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Osterland SL, Adli M, Saritas T, Schlattmann P, Behr J, Müller-Mertel R, Hoffmann K, Stamm TJ, Bschor T, Richter C, Steinacher B, Jockers-Scherübl MC, Köhler S, Heinz A, Ricken R, Buspavanich P. Acute effects of lithium augmentation on the kidney in geriatric compared with non-geriatric patients with treatment-resistant depression. Acta Psychiatr Scand 2023; 147:267-275. [PMID: 36585782 DOI: 10.1111/acps.13531] [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: 09/20/2022] [Revised: 12/13/2022] [Accepted: 12/28/2022] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Lithium augmentation (LA) of antidepressants is a first-line therapy option for treatment-resistant depression (TRD). Nevertheless, it is rarely used in geriatric patients mostly because of the fear of kidney toxicity. The purpose of this study is to investigate estimated glomerular filtration rate (eGFR) changes and number of acute kidney injuries (AKI) using LA in geriatric compared with non-geriatric patients. METHODS In a prospective multicenter cohort study, eGFR changes were measured in 201 patients with unipolar depression (nage≥65years = 29; nage<65years = 172) at baseline and over 2-6 weeks of LA. We used linear mixed models to investigate changes in eGFR upon LA and assessed the number of AKIs, according to the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines. RESULTS Both age groups showed a significant eGFR decline over the course of treatment with lower eGFR in geriatric patients. The lithium serum level (interpretable as "effect of LA") had a significant effect on eGFR decline. Both effects (age group and lithium serum level) on eGFR decline did not influence each other, meaning the effect of LA on eGFR decline did not differ between age groups. Two AKIs were observed in the geriatric age group when serum lithium levels exceeded the therapeutic range of >0.8 mmol/L. CONCLUSION This is the first study investigating eGFR change and AKI upon LA for TRD in geriatric compared with non-geriatric patients. Our data suggest that LA, as an effective treatment option in geriatric patients, should be closely monitored to avoid AKIs.
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Affiliation(s)
- Sarah Luise Osterland
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Mazda Adli
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Department of Psychiatry and Psychotherapy, Fliedner Klinik Berlin, Berlin, Germany
| | - Turgay Saritas
- Division of Nephrology and Clinical Immunology, University Hospital RWTH Aachen, Aachen, Germany.,University Hospital RWTH Aachen, Institute of Experimental Medicine and Systems Biology, Aachen, Germany
| | - Peter Schlattmann
- Department of Statistics, Informatics and Data Sciences, Jena University Hospital, Jena, Germany
| | - Joachim Behr
- Department of Psychiatry, Psychotherapy and Psychosomatics, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany.,Faculty of Health Sciences Brandenburg, Joint Faculty of the University of Potsdam, Brandenburg University of Technology Cottbus-Senftenberg and Brandenburg Medical School, Potsdam, Germany.,Research Department of Experimental and Molecular Psychiatry, Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Ronja Müller-Mertel
- Department of Psychology - Clinical Psychology and Psychotherapy, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - Kai Hoffmann
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Thomas J Stamm
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Department of Psychology - Clinical Psychology and Psychotherapy, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - Tom Bschor
- Department of Psychiatry and Psychotherapy, Technical University of Dresden Medical School, Dresden, Germany
| | - Christoph Richter
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Department of Psychiatry and Psychotherapy, Vivantes Klinikum Kaulsdorf, Berlin, Germany
| | - Bruno Steinacher
- Department of Psychiatry and Psychotherapy, Vivantes Wenckebach-Klinikum, Berlin, Germany.,Department of Psychiatry and Psychotherapy, Vivantes Auguste-Viktoria-Klinikum, Berlin, Germany
| | | | - Stephan Köhler
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Andreas Heinz
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Roland Ricken
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Pichit Buspavanich
- Department of Psychiatry, Psychotherapy and Psychosomatics, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany.,Faculty of Health Sciences Brandenburg, Joint Faculty of the University of Potsdam, Brandenburg University of Technology Cottbus-Senftenberg and Brandenburg Medical School, Potsdam, Germany.,Research Unit Gender in Medicine, Department of Psychiatry and Psychotherapy, Institute of Sexology and Sexual Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
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2
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Ortelbach N, Rote J, Dingelstadt AML, Stolzenburg A, Koenig C, O'Malley G, Quinlivan E, Fiebig J, Pfeiffer S, König B, Simhandl C, Bauer M, Pfennig A, Stamm TJ. The big five model in bipolar disorder: a latent profile analysis and its impact on longterm illness severity. Int J Bipolar Disord 2022; 10:1. [PMID: 35041119 PMCID: PMC8766615 DOI: 10.1186/s40345-021-00248-y] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 12/16/2021] [Indexed: 12/12/2022] Open
Abstract
Background Using a personality typing approach, we investigated the relationship between personality profiles and the prediction of longterm illness severity in patients with bipolar disorder (BD). While previous research suggests associations between BD and traits from the NEO-FFI profiles, the current study firstly aimed to identify latent classes of NEO-FFI profiles, and, secondly, to examine their impact on the longterm prognosis of BD. Methods Based on the NEO-FFI profiles of 134 euthymic patients diagnosed with BD (64.2% female, mean age = 44.3 years), successive latent profile analyses were conducted. Subsequently, a subsample (n = 80) was examined prospectively by performing multiple regression analysis of the latent classes to evaluate the longitudinal course of the disease (mean: 54.7 weeks) measured using a modified Morbidity Index. Results The latent profile analyses suggested a 3-class model typifying in a resilient (n = 68, 51%), vulnerable (n = 55, 41%) and highly vulnerable (n = 11, 8%) class. In the regression analysis, higher vulnerability predicted a higher longterm Morbidity Index (R2 = 0.28). Conclusions Subgroups of patients with BD share a number of discrete personality features and their illness is characterized by a similar clinical course. This knowledge is valuable in a variety of clinical contexts including early detection, intervention planning and treatment process.
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Affiliation(s)
- Niklas Ortelbach
- Department of Educational Science and Psychology, Free University of Berlin, Berlin, Germany
| | - Jonas Rote
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Alice Mai Ly Dingelstadt
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Anna Stolzenburg
- Department of Psychology, Brandenburg Medical School Theodor Fontane, Fehrbelliner Straße 38, 16816, Neuruppin, Germany
| | - Cornelia Koenig
- Department of Psychology, Brandenburg Medical School Theodor Fontane, Fehrbelliner Straße 38, 16816, Neuruppin, Germany
| | - Grace O'Malley
- Department of Psychology, Brandenburg Medical School Theodor Fontane, Fehrbelliner Straße 38, 16816, Neuruppin, Germany.,Department of Pediatrics, Division of Oncology and Hematology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Esther Quinlivan
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Jana Fiebig
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Steffi Pfeiffer
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | | | - Christian Simhandl
- Bipolar Center, Wiener Neustadt, Austria.,Faculty of Medicine, Sigmund Freud University Vienna, Vienna, Austria
| | - Michael Bauer
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Andrea Pfennig
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Thomas J Stamm
- Department of Psychology, Brandenburg Medical School Theodor Fontane, Fehrbelliner Straße 38, 16816, Neuruppin, Germany. .,Schloss Luetgenhof Hospital, Centre for Personal Medicine, Psychosomatics and Psychotherapy, Dassow, Mecklenburg-Western Pomerania, Germany.
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3
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Stamm TJ, Zwick JC, O'Malley G, Sondergeld LM, Hautzinger M. Adjuvant psychotherapy in early-stage bipolar disorder: study protocol for a randomized controlled trial. Trials 2020; 21:845. [PMID: 33050952 PMCID: PMC7552468 DOI: 10.1186/s13063-020-04755-8] [Citation(s) in RCA: 4] [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: 05/28/2019] [Accepted: 09/22/2020] [Indexed: 11/30/2022] Open
Abstract
Background Bipolar disorders are serious illnesses with a chronic course and a high rate of relapse. Typically, bipolar disorders onset during adolescence or early adulthood, with patients experiencing significant personal and social costs as a consequence of their illness. Despite this, to date, there is limited (controlled) evidence regarding the effectiveness of psychotherapy during the critical stages of the disorder (e.g., early onset). Some preliminary studies suggest that targeted, tailored early interventions in particular may improve disease prognosis. The proposed study examines the effectiveness of group psychotherapy on relapse prevention, global adaptive functioning, and neuropsychological functioning in early-stage bipolar disorder. Methods In this multicenter randomized controlled trial (RCT), 300 patients with bipolar disorder are randomized to one of two group psychotherapies: Specific Emotional-Cognitive Therapy (SECT; intervention group) or Emotion-Focused Supportive Therapy (EFST; active control group). Each therapy comprises of a total of 48-h sessions (delivered once a month) over a period of 4 months. Assessments take place at baseline (t1); 6 months follow-up, i.e., post-intervention (t2); 12 months follow-up (t3); and 18 months follow-up (t4), whereby 18 months follow-up is the primary time point of interest. Discussion The goal of this study is to test the effects of an innovative, specific group therapy relative to an active control condition in terms of rates of relapse, global functioning, and neuropsychological functioning. Pending the outcomes of the trial, it will be possible to establish a firm evidence base for accessible group psychotherapy adjuvant to routine psychiatric care for individuals with bipolar disorder. Trial registration USA: ClinicalTrials.gov NCT02506322. Registered on 19 December 2014; Germany: German Clinical Trials Register DRKS00006013. Registered on21 May 2015
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Affiliation(s)
- Thomas J Stamm
- Department of Clinical Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany. .,Department of Psychiatry and Psychotherapy, Charité University Medicine, Berlin, Germany.
| | - Julia C Zwick
- Department of Psychology, Clinical Psychology and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Grace O'Malley
- Department of Clinical Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - Lene-Marie Sondergeld
- Department of Clinical Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - Martin Hautzinger
- Department of Psychology, Clinical Psychology and Psychotherapy, University of Tübingen, Tübingen, Germany
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4
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Leopold K, Bauer M, Bechdolf A, Correll CU, Holtmann M, Juckel G, Lambert M, Meyer TD, Pfeiffer S, Kittel-Schneider S, Reif A, Stamm TJ, Rottmann-Wolf M, Mathiebe J, Kellmann EL, Ritter P, Krüger-Özgürdal S, Karow A, Sondergeld LM, Roessner V, Sauer C, Pfennig A. Efficacy of cognitive-behavioral group therapy in patients at risk for serious mental illness presenting with subthreshold bipolar symptoms: Results from a prespecified interim analysis of a multicenter, randomized, controlled study. Bipolar Disord 2020; 22:517-529. [PMID: 32112496 DOI: 10.1111/bdi.12894] [Citation(s) in RCA: 12] [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] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Most patients with bipolar disorders (BD) exhibit prodromal symptoms before a first (hypo)manic episode. Patients with clinically significant symptoms fulfilling at-risk criteria for serious mental illness (SMI) require effective and safe treatment. Cognitive-behavioral psychotherapy (CBT) has shown promising results in early stages of BD and in patients at high risk for psychosis. We aimed to investigate whether group CBT can improve symptoms and functional deficits in young patients at risk for SMI presenting with subthreshold bipolar symptoms. METHOD In a multicenter, randomized, controlled trial, patients at clinical risk for SMI presenting with subthreshold bipolar symptoms aged 15-30 years were randomized to 14 weeks of at-risk for BD-specific group CBT or unstructured group meetings. Primary efficacy endpoints were differences in affective symptomatology and psychosocial functioning at 14 weeks. At-risk status was defined as a combination of subthreshold bipolar symptomatology, reduction of psychosocial functioning and a family history for (schizo)affective disorders. A prespecified interim analysis was conducted at 75% of the targeted sample. RESULTS Of 128 screened participants, 75 were randomized to group CBT (n = 38, completers = 65.8%) vs unstructured group meetings (n = 37, completers = 78.4%). Affective symptomatology and psychosocial functioning improved significantly at week 14 (P < .001) and during 6 months (P < .001) in both groups, without significant between-group differences. Findings are limited by the interim character of the analysis, the use of not fully validated early detection interviews, a newly adapted intervention manual, and the substantial drop-outs. CONCLUSIONS Results suggest that young patients at-risk for SMI presenting with subthreshold bipolar symptoms benefit from early group sessions. The degree of specificity and psychotherapeutic interaction needed requires clarification.
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Affiliation(s)
- Karolina Leopold
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany.,Department of Psychiatry, Psychotherapy and Psychosomatics, Vivantes Klinikum Am Urban, Berlin, Germany
| | - Michael Bauer
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Andreas Bechdolf
- Department of Psychiatry, Psychotherapy and Psychosomatics, Vivantes Klinikum Am Urban, Berlin, Germany.,Department of Psychiatry and Psychotherapy, University Hospital Cologne, University Cologne, Köln, Germany
| | - Christoph U Correll
- Psychiatry and Molecular Medicine Hofstra Northwell School of Medicine, Hempstead, NY, USA.,Center for Psychiatric Neuroscience Feinstein Institute for Medical Research, Manhasset, NY, USA.,Department of Psychiatry, Recognition and Prevention (RAP) Program, The Zucker Hillside Hospital, Long Island, USA.,Department of Child and Adolescent Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Martin Holtmann
- Department of Child and Adolescent Psychiatry and Psychotherapy, LWL-University Hospital Hamm, Ruhr-University, Bochum, Germany
| | - Georg Juckel
- Department of Psychiatry and Psychotherapy, LWL- University Hospital Bochum, Ruhr-University, Bochum, Germany
| | - Martin Lambert
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas D Meyer
- Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas HSC at Houston, Houston, TX, USA
| | - Steffi Pfeiffer
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Sarah Kittel-Schneider
- Department of Psychiatry and Psychotherapy, University Hospital Würzburg, Würzburg, Germany.,Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital, Frankfurt, Germany
| | - Andreas Reif
- Department of Psychiatry and Psychotherapy, University Hospital Würzburg, Würzburg, Germany.,Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital, Frankfurt, Germany
| | - Thomas J Stamm
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Berlin, Germany.,Department of Psychiatry, Psychotherapy and Psychosomatic, Medical School Brandenburg, Neuruppin, Germany
| | - Maren Rottmann-Wolf
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Josephine Mathiebe
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Eva L Kellmann
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Philipp Ritter
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Seza Krüger-Özgürdal
- Department of Psychiatry and Psychotherapy, LWL- University Hospital Bochum, Ruhr-University, Bochum, Germany
| | - Anne Karow
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lene-Marie Sondergeld
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Berlin, Germany.,Department of Psychiatry, Psychotherapy and Psychosomatic, Medical School Brandenburg, Neuruppin, Germany
| | - Veit Roessner
- Department of Child and Adolescent Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Cathrin Sauer
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Andrea Pfennig
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
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5
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Bopp SK, Heilbronner U, Schlattmann P, Mühleisen TW, Bschor T, Richter C, Steinacher B, Stamm TJ, Merkl A, Herms S, Köhler S, Sterzer P, Hellweg R, Heinz A, Cichon S, Lang UE, Schulze TG, Adli M, Ricken R. Leptin gene polymorphisms are associated with weight gain during lithium augmentation in patients with major depression. Eur Neuropsychopharmacol 2019; 29:211-221. [PMID: 30554862 DOI: 10.1016/j.euroneuro.2018.12.006] [Citation(s) in RCA: 5] [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: 05/16/2018] [Revised: 11/29/2018] [Accepted: 12/01/2018] [Indexed: 12/28/2022]
Abstract
Weight gain is a common adverse effect of lithium augmentation. Previous studies indicate an impact of genetic variants at the leptin gene on weight gain as a consequence of psychopharmacological treatment. The primary aim of our study was to identify variants at the leptin locus that might predict lithium-induced weight gain. The secondary aim was to investigate if these variants modulate leptin levels. In 180 patients with acute major depressive disorder, body mass index was measured before and after 4 weeks of lithium augmentation, in a subsample also after 4 and/or 7 months. In a subsample of 89 patients, leptin serum concentrations were measured before and during lithium augmentation. We used linear mixed model analyzes to investigate the effects of 2 polymorphisms at the leptin locus (rs4731426 and rs7799039, employing the respective proxy SNPs rs2278815 and rs10487506) on changes in body mass index and leptin levels. For both polymorphisms, which are in high linkage disequilibrium, body mass index was significantly lower in homozygous A-allele carriers than in carriers of other genotypes at baseline. Over the follow-up period, body mass index increased less in homozygous A-allele carriers of rs4731426 than in carriers of other genotypes. This was not the case for rs7799039. Neither polymorphism modulated leptin protein expression. Our study strongly supports the hypothesis that genetic variability at the leptin locus is involved in lithium augmentation-associated weight gain in major depressive disorder. Furthermore, Genotype-Tissue Expression data provide strong evidence that rs4731426 influences the expression of leptin messenger ribonucleic acid in fibroblasts.
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Affiliation(s)
- Sandra K Bopp
- Department of Psychiatry and Psychotherapy, Charité University Medicine Berlin, Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany
| | - Urs Heilbronner
- Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, LMU Munich, Germany
| | - Peter Schlattmann
- Department of Statistics, Informatics and Documentation, Friedrich-Schiller-University Jena, Jena, Germany
| | - Thomas W Mühleisen
- Institute of Neuroscience and Medicine (INM-1), Research Centre Jülich, Jülich, Germany; Human Genomics Research Group and Division of Medical Genetics, Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Tom Bschor
- Department of Psychiatry, Schlosspark Hospital Berlin, Berlin, Germany; Department of Psychiatry and Psychotherapy, Technical University of Dresden Medical School, Dresden, Germany
| | - Christoph Richter
- Department of Psychiatry and Psychotherapy, Vivantes Hospital, Kaulsdorf, Berlin, Germany; Department of Psychiatry and Psychotherapy, Charité University Medicine Berlin, Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany
| | - Bruno Steinacher
- Department of Psychiatry and Psychotherapy, Vivantes Hospital Wenckebach, Berlin, Germany
| | - Thomas J Stamm
- Department of Psychiatry and Psychotherapy, Charité University Medicine Berlin, Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany; Medical School Brandenburg Theodor Fontane, Neuruppin, Germany
| | - Angela Merkl
- Department of Psychiatry and Psychotherapy, Charité University Medicine Berlin, Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany; Department of Psychiatry and Psychotherapy, Fliedner Hospital Berlin, Berlin, Germany
| | - Stefan Herms
- Human Genomics Research Group and Division of Medical Genetics, Department of Biomedicine, University of Basel, Basel, Switzerland; Institute of Human Genetics, University of Bonn, Bonn, Germany
| | - Stephan Köhler
- Department of Psychiatry and Psychotherapy, Charité University Medicine Berlin, Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany
| | - Philipp Sterzer
- Department of Psychiatry and Psychotherapy, Charité University Medicine Berlin, Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany
| | - Rainer Hellweg
- Department of Psychiatry and Psychotherapy, Charité University Medicine Berlin, Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany
| | - Andreas Heinz
- Department of Psychiatry and Psychotherapy, Charité University Medicine Berlin, Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany
| | - Sven Cichon
- Institute of Neuroscience and Medicine (INM-1), Research Centre Jülich, Jülich, Germany; Human Genomics Research Group and Division of Medical Genetics, Department of Biomedicine, University of Basel, Basel, Switzerland; Institute of Medical Genetics and Pathology, University Hospital Basel, Basel, Switzerland
| | - Undine E Lang
- Department of Psychiatry and Psychotherapy, University Psychiatric Clinics (UPK),University of Basel, Switzerland
| | - Thomas G Schulze
- Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, LMU Munich, Germany; Department of Psychiatry and Psychotherapy, University Medical Center, Georg-August-University, Göttingen, Germany
| | - Mazda Adli
- Department of Psychiatry and Psychotherapy, Charité University Medicine Berlin, Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany; Department of Psychiatry and Psychotherapy, Fliedner Hospital Berlin, Berlin, Germany
| | - Roland Ricken
- Department of Psychiatry and Psychotherapy, Charité University Medicine Berlin, Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany.
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6
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Pilhatsch M, J Stamm T, Stahl P, Lewitzka U, Berghöfer A, Sauer C, Gitlin M, Frye MA, Whybrow PC, Bauer M. Treatment of bipolar depression with supraphysiologic doses of levothyroxine: a randomized, placebo-controlled study of comorbid anxiety symptoms. Int J Bipolar Disord 2019; 7:21. [PMID: 31583561 PMCID: PMC6776578 DOI: 10.1186/s40345-019-0155-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 07/24/2019] [Indexed: 11/25/2022] Open
Abstract
Background Symptoms of anxiety co-occur in a variety of disorders including in depressive episodes of bipolar disorder and in patients with thyrotoxicosis. Treatment of refractory bipolar disorder with supraphysiologic doses of levothyroxine (L-T4) has been shown to improve the phenotypic expression of the disorder and is associated with an increase of circulating thyroid hormones. However, it might be associated with somatic and mental adverse effects. Here we report the investigation of the influence of treatment with supraphysiologic doses of L-T4 on symptoms of anxiety in patients with refractory bipolar depression. Methods Post-hoc analysis from a 6-week, multi-center, randomized, double-blind, placebo-controlled study of the effects of supraphysiologic L-T4 treatment on anxiety symptoms in bipolar depression. Anxiety symptoms were measured weekly with the Hamilton anxiety/somatization factor (HASF) score of the Hamilton Depression Rating Scale (HAMD) and the State- and Trait Anxiety Inventory (STAI). Results Treatment of both groups was associated with a significant reduction in anxiety symptoms (p < 0.001) with no statistical difference between groups (LT-4: from 5.9 (SD = 2.0) at baseline to 3.7 (SD = 2.4) at study end; placebo: from 6.1 (SD = 2.4) at baseline to 4.4 (SD = 2.8) at study end; p = 0.717). Severity of anxiety at baseline did not show a statistically significant correlation to the antidepressive effect of treatment with supraphysiologic doses of L-T4 (p = 0.811). Gender did not show an influence on the reduction of anxiety symptoms (females: from 5.6 (SD = 1.7) at baseline to 3.5 (SD = 2.4) at study end; males: from 6.1 (SD = 2.3) at baseline to 4.0 (SD = 2.4) at study end; p = 0.877). Conclusions This study failed to detect a difference in change of anxiety between bipolar depressed patients treated with supraphysiologic doses of L-T4 or placebo. Comorbid anxiety symptoms should not be considered a limitation for the administration of supraphysiologic doses of L-T4 refractory bipolar depressed patients. Trial registration ClinicalTrials, ClinicalTrials.gov identifier: NCT01528839. Registered 2 June 2012—Retrospectively registered, https://clinicaltrials.gov/ct2/show/study/NCT01528839
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Affiliation(s)
- Maximilian Pilhatsch
- Department of Psychiatry and Psychotherapy, Medical Faculty, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany.
| | - Thomas J Stamm
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Department of Psychiatry, Psychotherapy and Psychosomatics, Brandenburg Medical School, Neuruppin, Germany
| | - Petra Stahl
- Psychiatrische Universitätsklinik der Charité, St. Hedwig-Krankenhaus, Berlin, Germany
| | - Ute Lewitzka
- Department of Psychiatry and Psychotherapy, Medical Faculty, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Anne Berghöfer
- Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Cathrin Sauer
- Department of Psychiatry and Psychotherapy, Medical Faculty, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Michael Gitlin
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Mark A Frye
- Department of Psychiatry & Psychology, Mayo Clinic Depression Center, Mayo Clinic, Rochester, MN, USA
| | - Peter C Whybrow
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Michael Bauer
- Department of Psychiatry and Psychotherapy, Medical Faculty, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany
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7
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Rote J, Dingelstadt AML, Aigner A, Bauer M, Fiebig J, König B, Kunze J, Pfeiffer S, Pfennig A, Quinlivan E, Simhandl C, Stamm TJ. Impulsivity predicts illness severity in long-term course of bipolar disorder: A prospective approach. Aust N Z J Psychiatry 2018; 52:876-886. [PMID: 29969910 DOI: 10.1177/0004867418783062] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 12/13/2022]
Abstract
BACKGROUND Bipolar disorder is a common, severe and chronic mental illness. Despite this, predictors of illness severity remain poorly understood. Impulsivity is reported to be associated with bipolar disorder and aggravating comorbidities. This study therefore sought to examine the predictive value of impulsivity for determining illness severity in euthymic bipolar disorder patients. METHODS Baseline trait impulsivity of 120 bipolar euthymic patients (81 bipolar disorder I [68%], 80 female [67%]) and 51 healthy controls was assessed using Barratt Impulsiveness Scale 11. The impact of impulsivity on illness severity (measured with morbidity index) was prospectively tested in 97 patients with sufficient follow-up data (average observation time: 54.4 weeks), using linear regression analysis. RESULTS Barratt Impulsiveness Scale 11 total (β = 0.01; p < 0.01) and in particular Barratt Impulsiveness Scale 11 attentional subscale scores (β = 0.04; p < 0.001) predicted illness severity in bipolar disorder, while controlling for other clinical variables. Only age at onset persisted as an additional, but less influential predictor. Barratt Impulsiveness Scale 11 total scores and Barratt Impulsiveness Scale 11 attentional subscale scores were significantly higher in euthymic patients compared to controls. This was not observed for the motor or non-planning subscale scores. LIMITATIONS The average year-long observation time might not be long enough to account for the chronic course of bipolar disorder. CONCLUSION Trait impulsivity and particularly attentional impulsivity in euthymic bipolar patients can be strong predictors of illness severity in bipolar disorder. Future studies should explore impulsivity as a risk assessment for morbidity and as a therapeutic target in bipolar disorder patients.
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Affiliation(s)
- Jonas Rote
- 1 Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Berlin, Germany.,2 Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Alice-Mai-Ly Dingelstadt
- 1 Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Berlin, Germany.,2 Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Annette Aigner
- 3 Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Bauer
- 2 Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Jana Fiebig
- 1 Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Berlin, Germany.,4 Department of Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - Barbara König
- 5 Department of Psychiatry and Psychotherapy, Landesklinikum Neunkirchen, Neunkirchen, Austria
| | | | - Steffi Pfeiffer
- 2 Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Andrea Pfennig
- 2 Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Esther Quinlivan
- 1 Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Christian Simhandl
- 7 Bipolar Center Wiener Neustadt, Vienna, Austria.,8 Sigmund Freud Privatuniversität Wien, Vienna, Austria
| | - Thomas J Stamm
- 1 Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Berlin, Germany.,4 Department of Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
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8
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Ricken R, Busche M, Schlattmann P, Himmerich H, Bopp S, Bschor T, Richter C, Stamm TJ, Heinz A, Hellweg R, Lang UE, Adli M. Cytokine serum levels remain unchanged during lithium augmentation of antidepressants in major depression. J Psychiatr Res 2018; 96:203-208. [PMID: 29101798 DOI: 10.1016/j.jpsychires.2017.10.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 04/12/2017] [Revised: 09/25/2017] [Accepted: 10/04/2017] [Indexed: 12/28/2022]
Abstract
Lithium augmentation (LA) of antidepressants is a first-line therapy in treatment-resistant depression. Immunomodulatory effects of lithium have been described. The cytokine hypothesis of depression postulates that cytokines play a key role in the pathophysiology of depression. Concordantly, it has been shown that proinflammatory cytokine serum levels decrease during antidepressant treatment. The aim of this study was to investigate changes in cytokine serum levels during LA. Serum concentrations of the cytokines interleukin (IL)-2, IL-4, IL-6, IL-8, IL-10, tumour necrosis factor alpha, interferon-gamma, granulocyte and monocyte colony stimulating factor were measured in a total of 95 acutely depressed patients before and after four weeks of LA. Changes in cytokine levels were corrected for the confounding factors severity of depression, treatment response, lithium serum level, gender, age and body mass index in a linear mixed-model analysis. We did not find a significant change in any of the measured cytokine serum levels during LA (p > 0.05). In conclusion, our study does not support the role of cytokine serum levels as a state marker in treatment of depression with LA.
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Affiliation(s)
- Roland Ricken
- Department of Psychiatry and Psychotherapy, Charité University Medicine Berlin, Campus Mitte, Berlin, Germany.
| | - Marlene Busche
- Department of Psychiatry and Psychotherapy, Charité University Medicine Berlin, Campus Mitte, Berlin, Germany
| | - Peter Schlattmann
- Department of Statistics, Informatics and Documentation, Friedrich-Schiller-Universität Jena, Jena, Germany
| | - Hubertus Himmerich
- Department of Psychiatry and Psychotherapy, University of Leipzig, Leipzig, Germany
| | - Sandra Bopp
- Department of Psychiatry and Psychotherapy, Charité University Medicine Berlin, Campus Mitte, Berlin, Germany
| | - Tom Bschor
- Department of Psychiatry, Schlosspark-Klinik Berlin, Berlin, Germany; Department of Psychiatry and Psychotherapy, Technical University of Dresden Medical School, Dresden, Germany
| | - Christoph Richter
- Department of Psychiatry and Psychotherapy, Charité University Medicine Berlin, Campus Mitte, Berlin, Germany; Department of Psychiatry and Psychotherapy, Vivantes Wenckebach Klinikum, Berlin, Germany; Department of Psychiatry and Psychotherapy, Vivantes Klinikum, Kaulsdorf, Berlin, Germany
| | - Thomas J Stamm
- Department of Psychiatry and Psychotherapy, Charité University Medicine Berlin, Campus Mitte, Berlin, Germany; Department of Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - Andreas Heinz
- Department of Psychiatry and Psychotherapy, Charité University Medicine Berlin, Campus Mitte, Berlin, Germany
| | - Rainer Hellweg
- Department of Psychiatry and Psychotherapy, Charité University Medicine Berlin, Campus Mitte, Berlin, Germany
| | - Undine E Lang
- Department of Psychiatry and Psychotherapy, University Psychiatric Clinics (UPK), Switzerland
| | - Mazda Adli
- Department of Psychiatry and Psychotherapy, Charité University Medicine Berlin, Campus Mitte, Berlin, Germany; Department of Psychiatry and Psychotherapy, Fliedner Klinik Berlin, Berlin, Germany
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9
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Reinbold CS, Forstner AJ, Hecker J, Fullerton JM, Hoffmann P, Hou L, Heilbronner U, Degenhardt F, Adli M, Akiyama K, Akula N, Ardau R, Arias B, Backlund L, Benabarre A, Bengesser S, Bhattacharjee AK, Biernacka JM, Birner A, Marie-Claire C, Cervantes P, Chen GB, Chen HC, Chillotti C, Clark SR, Colom F, Cousins DA, Cruceanu C, Czerski PM, Dayer A, Étain B, Falkai P, Frisén L, Gard S, Garnham JS, Goes FS, Grof P, Gruber O, Hashimoto R, Hauser J, Herms S, Jamain S, Jiménez E, Kahn JP, Kassem L, Kittel-Schneider S, Kliwicki S, König B, Kusumi I, Lackner N, Laje G, Landén M, Lavebratt C, Leboyer M, Leckband SG, López Jaramillo CA, MacQueen G, Manchia M, Martinsson L, Mattheisen M, McCarthy MJ, McElroy SL, Mitjans M, Mondimore FM, Monteleone P, Nievergelt CM, Ösby U, Ozaki N, Perlis RH, Pfennig A, Reich-Erkelenz D, Rouleau GA, Schofield PR, Schubert KO, Schweizer BW, Seemüller F, Severino G, Shekhtman T, Shilling PD, Shimoda K, Simhandl C, Slaney CM, Smoller JW, Squassina A, Stamm TJ, Stopkova P, Tighe SK, Tortorella A, Turecki G, Volkert J, Witt SH, Wright AJ, Young LT, Zandi PP, Potash JB, DePaulo JR, Bauer M, Reininghaus E, Novák T, Aubry JM, Maj M, Baune BT, Mitchell PB, Vieta E, Frye MA, Rybakowski JK, Kuo PH, Kato T, Grigoroiu-Serbanescu M, Reif A, Del Zompo M, Bellivier F, Schalling M, Wray NR, Kelsoe JR, Alda M, McMahon FJ, Schulze TG, Rietschel M, Nöthen MM, Cichon S. Analysis of the Influence of microRNAs in Lithium Response in Bipolar Disorder. Front Psychiatry 2018; 9:207. [PMID: 29904359 PMCID: PMC5991073 DOI: 10.3389/fpsyt.2018.00207] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [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: 02/09/2018] [Accepted: 05/03/2018] [Indexed: 12/30/2022] Open
Abstract
Bipolar disorder (BD) is a common, highly heritable neuropsychiatric disease characterized by recurrent episodes of mania and depression. Lithium is the best-established long-term treatment for BD, even though individual response is highly variable. Evidence suggests that some of this variability has a genetic basis. This is supported by the largest genome-wide association study (GWAS) of lithium response to date conducted by the International Consortium on Lithium Genetics (ConLiGen). Recently, we performed the first genome-wide analysis of the involvement of miRNAs in BD and identified nine BD-associated miRNAs. However, it is unknown whether these miRNAs are also associated with lithium response in BD. In the present study, we therefore tested whether common variants at these nine candidate miRNAs contribute to the variance in lithium response in BD. Furthermore, we systematically analyzed whether any other miRNA in the genome is implicated in the response to lithium. For this purpose, we performed gene-based tests for all known miRNA coding genes in the ConLiGen GWAS dataset (n = 2,563 patients) using a set-based testing approach adapted from the versatile gene-based test for GWAS (VEGAS2). In the candidate approach, miR-499a showed a nominally significant association with lithium response, providing some evidence for involvement in both development and treatment of BD. In the genome-wide miRNA analysis, 71 miRNAs showed nominally significant associations with the dichotomous phenotype and 106 with the continuous trait for treatment response. A total of 15 miRNAs revealed nominal significance in both phenotypes with miR-633 showing the strongest association with the continuous trait (p = 9.80E-04) and miR-607 with the dichotomous phenotype (p = 5.79E-04). No association between miRNAs and treatment response to lithium in BD in either of the tested conditions withstood multiple testing correction. Given the limited power of our study, the investigation of miRNAs in larger GWAS samples of BD and lithium response is warranted.
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Affiliation(s)
- Céline S Reinbold
- Human Genomics Research Group, Department of Biomedicine, University of Basel, Basel, Switzerland.,Institute of Medical Genetics and Pathology, University Hospital Basel, Basel, Switzerland
| | - Andreas J Forstner
- Human Genomics Research Group, Department of Biomedicine, University of Basel, Basel, Switzerland.,Institute of Medical Genetics and Pathology, University Hospital Basel, Basel, Switzerland.,Institute of Human Genetics, University of Bonn, Bonn, Germany.,Department of Genomics, Life & Brain Center, University of Bonn, Bonn, Germany.,Department of Psychiatry (UPK), University of Basel, Basel, Switzerland
| | - Julian Hecker
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Janice M Fullerton
- Neuroscience Research Australia, Sydney, NSW, Australia.,School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia
| | - Per Hoffmann
- Human Genomics Research Group, Department of Biomedicine, University of Basel, Basel, Switzerland.,Institute of Medical Genetics and Pathology, University Hospital Basel, Basel, Switzerland.,Institute of Human Genetics, University of Bonn, Bonn, Germany.,Department of Genomics, Life & Brain Center, University of Bonn, Bonn, Germany
| | - Liping Hou
- Intramural Research Program, US Department of Health & Human Services, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, United States
| | - Urs Heilbronner
- Department Psychiatry and Psychotherapy, Institute of Psychiatric Phenomics and Genomics, University Hospital, LMU Munich, Munich, Germany
| | - Franziska Degenhardt
- Institute of Human Genetics, University of Bonn, Bonn, Germany.,Department of Genomics, Life & Brain Center, University of Bonn, Bonn, Germany
| | - Mazda Adli
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin, Berlin, Germany
| | - Kazufumi Akiyama
- Department of Biological Psychiatry and Neuroscience, Dokkyo Medical University School of Medicine, Mibu, Japan
| | - Nirmala Akula
- Intramural Research Program, US Department of Health & Human Services, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, United States
| | - Raffaella Ardau
- Unit of Clinical Pharmacology, University Hospital of Cagliari, Cagliari, Italy
| | - Bárbara Arias
- Zoology and Biological Anthropology Section (Department of Evolutive Biology, Ecology and Environmental Sciences), Facultat de Biologia and Institut de Biomedicina, CIBERSAM, Universitat de Barcelona, Barcelona, Spain
| | - Lena Backlund
- Department of Molecular Medicine and Surgery, Karolinska Institutet and Center for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Antonio Benabarre
- Bipolar Disorder Program, Institute of Neuroscience, Hospital Clinic, CIBERSAM, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Susanne Bengesser
- Special Outpatient Center for Bipolar Affective Disorder, Medical University of Graz, Graz, Austria
| | | | - Joanna M Biernacka
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States.,Institut National de la Santé et de la Recherche Médicale, U1144, Paris, France
| | - Armin Birner
- Special Outpatient Center for Bipolar Affective Disorder, Medical University of Graz, Graz, Austria
| | - Cynthia Marie-Claire
- Université Paris Diderot, Sorbonne Paris Cité, UMR-S 1144, Paris, France.,Department of Psychiatry, University of California, San Diego, San Diego, CA, United States
| | - Pablo Cervantes
- The Neuromodulation Unit, McGill University Health Centre, Montreal, QC, Canada
| | - Guo-Bo Chen
- Queensland Brain Institute, The University of Queensland, Brisbane, QLD, Australia
| | - Hsi-Chung Chen
- Department of Psychiatry & Center of Sleep Disorders, National Taiwan University Hospital, Taipei, Taiwan
| | - Caterina Chillotti
- Unit of Clinical Pharmacology, University Hospital of Cagliari, Cagliari, Italy
| | - Scott R Clark
- Discipline of Psychiatry, University of Adelaide, Adelaide, SA, Australia
| | - Francesc Colom
- Mental Health Research Group, IMIM-Hospital del Mar, Barcelona, Spain
| | - David A Cousins
- Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Cristiana Cruceanu
- Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada
| | - Piotr M Czerski
- Psychiatric Genetic Unit, Poznan University of Medical Sciences, Poznan, Poland
| | - Alexandre Dayer
- Mood Disorders Unit, HUG - Geneva University Hospitals, Geneva, Switzerland
| | - Bruno Étain
- Université Paris Diderot, Sorbonne Paris Cité, UMR-S 1144, Paris, France.,Department of Psychiatry, University of California, San Diego, San Diego, CA, United States.,AP-HP, GH Saint-Louis - Lariboisière - F. Widal, Département de Psychiatrie et de Médecine Addictologique, Paris, France
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Louise Frisén
- Department of Molecular Medicine and Surgery, Karolinska Institutet and Center for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Sébastien Gard
- Service de Psychiatrie, Hôpital Charles Perrens, Bordeaux, France
| | - Julie S Garnham
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Fernando S Goes
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD, United States
| | - Paul Grof
- Mood Disorders Center of Ottawa, Ottawa, ON, Canada
| | - Oliver Gruber
- Department of Psychiatry and Psychotherapy, University Medical Center, Georg-August University Göttingen, Göttingen, Germany
| | - Ryota Hashimoto
- Molecular Research Center for Children's Mental Development, United Graduate School of Child Development, Osaka University, Osaka, Japan
| | - Joanna Hauser
- Psychiatric Genetic Unit, Poznan University of Medical Sciences, Poznan, Poland
| | - Stefan Herms
- Human Genomics Research Group, Department of Biomedicine, University of Basel, Basel, Switzerland.,Institute of Medical Genetics and Pathology, University Hospital Basel, Basel, Switzerland.,Institute of Human Genetics, University of Bonn, Bonn, Germany.,Department of Genomics, Life & Brain Center, University of Bonn, Bonn, Germany
| | - Stéphane Jamain
- Institut National de la Santé et de la Recherche Médicale U955, Psychiatrie Translationnelle, Créteil, France
| | - Esther Jiménez
- Bipolar Disorder Program, Institute of Neuroscience, Hospital Clinic, CIBERSAM, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Jean-Pierre Kahn
- Service de Psychiatrie et Psychologie Clinique, Centre Psychothérapique de Nancy - Université de Lorraine, Nancy, France
| | - Layla Kassem
- Intramural Research Program, US Department of Health & Human Services, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, United States
| | - Sarah Kittel-Schneider
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Frankfurt, Germany
| | - Sebastian Kliwicki
- Department of Adult Psychiatry, Poznan University of Medical Sciences, Poznan, Poland
| | - Barbara König
- Department of Psychiatry and Psychotherapeuthic Medicine, Landesklinikum Neunkirchen, Neunkirchen, Austria
| | - Ichiro Kusumi
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Nina Lackner
- Special Outpatient Center for Bipolar Affective Disorder, Medical University of Graz, Graz, Austria
| | - Gonzalo Laje
- Intramural Research Program, US Department of Health & Human Services, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, United States
| | - Mikael Landén
- Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the Gothenburg University, Gothenburg, Sweden.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Catharina Lavebratt
- Department of Molecular Medicine and Surgery, Karolinska Institutet and Center for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Marion Leboyer
- Assistance Publique-Hôpitaux de Paris, Hôpital Albert Chenevier - Henri Mondor, Pôle de Psychiatrie, Créteil, France
| | - Susan G Leckband
- Department of Pharmacy, VA San Diego Healthcare System, San Diego, CA, United States
| | | | - Glenda MacQueen
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Mirko Manchia
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Department of Pharmacology, Dalhousie University, Halifax, NS, Canada
| | - Lina Martinsson
- Department of Clinical Neurosciences, Karolinska Institutet, Stockholm, Sweden
| | | | - Michael J McCarthy
- Department of Psychiatry, VA San Diego Healthcare System, San Diego, CA, United States
| | - Susan L McElroy
- Department of Psychiatry, Lindner Center of Hope/University of Cincinnati, Mason, OH, United States
| | - Marina Mitjans
- Zoology and Biological Anthropology Section (Department of Evolutive Biology, Ecology and Environmental Sciences), Facultat de Biologia and Institut de Biomedicina, CIBERSAM, Universitat de Barcelona, Barcelona, Spain
| | - Francis M Mondimore
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD, United States
| | - Palmiero Monteleone
- Neurosciences Section, Department of Medicine and Surgery, University of Salerno, Salerno, Italy.,Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | | | - Urban Ösby
- Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet and Center for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Norio Ozaki
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Roy H Perlis
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Andrea Pfennig
- Department of Psychiatry and Psychotherapy, Medical Faculty, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Daniela Reich-Erkelenz
- Department Psychiatry and Psychotherapy, Institute of Psychiatric Phenomics and Genomics, University Hospital, LMU Munich, Munich, Germany
| | - Guy A Rouleau
- Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada
| | - Peter R Schofield
- School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia.,Mental Illness, Neuroscience Research Australia, Sydney, NSW, Australia
| | - K Oliver Schubert
- Discipline of Psychiatry, University of Adelaide, Adelaide, SA, Australia
| | - Barbara W Schweizer
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD, United States
| | - Florian Seemüller
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Giovanni Severino
- Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy
| | | | - Paul D Shilling
- Health Sciences Research, Mayo Clinic, Rochester, MN, United States
| | - Kazutaka Shimoda
- Department of Psychiatry, Dokkyo Medical University School of Medicine, Mibu, Japan
| | - Christian Simhandl
- Medical school, Sigmund Freud University, Vienna, Austria.,Bipolar Center Wiener Neustadt, Vienna, Austria
| | - Claire M Slaney
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Jordan W Smoller
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Alessio Squassina
- Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy
| | - Thomas J Stamm
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin, Berlin, Germany.,Department of Psychiatry, Psychotherapy and Psychosomatics, Medical School Brandenburg, Neuruppin, Germany
| | - Pavla Stopkova
- Department of Psychiatry, National Institute of Mental Health, Klecany, Czechia
| | - Sarah K Tighe
- Department of Psychiatry, University of Iowa, Iowa, IA, United States
| | - Alfonso Tortorella
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Gustavo Turecki
- Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada
| | - Julia Volkert
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Frankfurt, Germany
| | - Stephanie H Witt
- Department of Genetic Epidemiology in Psychiatry, Medical Faculty Mannheim, Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany
| | - Adam J Wright
- School of Psychiatry, University of New South Wales, and Black Dog Institute, Sydney, NSW, Australia
| | - L Trevor Young
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Peter P Zandi
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - James B Potash
- Department of Psychiatry, University of Iowa, Iowa, IA, United States
| | - J Raymond DePaulo
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD, United States
| | - Michael Bauer
- Department of Psychiatry and Psychotherapy, Medical Faculty, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Eva Reininghaus
- Special Outpatient Center for Bipolar Affective Disorder, Medical University of Graz, Graz, Austria
| | - Tomáš Novák
- Department of Psychiatry, National Institute of Mental Health, Klecany, Czechia
| | - Jean-Michel Aubry
- Mood Disorders Unit, HUG - Geneva University Hospitals, Geneva, Switzerland
| | - Mario Maj
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Bernhard T Baune
- Discipline of Psychiatry, University of Adelaide, Adelaide, SA, Australia
| | - Philip B Mitchell
- School of Psychiatry, University of New South Wales, and Black Dog Institute, Sydney, NSW, Australia
| | - Eduard Vieta
- Bipolar Disorder Program, Institute of Neuroscience, Hospital Clinic, CIBERSAM, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Mark A Frye
- Institut National de la Santé et de la Recherche Médicale, U1144, Paris, France
| | - Janusz K Rybakowski
- Department of Adult Psychiatry, Poznan University of Medical Sciences, Poznan, Poland
| | - Po-Hsiu Kuo
- Department of Public Health and Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan
| | - Tadafumi Kato
- Laboratory for Molecular Dynamics of Mental Disorders, RIKEN Brain Science Institute, Saitama, Japan
| | - Maria Grigoroiu-Serbanescu
- Biometric Psychiatric Genetics Research Unit, Alexandru Obregia Clinical Psychiatric Hospital, Bucharest, Romania
| | - Andreas Reif
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Frankfurt, Germany
| | - Maria Del Zompo
- Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy
| | - Frank Bellivier
- Université Paris Diderot, Sorbonne Paris Cité, UMR-S 1144, Paris, France.,Department of Psychiatry, University of California, San Diego, San Diego, CA, United States.,AP-HP, GH Saint-Louis - Lariboisière - F. Widal, Département de Psychiatrie et de Médecine Addictologique, Paris, France
| | - Martin Schalling
- Department of Molecular Medicine and Surgery, Karolinska Institutet and Center for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Naomi R Wray
- Queensland Brain Institute, The University of Queensland, Brisbane, QLD, Australia
| | - John R Kelsoe
- Health Sciences Research, Mayo Clinic, Rochester, MN, United States
| | - Martin Alda
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada.,Department of Psychiatry, National Institute of Mental Health, Klecany, Czechia
| | - Francis J McMahon
- Intramural Research Program, US Department of Health & Human Services, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, United States
| | - Thomas G Schulze
- Intramural Research Program, US Department of Health & Human Services, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, United States.,Department Psychiatry and Psychotherapy, Institute of Psychiatric Phenomics and Genomics, University Hospital, LMU Munich, Munich, Germany.,Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD, United States.,Department of Psychiatry and Psychotherapy, University Medical Center, Georg-August University Göttingen, Göttingen, Germany.,Department of Genetic Epidemiology in Psychiatry, Medical Faculty Mannheim, Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany
| | - Marcella Rietschel
- Department of Genetic Epidemiology in Psychiatry, Medical Faculty Mannheim, Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany
| | - Markus M Nöthen
- Institute of Human Genetics, University of Bonn, Bonn, Germany.,Department of Genomics, Life & Brain Center, University of Bonn, Bonn, Germany
| | - Sven Cichon
- Human Genomics Research Group, Department of Biomedicine, University of Basel, Basel, Switzerland.,Institute of Medical Genetics and Pathology, University Hospital Basel, Basel, Switzerland.,Institute of Human Genetics, University of Bonn, Bonn, Germany.,Department of Genomics, Life & Brain Center, University of Bonn, Bonn, Germany.,Research Centre Jülich, Institute of Neuroscience and Medicine (INM-1), Jülich, Germany
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Ricken R, Bopp S, Schlattmann P, Himmerich H, Bschor T, Richter C, Elstner S, Stamm TJ, Schulz-Ratei B, Lingesleben A, Reischies FM, Sterzer P, Borgwardt S, Bauer M, Heinz A, Hellweg R, Lang UE, Adli M. Ghrelin Serum Concentrations Are Associated with Treatment Response During Lithium Augmentation of Antidepressants. Int J Neuropsychopharmacol 2017; 20:692-697. [PMID: 28911006 PMCID: PMC5581484 DOI: 10.1093/ijnp/pyw082] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [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: 04/12/2016] [Accepted: 10/28/2016] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Lithium augmentation of antidepressants is an effective strategy in treatment-resistant depression. The proteohormone ghrelin is thought to be involved in the pathophysiology of depression. The purpose of this study was to investigate the association of treatment response with the course of ghrelin levels during lithium augmentation. METHOD Ghrelin serum concentrations and severity of depression were measured in 85 acute depressive patients before and after 4 weeks of lithium augmentation. RESULTS In a linear mixed model analysis, we found a significant effect of response*time interaction (F1.81=9.48; P=.0028): under treatment, ghrelin levels increased in nonresponders and slightly decreased in responders to lithium augmentation. The covariate female gender had a significant positive effect (F1.83=4.69; P=.033), whereas time, response, appetite, and body mass index (kg/m2) did not show any significant effect on ghrelin levels (P>.05). CONCLUSION This is the first study showing that the course of ghrelin levels separates responders and nonresponders to lithium augmentation. Present results support the hypothesis that ghrelin serum concentrations might be involved in response to pharmacological treatment of depression.
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Affiliation(s)
- Roland Ricken
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany (Drs Ricken, Bopp, Richter, Stamm, Sterzer, Heinz, Hellweg, and Adli); Department of Statistics, Informatics and Documentation, Friedrich-Schiller-Universität Jena, Jena, Germany (Dr Schlattmann); Department of Psychiatry and Psychotherapy, University of Leipzig, Leipzig, Germany (Dr Himmerich); King’s College London, London, Great Britain (Dr Himmerich); Department of Psychiatry and Psychotherapy, Schlosspark-Klinik Berlin, Berlin, Germany (Dr Bschor); Department of Psychiatry and Psychotherapy, Vivantes Wenckebach Klinikum, Berlin, Germany (Dr Richter); Vivantes Klinikum Kaulsdorf, Berlin, Germany (Dr Richter); Department of Psychiatry and Psychotherapy, Evangelisches Krankenhaus Königin Elisabeth Herzberge gGmbH, Berlin, Germany (Dr Elstner); Department of Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany (Dr Stamm); Department of Psychiatry and Psychotherapy, Fliedner Klinik Berlin, Berlin, Germany (Dr Schulz-Ratei); Department of Psychiatry and Psychotherapy, Vivantes Auguste-Viktoria-Klinikum, Berlin, Germany (Dr Lingesleben); Department of Psychiatry and Psychotherapy, Friedrich von Bodelschwingh-Klinik, Berlin, Germany (Dr Reischies); Department of Psychiatry and Psychotherapy, University Psychiatric Clinics (UPK), Switzerland (Drs Borgwardt and Lang); Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany (Drs Bauer and Bschor).,Correspondence: Roland Ricken, MD, Department of Psychiatry and Psychotherapy Charité – Universitätsmedizin Berlin, Campus Charité Mitte, Charitéplatz 1, 10117 Berlin, Germany ()
| | - Sandra Bopp
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany (Drs Ricken, Bopp, Richter, Stamm, Sterzer, Heinz, Hellweg, and Adli); Department of Statistics, Informatics and Documentation, Friedrich-Schiller-Universität Jena, Jena, Germany (Dr Schlattmann); Department of Psychiatry and Psychotherapy, University of Leipzig, Leipzig, Germany (Dr Himmerich); King’s College London, London, Great Britain (Dr Himmerich); Department of Psychiatry and Psychotherapy, Schlosspark-Klinik Berlin, Berlin, Germany (Dr Bschor); Department of Psychiatry and Psychotherapy, Vivantes Wenckebach Klinikum, Berlin, Germany (Dr Richter); Vivantes Klinikum Kaulsdorf, Berlin, Germany (Dr Richter); Department of Psychiatry and Psychotherapy, Evangelisches Krankenhaus Königin Elisabeth Herzberge gGmbH, Berlin, Germany (Dr Elstner); Department of Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany (Dr Stamm); Department of Psychiatry and Psychotherapy, Fliedner Klinik Berlin, Berlin, Germany (Dr Schulz-Ratei); Department of Psychiatry and Psychotherapy, Vivantes Auguste-Viktoria-Klinikum, Berlin, Germany (Dr Lingesleben); Department of Psychiatry and Psychotherapy, Friedrich von Bodelschwingh-Klinik, Berlin, Germany (Dr Reischies); Department of Psychiatry and Psychotherapy, University Psychiatric Clinics (UPK), Switzerland (Drs Borgwardt and Lang); Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany (Drs Bauer and Bschor)
| | - Peter Schlattmann
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany (Drs Ricken, Bopp, Richter, Stamm, Sterzer, Heinz, Hellweg, and Adli); Department of Statistics, Informatics and Documentation, Friedrich-Schiller-Universität Jena, Jena, Germany (Dr Schlattmann); Department of Psychiatry and Psychotherapy, University of Leipzig, Leipzig, Germany (Dr Himmerich); King’s College London, London, Great Britain (Dr Himmerich); Department of Psychiatry and Psychotherapy, Schlosspark-Klinik Berlin, Berlin, Germany (Dr Bschor); Department of Psychiatry and Psychotherapy, Vivantes Wenckebach Klinikum, Berlin, Germany (Dr Richter); Vivantes Klinikum Kaulsdorf, Berlin, Germany (Dr Richter); Department of Psychiatry and Psychotherapy, Evangelisches Krankenhaus Königin Elisabeth Herzberge gGmbH, Berlin, Germany (Dr Elstner); Department of Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany (Dr Stamm); Department of Psychiatry and Psychotherapy, Fliedner Klinik Berlin, Berlin, Germany (Dr Schulz-Ratei); Department of Psychiatry and Psychotherapy, Vivantes Auguste-Viktoria-Klinikum, Berlin, Germany (Dr Lingesleben); Department of Psychiatry and Psychotherapy, Friedrich von Bodelschwingh-Klinik, Berlin, Germany (Dr Reischies); Department of Psychiatry and Psychotherapy, University Psychiatric Clinics (UPK), Switzerland (Drs Borgwardt and Lang); Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany (Drs Bauer and Bschor)
| | - Hubertus Himmerich
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany (Drs Ricken, Bopp, Richter, Stamm, Sterzer, Heinz, Hellweg, and Adli); Department of Statistics, Informatics and Documentation, Friedrich-Schiller-Universität Jena, Jena, Germany (Dr Schlattmann); Department of Psychiatry and Psychotherapy, University of Leipzig, Leipzig, Germany (Dr Himmerich); King’s College London, London, Great Britain (Dr Himmerich); Department of Psychiatry and Psychotherapy, Schlosspark-Klinik Berlin, Berlin, Germany (Dr Bschor); Department of Psychiatry and Psychotherapy, Vivantes Wenckebach Klinikum, Berlin, Germany (Dr Richter); Vivantes Klinikum Kaulsdorf, Berlin, Germany (Dr Richter); Department of Psychiatry and Psychotherapy, Evangelisches Krankenhaus Königin Elisabeth Herzberge gGmbH, Berlin, Germany (Dr Elstner); Department of Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany (Dr Stamm); Department of Psychiatry and Psychotherapy, Fliedner Klinik Berlin, Berlin, Germany (Dr Schulz-Ratei); Department of Psychiatry and Psychotherapy, Vivantes Auguste-Viktoria-Klinikum, Berlin, Germany (Dr Lingesleben); Department of Psychiatry and Psychotherapy, Friedrich von Bodelschwingh-Klinik, Berlin, Germany (Dr Reischies); Department of Psychiatry and Psychotherapy, University Psychiatric Clinics (UPK), Switzerland (Drs Borgwardt and Lang); Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany (Drs Bauer and Bschor)
| | - Tom Bschor
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany (Drs Ricken, Bopp, Richter, Stamm, Sterzer, Heinz, Hellweg, and Adli); Department of Statistics, Informatics and Documentation, Friedrich-Schiller-Universität Jena, Jena, Germany (Dr Schlattmann); Department of Psychiatry and Psychotherapy, University of Leipzig, Leipzig, Germany (Dr Himmerich); King’s College London, London, Great Britain (Dr Himmerich); Department of Psychiatry and Psychotherapy, Schlosspark-Klinik Berlin, Berlin, Germany (Dr Bschor); Department of Psychiatry and Psychotherapy, Vivantes Wenckebach Klinikum, Berlin, Germany (Dr Richter); Vivantes Klinikum Kaulsdorf, Berlin, Germany (Dr Richter); Department of Psychiatry and Psychotherapy, Evangelisches Krankenhaus Königin Elisabeth Herzberge gGmbH, Berlin, Germany (Dr Elstner); Department of Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany (Dr Stamm); Department of Psychiatry and Psychotherapy, Fliedner Klinik Berlin, Berlin, Germany (Dr Schulz-Ratei); Department of Psychiatry and Psychotherapy, Vivantes Auguste-Viktoria-Klinikum, Berlin, Germany (Dr Lingesleben); Department of Psychiatry and Psychotherapy, Friedrich von Bodelschwingh-Klinik, Berlin, Germany (Dr Reischies); Department of Psychiatry and Psychotherapy, University Psychiatric Clinics (UPK), Switzerland (Drs Borgwardt and Lang); Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany (Drs Bauer and Bschor)
| | - Christoph Richter
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany (Drs Ricken, Bopp, Richter, Stamm, Sterzer, Heinz, Hellweg, and Adli); Department of Statistics, Informatics and Documentation, Friedrich-Schiller-Universität Jena, Jena, Germany (Dr Schlattmann); Department of Psychiatry and Psychotherapy, University of Leipzig, Leipzig, Germany (Dr Himmerich); King’s College London, London, Great Britain (Dr Himmerich); Department of Psychiatry and Psychotherapy, Schlosspark-Klinik Berlin, Berlin, Germany (Dr Bschor); Department of Psychiatry and Psychotherapy, Vivantes Wenckebach Klinikum, Berlin, Germany (Dr Richter); Vivantes Klinikum Kaulsdorf, Berlin, Germany (Dr Richter); Department of Psychiatry and Psychotherapy, Evangelisches Krankenhaus Königin Elisabeth Herzberge gGmbH, Berlin, Germany (Dr Elstner); Department of Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany (Dr Stamm); Department of Psychiatry and Psychotherapy, Fliedner Klinik Berlin, Berlin, Germany (Dr Schulz-Ratei); Department of Psychiatry and Psychotherapy, Vivantes Auguste-Viktoria-Klinikum, Berlin, Germany (Dr Lingesleben); Department of Psychiatry and Psychotherapy, Friedrich von Bodelschwingh-Klinik, Berlin, Germany (Dr Reischies); Department of Psychiatry and Psychotherapy, University Psychiatric Clinics (UPK), Switzerland (Drs Borgwardt and Lang); Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany (Drs Bauer and Bschor)
| | - Samuel Elstner
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany (Drs Ricken, Bopp, Richter, Stamm, Sterzer, Heinz, Hellweg, and Adli); Department of Statistics, Informatics and Documentation, Friedrich-Schiller-Universität Jena, Jena, Germany (Dr Schlattmann); Department of Psychiatry and Psychotherapy, University of Leipzig, Leipzig, Germany (Dr Himmerich); King’s College London, London, Great Britain (Dr Himmerich); Department of Psychiatry and Psychotherapy, Schlosspark-Klinik Berlin, Berlin, Germany (Dr Bschor); Department of Psychiatry and Psychotherapy, Vivantes Wenckebach Klinikum, Berlin, Germany (Dr Richter); Vivantes Klinikum Kaulsdorf, Berlin, Germany (Dr Richter); Department of Psychiatry and Psychotherapy, Evangelisches Krankenhaus Königin Elisabeth Herzberge gGmbH, Berlin, Germany (Dr Elstner); Department of Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany (Dr Stamm); Department of Psychiatry and Psychotherapy, Fliedner Klinik Berlin, Berlin, Germany (Dr Schulz-Ratei); Department of Psychiatry and Psychotherapy, Vivantes Auguste-Viktoria-Klinikum, Berlin, Germany (Dr Lingesleben); Department of Psychiatry and Psychotherapy, Friedrich von Bodelschwingh-Klinik, Berlin, Germany (Dr Reischies); Department of Psychiatry and Psychotherapy, University Psychiatric Clinics (UPK), Switzerland (Drs Borgwardt and Lang); Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany (Drs Bauer and Bschor)
| | - Thomas J Stamm
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany (Drs Ricken, Bopp, Richter, Stamm, Sterzer, Heinz, Hellweg, and Adli); Department of Statistics, Informatics and Documentation, Friedrich-Schiller-Universität Jena, Jena, Germany (Dr Schlattmann); Department of Psychiatry and Psychotherapy, University of Leipzig, Leipzig, Germany (Dr Himmerich); King’s College London, London, Great Britain (Dr Himmerich); Department of Psychiatry and Psychotherapy, Schlosspark-Klinik Berlin, Berlin, Germany (Dr Bschor); Department of Psychiatry and Psychotherapy, Vivantes Wenckebach Klinikum, Berlin, Germany (Dr Richter); Vivantes Klinikum Kaulsdorf, Berlin, Germany (Dr Richter); Department of Psychiatry and Psychotherapy, Evangelisches Krankenhaus Königin Elisabeth Herzberge gGmbH, Berlin, Germany (Dr Elstner); Department of Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany (Dr Stamm); Department of Psychiatry and Psychotherapy, Fliedner Klinik Berlin, Berlin, Germany (Dr Schulz-Ratei); Department of Psychiatry and Psychotherapy, Vivantes Auguste-Viktoria-Klinikum, Berlin, Germany (Dr Lingesleben); Department of Psychiatry and Psychotherapy, Friedrich von Bodelschwingh-Klinik, Berlin, Germany (Dr Reischies); Department of Psychiatry and Psychotherapy, University Psychiatric Clinics (UPK), Switzerland (Drs Borgwardt and Lang); Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany (Drs Bauer and Bschor)
| | - Brigitte Schulz-Ratei
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany (Drs Ricken, Bopp, Richter, Stamm, Sterzer, Heinz, Hellweg, and Adli); Department of Statistics, Informatics and Documentation, Friedrich-Schiller-Universität Jena, Jena, Germany (Dr Schlattmann); Department of Psychiatry and Psychotherapy, University of Leipzig, Leipzig, Germany (Dr Himmerich); King’s College London, London, Great Britain (Dr Himmerich); Department of Psychiatry and Psychotherapy, Schlosspark-Klinik Berlin, Berlin, Germany (Dr Bschor); Department of Psychiatry and Psychotherapy, Vivantes Wenckebach Klinikum, Berlin, Germany (Dr Richter); Vivantes Klinikum Kaulsdorf, Berlin, Germany (Dr Richter); Department of Psychiatry and Psychotherapy, Evangelisches Krankenhaus Königin Elisabeth Herzberge gGmbH, Berlin, Germany (Dr Elstner); Department of Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany (Dr Stamm); Department of Psychiatry and Psychotherapy, Fliedner Klinik Berlin, Berlin, Germany (Dr Schulz-Ratei); Department of Psychiatry and Psychotherapy, Vivantes Auguste-Viktoria-Klinikum, Berlin, Germany (Dr Lingesleben); Department of Psychiatry and Psychotherapy, Friedrich von Bodelschwingh-Klinik, Berlin, Germany (Dr Reischies); Department of Psychiatry and Psychotherapy, University Psychiatric Clinics (UPK), Switzerland (Drs Borgwardt and Lang); Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany (Drs Bauer and Bschor)
| | - Alexandra Lingesleben
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany (Drs Ricken, Bopp, Richter, Stamm, Sterzer, Heinz, Hellweg, and Adli); Department of Statistics, Informatics and Documentation, Friedrich-Schiller-Universität Jena, Jena, Germany (Dr Schlattmann); Department of Psychiatry and Psychotherapy, University of Leipzig, Leipzig, Germany (Dr Himmerich); King’s College London, London, Great Britain (Dr Himmerich); Department of Psychiatry and Psychotherapy, Schlosspark-Klinik Berlin, Berlin, Germany (Dr Bschor); Department of Psychiatry and Psychotherapy, Vivantes Wenckebach Klinikum, Berlin, Germany (Dr Richter); Vivantes Klinikum Kaulsdorf, Berlin, Germany (Dr Richter); Department of Psychiatry and Psychotherapy, Evangelisches Krankenhaus Königin Elisabeth Herzberge gGmbH, Berlin, Germany (Dr Elstner); Department of Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany (Dr Stamm); Department of Psychiatry and Psychotherapy, Fliedner Klinik Berlin, Berlin, Germany (Dr Schulz-Ratei); Department of Psychiatry and Psychotherapy, Vivantes Auguste-Viktoria-Klinikum, Berlin, Germany (Dr Lingesleben); Department of Psychiatry and Psychotherapy, Friedrich von Bodelschwingh-Klinik, Berlin, Germany (Dr Reischies); Department of Psychiatry and Psychotherapy, University Psychiatric Clinics (UPK), Switzerland (Drs Borgwardt and Lang); Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany (Drs Bauer and Bschor)
| | - Friedel M Reischies
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany (Drs Ricken, Bopp, Richter, Stamm, Sterzer, Heinz, Hellweg, and Adli); Department of Statistics, Informatics and Documentation, Friedrich-Schiller-Universität Jena, Jena, Germany (Dr Schlattmann); Department of Psychiatry and Psychotherapy, University of Leipzig, Leipzig, Germany (Dr Himmerich); King’s College London, London, Great Britain (Dr Himmerich); Department of Psychiatry and Psychotherapy, Schlosspark-Klinik Berlin, Berlin, Germany (Dr Bschor); Department of Psychiatry and Psychotherapy, Vivantes Wenckebach Klinikum, Berlin, Germany (Dr Richter); Vivantes Klinikum Kaulsdorf, Berlin, Germany (Dr Richter); Department of Psychiatry and Psychotherapy, Evangelisches Krankenhaus Königin Elisabeth Herzberge gGmbH, Berlin, Germany (Dr Elstner); Department of Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany (Dr Stamm); Department of Psychiatry and Psychotherapy, Fliedner Klinik Berlin, Berlin, Germany (Dr Schulz-Ratei); Department of Psychiatry and Psychotherapy, Vivantes Auguste-Viktoria-Klinikum, Berlin, Germany (Dr Lingesleben); Department of Psychiatry and Psychotherapy, Friedrich von Bodelschwingh-Klinik, Berlin, Germany (Dr Reischies); Department of Psychiatry and Psychotherapy, University Psychiatric Clinics (UPK), Switzerland (Drs Borgwardt and Lang); Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany (Drs Bauer and Bschor)
| | - Philipp Sterzer
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany (Drs Ricken, Bopp, Richter, Stamm, Sterzer, Heinz, Hellweg, and Adli); Department of Statistics, Informatics and Documentation, Friedrich-Schiller-Universität Jena, Jena, Germany (Dr Schlattmann); Department of Psychiatry and Psychotherapy, University of Leipzig, Leipzig, Germany (Dr Himmerich); King’s College London, London, Great Britain (Dr Himmerich); Department of Psychiatry and Psychotherapy, Schlosspark-Klinik Berlin, Berlin, Germany (Dr Bschor); Department of Psychiatry and Psychotherapy, Vivantes Wenckebach Klinikum, Berlin, Germany (Dr Richter); Vivantes Klinikum Kaulsdorf, Berlin, Germany (Dr Richter); Department of Psychiatry and Psychotherapy, Evangelisches Krankenhaus Königin Elisabeth Herzberge gGmbH, Berlin, Germany (Dr Elstner); Department of Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany (Dr Stamm); Department of Psychiatry and Psychotherapy, Fliedner Klinik Berlin, Berlin, Germany (Dr Schulz-Ratei); Department of Psychiatry and Psychotherapy, Vivantes Auguste-Viktoria-Klinikum, Berlin, Germany (Dr Lingesleben); Department of Psychiatry and Psychotherapy, Friedrich von Bodelschwingh-Klinik, Berlin, Germany (Dr Reischies); Department of Psychiatry and Psychotherapy, University Psychiatric Clinics (UPK), Switzerland (Drs Borgwardt and Lang); Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany (Drs Bauer and Bschor)
| | - Stefan Borgwardt
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany (Drs Ricken, Bopp, Richter, Stamm, Sterzer, Heinz, Hellweg, and Adli); Department of Statistics, Informatics and Documentation, Friedrich-Schiller-Universität Jena, Jena, Germany (Dr Schlattmann); Department of Psychiatry and Psychotherapy, University of Leipzig, Leipzig, Germany (Dr Himmerich); King’s College London, London, Great Britain (Dr Himmerich); Department of Psychiatry and Psychotherapy, Schlosspark-Klinik Berlin, Berlin, Germany (Dr Bschor); Department of Psychiatry and Psychotherapy, Vivantes Wenckebach Klinikum, Berlin, Germany (Dr Richter); Vivantes Klinikum Kaulsdorf, Berlin, Germany (Dr Richter); Department of Psychiatry and Psychotherapy, Evangelisches Krankenhaus Königin Elisabeth Herzberge gGmbH, Berlin, Germany (Dr Elstner); Department of Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany (Dr Stamm); Department of Psychiatry and Psychotherapy, Fliedner Klinik Berlin, Berlin, Germany (Dr Schulz-Ratei); Department of Psychiatry and Psychotherapy, Vivantes Auguste-Viktoria-Klinikum, Berlin, Germany (Dr Lingesleben); Department of Psychiatry and Psychotherapy, Friedrich von Bodelschwingh-Klinik, Berlin, Germany (Dr Reischies); Department of Psychiatry and Psychotherapy, University Psychiatric Clinics (UPK), Switzerland (Drs Borgwardt and Lang); Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany (Drs Bauer and Bschor)
| | - Michael Bauer
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany (Drs Ricken, Bopp, Richter, Stamm, Sterzer, Heinz, Hellweg, and Adli); Department of Statistics, Informatics and Documentation, Friedrich-Schiller-Universität Jena, Jena, Germany (Dr Schlattmann); Department of Psychiatry and Psychotherapy, University of Leipzig, Leipzig, Germany (Dr Himmerich); King’s College London, London, Great Britain (Dr Himmerich); Department of Psychiatry and Psychotherapy, Schlosspark-Klinik Berlin, Berlin, Germany (Dr Bschor); Department of Psychiatry and Psychotherapy, Vivantes Wenckebach Klinikum, Berlin, Germany (Dr Richter); Vivantes Klinikum Kaulsdorf, Berlin, Germany (Dr Richter); Department of Psychiatry and Psychotherapy, Evangelisches Krankenhaus Königin Elisabeth Herzberge gGmbH, Berlin, Germany (Dr Elstner); Department of Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany (Dr Stamm); Department of Psychiatry and Psychotherapy, Fliedner Klinik Berlin, Berlin, Germany (Dr Schulz-Ratei); Department of Psychiatry and Psychotherapy, Vivantes Auguste-Viktoria-Klinikum, Berlin, Germany (Dr Lingesleben); Department of Psychiatry and Psychotherapy, Friedrich von Bodelschwingh-Klinik, Berlin, Germany (Dr Reischies); Department of Psychiatry and Psychotherapy, University Psychiatric Clinics (UPK), Switzerland (Drs Borgwardt and Lang); Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany (Drs Bauer and Bschor)
| | - Andreas Heinz
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany (Drs Ricken, Bopp, Richter, Stamm, Sterzer, Heinz, Hellweg, and Adli); Department of Statistics, Informatics and Documentation, Friedrich-Schiller-Universität Jena, Jena, Germany (Dr Schlattmann); Department of Psychiatry and Psychotherapy, University of Leipzig, Leipzig, Germany (Dr Himmerich); King’s College London, London, Great Britain (Dr Himmerich); Department of Psychiatry and Psychotherapy, Schlosspark-Klinik Berlin, Berlin, Germany (Dr Bschor); Department of Psychiatry and Psychotherapy, Vivantes Wenckebach Klinikum, Berlin, Germany (Dr Richter); Vivantes Klinikum Kaulsdorf, Berlin, Germany (Dr Richter); Department of Psychiatry and Psychotherapy, Evangelisches Krankenhaus Königin Elisabeth Herzberge gGmbH, Berlin, Germany (Dr Elstner); Department of Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany (Dr Stamm); Department of Psychiatry and Psychotherapy, Fliedner Klinik Berlin, Berlin, Germany (Dr Schulz-Ratei); Department of Psychiatry and Psychotherapy, Vivantes Auguste-Viktoria-Klinikum, Berlin, Germany (Dr Lingesleben); Department of Psychiatry and Psychotherapy, Friedrich von Bodelschwingh-Klinik, Berlin, Germany (Dr Reischies); Department of Psychiatry and Psychotherapy, University Psychiatric Clinics (UPK), Switzerland (Drs Borgwardt and Lang); Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany (Drs Bauer and Bschor)
| | - Rainer Hellweg
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany (Drs Ricken, Bopp, Richter, Stamm, Sterzer, Heinz, Hellweg, and Adli); Department of Statistics, Informatics and Documentation, Friedrich-Schiller-Universität Jena, Jena, Germany (Dr Schlattmann); Department of Psychiatry and Psychotherapy, University of Leipzig, Leipzig, Germany (Dr Himmerich); King’s College London, London, Great Britain (Dr Himmerich); Department of Psychiatry and Psychotherapy, Schlosspark-Klinik Berlin, Berlin, Germany (Dr Bschor); Department of Psychiatry and Psychotherapy, Vivantes Wenckebach Klinikum, Berlin, Germany (Dr Richter); Vivantes Klinikum Kaulsdorf, Berlin, Germany (Dr Richter); Department of Psychiatry and Psychotherapy, Evangelisches Krankenhaus Königin Elisabeth Herzberge gGmbH, Berlin, Germany (Dr Elstner); Department of Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany (Dr Stamm); Department of Psychiatry and Psychotherapy, Fliedner Klinik Berlin, Berlin, Germany (Dr Schulz-Ratei); Department of Psychiatry and Psychotherapy, Vivantes Auguste-Viktoria-Klinikum, Berlin, Germany (Dr Lingesleben); Department of Psychiatry and Psychotherapy, Friedrich von Bodelschwingh-Klinik, Berlin, Germany (Dr Reischies); Department of Psychiatry and Psychotherapy, University Psychiatric Clinics (UPK), Switzerland (Drs Borgwardt and Lang); Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany (Drs Bauer and Bschor)
| | - Undine E Lang
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany (Drs Ricken, Bopp, Richter, Stamm, Sterzer, Heinz, Hellweg, and Adli); Department of Statistics, Informatics and Documentation, Friedrich-Schiller-Universität Jena, Jena, Germany (Dr Schlattmann); Department of Psychiatry and Psychotherapy, University of Leipzig, Leipzig, Germany (Dr Himmerich); King’s College London, London, Great Britain (Dr Himmerich); Department of Psychiatry and Psychotherapy, Schlosspark-Klinik Berlin, Berlin, Germany (Dr Bschor); Department of Psychiatry and Psychotherapy, Vivantes Wenckebach Klinikum, Berlin, Germany (Dr Richter); Vivantes Klinikum Kaulsdorf, Berlin, Germany (Dr Richter); Department of Psychiatry and Psychotherapy, Evangelisches Krankenhaus Königin Elisabeth Herzberge gGmbH, Berlin, Germany (Dr Elstner); Department of Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany (Dr Stamm); Department of Psychiatry and Psychotherapy, Fliedner Klinik Berlin, Berlin, Germany (Dr Schulz-Ratei); Department of Psychiatry and Psychotherapy, Vivantes Auguste-Viktoria-Klinikum, Berlin, Germany (Dr Lingesleben); Department of Psychiatry and Psychotherapy, Friedrich von Bodelschwingh-Klinik, Berlin, Germany (Dr Reischies); Department of Psychiatry and Psychotherapy, University Psychiatric Clinics (UPK), Switzerland (Drs Borgwardt and Lang); Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany (Drs Bauer and Bschor)
| | - Mazda Adli
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany (Drs Ricken, Bopp, Richter, Stamm, Sterzer, Heinz, Hellweg, and Adli); Department of Statistics, Informatics and Documentation, Friedrich-Schiller-Universität Jena, Jena, Germany (Dr Schlattmann); Department of Psychiatry and Psychotherapy, University of Leipzig, Leipzig, Germany (Dr Himmerich); King’s College London, London, Great Britain (Dr Himmerich); Department of Psychiatry and Psychotherapy, Schlosspark-Klinik Berlin, Berlin, Germany (Dr Bschor); Department of Psychiatry and Psychotherapy, Vivantes Wenckebach Klinikum, Berlin, Germany (Dr Richter); Vivantes Klinikum Kaulsdorf, Berlin, Germany (Dr Richter); Department of Psychiatry and Psychotherapy, Evangelisches Krankenhaus Königin Elisabeth Herzberge gGmbH, Berlin, Germany (Dr Elstner); Department of Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany (Dr Stamm); Department of Psychiatry and Psychotherapy, Fliedner Klinik Berlin, Berlin, Germany (Dr Schulz-Ratei); Department of Psychiatry and Psychotherapy, Vivantes Auguste-Viktoria-Klinikum, Berlin, Germany (Dr Lingesleben); Department of Psychiatry and Psychotherapy, Friedrich von Bodelschwingh-Klinik, Berlin, Germany (Dr Reischies); Department of Psychiatry and Psychotherapy, University Psychiatric Clinics (UPK), Switzerland (Drs Borgwardt and Lang); Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany (Drs Bauer and Bschor)
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Adli M, Wiethoff K, Baghai TC, Fisher R, Seemüller F, Laakmann G, Brieger P, Cordes J, Malevani J, Laux G, Hauth I, Möller HJ, Kronmüller KT, Smolka MN, Schlattmann P, Berger M, Ricken R, Stamm TJ, Heinz A, Bauer M. How Effective Is Algorithm-Guided Treatment for Depressed Inpatients? Results from the Randomized Controlled Multicenter German Algorithm Project 3 Trial. Int J Neuropsychopharmacol 2017; 20. [PMID: 28645191 PMCID: PMC5581493 DOI: 10.1093/ijnp/pyx043] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [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] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Treatment algorithms are considered as key to improve outcomes by enhancing the quality of care. This is the first randomized controlled study to evaluate the clinical effect of algorithm-guided treatment in inpatients with major depressive disorder. METHODS Inpatients, aged 18 to 70 years with major depressive disorder from 10 German psychiatric departments were randomized to 5 different treatment arms (from 2000 to 2005), 3 of which were standardized stepwise drug treatment algorithms (ALGO). The fourth arm proposed medications and provided less specific recommendations based on a computerized documentation and expert system (CDES), the fifth arm received treatment as usual (TAU). ALGO included 3 different second-step strategies: lithium augmentation (ALGO LA), antidepressant dose-escalation (ALGO DE), and switch to a different antidepressant (ALGO SW). Time to remission (21-item Hamilton Depression Rating Scale ≤9) was the primary outcome. RESULTS Time to remission was significantly shorter for ALGO DE (n=91) compared with both TAU (n=84) (HR=1.67; P=.014) and CDES (n=79) (HR=1.59; P=.031) and ALGO SW (n=89) compared with both TAU (HR=1.64; P=.018) and CDES (HR=1.56; P=.038). For both ALGO LA (n=86) and ALGO DE, fewer antidepressant medications were needed to achieve remission than for CDES or TAU (P<.001). Remission rates at discharge differed across groups; ALGO DE had the highest (89.2%) and TAU the lowest rates (66.2%). CONCLUSIONS A highly structured algorithm-guided treatment is associated with shorter times and fewer medication changes to achieve remission with depressed inpatients than treatment as usual or computerized medication choice guidance.
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Affiliation(s)
- Mazda Adli
- Charité – Universitätsmedizin Berlin, Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Berlin, Germany (Drs Adli, Wiethoff, Mr Berger, Ricken, Stamm, and Heinz); Universität Regensburg, Department of Psychiatry and Psychotherapy, Regensburg, Germany (Dr Baghai); East London NHS Foundation Trust, City and Hackney Centre for Mental Health, Donald Winnicott Centre, London, United Kingdom (Dr Fisher); kbo-Lech-Mangfall-Klinik Garmisch-Partenkirchen, Department of Psychiatry and Psychotherapy, Garmisch-Partenkirchen, Germany (Dr Seemüller); Ludwig-Maximilians-Universität, Department of Psychiatry and Psychotherapy, München, Germany (Drs Laakmann and Möller); kbo-Isar-Amper-Klinikum, Department of Psychiatry and Psychotherapy, München, Germany (Dr Brieger); Heinrich-Heine-Universität Düsseldorf, Department of Psychiatry and Psychotherapy, Düsseldorf, Germany (Drs Cordes and Malevani); Institut für Psychologische Medizin, Haag, Germany (Dr Laux); St. Joseph-Krankenhaus, Department of Psychiatry and Psychotherapy, Berlin, Germany (Dr Hauth); LWL-Klinikum Gütersloh, Department of Psychiatry and Psychotherapy, Gütersloh, Germany (Dr Kronmüller); Universitätsklinikum Carl Gustav Carus, Department of Psychiatry and Psychotherapy, Technische Universität Dresden, Dresden, Germany (Dr Smolka); Jena University Hospital, Department of Medical Statistics, Informatics and Documentation, Friedrich-Schiller-Universität Jena, Jena, Germany (Dr Schlattmann); Fliedner Klinik Berlin, Center for Psychiatry, Psychotherapy and Psychosomatic Medicine (Dr Adli).,Correspondence: Mazda Adli, MD, Charité – Universitätsmedizin Berlin, Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charitéplatz 1, 10117 Berlin, Germany ()
| | - Katja Wiethoff
- Charité – Universitätsmedizin Berlin, Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Berlin, Germany (Drs Adli, Wiethoff, Mr Berger, Ricken, Stamm, and Heinz); Universität Regensburg, Department of Psychiatry and Psychotherapy, Regensburg, Germany (Dr Baghai); East London NHS Foundation Trust, City and Hackney Centre for Mental Health, Donald Winnicott Centre, London, United Kingdom (Dr Fisher); kbo-Lech-Mangfall-Klinik Garmisch-Partenkirchen, Department of Psychiatry and Psychotherapy, Garmisch-Partenkirchen, Germany (Dr Seemüller); Ludwig-Maximilians-Universität, Department of Psychiatry and Psychotherapy, München, Germany (Drs Laakmann and Möller); kbo-Isar-Amper-Klinikum, Department of Psychiatry and Psychotherapy, München, Germany (Dr Brieger); Heinrich-Heine-Universität Düsseldorf, Department of Psychiatry and Psychotherapy, Düsseldorf, Germany (Drs Cordes and Malevani); Institut für Psychologische Medizin, Haag, Germany (Dr Laux); St. Joseph-Krankenhaus, Department of Psychiatry and Psychotherapy, Berlin, Germany (Dr Hauth); LWL-Klinikum Gütersloh, Department of Psychiatry and Psychotherapy, Gütersloh, Germany (Dr Kronmüller); Universitätsklinikum Carl Gustav Carus, Department of Psychiatry and Psychotherapy, Technische Universität Dresden, Dresden, Germany (Dr Smolka); Jena University Hospital, Department of Medical Statistics, Informatics and Documentation, Friedrich-Schiller-Universität Jena, Jena, Germany (Dr Schlattmann); Fliedner Klinik Berlin, Center for Psychiatry, Psychotherapy and Psychosomatic Medicine (Dr Adli)
| | - Thomas C Baghai
- Charité – Universitätsmedizin Berlin, Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Berlin, Germany (Drs Adli, Wiethoff, Mr Berger, Ricken, Stamm, and Heinz); Universität Regensburg, Department of Psychiatry and Psychotherapy, Regensburg, Germany (Dr Baghai); East London NHS Foundation Trust, City and Hackney Centre for Mental Health, Donald Winnicott Centre, London, United Kingdom (Dr Fisher); kbo-Lech-Mangfall-Klinik Garmisch-Partenkirchen, Department of Psychiatry and Psychotherapy, Garmisch-Partenkirchen, Germany (Dr Seemüller); Ludwig-Maximilians-Universität, Department of Psychiatry and Psychotherapy, München, Germany (Drs Laakmann and Möller); kbo-Isar-Amper-Klinikum, Department of Psychiatry and Psychotherapy, München, Germany (Dr Brieger); Heinrich-Heine-Universität Düsseldorf, Department of Psychiatry and Psychotherapy, Düsseldorf, Germany (Drs Cordes and Malevani); Institut für Psychologische Medizin, Haag, Germany (Dr Laux); St. Joseph-Krankenhaus, Department of Psychiatry and Psychotherapy, Berlin, Germany (Dr Hauth); LWL-Klinikum Gütersloh, Department of Psychiatry and Psychotherapy, Gütersloh, Germany (Dr Kronmüller); Universitätsklinikum Carl Gustav Carus, Department of Psychiatry and Psychotherapy, Technische Universität Dresden, Dresden, Germany (Dr Smolka); Jena University Hospital, Department of Medical Statistics, Informatics and Documentation, Friedrich-Schiller-Universität Jena, Jena, Germany (Dr Schlattmann); Fliedner Klinik Berlin, Center for Psychiatry, Psychotherapy and Psychosomatic Medicine (Dr Adli)
| | - Robert Fisher
- Charité – Universitätsmedizin Berlin, Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Berlin, Germany (Drs Adli, Wiethoff, Mr Berger, Ricken, Stamm, and Heinz); Universität Regensburg, Department of Psychiatry and Psychotherapy, Regensburg, Germany (Dr Baghai); East London NHS Foundation Trust, City and Hackney Centre for Mental Health, Donald Winnicott Centre, London, United Kingdom (Dr Fisher); kbo-Lech-Mangfall-Klinik Garmisch-Partenkirchen, Department of Psychiatry and Psychotherapy, Garmisch-Partenkirchen, Germany (Dr Seemüller); Ludwig-Maximilians-Universität, Department of Psychiatry and Psychotherapy, München, Germany (Drs Laakmann and Möller); kbo-Isar-Amper-Klinikum, Department of Psychiatry and Psychotherapy, München, Germany (Dr Brieger); Heinrich-Heine-Universität Düsseldorf, Department of Psychiatry and Psychotherapy, Düsseldorf, Germany (Drs Cordes and Malevani); Institut für Psychologische Medizin, Haag, Germany (Dr Laux); St. Joseph-Krankenhaus, Department of Psychiatry and Psychotherapy, Berlin, Germany (Dr Hauth); LWL-Klinikum Gütersloh, Department of Psychiatry and Psychotherapy, Gütersloh, Germany (Dr Kronmüller); Universitätsklinikum Carl Gustav Carus, Department of Psychiatry and Psychotherapy, Technische Universität Dresden, Dresden, Germany (Dr Smolka); Jena University Hospital, Department of Medical Statistics, Informatics and Documentation, Friedrich-Schiller-Universität Jena, Jena, Germany (Dr Schlattmann); Fliedner Klinik Berlin, Center for Psychiatry, Psychotherapy and Psychosomatic Medicine (Dr Adli)
| | - Florian Seemüller
- Charité – Universitätsmedizin Berlin, Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Berlin, Germany (Drs Adli, Wiethoff, Mr Berger, Ricken, Stamm, and Heinz); Universität Regensburg, Department of Psychiatry and Psychotherapy, Regensburg, Germany (Dr Baghai); East London NHS Foundation Trust, City and Hackney Centre for Mental Health, Donald Winnicott Centre, London, United Kingdom (Dr Fisher); kbo-Lech-Mangfall-Klinik Garmisch-Partenkirchen, Department of Psychiatry and Psychotherapy, Garmisch-Partenkirchen, Germany (Dr Seemüller); Ludwig-Maximilians-Universität, Department of Psychiatry and Psychotherapy, München, Germany (Drs Laakmann and Möller); kbo-Isar-Amper-Klinikum, Department of Psychiatry and Psychotherapy, München, Germany (Dr Brieger); Heinrich-Heine-Universität Düsseldorf, Department of Psychiatry and Psychotherapy, Düsseldorf, Germany (Drs Cordes and Malevani); Institut für Psychologische Medizin, Haag, Germany (Dr Laux); St. Joseph-Krankenhaus, Department of Psychiatry and Psychotherapy, Berlin, Germany (Dr Hauth); LWL-Klinikum Gütersloh, Department of Psychiatry and Psychotherapy, Gütersloh, Germany (Dr Kronmüller); Universitätsklinikum Carl Gustav Carus, Department of Psychiatry and Psychotherapy, Technische Universität Dresden, Dresden, Germany (Dr Smolka); Jena University Hospital, Department of Medical Statistics, Informatics and Documentation, Friedrich-Schiller-Universität Jena, Jena, Germany (Dr Schlattmann); Fliedner Klinik Berlin, Center for Psychiatry, Psychotherapy and Psychosomatic Medicine (Dr Adli)
| | - Gregor Laakmann
- Charité – Universitätsmedizin Berlin, Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Berlin, Germany (Drs Adli, Wiethoff, Mr Berger, Ricken, Stamm, and Heinz); Universität Regensburg, Department of Psychiatry and Psychotherapy, Regensburg, Germany (Dr Baghai); East London NHS Foundation Trust, City and Hackney Centre for Mental Health, Donald Winnicott Centre, London, United Kingdom (Dr Fisher); kbo-Lech-Mangfall-Klinik Garmisch-Partenkirchen, Department of Psychiatry and Psychotherapy, Garmisch-Partenkirchen, Germany (Dr Seemüller); Ludwig-Maximilians-Universität, Department of Psychiatry and Psychotherapy, München, Germany (Drs Laakmann and Möller); kbo-Isar-Amper-Klinikum, Department of Psychiatry and Psychotherapy, München, Germany (Dr Brieger); Heinrich-Heine-Universität Düsseldorf, Department of Psychiatry and Psychotherapy, Düsseldorf, Germany (Drs Cordes and Malevani); Institut für Psychologische Medizin, Haag, Germany (Dr Laux); St. Joseph-Krankenhaus, Department of Psychiatry and Psychotherapy, Berlin, Germany (Dr Hauth); LWL-Klinikum Gütersloh, Department of Psychiatry and Psychotherapy, Gütersloh, Germany (Dr Kronmüller); Universitätsklinikum Carl Gustav Carus, Department of Psychiatry and Psychotherapy, Technische Universität Dresden, Dresden, Germany (Dr Smolka); Jena University Hospital, Department of Medical Statistics, Informatics and Documentation, Friedrich-Schiller-Universität Jena, Jena, Germany (Dr Schlattmann); Fliedner Klinik Berlin, Center for Psychiatry, Psychotherapy and Psychosomatic Medicine (Dr Adli)
| | - Peter Brieger
- Charité – Universitätsmedizin Berlin, Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Berlin, Germany (Drs Adli, Wiethoff, Mr Berger, Ricken, Stamm, and Heinz); Universität Regensburg, Department of Psychiatry and Psychotherapy, Regensburg, Germany (Dr Baghai); East London NHS Foundation Trust, City and Hackney Centre for Mental Health, Donald Winnicott Centre, London, United Kingdom (Dr Fisher); kbo-Lech-Mangfall-Klinik Garmisch-Partenkirchen, Department of Psychiatry and Psychotherapy, Garmisch-Partenkirchen, Germany (Dr Seemüller); Ludwig-Maximilians-Universität, Department of Psychiatry and Psychotherapy, München, Germany (Drs Laakmann and Möller); kbo-Isar-Amper-Klinikum, Department of Psychiatry and Psychotherapy, München, Germany (Dr Brieger); Heinrich-Heine-Universität Düsseldorf, Department of Psychiatry and Psychotherapy, Düsseldorf, Germany (Drs Cordes and Malevani); Institut für Psychologische Medizin, Haag, Germany (Dr Laux); St. Joseph-Krankenhaus, Department of Psychiatry and Psychotherapy, Berlin, Germany (Dr Hauth); LWL-Klinikum Gütersloh, Department of Psychiatry and Psychotherapy, Gütersloh, Germany (Dr Kronmüller); Universitätsklinikum Carl Gustav Carus, Department of Psychiatry and Psychotherapy, Technische Universität Dresden, Dresden, Germany (Dr Smolka); Jena University Hospital, Department of Medical Statistics, Informatics and Documentation, Friedrich-Schiller-Universität Jena, Jena, Germany (Dr Schlattmann); Fliedner Klinik Berlin, Center for Psychiatry, Psychotherapy and Psychosomatic Medicine (Dr Adli)
| | - Joachim Cordes
- Charité – Universitätsmedizin Berlin, Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Berlin, Germany (Drs Adli, Wiethoff, Mr Berger, Ricken, Stamm, and Heinz); Universität Regensburg, Department of Psychiatry and Psychotherapy, Regensburg, Germany (Dr Baghai); East London NHS Foundation Trust, City and Hackney Centre for Mental Health, Donald Winnicott Centre, London, United Kingdom (Dr Fisher); kbo-Lech-Mangfall-Klinik Garmisch-Partenkirchen, Department of Psychiatry and Psychotherapy, Garmisch-Partenkirchen, Germany (Dr Seemüller); Ludwig-Maximilians-Universität, Department of Psychiatry and Psychotherapy, München, Germany (Drs Laakmann and Möller); kbo-Isar-Amper-Klinikum, Department of Psychiatry and Psychotherapy, München, Germany (Dr Brieger); Heinrich-Heine-Universität Düsseldorf, Department of Psychiatry and Psychotherapy, Düsseldorf, Germany (Drs Cordes and Malevani); Institut für Psychologische Medizin, Haag, Germany (Dr Laux); St. Joseph-Krankenhaus, Department of Psychiatry and Psychotherapy, Berlin, Germany (Dr Hauth); LWL-Klinikum Gütersloh, Department of Psychiatry and Psychotherapy, Gütersloh, Germany (Dr Kronmüller); Universitätsklinikum Carl Gustav Carus, Department of Psychiatry and Psychotherapy, Technische Universität Dresden, Dresden, Germany (Dr Smolka); Jena University Hospital, Department of Medical Statistics, Informatics and Documentation, Friedrich-Schiller-Universität Jena, Jena, Germany (Dr Schlattmann); Fliedner Klinik Berlin, Center for Psychiatry, Psychotherapy and Psychosomatic Medicine (Dr Adli)
| | - Jaroslav Malevani
- Charité – Universitätsmedizin Berlin, Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Berlin, Germany (Drs Adli, Wiethoff, Mr Berger, Ricken, Stamm, and Heinz); Universität Regensburg, Department of Psychiatry and Psychotherapy, Regensburg, Germany (Dr Baghai); East London NHS Foundation Trust, City and Hackney Centre for Mental Health, Donald Winnicott Centre, London, United Kingdom (Dr Fisher); kbo-Lech-Mangfall-Klinik Garmisch-Partenkirchen, Department of Psychiatry and Psychotherapy, Garmisch-Partenkirchen, Germany (Dr Seemüller); Ludwig-Maximilians-Universität, Department of Psychiatry and Psychotherapy, München, Germany (Drs Laakmann and Möller); kbo-Isar-Amper-Klinikum, Department of Psychiatry and Psychotherapy, München, Germany (Dr Brieger); Heinrich-Heine-Universität Düsseldorf, Department of Psychiatry and Psychotherapy, Düsseldorf, Germany (Drs Cordes and Malevani); Institut für Psychologische Medizin, Haag, Germany (Dr Laux); St. Joseph-Krankenhaus, Department of Psychiatry and Psychotherapy, Berlin, Germany (Dr Hauth); LWL-Klinikum Gütersloh, Department of Psychiatry and Psychotherapy, Gütersloh, Germany (Dr Kronmüller); Universitätsklinikum Carl Gustav Carus, Department of Psychiatry and Psychotherapy, Technische Universität Dresden, Dresden, Germany (Dr Smolka); Jena University Hospital, Department of Medical Statistics, Informatics and Documentation, Friedrich-Schiller-Universität Jena, Jena, Germany (Dr Schlattmann); Fliedner Klinik Berlin, Center for Psychiatry, Psychotherapy and Psychosomatic Medicine (Dr Adli)
| | - Gerd Laux
- Charité – Universitätsmedizin Berlin, Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Berlin, Germany (Drs Adli, Wiethoff, Mr Berger, Ricken, Stamm, and Heinz); Universität Regensburg, Department of Psychiatry and Psychotherapy, Regensburg, Germany (Dr Baghai); East London NHS Foundation Trust, City and Hackney Centre for Mental Health, Donald Winnicott Centre, London, United Kingdom (Dr Fisher); kbo-Lech-Mangfall-Klinik Garmisch-Partenkirchen, Department of Psychiatry and Psychotherapy, Garmisch-Partenkirchen, Germany (Dr Seemüller); Ludwig-Maximilians-Universität, Department of Psychiatry and Psychotherapy, München, Germany (Drs Laakmann and Möller); kbo-Isar-Amper-Klinikum, Department of Psychiatry and Psychotherapy, München, Germany (Dr Brieger); Heinrich-Heine-Universität Düsseldorf, Department of Psychiatry and Psychotherapy, Düsseldorf, Germany (Drs Cordes and Malevani); Institut für Psychologische Medizin, Haag, Germany (Dr Laux); St. Joseph-Krankenhaus, Department of Psychiatry and Psychotherapy, Berlin, Germany (Dr Hauth); LWL-Klinikum Gütersloh, Department of Psychiatry and Psychotherapy, Gütersloh, Germany (Dr Kronmüller); Universitätsklinikum Carl Gustav Carus, Department of Psychiatry and Psychotherapy, Technische Universität Dresden, Dresden, Germany (Dr Smolka); Jena University Hospital, Department of Medical Statistics, Informatics and Documentation, Friedrich-Schiller-Universität Jena, Jena, Germany (Dr Schlattmann); Fliedner Klinik Berlin, Center for Psychiatry, Psychotherapy and Psychosomatic Medicine (Dr Adli)
| | - Iris Hauth
- Charité – Universitätsmedizin Berlin, Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Berlin, Germany (Drs Adli, Wiethoff, Mr Berger, Ricken, Stamm, and Heinz); Universität Regensburg, Department of Psychiatry and Psychotherapy, Regensburg, Germany (Dr Baghai); East London NHS Foundation Trust, City and Hackney Centre for Mental Health, Donald Winnicott Centre, London, United Kingdom (Dr Fisher); kbo-Lech-Mangfall-Klinik Garmisch-Partenkirchen, Department of Psychiatry and Psychotherapy, Garmisch-Partenkirchen, Germany (Dr Seemüller); Ludwig-Maximilians-Universität, Department of Psychiatry and Psychotherapy, München, Germany (Drs Laakmann and Möller); kbo-Isar-Amper-Klinikum, Department of Psychiatry and Psychotherapy, München, Germany (Dr Brieger); Heinrich-Heine-Universität Düsseldorf, Department of Psychiatry and Psychotherapy, Düsseldorf, Germany (Drs Cordes and Malevani); Institut für Psychologische Medizin, Haag, Germany (Dr Laux); St. Joseph-Krankenhaus, Department of Psychiatry and Psychotherapy, Berlin, Germany (Dr Hauth); LWL-Klinikum Gütersloh, Department of Psychiatry and Psychotherapy, Gütersloh, Germany (Dr Kronmüller); Universitätsklinikum Carl Gustav Carus, Department of Psychiatry and Psychotherapy, Technische Universität Dresden, Dresden, Germany (Dr Smolka); Jena University Hospital, Department of Medical Statistics, Informatics and Documentation, Friedrich-Schiller-Universität Jena, Jena, Germany (Dr Schlattmann); Fliedner Klinik Berlin, Center for Psychiatry, Psychotherapy and Psychosomatic Medicine (Dr Adli)
| | - Hans-Jürgen Möller
- Charité – Universitätsmedizin Berlin, Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Berlin, Germany (Drs Adli, Wiethoff, Mr Berger, Ricken, Stamm, and Heinz); Universität Regensburg, Department of Psychiatry and Psychotherapy, Regensburg, Germany (Dr Baghai); East London NHS Foundation Trust, City and Hackney Centre for Mental Health, Donald Winnicott Centre, London, United Kingdom (Dr Fisher); kbo-Lech-Mangfall-Klinik Garmisch-Partenkirchen, Department of Psychiatry and Psychotherapy, Garmisch-Partenkirchen, Germany (Dr Seemüller); Ludwig-Maximilians-Universität, Department of Psychiatry and Psychotherapy, München, Germany (Drs Laakmann and Möller); kbo-Isar-Amper-Klinikum, Department of Psychiatry and Psychotherapy, München, Germany (Dr Brieger); Heinrich-Heine-Universität Düsseldorf, Department of Psychiatry and Psychotherapy, Düsseldorf, Germany (Drs Cordes and Malevani); Institut für Psychologische Medizin, Haag, Germany (Dr Laux); St. Joseph-Krankenhaus, Department of Psychiatry and Psychotherapy, Berlin, Germany (Dr Hauth); LWL-Klinikum Gütersloh, Department of Psychiatry and Psychotherapy, Gütersloh, Germany (Dr Kronmüller); Universitätsklinikum Carl Gustav Carus, Department of Psychiatry and Psychotherapy, Technische Universität Dresden, Dresden, Germany (Dr Smolka); Jena University Hospital, Department of Medical Statistics, Informatics and Documentation, Friedrich-Schiller-Universität Jena, Jena, Germany (Dr Schlattmann); Fliedner Klinik Berlin, Center for Psychiatry, Psychotherapy and Psychosomatic Medicine (Dr Adli)
| | - Klaus-Thomas Kronmüller
- Charité – Universitätsmedizin Berlin, Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Berlin, Germany (Drs Adli, Wiethoff, Mr Berger, Ricken, Stamm, and Heinz); Universität Regensburg, Department of Psychiatry and Psychotherapy, Regensburg, Germany (Dr Baghai); East London NHS Foundation Trust, City and Hackney Centre for Mental Health, Donald Winnicott Centre, London, United Kingdom (Dr Fisher); kbo-Lech-Mangfall-Klinik Garmisch-Partenkirchen, Department of Psychiatry and Psychotherapy, Garmisch-Partenkirchen, Germany (Dr Seemüller); Ludwig-Maximilians-Universität, Department of Psychiatry and Psychotherapy, München, Germany (Drs Laakmann and Möller); kbo-Isar-Amper-Klinikum, Department of Psychiatry and Psychotherapy, München, Germany (Dr Brieger); Heinrich-Heine-Universität Düsseldorf, Department of Psychiatry and Psychotherapy, Düsseldorf, Germany (Drs Cordes and Malevani); Institut für Psychologische Medizin, Haag, Germany (Dr Laux); St. Joseph-Krankenhaus, Department of Psychiatry and Psychotherapy, Berlin, Germany (Dr Hauth); LWL-Klinikum Gütersloh, Department of Psychiatry and Psychotherapy, Gütersloh, Germany (Dr Kronmüller); Universitätsklinikum Carl Gustav Carus, Department of Psychiatry and Psychotherapy, Technische Universität Dresden, Dresden, Germany (Dr Smolka); Jena University Hospital, Department of Medical Statistics, Informatics and Documentation, Friedrich-Schiller-Universität Jena, Jena, Germany (Dr Schlattmann); Fliedner Klinik Berlin, Center for Psychiatry, Psychotherapy and Psychosomatic Medicine (Dr Adli)
| | - Michael N Smolka
- Charité – Universitätsmedizin Berlin, Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Berlin, Germany (Drs Adli, Wiethoff, Mr Berger, Ricken, Stamm, and Heinz); Universität Regensburg, Department of Psychiatry and Psychotherapy, Regensburg, Germany (Dr Baghai); East London NHS Foundation Trust, City and Hackney Centre for Mental Health, Donald Winnicott Centre, London, United Kingdom (Dr Fisher); kbo-Lech-Mangfall-Klinik Garmisch-Partenkirchen, Department of Psychiatry and Psychotherapy, Garmisch-Partenkirchen, Germany (Dr Seemüller); Ludwig-Maximilians-Universität, Department of Psychiatry and Psychotherapy, München, Germany (Drs Laakmann and Möller); kbo-Isar-Amper-Klinikum, Department of Psychiatry and Psychotherapy, München, Germany (Dr Brieger); Heinrich-Heine-Universität Düsseldorf, Department of Psychiatry and Psychotherapy, Düsseldorf, Germany (Drs Cordes and Malevani); Institut für Psychologische Medizin, Haag, Germany (Dr Laux); St. Joseph-Krankenhaus, Department of Psychiatry and Psychotherapy, Berlin, Germany (Dr Hauth); LWL-Klinikum Gütersloh, Department of Psychiatry and Psychotherapy, Gütersloh, Germany (Dr Kronmüller); Universitätsklinikum Carl Gustav Carus, Department of Psychiatry and Psychotherapy, Technische Universität Dresden, Dresden, Germany (Dr Smolka); Jena University Hospital, Department of Medical Statistics, Informatics and Documentation, Friedrich-Schiller-Universität Jena, Jena, Germany (Dr Schlattmann); Fliedner Klinik Berlin, Center for Psychiatry, Psychotherapy and Psychosomatic Medicine (Dr Adli)
| | - Peter Schlattmann
- Charité – Universitätsmedizin Berlin, Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Berlin, Germany (Drs Adli, Wiethoff, Mr Berger, Ricken, Stamm, and Heinz); Universität Regensburg, Department of Psychiatry and Psychotherapy, Regensburg, Germany (Dr Baghai); East London NHS Foundation Trust, City and Hackney Centre for Mental Health, Donald Winnicott Centre, London, United Kingdom (Dr Fisher); kbo-Lech-Mangfall-Klinik Garmisch-Partenkirchen, Department of Psychiatry and Psychotherapy, Garmisch-Partenkirchen, Germany (Dr Seemüller); Ludwig-Maximilians-Universität, Department of Psychiatry and Psychotherapy, München, Germany (Drs Laakmann and Möller); kbo-Isar-Amper-Klinikum, Department of Psychiatry and Psychotherapy, München, Germany (Dr Brieger); Heinrich-Heine-Universität Düsseldorf, Department of Psychiatry and Psychotherapy, Düsseldorf, Germany (Drs Cordes and Malevani); Institut für Psychologische Medizin, Haag, Germany (Dr Laux); St. Joseph-Krankenhaus, Department of Psychiatry and Psychotherapy, Berlin, Germany (Dr Hauth); LWL-Klinikum Gütersloh, Department of Psychiatry and Psychotherapy, Gütersloh, Germany (Dr Kronmüller); Universitätsklinikum Carl Gustav Carus, Department of Psychiatry and Psychotherapy, Technische Universität Dresden, Dresden, Germany (Dr Smolka); Jena University Hospital, Department of Medical Statistics, Informatics and Documentation, Friedrich-Schiller-Universität Jena, Jena, Germany (Dr Schlattmann); Fliedner Klinik Berlin, Center for Psychiatry, Psychotherapy and Psychosomatic Medicine (Dr Adli)
| | - Maximilian Berger
- Charité – Universitätsmedizin Berlin, Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Berlin, Germany (Drs Adli, Wiethoff, Mr Berger, Ricken, Stamm, and Heinz); Universität Regensburg, Department of Psychiatry and Psychotherapy, Regensburg, Germany (Dr Baghai); East London NHS Foundation Trust, City and Hackney Centre for Mental Health, Donald Winnicott Centre, London, United Kingdom (Dr Fisher); kbo-Lech-Mangfall-Klinik Garmisch-Partenkirchen, Department of Psychiatry and Psychotherapy, Garmisch-Partenkirchen, Germany (Dr Seemüller); Ludwig-Maximilians-Universität, Department of Psychiatry and Psychotherapy, München, Germany (Drs Laakmann and Möller); kbo-Isar-Amper-Klinikum, Department of Psychiatry and Psychotherapy, München, Germany (Dr Brieger); Heinrich-Heine-Universität Düsseldorf, Department of Psychiatry and Psychotherapy, Düsseldorf, Germany (Drs Cordes and Malevani); Institut für Psychologische Medizin, Haag, Germany (Dr Laux); St. Joseph-Krankenhaus, Department of Psychiatry and Psychotherapy, Berlin, Germany (Dr Hauth); LWL-Klinikum Gütersloh, Department of Psychiatry and Psychotherapy, Gütersloh, Germany (Dr Kronmüller); Universitätsklinikum Carl Gustav Carus, Department of Psychiatry and Psychotherapy, Technische Universität Dresden, Dresden, Germany (Dr Smolka); Jena University Hospital, Department of Medical Statistics, Informatics and Documentation, Friedrich-Schiller-Universität Jena, Jena, Germany (Dr Schlattmann); Fliedner Klinik Berlin, Center for Psychiatry, Psychotherapy and Psychosomatic Medicine (Dr Adli)
| | - Roland Ricken
- Charité – Universitätsmedizin Berlin, Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Berlin, Germany (Drs Adli, Wiethoff, Mr Berger, Ricken, Stamm, and Heinz); Universität Regensburg, Department of Psychiatry and Psychotherapy, Regensburg, Germany (Dr Baghai); East London NHS Foundation Trust, City and Hackney Centre for Mental Health, Donald Winnicott Centre, London, United Kingdom (Dr Fisher); kbo-Lech-Mangfall-Klinik Garmisch-Partenkirchen, Department of Psychiatry and Psychotherapy, Garmisch-Partenkirchen, Germany (Dr Seemüller); Ludwig-Maximilians-Universität, Department of Psychiatry and Psychotherapy, München, Germany (Drs Laakmann and Möller); kbo-Isar-Amper-Klinikum, Department of Psychiatry and Psychotherapy, München, Germany (Dr Brieger); Heinrich-Heine-Universität Düsseldorf, Department of Psychiatry and Psychotherapy, Düsseldorf, Germany (Drs Cordes and Malevani); Institut für Psychologische Medizin, Haag, Germany (Dr Laux); St. Joseph-Krankenhaus, Department of Psychiatry and Psychotherapy, Berlin, Germany (Dr Hauth); LWL-Klinikum Gütersloh, Department of Psychiatry and Psychotherapy, Gütersloh, Germany (Dr Kronmüller); Universitätsklinikum Carl Gustav Carus, Department of Psychiatry and Psychotherapy, Technische Universität Dresden, Dresden, Germany (Dr Smolka); Jena University Hospital, Department of Medical Statistics, Informatics and Documentation, Friedrich-Schiller-Universität Jena, Jena, Germany (Dr Schlattmann); Fliedner Klinik Berlin, Center for Psychiatry, Psychotherapy and Psychosomatic Medicine (Dr Adli)
| | - Thomas J Stamm
- Charité – Universitätsmedizin Berlin, Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Berlin, Germany (Drs Adli, Wiethoff, Mr Berger, Ricken, Stamm, and Heinz); Universität Regensburg, Department of Psychiatry and Psychotherapy, Regensburg, Germany (Dr Baghai); East London NHS Foundation Trust, City and Hackney Centre for Mental Health, Donald Winnicott Centre, London, United Kingdom (Dr Fisher); kbo-Lech-Mangfall-Klinik Garmisch-Partenkirchen, Department of Psychiatry and Psychotherapy, Garmisch-Partenkirchen, Germany (Dr Seemüller); Ludwig-Maximilians-Universität, Department of Psychiatry and Psychotherapy, München, Germany (Drs Laakmann and Möller); kbo-Isar-Amper-Klinikum, Department of Psychiatry and Psychotherapy, München, Germany (Dr Brieger); Heinrich-Heine-Universität Düsseldorf, Department of Psychiatry and Psychotherapy, Düsseldorf, Germany (Drs Cordes and Malevani); Institut für Psychologische Medizin, Haag, Germany (Dr Laux); St. Joseph-Krankenhaus, Department of Psychiatry and Psychotherapy, Berlin, Germany (Dr Hauth); LWL-Klinikum Gütersloh, Department of Psychiatry and Psychotherapy, Gütersloh, Germany (Dr Kronmüller); Universitätsklinikum Carl Gustav Carus, Department of Psychiatry and Psychotherapy, Technische Universität Dresden, Dresden, Germany (Dr Smolka); Jena University Hospital, Department of Medical Statistics, Informatics and Documentation, Friedrich-Schiller-Universität Jena, Jena, Germany (Dr Schlattmann); Fliedner Klinik Berlin, Center for Psychiatry, Psychotherapy and Psychosomatic Medicine (Dr Adli)
| | - Andreas Heinz
- Charité – Universitätsmedizin Berlin, Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Berlin, Germany (Drs Adli, Wiethoff, Mr Berger, Ricken, Stamm, and Heinz); Universität Regensburg, Department of Psychiatry and Psychotherapy, Regensburg, Germany (Dr Baghai); East London NHS Foundation Trust, City and Hackney Centre for Mental Health, Donald Winnicott Centre, London, United Kingdom (Dr Fisher); kbo-Lech-Mangfall-Klinik Garmisch-Partenkirchen, Department of Psychiatry and Psychotherapy, Garmisch-Partenkirchen, Germany (Dr Seemüller); Ludwig-Maximilians-Universität, Department of Psychiatry and Psychotherapy, München, Germany (Drs Laakmann and Möller); kbo-Isar-Amper-Klinikum, Department of Psychiatry and Psychotherapy, München, Germany (Dr Brieger); Heinrich-Heine-Universität Düsseldorf, Department of Psychiatry and Psychotherapy, Düsseldorf, Germany (Drs Cordes and Malevani); Institut für Psychologische Medizin, Haag, Germany (Dr Laux); St. Joseph-Krankenhaus, Department of Psychiatry and Psychotherapy, Berlin, Germany (Dr Hauth); LWL-Klinikum Gütersloh, Department of Psychiatry and Psychotherapy, Gütersloh, Germany (Dr Kronmüller); Universitätsklinikum Carl Gustav Carus, Department of Psychiatry and Psychotherapy, Technische Universität Dresden, Dresden, Germany (Dr Smolka); Jena University Hospital, Department of Medical Statistics, Informatics and Documentation, Friedrich-Schiller-Universität Jena, Jena, Germany (Dr Schlattmann); Fliedner Klinik Berlin, Center for Psychiatry, Psychotherapy and Psychosomatic Medicine (Dr Adli)
| | - Michael Bauer
- Charité – Universitätsmedizin Berlin, Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Berlin, Germany (Drs Adli, Wiethoff, Mr Berger, Ricken, Stamm, and Heinz); Universität Regensburg, Department of Psychiatry and Psychotherapy, Regensburg, Germany (Dr Baghai); East London NHS Foundation Trust, City and Hackney Centre for Mental Health, Donald Winnicott Centre, London, United Kingdom (Dr Fisher); kbo-Lech-Mangfall-Klinik Garmisch-Partenkirchen, Department of Psychiatry and Psychotherapy, Garmisch-Partenkirchen, Germany (Dr Seemüller); Ludwig-Maximilians-Universität, Department of Psychiatry and Psychotherapy, München, Germany (Drs Laakmann and Möller); kbo-Isar-Amper-Klinikum, Department of Psychiatry and Psychotherapy, München, Germany (Dr Brieger); Heinrich-Heine-Universität Düsseldorf, Department of Psychiatry and Psychotherapy, Düsseldorf, Germany (Drs Cordes and Malevani); Institut für Psychologische Medizin, Haag, Germany (Dr Laux); St. Joseph-Krankenhaus, Department of Psychiatry and Psychotherapy, Berlin, Germany (Dr Hauth); LWL-Klinikum Gütersloh, Department of Psychiatry and Psychotherapy, Gütersloh, Germany (Dr Kronmüller); Universitätsklinikum Carl Gustav Carus, Department of Psychiatry and Psychotherapy, Technische Universität Dresden, Dresden, Germany (Dr Smolka); Jena University Hospital, Department of Medical Statistics, Informatics and Documentation, Friedrich-Schiller-Universität Jena, Jena, Germany (Dr Schlattmann); Fliedner Klinik Berlin, Center for Psychiatry, Psychotherapy and Psychosomatic Medicine (Dr Adli)
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Quinlivan E, Dallacker M, Renneberg B, Strasser E, Fiebig J, Stamm TJ. Autobiographical Memory in Bipolar Disorder and Its Link to Neuropsychological Functioning. Psychopathology 2017; 50:246-254. [PMID: 28586778 DOI: 10.1159/000475533] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 07/28/2016] [Accepted: 04/01/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The aim of this study was to examine the specificity of autobiographical memory (AM) in bipolar disorder (BD) and to investigate the association between AM and neuropsychological functions. METHOD Twenty bipolar patients and 22 matched healthy controls (HCs) were included in this study. AM was assessed with an extended version of the Autobiographical Memory Test (AMT) including rejection cue words. A neuropsychological test battery was used to examine verbal memory, executive functions, and attention. RESULTS Across both groups, the number of specific memories in the AMT was significantly smaller in response to rejection cue words and positive cue words than in response to negative cue words. Participants with BD and HCs did not differ significantly in neuropsychological measures. Across both groups, scores of verbal memory, executive functions, and attention were significantly correlated with specificity of retrieved memories. LIMITATIONS Although our clinical sample consisted of clinically stable outpatients, 6 out of 20 patients were not rated as euthymic but as mildly depressed. All BD patients were medicated. CONCLUSION Contrary to previous results, patients with BD did not differ in the number of specific memories compared to an HC group. Our findings suggest that neuropsychological functioning is associated with AMT specificity. Further research is required to gain a better understanding of the underlying mechanisms which may influence the ease of memory retrieval.
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Affiliation(s)
- Esther Quinlivan
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Berlin, Germany
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Ricken R, Bopp S, Schlattmann P, Himmerich H, Bschor T, Richter C, Stamm TJ, Bauer F, Heinz A, Hellweg R, Lang UE, Adli M. Leptin serum concentrations are associated with weight gain during lithium augmentation. Psychoneuroendocrinology 2016; 71:31-5. [PMID: 27235637 DOI: 10.1016/j.psyneuen.2016.04.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [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: 12/08/2015] [Revised: 03/26/2016] [Accepted: 04/15/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND Meta-analytical data show lithium augmentation (LA) as an effective treatment strategy in major depression. Weight-gain is a common side effect of LA. The proteohormone leptin is discussed to be involved in the pathophysiology of weight gain induced by psychopharmacological treatment. The purpose of our study was to investigate the association of leptin and body mass index (BMI) during LA in a prospective cohort study. METHODS Leptin serum concentrations and body mass index (BMI) were measured in a total of 89 acute depressive patients before and then after four weeks of LA. RESULTS In a linear mixed model analysis the following variables had a significant positive effect on BMI: time (equal with "treatment effect of LA"; F1.83=6.05; p=0.016) and leptin (F1.111=13.83; p=0.0003) as well as the covariates male gender (F1.89=5.08; p=0.027) and adiposity (F1.85=105.13; p<0.0001). LIMITATIONS If the reported effect of leptin on BMI is specific to LA remains unclear without a control group. CONCLUSION Leptin signalling might be involved in lithium-induced weight-gain.
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Affiliation(s)
- Roland Ricken
- Department of Psychiatry and Psychotherapy, Charité University Medicine Berlin, Campus Mitte, Berlin, Germany.
| | - Sandra Bopp
- Department of Psychiatry and Psychotherapy, Charité University Medicine Berlin, Campus Mitte, Berlin, Germany
| | - Peter Schlattmann
- Department of statistics, informatics and documentation, Friedrich-Schiller-Universität Jena, Jena, Germany
| | - Hubertus Himmerich
- Department of Psychiatry and Psychotherapy, University of Leipzig, Leipzig, Germany
| | - Tom Bschor
- Department of Psychiatry, Schlosspark-Klinik Berlin; Berlin, Germany; Department of Psychiatry and Psychotherapy, Technical University of Dresden Medical School, Dresden, Germany
| | - Christoph Richter
- Department of Psychiatry and Psychotherapy, Charité University Medicine Berlin, Campus Mitte, Berlin, Germany; Department of Psychiatry and Psychotherapy, Vivantes Wenckebach Klinikum, Berlin, Germany
| | - Thomas J Stamm
- Department of Psychiatry and Psychotherapy, Charité University Medicine Berlin, Campus Mitte, Berlin, Germany
| | - Frank Bauer
- Department of Psychiatry and Psychotherapy, Fliedner Klinik Berlin, Berlin, Germany
| | - Andreas Heinz
- Department of Psychiatry and Psychotherapy, Charité University Medicine Berlin, Campus Mitte, Berlin, Germany
| | - Rainer Hellweg
- Department of Psychiatry and Psychotherapy, Charité University Medicine Berlin, Campus Mitte, Berlin, Germany
| | - Undine E Lang
- Department of Psychiatry and Psychotherapy, University Psychiatric Clinics (UPK), Switzerland
| | - Mazda Adli
- Department of Psychiatry and Psychotherapy, Charité University Medicine Berlin, Campus Mitte, Berlin, Germany; Department of Psychiatry and Psychotherapy, Fliedner Klinik Berlin, Berlin, Germany
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Stamm TJ, Rampp C, Wiethoff K, Stingl J, Mössner R, O Malley G, Ricken R, Seemüller F, Keck M, Fisher R, Gaebel W, Maier W, Möller HJ, Bauer M, Adli M. The FKBP5 polymorphism rs1360780 influences the effect of an algorithm-based antidepressant treatment and is associated with remission in patients with major depression. J Psychopharmacol 2016; 30:40-7. [PMID: 26645208 DOI: 10.1177/0269881115620459] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [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] [Indexed: 01/30/2023]
Abstract
OBJECTIVE The FKBP5-gene influences the HPA-system by modulating the sensitivity of the glucocorticoid receptor (GR). The polymorphism rs1360780 has been associated with response in studies with heterogeneous antidepressant treatment. In contrast, several antidepressant studies with standardized antidepressant treatment could not detect this effect. We therefore compared patients with standardized vs naturalistic antidepressant treatment to (a) investigate a possible interaction between FKBP5-genotype and treatment mode and (b) replicate the effect of the FKBP5-genotype on antidepressant treatment outcome. METHODS A total of 298 major depressive disorder (MDD) inpatients from the multicentred German project and the Zurich Algorithm Project were genotyped for their FKBP5 status. Patients were treated as usual (n=127) or according to a standardized algorithm (n=171). Main outcome criteria was remission (Hamilton Depression Rating Scale-21<10). RESULTS We detected an interaction of treatment as usual (TAU) treatment and C-allele with the worst outcome for patients combining those two factors (HR=0.46; p=0.000). Even though C-allele patients did better when treated in the structured, stepwise treatment algorithm (SSTR) group, we still could confirm the influence of the FKBP5-genotype in the whole sample (HR=0.52; p=0.01). CONCLUSIONS This is the first study to show an interaction between a genetic polymorphism and treatment mode. Patients with the C-allele of the rs1360780 polymorphism seem to benefit from a standardized antidepressant treatment.
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Affiliation(s)
- Thomas J Stamm
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Carina Rampp
- Max Planck Institute for Psychiatry, München, Germany
| | - Katja Wiethoff
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Julia Stingl
- Department of Pharmacology of Natural Products and Clinical Pharmacology, University of Ulm, Ulm, Germany
| | - Rainald Mössner
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Grace O Malley
- School of Psychology, University College Dublin, Dublin, Ireland
| | - Roland Ricken
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Florian Seemüller
- Department of Psychiatry and Psychotherapy, University Hospital Ludwig-Maximilian University, München, Germany
| | - Martin Keck
- Max Planck Institute for Psychiatry, München, Germany
| | - Robert Fisher
- City and Hackney Centre for Mental Health, East London NHS Foundation Trust, London, UK
| | - Wolfgang Gaebel
- Department of Psychiatry and Psychotherapy, Heinrich-Heine-Universität, Düsseldorf, Germany
| | - Wolfgang Maier
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Hans-Jürgen Möller
- Department of Psychiatry and Psychotherapy, University Hospital Ludwig-Maximilian University, München, Germany
| | - Michael Bauer
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Mazda Adli
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Berlin, Germany
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Stamm TJ, Lewitzka U, Sauer C, Pilhatsch M, Smolka MN, Koeberle U, Adli M, Ricken R, Scherk H, Frye MA, Juckel G, Assion HJ, Gitlin M, Whybrow PC, Bauer M. Supraphysiologic doses of levothyroxine as adjunctive therapy in bipolar depression: a randomized, double-blind, placebo-controlled study. J Clin Psychiatry 2014; 75:162-8. [PMID: 24345793 DOI: 10.4088/jcp.12m08305] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [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: 11/29/2012] [Accepted: 06/19/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Suboptimal availability of circulating thyroid hormones may contribute to the high rate of treatment failures in bipolar disorder. This study tested the efficacy of adjunctive treatment with supraphysiologic doses of levothyroxine in patients with bipolar depression and the hypothesis that women would display a better outcome compared to men. METHOD The aims of this multicenter, 6-week, double-blind, randomized, placebo-controlled fixed-dose (300 μg/d) trial conducted from 2004 to 2009 were to assess efficacy and tolerability of levothyroxine adjunctive to continuing treatment with mood stabilizer and/or antidepressant medication for patients with bipolar I or II disorder, currently depressed (DSM-IV), and to investigate gender differences in treatment response. The primary efficacy variable was mean change in Hamilton Depression Rating Scale (HDRS) score. RESULTS Of 74 patients enrolled in the study, 62 (35 with bipolar I; mean age = 44.9 years) were randomized. Mean change in HDRS score from randomization to week 6 was larger in the levothyroxine group compared to the placebo group, with a 2.7-point difference (decline of -7.8 [38.3%] vs -5.1 [25.5%]; last-observation-carried-forward analysis). The course of HDRS scores over time from randomization to week 6 was significantly different between groups at week 4 (P = .046) but not at the end of the placebo-controlled phase (P = .198). The secondary analysis of women (n = 32) revealed a significant difference between groups in mean change in HDRS score (-16.6% placebo vs -42.4% levothyroxine, P = .018). A mixed-effects model for repeated-measures analysis showed a significant between-group difference in HDRS score (6.8, P = .012) for women. High thyroid-stimulating hormone levels, indicating suboptimal levels of circulating thyroid hormones, were predictive for positive treatment outcome in women treated with levothyroxine in a linear regression model (F3 = 3.47; P = .05). DISCUSSION This trial demonstrated that patients treated with levothyroxine did numerically better than those treated with placebo; however, the study failed to detect a statistically significant difference between the 2 groups in the primary outcome measure due to a high placebo response rate. Previous findings that women show better improvement in depression scores with levothyroxine compared to men were confirmed. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01528839.
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Affiliation(s)
- Thomas J Stamm
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Campus Mitte, Berlin
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Stamm TJ, Stingl J, Wiethoff K, Ricken R, Heinz A, Bauer M, O'Malley G, Adli M. Depression with psychotic features is influenced by the polymorphism of the serotonin transporter gene. J Affect Disord 2013; 151:605-610. [PMID: 23948632 DOI: 10.1016/j.jad.2013.07.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [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: 06/28/2012] [Revised: 07/03/2013] [Accepted: 07/06/2013] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Current diagnostic classifications regard psychotic symptoms during depressive episodes as indicators of depression severity. However, growing evidence suggests that depression with psychotic symptoms (MDP) may represent a distinct subtype of depression. In the course of the search for discriminating factors we tested the hypothesis that the serotonin transporter gene (5-HTTLPR) may interact with the manifestation of psychotic symptoms in acute depression. METHODS 112 inpatients (61 female) with a depressive episode (16 bipolar, 86 unipolar) at admission were genotyped for 5-HTTLPR variants. Psychotic symptoms und general psychopathology were evaluated comprehensively using the Manual of the Association for Methodology and Documentation in Psychiatry (Arbeitsgemeinschaft für Methodik und Dokumentation in der Psychiatrie, 1981). For statistical analysis a chi-square test and a logistic regression model was used. RESULTS 16 (14.3%) out of 112 patients were currently presenting with psychotic symptoms. The primary finding of our study was the higher prevalence of the s-allele of the 5-HTTLPR within the group of MDP patients (Pearson χ²=7.87; df=2; p<0.03). Secondly, in a logistic regression model, 5-HTTLPR was found to significantly contribute to the diagnosis of MDP (χ²=6.5; df=1; p=0.01). This effect was even more pronounced upon comparing only severely depressed patients with MDP patients. From a psychopathological perspective, MDP patients showed higher AMDP hostility and apathy scores but equal AMDP depression scores. DISCUSSION This is the first study to show an influence of 5-HTTLPR on psychotic symptoms in acutely depressed patients. LIMITATIONS The lack of a control group and the relatively small sample size limits the present study's findings, thus replication in a larger sample is necessary.
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Affiliation(s)
- T J Stamm
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany.
| | - J Stingl
- Department of Pharmacology of Natural Products and Clinical Pharmacology, University of Ulm, Germany
| | - K Wiethoff
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
| | - R Ricken
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
| | - A Heinz
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
| | - M Bauer
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - G O'Malley
- School of Psychology, University College Dublin, Ireland
| | - M Adli
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
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Stamm TJ, Becker D, Kirchheiner J, Wiethoff K, Bauer M, Möller HJ, Baghai T, Adli M. Is the evaluation of early symptom decrease and serum drug levels predictive for response in depressed patients? Pharmacopsychiatry 2007. [DOI: 10.1055/s-2007-991730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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