvement During Antidepressant Treatment of Patients With Major Depressive Disorder: A STAR*D and CAN-BIND-1 Report. J Clin Psychiatry 2023; 85:23m14864. [PMID: 37967350 DOI: 10.4088/jcp.23m14864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2023]
Abstract
Background: Quality of life (QoL) is an important patient-centric outcome to evaluate in treatment of major depressive disorder (MDD). This work sought to investigate the performance of several machine learning methods to predict a return to normative QoL in patients with MDD after antidepressant treatment. Methods: Several binary classification algorithms were trained on data from the first 2 weeks of the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study (n = 651, conducted from 2001 to 2006) to predict week 9 normative QoL (score ≥ 67, based on a community normative sample, on the Quality of Life Enjoyment and Satisfaction Questionnaire-Short Form [Q-LES-Q-SF]) after treatment with citalopram. Internal validation was performed using a STAR*D holdout dataset, and external validation was performed using the Canadian Biomarker Integration Network in Depression-1 (CAN-BIND-1) dataset (n = 175, study conducted from 2012 to 2017) after treatment with escitalopram. Feature importance was calculated using SHapley Additive exPlanations (SHAP). Results: Random Forest performed most consistently on internal and external validation, with balanced accuracy (area under the receiver operator curve) of 71% (0.81) on the STAR*D dataset and 69% (0.75) on the CAN-BIND-1 dataset. Random Forest Classifiers trained on Q-LES-Q-SF and Quick Inventory of Depressive Symptomatology-Self-Rated variables had similar performance on both internal and external validation. Important predictive variables came from psychological, physical, and socioeconomic domains. Conclusions: Machine learning can predict normative QoL after antidepressant treatment with similar performance to that of prior work predicting depressive symptom response and remission. These results suggest that QoL outcomes in MDD patients can be predicted with simple patient-rated measures and provide a foundation to further improve performance and demonstrate clinical utility. Trial Registration: ClinicalTrials.gov identifiers NCT00021528 and NCT01655706.
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Affiliation(s)
- Tejas Phaterpekar
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
- Drs Phaterpekar and Nunez contributed equally to this work
| | - John-Jose Nunez
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
- Drs Phaterpekar and Nunez contributed equally to this work
| | - Emma Morton
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Yang S Liu
- Department of Psychiatry, University of Alberta, Edmonton, Canada
| | - Bo Cao
- Department of Psychiatry, University of Alberta, Edmonton, Canada
| | - Benicio N Frey
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada
| | - Roumen V Milev
- Departments of Psychiatry and Psychology, Queen's University, Kingston, Canada
| | - Daniel J Müller
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Centre for Addiction and Mental Health, Toronto, Canada
| | - Susan Rotzinger
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Claudio N Soares
- Departments of Psychiatry and Psychology, Queen's University, Kingston, Canada
| | - Valerie H Taylor
- Department of Psychiatry, University of Calgary, Calgary, Canada
| | - Rudolf Uher
- Department of Psychiatry, Dalhousie University, Halifax, Canada
| | - Sidney H Kennedy
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Raymond W Lam
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
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9
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Rowe J, Poppenk J, Squires S, Mazurka R, Nogovitsyn N, Hassel S, Zamyadi M, Arnott SR, Rotzinger S, Kennedy SH, Milev RV, Harkness KL. Anxious arousal predicts within-person changes in hippocampal volume in adults with a history of childhood maltreatment: A CAN-BIND4 report. J Psychopathol Clin Sci 2023; 132:797-807. [PMID: 37843538 DOI: 10.1037/abn0000864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
Childhood maltreatment (CM) is a strong transdiagnostic risk factor for future psychopathology. This risk is theorized to emerge partly because of glucocorticoid-mediated atrophy in the hippocampus, which leaves this area sensitive to further volume loss even through adulthood in the face of future stress and the emergence of psychopathology. This proof-of-principle study examines which specific dimensions of internalizing psychopathology in the context of a CM history are associated with decreases in hippocampal volume over a 6-month period. This study included 80 community-recruited adults (ages 18-66 years, 61.3% women) oversampled for a lifetime history of internalizing psychopathology. At baseline and a naturalistic 6-month follow-up, the symptom dimensions of the tripartite model (anxious arousal, anhedonic depression, and general distress) were assessed by self-report. Hippocampal volume was derived through T1-weighted magnetic resonance imaging scanning segmented via the volBrain HIPS pipeline. CM severity was determined via a semistructured, contextual interview with independent ratings. We found that higher levels of anxious arousal predicted decreases in hippocampal volume over time in those with greater severity of CM but were associated at a trend with increases in hippocampal volume over time in those with lower severity of maltreatment. Findings were specific to anxious arousal and the CA1 subregion of the hippocampus. These novel results suggest that for individuals with a history of CM, transdiagnostic interventions that target and reduce psychological and physiological arousal may result in the preservation of hippocampal structure and, thus, improvements in cognitive and emotional regulation in the face of stress. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
| | | | | | | | | | | | - Mojdeh Zamyadi
- University of Toronto, Centre for Addiction and Mental Health
| | | | | | - Sidney H Kennedy
- University of Toronto, Centre for Depression and Suicide Studies
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10
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Slyepchenko A, Uher R, Ho K, Hassel S, Matthews C, Lukus PK, Daros AR, Minarik A, Placenza F, Li QS, Rotzinger S, Parikh SV, Foster JA, Turecki G, Müller DJ, Taylor VH, Quilty LC, Milev R, Soares CN, Kennedy SH, Lam RW, Frey BN. A standardized workflow for long-term longitudinal actigraphy data processing using one year of continuous actigraphy from the CAN-BIND Wellness Monitoring Study. Sci Rep 2023; 13:15300. [PMID: 37714910 PMCID: PMC10504311 DOI: 10.1038/s41598-023-42138-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 09/05/2023] [Indexed: 09/17/2023] Open
Abstract
Monitoring sleep and activity through wearable devices such as wrist-worn actigraphs has the potential for long-term measurement in the individual's own environment. Long periods of data collection require a complex approach, including standardized pre-processing and data trimming, and robust algorithms to address non-wear and missing data. In this study, we used a data-driven approach to quality control, pre-processing and analysis of longitudinal actigraphy data collected over the course of 1 year in a sample of 95 participants. We implemented a data processing pipeline using open-source packages for longitudinal data thereby providing a framework for treating missing data patterns, non-wear scoring, sleep/wake scoring, and conducted a sensitivity analysis to demonstrate the impact of non-wear and missing data on the relationship between sleep variables and depressive symptoms. Compliance with actigraph wear decreased over time, with missing data proportion increasing from a mean of 4.8% in the first week to 23.6% at the end of the 12 months of data collection. Sensitivity analyses demonstrated the importance of defining a pre-processing threshold, as it substantially impacts the predictive value of variables on sleep-related outcomes. We developed a novel non-wear algorithm which outperformed several other algorithms and a capacitive wear sensor in quality control. These findings provide essential insight informing study design in digital health research.
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Affiliation(s)
- Anastasiya Slyepchenko
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, 100 West 5th Street, Suite C124, Hamilton, ON, L8N 3K7, Canada
| | - Rudolf Uher
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Keith Ho
- Centre for Depression and Suicide Studies, St. Michael's Hospital, Toronto, ON, Canada
| | - Stefanie Hassel
- Department of Psychiatry, Cumming School of Medicine, and Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Craig Matthews
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, 100 West 5th Street, Suite C124, Hamilton, ON, L8N 3K7, Canada
| | - Patricia K Lukus
- Mood Disorders Program, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Alexander R Daros
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Anna Minarik
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Franca Placenza
- University Health Network, University of Toronto, Toronto, ON, Canada
| | - Qingqin S Li
- Neuroscience, Janssen Research & Development, LLC, Titusville, NJ, 08560, USA
| | - Susan Rotzinger
- Centre for Depression and Suicide Studies, St. Michael's Hospital, Toronto, ON, Canada
| | - Sagar V Parikh
- Department of Psychiatry, University of Michigan, Ann Arbor, USA
| | - Jane A Foster
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, 100 West 5th Street, Suite C124, Hamilton, ON, L8N 3K7, Canada
- Center for Depression Research and Clinical Care, UT Southwestern Medical Center, Dallas, TX, USA
| | - Gustavo Turecki
- Douglas Institute, Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Daniel J Müller
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Valerie H Taylor
- Department of Psychiatry, Cumming School of Medicine, and Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Lena C Quilty
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Roumen Milev
- Department of Psychiatry, Queen's University and Providence Care Hospital, Kingston, ON, Canada
| | - Claudio N Soares
- Department of Psychiatry, Queen's University and Providence Care Hospital, Kingston, ON, Canada
| | - Sidney H Kennedy
- Centre for Depression and Suicide Studies, St. Michael's Hospital, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Raymond W Lam
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Benicio N Frey
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, 100 West 5th Street, Suite C124, Hamilton, ON, L8N 3K7, Canada.
- Mood Disorders Program, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada.
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11
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Schwartzmann B, Dhami P, Uher R, Lam RW, Frey BN, Milev R, Müller DJ, Blier P, Soares CN, Parikh SV, Turecki G, Foster JA, Rotzinger S, Kennedy SH, Farzan F. Developing an Electroencephalography-Based Model for Predicting Response to Antidepressant Medication. JAMA Netw Open 2023; 6:e2336094. [PMID: 37768659 PMCID: PMC10539986 DOI: 10.1001/jamanetworkopen.2023.36094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/29/2023] Open
Abstract
Importance Untreated depression is a growing public health concern, with patients often facing a prolonged trial-and-error process in search of effective treatment. Developing a predictive model for treatment response in clinical practice remains challenging. Objective To establish a model based on electroencephalography (EEG) to predict response to 2 distinct selective serotonin reuptake inhibitor (SSRI) medications. Design, Setting, and Participants This prognostic study developed a predictive model using EEG data collected between 2011 and 2017 from 2 independent cohorts of participants with depression: 1 from the first Canadian Biomarker Integration Network in Depression (CAN-BIND) group and the other from the Establishing Moderators and Biosignatures of Antidepressant Response for Clinical Care (EMBARC) consortium. Eligible participants included those aged 18 to 65 years who had a diagnosis of major depressive disorder. Data were analyzed from January to December 2022. Exposures In an open-label trial, CAN-BIND participants received an 8-week treatment regimen of escitalopram treatment (10-20 mg), and EMBARC participants were randomized in a double-blind trial to receive an 8-week sertraline (50-200 mg) treatment or placebo treatment. Main Outcomes and Measures The model's performance was estimated using balanced accuracy, specificity, and sensitivity metrics. The model used data from the CAN-BIND cohort for internal validation, and data from the treatment group of the EMBARC cohort for external validation. At week 8, response to treatment was defined as a 50% or greater reduction in the primary, clinician-rated scale of depression severity. Results The CAN-BIND cohort included 125 participants (mean [SD] age, 36.4 [13.0] years; 78 [62.4%] women), and the EMBARC sertraline treatment group included 105 participants (mean [SD] age, 38.4 [13.8] years; 72 [68.6%] women). The model achieved a balanced accuracy of 64.2% (95% CI, 55.8%-72.6%), sensitivity of 66.1% (95% CI, 53.7%-78.5%), and specificity of 62.3% (95% CI, 50.1%-73.8%) during internal validation with CAN-BIND. During external validation with EMBARC, the model achieved a balanced accuracy of 63.7% (95% CI, 54.5%-72.8%), sensitivity of 58.8% (95% CI, 45.3%-72.3%), and specificity of 68.5% (95% CI, 56.1%-80.9%). Additionally, the balanced accuracy for the EMBARC placebo group (118 participants) was 48.7% (95% CI, 39.3%-58.0%), the sensitivity was 50.0% (95% CI, 35.2%-64.8%), and the specificity was 47.3% (95% CI, 35.9%-58.7%), suggesting the model's specificity in predicting SSRIs treatment response. Conclusions and Relevance In this prognostic study, an EEG-based model was developed and validated in 2 independent cohorts. The model showed promising accuracy in predicting treatment response to 2 distinct SSRIs, suggesting potential applications for personalized depression treatment.
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Affiliation(s)
- Benjamin Schwartzmann
- eBrain Lab, School of Mechatronic Systems Engineering, Simon Fraser University, Surrey, British Columbia, Canada
| | - Prabhjot Dhami
- eBrain Lab, School of Mechatronic Systems Engineering, Simon Fraser University, Surrey, British Columbia, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Rudolf Uher
- Department of Psyciatry, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Raymond W Lam
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Benicio N Frey
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
- Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare, Hamilton, Ontario, Canada
| | - Roumen Milev
- Department of Psychiatry, Queen's University, Providence Care, Kingston, Ontario, Canada
- Department of Psychology, Queen's University, Providence Care, Kingston, Ontario, Canada
| | - Daniel J Müller
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Pierre Blier
- Mood Disorders Research Unit, University of Ottawa Institute of Mental Health Research, Ottawa, Ontario, Canada
| | - Claudio N Soares
- Department of Psychiatry, Queen's University, Providence Care, Kingston, Ontario, Canada
- Department of Psychology, Queen's University, Providence Care, Kingston, Ontario, Canada
| | | | - Gustavo Turecki
- Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Jane A Foster
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
- Center for Depression Research and Clinical Care, University of Texas Southwestern Medical Center, Dallas
| | - Susan Rotzinger
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare, Hamilton, Ontario, Canada
| | - Sidney H Kennedy
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Unity Health Toronto, Toronto, Ontario, Canada
| | - Faranak Farzan
- eBrain Lab, School of Mechatronic Systems Engineering, Simon Fraser University, Surrey, British Columbia, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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12
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Nunez JJ, Liu YS, Cao B, Frey BN, Ho K, Milev R, Müller DJ, Rotzinger S, Soares CN, Taylor VH, Uher R, Kennedy SH, Lam RW. Response trajectories during escitalopram treatment of patients with major depressive disorder. Psychiatry Res 2023; 327:115361. [PMID: 37523890 DOI: 10.1016/j.psychres.2023.115361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 07/17/2023] [Accepted: 07/21/2023] [Indexed: 08/02/2023]
Abstract
Depression is a leading global cause of disability, yet about half of patients do not respond to initial antidepressant treatment. This treatment difficulty may be in part due to the heterogeneity of depression and corresponding response to treatment. Unsupervised machine learning allows underlying patterns to be uncovered, and can be used to understand this heterogeneity by finding groups of patients with similar response trajectories. Prior studies attempting this have clustered patients using a narrow range of data primarily from depression scales. In this work, we used unsupervised machine learning to cluster patients receiving escitalopram therapy using a wide variety of subjective and objective clinical features from the first eight weeks of the Canadian Biomarker Integration Network in Depression-1 trial. We investigated how these clusters responded to treatment by comparing changes in symptoms and symptom categories, and by using Principal Component Analysis (PCA). Our algorithm found three clusters, which broadly represented non-responders, responders, and remitters. Most categories of features followed this response pattern except for objective cognitive features. Using PCA with our clusters, we found that subjective mood state/anhedonia is the core feature of response with escitalopram, but there exists other distinct patterns of response around neurovegetative symptoms, activation, and cognition.
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Affiliation(s)
- John-Jose Nunez
- Department of Psychiatry, University of British Columbia, Vancouver, Canada.
| | - Yang S Liu
- Department of Psychiatry, University of Alberta, Edmonton, Canada
| | - Bo Cao
- Department of Psychiatry, University of Alberta, Edmonton, Canada; Department of Computing Science, University of Alberta, Edmonton, Canada
| | - Benicio N Frey
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada
| | - Keith Ho
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Roumen Milev
- Department of Psychiatry, Queen's University, Providence Care, Kingston, Canada
| | - Daniel J Müller
- Department of Psychiatry, University of Toronto, Toronto, Canada; Centre for Addiction and Mental Health, Toronto, Canada
| | - Susan Rotzinger
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Claudio N Soares
- Department of Psychiatry, Queen's University, Providence Care, Kingston, Canada
| | - Valerie H Taylor
- Department of Psychiatry, University of Calgary, Calgary, Canada
| | - Rudolf Uher
- Department of Psychiatry, Dalhousie University, Halifax, Canada
| | - Sidney H Kennedy
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Raymond W Lam
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
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13
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Sajjadian M, Uher R, Ho K, Hassel S, Milev R, Frey BN, Farzan F, Blier P, Foster JA, Parikh SV, Müller DJ, Rotzinger S, Soares CN, Turecki G, Taylor VH, Lam RW, Strother SC, Kennedy SH. Prediction of depression treatment outcome from multimodal data: a CAN-BIND-1 report. Psychol Med 2023; 53:5374-5384. [PMID: 36004538 PMCID: PMC10482706 DOI: 10.1017/s0033291722002124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 05/04/2022] [Accepted: 06/20/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Prediction of treatment outcomes is a key step in improving the treatment of major depressive disorder (MDD). The Canadian Biomarker Integration Network in Depression (CAN-BIND) aims to predict antidepressant treatment outcomes through analyses of clinical assessment, neuroimaging, and blood biomarkers. METHODS In the CAN-BIND-1 dataset of 192 adults with MDD and outcomes of treatment with escitalopram, we applied machine learning models in a nested cross-validation framework. Across 210 analyses, we examined combinations of predictive variables from three modalities, measured at baseline and after 2 weeks of treatment, and five machine learning methods with and without feature selection. To optimize the predictors-to-observations ratio, we followed a tiered approach with 134 and 1152 variables in tier 1 and tier 2 respectively. RESULTS A combination of baseline tier 1 clinical, neuroimaging, and molecular variables predicted response with a mean balanced accuracy of 0.57 (best model mean 0.62) compared to 0.54 (best model mean 0.61) in single modality models. Adding week 2 predictors improved the prediction of response to a mean balanced accuracy of 0.59 (best model mean 0.66). Adding tier 2 features did not improve prediction. CONCLUSIONS A combination of clinical, neuroimaging, and molecular data improves the prediction of treatment outcomes over single modality measurement. The addition of measurements from the early stages of treatment adds precision. Present results are limited by lack of external validation. To achieve clinically meaningful prediction, the multimodal measurement should be scaled up to larger samples and the robustness of prediction tested in an external validation dataset.
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Affiliation(s)
- Mehri Sajjadian
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Rudolf Uher
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Keith Ho
- University Health Network, 399 Bathurst Street, Toronto, ON, M5T 2S8, Canada
- Unity Health Toronto, St. Michael's Hospital, 193 Yonge Street, 6th floor, Toronto, ON, M5B 1M4, Canada
| | - Stefanie Hassel
- Department of Psychiatry and Mathison Centre for Mental Health Research and Education, Cumming School of Medicine, University of Calgary, 3330 Hospital Dr NW, Calgary, AB, T2N 4N1, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Roumen Milev
- Departments of Psychiatry and Psychology, Queen's University, Providence Care Hospital, Kingston, ON, Canada
| | - Benicio N. Frey
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
- Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Faranak Farzan
- eBrain Lab, School of Mechatronic Systems Engineering, Simon Fraser University, Surrey, BC, Canada
| | - Pierre Blier
- The Royal's Institute of Mental Health Research, 1145 Carling Avenue, Ottawa, ON, K1Z 7K4, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada
- Department of Psychiatry, University of Ottawa, 1145 Carling Avenue, Ottawa, ON, K1Z 7K4, Canada
| | - Jane A. Foster
- Department of Psychiatry & Behavioural Neurosciences, St Joseph's Healthcare, Hamilton, ON, Canada
| | - Sagar V. Parikh
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Daniel J. Müller
- Campbell Family Mental Health Research Institute, Center for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Susan Rotzinger
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, St Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Claudio N. Soares
- Department of Psychiatry, Queen's University School of Medicine, Kingston, ON, Canada
| | - Gustavo Turecki
- Department of Psychiatry, Douglas Institute, McGill University, Montreal, QC, Canada
| | - Valerie H. Taylor
- Department of Psychiatry, Foothills Medical Centre, University of Calgary, Calgary, AB, Canada
| | - Raymond W. Lam
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Stephen C. Strother
- Rotman Research Center, Baycrest, Toronto, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, Canada
| | - Sidney H. Kennedy
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, St Michael's Hospital, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, University Health Network, Toronto, Ontario, Canada
- Krembil Research Centre, University Health Network, University of Toronto, Toronto, Canada
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14
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Harkness KL, Chakrabarty T, Rizvi SJ, Mazurka R, Quilty L, Uher R, Milev RV, Frey BN, Parikh SV, Foster JA, Rotzinger S, Kennedy SH, Lam RW. The Differential Relation of Emotional, Physical, and Sexual Abuse Histories to Antidepressant Treatment Remission and Persistence of Anhedonia in Major Depression: A CAN-BIND-1 Report. Can J Psychiatry 2023; 68:586-595. [PMID: 36785892 PMCID: PMC10411366 DOI: 10.1177/07067437231156255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
OBJECTIVE Childhood maltreatment is a potent enviromarker of risk for poor response to antidepressant medication (ADM). However, childhood maltreatment is a heterogeneous construct that includes distinct exposures that have distinct neurobiological and psychological correlates. The purpose of the current study is to examine the differential associations of emotional, physical, and sexual maltreatment to ADM outcome and to examine the unique role of anhedonia in driving poor response in patients with specific maltreatment histories. METHODS In a multicentre clinical trial of major depression, 164 individuals were assessed for childhood emotional, physical, and sexual maltreatment with a contextual interview with independent, standardized ratings. All individuals received 8 weeks of escitalopram, with nonresponders subsequently also receiving augmentation with aripiprazole, with outcomes measured with depression rating scales and an anhedonia scale. RESULTS Greater severity of emotional maltreatment perpetrated by the mother was a significant and direct predictor of lower odds of week 16 remission (odds ratio [OR] = 1.68, P = 0.02). In contrast, the relations of paternal-perpetrated emotional maltreatment and physical maltreatment to week 16 remission were indirect, mediated through greater severity of anhedonia at week 8. CONCLUSIONS We identify emotional maltreatment as a specific early exposure that places patients at the greatest risk for nonremission following pharmacological treatment. Further, we suggest that anhedonia is a key symptom domain driving nonremission in patients with particular maltreatment histories.
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Affiliation(s)
- Kate L. Harkness
- Department of Psychology, Queen's University, Kingston, ON, Canada
| | - Trisha Chakrabarty
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Sakina J. Rizvi
- Centre for Depression and Suicide Studies, St. Michael's Hospital, Toronto ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Raegan Mazurka
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Lena Quilty
- Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada
| | - Rudolf Uher
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Roumen V. Milev
- Department of Psychiatry, Queen's University, and Providence Care, Kingston, ON, Canada
| | - Benicio N. Frey
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
- Mood Disorders Program, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Sagar V. Parikh
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Jane A. Foster
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Susan Rotzinger
- Centre for Depression and Suicide Studies, St. Michael's Hospital, Toronto ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Sidney H. Kennedy
- Centre for Depression and Suicide Studies, St. Michael's Hospital, Toronto ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Raymond W. Lam
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
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15
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Schwartzmann B, Quilty LC, Dhami P, Uher R, Allen TA, Kloiber S, Lam RW, Frey BN, Milev R, Müller DJ, Soares CN, Foster JA, Rotzinger S, Kennedy SH, Farzan F. Resting-state EEG delta and alpha power predict response to cognitive behavioral therapy in depression: a Canadian biomarker integration network for depression study. Sci Rep 2023; 13:8418. [PMID: 37225718 DOI: 10.1038/s41598-023-35179-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 05/14/2023] [Indexed: 05/26/2023] Open
Abstract
Cognitive behavioral therapy (CBT) is often recommended as a first-line treatment in depression. However, access to CBT remains limited, and up to 50% of patients do not benefit from this therapy. Identifying biomarkers that can predict which patients will respond to CBT may assist in designing optimal treatment allocation strategies. In a Canadian Biomarker Integration Network for Depression (CAN-BIND) study, forty-one adults with depression were recruited to undergo a 16-week course of CBT with thirty having resting-state electroencephalography (EEG) recorded at baseline and week 2 of therapy. Successful clinical response to CBT was defined as a 50% or greater reduction in Montgomery-Åsberg Depression Rating Scale (MADRS) score from baseline to post-treatment completion. EEG relative power spectral measures were analyzed at baseline, week 2, and as early changes from baseline to week 2. At baseline, lower relative delta (0.5-4 Hz) power was observed in responders. This difference was predictive of successful clinical response to CBT. Furthermore, responders exhibited an early increase in relative delta power and a decrease in relative alpha (8-12 Hz) power compared to non-responders. These changes were also found to be good predictors of response to the therapy. These findings showed the potential utility of resting-state EEG in predicting CBT outcomes. They also further reinforce the promise of an EEG-based clinical decision-making tool to support treatment decisions for each patient.
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Affiliation(s)
- Benjamin Schwartzmann
- eBrain Lab, School of Mechatronic Systems Engineering, Simon Fraser University, 13750-96 Ave, Surrey, BC, V3V 1Z2, Canada
| | - Lena C Quilty
- University of Toronto, 27 King's College Circle, Toronto, ON, M5S 1A1, Canada
- Centre for Addiction and Mental Health, 1001 Queen St. W, Toronto, ON, M6J 1H4, Canada
| | - Prabhjot Dhami
- eBrain Lab, School of Mechatronic Systems Engineering, Simon Fraser University, 13750-96 Ave, Surrey, BC, V3V 1Z2, Canada
- University of Toronto, 27 King's College Circle, Toronto, ON, M5S 1A1, Canada
- Centre for Addiction and Mental Health, 1001 Queen St. W, Toronto, ON, M6J 1H4, Canada
| | - Rudolf Uher
- Department of Psychiatry, Dalhousie University, 5909 Veterans' Memorial Lane, Halifax, NS, B3H 2E2, Canada
| | - Timothy A Allen
- Centre for Addiction and Mental Health, 1001 Queen St. W, Toronto, ON, M6J 1H4, Canada
| | - Stefan Kloiber
- University of Toronto, 27 King's College Circle, Toronto, ON, M5S 1A1, Canada
- Centre for Addiction and Mental Health, 1001 Queen St. W, Toronto, ON, M6J 1H4, Canada
| | - Raymond W Lam
- Department of Psychiatry, University of British Columbia, 2255 Wesbrook Mall, Vancouver, BC, V6T 2A1, Canada
| | - Benicio N Frey
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, 100 West 5th St., Hamilton, ON, L8N 3K7, Canada
- Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare, 100 West 5th St., Hamilton, ON, L8N 3K7, Canada
| | - Roumen Milev
- Department of Psychiatry, Providence Care, Queen's University, 752 King Street West, Kingston, ON, K7L 4X3, Canada
| | - Daniel J Müller
- University of Toronto, 27 King's College Circle, Toronto, ON, M5S 1A1, Canada
- Centre for Addiction and Mental Health, 1001 Queen St. W, Toronto, ON, M6J 1H4, Canada
| | - Claudio N Soares
- Department of Psychiatry, Providence Care, Queen's University, 752 King Street West, Kingston, ON, K7L 4X3, Canada
| | - Jane A Foster
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, 100 West 5th St., Hamilton, ON, L8N 3K7, Canada
| | - Susan Rotzinger
- University of Toronto, 27 King's College Circle, Toronto, ON, M5S 1A1, Canada
- Unity Health Toronto, Toronto, ON, Canada
- University Health Network, 399 Bathurst Street, Toronto, ON, M5T 2S8, Canada
| | - Sidney H Kennedy
- University of Toronto, 27 King's College Circle, Toronto, ON, M5S 1A1, Canada
- Unity Health Toronto, Toronto, ON, Canada
- University Health Network, 399 Bathurst Street, Toronto, ON, M5T 2S8, Canada
| | - Faranak Farzan
- eBrain Lab, School of Mechatronic Systems Engineering, Simon Fraser University, 13750-96 Ave, Surrey, BC, V3V 1Z2, Canada.
- University of Toronto, 27 King's College Circle, Toronto, ON, M5S 1A1, Canada.
- Centre for Addiction and Mental Health, 1001 Queen St. W, Toronto, ON, M6J 1H4, Canada.
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16
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Dama M, Wu M, Tassone VK, Demchenko I, Frey BN, Milev RV, Ravindran AV, Parikh SV, Rotzinger S, Lou W, Lam RW, Kennedy SH, Bhat V. The course of insomnia symptoms during the acute treatment of major depressive disorder: A CAN-BIND-1 report. Psychiatry Res 2023; 325:115222. [PMID: 37163883 DOI: 10.1016/j.psychres.2023.115222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 04/17/2023] [Accepted: 04/23/2023] [Indexed: 05/12/2023]
Abstract
Despite considerable efforts to study the relationship between insomnia and depression, there is minimal research investigating whether insomnia symptoms change over time during a course of antidepressant pharmacotherapy. This study investigated the course of insomnia symptoms during the acute treatment of major depressive disorder (MDD) using a secondary analysis of data from MDD patients (N = 180) who were treated with open-label escitalopram (10-20 mg/day) for 8-weeks. Montgomery-Asberg Depression Rating Scale without sleep item (modified-MADRS) assessed depression and Self-reported Quick Inventory Depressive Scale (QIDS-SR) measured subjective sleep-onset, mid-nocturnal, and early-morning insomnia throughout 8-weeks of treatment. Pittsburgh Sleep Quality Index (PSQI) was used to assess subjective sleep quality, duration, onset latency, and efficiency throughout 8-weeks of treatment. Remission of depression was defined as modified-MADRS ≤10 at week-8. Mixed model repeated measures (MMRMs) were conducted with remission status as an independent variable and each sleep variable as a dependent variable. MMRMs demonstrated that remitters had significantly lower QIDS-SR sleep-onset and mid-nocturnal insomnia scores as well as a significantly lower PSQI sleep quality score than non-remitters throughout 8-weeks of treatment. Monitoring subjective sleep-onset and mid-nocturnal insomnia during the course of treatment with serotonergic antidepressants may be useful for predicting acute remission of depression.
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Affiliation(s)
- Manish Dama
- School of Medicine, Trinity College Dublin, The University of Dublin, Dublin, Ireland; Interventional Psychiatry Program and Centre for Depression & Suicide Studies, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Michelle Wu
- Interventional Psychiatry Program and Centre for Depression & Suicide Studies, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Vanessa K Tassone
- Interventional Psychiatry Program and Centre for Depression & Suicide Studies, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Ilya Demchenko
- Interventional Psychiatry Program and Centre for Depression & Suicide Studies, St. Michael's Hospital, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Benicio N Frey
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada; Mood Disorders Program, St. Joseph's Healthcare Hamilton, Ontario, Canada
| | - Roumen V Milev
- Department of Psychiatry, Queen's University, Kingston, Ontario, Canada
| | - Arun V Ravindran
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Sagar V Parikh
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, United States
| | - Susan Rotzinger
- Interventional Psychiatry Program and Centre for Depression & Suicide Studies, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Wendy Lou
- Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | - Raymond W Lam
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sidney H Kennedy
- Interventional Psychiatry Program and Centre for Depression & Suicide Studies, St. Michael's Hospital, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute & Krembil Research Institute, Toronto, Ontario, Canada
| | - Venkat Bhat
- Interventional Psychiatry Program and Centre for Depression & Suicide Studies, St. Michael's Hospital, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute & Krembil Research Institute, Toronto, Ontario, Canada.
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17
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Dhami P, Quilty LC, Schwartzmann B, Uher R, Allen TA, Kloiber S, Lam RW, MacQueen G, Frey BN, Milev R, Müller DJ, Strother SC, Blier P, Soares CN, Parikh SV, Turecki G, Foster JA, Rotzinger S, Kennedy SH, Farzan F. Response Inhibition and Predicting Response to Pharmacological and Cognitive Behavioral Therapy Treatments for Major Depressive Disorder: A Canadian Biomarker Integration Network for Depression Study. Biol Psychiatry Cogn Neurosci Neuroimaging 2023; 8:162-170. [PMID: 35032682 DOI: 10.1016/j.bpsc.2021.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 12/11/2021] [Accepted: 12/28/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Major depressive disorder (MDD) is associated with various cognitive impairments, including response inhibition. Deficits in response inhibition may also underlie poor antidepressant treatment response. Recent studies revealed that the neurobiological correlates of response inhibition can predict response to pharmacological treatments. However, the generalizability of this finding to first-line nonpharmacological treatments, particularly cognitive behavioral therapy, remains to be investigated. METHODS Data from two independent treatment protocols were combined, one in which 65 patients with MDD underwent treatment with escitalopram, and the other in which 41 patients with MDD underwent a course of cognitive behavioral therapy. A total of 25 healthy control subjects were also recruited. Neural correlates of response inhibition were captured by participants completing a Go/NoGo task during electroencephalography recording. Response inhibition-related measures of interest included the amplitudes of the N2 and P3 event-related potentials. RESULTS Pretreatment P3 amplitude, which has been linked to both the motor and cognitive aspects of response inhibition, was a significant predictor of change in depressive symptoms following escitalopram and cognitive behavioral therapy treatment. A greater pretreatment P3 amplitude was associated with a greater reduction in depressive severity. In addition, the pretreatment P3 amplitude was found to be significantly greater at baseline in remitters than in nonremitters and healthy control subjects. CONCLUSIONS The integrity of response inhibition may be critical for a successful course of pharmacological or psychological treatment for MDD. Electrophysiological correlates of response inhibition may have utility as a general prognostic marker of treatment response in MDD. Future studies may investigate the benefit of preceding first-line treatments with interventions that improve response inhibition in MDD.
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Affiliation(s)
- Prabhjot Dhami
- eBrain Lab, Simon Fraser University, Surrey, British Columbia, Canada; Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Lena C Quilty
- Department of Psychology, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | | | - Rudolf Uher
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Timothy A Allen
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Stefan Kloiber
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Raymond W Lam
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Glenda MacQueen
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Benicio N Frey
- Mood Disorders Program and Women's Health Concerns Clinic, St Joseph's Healthcare, Hamilton, Ontario, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Roumen Milev
- Departments of Psychiatry and Psychology, Queen's University, Providence Care, Kingston, Ontario, Canada
| | - Daniel J Müller
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | | | - Pierre Blier
- Mood Disorders Research Unit, University of Ottawa Institute of Mental Health Research, Ottawa, Ontario, Canada
| | - Claudio N Soares
- Departments of Psychiatry and Psychology, Queen's University, Providence Care, Kingston, Ontario, Canada
| | - Sagar V Parikh
- University of Michigan Depression Center, Ann Arbor, Michigan
| | - Gustavo Turecki
- Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Jane A Foster
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Susan Rotzinger
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Centre for Depression and Suicide Studies, Unity Health Toronto, Toronto, Ontario, Canada
| | - Sidney H Kennedy
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Centre for Depression and Suicide Studies, Unity Health Toronto, Toronto, Ontario, Canada
| | - Faranak Farzan
- eBrain Lab, Simon Fraser University, Surrey, British Columbia, Canada; Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
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18
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Fu CHY, Erus G, Fan Y, Antoniades M, Arnone D, Arnott SR, Chen T, Choi KS, Fatt CC, Frey BN, Frokjaer VG, Ganz M, Garcia J, Godlewska BR, Hassel S, Ho K, McIntosh AM, Qin K, Rotzinger S, Sacchet MD, Savitz J, Shou H, Singh A, Stolicyn A, Strigo I, Strother SC, Tosun D, Victor TA, Wei D, Wise T, Woodham RD, Zahn R, Anderson IM, Deakin JFW, Dunlop BW, Elliott R, Gong Q, Gotlib IH, Harmer CJ, Kennedy SH, Knudsen GM, Mayberg HS, Paulus MP, Qiu J, Trivedi MH, Whalley HC, Yan CG, Young AH, Davatzikos C. AI-based dimensional neuroimaging system for characterizing heterogeneity in brain structure and function in major depressive disorder: COORDINATE-MDD consortium design and rationale. BMC Psychiatry 2023; 23:59. [PMID: 36690972 PMCID: PMC9869598 DOI: 10.1186/s12888-022-04509-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 12/29/2022] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Efforts to develop neuroimaging-based biomarkers in major depressive disorder (MDD), at the individual level, have been limited to date. As diagnostic criteria are currently symptom-based, MDD is conceptualized as a disorder rather than a disease with a known etiology; further, neural measures are often confounded by medication status and heterogeneous symptom states. METHODS We describe a consortium to quantify neuroanatomical and neurofunctional heterogeneity via the dimensions of novel multivariate coordinate system (COORDINATE-MDD). Utilizing imaging harmonization and machine learning methods in a large cohort of medication-free, deeply phenotyped MDD participants, patterns of brain alteration are defined in replicable and neurobiologically-based dimensions and offer the potential to predict treatment response at the individual level. International datasets are being shared from multi-ethnic community populations, first episode and recurrent MDD, which are medication-free, in a current depressive episode with prospective longitudinal treatment outcomes and in remission. Neuroimaging data consist of de-identified, individual, structural MRI and resting-state functional MRI with additional positron emission tomography (PET) data at specific sites. State-of-the-art analytic methods include automated image processing for extraction of anatomical and functional imaging variables, statistical harmonization of imaging variables to account for site and scanner variations, and semi-supervised machine learning methods that identify dominant patterns associated with MDD from neural structure and function in healthy participants. RESULTS We are applying an iterative process by defining the neural dimensions that characterise deeply phenotyped samples and then testing the dimensions in novel samples to assess specificity and reliability. Crucially, we aim to use machine learning methods to identify novel predictors of treatment response based on prospective longitudinal treatment outcome data, and we can externally validate the dimensions in fully independent sites. CONCLUSION We describe the consortium, imaging protocols and analytics using preliminary results. Our findings thus far demonstrate how datasets across many sites can be harmonized and constructively pooled to enable execution of this large-scale project.
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Affiliation(s)
- Cynthia H Y Fu
- Department of Psychological Sciences, University of East London, London, UK.
- Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK.
| | - Guray Erus
- Center for Biomedical Image Computing and Analytics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Yong Fan
- Center for Biomedical Image Computing and Analytics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Mathilde Antoniades
- Center for Biomedical Image Computing and Analytics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Danilo Arnone
- Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
- Department of Psychiatry and Behavioral Science, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | | | - Taolin Chen
- Huaxi MR Research Center, Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
- Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, China
| | - Ki Sueng Choi
- Nash Family Center for Advanced Circuit Therapeutics, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Cherise Chin Fatt
- Department of Psychiatry, Center for Depression Research and Clinical Care, University of Texas Southwestern Medical Center, Dallas, USA
| | - Benicio N Frey
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada
- Mood Disorders Treatment and Research Centre and Women's Health Concerns Clinic, St Joseph's Healthcare Hamilton, Hamilton, Canada
| | - Vibe G Frokjaer
- Neurobiology Research Unit, University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Psychiatry, Psychiatric Centre Copenhagen, Copenhagen, Denmark
| | - Melanie Ganz
- Neurobiology Research Unit, University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Computer Science, University of Copenhagen, Copenhagen, Denmark
| | - Jose Garcia
- Center for Biomedical Image Computing and Analytics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Beata R Godlewska
- Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Stefanie Hassel
- Mathison Centre for Mental Health Research and Education, University of Calgary, Calgary, Canada
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Keith Ho
- Department of Psychiatry, University Health Network, Toronto, Canada
| | - Andrew M McIntosh
- Division of Psychiatry, Royal Edinburgh Hospital, University of Edinburgh, Edinburgh, UK
| | - Kun Qin
- Huaxi MR Research Center, Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
- Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, China
| | - Susan Rotzinger
- Department of Psychiatry, University Health Network, Toronto, Canada
- Centre for Depression and Suicide Studies, Unity Health Toronto, Toronto, Canada
| | - Matthew D Sacchet
- Meditation Research Program, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | | | - Haochang Shou
- Center for Biomedical Image Computing and Analytics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
- Penn Statistics in Imaging and Visualization Endeavor (PennSIVE) Center, Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, USA
| | - Ashish Singh
- Center for Biomedical Image Computing and Analytics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Aleks Stolicyn
- Division of Psychiatry, Royal Edinburgh Hospital, University of Edinburgh, Edinburgh, UK
| | - Irina Strigo
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, USA
| | - Stephen C Strother
- Rotman Research Institute, Baycrest Centre, Toronto, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, Canada
| | - Duygu Tosun
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, USA
| | | | - Dongtao Wei
- School of Psychology, Southwest University, Chongqing, China
| | - Toby Wise
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Rachel D Woodham
- Department of Psychological Sciences, University of East London, London, UK
| | - Roland Zahn
- Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Ian M Anderson
- Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, UK
| | - J F William Deakin
- Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, UK
| | - Boadie W Dunlop
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, USA
| | - Rebecca Elliott
- Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, UK
| | - Qiyong Gong
- Huaxi MR Research Center, Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
- Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, China
| | - Ian H Gotlib
- Department of Psychology, Stanford University, Stanford, USA
| | | | - Sidney H Kennedy
- Department of Psychiatry, University Health Network, Toronto, Canada
- Centre for Depression and Suicide Studies, Unity Health Toronto, Toronto, Canada
- Unity Health Toronto, Toronto, Canada
| | - Gitte M Knudsen
- Neurobiology Research Unit, University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Helen S Mayberg
- Nash Family Center for Advanced Circuit Therapeutics, Icahn School of Medicine at Mount Sinai, New York, USA
| | | | - Jiang Qiu
- School of Psychology, Southwest University, Chongqing, China
| | - Madhukar H Trivedi
- Department of Psychiatry, Center for Depression Research and Clinical Care, University of Texas Southwestern Medical Center, Dallas, USA
| | - Heather C Whalley
- Division of Psychiatry, Royal Edinburgh Hospital, University of Edinburgh, Edinburgh, UK
| | - Chao-Gan Yan
- CAS Key Laboratory of Behavioral Science, Institute of Psychology, Beijing, China
| | - Allan H Young
- Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, London, UK
| | - Christos Davatzikos
- Center for Biomedical Image Computing and Analytics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
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19
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Magarbeh L, Hassel C, Choi M, Islam F, Marshe VS, Zai CC, Zuberi R, Gammal RS, Men X, Scherf-Clavel M, Enko D, Frey BN, Milev R, Soares CN, Parikh SV, Placenza F, Strother SC, Hassel S, Taylor VH, Leri F, Blier P, Farzan F, Lam RW, Turecki G, Foster JA, Rotzinger S, Kloiber S, Kennedy JL, Kennedy SH, Bousman CA, Müller DJ. ABCB1 Gene Variants and Antidepressant Treatment Outcomes: A Systematic Review and Meta-Analysis Including Results from the CAN-BIND-1 Study. Clin Pharmacol Ther 2023. [PMID: 36681895 DOI: 10.1002/cpt.2854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 01/06/2023] [Indexed: 01/23/2023]
Abstract
The P-glycoprotein efflux pump, encoded by the ABCB1 gene, has been shown to alter concentrations of various antidepressants in the brain. In this study, we conducted a systematic review and meta-analysis to investigate the association between six ABCB1 single-nucleotide polymorphisms (SNPs; rs1045642, rs2032582, rs1128503, rs2032583, rs2235015, and rs2235040) and antidepressant treatment outcomes in individuals with major depressive disorder (MDD), including new data from the Canadian Biomarker and Integration Network for Depression (CAN-BIND-1) cohort. For the CAN-BIND-1 sample, we applied regression models to investigate the association between ABCB1 SNPs and antidepressant treatment response, remission, tolerability, and antidepressant serum levels. For the meta-analysis, we systematically summarized pharmacogenetic evidence of the association between ABCB1 SNPs and antidepressant treatment outcomes. Studies were included in the meta-analysis if they investigated at least one ABCB1 SNP in individuals with MDD treated with at least one antidepressant. We did not find a significant association between ABCB1 SNPs and antidepressant treatment outcomes in the CAN-BIND-1 sample. A total of 39 studies were included in the systematic review. In the meta-analysis, we observed a significant association between rs1128503 and treatment response (T vs. C-allele, odds ratio = 1.30, 95% confidence interval = 1.15-1.48, P value (adjusted) = 0.024, n = 2,526). We did not find associations among the six SNPs and treatment remission nor tolerability. Our findings provide limited evidence for an association between common ABCB1 SNPs and antidepressant outcomes, which do not support the implementation of ABCB1 genotyping to inform antidepressant treatment at this time. Future research, especially on rs1128503, is recommended.
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Affiliation(s)
- Leen Magarbeh
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Pharmacology & Toxicology, University of Toronto, Toronto, Ontario, Canada
| | - Claudia Hassel
- Department of Life Sciences, Queen's University, Kingston, Ontario, Canada.,Department of Medical Genetics, University of Calgary, Calgary, Alberta, Canada
| | - Maximilian Choi
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Pharmacology & Toxicology, University of Toronto, Toronto, Ontario, Canada
| | - Farhana Islam
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Pharmacology & Toxicology, University of Toronto, Toronto, Ontario, Canada
| | - Victoria S Marshe
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Center for Translational and Computational Neuroimmunology, Columbia University Medical Center, New York, New York, USA
| | - Clement C Zai
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.,Stanley Center for Psychiatric Research, Broad Institute of Harvard and MIT, Cambridge, Massachusetts, USA
| | - Rayyan Zuberi
- Department of Medical Genetics, University of Calgary, Calgary, Alberta, Canada
| | - Roseann S Gammal
- Massachusetts College of Pharmacy and Health Sciences, Boston, Massachusetts, USA
| | - Xiaoyu Men
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Pharmacology & Toxicology, University of Toronto, Toronto, Ontario, Canada
| | - Maike Scherf-Clavel
- Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Würzburg, Würzburg, Germany
| | - Dietmar Enko
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - Benicio N Frey
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada.,Mood Disorders Program, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Roumen Milev
- Department of Psychiatry, Queen's University, Providence Care, Kingston, Ontario, Canada
| | - Claudio N Soares
- Department of Psychiatry, Queen's University, Providence Care, Kingston, Ontario, Canada
| | - Sagar V Parikh
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Franca Placenza
- Centre for Mental Health, University Health Network, Toronto, Ontario, Canada
| | | | - Stefanie Hassel
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada.,Mathison Centre for Mental Health Research and Education, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Valerie H Taylor
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Francesco Leri
- Department of Psychology and Neuroscience, University of Guelph, Guelph, Ontario, Canada
| | - Pierre Blier
- The Royal Institute of Mental Health Research, Ottawa, Ontario, Canada
| | - Faranak Farzan
- Mechatronic Systems Engineering, Simon Fraser University, Surrey, British Columbia, Canada
| | - Raymond W Lam
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Gustavo Turecki
- McGill Group for Suicide Studies, Douglas Mental Health University Institute, McGill University, Verdun, Quebec, Canada
| | - Jane A Foster
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada.,Centre for Mental Health, University Health Network, Toronto, Ontario, Canada.,Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Susan Rotzinger
- Department of Psychiatry, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Stefan Kloiber
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Pharmacology & Toxicology, University of Toronto, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - James L Kennedy
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Sidney H Kennedy
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Centre for Mental Health, University Health Network, Toronto, Ontario, Canada.,Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Psychiatry, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Chad A Bousman
- Department of Medical Genetics, University of Calgary, Calgary, Alberta, Canada.,Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada.,Department of Physiology and Pharmacology, University of Calgary, Calgary, Alberta, Canada
| | - Daniel J Müller
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Pharmacology & Toxicology, University of Toronto, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Würzburg, Würzburg, Germany
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20
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Dhami P, Quilty LC, Schwartzmann B, Uher R, Allen TA, Kloiber S, Lam RW, MacQueen G, Frey BN, Milev R, Müller DJ, Rotzinger S, Kennedy SH, Farzan F. Alterations in the neural correlates of affective inhibitory control following cognitive behavioral therapy for depression: A Canadian biomarker integration network for depression (CAN-BIND) study. Journal of Affective Disorders Reports 2022. [DOI: 10.1016/j.jadr.2022.100413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022] Open
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21
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Hicks O, McInerney SJ, Lam RW, Milev RV, Frey BN, Soares CN, Foster JA, Rotzinger S, Kennedy SH, Harkness KL. Acute and chronic stress predict anti-depressant treatment outcome and naturalistic course of major depression: A CAN-BIND report. J Affect Disord 2022; 313:8-14. [PMID: 35760190 DOI: 10.1016/j.jad.2022.06.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 06/09/2022] [Accepted: 06/20/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND In treatment studies of major depressive disorder (MDD), exposure to major life events predicts less symptom improvement and greater likelihood of relapse. In contrast, the impact of minor life events has received less attention. We hypothesized that the impact of minor events on symptom improvement and risk of relapse would be heightened in the presence of concurrent chronic stress. We also hypothesized that major events would predict less symptom improvement and greater risk of relapse independently of chronic stress. METHODS Adult patients experiencing an episode of MDD were enrolled into a 16-week trial with antidepressant treatments (n = 156). Forty-three fully remitted patients agreed to participate in a naturalistic 18-month follow-up, and 30 had full data for analyses. Life events and chronic stressors were assessed using a contextual life stress interview. RESULTS Greater exposure to minor events predicted greater improvement in symptoms during acute treatment, but this relation was specific to those who reported greater severity of chronic stress. During follow-up, however, major life events predicted increased risk of relapse, and this effect was not moderated by chronic stress. LIMITATION High attrition rates led to a small sample size for the follow-up analyses. CONCLUSIONS Exposure to minor events may provide an opportunity to practice problem-solving skills, thereby facilitating symptom improvement. Nevertheless, acute treatment did not protect patients from relapse when they subsequently faced major events during follow-up. Therefore, adjunctive strategies may be needed to enhance outcomes during pharmacotherapy, consolidating benefits from acute treatment and providing skills to prevent relapse.
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Affiliation(s)
- Owen Hicks
- Department of Psychology, Queen's University, Canada
| | | | - Raymond W Lam
- Department of Psychiatry, University of British Columbia, Canada
| | | | - Benicio N Frey
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Canada; Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Canada
| | | | - Jane A Foster
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Canada
| | - Susan Rotzinger
- Centre for Depression and Suicide Studies, St. Michael's Hospital, Canada
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22
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Islam F, Marshe VS, Magarbeh L, Frey BN, Milev RV, Soares CN, Parikh SV, Placenza F, Strother SC, Hassel S, Taylor VH, Leri F, Blier P, Uher R, Farzan F, Lam RW, Turecki G, Foster JA, Rotzinger S, Kennedy SH, Müller DJ. Effects of CYP2C19 and CYP2D6 gene variants on escitalopram and aripiprazole treatment outcome and serum levels: results from the CAN-BIND 1 study. Transl Psychiatry 2022; 12:366. [PMID: 36068210 PMCID: PMC9448818 DOI: 10.1038/s41398-022-02124-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 08/16/2022] [Accepted: 08/18/2022] [Indexed: 11/25/2022] Open
Abstract
Cytochrome P450 drug-metabolizing enzymes may contribute to interindividual differences in antidepressant outcomes. We investigated the effects of CYP2C19 and CYP2D6 gene variants on response, tolerability, and serum concentrations. Patients (N = 178) were treated with escitalopram (ESC) from weeks 0-8 (Phase I), and at week 8, either continued ESC if they were responders or were augmented with aripiprazole (ARI) if they were non-responders (<50% reduction in Montgomery-Åsberg Depression Rating Scale from baseline) for weeks 8-16 (Phase II). Our results showed that amongst patients on ESC-Only, CYP2C19 intermediate and poor metabolizers (IM + PMs), with reduced or null enzyme function, trended towards significantly lower symptom improvement during Phase II compared to normal metabolizers (NMs), which was not observed in ESC + ARI. We further showed that CYP2D6 NMs and IM + PMs had a higher likelihood of reporting a treatment-related central nervous system side effect in ESC-Only and ESC + ARI, respectively. The differences in the findings between ESC-Only and ESC + ARI may be due to the altered pharmacokinetics of ESC by ARI coadministration in ESC + ARI. We provided evidence for this postulation when we showed that in ESC-Only, CYP2C19 and CYP2D6 IM + PMs demonstrated significantly higher ESC concentrations at Weeks 10 and 16 compared to NMs. In contrast, ESC + ARI showed an association with CYP2C19 but not with CYP2D6 metabolizer group. Instead, ESC + ARI showed an association between CYP2D6 metabolizer group and ARI metabolite-to-drug ratio suggesting potential competition between ESC and ARI for CYP2D6. Our findings suggest that dosing based on CYP2C19 and CYP2D6 genotyping could improve safety and outcome in patients on ESC monotherapy.
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Affiliation(s)
- Farhana Islam
- grid.155956.b0000 0000 8793 5925Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Department of Pharmacology & Toxicology, University of Toronto, Toronto, ON Canada
| | - Victoria S. Marshe
- grid.155956.b0000 0000 8793 5925Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Institute of Medical Science, University of Toronto, Toronto, ON Canada
| | - Leen Magarbeh
- grid.155956.b0000 0000 8793 5925Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Department of Pharmacology & Toxicology, University of Toronto, Toronto, ON Canada
| | - Benicio N. Frey
- grid.25073.330000 0004 1936 8227Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON Canada ,grid.416721.70000 0001 0742 7355St. Joseph’s Healthcare Hamilton, Hamilton, ON Canada
| | - Roumen V. Milev
- grid.410356.50000 0004 1936 8331Department of Psychiatry, Queen’s University, Providence Care, Kingston, ON Canada
| | - Claudio N. Soares
- grid.410356.50000 0004 1936 8331Department of Psychiatry, Queen’s University, Providence Care, Kingston, ON Canada
| | - Sagar V. Parikh
- grid.214458.e0000000086837370Department of Psychiatry, University of Michigan, Ann Arbor, MI USA
| | - Franca Placenza
- grid.231844.80000 0004 0474 0428Centre for Mental Health, University Health Network, Toronto, ON Canada
| | - Stephen C. Strother
- grid.17063.330000 0001 2157 2938Rotman Research Institute, Baycrest Medical Centre, and Medical Biophysics, University of Toronto, Toronto, ON Canada
| | - Stefanie Hassel
- grid.22072.350000 0004 1936 7697Department of Psychiatry, University of Calgary, Calgary, AB Canada
| | - Valerie H. Taylor
- grid.22072.350000 0004 1936 7697Department of Psychiatry, University of Calgary, Calgary, AB Canada
| | - Francesco Leri
- grid.34429.380000 0004 1936 8198Department of Psychology and Neuroscience, University of Guelph, Guelph, ON Canada
| | - Pierre Blier
- grid.414622.70000 0001 1503 7525The Royal Institute of Mental Health Research, Ottawa, ON Canada
| | - Rudolf Uher
- grid.55602.340000 0004 1936 8200Department of Psychiatry, Dalhousie University, Halifax, NS Canada
| | - Faranak Farzan
- grid.61971.380000 0004 1936 7494Mechatronic Systems Engineering, Simon Fraser University, Surrey, BC Canada
| | - Raymond W. Lam
- grid.17091.3e0000 0001 2288 9830University of British Columbia and Vancouver Coastal Health Authority, Vancouver, BC Canada
| | - Gustavo Turecki
- grid.14709.3b0000 0004 1936 8649McGill Group for Suicide Studies, Douglas Mental Health University Institute, McGill University, Verdun, QC Canada
| | - Jane A. Foster
- grid.25073.330000 0004 1936 8227Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON Canada ,grid.416721.70000 0001 0742 7355St. Joseph’s Healthcare Hamilton, Hamilton, ON Canada ,grid.231844.80000 0004 0474 0428Centre for Mental Health, University Health Network, Toronto, ON Canada
| | - Susan Rotzinger
- grid.17063.330000 0001 2157 2938Department of Psychiatry, St Michael’s Hospital, University of Toronto, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Department of Psychiatry, University of Toronto, Toronto, ON Canada
| | - Sidney H. Kennedy
- grid.17063.330000 0001 2157 2938Institute of Medical Science, University of Toronto, Toronto, ON Canada ,grid.231844.80000 0004 0474 0428Centre for Mental Health, University Health Network, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Department of Psychiatry, St Michael’s Hospital, University of Toronto, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Department of Psychiatry, University of Toronto, Toronto, ON Canada ,grid.415502.7Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, ON Canada
| | - Daniel J. Müller
- grid.155956.b0000 0000 8793 5925Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Department of Pharmacology & Toxicology, University of Toronto, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Institute of Medical Science, University of Toronto, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Department of Psychiatry, University of Toronto, Toronto, ON Canada ,grid.411760.50000 0001 1378 7891Department of Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Clinic of Würzburg, Würzburg, Germany
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23
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Ceniti AK, Abdelmoemin WR, Ho K, Kang Y, Placenza F, Laframboise R, Bhat V, Foster JA, Frey BN, Lam RW, Milev R, Rotzinger S, Soares CN, Uher R, Kennedy SH. "One Degree of Separation": A Mixed-Methods Evaluation of Canadian Mental Health Care User and Provider Experiences With Remote Care During COVID-19. Can J Psychiatry 2022; 67:712-722. [PMID: 34986035 PMCID: PMC9445628 DOI: 10.1177/07067437211070656] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The COVID-19 pandemic has contributed to a shift from in-person to remote mental health care. While remote care methods have long existed, their widespread use is unprecedented. There is little research about mental health care user and provider experiences with this transition, and no published studies to date have compared satisfaction between these groups. METHODS Canadian mental health care users (n = 332) and providers (n = 107) completed an online self-report survey from October 2020 to February 2021 hosted by the Canadian Biomarker Integration Network in Depression. Using a mixed-methods approach, participants were asked about their use of remote care, including satisfaction, barriers to use, helpful and unhelpful factors, and suggestions for improvement. RESULTS Overall, 59% to 63% of health care users and 59% of health care providers were satisfied with remote care. Users reported the greatest satisfaction with the convenience of remote care, while providers were most satisfied with the speed of provision of care; all groups were least satisfied with therapeutic rapport. Health care providers were less satisfied with the user-friendliness of remote care (P < 0.001) than users, while health care users were less satisfied than providers with continuity of care (P < 0.001). The use of a video-based platform was associated with remote care satisfaction among health care users (P < 0.02), and qualitative responses support the importance of visual cues in maintaining therapeutic rapport remotely. The majority of users (55%) and providers (87%) reported a likelihood of using remote care after the pandemic. CONCLUSIONS Remote mental health care is generally accepted by both users and providers, and the majority would consider using remote care following the pandemic. Suggestions for improvement include greater use of video, increased attention to body language and eye contact, consistency with in-person care, as well as increased provider training and administrative support.
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Affiliation(s)
- Amanda K Ceniti
- Arthur Sommer Rotenberg Suicide & Depression Studies Program, 10071St. Michael's Hospital, Toronto, Canada.,Centre for Depression and Suicide Studies, 10071St. Michael's Hospital, Toronto, Canada.,Institute of Medical Science, 7938University of Toronto, Toronto, Canada
| | - Wegdan R Abdelmoemin
- Centre for Depression and Suicide Studies, 10071St. Michael's Hospital, Toronto, Canada
| | - Keith Ho
- Centre for Depression and Suicide Studies, 10071St. Michael's Hospital, Toronto, Canada.,Centre for Mental Health, 7989University Health Network, Toronto, Canada
| | - Yudi Kang
- Centre for Mental Health, 7989University Health Network, Toronto, Canada
| | - Franca Placenza
- Centre for Mental Health, 7989University Health Network, Toronto, Canada
| | - Rachel Laframboise
- Centre for Mental Health, 7989University Health Network, Toronto, Canada
| | - Venkat Bhat
- Arthur Sommer Rotenberg Suicide & Depression Studies Program, 10071St. Michael's Hospital, Toronto, Canada.,Centre for Depression and Suicide Studies, 10071St. Michael's Hospital, Toronto, Canada.,Institute of Medical Science, 7938University of Toronto, Toronto, Canada.,Centre for Mental Health, 7989University Health Network, Toronto, Canada.,Department of Psychiatry, 7938University of Toronto, Toronto, Canada.,Li Ka Shing Knowledge Institute, 10071St. Michael's Hospital, Toronto, Canada
| | - Jane A Foster
- Centre for Mental Health, 7989University Health Network, Toronto, Canada.,Department of Psychiatry and Behavioural Neurosciences, 3710McMaster University, Hamilton, Canada
| | - Benicio N Frey
- Department of Psychiatry and Behavioural Neurosciences, 3710McMaster University, Hamilton, Canada.,Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Hamilton, Canada
| | - Raymond W Lam
- Department of Psychiatry, 8166University of British Columbia, Vancouver, Canada
| | - Roumen Milev
- Departments of Psychiatry and Psychology, 4257Queen's University, Kingston, Canada.,Providence Care, Kingston, ON, Canada
| | - Susan Rotzinger
- Arthur Sommer Rotenberg Suicide & Depression Studies Program, 10071St. Michael's Hospital, Toronto, Canada.,Centre for Depression and Suicide Studies, 10071St. Michael's Hospital, Toronto, Canada.,Centre for Mental Health, 7989University Health Network, Toronto, Canada.,Department of Psychiatry, 7938University of Toronto, Toronto, Canada
| | - Claudio N Soares
- Departments of Psychiatry and Psychology, 4257Queen's University, Kingston, Canada.,Providence Care, Kingston, ON, Canada
| | - Rudolf Uher
- Department of Psychiatry, 3688Dalhousie University, Halifax, Canada
| | - Sidney H Kennedy
- Arthur Sommer Rotenberg Suicide & Depression Studies Program, 10071St. Michael's Hospital, Toronto, Canada.,Centre for Depression and Suicide Studies, 10071St. Michael's Hospital, Toronto, Canada.,Institute of Medical Science, 7938University of Toronto, Toronto, Canada.,Centre for Mental Health, 7989University Health Network, Toronto, Canada.,Department of Psychiatry, 7938University of Toronto, Toronto, Canada.,Li Ka Shing Knowledge Institute, 10071St. Michael's Hospital, Toronto, Canada
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24
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Espinola CW, Khoo Y, Parmar R, Demchenko I, Frey BN, Milev RV, Ravindran AV, Parikh SV, Ho K, Rotzinger S, Lou W, Lam RW, Kennedy SH, Bhat V. Pretreatment anxious depression as a predictor of side effect frequency and severity in escitalopram and aripiprazole adjunctive therapy. Brain Behav 2022; 12:e2555. [PMID: 35333448 PMCID: PMC9120722 DOI: 10.1002/brb3.2555] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 01/02/2022] [Accepted: 03/01/2022] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVE To report side effect frequency and severity in patients with major depressive disorder (MDD) receiving escitalopram and aripiprazole adjunctive therapy and to examine whether pretreatment anxious depression is associated with the number and presence of specific side effects. METHODS 188 of the 211 trial participants provided information on side effects during treatment with escitalopram (10-20 mg) for 8 weeks, and nonresponders received further augmentation on aripiprazole (2-10 mg) adjunctive therapy for another 8 weeks, whereas responders remained on escitalopram. Participants completed the Toronto Side Effects Scale at weeks 2, 4, 10, and 12. Covariate-adjusted negative binomial regression and Wilcoxon tests examined the association between anxious depression (GAD-7 ≥ 10) and number of side effects. Covariate-adjusted logistic regression and chi-square tests explored the association between anxious depression and specific side effects. RESULTS For both therapies, the most frequent side effects were also the most severe. They mostly related to the central nervous system (CNS) (i.e., drowsiness and nervousness). Between baseline and week 2, the number of side effects participants experienced (incidence rate ratio [IRR] = 1.38, p = .010) or had trouble with (IRR = 1.34, p = .026) was significantly higher among those with anxious depression for escitalopram but not adjunctive aripiprazole. Further, odds of experiencing and having trouble with nervousness and agitation were also significantly higher in anxious depression for escitalopram only (p < .05). CONCLUSION Patients on escitalopram and aripiprazole adjunctive therapy may experience and have trouble with CNS side effects. Pretreatment anxious depression may predispose escitalopram recipients with MDD to developing side effects, especially those related to anxiety.
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Affiliation(s)
- Caroline W Espinola
- Interventional Psychiatry Program, St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Yuelee Khoo
- Interventional Psychiatry Program, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Roohie Parmar
- Interventional Psychiatry Program, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Ilya Demchenko
- Interventional Psychiatry Program, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Benicio N Frey
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada.,Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare, Hamilton, Ontario, Canada
| | - Roumen V Milev
- Departments of Psychiatry and Psychology, Queen's University, Providence Care, Kingston, Ontario, Canada
| | - Arun V Ravindran
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Sagar V Parikh
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Keith Ho
- Interventional Psychiatry Program, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Susan Rotzinger
- Interventional Psychiatry Program, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Wendy Lou
- Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Raymond W Lam
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sidney H Kennedy
- Interventional Psychiatry Program, St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital & Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Venkat Bhat
- Interventional Psychiatry Program, St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital & Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
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- Interventional Psychiatry Program, St. Michael's Hospital, Toronto, Ontario, Canada
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Dama M, Khoo Y, Frey BN, Milev RV, Ravindran AV, Parikh SV, Rotzinger S, Lou W, Lam RW, Kennedy SH, Bhat V. Rhythmicity of sleep and clinical outcomes in major depressive disorder: A CAN-BIND-1 Report. Journal of Affective Disorders Reports 2022. [DOI: 10.1016/j.jadr.2022.100370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Espinola CW, Khoo Y, Parmar R, Demchenko I, Frey BN, Milev RV, Ravindran AV, Parikh SV, Ho K, Rotzinger S, Lou W, Lam RW, Kennedy SH, Bhat V. Males and females differ in reported sexual functioning with escitalopram treatment for major depressive disorder: A CAN-BIND-1 study report. J Psychopharmacol 2022; 36:604-613. [PMID: 35546043 DOI: 10.1177/02698811221095832] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Antidepressant use for major depressive disorder (MDD) is frequently associated with sexual dysfunction. AIMS Cross-sectional and longitudinal relationships between antidepressant treatment outcomes and sexual functioning (SF) were evaluated separately for males and females receiving escitalopram. We further assessed the association between pre- and posttreatment SF. METHODS In all, 208 of the 211 CAN-BIND-1 trial participants (77 males and 131 females) with MDD and detectable drug blood levels were eligible for the analyses. All received escitalopram (10-20 mg) for 8 weeks. At baseline and Week 8, participants completed the Montgomery-Åsberg Depression Rating Scale (MADRS) and the SexFx scale, which measures sexual satisfaction and SF frequency. Mixed-model repeated measures assessed baseline to Week 8 SF changes among participants with different response/remission statuses. Multiple linear regression analyses examined SF differences between treatment outcomes at Week 8 as well as associations between pretreatment and eventual SF. RESULTS For both sexes, overall sexual satisfaction improved among responders but not among nonresponders (p < 0.05). For females, overall SF frequency did not change significantly over time regardless of response status. For males, overall SF decreased significantly among nonresponders; orgasm decreased significantly among nonresponders and, to a lesser extent, among responders (p < 0.05). For both sexes, pretreatment SF was significantly associated with SF at Week 8 across all domains (p < 0.05). CONCLUSION For both sexes, sexual satisfaction improves with response to escitalopram. For females, the response does not correspond to improvements in SF frequency. For males, SF frequency, particularly that of orgasm, declines regardless of response/nonresponse.ClinicalTrials.gov identifier: NCT01655706.
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Affiliation(s)
- Caroline W Espinola
- Interventional Psychiatry Program, Centre for Depression & Suicide Studies, St. Michael's Hospital, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Yuelee Khoo
- Interventional Psychiatry Program, Centre for Depression & Suicide Studies, St. Michael's Hospital, Toronto, ON, Canada
| | - Roohie Parmar
- Interventional Psychiatry Program, Centre for Depression & Suicide Studies, St. Michael's Hospital, Toronto, ON, Canada
| | - Ilya Demchenko
- Interventional Psychiatry Program, Centre for Depression & Suicide Studies, St. Michael's Hospital, Toronto, ON, Canada
| | - Benicio N Frey
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.,Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare, Hamilton, ON, Canada
| | - Roumen V Milev
- Departments of Psychiatry and Psychology, Queen's University, Providence Care Hospital, Kingston, ON, Canada
| | - Arun V Ravindran
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Sagar V Parikh
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Keith Ho
- Interventional Psychiatry Program, Centre for Depression & Suicide Studies, St. Michael's Hospital, Toronto, ON, Canada
| | - Susan Rotzinger
- Interventional Psychiatry Program, Centre for Depression & Suicide Studies, St. Michael's Hospital, Toronto, ON, Canada
| | - Wendy Lou
- Dalla Lana School of Public Health, University of Toronto, ON, Canada
| | - Raymond W Lam
- Department of Psychiatry, The University of British Columbia, Vancouver, BC, Canada
| | - Sidney H Kennedy
- Interventional Psychiatry Program, Centre for Depression & Suicide Studies, St. Michael's Hospital, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada.,Li Ka Shing Knowledge Institute & Krembil Research Institute, Toronto, ON, Canada
| | - Venkat Bhat
- Interventional Psychiatry Program, Centre for Depression & Suicide Studies, St. Michael's Hospital, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada.,Li Ka Shing Knowledge Institute & Krembil Research Institute, Toronto, ON, Canada
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Khoo Y, Demchenko I, Frey BN, Milev RV, Ravindran AV, Parikh SV, Ho K, Rotzinger S, Lou W, Lam RW, Kennedy SH, Bhat V. Baseline anxiety, and early anxiety/depression improvement in anxious depression predicts treatment outcomes with escitalopram: A CAN-BIND-1 study report. J Affect Disord 2022; 300:50-58. [PMID: 34921820 DOI: 10.1016/j.jad.2021.12.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 11/09/2021] [Accepted: 12/12/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Although anxiety symptoms frequently co-occur with major depressive disorder, few studies examined the prediction of treatment outcomes among participants with anxious depression receiving antidepressants. We investigated whether baseline anxiety, and early improvements in anxiety and depression symptoms predict eventual treatment outcomes. METHODS 111 participants with anxious depression, defined using ≥ 10 on GAD-7, received escitalopram (10-20 mg) for 8 weeks. Covariate-adjusted logistic regression was conducted to examine the impact of baseline anxiety, and to assess the extent week 2 anxiety (GAD-7) and depression (QIDS-SR) percentage improvement associates with week 8 anxiety (GAD-7) and depression (MADRS) response/remission. Optimum improvement thresholds were identified using receiving-operating-curve analysis and their predictive values assessed. RESULTS Greater percentage improvement in anxiety and depression after the first 2 weeks of treatment significantly increased odds of achieving week 8 anxiety and depression response/remission (OR:1.01-1.04, p<0.05). Early anxiety (68.4%/87.2%) and depression (52.2%/83.0%) improvement thresholds around 30 and 40% provided moderate to high positive predictive value (PPV) for predicting week 8 anxiety response/remission, as well as moderate to high negative predictive value (NPV) for predicting week 8 depression response/remission (anxiety:70.8%/91.7%; depression:72.2%/90.1%). Baseline anxiety severity predicted anxiety outcomes at weeks 2 and 8. LIMITATIONS Trial lacked placebo group. CONCLUSION In anxious depression, early improvement in anxiety may be better than depression in predicting anxiety outcomes, with similar or higher PPVs. Both improvement types perform similarly in predicting depression outcomes, with the lack of improvement predictive of non-response and non-remission. Finally, baseline anxiety predicts eventual anxiety but not depression outcomes.
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Affiliation(s)
- Yuelee Khoo
- Interventional Psychiatry Program, Centre for Depression & Suicide Studies, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Ilya Demchenko
- Interventional Psychiatry Program, Centre for Depression & Suicide Studies, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Benicio N Frey
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada; Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare, Hamilton, Ontario, Canada
| | - Roumen V Milev
- Departments of Psychiatry and Psychology, Queen's University, Providence Care, Kingston, Ontario, Canada
| | - Arun V Ravindran
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Sagar V Parikh
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, United States
| | - Keith Ho
- Interventional Psychiatry Program, Centre for Depression & Suicide Studies, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Susan Rotzinger
- Interventional Psychiatry Program, Centre for Depression & Suicide Studies, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Wendy Lou
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Raymond W Lam
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sidney H Kennedy
- Interventional Psychiatry Program, Centre for Depression & Suicide Studies, St. Michael's Hospital, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute & Krembil Research Institute, Toronto, Ontario, Canada
| | - Venkat Bhat
- Interventional Psychiatry Program, Centre for Depression & Suicide Studies, St. Michael's Hospital, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute & Krembil Research Institute, Toronto, Ontario, Canada.
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Mosabbir AA, Braun Janzen T, Al Shirawi M, Rotzinger S, Kennedy SH, Farzan F, Meltzer J, Bartel L. Investigating the Effects of Auditory and Vibrotactile Rhythmic Sensory Stimulation on Depression: An EEG Pilot Study. Cureus 2022; 14:e22557. [PMID: 35371676 PMCID: PMC8958118 DOI: 10.7759/cureus.22557] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2022] [Indexed: 12/18/2022] Open
Abstract
Background Major depressive disorder (MDD) is a persistent psychiatric condition and one of the leading causes of global disease burden. In a previous study, we investigated the effects of a five-week intervention consisting of rhythmic gamma frequency (30-70 Hz) vibroacoustic stimulation in 20 patients formally diagnosed with MDD. In that study, the findings suggested a significant clinical improvement in depression symptoms as measured using the Montgomery-Asberg Depression Rating Scale (MADRS), with 37% of participants meeting the criteria for clinical response. The goal of the present research was to examine possible changes from baseline to posttreatment in resting-state electroencephalography (EEG) recordings using the same treatment protocol and to characterize basic changes in EEG related to treatment response. Materials and methods The study sample consisted of 19 individuals aged 18-70 years with a clinical diagnosis of MDD. The participants were assessed before and after a five-week treatment period, which consisted of listening to an instrumental musical track on a vibroacoustic device, delivering auditory and vibrotactile stimulus in the gamma-band range (30-70 Hz, with particular emphasis on 40 Hz). The primary outcome measure was the change in Montgomery-Asberg Depression Rating Scale (MADRS) from baseline to posttreatment and resting-state EEG. Results Analysis comparing MADRS score at baseline and post-intervention indicated a significant change in the severity of depression symptoms after five weeks (t = 3.9923, df = 18, p = 0.0009). The clinical response rate was 36.85%. Resting-state EEG power analysis revealed a significant increase in occipital alpha power (t = -2.149, df = 18, p = 0.04548), as well as an increase in the prefrontal gamma power of the responders (t = 2.8079, df = 13.431, p = 0.01442). Conclusions The results indicate that improvements in MADRS scores after rhythmic sensory stimulation (RSS) were accompanied by an increase in alpha power in the occipital region and an increase in gamma in the prefrontal region, thus suggesting treatment effects on cortical activity in depression. The results of this pilot study will help inform subsequent controlled studies evaluating whether treatment response to vibroacoustic stimulation constitutes a real and replicable reduction of depressive symptoms and to characterize the underlying mechanisms.
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Affiliation(s)
| | | | | | - Susan Rotzinger
- Department of Psychiatry, University Health Network, Toronto, CAN
| | - Sidney H Kennedy
- Centre for Depression and Suicide Studies, St. Michael's Hospital, Toronto, CAN
| | - Faranak Farzan
- School of Mechatronic Systems Engineering, Simon Fraser University, Surrey, CAN
| | - Jed Meltzer
- Rotman Research Institute, Baycrest Health Sciences, Toronto, CAN
| | - Lee Bartel
- Faculty of Music, University of Toronto, Toronto, CAN
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Harris JK, Hassel S, Davis AD, Zamyadi M, Arnott SR, Milev R, Lam RW, Frey BN, Hall GB, Müller DJ, Rotzinger S, Kennedy SH, Strother SC, MacQueen GM, Greiner R. Predicting escitalopram treatment response from pre-treatment and early response resting state fMRI in a multi-site sample: A CAN-BIND-1 report. NeuroImage: Clinical 2022; 35:103120. [PMID: 35908308 PMCID: PMC9421454 DOI: 10.1016/j.nicl.2022.103120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 05/17/2022] [Accepted: 07/14/2022] [Indexed: 11/22/2022] Open
Abstract
Baseline measures alone not able to predict escitalopram response above default. This poor baseline performance contradicts results from smaller studies. Accuracy improved using change in functional connectivity from baseline to week 2. Measures of early change following treatment may be crucial for accurate prediction.
Many previous intervention studies have used functional magnetic resonance imaging (fMRI) data to predict the antidepressant response of patients with major depressive disorder (MDD); however, practical constraints have limited many of those attempts to small, single centre studies which may not adequately reflect how these models will generalize when used in clinical practice. Not only does the act of collecting data at multiple sites generally increase sample sizes (a critical point in machine learning development) it also generates a more heterogeneous dataset due to systematic differences in scanners at different sites, and geographical differences in patient populations. As part of the Canadian Biomarker Integration Network in Depression (CAN-BIND-1) study, 144 MDD patients from six sites underwent resting state fMRI prior to starting escitalopram treatment, and again two weeks after the start. Here, we consider ways to use machine learning techniques to produce models that can predict response (measured at eight weeks after initiation), based on various parcellations, functional connectivity (FC) metrics, dimensionality reduction algorithms, and base learners, and also whether to use scans from one or both time points. Models that use only baseline (pre-treatment) or only week 2 (early-response) whole-brain FC features consistently failed to perform significantly better than default models. Utilizing the change in FC between these two time points, however, yielded significant results, with the best performing analytical pipeline achieving 69.6% (SD 10.8) accuracy. These results appear contrary to findings from many smaller single-site studies, which report substantially higher predictive accuracies from models trained on only baseline resting state FC features, suggesting these models may not generalize well beyond data used for development. Further, these results indicate the potential value of collecting data both before and shortly after treatment initiation.
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Vaccarino AL, Beaton D, Black SE, Blier P, Farzan F, Finger E, Foster JA, Freedman M, Frey BN, Gilbert Evans S, Ho K, Javadi M, Kennedy SH, Lam RW, Lang AE, Lasalandra B, Latour S, Masellis M, Milev RV, Müller DJ, Munoz DP, Parikh SV, Placenza F, Rotzinger S, Soares CN, Sparks A, Strother SC, Swartz RH, Tan B, Tartaglia MC, Taylor VH, Theriault E, Turecki G, Uher R, Zinman L, Evans KR. Common Data Elements to Facilitate Sharing and Re-use of Participant-Level Data: Assessment of Psychiatric Comorbidity Across Brain Disorders. Front Psychiatry 2022; 13:816465. [PMID: 35197877 PMCID: PMC8859302 DOI: 10.3389/fpsyt.2022.816465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 01/12/2022] [Indexed: 11/24/2022] Open
Abstract
The Ontario Brain Institute's "Brain-CODE" is a large-scale informatics platform designed to support the collection, storage and integration of diverse types of data across several brain disorders as a means to understand underlying causes of brain dysfunction and developing novel approaches to treatment. By providing access to aggregated datasets on participants with and without different brain disorders, Brain-CODE will facilitate analyses both within and across diseases and cover multiple brain disorders and a wide array of data, including clinical, neuroimaging, and molecular. To help achieve these goals, consensus methodology was used to identify a set of core demographic and clinical variables that should be routinely collected across all participating programs. Establishment of Common Data Elements within Brain-CODE is critical to enable a high degree of consistency in data collection across studies and thus optimize the ability of investigators to analyze pooled participant-level data within and across brain disorders. Results are also presented using selected common data elements pooled across three studies to better understand psychiatric comorbidity in neurological disease (Alzheimer's disease/amnesic mild cognitive impairment, amyotrophic lateral sclerosis, cerebrovascular disease, frontotemporal dementia, and Parkinson's disease).
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Affiliation(s)
| | - Derek Beaton
- Data Science and Advanced Analytics, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada.,Rotman Research Institute, Baycrest Health Sciences, Toronto, ON, Canada
| | - Sandra E Black
- Hurvitz Brain Sciences Research Program, Dr. Sandra Black Centre for Brain Resilience and Recovery, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada.,Department of Medicine (Neurology), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Pierre Blier
- Mood Disorders Research Unit, University of Ottawa Institute of Mental Health Research, Ottawa, ON, Canada
| | - Farnak Farzan
- School of Mechatronic Systems Engineering, Simon Fraser University, Surrey, BC, Canada
| | - Elizabeth Finger
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
| | - Jane A Foster
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Morris Freedman
- Rotman Research Institute, Baycrest Health Sciences, Toronto, ON, Canada
| | - Benicio N Frey
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.,Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare, Hamilton, ON, Canada
| | | | - Keith Ho
- Department of Psychiatry, University Health Network, Toronto, ON, Canada
| | | | - Sidney H Kennedy
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Raymond W Lam
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Anthony E Lang
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, ON, Canada.,Edmond J. Safra Program in Parkinson's Disease, University Health Network, Toronto, ON, Canada
| | | | | | - Mario Masellis
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Roumen V Milev
- Departments of Psychiatry and Psychology, Queen's University, Providence Care, Kingston, ON, Canada
| | - Daniel J Müller
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Centre for Addiction and Mental Health, Campbell Family Mental Health Research Institute, Toronto, ON, Canada
| | - Douglas P Munoz
- Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada
| | - Sagar V Parikh
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
| | - Franca Placenza
- Department of Psychiatry, University Health Network, Toronto, ON, Canada
| | - Susan Rotzinger
- Department of Psychiatry, University Health Network, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Claudio N Soares
- Department of Psychiatry, Queen's University, Kingston, ON, Canada
| | | | - Stephen C Strother
- Indoc Research, Toronto, ON, Canada.,Rotman Research Institute, Baycrest Health Sciences, Toronto, ON, Canada
| | - Richard H Swartz
- Hurvitz Brain Sciences Research Program, Dr. Sandra Black Centre for Brain Resilience and Recovery, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada.,Department of Medicine (Neurology), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Brian Tan
- Rotman Research Institute, Baycrest Health Sciences, Toronto, ON, Canada
| | - Maria Carmela Tartaglia
- Tanz Centre for Research in Neurodegenerative Diseases University of Toronto, Toronto, ON, Canada
| | - Valerie H Taylor
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | | | - Gustavo Turecki
- Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada
| | - Rudolf Uher
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Lorne Zinman
- Department of Medicine (Neurology), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
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Ge R, Hassel S, Arnott SR, Davis AD, Harris JK, Zamyadi M, Milev R, Frey BN, Strother SC, Müller DJ, Rotzinger S, MacQueen GM, Kennedy SH, Lam RW, Vila-Rodriguez F. Structural covariance pattern abnormalities of insula in major depressive disorder: A CAN-BIND study report. Prog Neuropsychopharmacol Biol Psychiatry 2021; 111:110194. [PMID: 33296696 DOI: 10.1016/j.pnpbp.2020.110194] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 09/25/2020] [Accepted: 11/30/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND METHODS Investigation of the insula may inform understanding of the etiopathogenesis of major depressive disorder (MDD). In the present study, we introduced a novel gray matter volume (GMV) based structural covariance technique, and applied it to a multi-centre study of insular subregions of 157 patients with MDD and 93 healthy controls from the Canadian Biomarker Integration Network in Depression (CAN-BIND, https://www.canbind.ca/). Specifically, we divided the unilateral insula into three subregions, and investigated their coupling with whole-brain GMV-based structural brain networks (SBNs). We compared between-group difference of the structural coupling patterns between the insular subregions and SBNs. RESULTS The insula was divided into three subregions, including an anterior one, a superior-posterior one and an inferior-posterior one. In the comparison between MDD patients and controls we found that patients' right anterior insula showed increased inter-network coupling with the default mode network, and it showed decreased inter-network coupling with the central executive network; whereas patients' right ventral-posterior insula showed decreased inter-network coupling with the default mode network, and it showed increased inter-network coupling with the central executive network. We also demonstrated that patients' loading parameters of the right ventral-posterior insular structural covariance negatively correlated with their suicidal ideation scores; and controls' loading parameters of the right ventral-posterior insular structural covariance positively correlated with their motor and psychomotor speed scores, whereas these phenomena were not found in patients. Additionally, we did not find significant inter-network coupling between the whole-brain SBNs, including salience network, default mode network, and central executive network. CONCLUSIONS Our work proposed a novel technique to investigate the structural covariance coupling between large-scale structural covariance networks, and provided further evidence that MDD is a system-level disorder that shows disrupted structural coupling between brain networks.
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Affiliation(s)
- Ruiyang Ge
- Non-Invasive Neurostimulation Therapies (NINET) Laboratory, Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Stefanie Hassel
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Mathison Centre for Mental Health Research and Education, University of Calgary, Calgary, AB, Canada
| | | | - Andrew D Davis
- Department of Psychology, Neuroscience & Behaviour, McMaster University, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | | | - Mojdeh Zamyadi
- Rotman Research Institute, Baycrest, Toronto, ON, Canada
| | - Roumen Milev
- Department of Psychiatry, Queen's University and Providence Care Hospital, Kingston, ON, Canada; Department of Psychology, Queen's University, Kingston, ON, Canada
| | - Benicio N Frey
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada; Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare, Hamilton, ON, Canada
| | | | - Daniel J Müller
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Susan Rotzinger
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, Krembil Research Centre, University Health Network, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Glenda M MacQueen
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Sidney H Kennedy
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, Krembil Research Centre, University Health Network, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada; Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Raymond W Lam
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Fidel Vila-Rodriguez
- Non-Invasive Neurostimulation Therapies (NINET) Laboratory, Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.
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Sajjadian M, Lam RW, Milev R, Rotzinger S, Frey BN, Soares CN, Parikh SV, Foster JA, Turecki G, Müller DJ, Strother SC, Farzan F, Kennedy SH, Uher R. Machine learning in the prediction of depression treatment outcomes: a systematic review and meta-analysis. Psychol Med 2021; 51:2742-2751. [PMID: 35575607 DOI: 10.1017/s0033291721003871] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Multiple treatments are effective for major depressive disorder (MDD), but the outcomes of each treatment vary broadly among individuals. Accurate prediction of outcomes is needed to help select a treatment that is likely to work for a given person. We aim to examine the performance of machine learning methods in delivering replicable predictions of treatment outcomes. METHODS Of 7732 non-duplicate records identified through literature search, we retained 59 eligible reports and extracted data on sample, treatment, predictors, machine learning method, and treatment outcome prediction. A minimum sample size of 100 and an adequate validation method were used to identify adequate-quality studies. The effects of study features on prediction accuracy were tested with mixed-effects models. Fifty-four of the studies provided accuracy estimates or other estimates that allowed calculation of balanced accuracy of predicting outcomes of treatment. RESULTS Eight adequate-quality studies reported a mean accuracy of 0.63 [95% confidence interval (CI) 0.56-0.71], which was significantly lower than a mean accuracy of 0.75 (95% CI 0.72-0.78) in the other 46 studies. Among the adequate-quality studies, accuracies were higher when predicting treatment resistance (0.69) and lower when predicting remission (0.60) or response (0.56). The choice of machine learning method, feature selection, and the ratio of features to individuals were not associated with reported accuracy. CONCLUSIONS The negative relationship between study quality and prediction accuracy, combined with a lack of independent replication, invites caution when evaluating the potential of machine learning applications for personalizing the treatment of depression.
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Affiliation(s)
- Mehri Sajjadian
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Raymond W Lam
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Roumen Milev
- Department of Psychiatry and Psychology, Queen's University, Providence Care Hospital, Kingston, ON, Canada
| | - Susan Rotzinger
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Benicio N Frey
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
- Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Claudio N Soares
- Department of Psychiatry, Queen's University School of Medicine, Kingston, ON, Canada
| | - Sagar V Parikh
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Jane A Foster
- Department of Psychiatry & Behavioural Neurosciences, St. Joseph's Healthcare, Hamilton, ON, Canada
| | - Gustavo Turecki
- Department of Psychiatry, Douglas Institute, McGill University, Montreal, QC, Canada
| | - Daniel J Müller
- Campbell Family Mental Health Research Institute, Center for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Stephen C Strother
- Baycrest and Department of Medical Biophysics, Rotman Research Center, University of Toronto, Toronto, ON, Canada
| | - Faranak Farzan
- eBrain Lab, School of Mechatronic Systems Engineering, Simon Fraser University, Surrey, BC, Canada
| | - Sidney H Kennedy
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, University Health Network, Toronto, ON, Canada
- Krembil Research Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Rudolf Uher
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
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Rnic K, Jung YE, Torres I, Chakrabarty T, LeMoult J, Vaccarino AL, Morton E, Bhat V, Giacobbe P, McInerney S, Frey BN, Milev RV, Müller D, Ravindran AV, Rotzinger S, Kennedy SH, Lam RW. Association between discrepancy in objective and subjective cognitive abilities and treatment response in patients with major depressive disorder: A CAN-BIND-1 study report. J Affect Disord 2021; 295:1095-1101. [PMID: 34706420 DOI: 10.1016/j.jad.2021.09.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 08/31/2021] [Accepted: 09/02/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND Major Depressive Disorder (MDD) is characterized by objective and subjective cognitive deficits. Discrepancies between objective and subjective cognitive performance can reflect under- to over-estimations of cognitive abilities, and these discrepancies are referred to as cognitive self-appraisals. Despite evidence that low self-appraisals are associated with depression, the modifiability of self-appraisals and their association with treatment outcome remains unclear. The current study examined whether self-appraisals change following antidepressant treatment. Furthermore, we investigated the association of self-appraisals with treatment outcome. METHODS As part of the CAN-BIND-1 clinical trial, 154 patients with MDD completed measures of objective and subjective cognitive abilities, depressive symptoms, and functional outcomes (work productivity, psychosocial functioning, and quality of life) at baseline and post-escitalopram treatment. Self-appraisals were calculated based on discrepancies between objective and subjective cognitive abilities, with higher scores indicating overestimation of cognitive abilities. RESULTS Baseline self-appraisals were not predictive of treatment outcomes. However, self-appraisals increased from pre- to post-treatment. Moreover, pre-post treatment increases in self-appraisals were associated with positive treatment response and remission, decreases in depressive symptoms, and improvements in work productivity, psychosocial functioning, and quality of life. LIMITATIONS The pre-post intervention design precluded examining the temporal precedence of change in self-appraisals versus depressive symptoms and functional outcomes. CONCLUSIONS Findings are the first to demonstrate that self-appraisals are treatment-sensitive and are associated with treatment outcomes and recovery from MDD. Cognitive self-appraisals may represent a key marker of treatment response and a valuable target for assessment and intervention, as well as a potential mechanism underlying risk and recovery.
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Affiliation(s)
- Katerina Rnic
- Department of Psychology, University of British Columbia, Vancouver, British Columbia V6T 1Z4, Canada,.
| | - Young-Eun Jung
- Department of Psychiatry, College of Medicine, Jeju National University, Jeju 63241, Korea
| | - Ivan Torres
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia V6T 1Z4, Canada
| | - Trisha Chakrabarty
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia V6T 1Z4, Canada
| | - Joelle LeMoult
- Department of Psychology, University of British Columbia, Vancouver, British Columbia V6T 1Z4, Canada
| | | | - Emma Morton
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia V6T 1Z4, Canada
| | - Venkat Bhat
- Department of Psychiatry, University of Toronto, Toronto, Ontario M5T 1R8, Canada
| | - Peter Giacobbe
- Department of Psychiatry, University of Toronto, Toronto, Ontario M5T 1R8, Canada
| | - Shane McInerney
- Department of Psychiatry, National University of Ireland, Galway H91 Tk33, Ireland
| | - Benicio N Frey
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario L8N 3K7, Canada
| | - Roumen V Milev
- Departments of Psychiatry and Psychology, Queen's University, Kingston, Ontario K7L 3N6, Canada
| | - Daniel Müller
- Department of Psychiatry, University of Toronto, Toronto, Ontario M5T 1R8, Canada
| | - Arun V Ravindran
- Department of Psychiatry, University of Toronto, Toronto, Ontario M5T 1R8, Canada
| | - Susan Rotzinger
- Department of Psychiatry, University of Toronto, Toronto, Ontario M5T 1R8, Canada
| | - Sidney H Kennedy
- Department of Psychiatry, University of Toronto, Toronto, Ontario M5T 1R8, Canada
| | - Raymond W Lam
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia V6T 1Z4, Canada
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Saeedi S, Nagy C, Ibrahim P, Théroux JF, Wakid M, Fiori LM, Yang J, Rotzinger S, Foster JA, Mechawar N, Kennedy SH, Turecki G. Neuron-derived extracellular vesicles enriched from plasma show altered size and miRNA cargo as a function of antidepressant drug response. Mol Psychiatry 2021; 26:7417-7424. [PMID: 34385599 DOI: 10.1038/s41380-021-01255-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 07/27/2021] [Accepted: 07/30/2021] [Indexed: 11/09/2022]
Abstract
Previous work has demonstrated that microRNAs (miRNAs) change as a function of antidepressant treatment (ADT) response. However, it is unclear how representative these peripherally detected miRNA changes are to those occurring in the brain. This study aimed to use peripherally extracted neuron-derived extracellular vesicles (NDEV) to circumvent these limitations and investigate neuronal miRNA changes associated with antidepressant response. Samples were collected at two time points (baseline and after 8 weeks of follow-up) from depressed patients who responded (N = 20) and did not respond (N = 20) to escitalopram treatment, as well as controls (N = 20). Total extracellular vesicles (EVs) were extracted from plasma, and then further enriched for NDEV by immunoprecipitation with L1CAM. EVs and NDEVs were characterized, and NDEV miRNA cargo was extracted and sequenced. Subsequently, studies in cell lines and postmortem tissue were conducted. Characterization of NDEVs revealed that they were smaller than other EVs isolated from plasma (p < 0.0001), had brain-specific neuronal markers, and contained miRNAs enriched for brain functions (p < 0.0001) Furthermore, NDEVs from depressed patients were smaller than controls (p < 0.05), and NDEV size increased with ADT response (p < 0.01). Finally, changes in NDEV cargo, specifically changes in miR-21-5p, miR-30d-5p, and miR-486-5p together (p < 0.01), were associated with ADT response. Targets of these three miRNAs were altered in brain tissue from depressed individuals (p < 0.05). Together, this study indicates that changes in peripherally isolated NDEV can act as both a clinically accessible and informative biomarker of ADT response specifically through size and cargo.
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Affiliation(s)
- Saumeh Saeedi
- McGill Group for Suicide Studies, Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada.,Department of Human Genetics, McGill University, Montreal, QC, Canada
| | - Corina Nagy
- McGill Group for Suicide Studies, Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada.,Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Pascal Ibrahim
- McGill Group for Suicide Studies, Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada.,Integrated Program in Neuroscience, McGill University, Montreal, QC, Canada
| | - Jean-Francois Théroux
- McGill Group for Suicide Studies, Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada
| | - Marina Wakid
- McGill Group for Suicide Studies, Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada.,Integrated Program in Neuroscience, McGill University, Montreal, QC, Canada
| | - Laura M Fiori
- McGill Group for Suicide Studies, Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada
| | - Jennie Yang
- McGill Group for Suicide Studies, Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada
| | - Susan Rotzinger
- Department of Psychiatry, University Health Network, Krembil Research Institute, University of Toronto, Toronto, ON, Canada.,St Michael's Hospital, Li Ka Shing Knowledge Institute, Arthur Sommer Rotenberg Suicide and Depression Studies Program and Centre for Depression and Suicide Studies, Toronto, ON, Canada
| | - Jane A Foster
- Department of Psychiatry, University Health Network, Krembil Research Institute, University of Toronto, Toronto, ON, Canada.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Naguib Mechawar
- McGill Group for Suicide Studies, Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada.,Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Sidney H Kennedy
- Department of Psychiatry, University Health Network, Krembil Research Institute, University of Toronto, Toronto, ON, Canada.,St Michael's Hospital, Li Ka Shing Knowledge Institute, Arthur Sommer Rotenberg Suicide and Depression Studies Program and Centre for Depression and Suicide Studies, Toronto, ON, Canada
| | - Gustavo Turecki
- McGill Group for Suicide Studies, Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada. .,Department of Psychiatry, McGill University, Montreal, QC, Canada.
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35
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Jones BDM, Levitan RD, Wang W, Uher R, Rotzinger S, Foster JA, Kennedy SH, Farzan F, Quilty LC, Kloiber S. Metabolic variables associated with response to cognitive behavioural therapy for depression in females: A Canadian biomarker integration network for depression (CAN-BIND) study. J Psychiatr Res 2021; 142:321-327. [PMID: 34419752 DOI: 10.1016/j.jpsychires.2021.07.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 07/13/2021] [Accepted: 07/18/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Cognitive behavioural therapy (CBT) is an established first-line treatment for depression; however, it remains unclear which factors predict a positive outcome with this approach. Prior work suggests that co-morbid obesity predicts a poorer response to antidepressant medication. The current study examined whether there is an association between weight parameters and improvement of depressive symptoms with CBT. METHODS This was a secondary analysis of data from the "Clinical and Biological Markers of Response to Cognitive Behavioural Therapy for Depression - 6" (CANBIND-6; https://clinicaltrials.gov/ct2/show/NCT02883257) study. Adult participants (n = 41) with a diagnosis of Major Depressive Disorder (MDD) or Persistent Depressive Disorder (PDD) were recruited from an outpatient tertiary psychiatric centre in Canada. Participants completed 20 individual sessions of CBT over 16 weeks. The primary measure for treatment outcome was the Montgomery-Åsberg Depression Rating Scale (MADRS) total score at week 16. RESULTS Thirty-seven participants completed assessments pre and post CBT. Baseline weight parameters were not correlated with treatment response to CBT in the entire group. There was a significant sex*waist circumference (WC) (B:-1.34; p = 0.004) and sex*body mass index (BMI) interaction (B:-2.03; p:0.009). In female participants, baseline waist circumference, but not BMI, significantly predicted week 16 MADRS after controlling for age and baseline MADRS (B:0.422 p:0.049). LIMITATIONS The major limitation of our preliminary finding is the small sample size. CONCLUSION Our preliminary findings suggest that higher waist circumference may be associated with a better treatment response to CBT for depression in females. This result could be of clinical relevance and warrants further investigation in larger and independent samples.
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Affiliation(s)
- Brett D M Jones
- Centre for Addiction and Mental Health and Campbell Family Mental Health Research Institute, 1000 Queen St West, Toronto, Canada; Department of Psychiatry, University of Toronto, 250 College St, Toronto, Canada
| | - Robert D Levitan
- Centre for Addiction and Mental Health and Campbell Family Mental Health Research Institute, 1000 Queen St West, Toronto, Canada; Department of Psychiatry, University of Toronto, 250 College St, Toronto, Canada
| | - Wei Wang
- Centre for Addiction and Mental Health and Campbell Family Mental Health Research Institute, 1000 Queen St West, Toronto, Canada; Department of Psychiatry, University of Toronto, 250 College St, Toronto, Canada
| | - Rudolf Uher
- Department of Psychiatry, Dalhousie University, Halifax, 5909 Veteran Memorial Lane, Halifax, NS, Canada
| | - Susan Rotzinger
- Department of Psychiatry, University Health Network, University of Toronto, 200 Elizabeth St, Toronto, Ontario, Canada
| | - Jane A Foster
- Psychiatry and Behavioural Neuroscience, McMaster University, 1280 Main St West, Hamilton, Ontario, Canada; Department of Psychiatry, St. Michael's Hospital, 30 Bond St, Toronto, Ontario, Canada
| | - Sidney H Kennedy
- Department of Psychiatry, University Health Network, University of Toronto, 200 Elizabeth St, Toronto, Ontario, Canada
| | - Faranak Farzan
- Brain Lab, School of Mechatronic Systems Engineering, Simon Fraser University, 250-13450, 102 Avenue, Surrey, BC, Canada
| | - Lena C Quilty
- Centre for Addiction and Mental Health and Campbell Family Mental Health Research Institute, 1000 Queen St West, Toronto, Canada; Department of Psychiatry, University of Toronto, 250 College St, Toronto, Canada
| | - Stefan Kloiber
- Centre for Addiction and Mental Health and Campbell Family Mental Health Research Institute, 1000 Queen St West, Toronto, Canada; Department of Psychiatry, University of Toronto, 250 College St, Toronto, Canada.
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36
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Suh JS, Fiori LM, Ali M, Harkness KL, Ramonas M, Minuzzi L, Hassel S, Strother SC, Zamyadi M, Arnott SR, Farzan F, Foster JA, Lam RW, MacQueen GM, Milev R, Müller DJ, Parikh SV, Rotzinger S, Sassi RB, Soares CN, Uher R, Kennedy SH, Turecki G, Frey BN. Hypothalamus volume and DNA methylation of stress axis genes in major depressive disorder: A CAN-BIND study report. Psychoneuroendocrinology 2021; 132:105348. [PMID: 34229186 DOI: 10.1016/j.psyneuen.2021.105348] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 06/14/2021] [Accepted: 06/25/2021] [Indexed: 11/28/2022]
Abstract
Dysfunction of the hypothalamic-pituitary-adrenal (HPA) axis is considered one of the mechanisms underlying the development of major depressive disorder (MDD), but the exact nature of this dysfunction is unknown. We investigated the relationship between hypothalamus volume (HV) and blood-derived DNA methylation in MDD. We obtained brain MRI, clinical and molecular data from 181 unmedicated MDD and 90 healthy control (HC) participants. MDD participants received a 16-week standardized antidepressant treatment protocol, as part of the first Canadian Biomarker Integration Network in Depression (CAN-BIND) study. We collected bilateral HV measures via manual segmentation by two independent raters. DNA methylation and RNA sequencing were performed for three key HPA axis-regulating genes coding for the corticotropin-binding protein (CRHBP), glucocorticoid receptor (NR3C1) and FK506 binding protein 5 (FKBP5). We used elastic net regression to perform variable selection and assess predictive ability of methylation variables on HV. Left HV was negatively associated with duration of current episode (ρ = -0.17, p = 0.035). We did not observe significant differences in HV between MDD and HC or any associations between HV and treatment response at weeks 8 or 16, overall depression severity, illness duration or childhood maltreatment. We also did not observe any differentially methylated CpG sites between MDD and HC groups. After assessing functionality by correlating methylation levels with RNA expression of the respective genes, we observed that the number of functionally relevant CpG sites differed between MDD and HC groups in FKBP5 (χ2 = 77.25, p < 0.0001) and NR3C1 (χ2 = 7.29, p = 0.007). Cross-referencing functionally relevant CpG sites to those that were highly ranked in predicting HV in elastic net modeling identified one site from FKBP5 (cg03591753) and one from NR3C1 (cg20728768) within the MDD group. Stronger associations between DNA methylation, gene expression and HV in MDD suggest a novel putative molecular pathway of stress-related sensitivity in depression. Future studies should consider utilizing the epigenome and ultra-high field MR data which would allow the investigation of HV sub-fields.
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Affiliation(s)
- Jee Su Suh
- Neuroscience Graduate Program, McMaster University, Hamilton, ON, Canada; Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, ON, Canada
| | - Laura M Fiori
- Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Mohammad Ali
- Neuroscience Graduate Program, McMaster University, Hamilton, ON, Canada; Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, ON, Canada
| | - Kate L Harkness
- Department of Psychology, Queen's University, Kingston, ON, Canada
| | - Milita Ramonas
- Juravinski Hospital and Cancer Centre, Hamilton Health Sciences, Hamilton, ON, Canada
| | - Luciano Minuzzi
- Neuroscience Graduate Program, McMaster University, Hamilton, ON, Canada; Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, ON, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Stefanie Hassel
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | | | - Mojdeh Zamyadi
- Rotman Research Institute, Baycrest, Toronto, ON, Canada
| | | | - Faranak Farzan
- eBrain Lab, School of Mechatronic Systems Engineering, Simon Fraser University, Surrey, BC, Canada
| | - Jane A Foster
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Raymond W Lam
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Glenda M MacQueen
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Roumen Milev
- Departments of Psychiatry and Psychology, Queen's University, and Providence Care Hospital, Kingston, ON, Canada
| | - Daniel J Müller
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Centre for Addiction and Mental Health, Pharmacogenetics Research Clinic, Toronto, ON, Canada
| | - Sagar V Parikh
- University of Michigan Depression Center, Ann Arbor, MI, United States
| | - Susan Rotzinger
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Roberto B Sassi
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Claudio N Soares
- Departments of Psychiatry and Psychology, Queen's University, and Providence Care Hospital, Kingston, ON, Canada
| | - Rudolf Uher
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Sidney H Kennedy
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Centre for Depression and Suicide Studies, St. Michael's Hospital, Toronto, ON, Canada
| | - Gustavo Turecki
- Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Benicio N Frey
- Neuroscience Graduate Program, McMaster University, Hamilton, ON, Canada; Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, ON, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.
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McInerney SJ, Chakrabarty T, Maciukiewicz M, Frey BN, MacQueen GM, Milev RV, Ravindran AV, Rotzinger S, Kennedy SH, Lam RW. Cognition and Its Association with Psychosocial and Occupational Functioning during Treatment with Escitalopram in Patients with Major Depressive Disorder: A CAN-BIND-1 Report: La Cognition Et Son Association Avec Le Fonctionnement Psychosocial Et Professionnel Durant Le Traitement Par Escitalopram Chez Des Patients Souffrant De Trouble Dépressif Majeur: Une Étude Can-Bind-1. Can J Psychiatry 2021; 66:798-806. [PMID: 33353384 PMCID: PMC8504285 DOI: 10.1177/0706743720974823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Major depressive disorder (MDD) is associated with impairments in both cognition and functioning. However, whether cognitive deficits significantly contribute to impaired psychosocial and occupational functioning, independent of other depressive symptoms, is not well established. We examined the relationship between cognitive performance and functioning in depressed patients before and after antidepressant treatment using secondary data from the first Canadian Biomarker Integration Network in Depression-1 study. METHODS Cognition was assessed at baseline in unmedicated, depressed participants with MDD (n = 207) using the Central Nervous System Vital Signs computerized battery, psychosocial functioning with the Sheehan Disability Scale (SDS), and occupational functioning with the Lam Employment Absence and Productivity Scale (LEAPS). Cognition (n = 181), SDS (n = 175), and LEAPS (n = 118) were reassessed after participants received 8 weeks of open-label escitalopram monotherapy. A series of linear regressions were conducted to determine (1) whether cognitive functioning was associated with psychosocial and occupational functioning prior to treatment, after adjusting for overall depressive symptom severity and (2) whether changes in cognitive functioning after an 8-week treatment phase were associated with changes in psychosocial and occupational functioning, after adjusting for changes in overall symptom severity. RESULTS Baseline global cognitive functioning, after adjusting for depression symptom severity and demographic variables, was associated with the SDS work/study subscale (β = -0.17; P = 0.03) and LEAPS productivity subscale (β = -0.17; P = 0.05), but not SDS total (β = 0.19; P = 0.12) or LEAPS total (β = 0.41; P = 0.17) scores. Although LEAPS and SDS scores showed significant improvements after 8 weeks of treatment (P < 0.001), there were no significant associations between changes in cognitive domain scores and functional improvements. CONCLUSION Cognition was associated with occupational functioning at baseline, but changes in cognition were not associated with psychosocial or occupational functional improvements following escitalopram treatment. We recommend the use of more comprehensive functional assessments to determine the impact of cognitive change on functional outcomes in future research.
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Affiliation(s)
- Shane J McInerney
- Department of Psychiatry, University of Toronto, Ontario, Canada.,Department of Psychiatry, University Hospital Galway, Ireland
| | - Trisha Chakrabarty
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Malgorzata Maciukiewicz
- Centre for Addiction and Mental Health, Campbell Family Mental Health Research Institute, Toronto, Ontario, Canada.,Department of Rheumatology, Center of Experimental Rheumatology, University Hospital Zurich, Switzerland
| | - Benicio N Frey
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Glenda M MacQueen
- Deceased, formerly Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Roumen V Milev
- Department of Psychiatry, Queen's University, Kingston, Ontario, Canada.,Department of Psychology, Queen's University, Kingston, Ontario, Canada
| | - Arun V Ravindran
- Department of Psychiatry, University of Toronto, Ontario, Canada
| | - Susan Rotzinger
- Department of Psychiatry, University of Toronto, Ontario, Canada
| | - Sidney H Kennedy
- Department of Psychiatry, University of Toronto, Ontario, Canada
| | - Raymond W Lam
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
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38
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Fiori LM, Orri M, Aouabed Z, Théroux JF, Lin R, Nagy C, Frey BN, Lam RW, MacQueen GM, Milev R, Müller DJ, Parikh SV, Rotzinger S, Uher R, Foster JA, Kennedy SH, Turecki G. Treatment-emergent and trajectory-based peripheral gene expression markers of antidepressant response. Transl Psychiatry 2021; 11:439. [PMID: 34420030 PMCID: PMC8380246 DOI: 10.1038/s41398-021-01564-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 07/27/2021] [Accepted: 08/10/2021] [Indexed: 12/31/2022] Open
Abstract
Identifying biomarkers of antidepressant response may advance personalized treatment of major depressive disorder (MDD). We aimed to identify longitudinal changes in gene expression associated with response to antidepressants in a sample of MDD patients treated with escitalopram. Patients (N = 153) from the CAN-BIND-1 cohort were treated for 8 weeks, and depressive symptoms were assessed using the Montgomery-Åsberg Depression Rating Scale at 0, 2, 4, 6, and 8 weeks. We identified three groups of patients according to response status: early responders (22.9%), later responders (32.0%), and nonresponders (45.1%). RNA sequencing was performed in blood obtained at weeks 0, 2, and 8. RNA expression was modeled using growth models, and differences in the longitudinal changes in expression according to response were investigated using multiple regression models. The expression of RNAs related to response was investigated in the brains of depressed individuals, as well as in neuronal cells in vitro. We identified four RNAs (CERCAM, DARS-AS1, FAM228B, HBEGF) whose change over time was independently associated with a response status. For all except HBEGF, responders showed higher expression over time, compared to nonresponders. While the change in all RNAs differentiated early responders from nonresponders, changes in DARS-AS1 and HBEGF also differentiated later responders from nonresponders. Additionally, HBEGF was downregulated in the brains of depressed individuals, and increased in response to escitalopram treatment in vitro. In conclusion, using longitudinal assessments of gene expression, we provide insights into biological processes involved in the intermediate stages of escitalopram response, highlighting several genes with potential utility as biomarkers of antidepressant response.
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Affiliation(s)
- Laura M. Fiori
- grid.14709.3b0000 0004 1936 8649McGill Group for Suicide Studies, Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, Quebec Canada
| | - Massimiliano Orri
- grid.14709.3b0000 0004 1936 8649McGill Group for Suicide Studies, Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, Quebec Canada
| | - Zahia Aouabed
- grid.14709.3b0000 0004 1936 8649McGill Group for Suicide Studies, Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, Quebec Canada
| | - Jean François Théroux
- grid.14709.3b0000 0004 1936 8649McGill Group for Suicide Studies, Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, Quebec Canada
| | - Rixing Lin
- grid.14709.3b0000 0004 1936 8649McGill Group for Suicide Studies, Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, Quebec Canada
| | - Corina Nagy
- grid.14709.3b0000 0004 1936 8649McGill Group for Suicide Studies, Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, Quebec Canada
| | - Benicio N. Frey
- grid.416721.70000 0001 0742 7355Department of Psychiatry & Behavioural Neurosciences, McMaster University and St Joseph’s Healthcare Hamilton, Hamilton, Ontario Canada
| | - Raymond W. Lam
- grid.17091.3e0000 0001 2288 9830Department of Psychiatry, University of British Columbia, Vancouver, British Columbia Canada
| | - Glenda M. MacQueen
- grid.22072.350000 0004 1936 7697Hotchkiss Brain Institute, University of Calgary, Calgary, AB Canada
| | - Roumen Milev
- grid.410356.50000 0004 1936 8331Departments of Psychiatry and Psychology, Queens University, Providence Care Hospital, Kingston, Ontario Canada
| | - Daniel J. Müller
- grid.17063.330000 0001 2157 2938Department of Psychiatry, University Health Network, Krembil Research Institute, University of Toronto, Toronto, Ontario Canada ,grid.155956.b0000 0000 8793 5925Centre for Addiction and Mental Health, Toronto, Ontario Canada
| | - Sagar V. Parikh
- grid.214458.e0000000086837370Department of Psychiatry, University of Michigan, Ann Arbor, Michigan USA
| | - Susan Rotzinger
- grid.17063.330000 0001 2157 2938Department of Psychiatry, University Health Network, Krembil Research Institute, University of Toronto, Toronto, Ontario Canada
| | - Rudolf Uher
- grid.458365.90000 0004 4689 2163Nova Scotia Health Authority, Halifax, NS Canada ,grid.55602.340000 0004 1936 8200Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia Canada
| | - Jane A. Foster
- grid.17063.330000 0001 2157 2938Department of Psychiatry, University Health Network, Krembil Research Institute, University of Toronto, Toronto, Ontario Canada
| | - Sidney H. Kennedy
- grid.17063.330000 0001 2157 2938Department of Psychiatry, University Health Network, Krembil Research Institute, University of Toronto, Toronto, Ontario Canada ,grid.415502.7St Michael’s Hospital, Li Ka Shing Knowledge Institute, Centre for Depression and Suicide Studies, Toronto, Ontario Canada
| | - Gustavo Turecki
- McGill Group for Suicide Studies, Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, Quebec, Canada.
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van der Wijk G, Harris JK, Hassel S, Davis AD, Zamyadi M, Arnott SR, Milev R, Lam RW, Frey BN, Hall GB, Müller DJ, Rotzinger S, Kennedy SH, Strother SC, MacQueen GM, Protzner AB. Baseline Functional Connectivity in Resting State Networks Associated with Depression and Remission Status after 16 Weeks of Pharmacotherapy: A CAN-BIND Report. Cereb Cortex 2021; 32:1223-1243. [PMID: 34416758 DOI: 10.1093/cercor/bhab286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 07/19/2021] [Accepted: 07/20/2021] [Indexed: 02/07/2023] Open
Abstract
Understanding the neural underpinnings of major depressive disorder (MDD) and its treatment could improve treatment outcomes. So far, findings are variable and large sample replications scarce. We aimed to replicate and extend altered functional connectivity associated with MDD and pharmacotherapy outcomes in a large, multisite sample. Resting-state fMRI data were collected from 129 patients and 99 controls through the Canadian Biomarker Integration Network in Depression. Symptoms were assessed with the Montgomery-Åsberg Depression Rating Scale (MADRS). Connectivity was measured as correlations between four seeds (anterior and posterior cingulate cortex, insula and dorsolateral prefrontal cortex) and all other brain voxels. Partial least squares was used to compare connectivity prior to treatment between patients and controls, and between patients reaching remission (MADRS ≤ 10) early (within 8 weeks), late (within 16 weeks), or not at all. We replicated previous findings of altered connectivity in patients. In addition, baseline connectivity of the anterior/posterior cingulate and insula seeds differentiated patients with different treatment outcomes. The stability of these differences was established in the largest single-site subsample. Our replication and extension of altered connectivity highlighted previously reported and new differences between patients and controls, and revealed features that might predict remission prior to pharmacotherapy. Trial registration: ClinicalTrials.gov: NCT01655706.
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Affiliation(s)
- Gwen van der Wijk
- Department of Psychology, University of Calgary, Calgary AB T2N 1N4, Canada
| | - Jacqueline K Harris
- Department of Computing Science, University of Alberta, Edmonton AB T6G 2S4, Canada.,Alberta Machine Intelligence Institute, Edmonton AB T5J 3B1, Canada
| | - Stefanie Hassel
- Cumming School of Medicine, Department of Psychiatry, University of Calgary, Calgary AB T2N 4N1, Canada.,Mathison Centre for Mental Health Research and Education, University of Calgary, Calgary AB T2N 4Z6, Canada
| | - Andrew D Davis
- Rotman Research Institute, Baycrest Health Sciences, Toronto ON M6A 2E1, Canada.,Department of Psychology, Neuroscience & Behaviour, McMaster University, Hamilton ON L8S 4L6, Canada
| | - Mojdeh Zamyadi
- Rotman Research Institute, Baycrest Health Sciences, Toronto ON M6A 2E1, Canada
| | - Stephen R Arnott
- Rotman Research Institute, Baycrest Health Sciences, Toronto ON M6A 2E1, Canada
| | - Roumen Milev
- Queen's University, Departments of Psychiatry and Psychology, and Providence Care Hospital, Kingston ON K7L 3N6, Canada
| | - Raymond W Lam
- Department of Psychiatry, University of British Columbia, Vancouver BC V6T 2A1, Canada
| | - Benicio N Frey
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton ON L8S 4L8, Canada.,Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare, Hamilton ON L8N 4N6, Canada
| | - Geoffrey B Hall
- Department of Psychology, Neuroscience & Behaviour, McMaster University, Hamilton ON L8S 4L6, Canada.,Imaging Research Centre, St. Joseph's Healthcare Hamilton, Hamilton ON L8N 4N6, Canada
| | - Daniel J Müller
- Department of Psychiatry, University of Toronto, Toronto ON M5T 1R8, Canada.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto ON M5T 1R8, Canada.,Department of Pharmacology and Toxicology, University of Toronto, Toronto ON M5S 1A8, Canada.,Institute of Medical Sciences, University of Toronto, Toronto ON M5S 1A8, Canada
| | - Susan Rotzinger
- Centre for Mental Health, University Health Network, Toronto ON M5G 1L7, Canada.,Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto ON M5B 1T8, Canada
| | - Sidney H Kennedy
- Department of Psychiatry, University of Toronto, Toronto ON M5T 1R8, Canada.,Institute of Medical Sciences, University of Toronto, Toronto ON M5S 1A8, Canada.,Centre for Mental Health, University Health Network, Toronto ON M5G 1L7, Canada.,Centre for Depression and Suicide Studies, Unity Health Toronto, Toronto ON M5B 1W8, Canada.,Krembil Research Institute, Toronto Western Hospital, Toronto ON M5T 0S8, Canada
| | - Stephen C Strother
- Rotman Research Institute, Baycrest Health Sciences, Toronto ON M6A 2E1, Canada.,Department of Medical Biophysics, University of Toronto, Toronto ON M5G 1L7, Canada
| | - Glenda M MacQueen
- Cumming School of Medicine, Department of Psychiatry, University of Calgary, Calgary AB T2N 4N1, Canada.,Mathison Centre for Mental Health Research and Education, University of Calgary, Calgary AB T2N 4Z6, Canada
| | - Andrea B Protzner
- Department of Psychology, University of Calgary, Calgary AB T2N 1N4, Canada.,Mathison Centre for Mental Health Research and Education, University of Calgary, Calgary AB T2N 4Z6, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary AB T2N 4N1, Canada
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40
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Ayyash S, Davis AD, Alders GL, MacQueen G, Strother SC, Hassel S, Zamyadi M, Arnott SR, Harris JK, Lam RW, Milev R, Müller DJ, Kennedy SH, Rotzinger S, Frey BN, Minuzzi L, Hall GB. Exploring brain connectivity changes in major depressive disorder using functional-structural data fusion: A CAN-BIND-1 study. Hum Brain Mapp 2021; 42:4940-4957. [PMID: 34296501 PMCID: PMC8449113 DOI: 10.1002/hbm.25590] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 06/14/2021] [Accepted: 07/01/2021] [Indexed: 01/23/2023] Open
Abstract
There is a growing interest in examining the wealth of data generated by fusing functional and structural imaging information sources. These approaches may have clinical utility in identifying disruptions in the brain networks that underlie major depressive disorder (MDD). We combined an existing software toolbox with a mathematically dense statistical method to produce a novel processing pipeline for the fast and easy implementation of data fusion analysis (FATCAT‐awFC). The novel FATCAT‐awFC pipeline was then utilized to identify connectivity (conventional functional, conventional structural and anatomically weighted functional connectivy) changes in MDD patients compared to healthy comparison participants (HC). Data were acquired from the Canadian Biomarker Integration Network for Depression (CAN‐BIND‐1) study. Large‐scale resting‐state networks were assessed. We found statistically significant anatomically‐weighted functional connectivity (awFC) group differences in the default mode network and the ventral attention network, with a modest effect size (d < 0.4). Functional and structural connectivity seemed to overlap in significance between one region‐pair within the default mode network. By combining structural and functional data, awFC served to heighten or reduce the magnitude of connectivity differences in various regions distinguishing MDD from HC. This method can help us more fully understand the interconnected nature of structural and functional connectivity as it relates to depression.
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Affiliation(s)
- Sondos Ayyash
- School of Biomedical Engineering, McMaster University, Hamilton, Ontario, Canada.,Department of Psychology Neuroscience & Behaviour, McMaster University, Hamilton, Ontario, Canada
| | - Andrew D Davis
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada.,Rotman Research Institute, Baycrest, Toronto, Ontario, Canada
| | - Gésine L Alders
- Neuroscience Graduate Program, McMaster University, Hamilton, Ontario, Canada
| | - Glenda MacQueen
- Mathison Centre for Mental Health Research and Education, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Stephen C Strother
- Rotman Research Institute, Baycrest, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada.,Department of Medical Biophysics, University of Toronto, Ontario, Canada
| | - Stefanie Hassel
- Mathison Centre for Mental Health Research and Education, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Mojdeh Zamyadi
- Rotman Research Institute, Baycrest, Toronto, Ontario, Canada
| | | | - Jacqueline K Harris
- Department of Computer Science, University of Alberta, Edmonton, Alberta, Canada
| | - Raymond W Lam
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Roumen Milev
- Departments of Psychiatry and Psychology, Queen's University, Providence Care Hospital, Kingston, Ontario, Canada
| | - Daniel J Müller
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Sidney H Kennedy
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Centre for Mental Health, University Health Network, Toronto, Ontario, Canada.,Krembil Research Institute, University Health Network, Toronto, Ontario, Canada.,Centre for Depression and Suicide Studies, and Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Susan Rotzinger
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Krembil Research Institute, University Health Network, Toronto, Ontario, Canada.,Centre for Depression and Suicide Studies, and Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Benicio N Frey
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada.,Neuroscience Graduate Program, McMaster University, Hamilton, Ontario, Canada.,Mood Disorders Treatment and Research Centre and Women's Health Concerns Clinic, St. Joseph's Healthcare, Hamilton, Ontario, Canada
| | - Luciano Minuzzi
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada.,Neuroscience Graduate Program, McMaster University, Hamilton, Ontario, Canada.,Mood Disorders Treatment and Research Centre and Women's Health Concerns Clinic, St. Joseph's Healthcare, Hamilton, Ontario, Canada
| | - Geoffrey B Hall
- School of Biomedical Engineering, McMaster University, Hamilton, Ontario, Canada.,Department of Psychology Neuroscience & Behaviour, McMaster University, Hamilton, Ontario, Canada.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada.,Neuroscience Graduate Program, McMaster University, Hamilton, Ontario, Canada
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41
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Caspani G, Turecki G, Lam RW, Milev RV, Frey BN, MacQueen GM, Müller DJ, Rotzinger S, Kennedy SH, Foster JA, Swann JR. Metabolomic signatures associated with depression and predictors of antidepressant response in humans: A CAN-BIND-1 report. Commun Biol 2021; 4:903. [PMID: 34294869 PMCID: PMC8298446 DOI: 10.1038/s42003-021-02421-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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: 10/23/2020] [Accepted: 06/07/2021] [Indexed: 11/09/2022] Open
Abstract
One of the biggest challenges in treating depression is the heterogeneous and qualitative nature of its clinical presentations. This highlights the need to find quantitative molecular markers to tailor existing treatment strategies to the individual's biological system. In this study, high-resolution metabolic phenotyping of urine and plasma samples from the CAN-BIND study collected before treatment with two common pharmacological strategies, escitalopram and aripiprazole, was performed. Here we show that a panel of LDL and HDL subfractions were negatively correlated with depression in males. For treatment response, lower baseline concentrations of apolipoprotein A1 and HDL were predictive of escitalopram response in males, while higher baseline concentrations of apolipoprotein A2, HDL and VLDL subfractions were predictive of aripiprazole response in females. These findings support the potential of metabolomics in precision medicine and the possibility of identifying personalized interventions for depression.
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Affiliation(s)
- Giorgia Caspani
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Gustavo Turecki
- Department of Psychiatry, McGill University, Montreal, QC, Canada
- Douglas Mental Health University Institute Frank B. Common (FBC), Montreal, QC, Canada
| | - Raymond W Lam
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Roumen V Milev
- Department of Psychiatry, Queen's University, Kingston, ON, Canada
- Providence Care Hospital, Kingston, ON, Canada
| | - Benicio N Frey
- Department of Psychiatry & Behavioral Neurosciences, McMaster University, Hamilton, ON, Canada
- St. Joseph's Healthcare, Hamilton, ON, Canada
| | - Glenda M MacQueen
- Hotchkiss Brain Institute, University of Calgary, Calgary, AL, Canada
| | - Daniel J Müller
- Pharmacogenetics Research Clinic, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Susan Rotzinger
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, Centre for Mental Health, University Health Network, Krembil Research Institute, University of Toronto, Toronto, ON, Canada
- Centre for Depression and Suicide Studies, St Michael's Hospital, Li Ka Shing Knowledge Institute, Toronto, ON, Canada
| | - Sidney H Kennedy
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, Centre for Mental Health, University Health Network, Krembil Research Institute, University of Toronto, Toronto, ON, Canada
- Centre for Depression and Suicide Studies, St Michael's Hospital, Li Ka Shing Knowledge Institute, Toronto, ON, Canada
| | - Jane A Foster
- Department of Psychiatry & Behavioral Neurosciences, McMaster University, Hamilton, ON, Canada
- St. Joseph's Healthcare, Hamilton, ON, Canada
- Centre for Depression and Suicide Studies, St Michael's Hospital, Li Ka Shing Knowledge Institute, Toronto, ON, Canada
| | - Jonathan R Swann
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK.
- School of Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK.
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42
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Shakeel MK, Hassel S, Davis AD, Metzak PD, MacQueen GM, Arnott SR, Bray S, Frey BN, Goldstein BI, Hall GB, Harris J, Lam RW, MacIntosh BJ, Milev R, Mueller DJ, Rotzinger S, Strother SC, Wang J, Zamyadi M, Kennedy SH, Addington J, Lebel C. White matter microstructure in youth at risk for serious mental illness: A comparative analysis. Psychiatry Res Neuroimaging 2021; 312:111289. [PMID: 33910139 DOI: 10.1016/j.pscychresns.2021.111289] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 12/01/2020] [Accepted: 04/08/2021] [Indexed: 10/21/2022]
Abstract
Identifying biomarkers of serious mental illness, such as altered white matter microstructure, can aid in early diagnosis and treatment. White matter microstructure was assessed using constrained spherical deconvolution of diffusion imaging data in a sample of 219 youth (age 12-25 years, 64.84% female) across 8 sites. Participants were classified as healthy controls (HC; n = 47), familial risk for serious mental illness (n = 31), mild-symptoms (n = 37), attenuated syndromes (n = 66), or discrete disorder (n = 38) based on clinical assessments. Fractional anisotropy (FA) and mean diffusivity (MD) values were derived for the whole brain white matter, forceps minor, anterior cingulate, anterior thalamic radiations (ATR), inferior fronto-occipital fasciculus, superior longitudinal fasciculus (SLF), and uncinate fasciculus (UF). Linear mixed effects models showed a significant effect of age on MD of the left ATR, left SLF, and left UF, and a significant effect of group on FA for all tracts examined. For most tracts, the discrete disorder group had significantly lower FA than other groups, and the attenuated syndromes group had higher FA compared to HC, with few differences between the remaining groups. White matter differences in MDD are most evident in individuals following illness onset, as few significant differences were observed in the risk phase.
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Affiliation(s)
| | | | - Andrew D Davis
- Department of Psychology, Neuroscience & Behavior, Canada; Imaging Research Center, Canada; Rotman Research Institute, Baycrest Centre, Toronto
| | - Paul D Metzak
- Department of Psychiatry, Hotchkiss Brain Institute, Canada
| | | | | | - Signe Bray
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada; Department of Radiology, Alberta Children's Hospital Research Institute,; Department of Radiology, Child and Adolescent Imaging Research Program, Calgary, Alberta, Canada
| | - Benicio N Frey
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, Ontario, Canada; Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Hamilton
| | - Benjamin I Goldstein
- Centre for Youth Bipolar Disorder, Sunnybrook Health Sciences Centre, Department of Psychiatry and Department of Pharmacology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Geoffrey B Hall
- Department of Psychology, Neuroscience & Behavior, Canada; Imaging Research Center, Canada
| | - Jacqueline Harris
- Department of Computer Science, University of Alberta, Edmonton, Alberta
| | - Raymond W Lam
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Bradley J MacIntosh
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, and Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
| | - Roumen Milev
- Department of Psychology, and Department of Psychiatry (RM), Queen's University and Providence Care Hospital, Kingston
| | - Daniel J Mueller
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Canada
| | - Susan Rotzinger
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Canada; Department of Psychiatry, St. Michael's Hospital, Canada; Department of Psychiatry, Krembil Research Centre, University Health Network, Canada; Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario
| | - Stephen C Strother
- Rotman Research Institute, Baycrest Centre, Toronto; Department of Medical Biophysics, University of Toronto, Canada
| | - JianLi Wang
- Work and Mental Health Research Unit, Institute of Mental Health Research, and School of Epidemiology and Public Health (JW), Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Sidney H Kennedy
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Canada; Department of Psychiatry, St. Michael's Hospital, Canada; Department of Psychiatry, Krembil Research Centre, University Health Network, Canada; Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario
| | - Jean Addington
- Department of Psychiatry, Hotchkiss Brain Institute, Canada
| | - Catherine Lebel
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada; Department of Radiology, Alberta Children's Hospital Research Institute,; Department of Radiology, Child and Adolescent Imaging Research Program, Calgary, Alberta, Canada
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43
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Morton E, Bhat V, Giacobbe P, Lou W, Michalak EE, Chakrabarty T, Frey BN, Milev RV, Müller DJ, Parikh SV, Rotzinger S, Kennedy SH, Lam RW. Impacts on Quality of Life with Escitalopram Monotherapy and Aripiprazole Augmentation in Patients with Major Depressive Disorder: A CAN-BIND Report. Pharmacopsychiatry 2021; 54:225-231. [PMID: 33652477 DOI: 10.1055/a-1385-0263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Many individuals with major depressive disorder (MDD) do not respond to initial antidepressant monotherapy. Adjunctive aripiprazole is recommended for treatment non-response; however, the impacts on quality of life (QoL) for individuals who receive this second-line treatment strategy have not been described. METHODS We evaluated secondary QoL outcomes in patients with MDD (n=179). After 8 weeks of escitalopram, non-responders (<50% decrease in clinician-rated depression) were treated with adjunctive aripiprazole for 8 weeks (n=97); responders continued escitalopram (n=82). A repeated-measures ANOVA evaluated change in Quality of Life Enjoyment and Satisfaction Short Form scores. QoL was described relative to normative benchmarks. RESULTS Escitalopram responders experienced the most QoL improvements in the first treatment phase. For non-responders, QoL improved with a large effect during adjunctive aripiprazole treatment. At the endpoint, 47% of patients achieving symptomatic remission still had impaired QoL. DISCUSSION Individuals who were treated with adjunctive aripiprazole after non-response to escitalopram experienced improved QoL, but a substantial degree of QoL impairment persisted. Since QoL deficits may predict MDD recurrence, attention to ways to support this outcome is required.
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Affiliation(s)
- Emma Morton
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Venkat Bhat
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Peter Giacobbe
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Wendy Lou
- Dalla Lane School of Public Health, University of Toronto, ON, Canada
| | - Erin E Michalak
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Trisha Chakrabarty
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Benicio N Frey
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Roumen V Milev
- Departments of Psychiatry and Psychology, Queen's University, Kingston, ON, Canada
| | - Daniel J Müller
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Sagar V Parikh
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Susan Rotzinger
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Sidney H Kennedy
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Raymond W Lam
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
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44
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Chakrabarty T, Harkness KL, McInerney SJ, Quilty LC, Milev RV, Kennedy SH, Frey BN, MacQueen GM, Müller DJ, Rotzinger S, Uher R, Lam RW. Childhood maltreatment and cognitive functioning in patients with major depressive disorder: a CAN-BIND-1 report. Psychol Med 2020; 50:2536-2547. [PMID: 31583989 DOI: 10.1017/s003329171900268x] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Patients with major depressive disorder (MDD) display cognitive deficits in acutely depressed and remitted states. Childhood maltreatment is associated with cognitive dysfunction in adults, but its impact on cognition and treatment related cognitive outcomes in adult MDD has received little consideration. We investigate whether, compared to patients without maltreatment and healthy participants, adult MDD patients with childhood maltreatment display greater cognitive deficits in acute depression, lower treatment-associated cognitive improvements, and lower cognitive performance in remission. METHODS Healthy and acutely depressed MDD participants were enrolled in a multi-center MDD predictive marker discovery trial. MDD participants received 16 weeks of standardized antidepressant treatment. Maltreatment and cognition were assessed with the Childhood Experience of Care and Abuse interview and the CNS Vital Signs battery, respectively. Cognitive scores and change from baseline to week 16 were compared amongst MDD participants with (DM+, n = 93) and without maltreatment (DM-, n = 90), and healthy participants with (HM+, n = 22) and without maltreatment (HM-, n = 80). Separate analyses in MDD participants who remitted were conducted. RESULTS DM+ had lower baseline global cognition, processing speed, and memory v. HM-, with no significant baseline differences amongst DM-, HM+, and HM- groups. There were no significant between-group differences in cognitive change over 16 weeks. Post-treatment remitted DM+, but not remitted DM-, scored significantly lower than HM- in working memory and processing speed. CONCLUSIONS Childhood maltreatment was associated with cognitive deficits in depressed and remitted adults with MDD. Maltreatment may be a risk factor for more severe and persistent cognitive deficits in adult MDD.
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Affiliation(s)
- Trisha Chakrabarty
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Kate L Harkness
- Department of Psychology, Queen's University, Kingston, ON, Canada
- Department of Psychiatry, Queen's University, Kingston, ON, Canada
| | - Shane J McInerney
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Lena C Quilty
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Roumen V Milev
- Department of Psychology, Queen's University, Kingston, ON, Canada
- Department of Psychiatry, Queen's University, Kingston, ON, Canada
| | - Sidney H Kennedy
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Benicio N Frey
- Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
- Mood Disorders Program, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Glenda M MacQueen
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Daniel J Müller
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Susan Rotzinger
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Rudolf Uher
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Raymond W Lam
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
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45
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Vaccarino AL, Kalali AH, Blier P, Gilbert Evans S, Engelhardt N, Foster JA, Frey BN, Greist JH, Kobak KA, Lam RW, MacQueen G, Milev R, Müller DJ, Parikh SV, Placenza FM, Rizvi SJ, Rotzinger S, Sheehan DV, Sills T, Soares CN, Turecki G, Uher R, Williams JBW, Kennedy SH, Evans KR. THE DEPRESSION INVENTORY DEVELOPMENT SCALE: Assessment of Psychometric Properties Using Classical and Modern Measurement Theory in a CAN-BIND Trial. Innov Clin Neurosci 2020; 17:30-40. [PMID: 33520402 PMCID: PMC7839654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Objective: The goal of the Depression Inventory Development (DID) project is to develop a comprehensive and psychometrically sound rating scale for major depressive disorder (MDD) that reflects current diagnostic criteria and conceptualizations of depression. We report here the evaluation of the current DID item bank using Classical Test Theory (CTT), Item Response Theory (IRT) and Rasch Measurement Theory (RMT). Methods: The present study was part of a larger multisite, open-label study conducted by the Canadian Biomarker Integration Network in Depression (ClinicalTrials.gov: NCT01655706). Trained raters administered the 32 DID items at each of two visits (MDD: baseline, n=211 and Week 8, n=177; healthy participants: baseline, n=112 and Week 8, n=104). The DID's "grid" structure operationalizes intensity and frequency of each item, with clear symptom definitions and a structured interview guide, with the current iteration assessing symptoms related to anhedonia, cognition, fatigue, general malaise, motivation, anxiety, negative thinking, pain, and appetite. Participants were also administered the Montgomery- Åsberg Depression Rating Scale (MADRS) and Quick Inventory of Depressive Symptomatology-Self-Report (QIDS-SR) that allowed DID items to be evaluated against existing "benchmark" items. CTT was used to assess data quality/reliability (i.e., missing data, skewness, scoring frequency, internal consistency), IRT to assess individual item performance by modelling an item's ability to discriminate levels of depressive severity (as assessed by the MADRS), and RMT to assess how the items perform together as a scale to capture a range of depressive severity (item targeting). These analyses together provided empirical evidence to base decisions on which DID items to remove, modify, or advance. Results: Of the 32 DID items evaluated, eight items were identified by CTT as problematic, displaying low variability in the range of responses, floor effects, and/or skewness; and four items were identified by IRT to show poor discriminative properties that would limit their clinical utility. Five additional items were deemed to be redundant. The remaining 15 DID items all fit the Rasch model, with person and item difficulty estimates indicating satisfactory item targeting, with lower precision in participants with mild levels of depression. These 15 DID items also showed good internal consistency (alpha=0.95 and inter-item correlations ranging from r=0.49 to r=0.84) and all items were sensitive to change following antidepressant treatment (baseline vs. Week 8). RMT revealed problematic item targeting for the MADRS and QIDSSR, including an absence of MADRS items targeting participants with mild/moderate depression and an absence of QIDS-SR items targeting participants with mild or severe depression. Conclusion: The present study applied CTT, IRT, and RMT to assess the measurement properties of the DID items and identify those that should be advanced, modified, or removed. Of the 32 items evaluated, 15 items showed good measurement properties. These items (along with previously evaluated items) will provide the basis for validation of a penultimate DID scale assessing anhedonia, cognitive slowing, concentration, executive function, recent memory, drive, emotional fatigue, guilt, self-esteem, hopelessness, tension, rumination, irritability, reduced appetite, insomnia, sadness, worry, suicidality, and depressed mood. The strategies adopted by the DID process provide a framework for rating scale development and validation.
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Affiliation(s)
- Anthony L Vaccarino
- Drs. Vaccarino, Evans and Gilbert Evans are with Indoc Research in Toronto, Ontario, Canada
- Dr Kalali is with the International Society for CNS Drug Development in San Diego, California
- Dr. Blier is with the Departments of Psychiatry and Cellular & Molecular Medicine at the University of Ottawa Institute of Mental Health Research in Ottawa, Ontario, Canada
- Dr. Engelhardt is with Intra-Cellular Therapies in New York, New York
- Dr. Foster is with Department of Psychiatry & Behavioural Neurosciences at McMaster University in Hamilton, Ontario, Canada
- Dr. Frey is with the Department of Psychiatry and Behavioural Neurosciences at McMaster University and Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare in Hamilton, Ontario, Canada
- Dr. Greist is with the Department of Psychiatry at the University of Wisconsin School of Medicine and Public Health in Madison, Wisconsin
- Dr. Kobak is with the Center for Telepsychology in Madison, Wisconsin
- Dr. Lam is with the Department of Psychiatry at the University of British Columbia in Vancouver, British Columbia, Canada
- Dr. MacQueen is with Mathison Centre for Mental Health Research and Education at the Department of Psychiatry, University of Calgary in Calgary, Alberta, Canada
- Dr. Milev is with the Department of Psychiatry and the Department of Psychology, and Centre for Neuroscience Studies at Queen's University in Kingston, Ontario, Canada
- Dr. Müller is with the Centre for Addiction and Mental Health and the Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada. Parikh is with the Department of Psychiatry at the University of Michigan in Ann Arbor, Michigan
- Dr. Placenza is with the Department of Psychiatry at the Krembil Research Centre, University Health Network, University of Toronto in Toronto, Ontario, Canada
- Dr. Rizvi is with Arthur Sommer Rotenberg Program for Suicide and Depression Studies at St. Michael's Hospital in Toronto, Ontario, Canada
- Dr. Rotzinger is with St. Michael's Hospital (Unity Health Toronto) and Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada
- Dr. Sheehan is with the University of South Florida College of Medicine in Tampa, Florida
- Dr. Sills was with OCBN in Toronto, Ontario, Canada
- Dr. Soares is with the Department of Psychiatry at Queen's University and Providence Care Hospital in Kingston, Ontario, Canada
- Dr. Turecki is with the Department of Psychiatry at McGill University in Montreal, Quebec, Canada
- Dr. Uher is with the Department of Psychiatry at Dalhousie University in Halifax, Nova Scotia, Canada
- Dr. Williams is with the Departments of Psychiatry and Neurology at Columbia University in New York, New York
- Dr. Kennedy is with the Department of Psychiatry at the University of Toronto and Centre for Depression and Suicide, St. Michael's Hospital in Toronto, Ontario, Canada
| | - Amir H Kalali
- Drs. Vaccarino, Evans and Gilbert Evans are with Indoc Research in Toronto, Ontario, Canada
- Dr Kalali is with the International Society for CNS Drug Development in San Diego, California
- Dr. Blier is with the Departments of Psychiatry and Cellular & Molecular Medicine at the University of Ottawa Institute of Mental Health Research in Ottawa, Ontario, Canada
- Dr. Engelhardt is with Intra-Cellular Therapies in New York, New York
- Dr. Foster is with Department of Psychiatry & Behavioural Neurosciences at McMaster University in Hamilton, Ontario, Canada
- Dr. Frey is with the Department of Psychiatry and Behavioural Neurosciences at McMaster University and Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare in Hamilton, Ontario, Canada
- Dr. Greist is with the Department of Psychiatry at the University of Wisconsin School of Medicine and Public Health in Madison, Wisconsin
- Dr. Kobak is with the Center for Telepsychology in Madison, Wisconsin
- Dr. Lam is with the Department of Psychiatry at the University of British Columbia in Vancouver, British Columbia, Canada
- Dr. MacQueen is with Mathison Centre for Mental Health Research and Education at the Department of Psychiatry, University of Calgary in Calgary, Alberta, Canada
- Dr. Milev is with the Department of Psychiatry and the Department of Psychology, and Centre for Neuroscience Studies at Queen's University in Kingston, Ontario, Canada
- Dr. Müller is with the Centre for Addiction and Mental Health and the Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada. Parikh is with the Department of Psychiatry at the University of Michigan in Ann Arbor, Michigan
- Dr. Placenza is with the Department of Psychiatry at the Krembil Research Centre, University Health Network, University of Toronto in Toronto, Ontario, Canada
- Dr. Rizvi is with Arthur Sommer Rotenberg Program for Suicide and Depression Studies at St. Michael's Hospital in Toronto, Ontario, Canada
- Dr. Rotzinger is with St. Michael's Hospital (Unity Health Toronto) and Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada
- Dr. Sheehan is with the University of South Florida College of Medicine in Tampa, Florida
- Dr. Sills was with OCBN in Toronto, Ontario, Canada
- Dr. Soares is with the Department of Psychiatry at Queen's University and Providence Care Hospital in Kingston, Ontario, Canada
- Dr. Turecki is with the Department of Psychiatry at McGill University in Montreal, Quebec, Canada
- Dr. Uher is with the Department of Psychiatry at Dalhousie University in Halifax, Nova Scotia, Canada
- Dr. Williams is with the Departments of Psychiatry and Neurology at Columbia University in New York, New York
- Dr. Kennedy is with the Department of Psychiatry at the University of Toronto and Centre for Depression and Suicide, St. Michael's Hospital in Toronto, Ontario, Canada
| | - Pierre Blier
- Drs. Vaccarino, Evans and Gilbert Evans are with Indoc Research in Toronto, Ontario, Canada
- Dr Kalali is with the International Society for CNS Drug Development in San Diego, California
- Dr. Blier is with the Departments of Psychiatry and Cellular & Molecular Medicine at the University of Ottawa Institute of Mental Health Research in Ottawa, Ontario, Canada
- Dr. Engelhardt is with Intra-Cellular Therapies in New York, New York
- Dr. Foster is with Department of Psychiatry & Behavioural Neurosciences at McMaster University in Hamilton, Ontario, Canada
- Dr. Frey is with the Department of Psychiatry and Behavioural Neurosciences at McMaster University and Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare in Hamilton, Ontario, Canada
- Dr. Greist is with the Department of Psychiatry at the University of Wisconsin School of Medicine and Public Health in Madison, Wisconsin
- Dr. Kobak is with the Center for Telepsychology in Madison, Wisconsin
- Dr. Lam is with the Department of Psychiatry at the University of British Columbia in Vancouver, British Columbia, Canada
- Dr. MacQueen is with Mathison Centre for Mental Health Research and Education at the Department of Psychiatry, University of Calgary in Calgary, Alberta, Canada
- Dr. Milev is with the Department of Psychiatry and the Department of Psychology, and Centre for Neuroscience Studies at Queen's University in Kingston, Ontario, Canada
- Dr. Müller is with the Centre for Addiction and Mental Health and the Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada. Parikh is with the Department of Psychiatry at the University of Michigan in Ann Arbor, Michigan
- Dr. Placenza is with the Department of Psychiatry at the Krembil Research Centre, University Health Network, University of Toronto in Toronto, Ontario, Canada
- Dr. Rizvi is with Arthur Sommer Rotenberg Program for Suicide and Depression Studies at St. Michael's Hospital in Toronto, Ontario, Canada
- Dr. Rotzinger is with St. Michael's Hospital (Unity Health Toronto) and Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada
- Dr. Sheehan is with the University of South Florida College of Medicine in Tampa, Florida
- Dr. Sills was with OCBN in Toronto, Ontario, Canada
- Dr. Soares is with the Department of Psychiatry at Queen's University and Providence Care Hospital in Kingston, Ontario, Canada
- Dr. Turecki is with the Department of Psychiatry at McGill University in Montreal, Quebec, Canada
- Dr. Uher is with the Department of Psychiatry at Dalhousie University in Halifax, Nova Scotia, Canada
- Dr. Williams is with the Departments of Psychiatry and Neurology at Columbia University in New York, New York
- Dr. Kennedy is with the Department of Psychiatry at the University of Toronto and Centre for Depression and Suicide, St. Michael's Hospital in Toronto, Ontario, Canada
| | - Susan Gilbert Evans
- Drs. Vaccarino, Evans and Gilbert Evans are with Indoc Research in Toronto, Ontario, Canada
- Dr Kalali is with the International Society for CNS Drug Development in San Diego, California
- Dr. Blier is with the Departments of Psychiatry and Cellular & Molecular Medicine at the University of Ottawa Institute of Mental Health Research in Ottawa, Ontario, Canada
- Dr. Engelhardt is with Intra-Cellular Therapies in New York, New York
- Dr. Foster is with Department of Psychiatry & Behavioural Neurosciences at McMaster University in Hamilton, Ontario, Canada
- Dr. Frey is with the Department of Psychiatry and Behavioural Neurosciences at McMaster University and Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare in Hamilton, Ontario, Canada
- Dr. Greist is with the Department of Psychiatry at the University of Wisconsin School of Medicine and Public Health in Madison, Wisconsin
- Dr. Kobak is with the Center for Telepsychology in Madison, Wisconsin
- Dr. Lam is with the Department of Psychiatry at the University of British Columbia in Vancouver, British Columbia, Canada
- Dr. MacQueen is with Mathison Centre for Mental Health Research and Education at the Department of Psychiatry, University of Calgary in Calgary, Alberta, Canada
- Dr. Milev is with the Department of Psychiatry and the Department of Psychology, and Centre for Neuroscience Studies at Queen's University in Kingston, Ontario, Canada
- Dr. Müller is with the Centre for Addiction and Mental Health and the Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada. Parikh is with the Department of Psychiatry at the University of Michigan in Ann Arbor, Michigan
- Dr. Placenza is with the Department of Psychiatry at the Krembil Research Centre, University Health Network, University of Toronto in Toronto, Ontario, Canada
- Dr. Rizvi is with Arthur Sommer Rotenberg Program for Suicide and Depression Studies at St. Michael's Hospital in Toronto, Ontario, Canada
- Dr. Rotzinger is with St. Michael's Hospital (Unity Health Toronto) and Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada
- Dr. Sheehan is with the University of South Florida College of Medicine in Tampa, Florida
- Dr. Sills was with OCBN in Toronto, Ontario, Canada
- Dr. Soares is with the Department of Psychiatry at Queen's University and Providence Care Hospital in Kingston, Ontario, Canada
- Dr. Turecki is with the Department of Psychiatry at McGill University in Montreal, Quebec, Canada
- Dr. Uher is with the Department of Psychiatry at Dalhousie University in Halifax, Nova Scotia, Canada
- Dr. Williams is with the Departments of Psychiatry and Neurology at Columbia University in New York, New York
- Dr. Kennedy is with the Department of Psychiatry at the University of Toronto and Centre for Depression and Suicide, St. Michael's Hospital in Toronto, Ontario, Canada
| | - Nina Engelhardt
- Drs. Vaccarino, Evans and Gilbert Evans are with Indoc Research in Toronto, Ontario, Canada
- Dr Kalali is with the International Society for CNS Drug Development in San Diego, California
- Dr. Blier is with the Departments of Psychiatry and Cellular & Molecular Medicine at the University of Ottawa Institute of Mental Health Research in Ottawa, Ontario, Canada
- Dr. Engelhardt is with Intra-Cellular Therapies in New York, New York
- Dr. Foster is with Department of Psychiatry & Behavioural Neurosciences at McMaster University in Hamilton, Ontario, Canada
- Dr. Frey is with the Department of Psychiatry and Behavioural Neurosciences at McMaster University and Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare in Hamilton, Ontario, Canada
- Dr. Greist is with the Department of Psychiatry at the University of Wisconsin School of Medicine and Public Health in Madison, Wisconsin
- Dr. Kobak is with the Center for Telepsychology in Madison, Wisconsin
- Dr. Lam is with the Department of Psychiatry at the University of British Columbia in Vancouver, British Columbia, Canada
- Dr. MacQueen is with Mathison Centre for Mental Health Research and Education at the Department of Psychiatry, University of Calgary in Calgary, Alberta, Canada
- Dr. Milev is with the Department of Psychiatry and the Department of Psychology, and Centre for Neuroscience Studies at Queen's University in Kingston, Ontario, Canada
- Dr. Müller is with the Centre for Addiction and Mental Health and the Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada. Parikh is with the Department of Psychiatry at the University of Michigan in Ann Arbor, Michigan
- Dr. Placenza is with the Department of Psychiatry at the Krembil Research Centre, University Health Network, University of Toronto in Toronto, Ontario, Canada
- Dr. Rizvi is with Arthur Sommer Rotenberg Program for Suicide and Depression Studies at St. Michael's Hospital in Toronto, Ontario, Canada
- Dr. Rotzinger is with St. Michael's Hospital (Unity Health Toronto) and Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada
- Dr. Sheehan is with the University of South Florida College of Medicine in Tampa, Florida
- Dr. Sills was with OCBN in Toronto, Ontario, Canada
- Dr. Soares is with the Department of Psychiatry at Queen's University and Providence Care Hospital in Kingston, Ontario, Canada
- Dr. Turecki is with the Department of Psychiatry at McGill University in Montreal, Quebec, Canada
- Dr. Uher is with the Department of Psychiatry at Dalhousie University in Halifax, Nova Scotia, Canada
- Dr. Williams is with the Departments of Psychiatry and Neurology at Columbia University in New York, New York
- Dr. Kennedy is with the Department of Psychiatry at the University of Toronto and Centre for Depression and Suicide, St. Michael's Hospital in Toronto, Ontario, Canada
| | - Jane A Foster
- Drs. Vaccarino, Evans and Gilbert Evans are with Indoc Research in Toronto, Ontario, Canada
- Dr Kalali is with the International Society for CNS Drug Development in San Diego, California
- Dr. Blier is with the Departments of Psychiatry and Cellular & Molecular Medicine at the University of Ottawa Institute of Mental Health Research in Ottawa, Ontario, Canada
- Dr. Engelhardt is with Intra-Cellular Therapies in New York, New York
- Dr. Foster is with Department of Psychiatry & Behavioural Neurosciences at McMaster University in Hamilton, Ontario, Canada
- Dr. Frey is with the Department of Psychiatry and Behavioural Neurosciences at McMaster University and Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare in Hamilton, Ontario, Canada
- Dr. Greist is with the Department of Psychiatry at the University of Wisconsin School of Medicine and Public Health in Madison, Wisconsin
- Dr. Kobak is with the Center for Telepsychology in Madison, Wisconsin
- Dr. Lam is with the Department of Psychiatry at the University of British Columbia in Vancouver, British Columbia, Canada
- Dr. MacQueen is with Mathison Centre for Mental Health Research and Education at the Department of Psychiatry, University of Calgary in Calgary, Alberta, Canada
- Dr. Milev is with the Department of Psychiatry and the Department of Psychology, and Centre for Neuroscience Studies at Queen's University in Kingston, Ontario, Canada
- Dr. Müller is with the Centre for Addiction and Mental Health and the Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada. Parikh is with the Department of Psychiatry at the University of Michigan in Ann Arbor, Michigan
- Dr. Placenza is with the Department of Psychiatry at the Krembil Research Centre, University Health Network, University of Toronto in Toronto, Ontario, Canada
- Dr. Rizvi is with Arthur Sommer Rotenberg Program for Suicide and Depression Studies at St. Michael's Hospital in Toronto, Ontario, Canada
- Dr. Rotzinger is with St. Michael's Hospital (Unity Health Toronto) and Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada
- Dr. Sheehan is with the University of South Florida College of Medicine in Tampa, Florida
- Dr. Sills was with OCBN in Toronto, Ontario, Canada
- Dr. Soares is with the Department of Psychiatry at Queen's University and Providence Care Hospital in Kingston, Ontario, Canada
- Dr. Turecki is with the Department of Psychiatry at McGill University in Montreal, Quebec, Canada
- Dr. Uher is with the Department of Psychiatry at Dalhousie University in Halifax, Nova Scotia, Canada
- Dr. Williams is with the Departments of Psychiatry and Neurology at Columbia University in New York, New York
- Dr. Kennedy is with the Department of Psychiatry at the University of Toronto and Centre for Depression and Suicide, St. Michael's Hospital in Toronto, Ontario, Canada
| | - Benicio N Frey
- Drs. Vaccarino, Evans and Gilbert Evans are with Indoc Research in Toronto, Ontario, Canada
- Dr Kalali is with the International Society for CNS Drug Development in San Diego, California
- Dr. Blier is with the Departments of Psychiatry and Cellular & Molecular Medicine at the University of Ottawa Institute of Mental Health Research in Ottawa, Ontario, Canada
- Dr. Engelhardt is with Intra-Cellular Therapies in New York, New York
- Dr. Foster is with Department of Psychiatry & Behavioural Neurosciences at McMaster University in Hamilton, Ontario, Canada
- Dr. Frey is with the Department of Psychiatry and Behavioural Neurosciences at McMaster University and Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare in Hamilton, Ontario, Canada
- Dr. Greist is with the Department of Psychiatry at the University of Wisconsin School of Medicine and Public Health in Madison, Wisconsin
- Dr. Kobak is with the Center for Telepsychology in Madison, Wisconsin
- Dr. Lam is with the Department of Psychiatry at the University of British Columbia in Vancouver, British Columbia, Canada
- Dr. MacQueen is with Mathison Centre for Mental Health Research and Education at the Department of Psychiatry, University of Calgary in Calgary, Alberta, Canada
- Dr. Milev is with the Department of Psychiatry and the Department of Psychology, and Centre for Neuroscience Studies at Queen's University in Kingston, Ontario, Canada
- Dr. Müller is with the Centre for Addiction and Mental Health and the Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada. Parikh is with the Department of Psychiatry at the University of Michigan in Ann Arbor, Michigan
- Dr. Placenza is with the Department of Psychiatry at the Krembil Research Centre, University Health Network, University of Toronto in Toronto, Ontario, Canada
- Dr. Rizvi is with Arthur Sommer Rotenberg Program for Suicide and Depression Studies at St. Michael's Hospital in Toronto, Ontario, Canada
- Dr. Rotzinger is with St. Michael's Hospital (Unity Health Toronto) and Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada
- Dr. Sheehan is with the University of South Florida College of Medicine in Tampa, Florida
- Dr. Sills was with OCBN in Toronto, Ontario, Canada
- Dr. Soares is with the Department of Psychiatry at Queen's University and Providence Care Hospital in Kingston, Ontario, Canada
- Dr. Turecki is with the Department of Psychiatry at McGill University in Montreal, Quebec, Canada
- Dr. Uher is with the Department of Psychiatry at Dalhousie University in Halifax, Nova Scotia, Canada
- Dr. Williams is with the Departments of Psychiatry and Neurology at Columbia University in New York, New York
- Dr. Kennedy is with the Department of Psychiatry at the University of Toronto and Centre for Depression and Suicide, St. Michael's Hospital in Toronto, Ontario, Canada
| | - John H Greist
- Drs. Vaccarino, Evans and Gilbert Evans are with Indoc Research in Toronto, Ontario, Canada
- Dr Kalali is with the International Society for CNS Drug Development in San Diego, California
- Dr. Blier is with the Departments of Psychiatry and Cellular & Molecular Medicine at the University of Ottawa Institute of Mental Health Research in Ottawa, Ontario, Canada
- Dr. Engelhardt is with Intra-Cellular Therapies in New York, New York
- Dr. Foster is with Department of Psychiatry & Behavioural Neurosciences at McMaster University in Hamilton, Ontario, Canada
- Dr. Frey is with the Department of Psychiatry and Behavioural Neurosciences at McMaster University and Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare in Hamilton, Ontario, Canada
- Dr. Greist is with the Department of Psychiatry at the University of Wisconsin School of Medicine and Public Health in Madison, Wisconsin
- Dr. Kobak is with the Center for Telepsychology in Madison, Wisconsin
- Dr. Lam is with the Department of Psychiatry at the University of British Columbia in Vancouver, British Columbia, Canada
- Dr. MacQueen is with Mathison Centre for Mental Health Research and Education at the Department of Psychiatry, University of Calgary in Calgary, Alberta, Canada
- Dr. Milev is with the Department of Psychiatry and the Department of Psychology, and Centre for Neuroscience Studies at Queen's University in Kingston, Ontario, Canada
- Dr. Müller is with the Centre for Addiction and Mental Health and the Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada. Parikh is with the Department of Psychiatry at the University of Michigan in Ann Arbor, Michigan
- Dr. Placenza is with the Department of Psychiatry at the Krembil Research Centre, University Health Network, University of Toronto in Toronto, Ontario, Canada
- Dr. Rizvi is with Arthur Sommer Rotenberg Program for Suicide and Depression Studies at St. Michael's Hospital in Toronto, Ontario, Canada
- Dr. Rotzinger is with St. Michael's Hospital (Unity Health Toronto) and Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada
- Dr. Sheehan is with the University of South Florida College of Medicine in Tampa, Florida
- Dr. Sills was with OCBN in Toronto, Ontario, Canada
- Dr. Soares is with the Department of Psychiatry at Queen's University and Providence Care Hospital in Kingston, Ontario, Canada
- Dr. Turecki is with the Department of Psychiatry at McGill University in Montreal, Quebec, Canada
- Dr. Uher is with the Department of Psychiatry at Dalhousie University in Halifax, Nova Scotia, Canada
- Dr. Williams is with the Departments of Psychiatry and Neurology at Columbia University in New York, New York
- Dr. Kennedy is with the Department of Psychiatry at the University of Toronto and Centre for Depression and Suicide, St. Michael's Hospital in Toronto, Ontario, Canada
| | - Kenneth A Kobak
- Drs. Vaccarino, Evans and Gilbert Evans are with Indoc Research in Toronto, Ontario, Canada
- Dr Kalali is with the International Society for CNS Drug Development in San Diego, California
- Dr. Blier is with the Departments of Psychiatry and Cellular & Molecular Medicine at the University of Ottawa Institute of Mental Health Research in Ottawa, Ontario, Canada
- Dr. Engelhardt is with Intra-Cellular Therapies in New York, New York
- Dr. Foster is with Department of Psychiatry & Behavioural Neurosciences at McMaster University in Hamilton, Ontario, Canada
- Dr. Frey is with the Department of Psychiatry and Behavioural Neurosciences at McMaster University and Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare in Hamilton, Ontario, Canada
- Dr. Greist is with the Department of Psychiatry at the University of Wisconsin School of Medicine and Public Health in Madison, Wisconsin
- Dr. Kobak is with the Center for Telepsychology in Madison, Wisconsin
- Dr. Lam is with the Department of Psychiatry at the University of British Columbia in Vancouver, British Columbia, Canada
- Dr. MacQueen is with Mathison Centre for Mental Health Research and Education at the Department of Psychiatry, University of Calgary in Calgary, Alberta, Canada
- Dr. Milev is with the Department of Psychiatry and the Department of Psychology, and Centre for Neuroscience Studies at Queen's University in Kingston, Ontario, Canada
- Dr. Müller is with the Centre for Addiction and Mental Health and the Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada. Parikh is with the Department of Psychiatry at the University of Michigan in Ann Arbor, Michigan
- Dr. Placenza is with the Department of Psychiatry at the Krembil Research Centre, University Health Network, University of Toronto in Toronto, Ontario, Canada
- Dr. Rizvi is with Arthur Sommer Rotenberg Program for Suicide and Depression Studies at St. Michael's Hospital in Toronto, Ontario, Canada
- Dr. Rotzinger is with St. Michael's Hospital (Unity Health Toronto) and Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada
- Dr. Sheehan is with the University of South Florida College of Medicine in Tampa, Florida
- Dr. Sills was with OCBN in Toronto, Ontario, Canada
- Dr. Soares is with the Department of Psychiatry at Queen's University and Providence Care Hospital in Kingston, Ontario, Canada
- Dr. Turecki is with the Department of Psychiatry at McGill University in Montreal, Quebec, Canada
- Dr. Uher is with the Department of Psychiatry at Dalhousie University in Halifax, Nova Scotia, Canada
- Dr. Williams is with the Departments of Psychiatry and Neurology at Columbia University in New York, New York
- Dr. Kennedy is with the Department of Psychiatry at the University of Toronto and Centre for Depression and Suicide, St. Michael's Hospital in Toronto, Ontario, Canada
| | - Raymond W Lam
- Drs. Vaccarino, Evans and Gilbert Evans are with Indoc Research in Toronto, Ontario, Canada
- Dr Kalali is with the International Society for CNS Drug Development in San Diego, California
- Dr. Blier is with the Departments of Psychiatry and Cellular & Molecular Medicine at the University of Ottawa Institute of Mental Health Research in Ottawa, Ontario, Canada
- Dr. Engelhardt is with Intra-Cellular Therapies in New York, New York
- Dr. Foster is with Department of Psychiatry & Behavioural Neurosciences at McMaster University in Hamilton, Ontario, Canada
- Dr. Frey is with the Department of Psychiatry and Behavioural Neurosciences at McMaster University and Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare in Hamilton, Ontario, Canada
- Dr. Greist is with the Department of Psychiatry at the University of Wisconsin School of Medicine and Public Health in Madison, Wisconsin
- Dr. Kobak is with the Center for Telepsychology in Madison, Wisconsin
- Dr. Lam is with the Department of Psychiatry at the University of British Columbia in Vancouver, British Columbia, Canada
- Dr. MacQueen is with Mathison Centre for Mental Health Research and Education at the Department of Psychiatry, University of Calgary in Calgary, Alberta, Canada
- Dr. Milev is with the Department of Psychiatry and the Department of Psychology, and Centre for Neuroscience Studies at Queen's University in Kingston, Ontario, Canada
- Dr. Müller is with the Centre for Addiction and Mental Health and the Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada. Parikh is with the Department of Psychiatry at the University of Michigan in Ann Arbor, Michigan
- Dr. Placenza is with the Department of Psychiatry at the Krembil Research Centre, University Health Network, University of Toronto in Toronto, Ontario, Canada
- Dr. Rizvi is with Arthur Sommer Rotenberg Program for Suicide and Depression Studies at St. Michael's Hospital in Toronto, Ontario, Canada
- Dr. Rotzinger is with St. Michael's Hospital (Unity Health Toronto) and Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada
- Dr. Sheehan is with the University of South Florida College of Medicine in Tampa, Florida
- Dr. Sills was with OCBN in Toronto, Ontario, Canada
- Dr. Soares is with the Department of Psychiatry at Queen's University and Providence Care Hospital in Kingston, Ontario, Canada
- Dr. Turecki is with the Department of Psychiatry at McGill University in Montreal, Quebec, Canada
- Dr. Uher is with the Department of Psychiatry at Dalhousie University in Halifax, Nova Scotia, Canada
- Dr. Williams is with the Departments of Psychiatry and Neurology at Columbia University in New York, New York
- Dr. Kennedy is with the Department of Psychiatry at the University of Toronto and Centre for Depression and Suicide, St. Michael's Hospital in Toronto, Ontario, Canada
| | - Glenda MacQueen
- Drs. Vaccarino, Evans and Gilbert Evans are with Indoc Research in Toronto, Ontario, Canada
- Dr Kalali is with the International Society for CNS Drug Development in San Diego, California
- Dr. Blier is with the Departments of Psychiatry and Cellular & Molecular Medicine at the University of Ottawa Institute of Mental Health Research in Ottawa, Ontario, Canada
- Dr. Engelhardt is with Intra-Cellular Therapies in New York, New York
- Dr. Foster is with Department of Psychiatry & Behavioural Neurosciences at McMaster University in Hamilton, Ontario, Canada
- Dr. Frey is with the Department of Psychiatry and Behavioural Neurosciences at McMaster University and Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare in Hamilton, Ontario, Canada
- Dr. Greist is with the Department of Psychiatry at the University of Wisconsin School of Medicine and Public Health in Madison, Wisconsin
- Dr. Kobak is with the Center for Telepsychology in Madison, Wisconsin
- Dr. Lam is with the Department of Psychiatry at the University of British Columbia in Vancouver, British Columbia, Canada
- Dr. MacQueen is with Mathison Centre for Mental Health Research and Education at the Department of Psychiatry, University of Calgary in Calgary, Alberta, Canada
- Dr. Milev is with the Department of Psychiatry and the Department of Psychology, and Centre for Neuroscience Studies at Queen's University in Kingston, Ontario, Canada
- Dr. Müller is with the Centre for Addiction and Mental Health and the Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada. Parikh is with the Department of Psychiatry at the University of Michigan in Ann Arbor, Michigan
- Dr. Placenza is with the Department of Psychiatry at the Krembil Research Centre, University Health Network, University of Toronto in Toronto, Ontario, Canada
- Dr. Rizvi is with Arthur Sommer Rotenberg Program for Suicide and Depression Studies at St. Michael's Hospital in Toronto, Ontario, Canada
- Dr. Rotzinger is with St. Michael's Hospital (Unity Health Toronto) and Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada
- Dr. Sheehan is with the University of South Florida College of Medicine in Tampa, Florida
- Dr. Sills was with OCBN in Toronto, Ontario, Canada
- Dr. Soares is with the Department of Psychiatry at Queen's University and Providence Care Hospital in Kingston, Ontario, Canada
- Dr. Turecki is with the Department of Psychiatry at McGill University in Montreal, Quebec, Canada
- Dr. Uher is with the Department of Psychiatry at Dalhousie University in Halifax, Nova Scotia, Canada
- Dr. Williams is with the Departments of Psychiatry and Neurology at Columbia University in New York, New York
- Dr. Kennedy is with the Department of Psychiatry at the University of Toronto and Centre for Depression and Suicide, St. Michael's Hospital in Toronto, Ontario, Canada
| | - Roumen Milev
- Drs. Vaccarino, Evans and Gilbert Evans are with Indoc Research in Toronto, Ontario, Canada
- Dr Kalali is with the International Society for CNS Drug Development in San Diego, California
- Dr. Blier is with the Departments of Psychiatry and Cellular & Molecular Medicine at the University of Ottawa Institute of Mental Health Research in Ottawa, Ontario, Canada
- Dr. Engelhardt is with Intra-Cellular Therapies in New York, New York
- Dr. Foster is with Department of Psychiatry & Behavioural Neurosciences at McMaster University in Hamilton, Ontario, Canada
- Dr. Frey is with the Department of Psychiatry and Behavioural Neurosciences at McMaster University and Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare in Hamilton, Ontario, Canada
- Dr. Greist is with the Department of Psychiatry at the University of Wisconsin School of Medicine and Public Health in Madison, Wisconsin
- Dr. Kobak is with the Center for Telepsychology in Madison, Wisconsin
- Dr. Lam is with the Department of Psychiatry at the University of British Columbia in Vancouver, British Columbia, Canada
- Dr. MacQueen is with Mathison Centre for Mental Health Research and Education at the Department of Psychiatry, University of Calgary in Calgary, Alberta, Canada
- Dr. Milev is with the Department of Psychiatry and the Department of Psychology, and Centre for Neuroscience Studies at Queen's University in Kingston, Ontario, Canada
- Dr. Müller is with the Centre for Addiction and Mental Health and the Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada. Parikh is with the Department of Psychiatry at the University of Michigan in Ann Arbor, Michigan
- Dr. Placenza is with the Department of Psychiatry at the Krembil Research Centre, University Health Network, University of Toronto in Toronto, Ontario, Canada
- Dr. Rizvi is with Arthur Sommer Rotenberg Program for Suicide and Depression Studies at St. Michael's Hospital in Toronto, Ontario, Canada
- Dr. Rotzinger is with St. Michael's Hospital (Unity Health Toronto) and Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada
- Dr. Sheehan is with the University of South Florida College of Medicine in Tampa, Florida
- Dr. Sills was with OCBN in Toronto, Ontario, Canada
- Dr. Soares is with the Department of Psychiatry at Queen's University and Providence Care Hospital in Kingston, Ontario, Canada
- Dr. Turecki is with the Department of Psychiatry at McGill University in Montreal, Quebec, Canada
- Dr. Uher is with the Department of Psychiatry at Dalhousie University in Halifax, Nova Scotia, Canada
- Dr. Williams is with the Departments of Psychiatry and Neurology at Columbia University in New York, New York
- Dr. Kennedy is with the Department of Psychiatry at the University of Toronto and Centre for Depression and Suicide, St. Michael's Hospital in Toronto, Ontario, Canada
| | - Daniel J Müller
- Drs. Vaccarino, Evans and Gilbert Evans are with Indoc Research in Toronto, Ontario, Canada
- Dr Kalali is with the International Society for CNS Drug Development in San Diego, California
- Dr. Blier is with the Departments of Psychiatry and Cellular & Molecular Medicine at the University of Ottawa Institute of Mental Health Research in Ottawa, Ontario, Canada
- Dr. Engelhardt is with Intra-Cellular Therapies in New York, New York
- Dr. Foster is with Department of Psychiatry & Behavioural Neurosciences at McMaster University in Hamilton, Ontario, Canada
- Dr. Frey is with the Department of Psychiatry and Behavioural Neurosciences at McMaster University and Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare in Hamilton, Ontario, Canada
- Dr. Greist is with the Department of Psychiatry at the University of Wisconsin School of Medicine and Public Health in Madison, Wisconsin
- Dr. Kobak is with the Center for Telepsychology in Madison, Wisconsin
- Dr. Lam is with the Department of Psychiatry at the University of British Columbia in Vancouver, British Columbia, Canada
- Dr. MacQueen is with Mathison Centre for Mental Health Research and Education at the Department of Psychiatry, University of Calgary in Calgary, Alberta, Canada
- Dr. Milev is with the Department of Psychiatry and the Department of Psychology, and Centre for Neuroscience Studies at Queen's University in Kingston, Ontario, Canada
- Dr. Müller is with the Centre for Addiction and Mental Health and the Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada. Parikh is with the Department of Psychiatry at the University of Michigan in Ann Arbor, Michigan
- Dr. Placenza is with the Department of Psychiatry at the Krembil Research Centre, University Health Network, University of Toronto in Toronto, Ontario, Canada
- Dr. Rizvi is with Arthur Sommer Rotenberg Program for Suicide and Depression Studies at St. Michael's Hospital in Toronto, Ontario, Canada
- Dr. Rotzinger is with St. Michael's Hospital (Unity Health Toronto) and Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada
- Dr. Sheehan is with the University of South Florida College of Medicine in Tampa, Florida
- Dr. Sills was with OCBN in Toronto, Ontario, Canada
- Dr. Soares is with the Department of Psychiatry at Queen's University and Providence Care Hospital in Kingston, Ontario, Canada
- Dr. Turecki is with the Department of Psychiatry at McGill University in Montreal, Quebec, Canada
- Dr. Uher is with the Department of Psychiatry at Dalhousie University in Halifax, Nova Scotia, Canada
- Dr. Williams is with the Departments of Psychiatry and Neurology at Columbia University in New York, New York
- Dr. Kennedy is with the Department of Psychiatry at the University of Toronto and Centre for Depression and Suicide, St. Michael's Hospital in Toronto, Ontario, Canada
| | - Sagar V Parikh
- Drs. Vaccarino, Evans and Gilbert Evans are with Indoc Research in Toronto, Ontario, Canada
- Dr Kalali is with the International Society for CNS Drug Development in San Diego, California
- Dr. Blier is with the Departments of Psychiatry and Cellular & Molecular Medicine at the University of Ottawa Institute of Mental Health Research in Ottawa, Ontario, Canada
- Dr. Engelhardt is with Intra-Cellular Therapies in New York, New York
- Dr. Foster is with Department of Psychiatry & Behavioural Neurosciences at McMaster University in Hamilton, Ontario, Canada
- Dr. Frey is with the Department of Psychiatry and Behavioural Neurosciences at McMaster University and Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare in Hamilton, Ontario, Canada
- Dr. Greist is with the Department of Psychiatry at the University of Wisconsin School of Medicine and Public Health in Madison, Wisconsin
- Dr. Kobak is with the Center for Telepsychology in Madison, Wisconsin
- Dr. Lam is with the Department of Psychiatry at the University of British Columbia in Vancouver, British Columbia, Canada
- Dr. MacQueen is with Mathison Centre for Mental Health Research and Education at the Department of Psychiatry, University of Calgary in Calgary, Alberta, Canada
- Dr. Milev is with the Department of Psychiatry and the Department of Psychology, and Centre for Neuroscience Studies at Queen's University in Kingston, Ontario, Canada
- Dr. Müller is with the Centre for Addiction and Mental Health and the Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada. Parikh is with the Department of Psychiatry at the University of Michigan in Ann Arbor, Michigan
- Dr. Placenza is with the Department of Psychiatry at the Krembil Research Centre, University Health Network, University of Toronto in Toronto, Ontario, Canada
- Dr. Rizvi is with Arthur Sommer Rotenberg Program for Suicide and Depression Studies at St. Michael's Hospital in Toronto, Ontario, Canada
- Dr. Rotzinger is with St. Michael's Hospital (Unity Health Toronto) and Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada
- Dr. Sheehan is with the University of South Florida College of Medicine in Tampa, Florida
- Dr. Sills was with OCBN in Toronto, Ontario, Canada
- Dr. Soares is with the Department of Psychiatry at Queen's University and Providence Care Hospital in Kingston, Ontario, Canada
- Dr. Turecki is with the Department of Psychiatry at McGill University in Montreal, Quebec, Canada
- Dr. Uher is with the Department of Psychiatry at Dalhousie University in Halifax, Nova Scotia, Canada
- Dr. Williams is with the Departments of Psychiatry and Neurology at Columbia University in New York, New York
- Dr. Kennedy is with the Department of Psychiatry at the University of Toronto and Centre for Depression and Suicide, St. Michael's Hospital in Toronto, Ontario, Canada
| | - Franca M Placenza
- Drs. Vaccarino, Evans and Gilbert Evans are with Indoc Research in Toronto, Ontario, Canada
- Dr Kalali is with the International Society for CNS Drug Development in San Diego, California
- Dr. Blier is with the Departments of Psychiatry and Cellular & Molecular Medicine at the University of Ottawa Institute of Mental Health Research in Ottawa, Ontario, Canada
- Dr. Engelhardt is with Intra-Cellular Therapies in New York, New York
- Dr. Foster is with Department of Psychiatry & Behavioural Neurosciences at McMaster University in Hamilton, Ontario, Canada
- Dr. Frey is with the Department of Psychiatry and Behavioural Neurosciences at McMaster University and Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare in Hamilton, Ontario, Canada
- Dr. Greist is with the Department of Psychiatry at the University of Wisconsin School of Medicine and Public Health in Madison, Wisconsin
- Dr. Kobak is with the Center for Telepsychology in Madison, Wisconsin
- Dr. Lam is with the Department of Psychiatry at the University of British Columbia in Vancouver, British Columbia, Canada
- Dr. MacQueen is with Mathison Centre for Mental Health Research and Education at the Department of Psychiatry, University of Calgary in Calgary, Alberta, Canada
- Dr. Milev is with the Department of Psychiatry and the Department of Psychology, and Centre for Neuroscience Studies at Queen's University in Kingston, Ontario, Canada
- Dr. Müller is with the Centre for Addiction and Mental Health and the Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada. Parikh is with the Department of Psychiatry at the University of Michigan in Ann Arbor, Michigan
- Dr. Placenza is with the Department of Psychiatry at the Krembil Research Centre, University Health Network, University of Toronto in Toronto, Ontario, Canada
- Dr. Rizvi is with Arthur Sommer Rotenberg Program for Suicide and Depression Studies at St. Michael's Hospital in Toronto, Ontario, Canada
- Dr. Rotzinger is with St. Michael's Hospital (Unity Health Toronto) and Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada
- Dr. Sheehan is with the University of South Florida College of Medicine in Tampa, Florida
- Dr. Sills was with OCBN in Toronto, Ontario, Canada
- Dr. Soares is with the Department of Psychiatry at Queen's University and Providence Care Hospital in Kingston, Ontario, Canada
- Dr. Turecki is with the Department of Psychiatry at McGill University in Montreal, Quebec, Canada
- Dr. Uher is with the Department of Psychiatry at Dalhousie University in Halifax, Nova Scotia, Canada
- Dr. Williams is with the Departments of Psychiatry and Neurology at Columbia University in New York, New York
- Dr. Kennedy is with the Department of Psychiatry at the University of Toronto and Centre for Depression and Suicide, St. Michael's Hospital in Toronto, Ontario, Canada
| | - Sakina J Rizvi
- Drs. Vaccarino, Evans and Gilbert Evans are with Indoc Research in Toronto, Ontario, Canada
- Dr Kalali is with the International Society for CNS Drug Development in San Diego, California
- Dr. Blier is with the Departments of Psychiatry and Cellular & Molecular Medicine at the University of Ottawa Institute of Mental Health Research in Ottawa, Ontario, Canada
- Dr. Engelhardt is with Intra-Cellular Therapies in New York, New York
- Dr. Foster is with Department of Psychiatry & Behavioural Neurosciences at McMaster University in Hamilton, Ontario, Canada
- Dr. Frey is with the Department of Psychiatry and Behavioural Neurosciences at McMaster University and Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare in Hamilton, Ontario, Canada
- Dr. Greist is with the Department of Psychiatry at the University of Wisconsin School of Medicine and Public Health in Madison, Wisconsin
- Dr. Kobak is with the Center for Telepsychology in Madison, Wisconsin
- Dr. Lam is with the Department of Psychiatry at the University of British Columbia in Vancouver, British Columbia, Canada
- Dr. MacQueen is with Mathison Centre for Mental Health Research and Education at the Department of Psychiatry, University of Calgary in Calgary, Alberta, Canada
- Dr. Milev is with the Department of Psychiatry and the Department of Psychology, and Centre for Neuroscience Studies at Queen's University in Kingston, Ontario, Canada
- Dr. Müller is with the Centre for Addiction and Mental Health and the Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada. Parikh is with the Department of Psychiatry at the University of Michigan in Ann Arbor, Michigan
- Dr. Placenza is with the Department of Psychiatry at the Krembil Research Centre, University Health Network, University of Toronto in Toronto, Ontario, Canada
- Dr. Rizvi is with Arthur Sommer Rotenberg Program for Suicide and Depression Studies at St. Michael's Hospital in Toronto, Ontario, Canada
- Dr. Rotzinger is with St. Michael's Hospital (Unity Health Toronto) and Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada
- Dr. Sheehan is with the University of South Florida College of Medicine in Tampa, Florida
- Dr. Sills was with OCBN in Toronto, Ontario, Canada
- Dr. Soares is with the Department of Psychiatry at Queen's University and Providence Care Hospital in Kingston, Ontario, Canada
- Dr. Turecki is with the Department of Psychiatry at McGill University in Montreal, Quebec, Canada
- Dr. Uher is with the Department of Psychiatry at Dalhousie University in Halifax, Nova Scotia, Canada
- Dr. Williams is with the Departments of Psychiatry and Neurology at Columbia University in New York, New York
- Dr. Kennedy is with the Department of Psychiatry at the University of Toronto and Centre for Depression and Suicide, St. Michael's Hospital in Toronto, Ontario, Canada
| | - Susan Rotzinger
- Drs. Vaccarino, Evans and Gilbert Evans are with Indoc Research in Toronto, Ontario, Canada
- Dr Kalali is with the International Society for CNS Drug Development in San Diego, California
- Dr. Blier is with the Departments of Psychiatry and Cellular & Molecular Medicine at the University of Ottawa Institute of Mental Health Research in Ottawa, Ontario, Canada
- Dr. Engelhardt is with Intra-Cellular Therapies in New York, New York
- Dr. Foster is with Department of Psychiatry & Behavioural Neurosciences at McMaster University in Hamilton, Ontario, Canada
- Dr. Frey is with the Department of Psychiatry and Behavioural Neurosciences at McMaster University and Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare in Hamilton, Ontario, Canada
- Dr. Greist is with the Department of Psychiatry at the University of Wisconsin School of Medicine and Public Health in Madison, Wisconsin
- Dr. Kobak is with the Center for Telepsychology in Madison, Wisconsin
- Dr. Lam is with the Department of Psychiatry at the University of British Columbia in Vancouver, British Columbia, Canada
- Dr. MacQueen is with Mathison Centre for Mental Health Research and Education at the Department of Psychiatry, University of Calgary in Calgary, Alberta, Canada
- Dr. Milev is with the Department of Psychiatry and the Department of Psychology, and Centre for Neuroscience Studies at Queen's University in Kingston, Ontario, Canada
- Dr. Müller is with the Centre for Addiction and Mental Health and the Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada. Parikh is with the Department of Psychiatry at the University of Michigan in Ann Arbor, Michigan
- Dr. Placenza is with the Department of Psychiatry at the Krembil Research Centre, University Health Network, University of Toronto in Toronto, Ontario, Canada
- Dr. Rizvi is with Arthur Sommer Rotenberg Program for Suicide and Depression Studies at St. Michael's Hospital in Toronto, Ontario, Canada
- Dr. Rotzinger is with St. Michael's Hospital (Unity Health Toronto) and Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada
- Dr. Sheehan is with the University of South Florida College of Medicine in Tampa, Florida
- Dr. Sills was with OCBN in Toronto, Ontario, Canada
- Dr. Soares is with the Department of Psychiatry at Queen's University and Providence Care Hospital in Kingston, Ontario, Canada
- Dr. Turecki is with the Department of Psychiatry at McGill University in Montreal, Quebec, Canada
- Dr. Uher is with the Department of Psychiatry at Dalhousie University in Halifax, Nova Scotia, Canada
- Dr. Williams is with the Departments of Psychiatry and Neurology at Columbia University in New York, New York
- Dr. Kennedy is with the Department of Psychiatry at the University of Toronto and Centre for Depression and Suicide, St. Michael's Hospital in Toronto, Ontario, Canada
| | - David V Sheehan
- Drs. Vaccarino, Evans and Gilbert Evans are with Indoc Research in Toronto, Ontario, Canada
- Dr Kalali is with the International Society for CNS Drug Development in San Diego, California
- Dr. Blier is with the Departments of Psychiatry and Cellular & Molecular Medicine at the University of Ottawa Institute of Mental Health Research in Ottawa, Ontario, Canada
- Dr. Engelhardt is with Intra-Cellular Therapies in New York, New York
- Dr. Foster is with Department of Psychiatry & Behavioural Neurosciences at McMaster University in Hamilton, Ontario, Canada
- Dr. Frey is with the Department of Psychiatry and Behavioural Neurosciences at McMaster University and Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare in Hamilton, Ontario, Canada
- Dr. Greist is with the Department of Psychiatry at the University of Wisconsin School of Medicine and Public Health in Madison, Wisconsin
- Dr. Kobak is with the Center for Telepsychology in Madison, Wisconsin
- Dr. Lam is with the Department of Psychiatry at the University of British Columbia in Vancouver, British Columbia, Canada
- Dr. MacQueen is with Mathison Centre for Mental Health Research and Education at the Department of Psychiatry, University of Calgary in Calgary, Alberta, Canada
- Dr. Milev is with the Department of Psychiatry and the Department of Psychology, and Centre for Neuroscience Studies at Queen's University in Kingston, Ontario, Canada
- Dr. Müller is with the Centre for Addiction and Mental Health and the Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada. Parikh is with the Department of Psychiatry at the University of Michigan in Ann Arbor, Michigan
- Dr. Placenza is with the Department of Psychiatry at the Krembil Research Centre, University Health Network, University of Toronto in Toronto, Ontario, Canada
- Dr. Rizvi is with Arthur Sommer Rotenberg Program for Suicide and Depression Studies at St. Michael's Hospital in Toronto, Ontario, Canada
- Dr. Rotzinger is with St. Michael's Hospital (Unity Health Toronto) and Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada
- Dr. Sheehan is with the University of South Florida College of Medicine in Tampa, Florida
- Dr. Sills was with OCBN in Toronto, Ontario, Canada
- Dr. Soares is with the Department of Psychiatry at Queen's University and Providence Care Hospital in Kingston, Ontario, Canada
- Dr. Turecki is with the Department of Psychiatry at McGill University in Montreal, Quebec, Canada
- Dr. Uher is with the Department of Psychiatry at Dalhousie University in Halifax, Nova Scotia, Canada
- Dr. Williams is with the Departments of Psychiatry and Neurology at Columbia University in New York, New York
- Dr. Kennedy is with the Department of Psychiatry at the University of Toronto and Centre for Depression and Suicide, St. Michael's Hospital in Toronto, Ontario, Canada
| | - Terrence Sills
- Drs. Vaccarino, Evans and Gilbert Evans are with Indoc Research in Toronto, Ontario, Canada
- Dr Kalali is with the International Society for CNS Drug Development in San Diego, California
- Dr. Blier is with the Departments of Psychiatry and Cellular & Molecular Medicine at the University of Ottawa Institute of Mental Health Research in Ottawa, Ontario, Canada
- Dr. Engelhardt is with Intra-Cellular Therapies in New York, New York
- Dr. Foster is with Department of Psychiatry & Behavioural Neurosciences at McMaster University in Hamilton, Ontario, Canada
- Dr. Frey is with the Department of Psychiatry and Behavioural Neurosciences at McMaster University and Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare in Hamilton, Ontario, Canada
- Dr. Greist is with the Department of Psychiatry at the University of Wisconsin School of Medicine and Public Health in Madison, Wisconsin
- Dr. Kobak is with the Center for Telepsychology in Madison, Wisconsin
- Dr. Lam is with the Department of Psychiatry at the University of British Columbia in Vancouver, British Columbia, Canada
- Dr. MacQueen is with Mathison Centre for Mental Health Research and Education at the Department of Psychiatry, University of Calgary in Calgary, Alberta, Canada
- Dr. Milev is with the Department of Psychiatry and the Department of Psychology, and Centre for Neuroscience Studies at Queen's University in Kingston, Ontario, Canada
- Dr. Müller is with the Centre for Addiction and Mental Health and the Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada. Parikh is with the Department of Psychiatry at the University of Michigan in Ann Arbor, Michigan
- Dr. Placenza is with the Department of Psychiatry at the Krembil Research Centre, University Health Network, University of Toronto in Toronto, Ontario, Canada
- Dr. Rizvi is with Arthur Sommer Rotenberg Program for Suicide and Depression Studies at St. Michael's Hospital in Toronto, Ontario, Canada
- Dr. Rotzinger is with St. Michael's Hospital (Unity Health Toronto) and Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada
- Dr. Sheehan is with the University of South Florida College of Medicine in Tampa, Florida
- Dr. Sills was with OCBN in Toronto, Ontario, Canada
- Dr. Soares is with the Department of Psychiatry at Queen's University and Providence Care Hospital in Kingston, Ontario, Canada
- Dr. Turecki is with the Department of Psychiatry at McGill University in Montreal, Quebec, Canada
- Dr. Uher is with the Department of Psychiatry at Dalhousie University in Halifax, Nova Scotia, Canada
- Dr. Williams is with the Departments of Psychiatry and Neurology at Columbia University in New York, New York
- Dr. Kennedy is with the Department of Psychiatry at the University of Toronto and Centre for Depression and Suicide, St. Michael's Hospital in Toronto, Ontario, Canada
| | - Claudio N Soares
- Drs. Vaccarino, Evans and Gilbert Evans are with Indoc Research in Toronto, Ontario, Canada
- Dr Kalali is with the International Society for CNS Drug Development in San Diego, California
- Dr. Blier is with the Departments of Psychiatry and Cellular & Molecular Medicine at the University of Ottawa Institute of Mental Health Research in Ottawa, Ontario, Canada
- Dr. Engelhardt is with Intra-Cellular Therapies in New York, New York
- Dr. Foster is with Department of Psychiatry & Behavioural Neurosciences at McMaster University in Hamilton, Ontario, Canada
- Dr. Frey is with the Department of Psychiatry and Behavioural Neurosciences at McMaster University and Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare in Hamilton, Ontario, Canada
- Dr. Greist is with the Department of Psychiatry at the University of Wisconsin School of Medicine and Public Health in Madison, Wisconsin
- Dr. Kobak is with the Center for Telepsychology in Madison, Wisconsin
- Dr. Lam is with the Department of Psychiatry at the University of British Columbia in Vancouver, British Columbia, Canada
- Dr. MacQueen is with Mathison Centre for Mental Health Research and Education at the Department of Psychiatry, University of Calgary in Calgary, Alberta, Canada
- Dr. Milev is with the Department of Psychiatry and the Department of Psychology, and Centre for Neuroscience Studies at Queen's University in Kingston, Ontario, Canada
- Dr. Müller is with the Centre for Addiction and Mental Health and the Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada. Parikh is with the Department of Psychiatry at the University of Michigan in Ann Arbor, Michigan
- Dr. Placenza is with the Department of Psychiatry at the Krembil Research Centre, University Health Network, University of Toronto in Toronto, Ontario, Canada
- Dr. Rizvi is with Arthur Sommer Rotenberg Program for Suicide and Depression Studies at St. Michael's Hospital in Toronto, Ontario, Canada
- Dr. Rotzinger is with St. Michael's Hospital (Unity Health Toronto) and Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada
- Dr. Sheehan is with the University of South Florida College of Medicine in Tampa, Florida
- Dr. Sills was with OCBN in Toronto, Ontario, Canada
- Dr. Soares is with the Department of Psychiatry at Queen's University and Providence Care Hospital in Kingston, Ontario, Canada
- Dr. Turecki is with the Department of Psychiatry at McGill University in Montreal, Quebec, Canada
- Dr. Uher is with the Department of Psychiatry at Dalhousie University in Halifax, Nova Scotia, Canada
- Dr. Williams is with the Departments of Psychiatry and Neurology at Columbia University in New York, New York
- Dr. Kennedy is with the Department of Psychiatry at the University of Toronto and Centre for Depression and Suicide, St. Michael's Hospital in Toronto, Ontario, Canada
| | - Gustavo Turecki
- Drs. Vaccarino, Evans and Gilbert Evans are with Indoc Research in Toronto, Ontario, Canada
- Dr Kalali is with the International Society for CNS Drug Development in San Diego, California
- Dr. Blier is with the Departments of Psychiatry and Cellular & Molecular Medicine at the University of Ottawa Institute of Mental Health Research in Ottawa, Ontario, Canada
- Dr. Engelhardt is with Intra-Cellular Therapies in New York, New York
- Dr. Foster is with Department of Psychiatry & Behavioural Neurosciences at McMaster University in Hamilton, Ontario, Canada
- Dr. Frey is with the Department of Psychiatry and Behavioural Neurosciences at McMaster University and Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare in Hamilton, Ontario, Canada
- Dr. Greist is with the Department of Psychiatry at the University of Wisconsin School of Medicine and Public Health in Madison, Wisconsin
- Dr. Kobak is with the Center for Telepsychology in Madison, Wisconsin
- Dr. Lam is with the Department of Psychiatry at the University of British Columbia in Vancouver, British Columbia, Canada
- Dr. MacQueen is with Mathison Centre for Mental Health Research and Education at the Department of Psychiatry, University of Calgary in Calgary, Alberta, Canada
- Dr. Milev is with the Department of Psychiatry and the Department of Psychology, and Centre for Neuroscience Studies at Queen's University in Kingston, Ontario, Canada
- Dr. Müller is with the Centre for Addiction and Mental Health and the Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada. Parikh is with the Department of Psychiatry at the University of Michigan in Ann Arbor, Michigan
- Dr. Placenza is with the Department of Psychiatry at the Krembil Research Centre, University Health Network, University of Toronto in Toronto, Ontario, Canada
- Dr. Rizvi is with Arthur Sommer Rotenberg Program for Suicide and Depression Studies at St. Michael's Hospital in Toronto, Ontario, Canada
- Dr. Rotzinger is with St. Michael's Hospital (Unity Health Toronto) and Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada
- Dr. Sheehan is with the University of South Florida College of Medicine in Tampa, Florida
- Dr. Sills was with OCBN in Toronto, Ontario, Canada
- Dr. Soares is with the Department of Psychiatry at Queen's University and Providence Care Hospital in Kingston, Ontario, Canada
- Dr. Turecki is with the Department of Psychiatry at McGill University in Montreal, Quebec, Canada
- Dr. Uher is with the Department of Psychiatry at Dalhousie University in Halifax, Nova Scotia, Canada
- Dr. Williams is with the Departments of Psychiatry and Neurology at Columbia University in New York, New York
- Dr. Kennedy is with the Department of Psychiatry at the University of Toronto and Centre for Depression and Suicide, St. Michael's Hospital in Toronto, Ontario, Canada
| | - Rudolph Uher
- Drs. Vaccarino, Evans and Gilbert Evans are with Indoc Research in Toronto, Ontario, Canada
- Dr Kalali is with the International Society for CNS Drug Development in San Diego, California
- Dr. Blier is with the Departments of Psychiatry and Cellular & Molecular Medicine at the University of Ottawa Institute of Mental Health Research in Ottawa, Ontario, Canada
- Dr. Engelhardt is with Intra-Cellular Therapies in New York, New York
- Dr. Foster is with Department of Psychiatry & Behavioural Neurosciences at McMaster University in Hamilton, Ontario, Canada
- Dr. Frey is with the Department of Psychiatry and Behavioural Neurosciences at McMaster University and Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare in Hamilton, Ontario, Canada
- Dr. Greist is with the Department of Psychiatry at the University of Wisconsin School of Medicine and Public Health in Madison, Wisconsin
- Dr. Kobak is with the Center for Telepsychology in Madison, Wisconsin
- Dr. Lam is with the Department of Psychiatry at the University of British Columbia in Vancouver, British Columbia, Canada
- Dr. MacQueen is with Mathison Centre for Mental Health Research and Education at the Department of Psychiatry, University of Calgary in Calgary, Alberta, Canada
- Dr. Milev is with the Department of Psychiatry and the Department of Psychology, and Centre for Neuroscience Studies at Queen's University in Kingston, Ontario, Canada
- Dr. Müller is with the Centre for Addiction and Mental Health and the Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada. Parikh is with the Department of Psychiatry at the University of Michigan in Ann Arbor, Michigan
- Dr. Placenza is with the Department of Psychiatry at the Krembil Research Centre, University Health Network, University of Toronto in Toronto, Ontario, Canada
- Dr. Rizvi is with Arthur Sommer Rotenberg Program for Suicide and Depression Studies at St. Michael's Hospital in Toronto, Ontario, Canada
- Dr. Rotzinger is with St. Michael's Hospital (Unity Health Toronto) and Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada
- Dr. Sheehan is with the University of South Florida College of Medicine in Tampa, Florida
- Dr. Sills was with OCBN in Toronto, Ontario, Canada
- Dr. Soares is with the Department of Psychiatry at Queen's University and Providence Care Hospital in Kingston, Ontario, Canada
- Dr. Turecki is with the Department of Psychiatry at McGill University in Montreal, Quebec, Canada
- Dr. Uher is with the Department of Psychiatry at Dalhousie University in Halifax, Nova Scotia, Canada
- Dr. Williams is with the Departments of Psychiatry and Neurology at Columbia University in New York, New York
- Dr. Kennedy is with the Department of Psychiatry at the University of Toronto and Centre for Depression and Suicide, St. Michael's Hospital in Toronto, Ontario, Canada
| | - Janet B W Williams
- Drs. Vaccarino, Evans and Gilbert Evans are with Indoc Research in Toronto, Ontario, Canada
- Dr Kalali is with the International Society for CNS Drug Development in San Diego, California
- Dr. Blier is with the Departments of Psychiatry and Cellular & Molecular Medicine at the University of Ottawa Institute of Mental Health Research in Ottawa, Ontario, Canada
- Dr. Engelhardt is with Intra-Cellular Therapies in New York, New York
- Dr. Foster is with Department of Psychiatry & Behavioural Neurosciences at McMaster University in Hamilton, Ontario, Canada
- Dr. Frey is with the Department of Psychiatry and Behavioural Neurosciences at McMaster University and Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare in Hamilton, Ontario, Canada
- Dr. Greist is with the Department of Psychiatry at the University of Wisconsin School of Medicine and Public Health in Madison, Wisconsin
- Dr. Kobak is with the Center for Telepsychology in Madison, Wisconsin
- Dr. Lam is with the Department of Psychiatry at the University of British Columbia in Vancouver, British Columbia, Canada
- Dr. MacQueen is with Mathison Centre for Mental Health Research and Education at the Department of Psychiatry, University of Calgary in Calgary, Alberta, Canada
- Dr. Milev is with the Department of Psychiatry and the Department of Psychology, and Centre for Neuroscience Studies at Queen's University in Kingston, Ontario, Canada
- Dr. Müller is with the Centre for Addiction and Mental Health and the Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada. Parikh is with the Department of Psychiatry at the University of Michigan in Ann Arbor, Michigan
- Dr. Placenza is with the Department of Psychiatry at the Krembil Research Centre, University Health Network, University of Toronto in Toronto, Ontario, Canada
- Dr. Rizvi is with Arthur Sommer Rotenberg Program for Suicide and Depression Studies at St. Michael's Hospital in Toronto, Ontario, Canada
- Dr. Rotzinger is with St. Michael's Hospital (Unity Health Toronto) and Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada
- Dr. Sheehan is with the University of South Florida College of Medicine in Tampa, Florida
- Dr. Sills was with OCBN in Toronto, Ontario, Canada
- Dr. Soares is with the Department of Psychiatry at Queen's University and Providence Care Hospital in Kingston, Ontario, Canada
- Dr. Turecki is with the Department of Psychiatry at McGill University in Montreal, Quebec, Canada
- Dr. Uher is with the Department of Psychiatry at Dalhousie University in Halifax, Nova Scotia, Canada
- Dr. Williams is with the Departments of Psychiatry and Neurology at Columbia University in New York, New York
- Dr. Kennedy is with the Department of Psychiatry at the University of Toronto and Centre for Depression and Suicide, St. Michael's Hospital in Toronto, Ontario, Canada
| | - Sidney H Kennedy
- Drs. Vaccarino, Evans and Gilbert Evans are with Indoc Research in Toronto, Ontario, Canada
- Dr Kalali is with the International Society for CNS Drug Development in San Diego, California
- Dr. Blier is with the Departments of Psychiatry and Cellular & Molecular Medicine at the University of Ottawa Institute of Mental Health Research in Ottawa, Ontario, Canada
- Dr. Engelhardt is with Intra-Cellular Therapies in New York, New York
- Dr. Foster is with Department of Psychiatry & Behavioural Neurosciences at McMaster University in Hamilton, Ontario, Canada
- Dr. Frey is with the Department of Psychiatry and Behavioural Neurosciences at McMaster University and Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare in Hamilton, Ontario, Canada
- Dr. Greist is with the Department of Psychiatry at the University of Wisconsin School of Medicine and Public Health in Madison, Wisconsin
- Dr. Kobak is with the Center for Telepsychology in Madison, Wisconsin
- Dr. Lam is with the Department of Psychiatry at the University of British Columbia in Vancouver, British Columbia, Canada
- Dr. MacQueen is with Mathison Centre for Mental Health Research and Education at the Department of Psychiatry, University of Calgary in Calgary, Alberta, Canada
- Dr. Milev is with the Department of Psychiatry and the Department of Psychology, and Centre for Neuroscience Studies at Queen's University in Kingston, Ontario, Canada
- Dr. Müller is with the Centre for Addiction and Mental Health and the Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada. Parikh is with the Department of Psychiatry at the University of Michigan in Ann Arbor, Michigan
- Dr. Placenza is with the Department of Psychiatry at the Krembil Research Centre, University Health Network, University of Toronto in Toronto, Ontario, Canada
- Dr. Rizvi is with Arthur Sommer Rotenberg Program for Suicide and Depression Studies at St. Michael's Hospital in Toronto, Ontario, Canada
- Dr. Rotzinger is with St. Michael's Hospital (Unity Health Toronto) and Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada
- Dr. Sheehan is with the University of South Florida College of Medicine in Tampa, Florida
- Dr. Sills was with OCBN in Toronto, Ontario, Canada
- Dr. Soares is with the Department of Psychiatry at Queen's University and Providence Care Hospital in Kingston, Ontario, Canada
- Dr. Turecki is with the Department of Psychiatry at McGill University in Montreal, Quebec, Canada
- Dr. Uher is with the Department of Psychiatry at Dalhousie University in Halifax, Nova Scotia, Canada
- Dr. Williams is with the Departments of Psychiatry and Neurology at Columbia University in New York, New York
- Dr. Kennedy is with the Department of Psychiatry at the University of Toronto and Centre for Depression and Suicide, St. Michael's Hospital in Toronto, Ontario, Canada
| | - Kenneth R Evans
- Drs. Vaccarino, Evans and Gilbert Evans are with Indoc Research in Toronto, Ontario, Canada
- Dr Kalali is with the International Society for CNS Drug Development in San Diego, California
- Dr. Blier is with the Departments of Psychiatry and Cellular & Molecular Medicine at the University of Ottawa Institute of Mental Health Research in Ottawa, Ontario, Canada
- Dr. Engelhardt is with Intra-Cellular Therapies in New York, New York
- Dr. Foster is with Department of Psychiatry & Behavioural Neurosciences at McMaster University in Hamilton, Ontario, Canada
- Dr. Frey is with the Department of Psychiatry and Behavioural Neurosciences at McMaster University and Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare in Hamilton, Ontario, Canada
- Dr. Greist is with the Department of Psychiatry at the University of Wisconsin School of Medicine and Public Health in Madison, Wisconsin
- Dr. Kobak is with the Center for Telepsychology in Madison, Wisconsin
- Dr. Lam is with the Department of Psychiatry at the University of British Columbia in Vancouver, British Columbia, Canada
- Dr. MacQueen is with Mathison Centre for Mental Health Research and Education at the Department of Psychiatry, University of Calgary in Calgary, Alberta, Canada
- Dr. Milev is with the Department of Psychiatry and the Department of Psychology, and Centre for Neuroscience Studies at Queen's University in Kingston, Ontario, Canada
- Dr. Müller is with the Centre for Addiction and Mental Health and the Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada. Parikh is with the Department of Psychiatry at the University of Michigan in Ann Arbor, Michigan
- Dr. Placenza is with the Department of Psychiatry at the Krembil Research Centre, University Health Network, University of Toronto in Toronto, Ontario, Canada
- Dr. Rizvi is with Arthur Sommer Rotenberg Program for Suicide and Depression Studies at St. Michael's Hospital in Toronto, Ontario, Canada
- Dr. Rotzinger is with St. Michael's Hospital (Unity Health Toronto) and Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada
- Dr. Sheehan is with the University of South Florida College of Medicine in Tampa, Florida
- Dr. Sills was with OCBN in Toronto, Ontario, Canada
- Dr. Soares is with the Department of Psychiatry at Queen's University and Providence Care Hospital in Kingston, Ontario, Canada
- Dr. Turecki is with the Department of Psychiatry at McGill University in Montreal, Quebec, Canada
- Dr. Uher is with the Department of Psychiatry at Dalhousie University in Halifax, Nova Scotia, Canada
- Dr. Williams is with the Departments of Psychiatry and Neurology at Columbia University in New York, New York
- Dr. Kennedy is with the Department of Psychiatry at the University of Toronto and Centre for Depression and Suicide, St. Michael's Hospital in Toronto, Ontario, Canada
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46
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Uher R, Frey BN, Quilty LC, Rotzinger S, Blier P, Foster JA, Müller DJ, Ravindran AV, Soares CN, Turecki G, Parikh SV, Milev R, MacQueen G, Lam RW, Kennedy SH. Symptom Dimension of Interest-Activity Indicates Need for Aripiprazole Augmentation of Escitalopram in Major Depressive Disorder: A CAN-BIND-1 Report. J Clin Psychiatry 2020; 81. [PMID: 32558407 DOI: 10.4088/jcp.20m13229] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Accepted: 04/27/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Differential predictors of response to alternative treatment options are needed to improve the outcomes in major depressive disorder. The symptom dimension comprising loss of interest and reduced activity has been reported as a predictor of poor outcome of treatment with antidepressants. We hypothesized that augmentation with partial dopamine agonist aripiprazole will be effective for individuals with pronounced interest-activity symptoms. METHODS We tested the hypothesis in the 2-phase Canadian Biomarker Integration Network in Depression trial 1 (CAN-BIND-1). All participants had a primary diagnosis of major depressive disorder confirmed with the Mini-International Neuropsychiatric Interview. In phase 1, 188 individuals received escitalopram monotherapy 10-20 mg daily for 8 weeks. In phase 2, nonresponders received augmentation with aripiprazole 2-10 mg daily while responders continued escitalopram monotherapy for another 8 weeks. Outcomes were measured with the Montgomery-Åsberg Depression Rating Scale (MADRS) every 2 weeks. Effects of baseline interest-activity symptoms on outcomes were tested in repeated-measures mixed-effects models. RESULTS Higher baseline interest-activity score (indicative of more severe loss of interest and reduction in activity) predicted worse outcome of escitalopram monotherapy in phase 1 (b = 1.75; 95% CI, 0.45 to 3.05; P = .009), but the association disappeared with the augmentation option in phase 2 (b = -0.19; 95% CI, -1.30 to 0.92; P = .739). A significant interaction between the baseline interest-activity score and aripiprazole reflected the opposite direction of the relationship between baseline interest-activity score and degree of improvement with escitalopram monotherapy versus aripiprazole augmentation (b = -1.60; 95% CI, -2.35 to -0.84; P < .001). CONCLUSIONS Individuals with prominent loss of interest and reduction in activity benefit less from escitalopram monotherapy and more from aripiprazole augmentation. Future trials may test the benefits of early prodopaminergic augmentation guided by interest-activity symptoms. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01655706.
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Affiliation(s)
- Rudolf Uher
- Dalhousie University, 5909 Veterans Memorial Lane, Halifax, NS, B3H 2E2, NS, Canada. .,Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada.,Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Benicio N Frey
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada.,St Joseph's Healthcare, Hamilton, Ontario, Canada
| | - Lena C Quilty
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Susan Rotzinger
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Pierre Blier
- Royal's Institute of Mental Health Research, University of Ottawa, Ottawa, Ontario, Canada
| | - Jane A Foster
- Department of Psychiatry & Behavioural Neurosciences, St Joseph's Healthcare, Hamilton, Ontario, Canada
| | - Daniel J Müller
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Arun V Ravindran
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Claudio N Soares
- Departments of Psychiatry and Psychology, Queen's University, Providence Care Hospital, Kingston, Ontario, Canada
| | - Gustavo Turecki
- Douglas Institute, Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Sagar V Parikh
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Roumen Milev
- Departments of Psychiatry and Psychology, Queen's University, Providence Care Hospital, Kingston, Ontario, Canada
| | - Glenda MacQueen
- University of Calgary, Hotchkiss Brain Institute, Calgary, Alberta, Canada
| | - Raymond W Lam
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sidney H Kennedy
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, University Health Network, Toronto, Ontario, Canada.,Krembil Research Centre, University Health Network, University of Toronto, Canada
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- Members of the CAN-BIND Investigator Team are listed at www.canbind.ca/about-can-bind/our-team/
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47
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Hassel S, Sharma GB, Alders GL, Davis AD, Arnott SR, Frey BN, Hall GB, Harris JK, Lam RW, Milev R, Müller DJ, Rotzinger S, Zamyadi M, Kennedy SH, Strother SC, MacQueen GM. Reliability of a functional magnetic resonance imaging task of emotional conflict in healthy participants. Hum Brain Mapp 2020; 41:1400-1415. [PMID: 31794150 PMCID: PMC7267954 DOI: 10.1002/hbm.24883] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 06/05/2019] [Revised: 11/10/2019] [Accepted: 11/16/2019] [Indexed: 12/02/2022] Open
Abstract
Task-based functional neuroimaging methods are increasingly being used to identify biomarkers of treatment response in psychiatric disorders. To facilitate meaningful interpretation of neural correlates of tasks and their potential changes with treatment over time, understanding the reliability of the blood-oxygen-level dependent (BOLD) signal of such tasks is essential. We assessed test-retest reliability of an emotional conflict task in healthy participants collected as part of the Canadian Biomarker Integration Network in Depression. Data for 36 participants, scanned at three time points (weeks 0, 2, and 8) were analyzed, and intra-class correlation coefficients (ICC) were used to quantify reliability. We observed moderate reliability (median ICC values between 0.5 and 0.6), within occipital, parietal, and temporal regions, specifically for conditions of lower cognitive complexity, that is, face, congruent or incongruent trials. For these conditions, activation was also observed within frontal and sub-cortical regions, however, their reliability was poor (median ICC < 0.2). Clinically relevant prognostic markers based on task-based fMRI require high predictive accuracy at an individual level. For this to be achieved, reliability of BOLD responses needs to be high. We have shown that reliability of the BOLD response to an emotional conflict task in healthy individuals is moderate. Implications of these findings to further inform studies of treatment effects and biomarker discovery are discussed.
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Affiliation(s)
- Stefanie Hassel
- Department of Psychiatry, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
- Mathison Centre for Mental Health Research and EducationUniversity of CalgaryCalgaryAlbertaCanada
| | - Gulshan B. Sharma
- Department of Psychiatry, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - Gésine L. Alders
- Graduate Program in NeuroscienceMcMaster University, and St. Joseph's Healthcare HamiltonHamiltonOntarioCanada
| | - Andrew D. Davis
- Department of Psychiatry and Behavioural NeurosciencesMcMaster UniversityHamiltonOntarioCanada
| | | | - Benicio N. Frey
- Department of Psychiatry and Behavioural NeurosciencesMcMaster UniversityHamiltonOntarioCanada
- Mood Disorders Program and Women's Health Concerns ClinicSt. Joseph's HealthcareHamiltonOntarioCanada
| | - Geoffrey B. Hall
- Department of Psychology, Neuroscience and BehaviourMcMaster UniversityHamiltonOntarioCanada
| | | | - Raymond W. Lam
- Department of PsychiatryUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Roumen Milev
- Department of PsychiatryQueen's University and Providence Care HospitalKingstonOntarioCanada
- Department of PsychologyQueen's UniversityKingstonOntarioCanada
| | - Daniel J. Müller
- Department of PsychiatryCentre for Addiction and Mental Health, Campbell Family Mental Health Research Institute, Pharmacogenetic Research Clinic, University of TorontoTorontoOntarioCanada
| | - Susan Rotzinger
- Department of Psychiatry, Faculty of MedicineUniversity of TorontoTorontoOntarioCanada
- Department of Psychiatry, Krembil Research CentreUniversity Health Network, University of TorontoTorontoOntarioCanada
- Department of Psychiatry, St. Michael's HospitalUniversity of TorontoTorontoOntarioCanada
| | | | - Sidney H. Kennedy
- Department of Psychiatry, Faculty of MedicineUniversity of TorontoTorontoOntarioCanada
- Department of Psychiatry, Krembil Research CentreUniversity Health Network, University of TorontoTorontoOntarioCanada
- Department of Psychiatry, St. Michael's HospitalUniversity of TorontoTorontoOntarioCanada
- Keenan Research Centre for Biomedical ScienceLi Ka Shing Knowledge Institute, St. Michael's HospitalTorontoOntarioCanada
| | - Stephen C. Strother
- Rotman Research InstituteTorontoOntarioCanada
- Department of Medical Biophysics, Faculty of MedicineUniversity of TorontoTorontoOntarioCanada
| | - Glenda M. MacQueen
- Department of Psychiatry, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
- Mathison Centre for Mental Health Research and EducationUniversity of CalgaryCalgaryAlbertaCanada
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48
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Belzeaux R, Gorgievski V, Fiori LM, Lopez JP, Grenier J, Lin R, Nagy C, Ibrahim EC, Gascon E, Courtet P, Richard-Devantoy S, Berlim M, Chachamovich E, Théroux JF, Dumas S, Giros B, Rotzinger S, Soares CN, Foster JA, Mechawar N, Tall GG, Tzavara ET, Kennedy SH, Turecki G. GPR56/ADGRG1 is associated with response to antidepressant treatment. Nat Commun 2020; 11:1635. [PMID: 32242018 PMCID: PMC7118175 DOI: 10.1038/s41467-020-15423-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 03/10/2020] [Indexed: 02/07/2023] Open
Abstract
It remains unclear why many patients with depression do not respond to antidepressant treatment. In three cohorts of individuals with depression and treated with serotonin-norepinephrine reuptake inhibitor (N = 424) we show that responders, but not non-responders, display an increase of GPR56 mRNA in the blood. In a small group of subjects we also show that GPR56 is downregulated in the PFC of individuals with depression that died by suicide. In mice, we show that chronic stress-induced Gpr56 downregulation in the blood and prefrontal cortex (PFC), which is accompanied by depression-like behavior, and can be reversed by antidepressant treatment. Gpr56 knockdown in mouse PFC is associated with depressive-like behaviors, executive dysfunction and poor response to antidepressant treatment. GPR56 peptide agonists have antidepressant-like effects and upregulated AKT/GSK3/EIF4 pathways. Our findings uncover a potential role of GPR56 in antidepressant response.
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Affiliation(s)
- Raoul Belzeaux
- Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, QC, Canada.,Aix-Marseille Univ, AP-HM, CNRS, INT, Inst Neurosci Timone, Hôpital Sainte Marguerite, Pôle de psychiatrie, Marseille, France.,Fondation FondaMental, Créteil, France
| | - Victor Gorgievski
- CNRS (Integrative Neuroscience and Cognition Center, UMR 8002), Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Laura M Fiori
- Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Juan Pablo Lopez
- Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Julien Grenier
- INSERM UMR-S 1124 ERL 3649, Université Paris Descartes, Paris, France
| | - Rixing Lin
- Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Corina Nagy
- Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - El Chérif Ibrahim
- Aix-Marseille Univ, AP-HM, CNRS, INT, Inst Neurosci Timone, Hôpital Sainte Marguerite, Pôle de psychiatrie, Marseille, France.,Fondation FondaMental, Créteil, France
| | - Eduardo Gascon
- Aix-Marseille Univ, AP-HM, CNRS, INT, Inst Neurosci Timone, Hôpital Sainte Marguerite, Pôle de psychiatrie, Marseille, France
| | - Philippe Courtet
- Fondation FondaMental, Créteil, France.,Department of Emergency Psychiatry and Acute Care, Lapeyronie Hospital, CHU Montpellier, Montpellier, France
| | - Stéphane Richard-Devantoy
- Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Marcelo Berlim
- Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Eduardo Chachamovich
- Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Jean-François Théroux
- Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, QC, Canada
| | | | - Bruno Giros
- Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Susan Rotzinger
- Centre for Mental Health, Department of Psychiatry, University Health Network, Krembil Research Institute, University of Toronto, Toronto, ON, Canada
| | - Claudio N Soares
- St Michael's Hospital, Li Ka Shing Knowledge Institute, Centre for Depression and Suicide Studies, Toronto, ON, Canada.,Department of Psychiatry, Queen's University, Kingston, Ontario, Canada
| | - Jane A Foster
- Centre for Mental Health, Department of Psychiatry, University Health Network, Krembil Research Institute, University of Toronto, Toronto, ON, Canada
| | - Naguib Mechawar
- Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Gregory G Tall
- Department of Pharmacology, University of Michigan, Ann Arbor, MI, USA
| | - Eleni T Tzavara
- Fondation FondaMental, Créteil, France.,CNRS (Integrative Neuroscience and Cognition Center, UMR 8002), Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Sidney H Kennedy
- Centre for Mental Health, Department of Psychiatry, University Health Network, Krembil Research Institute, University of Toronto, Toronto, ON, Canada.,St Michael's Hospital, Li Ka Shing Knowledge Institute, Centre for Depression and Suicide Studies, Toronto, ON, Canada
| | - Gustavo Turecki
- Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, QC, Canada.
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49
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Zhdanov A, Atluri S, Wong W, Vaghei Y, Daskalakis ZJ, Blumberger DM, Frey BN, Giacobbe P, Lam RW, Milev R, Mueller DJ, Turecki G, Parikh SV, Rotzinger S, Soares CN, Brenner CA, Vila-Rodriguez F, McAndrews MP, Kleffner K, Alonso-Prieto E, Arnott SR, Foster JA, Strother SC, Uher R, Kennedy SH, Farzan F. Use of Machine Learning for Predicting Escitalopram Treatment Outcome From Electroencephalography Recordings in Adult Patients With Depression. JAMA Netw Open 2020; 3:e1918377. [PMID: 31899530 PMCID: PMC6991244 DOI: 10.1001/jamanetworkopen.2019.18377] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
IMPORTANCE Social and economic costs of depression are exacerbated by prolonged periods spent identifying treatments that would be effective for a particular patient. Thus, a tool that reliably predicts an individual patient's response to treatment could significantly reduce the burden of depression. OBJECTIVE To estimate how accurately an outcome of escitalopram treatment can be predicted from electroencephalographic (EEG) data on patients with depression. DESIGN, SETTING, AND PARTICIPANTS This prognostic study used a support vector machine classifier to predict treatment outcome using data from the first Canadian Biomarker Integration Network in Depression (CAN-BIND-1) study. The CAN-BIND-1 study comprised 180 patients (aged 18-60 years) diagnosed with major depressive disorder who had completed 8 weeks of treatment. Of this group, 122 patients had EEG data recorded before the treatment; 115 also had EEG data recorded after the first 2 weeks of treatment. INTERVENTIONS All participants completed 8 weeks of open-label escitalopram (10-20 mg) treatment. MAIN OUTCOMES AND MEASURES The ability of EEG data to predict treatment outcome, measured as accuracy, specificity, and sensitivity of the classifier at baseline and after the first 2 weeks of treatment. The treatment outcome was defined in terms of change in symptom severity, measured by the Montgomery-Åsberg Depression Rating Scale, before and after 8 weeks of treatment. A patient was designated as a responder if the Montgomery-Åsberg Depression Rating Scale score decreased by at least 50% during the 8 weeks and as a nonresponder if the score decrease was less than 50%. RESULTS Of the 122 participants who completed a baseline EEG recording (mean [SD] age, 36.3 [12.7] years; 76 [62.3%] female), the classifier was able to identify responders with an estimated accuracy of 79.2% (sensitivity, 67.3%; specificity, 91.0%) when using only the baseline EEG data. For a subset of 115 participants who had additional EEG data recorded after the first 2 weeks of treatment, use of these data increased the accuracy to 82.4% (sensitivity, 79.2%; specificity, 85.5%). CONCLUSIONS AND RELEVANCE These findings demonstrate the potential utility of EEG as a treatment planning tool for escitalopram therapy. Further development of the classification tools presented in this study holds the promise of expediting the search for optimal treatment for each patient.
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Affiliation(s)
- Andrey Zhdanov
- School of Mechatronic Systems Engineering, Simon Fraser University, Surrey, British Columbia, Canada
- Centre for Engineering-Led Brain Research, Simon Fraser University, Surrey, British Columbia, Canada
| | - Sravya Atluri
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Institute of Biomaterial and Biomedical Engineering, Toronto, Ontario, Canada
| | - Willy Wong
- The Edward S. Rogers Sr Department of Electrical & Computer Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Yasaman Vaghei
- School of Mechatronic Systems Engineering, Simon Fraser University, Surrey, British Columbia, Canada
- Centre for Engineering-Led Brain Research, Simon Fraser University, Surrey, British Columbia, Canada
| | - Zafiris J. Daskalakis
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Daniel M. Blumberger
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Benicio N. Frey
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
- Mood Disorders Program and Women’s Health Concerns Clinic, St Joseph’s Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Peter Giacobbe
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Raymond W. Lam
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Roumen Milev
- Departments of Psychiatry and Psychology, Queen’s University, Providence Care Hospital, Kingston, Ontario, Canada
| | - Daniel J. Mueller
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Gustavo Turecki
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | | | - Susan Rotzinger
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, University Health Network, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
| | - Claudio N. Soares
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
- Department of Psychiatry, Queen’s University, Kingston, Ontario, Canada
| | | | - Fidel Vila-Rodriguez
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mary Pat McAndrews
- Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Killian Kleffner
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Esther Alonso-Prieto
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Stephen R. Arnott
- Rotman Research Institute, Baycrest Centre, Toronto, Ontario, Canada
| | - Jane A. Foster
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
- St Michael’s Hospital, Toronto, Ontario, Canada
| | - Stephen C. Strother
- Rotman Research Institute, Baycrest Centre, Toronto, Ontario, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
| | - Rudolf Uher
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
- Institute of Psychiatry, Psychology & Neuroscience, Social, Genetic and Developmental Psychiatry Centre, King’s College London, London, United Kingdom
| | - Sidney H. Kennedy
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, University Health Network, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
- Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
- St Michael’s Hospital, Toronto, Ontario, Canada
| | - Faranak Farzan
- School of Mechatronic Systems Engineering, Simon Fraser University, Surrey, British Columbia, Canada
- Centre for Engineering-Led Brain Research, Simon Fraser University, Surrey, British Columbia, Canada
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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50
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Nogovitsyn N, Muller M, Souza R, Hassel S, Arnott SR, Davis AD, Hall GB, Harris JK, Zamyadi M, Metzak PD, Ismail Z, Downar J, Parikh SV, Soares CN, Addington JM, Milev R, Harkness KL, Frey BN, Lam RW, Strother SC, Rotzinger S, Kennedy SH, MacQueen GM. Hippocampal tail volume as a predictive biomarker of antidepressant treatment outcomes in patients with major depressive disorder: a CAN-BIND report. Neuropsychopharmacology 2020; 45:283-291. [PMID: 31610545 PMCID: PMC6901577 DOI: 10.1038/s41386-019-0542-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 09/06/2019] [Accepted: 10/03/2019] [Indexed: 01/01/2023]
Abstract
Finding a clinically useful neuroimaging biomarker that can predict treatment response in patients with major depressive disorder (MDD) is challenging, in part because of poor reproducibility and generalizability of findings across studies. Previous work has suggested that posterior hippocampal volumes in depressed patients may be associated with antidepressant treatment outcomes. The primary purpose of this investigation was to examine further whether posterior hippocampal volumes predict remission following antidepressant treatment. Magnetic resonance imaging (MRI) scans from 196 patients with MDD and 110 healthy participants were obtained as part of the first study in the Canadian Biomarker Integration Network in Depression program (CAN-BIND 1) in which patients were treated for 16 weeks with open-label medication. Hippocampal volumes were measured using both a manual segmentation protocol and FreeSurfer 6.0. Baseline hippocampal tail (Ht) volumes were significantly smaller in patients with depression compared to healthy participants. Larger baseline Ht volumes were positively associated with remission status at weeks 8 and 16. Participants who achieved early sustained remission had significantly greater Ht volumes compared to those who did not achieve remission by week 16. Ht volume is a prognostic biomarker for antidepressant treatment outcomes in patients with MDD.
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Affiliation(s)
- Nikita Nogovitsyn
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada. .,Mathison Centre for Mental Health Research and Education, University of Calgary, Calgary, AB, Canada. .,Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.
| | - Meghan Muller
- 0000 0004 1936 7697grid.22072.35Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB Canada
| | - Roberto Souza
- 0000 0004 1936 7697grid.22072.35Department of Radiology and Clinical Neuroscience, Hotchkiss Brain Institute, University of Calgary, Calgary, AB Canada
| | - Stefanie Hassel
- 0000 0004 1936 7697grid.22072.35Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB Canada ,0000 0004 1936 7697grid.22072.35Mathison Centre for Mental Health Research and Education, University of Calgary, Calgary, AB Canada
| | - Stephen R. Arnott
- 0000 0001 2157 2938grid.17063.33Rotman Research Institute, Baycrest, Toronto, ON Canada
| | - Andrew D. Davis
- 0000 0004 1936 8227grid.25073.33Department of Psychology, Neuroscience & Behaviour, McMaster University, and St. Joseph’s Healthcare Hamilton, Hamilton, ON Canada
| | - Geoffrey B. Hall
- 0000 0004 1936 8227grid.25073.33Department of Psychology, Neuroscience & Behaviour, McMaster University, and St. Joseph’s Healthcare Hamilton, Hamilton, ON Canada
| | - Jacqueline K. Harris
- grid.17089.37Department of Computer Science, University of Alberta, Edmonton, AB Canada
| | - Mojdeh Zamyadi
- 0000 0001 2157 2938grid.17063.33Rotman Research Institute, Baycrest, Toronto, ON Canada
| | - Paul D. Metzak
- 0000 0004 1936 7697grid.22072.35Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB Canada ,0000 0004 1936 7697grid.22072.35Mathison Centre for Mental Health Research and Education, University of Calgary, Calgary, AB Canada
| | - Zahinoor Ismail
- 0000 0004 1936 7697grid.22072.35Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB Canada
| | - Jonathan Downar
- 0000 0001 2157 2938grid.17063.33Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON Canada ,0000 0004 0474 0428grid.231844.8Krembil Research Institute and Centre for Mental Health, University Health Network, Toronto, ON Canada ,0000 0001 2157 2938grid.17063.33Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON Canada ,0000 0001 2157 2938grid.17063.33Department of Psychiatry, Krembil Research Centre, University Health Network, University of Toronto, Toronto, ON Canada
| | - Sagar V. Parikh
- 0000000086837370grid.214458.eDepartment of Psychiatry, University of Michigan, Ann Arbor, MI USA
| | - Claudio N. Soares
- 0000 0004 1936 8331grid.410356.5Department of Psychiatry, Queen’s University and Providence Care Hospital, Kingston, ON Canada
| | - Jean M. Addington
- 0000 0004 1936 7697grid.22072.35Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB Canada ,0000 0004 1936 7697grid.22072.35Mathison Centre for Mental Health Research and Education, University of Calgary, Calgary, AB Canada
| | - Roumen Milev
- 0000 0004 1936 8331grid.410356.5Department of Psychiatry, Queen’s University and Providence Care Hospital, Kingston, ON Canada ,0000 0004 1936 8331grid.410356.5Department of Psychology, Queen’s University, Kingston, ON Canada
| | - Kate L. Harkness
- 0000 0004 1936 8331grid.410356.5Department of Psychology, Queen’s University, Kingston, ON Canada
| | - Benicio N. Frey
- 0000 0004 1936 8227grid.25073.33Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON Canada ,Mood Disorders Program and Women’s Health Concerns Clinic, St. Joseph’s Healthcare, Hamilton, ON Canada
| | - Raymond W. Lam
- 0000 0001 2288 9830grid.17091.3eDepartment of Psychiatry, University of British Columbia, Vancouver, BC Canada
| | - Stephen C. Strother
- 0000 0001 2157 2938grid.17063.33Rotman Research Institute, Baycrest and Department of Medical Biophysics, University of Toronto, Toronto, ON Canada
| | - Susan Rotzinger
- 0000 0001 2157 2938grid.17063.33Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON Canada ,0000 0001 2157 2938grid.17063.33Department of Psychiatry, Krembil Research Centre, University Health Network, University of Toronto, Toronto, ON Canada ,0000 0001 2157 2938grid.17063.33Department of Psychiatry, St. Michael’s Hospital, University of Toronto, Toronto, ON Canada
| | - Sidney H. Kennedy
- 0000 0001 2157 2938grid.17063.33Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON Canada ,0000 0001 2157 2938grid.17063.33Department of Psychiatry, Krembil Research Centre, University Health Network, University of Toronto, Toronto, ON Canada ,0000 0001 2157 2938grid.17063.33Department of Psychiatry, St. Michael’s Hospital, University of Toronto, Toronto, ON Canada ,grid.415502.7Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON Canada
| | - Glenda M. MacQueen
- 0000 0004 1936 7697grid.22072.35Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB Canada
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