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Cole EJ, Phillips AL, Bentzley BS, Stimpson KH, Nejad R, Barmak F, Veerapal C, Khan N, Cherian K, Felber E, Brown R, Choi E, King S, Pankow H, Bishop JH, Azeez A, Coetzee J, Rapier R, Odenwald N, Carreon D, Hawkins J, Chang M, Keller J, Raj K, DeBattista C, Jo B, Espil FM, Schatzberg AF, Sudheimer KD, Williams NR. Stanford Neuromodulation Therapy (SNT): A Double-Blind Randomized Controlled Trial. Am J Psychiatry 2022; 179:132-141. [PMID: 34711062 DOI: 10.1176/appi.ajp.2021.20101429] [Citation(s) in RCA: 183] [Impact Index Per Article: 91.5] [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: 11/30/2022]
Abstract
OBJECTIVE Depression is the leading cause of disability worldwide, and half of patients with depression have treatment-resistant depression. Intermittent theta-burst stimulation (iTBS) is approved by the U.S. Food and Drug Administration for the treatment of treatment-resistant depression but is limited by suboptimal efficacy and a 6-week duration. The authors addressed these limitations by developing a neuroscience-informed accelerated iTBS protocol, Stanford neuromodulation therapy (SNT; previously referred to as Stanford accelerated intelligent neuromodulation therapy, or SAINT). This protocol was associated with a remission rate of ∼90% after 5 days of open-label treatment. Here, the authors report the results of a sham-controlled double-blind trial of SNT for treatment-resistant depression. METHODS Participants with treatment-resistant depression currently experiencing moderate to severe depressive episodes were randomly assigned to receive active or sham SNT. Resting-state functional MRI was used to individually target the region of the left dorsolateral prefrontal cortex most functionally anticorrelated with the subgenual anterior cingulate cortex. The primary outcome was score on the Montgomery-Åsberg Depression Rating Scale (MADRS) 4 weeks after treatment. RESULTS At the planned interim analysis, 32 participants with treatment-resistant depression had been enrolled, and 29 participants who continued to meet inclusion criteria received either active (N=14) or sham (N=15) SNT. The mean percent reduction from baseline in MADRS score 4 weeks after treatment was 52.5% in the active treatment group and 11.1% in the sham treatment group. CONCLUSIONS SNT, a high-dose iTBS protocol with functional-connectivity-guided targeting, was more effective than sham stimulation for treatment-resistant depression. Further trials are needed to determine SNT's durability and to compare it with other treatments.
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Affiliation(s)
- Eleanor J Cole
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors except King and Sudheimer); U.S. Department of Veterans Affairs, Palo Alto, Calif. (Phillips, Azeez, Coetzee); Department of Psychology, Palo Alto University, Palo Alto, Calif. (Stimpson, Cherian, Felber, Brown, Choi); Centre for Neuroimaging and Cognitive Genomics, National University of Ireland, Galway (King); Department of Anatomy, School of Medicine, Southern Illinois University, Carbondale (Sudheimer)
| | - Angela L Phillips
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors except King and Sudheimer); U.S. Department of Veterans Affairs, Palo Alto, Calif. (Phillips, Azeez, Coetzee); Department of Psychology, Palo Alto University, Palo Alto, Calif. (Stimpson, Cherian, Felber, Brown, Choi); Centre for Neuroimaging and Cognitive Genomics, National University of Ireland, Galway (King); Department of Anatomy, School of Medicine, Southern Illinois University, Carbondale (Sudheimer)
| | - Brandon S Bentzley
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors except King and Sudheimer); U.S. Department of Veterans Affairs, Palo Alto, Calif. (Phillips, Azeez, Coetzee); Department of Psychology, Palo Alto University, Palo Alto, Calif. (Stimpson, Cherian, Felber, Brown, Choi); Centre for Neuroimaging and Cognitive Genomics, National University of Ireland, Galway (King); Department of Anatomy, School of Medicine, Southern Illinois University, Carbondale (Sudheimer)
| | - Katy H Stimpson
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors except King and Sudheimer); U.S. Department of Veterans Affairs, Palo Alto, Calif. (Phillips, Azeez, Coetzee); Department of Psychology, Palo Alto University, Palo Alto, Calif. (Stimpson, Cherian, Felber, Brown, Choi); Centre for Neuroimaging and Cognitive Genomics, National University of Ireland, Galway (King); Department of Anatomy, School of Medicine, Southern Illinois University, Carbondale (Sudheimer)
| | - Romina Nejad
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors except King and Sudheimer); U.S. Department of Veterans Affairs, Palo Alto, Calif. (Phillips, Azeez, Coetzee); Department of Psychology, Palo Alto University, Palo Alto, Calif. (Stimpson, Cherian, Felber, Brown, Choi); Centre for Neuroimaging and Cognitive Genomics, National University of Ireland, Galway (King); Department of Anatomy, School of Medicine, Southern Illinois University, Carbondale (Sudheimer)
| | - Fahim Barmak
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors except King and Sudheimer); U.S. Department of Veterans Affairs, Palo Alto, Calif. (Phillips, Azeez, Coetzee); Department of Psychology, Palo Alto University, Palo Alto, Calif. (Stimpson, Cherian, Felber, Brown, Choi); Centre for Neuroimaging and Cognitive Genomics, National University of Ireland, Galway (King); Department of Anatomy, School of Medicine, Southern Illinois University, Carbondale (Sudheimer)
| | - Clive Veerapal
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors except King and Sudheimer); U.S. Department of Veterans Affairs, Palo Alto, Calif. (Phillips, Azeez, Coetzee); Department of Psychology, Palo Alto University, Palo Alto, Calif. (Stimpson, Cherian, Felber, Brown, Choi); Centre for Neuroimaging and Cognitive Genomics, National University of Ireland, Galway (King); Department of Anatomy, School of Medicine, Southern Illinois University, Carbondale (Sudheimer)
| | - Naushaba Khan
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors except King and Sudheimer); U.S. Department of Veterans Affairs, Palo Alto, Calif. (Phillips, Azeez, Coetzee); Department of Psychology, Palo Alto University, Palo Alto, Calif. (Stimpson, Cherian, Felber, Brown, Choi); Centre for Neuroimaging and Cognitive Genomics, National University of Ireland, Galway (King); Department of Anatomy, School of Medicine, Southern Illinois University, Carbondale (Sudheimer)
| | - Kirsten Cherian
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors except King and Sudheimer); U.S. Department of Veterans Affairs, Palo Alto, Calif. (Phillips, Azeez, Coetzee); Department of Psychology, Palo Alto University, Palo Alto, Calif. (Stimpson, Cherian, Felber, Brown, Choi); Centre for Neuroimaging and Cognitive Genomics, National University of Ireland, Galway (King); Department of Anatomy, School of Medicine, Southern Illinois University, Carbondale (Sudheimer)
| | - Emily Felber
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors except King and Sudheimer); U.S. Department of Veterans Affairs, Palo Alto, Calif. (Phillips, Azeez, Coetzee); Department of Psychology, Palo Alto University, Palo Alto, Calif. (Stimpson, Cherian, Felber, Brown, Choi); Centre for Neuroimaging and Cognitive Genomics, National University of Ireland, Galway (King); Department of Anatomy, School of Medicine, Southern Illinois University, Carbondale (Sudheimer)
| | - Randi Brown
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors except King and Sudheimer); U.S. Department of Veterans Affairs, Palo Alto, Calif. (Phillips, Azeez, Coetzee); Department of Psychology, Palo Alto University, Palo Alto, Calif. (Stimpson, Cherian, Felber, Brown, Choi); Centre for Neuroimaging and Cognitive Genomics, National University of Ireland, Galway (King); Department of Anatomy, School of Medicine, Southern Illinois University, Carbondale (Sudheimer)
| | - Elizabeth Choi
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors except King and Sudheimer); U.S. Department of Veterans Affairs, Palo Alto, Calif. (Phillips, Azeez, Coetzee); Department of Psychology, Palo Alto University, Palo Alto, Calif. (Stimpson, Cherian, Felber, Brown, Choi); Centre for Neuroimaging and Cognitive Genomics, National University of Ireland, Galway (King); Department of Anatomy, School of Medicine, Southern Illinois University, Carbondale (Sudheimer)
| | - Sinead King
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors except King and Sudheimer); U.S. Department of Veterans Affairs, Palo Alto, Calif. (Phillips, Azeez, Coetzee); Department of Psychology, Palo Alto University, Palo Alto, Calif. (Stimpson, Cherian, Felber, Brown, Choi); Centre for Neuroimaging and Cognitive Genomics, National University of Ireland, Galway (King); Department of Anatomy, School of Medicine, Southern Illinois University, Carbondale (Sudheimer)
| | - Heather Pankow
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors except King and Sudheimer); U.S. Department of Veterans Affairs, Palo Alto, Calif. (Phillips, Azeez, Coetzee); Department of Psychology, Palo Alto University, Palo Alto, Calif. (Stimpson, Cherian, Felber, Brown, Choi); Centre for Neuroimaging and Cognitive Genomics, National University of Ireland, Galway (King); Department of Anatomy, School of Medicine, Southern Illinois University, Carbondale (Sudheimer)
| | - James H Bishop
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors except King and Sudheimer); U.S. Department of Veterans Affairs, Palo Alto, Calif. (Phillips, Azeez, Coetzee); Department of Psychology, Palo Alto University, Palo Alto, Calif. (Stimpson, Cherian, Felber, Brown, Choi); Centre for Neuroimaging and Cognitive Genomics, National University of Ireland, Galway (King); Department of Anatomy, School of Medicine, Southern Illinois University, Carbondale (Sudheimer)
| | - Azeezat Azeez
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors except King and Sudheimer); U.S. Department of Veterans Affairs, Palo Alto, Calif. (Phillips, Azeez, Coetzee); Department of Psychology, Palo Alto University, Palo Alto, Calif. (Stimpson, Cherian, Felber, Brown, Choi); Centre for Neuroimaging and Cognitive Genomics, National University of Ireland, Galway (King); Department of Anatomy, School of Medicine, Southern Illinois University, Carbondale (Sudheimer)
| | - John Coetzee
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors except King and Sudheimer); U.S. Department of Veterans Affairs, Palo Alto, Calif. (Phillips, Azeez, Coetzee); Department of Psychology, Palo Alto University, Palo Alto, Calif. (Stimpson, Cherian, Felber, Brown, Choi); Centre for Neuroimaging and Cognitive Genomics, National University of Ireland, Galway (King); Department of Anatomy, School of Medicine, Southern Illinois University, Carbondale (Sudheimer)
| | - Rachel Rapier
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors except King and Sudheimer); U.S. Department of Veterans Affairs, Palo Alto, Calif. (Phillips, Azeez, Coetzee); Department of Psychology, Palo Alto University, Palo Alto, Calif. (Stimpson, Cherian, Felber, Brown, Choi); Centre for Neuroimaging and Cognitive Genomics, National University of Ireland, Galway (King); Department of Anatomy, School of Medicine, Southern Illinois University, Carbondale (Sudheimer)
| | - Nicole Odenwald
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors except King and Sudheimer); U.S. Department of Veterans Affairs, Palo Alto, Calif. (Phillips, Azeez, Coetzee); Department of Psychology, Palo Alto University, Palo Alto, Calif. (Stimpson, Cherian, Felber, Brown, Choi); Centre for Neuroimaging and Cognitive Genomics, National University of Ireland, Galway (King); Department of Anatomy, School of Medicine, Southern Illinois University, Carbondale (Sudheimer)
| | - David Carreon
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors except King and Sudheimer); U.S. Department of Veterans Affairs, Palo Alto, Calif. (Phillips, Azeez, Coetzee); Department of Psychology, Palo Alto University, Palo Alto, Calif. (Stimpson, Cherian, Felber, Brown, Choi); Centre for Neuroimaging and Cognitive Genomics, National University of Ireland, Galway (King); Department of Anatomy, School of Medicine, Southern Illinois University, Carbondale (Sudheimer)
| | - Jessica Hawkins
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors except King and Sudheimer); U.S. Department of Veterans Affairs, Palo Alto, Calif. (Phillips, Azeez, Coetzee); Department of Psychology, Palo Alto University, Palo Alto, Calif. (Stimpson, Cherian, Felber, Brown, Choi); Centre for Neuroimaging and Cognitive Genomics, National University of Ireland, Galway (King); Department of Anatomy, School of Medicine, Southern Illinois University, Carbondale (Sudheimer)
| | - Maureen Chang
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors except King and Sudheimer); U.S. Department of Veterans Affairs, Palo Alto, Calif. (Phillips, Azeez, Coetzee); Department of Psychology, Palo Alto University, Palo Alto, Calif. (Stimpson, Cherian, Felber, Brown, Choi); Centre for Neuroimaging and Cognitive Genomics, National University of Ireland, Galway (King); Department of Anatomy, School of Medicine, Southern Illinois University, Carbondale (Sudheimer)
| | - Jennifer Keller
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors except King and Sudheimer); U.S. Department of Veterans Affairs, Palo Alto, Calif. (Phillips, Azeez, Coetzee); Department of Psychology, Palo Alto University, Palo Alto, Calif. (Stimpson, Cherian, Felber, Brown, Choi); Centre for Neuroimaging and Cognitive Genomics, National University of Ireland, Galway (King); Department of Anatomy, School of Medicine, Southern Illinois University, Carbondale (Sudheimer)
| | - Kristin Raj
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors except King and Sudheimer); U.S. Department of Veterans Affairs, Palo Alto, Calif. (Phillips, Azeez, Coetzee); Department of Psychology, Palo Alto University, Palo Alto, Calif. (Stimpson, Cherian, Felber, Brown, Choi); Centre for Neuroimaging and Cognitive Genomics, National University of Ireland, Galway (King); Department of Anatomy, School of Medicine, Southern Illinois University, Carbondale (Sudheimer)
| | - Charles DeBattista
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors except King and Sudheimer); U.S. Department of Veterans Affairs, Palo Alto, Calif. (Phillips, Azeez, Coetzee); Department of Psychology, Palo Alto University, Palo Alto, Calif. (Stimpson, Cherian, Felber, Brown, Choi); Centre for Neuroimaging and Cognitive Genomics, National University of Ireland, Galway (King); Department of Anatomy, School of Medicine, Southern Illinois University, Carbondale (Sudheimer)
| | - Booil Jo
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors except King and Sudheimer); U.S. Department of Veterans Affairs, Palo Alto, Calif. (Phillips, Azeez, Coetzee); Department of Psychology, Palo Alto University, Palo Alto, Calif. (Stimpson, Cherian, Felber, Brown, Choi); Centre for Neuroimaging and Cognitive Genomics, National University of Ireland, Galway (King); Department of Anatomy, School of Medicine, Southern Illinois University, Carbondale (Sudheimer)
| | - Flint M Espil
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors except King and Sudheimer); U.S. Department of Veterans Affairs, Palo Alto, Calif. (Phillips, Azeez, Coetzee); Department of Psychology, Palo Alto University, Palo Alto, Calif. (Stimpson, Cherian, Felber, Brown, Choi); Centre for Neuroimaging and Cognitive Genomics, National University of Ireland, Galway (King); Department of Anatomy, School of Medicine, Southern Illinois University, Carbondale (Sudheimer)
| | - Alan F Schatzberg
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors except King and Sudheimer); U.S. Department of Veterans Affairs, Palo Alto, Calif. (Phillips, Azeez, Coetzee); Department of Psychology, Palo Alto University, Palo Alto, Calif. (Stimpson, Cherian, Felber, Brown, Choi); Centre for Neuroimaging and Cognitive Genomics, National University of Ireland, Galway (King); Department of Anatomy, School of Medicine, Southern Illinois University, Carbondale (Sudheimer)
| | - Keith D Sudheimer
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors except King and Sudheimer); U.S. Department of Veterans Affairs, Palo Alto, Calif. (Phillips, Azeez, Coetzee); Department of Psychology, Palo Alto University, Palo Alto, Calif. (Stimpson, Cherian, Felber, Brown, Choi); Centre for Neuroimaging and Cognitive Genomics, National University of Ireland, Galway (King); Department of Anatomy, School of Medicine, Southern Illinois University, Carbondale (Sudheimer)
| | - Nolan R Williams
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors except King and Sudheimer); U.S. Department of Veterans Affairs, Palo Alto, Calif. (Phillips, Azeez, Coetzee); Department of Psychology, Palo Alto University, Palo Alto, Calif. (Stimpson, Cherian, Felber, Brown, Choi); Centre for Neuroimaging and Cognitive Genomics, National University of Ireland, Galway (King); Department of Anatomy, School of Medicine, Southern Illinois University, Carbondale (Sudheimer)
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Cole EJ, Stimpson KH, Bentzley BS, Gulser M, Cherian K, Tischler C, Nejad R, Pankow H, Choi E, Aaron H, Espil FM, Pannu J, Xiao X, Duvio D, Solvason HB, Hawkins J, Guerra A, Jo B, Raj KS, Phillips AL, Barmak F, Bishop JH, Coetzee JP, DeBattista C, Keller J, Schatzberg AF, Sudheimer KD, Williams NR. Stanford Accelerated Intelligent Neuromodulation Therapy for Treatment-Resistant Depression. Am J Psychiatry 2020; 177:716-726. [PMID: 32252538 DOI: 10.1176/appi.ajp.2019.19070720] [Citation(s) in RCA: 261] [Impact Index Per Article: 65.3] [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] [Indexed: 12/24/2022]
Abstract
OBJECTIVE New antidepressant treatments are needed that are effective, rapid acting, safe, and tolerable. Intermittent theta-burst stimulation (iTBS) is a noninvasive brain stimulation treatment that has been approved by the U.S. Food and Drug Administration for treatment-resistant depression. Recent methodological advances suggest that the current iTBS protocol might be improved through 1) treating patients with multiple sessions per day at optimally spaced intervals, 2) applying a higher overall pulse dose of stimulation, and 3) precision targeting of the left dorsolateral prefrontal cortex (DLPFC) to subgenual anterior cingulate cortex (sgACC) circuit. The authors examined the feasibility, tolerability, and preliminary efficacy of Stanford Accelerated Intelligent Neuromodulation Therapy (SAINT), an accelerated, high-dose resting-state functional connectivity MRI (fcMRI)-guided iTBS protocol for treatment-resistant depression. METHODS Twenty-two participants with treatment-resistant depression received open-label SAINT. fcMRI was used to individually target the region of the left DLPFC most anticorrelated with sgACC in each participant. Fifty iTBS sessions (1,800 pulses per session, 50-minute intersession interval) were delivered as 10 daily sessions over 5 consecutive days at 90% resting motor threshold (adjusted for cortical depth). Neuropsychological testing was conducted before and after SAINT. RESULTS One participant withdrew, leaving a sample size of 21. Nineteen of 21 participants (90.5%) met remission criteria (defined as a score <11 on the Montgomery-Åsberg Depression Rating Scale). In the intent-to-treat analysis, 19 of 22 participants (86.4%) met remission criteria. Neuropsychological testing demonstrated no negative cognitive side effects. CONCLUSIONS SAINT, an accelerated, high-dose, iTBS protocol with fcMRI-guided targeting, was well tolerated and safe. Double-blinded sham-controlled trials are needed to confirm the remission rate observed in this initial study.
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Affiliation(s)
- Eleanor J Cole
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors), and Department of Psychology (Stimpson, Cherian, Choi, Aaron, Guerra, Phillips), Palo Alto University, Palo Alto, Calif
| | - Katy H Stimpson
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors), and Department of Psychology (Stimpson, Cherian, Choi, Aaron, Guerra, Phillips), Palo Alto University, Palo Alto, Calif
| | - Brandon S Bentzley
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors), and Department of Psychology (Stimpson, Cherian, Choi, Aaron, Guerra, Phillips), Palo Alto University, Palo Alto, Calif
| | - Merve Gulser
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors), and Department of Psychology (Stimpson, Cherian, Choi, Aaron, Guerra, Phillips), Palo Alto University, Palo Alto, Calif
| | - Kirsten Cherian
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors), and Department of Psychology (Stimpson, Cherian, Choi, Aaron, Guerra, Phillips), Palo Alto University, Palo Alto, Calif
| | - Claudia Tischler
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors), and Department of Psychology (Stimpson, Cherian, Choi, Aaron, Guerra, Phillips), Palo Alto University, Palo Alto, Calif
| | - Romina Nejad
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors), and Department of Psychology (Stimpson, Cherian, Choi, Aaron, Guerra, Phillips), Palo Alto University, Palo Alto, Calif
| | - Heather Pankow
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors), and Department of Psychology (Stimpson, Cherian, Choi, Aaron, Guerra, Phillips), Palo Alto University, Palo Alto, Calif
| | - Elizabeth Choi
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors), and Department of Psychology (Stimpson, Cherian, Choi, Aaron, Guerra, Phillips), Palo Alto University, Palo Alto, Calif
| | - Haley Aaron
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors), and Department of Psychology (Stimpson, Cherian, Choi, Aaron, Guerra, Phillips), Palo Alto University, Palo Alto, Calif
| | - Flint M Espil
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors), and Department of Psychology (Stimpson, Cherian, Choi, Aaron, Guerra, Phillips), Palo Alto University, Palo Alto, Calif
| | - Jaspreet Pannu
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors), and Department of Psychology (Stimpson, Cherian, Choi, Aaron, Guerra, Phillips), Palo Alto University, Palo Alto, Calif
| | - Xiaoqian Xiao
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors), and Department of Psychology (Stimpson, Cherian, Choi, Aaron, Guerra, Phillips), Palo Alto University, Palo Alto, Calif
| | - Dalton Duvio
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors), and Department of Psychology (Stimpson, Cherian, Choi, Aaron, Guerra, Phillips), Palo Alto University, Palo Alto, Calif
| | - Hugh B Solvason
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors), and Department of Psychology (Stimpson, Cherian, Choi, Aaron, Guerra, Phillips), Palo Alto University, Palo Alto, Calif
| | - Jessica Hawkins
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors), and Department of Psychology (Stimpson, Cherian, Choi, Aaron, Guerra, Phillips), Palo Alto University, Palo Alto, Calif
| | - Austin Guerra
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors), and Department of Psychology (Stimpson, Cherian, Choi, Aaron, Guerra, Phillips), Palo Alto University, Palo Alto, Calif
| | - Booil Jo
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors), and Department of Psychology (Stimpson, Cherian, Choi, Aaron, Guerra, Phillips), Palo Alto University, Palo Alto, Calif
| | - Kristin S Raj
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors), and Department of Psychology (Stimpson, Cherian, Choi, Aaron, Guerra, Phillips), Palo Alto University, Palo Alto, Calif
| | - Angela L Phillips
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors), and Department of Psychology (Stimpson, Cherian, Choi, Aaron, Guerra, Phillips), Palo Alto University, Palo Alto, Calif
| | - Fahim Barmak
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors), and Department of Psychology (Stimpson, Cherian, Choi, Aaron, Guerra, Phillips), Palo Alto University, Palo Alto, Calif
| | - James H Bishop
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors), and Department of Psychology (Stimpson, Cherian, Choi, Aaron, Guerra, Phillips), Palo Alto University, Palo Alto, Calif
| | - John P Coetzee
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors), and Department of Psychology (Stimpson, Cherian, Choi, Aaron, Guerra, Phillips), Palo Alto University, Palo Alto, Calif
| | - Charles DeBattista
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors), and Department of Psychology (Stimpson, Cherian, Choi, Aaron, Guerra, Phillips), Palo Alto University, Palo Alto, Calif
| | - Jennifer Keller
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors), and Department of Psychology (Stimpson, Cherian, Choi, Aaron, Guerra, Phillips), Palo Alto University, Palo Alto, Calif
| | - Alan F Schatzberg
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors), and Department of Psychology (Stimpson, Cherian, Choi, Aaron, Guerra, Phillips), Palo Alto University, Palo Alto, Calif
| | - Keith D Sudheimer
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors), and Department of Psychology (Stimpson, Cherian, Choi, Aaron, Guerra, Phillips), Palo Alto University, Palo Alto, Calif
| | - Nolan R Williams
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors), and Department of Psychology (Stimpson, Cherian, Choi, Aaron, Guerra, Phillips), Palo Alto University, Palo Alto, Calif
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