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Zhang Y, Yue W, Li J. The association of FKBP5 gene polymorphism with genetic susceptibility to depression and response to antidepressant treatment- a systematic review. BMC Psychiatry 2024; 24:274. [PMID: 38609904 PMCID: PMC11010372 DOI: 10.1186/s12888-024-05717-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 03/25/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Given the inconsistencies in current studies regarding the impact of FKBP5 gene polymorphisms on depression, arising from variations in study methods, subjects, and treatment strategies, this paper provides a comprehensive review of the relationship between FKBP5 gene polymorphisms and genetic susceptibility to depression, as well as their influence on response to antidepressant treatment. METHODS Electronic databases were searched up to April 11, 2023, for all literature in English and Chinese on depression, FKBP5 gene polymorphisms, and antidepressant treatment. Data extraction and quality assessment were performed for key study characteristics. Qualitative methods were used to synthesize the study results. RESULTS A total of 21 studies were included, with the majority exhibiting average to moderate quality. Six SNPs (rs3800373, rs1360780, rs9470080, rs4713916, rs9296158, rs9394309) were broadly implicated in susceptibility to depression, while rs1360780 and rs3800373 were linked to antidepressant treatment sensitivity. Additionally, rs1360780 was associated with adverse reactions to antidepressant drug treatment. However, these associations were largely unconfirmed in replication studies. CONCLUSIONS Depression is recognized as a polygenic genetic disorder, with multiple genes contributing, each exerting relatively small effects. Future studies should explore not only multiple gene interactions but also epigenetic changes. Presently, research on FKBP5 in affective disorders remains notably limited, highlighting the necessity for further investigations in this domain.
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Affiliation(s)
- Ying Zhang
- Institute of Mental Health, Peking University Sixth Hospital, 100191, Beijing, China
- Tianjin Anding Hospital, Tianjin Municipal Mental Health Center, 300222, Tianjin, China
| | - Weihua Yue
- Institute of Mental Health, Peking University Sixth Hospital, 100191, Beijing, China.
- National Clinical Research Center for Mental Disorders, Peking University Sixth Hospital), 100191, Beijing, China.
- NHC Key Laboratory of Mental Health, Peking University, 100191, Beijing, China.
- PKU-IDG/McGovern Institute for Brain Research, Peking University, 100871, Beijing, China.
- Chinese Institute for Brain Research, 102206, Beijing, China.
| | - Jie Li
- Institute of Mental Health, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, 300222, Tianjin, China.
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Carminati M, Fazio V, Maccario M, Zanardi R. The impact of menopause on antidepressant response: an explorative analysis from a real-world study. Arch Womens Ment Health 2024:10.1007/s00737-024-01465-x. [PMID: 38587634 DOI: 10.1007/s00737-024-01465-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 03/28/2024] [Indexed: 04/09/2024]
Abstract
This study endeavors to deepen our understanding of the subject matter by exploring, within a real-world sample, the impact of menopausal status on the antidepressant treatments response. The whole sample included a total of 447 patients, 156 male and 291 female, 110 pre-menopause and 181 post-menopause. In our sample post-menopause women showed a worse response to antidepressants than pre-menopause women (p = 0.006), and this difference seems to be unrelated to age or brain aging.
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Affiliation(s)
- Matteo Carminati
- Department of Clinical Neurosciences, Vita-Salute San Raffaele University, Via Stamira d'Ancona, 20, 20127, Milan, Italy.
| | - Valentina Fazio
- Department of Clinical Neurosciences, Vita-Salute San Raffaele University, Via Stamira d'Ancona, 20, 20127, Milan, Italy
| | - Melania Maccario
- Department of Clinical Neurosciences, Vita-Salute San Raffaele University, Via Stamira d'Ancona, 20, 20127, Milan, Italy
| | - Raffaella Zanardi
- Department of Clinical Neurosciences, Vita-Salute San Raffaele University, Via Stamira d'Ancona, 20, 20127, Milan, Italy
- Mood Disorder Unit, IRCCS San Raffaele Scientific Institute, Via Stamira d'Ancona, 20, 20127, Milan, Italy
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3
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Smit AJT, Wu GWY, Rampersaud R, Reus VI, Wolkowitz OM, Mellon SH. Serum brain-derived neurotrophic factor, Val66Met polymorphism and open-label SSRI treatment response in Major Depressive Disorder. Psychoneuroendocrinology 2024; 165:107045. [PMID: 38636352 DOI: 10.1016/j.psyneuen.2024.107045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 04/04/2024] [Accepted: 04/04/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Brain-derived neurotrophic factor (BDNF) has been implicated in the therapeutic action of antidepressants and possibly in the pathophysiology of Major Depressive Disorder (MDD). Clinical studies of peripheral blood levels of BDNF in MDD have provided conflicting results, and there are also conflicting reports regarding the predictive value of peripheral BDNF levels for antidepressant treatment response. The present study investigated the association between serum BDNF levels, the BDNF Val66Met polymorphism (rs6265), clinical characteristics and SSRI treatment response. METHODS This open-label clinical trial included 99 physically healthy, unmedicated MDD participants and 70 healthy controls. Following a baseline assessment, 53 of the MDD participants completed an eight-week, open-label course of SSRI antidepressant treatment. Serum BDNF levels and Hamilton Rating Scale for Depression (HDRS) ratings were examined at baseline and after eight weeks of treatment. Antidepressant response was defined as a decrease in HDRS ratings of > 50% from baseline to the end-of-treatment. Finally, serum BDNF levels and SSRI treatment response were compared between MDD participants who were heterozygous or homozygous for the Met allele ("Met-carriers") and individuals homozygous for the Val allele. RESULTS Serum BDNF levels at baseline were significantly higher in the unmedicated MDD participants compared to healthy controls (15.90 ng/ml vs 13.75 ng/ml, t (167) = -2.041, p = 0.043). In a post-hoc analysis, this difference was seen in the female but not male participants (16.85 ng/ml vs 14.06 ng/ml, t (91) = -2.067, p = 0.042; 14.86 ng/ml vs 13.31 ng/ml, t (74) = -0.923, p = 0.359). Baseline serum BDNF levels were not associated with treatment responder status or with absolute change in depression ratings over the course of 8-week SSRI treatment (p = 0.599). In both Responders and Non-responders, no significant changes in serum BDNF levels were found over the 8-week period of SSRI-treatment (16.32 ng/ml vs 16.23 ng/ml, t (18) = 0.060, p = 0.953; 16.04 ng/ml vs 15.61 ng/ml, t (29) = 0.438, p = 0.665, respectively). Further, no differences were found in serum BDNF levels prior to treatment between MDD Met-carriers and MDD Val/Val homozygotes (15.32 ng/ml vs 16.36 ng/ml, t (85) = 0.747, p = 0.457), and no differences were found in post-treatment serum BDNF (F1,42= 0.031, p = 0.862). However, MDD Val/Val homozygotes showed significantly greater antidepressant responses at week 8 than did MDD Met-carriers (F1,46 = 4.366, p = 0.043). CONCLUSION Our results do not support sufficient reliability of using peripheral BDNF to characterize depression or to predict antidepressant response in clinical use. The role of sex in moderating BDNF differences in depression, and the role of BDNF gene polymorphisms in predicting antidepressant response, remain to be further investigated. We conclude that, while central nervous system BDNF is likely involved in antidepressant efficacy and in aspects of MDD pathophysiology, its reflection in serum BDNF levels is of limited diagnostic or prognostic utility.
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Affiliation(s)
- Anna J T Smit
- Weill Institute for Neurosciences and Department of Psychiatry and Behavioral Sciences, University of California San Francisco (UCSF) School of Medicine, San Francisco, CA, USA
| | - Gwyneth W Y Wu
- Weill Institute for Neurosciences and Department of Psychiatry and Behavioral Sciences, University of California San Francisco (UCSF) School of Medicine, San Francisco, CA, USA
| | - Ryan Rampersaud
- Weill Institute for Neurosciences and Department of Psychiatry and Behavioral Sciences, University of California San Francisco (UCSF) School of Medicine, San Francisco, CA, USA
| | - Victor I Reus
- Weill Institute for Neurosciences and Department of Psychiatry and Behavioral Sciences, University of California San Francisco (UCSF) School of Medicine, San Francisco, CA, USA
| | - Owen M Wolkowitz
- Weill Institute for Neurosciences and Department of Psychiatry and Behavioral Sciences, University of California San Francisco (UCSF) School of Medicine, San Francisco, CA, USA
| | - Synthia H Mellon
- Department of OB-GYN and Reproductive Sciences, UCSF School of Medicine, San Francisco, CA, USA.
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Wang X, Xue L, Shao J, Dai Z, Hua L, Yan R, Yao Z, Lu Q. Distinct MRI-based functional and structural connectivity for antidepressant response prediction in major depressive disorder. Clin Neurophysiol 2024; 160:19-27. [PMID: 38367310 DOI: 10.1016/j.clinph.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 12/28/2023] [Accepted: 02/06/2024] [Indexed: 02/19/2024]
Abstract
OBJECTIVE Emerging studies have identified treatment-related connectome predictors in major depressive disorder (MDD). However, quantifying treatment-responsive patterns in structural connectivity (SC) and functional connectivity (FC) simultaneously remains underexplored. We aimed to evaluate whether spatial distributions of FC and SC associated treatment responses are shared or unique. METHODS Diffusion tensor imaging and resting-state functional magnetic resonance imaging were collected from 210 patients with MDD at baseline. We separately developed connectome-based prediction models (CPM) to predict reduction of depressive severity after 6-week monotherapy based on structural, functional, and combined connectomes, then validated them on the external dataset. We identified the predictive SC and FC from CPM with high occurrence frequencies during the cross-validation. RESULTS Structural connectomes (r = 0.2857, p < 0.0001), functional connectomes (r = 0.2057, p = 0.0025), and their combined CPM (r = 0.4, p < 0.0001) can significantly predict a reduction of depressive severity. We didn't find shared connectivity between predictive FC and SC. Specifically, the most predictive FC stemmed from the default mode network, while predictive SC was mainly characterized by within-network SC of fronto-limbic networks. CONCLUSIONS These distinct patterns suggest that SC and FC capture unique connectivity concerning the antidepressant response. SIGNIFICANCE Our findings provide comprehensive insights into the neurophysiology of antidepressants response.
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Affiliation(s)
- Xinyi Wang
- School of Biological Sciences & Medical Engineering, Southeast University, Nanjing 210096, China; Child Development and Learning Science, Key Laboratory of Ministry of Education, Nanjing 210096, China
| | - Li Xue
- School of Biological Sciences & Medical Engineering, Southeast University, Nanjing 210096, China; Child Development and Learning Science, Key Laboratory of Ministry of Education, Nanjing 210096, China
| | - Junneng Shao
- School of Biological Sciences & Medical Engineering, Southeast University, Nanjing 210096, China; Child Development and Learning Science, Key Laboratory of Ministry of Education, Nanjing 210096, China
| | - Zhongpeng Dai
- School of Biological Sciences & Medical Engineering, Southeast University, Nanjing 210096, China; Child Development and Learning Science, Key Laboratory of Ministry of Education, Nanjing 210096, China
| | - Lingling Hua
- Department of Psychiatry, the Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Rui Yan
- Department of Psychiatry, the Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Zhijian Yao
- Department of Psychiatry, the Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China; Nanjing Brain Hospital, Medical School of Nanjing University, Nanjing 210093, China.
| | - Qing Lu
- School of Biological Sciences & Medical Engineering, Southeast University, Nanjing 210096, China; Child Development and Learning Science, Key Laboratory of Ministry of Education, Nanjing 210096, China.
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Liu Y, Hu Q, Xu S, Li W, Liu J, Han L, Mao H, Cai F, Liu Q, Zhu R, Fang C, Lou Y, Wang Z, Yang H, Wang W. Antidepressant effects of dexmedetomidine compared with ECT in patients with treatment-resistant depression. J Affect Disord 2024; 347:437-444. [PMID: 38000472 DOI: 10.1016/j.jad.2023.11.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 11/16/2023] [Accepted: 11/19/2023] [Indexed: 11/26/2023]
Abstract
OBJECTIVE This pilot study was designed to investigate the antidepressant effects of dexmedetomidine (DEX), a selective α2-adrenergic receptor agonist, in patients with treatment-resistant depression (TRD). The antidepressant effects of dexmedetomidine was compared with ECT, which is widely used in clinical practice for treatment of patients with TRD. METHODS Seventy six patients with TRD were randomly assigned to receive 10 sessions of DEX infusions or electroconvulsive therapy (ECT) treatment. The primary outcome was the changes of depression severity determined by the improvement of 24-item Hamilton Depression Rating Scale (HDRS-24). The second outcomes were the rates of therapeutic response (reduction in HDRS-24 ≥ 50 %) and remission (HDRS-24 ≤ 10 and reduction in HDRS-24 ≥ 60 %) at posttreatment and after 3 months of follow-up visits. RESULTS We found that 10 sessions of DEX infusions or ECT treatments significantly improved HDRS-24 scores at posttreatment and after 3 months of follow-up visits compared with the baseline. In addition, there was no significant difference between DEX infusions and ECT treatments regarding HDRS-24 at these evaluating points. Furthermore, the depression severity dropped to mild after 2 sessions of DEX infusion. In contrast, at least 6 sessions of ECT treatment were needed to achieve a same level. Finally, the rates of therapeutic response and remission were comparable between the two groups. No serious adverse events were observed. CONCLUSIONS Based on current published evidence, we conclude that DEX exhibits rapid and durable antidepressant properties similar to ECT but with fewer side effects.
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Affiliation(s)
- Yusi Liu
- Jinzhou Medical University, Jinzhou, Liaoning 121001, China
| | - Qiyun Hu
- Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310053, China
| | - Sen Xu
- Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310053, China
| | - Wanwen Li
- Department of Psychiatry, Affiliated Mental Health Center, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310063, China
| | - Junyun Liu
- Department of Psychiatry, Affiliated Mental Health Center, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310063, China
| | - Liang Han
- Center for Rehabilitation Medicine, Department of Anesthesiology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang 310014, China
| | - Hui Mao
- Center for Rehabilitation Medicine, Department of Anesthesiology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang 310014, China
| | - Fang Cai
- Center for Rehabilitation Medicine, Department of Anesthesiology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang 310014, China
| | - Qiaoyan Liu
- Center for Rehabilitation Medicine, Department of Anesthesiology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang 310014, China
| | - Renlai Zhu
- Center for Rehabilitation Medicine, Department of Anesthesiology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang 310014, China
| | - Caiyun Fang
- Department of Anesthesiology, Affiliated Mental Health Center, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310063, China
| | - Yifei Lou
- Department of Anesthesiology, Affiliated Hangzhou Xixi Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310023, China
| | - Zhenhua Wang
- Department of Anesthesiology, Jiaxing Hospital of T.C.M., Affiliated Hospital of Zhejiang Chinese Medical University, Jiaxing, Zhejiang 314015, China
| | - Huiling Yang
- Department of Anesthesiology, Affiliated Hangzhou Xixi Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310023, China
| | - Wenyuan Wang
- Center for Rehabilitation Medicine, Department of Anesthesiology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang 310014, China.
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Singh P, Srivastava A, Philip L, Ahuja SK, Shivangi, Rawat C, Kutum R, Yadav J, Sood M, Chadda RK, Dash D, Vohora D, Kukreti R. Genome-wide transcriptomic and biochemical profiling of major depressive disorder: Unravelling association with susceptibility, severity, and antidepressant response. Genomics 2024; 116:110772. [PMID: 38158140 DOI: 10.1016/j.ygeno.2023.110772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 11/26/2023] [Accepted: 12/24/2023] [Indexed: 01/03/2024]
Abstract
Identifying biomarkers for diagnosing Major Depressive Disorder (MDD), assessing its severity, and guiding treatment is crucial. We conducted whole genome transcriptomic study in North Indian population, and analyzed biochemical parameters. Our longitudinal study investigated gene-expression profiles from 72 drug-free MDD patients and 50 healthy controls(HCs) at baseline and 24 patients after 12-weeks of treatment. Gene expression analyses identified differentially expressed genes(DEGs) associated with MDD susceptibility, symptom severity and treatment response, independently validated by qPCR. Hierarchical clustering revealed distinct expression patterns between MDD and HCs, also between mild and severe cases. Enrichment analyses of significant DEGs revealed inflammatory, apoptosis, and immune-related pathways in MDD susceptibility, severity, and treatment response. Simultaneously, we assessed thirty biochemical parameters in the same cohort, showed significant differences between MDD and HCs in 13 parameters with monocytes, eosinophils, creatinine, SGPT, and total protein remained independent predictors of MDD in a multivariate-regression model. Our study supports the role of altered immune/inflammatory signaling in MDD pathophysiology, offering clinically relevant biochemical parameters and insights into transcriptomic gene regulation in MDD pathogenesis and treatment response.
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Affiliation(s)
- Priyanka Singh
- Genomics and Molecular Medicine Unit, Council of Scientific and Industrial Research (CSIR) - Institute of Genomics and Integrative Biology (IGIB), New Delhi 110007, India; Academy of Scientific and Innovative Research (AcSIR), Ghaziabad 201002, India
| | - Ankit Srivastava
- Genomics and Molecular Medicine Unit, Council of Scientific and Industrial Research (CSIR) - Institute of Genomics and Integrative Biology (IGIB), New Delhi 110007, India; Department of Pharmacology, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi 110062, India
| | - Lini Philip
- Genomics and Molecular Medicine Unit, Council of Scientific and Industrial Research (CSIR) - Institute of Genomics and Integrative Biology (IGIB), New Delhi 110007, India; Department of Psychiatry, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - Simranpreet Kaur Ahuja
- Genomics and Molecular Medicine Unit, Council of Scientific and Industrial Research (CSIR) - Institute of Genomics and Integrative Biology (IGIB), New Delhi 110007, India
| | - Shivangi
- Genomics and Molecular Medicine Unit, Council of Scientific and Industrial Research (CSIR) - Institute of Genomics and Integrative Biology (IGIB), New Delhi 110007, India; Department of Biotechnology, Delhi Technological University, Shahbad Daulatpur, Main Bawana Road, New Delhi 110042, India
| | - Chitra Rawat
- Genomics and Molecular Medicine Unit, Council of Scientific and Industrial Research (CSIR) - Institute of Genomics and Integrative Biology (IGIB), New Delhi 110007, India; Academy of Scientific and Innovative Research (AcSIR), Ghaziabad 201002, India
| | - Rintu Kutum
- Department of Computer Science, Ashoka University, Haryana 131029, India
| | - Jyoti Yadav
- Genomics and Molecular Medicine Unit, Council of Scientific and Industrial Research (CSIR) - Institute of Genomics and Integrative Biology (IGIB), New Delhi 110007, India
| | - Mamta Sood
- Department of Psychiatry, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - Rakesh Kumar Chadda
- Department of Psychiatry, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - Debasis Dash
- Genomics and Molecular Medicine Unit, Council of Scientific and Industrial Research (CSIR) - Institute of Genomics and Integrative Biology (IGIB), New Delhi 110007, India; Academy of Scientific and Innovative Research (AcSIR), Ghaziabad 201002, India
| | - Divya Vohora
- Department of Pharmacology, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi 110062, India
| | - Ritushree Kukreti
- Genomics and Molecular Medicine Unit, Council of Scientific and Industrial Research (CSIR) - Institute of Genomics and Integrative Biology (IGIB), New Delhi 110007, India; Academy of Scientific and Innovative Research (AcSIR), Ghaziabad 201002, India.
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Carvalho Silva R, Pisanu C, Maffioletti E, Menesello V, Bortolomasi M, Gennarelli M, Baune BT, Squassina A, Minelli A. Biological markers of sex-based differences in major depressive disorder and in antidepressant response. Eur Neuropsychopharmacol 2023; 76:89-107. [PMID: 37595325 DOI: 10.1016/j.euroneuro.2023.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 07/27/2023] [Accepted: 07/30/2023] [Indexed: 08/20/2023]
Abstract
Major depressive disorder (MDD) presents different clinical features in women and men, with women being more affected and responding differently to antidepressant treatment. Specific molecular mechanisms underlying these differences are not well studied and this narrative review aims at providing an overview of the neurobiological features underlying sex-differences in biological systems involved in MDD pathophysiology and response to antidepressant treatment, focusing on human studies. The majority of the reviewed studies were performed through candidate gene approaches, focusing on biological systems involved in MDD pathophysiology, including the stress response, inflammatory and immune, monoaminergic, neurotrophic, gamma-aminobutyric acid and glutamatergic, and oxytocin systems. The influence of the endocrine system and sex-specific hormone effects are also discussed. Genome, epigenome and transcriptome-wide approaches are less frequently performed and most of these studies do not focus on sex-specific alterations, revealing a paucity of omics studies directed to unravel sex-based differences in MDD. Few studies about sex-related differences in antidepressant treatment response have been conducted, mostly involving the inflammatory system, with less evidence on the monoaminergic system and sparse evidence in omics approaches. Our review covers the importance of accounting for sex-differences in research, optimizing patient stratification for a more precise diagnostic and individualized treatment for women and men.
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Affiliation(s)
- Rosana Carvalho Silva
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Claudia Pisanu
- Department of Biomedical Sciences, Section of Neuroscience and Clinical Pharmacology, University of Cagliari, Italy
| | - Elisabetta Maffioletti
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Valentina Menesello
- Genetics Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | | | - Massimo Gennarelli
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy; Genetics Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Bernhard T Baune
- Department of Psychiatry and Psychotherapy, University of Münster, Münster, Germany; Department of Psychiatry, Melbourne Medical School, University of Melbourne, Parkville, VIC, Australia; The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Alessio Squassina
- Department of Biomedical Sciences, Section of Neuroscience and Clinical Pharmacology, University of Cagliari, Italy; Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, B3H 2E2, Canada
| | - Alessandra Minelli
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy; Genetics Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy.
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Paolini M, Harrington Y, Raffaelli L, Poletti S, Zanardi R, Colombo C, Benedetti F. Neutrophil to lymphocyte ratio and antidepressant treatment response in patients with major depressive disorder: Effect of sex and hippocampal volume. Eur Neuropsychopharmacol 2023; 76:52-60. [PMID: 37544076 DOI: 10.1016/j.euroneuro.2023.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 07/19/2023] [Accepted: 07/24/2023] [Indexed: 08/08/2023]
Abstract
Several factors may affect response to treatment in Major Depressive Disorder (MDD) including immune/inflammatory alterations and regional brain volumes, particularly in hippocampal regions which have shown to be influenced by inflammatory status. Neutrophil-to-lymphocyte ratio (NLR) is an inflammatory marker found to be elevated in depressed women in large population studies. Here we investigate the effect of NLR on treatment response in MDD patients, and the role of sex and hippocampal volume on influencing this relationship. A sample of 124 MDD depressed inpatients (F = 80) underwent MRI acquisition, admission NLR was calculated by dividing absolute neutrophil by absolute lymphocyte counts and depression severity was assessed at admission and discharge via the Hamilton Depression Rating Scale (HDRS). As a measure of treatment response, delta HDRS was calculated. We found a significant moderation effect of sex on the relationship between NLR and Delta HDRS: a negative relation was found in females and a positive one in males. NLR was found to negatively affect hippocampal volumes in females. Both left and right hippocampal volume positively associated with Delta HDRS. Finally, left hippocampal volume mediated the effect of NLR on Delta HDRS in females. Sex moderated the relation between inflammation and treatment response in line with previous reports linking inflammation to hampered antidepressant effect in females. Further, this effect is partially mediated by hippocampal volume, suggesting that antidepressant response may be hampered by the detrimental effect of inflammation on the brain.
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Affiliation(s)
- Marco Paolini
- Vita-Salute San Raffaele University, Milano, Italy; Psychiatry & Clinical Psychobiology, Division of Neuroscience, Scientific Institute IRCCS Ospedale San Raffaele, Milano, Italy
| | - Yasmin Harrington
- Vita-Salute San Raffaele University, Milano, Italy; Psychiatry & Clinical Psychobiology, Division of Neuroscience, Scientific Institute IRCCS Ospedale San Raffaele, Milano, Italy.
| | - Laura Raffaelli
- Psychiatry & Clinical Psychobiology, Division of Neuroscience, Scientific Institute IRCCS Ospedale San Raffaele, Milano, Italy
| | - Sara Poletti
- Vita-Salute San Raffaele University, Milano, Italy; Psychiatry & Clinical Psychobiology, Division of Neuroscience, Scientific Institute IRCCS Ospedale San Raffaele, Milano, Italy
| | - Raffaella Zanardi
- Mood Disorders Unit, Scientific Institute IRCCS Ospedale San Raffaele, Milano, Italy
| | - Cristina Colombo
- Psychiatry & Clinical Psychobiology, Division of Neuroscience, Scientific Institute IRCCS Ospedale San Raffaele, Milano, Italy; Mood Disorders Unit, Scientific Institute IRCCS Ospedale San Raffaele, Milano, Italy
| | - Francesco Benedetti
- Vita-Salute San Raffaele University, Milano, Italy; Psychiatry & Clinical Psychobiology, Division of Neuroscience, Scientific Institute IRCCS Ospedale San Raffaele, Milano, Italy
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Zanao TA, Luethi MS, Goerigk S, Suen P, Diaz AP, Soares JC, Brunoni AR. White matter predicts tDCS antidepressant effects in a sham-controlled clinical trial study. Eur Arch Psychiatry Clin Neurosci 2023; 273:1421-1431. [PMID: 36336757 DOI: 10.1007/s00406-022-01504-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 10/14/2022] [Indexed: 11/09/2022]
Abstract
Transcranial direct current stimulation (tDCS) has been used as treatment for depression, but its effects are heterogeneous. We investigated, in a subsample of the clinical trial Escitalopram versus Electrical Direct Current Therapy for Depression Study (ELECTTDCS), whether white matter areas associated with depression disorder were associated with tDCS response. Baseline diffusion tensor imaging data were analyzed from 49 patients (34 females, mean age 41.9) randomized to escitalopram 20 mg/day, tDCS (2 mA, 30 min, 22 sessions), or placebo. Antidepressant outcomes were assessed by Hamilton Depression Rating Scale-17 (HDRS) after 10-week treatment. We used whole-brain tractography for extracting white matter measures for anterior corpus callosum, and bilaterally for cingulum bundle, striato-frontal, inferior occipito-frontal fasciculus and uncinate. For the rostral body, tDCS group showed higher MD associated with antidepressant effects (estimate = -5.13 ± 1.64, p = 0.002), and tDCS significantly differed from the placebo and the escitalopram group. The left striato-frontal tract showed higher FA associated with antidepressant effects (estimate = -2.14 ± 0.72, p = 0.003), and tDCS differed only from the placebo group. For the right uncinate, the tDCS group lower AD values were associated with higher HDRS decrease (estimate = -1.45 ± 0.67, p = 0.031). Abnormalities in white matter MDD-related areas are associated with tDCS antidepressant effects. Suggested better white matter microstructure of the left prefrontal cortex was associated with tDCS antidepressant effects. Future studies should investigate whether these findings are driven by electric field diffusion and density in these areas.
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Affiliation(s)
- Tamires A Zanao
- Department of Internal Medicine, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Matthias S Luethi
- Department of Internal Medicine, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Stephan Goerigk
- Department and Institute of Psychiatry, Faculdade de Medicina da Universidade de São Paulo, Laboratory of Neurosciences LIM-27), São Paulo, Brazil
- Department of Psychological Methodology and Assessment, LMU Munich, Munich, Germany
| | - Paulo Suen
- Department of Internal Medicine, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Alexandre P Diaz
- Hochschule Fresenius, University of Applied Sciences, Munich, Germany
| | - Jair C Soares
- Hochschule Fresenius, University of Applied Sciences, Munich, Germany
| | - Andre R Brunoni
- Department of Internal Medicine, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
- Hospital Universitário, Departamento de Clínica Médica, Faculdade de Medicina da USP, São Paulo, Brazil.
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10
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Zhou J, Zhou J, Sun Z, Feng L, Feng Y, Xiao L, Chen X, Yang J. The association of C-reactive protein with responses to escitalopram antidepressant treatment in patients with major depressive disorder. J Affect Disord 2022; 306:32-38. [PMID: 35271871 DOI: 10.1016/j.jad.2022.02.069] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 02/13/2022] [Accepted: 02/27/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND The effects of escitalopram vary markedly among MDD patients, and approximately one-third of patients fail to respond. A poor antidepressant response might be associated with excessively high C-reactive protein (CRP) levels, but the impact is not clear. We hypothesized that in adults with major depressive disorder, the peripheral biomarker, CRP, was associated with the response to escitalopram (SSRI). METHODS This was a prospective follow-up study. All 71 patients were treated with escitalopram for 12 weeks. Blood samples were collected at baseline and week 12. Remission was defined as a score of 7 or less on the HAMD-17 scale at week 12. Spearman correlations and multiple linear regressions were used to explore the relationship between continuous CRP levels and the HAMD-17 scores. Logistic regression was used to determine the predictors for remission. The restricted maximum likelihood (REML)-based mixed-effect model for repeated measures (MMRM) was used to examine the change of the HAMD-17 total scores between high and low CRP groups. RESULTS Compared with the high CRP group (≥0.8 mg/l), the low baseline CRP group had a higher remission rate (22.73% vs. 48.89%, χ2 = 4.2, p = 0.0403). Logistic regression revealed that patients with lower CRPs were 3.920 times (95% CI: 1.142, 13.460) more likely to experience remission (p = 0.0300). The multiple linear regression model showed that the HAMD-17 total score reduction (baseline to week 12) was negatively correlated with the baseline CRP level (t = -2.00, p = 0.0494). CONCLUSIONS We observed a predictive role of CRP for remission and symptomatic improvement after escitalopram treatment of MDD patients based on continuous or categorical CRP levels.
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Affiliation(s)
- Jingjing Zhou
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Jia Zhou
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Zuoli Sun
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Lei Feng
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Yuan Feng
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Le Xiao
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Xu Chen
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Jian Yang
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China.
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11
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Pain O, Hodgson K, Trubetskoy V, Ripke S, Marshe VS, Adams MJ, Byrne EM, Campos AI, Carrillo-Roa T, Cattaneo A, Als TD, Souery D, Dernovsek MZ, Fabbri C, Hayward C, Henigsberg N, Hauser J, Kennedy JL, Lenze EJ, Lewis G, Müller DJ, Martin NG, Mulsant BH, Mors O, Perroud N, Porteous DJ, Rentería ME, Reynolds CF, Rietschel M, Uher R, Wigmore EM, Maier W, Wray NR, Aitchison KJ, Arolt V, Baune BT, Biernacka JM, Bondolfi G, Domschke K, Kato M, Li QS, Liu YL, Serretti A, Tsai SJ, Turecki G, Weinshilboum R, McIntosh AM, Lewis CM, Kasper S, Zohar J, Souery D, Montgomery S, Albani D, Forloni G, Ferentinos P, Rujescu D, Mendlewicz J, Wray NR, Ripke S, Mattheisen M, Trzaskowski M, Byrne EM, Abdellaoui A, Adams MJ, Agerbo E, Air TM, Andlauer TF, Bacanu SA, Bækvad-Hansen M, Beekman AT, Bigdeli TB, Binder EB, Bryois J, Buttenschøn HN, Bybjerg-Grauholm J, Cai N, Castelao E, Christensen JH, Clarke TK, Coleman JR, Colodro-Conde L, Couvy-Duchesne B, Craddock N, Crawford GE, Davies G, Deary IJ, Degenhardt F, Derks EM, Direk N, Dolan CV, Dunn EC, Eley TC, Escott-Price V, Hassan Kiadeh FF, Finucane HK, Foo JC, Forstner AJ, Frank J, Gaspar HA, Gill M, Goes FS, Gordon SD, Grove J, Hall LS, Hansen CS, Hansen TF, Herms S, Hickie IB, Hoffmann P, Homuth G, Horn C, Hottenga JJ, Hougaard DM, Howard DM, Ising M, Jansen R, Jones I, Jones LA, Jorgenson E, Knowles JA, Kohane IS, Kraft J, Kretzschmar WW, Kutalik Z, Li Y, Lind PA, MacIntyre DJ, MacKinnon DF, Maier RM, Maier W, Marchini J, Mbarek H, McGrath P, McGuffin P, Medland SE, Mehta D, Middeldorp CM, Mihailov E, Milaneschi Y, Milani L, Mondimore FM, Montgomery GW, Mostafavi S, Mullins N, Nauck M, Ng B, Nivard MG, Nyholt DR, O’Reilly PF, Oskarsson H, Owen MJ, Painter JN, Pedersen CB, Pedersen MG, Peterson RE, Peyrot WJ, Pistis G, Posthuma D, Quiroz JA, Qvist P, Rice JP, Riley BP, Rivera M, Mirza SS, Schoevers R, Schulte EC, Shen L, Shi J, Shyn SI, Sigurdsson E, Sinnamon GC, Smit JH, Smith DJ, Stefansson H, Steinberg S, Streit F, Strohmaier J, Tansey KE, Teismann H, Teumer A, Thompson W, Thomson PA, Thorgeirsson TE, Traylor M, Treutlein J, Trubetskoy V, Uitterlinden AG, Umbricht D, Van der Auwera S, van Hemert AM, Viktorin A, Visscher PM, Wang Y, Webb BT, Weinsheimer SM, Wellmann J, Willemsen G, Witt SH, Wu Y, Xi HS, Yang J, Zhang F, Arolt V, Baune BT, Berger K, Boomsma DI, Cichon S, Dannlowski U, de Geus E, DePaulo JR, Domenici E, Domschke K, Esko T, Grabe HJ, Hamilton SP, Hayward C, Heath AC, Kendler KS, Kloiber S, Lewis G, Li QS, Lucae S, Madden PA, Magnusson PK, Martin NG, McIntosh AM, Metspalu A, Mors O, Mortensen PB, Müller-Myhsok B, Nordentoft M, Nöthen MM, O’Donovan MC, Paciga SA, Pedersen NL, Penninx BW, Perlis RH, Porteous DJ, Potash JB, Preisig M, Rietschel M, Schaefer C, Schulze TG, Smoller JW, Stefansson K, Tiemeier H, Uher R, Völzke H, Weissman MM, Werge T, Lewis CM, Levinson DF, Breen G, Børglum AD, Sullivan PF. Identifying the Common Genetic Basis of Antidepressant Response. Biol Psychiatry Glob Open Sci 2022; 2:115-126. [PMID: 35712048 PMCID: PMC9117153 DOI: 10.1016/j.bpsgos.2021.07.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 07/15/2021] [Accepted: 07/19/2021] [Indexed: 01/20/2023] Open
Abstract
Background Antidepressants are a first-line treatment for depression. However, only a third of individuals experience remission after the first treatment. Common genetic variation, in part, likely regulates antidepressant response, yet the success of previous genome-wide association studies has been limited by sample size. This study performs the largest genetic analysis of prospectively assessed antidepressant response in major depressive disorder to gain insight into the underlying biology and enable out-of-sample prediction. Methods Genome-wide analysis of remission (n remit = 1852, n nonremit = 3299) and percentage improvement (n = 5218) was performed. Single nucleotide polymorphism-based heritability was estimated using genome-wide complex trait analysis. Genetic covariance with eight mental health phenotypes was estimated using polygenic scores/AVENGEME. Out-of-sample prediction of antidepressant response polygenic scores was assessed. Gene-level association analysis was performed using MAGMA and transcriptome-wide association study. Tissue, pathway, and drug binding enrichment were estimated using MAGMA. Results Neither genome-wide association study identified genome-wide significant associations. Single nucleotide polymorphism-based heritability was significantly different from zero for remission (h 2 = 0.132, SE = 0.056) but not for percentage improvement (h 2 = -0.018, SE = 0.032). Better antidepressant response was negatively associated with genetic risk for schizophrenia and positively associated with genetic propensity for educational attainment. Leave-one-out validation of antidepressant response polygenic scores demonstrated significant evidence of out-of-sample prediction, though results varied in external cohorts. Gene-based analyses identified ETV4 and DHX8 as significantly associated with antidepressant response. Conclusions This study demonstrates that antidepressant response is influenced by common genetic variation, has a genetic overlap schizophrenia and educational attainment, and provides a useful resource for future research. Larger sample sizes are required to attain the potential of genetics for understanding and predicting antidepressant response.
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12
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Funayama Y, Li H, Ishimori E, Kawatake-Kuno A, Inaba H, Yamagata H, Seki T, Nakagawa S, Watanabe Y, Murai T, Oishi N, Uchida S. Antidepressant Response and Stress Resilience Are Promoted by CART Peptides in GABAergic Neurons of the Anterior Cingulate Cortex. Biol Psychiatry Glob Open Sci 2022; 3:87-98. [PMID: 36712563 PMCID: PMC9874166 DOI: 10.1016/j.bpsgos.2021.12.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 12/09/2021] [Accepted: 12/27/2021] [Indexed: 02/01/2023] Open
Abstract
Background A key challenge in the understanding and treatment of depression is identifying cell types and molecular mechanisms that mediate behavioral responses to antidepressant drugs. Because treatment responses in clinical depression are heterogeneous, it is crucial to examine treatment responders and nonresponders in preclinical studies. Methods We used the large variance in behavioral responses to long-term treatment with multiple classes of antidepressant drugs in different inbred mouse strains and classified the mice into responders and nonresponders based on their response in the forced swim test. Medial prefrontal cortex tissues were subjected to RNA sequencing to identify molecules that are consistently associated across antidepressant responders. We developed and used virus-mediated gene transfer to induce the gene of interest in specific cell types and performed forced swim, sucrose preference, social interaction, and open field tests to investigate antidepressant-like and anxiety-like behaviors. Results Cartpt expression was consistently upregulated in responders to four types of antidepressants but not in nonresponders in different mice strains. Responder mice given a single dose of ketamine, a fast-acting non-monoamine-based antidepressant, exhibited high CART peptide expression. CART peptide overexpression in the GABAergic (gamma-aminobutyric acidergic) neurons of the anterior cingulate cortex led to antidepressant-like behavior and drove chronic stress resiliency independently of mouse genetic background. Conclusions These data demonstrate that activation of CART peptide signaling in GABAergic neurons of the anterior cingulate cortex is a common molecular mechanism across antidepressant responders and that this pathway also drives stress resilience.
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Affiliation(s)
- Yuki Funayama
- SK Project, Medical Innovation Center, Kyoto University Graduate School of Medicine, Kyoto, Japan,Department of Psychiatry, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Haiyan Li
- SK Project, Medical Innovation Center, Kyoto University Graduate School of Medicine, Kyoto, Japan,Department of Psychiatry, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Erina Ishimori
- SK Project, Medical Innovation Center, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Ayako Kawatake-Kuno
- SK Project, Medical Innovation Center, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hiromichi Inaba
- SK Project, Medical Innovation Center, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hirotaka Yamagata
- Division of Neuropsychiatry, Department of Neuroscience, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Tomoe Seki
- Division of Neuropsychiatry, Department of Neuroscience, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Shin Nakagawa
- Division of Neuropsychiatry, Department of Neuroscience, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Yoshifumi Watanabe
- Division of Neuropsychiatry, Department of Neuroscience, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Toshiya Murai
- SK Project, Medical Innovation Center, Kyoto University Graduate School of Medicine, Kyoto, Japan,Department of Psychiatry, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Naoya Oishi
- SK Project, Medical Innovation Center, Kyoto University Graduate School of Medicine, Kyoto, Japan,Naoya Oishi, M.D., Ph.D.
| | - Shusaku Uchida
- SK Project, Medical Innovation Center, Kyoto University Graduate School of Medicine, Kyoto, Japan,Address correspondence to Shusaku Uchida, Ph.D.
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13
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Minelli A, Barlati S, Vitali E, Bignotti S, Dattilo V, Tura GB, Maffioletti E, Giacopuzzi E, Santoro V, Perusi G, Cobelli C, Magri C, Bonizzato S, Bocchio-Chiavetto L, Spina E, Vita A, Gennarelli M. Clinical validation of a combinatorial PharmAcogeNomic approach in major Depressive disorder: an Observational prospective RAndomized, participant and rater-blinded, controlled trial (PANDORA trial). Trials 2021; 22:896. [PMID: 34895291 PMCID: PMC8665317 DOI: 10.1186/s13063-021-05775-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 10/29/2021] [Indexed: 11/16/2022] Open
Abstract
Background Major depressive disorder (MDD) is a common, chronic, debilitating mood disorder that causes serious functional impairment and significantly decreased quality of life. Pharmacotherapy represents the first-line treatment option; however, only approximately one third of patients respond to the first treatment because of the ineffectiveness or side effects of antidepressants. Precision medicine in psychiatry might offer clinicians the possibility to tailor treatment according to the best possible evidence of efficacy and tolerability for each subject. In this context, our study aims to carry out a clinical validation of a combinatorial pharmacogenomics (PGx) test in an Italian MDD patient cohort with advocacy license independence. Methods Our study is a prospective participant- and rater-blinded, randomized, controlled clinical observational trial enrolling 300 MDD patients who are referred to psychiatric services to receive a new antidepressant due to the failure of their current treatment and/or the onset of adverse effects. Eligible participants are randomized to the TGTG group (Treated with Genetic Test Guide) or TAU group (Treated as Usual). For all subjects, DNA is collected with a buccal brush. The primary outcome is the reduction in depressive symptomatology. The secondary outcomes involve a range of scales that assess MDD symptoms and social functioning outcomes. The assessment is performed at four timepoints: baseline and 4, 8, and 12 weeks. Discussion This project represents the first randomized controlled clinical trial to investigate whether a non-commercial PGx test improves outcomes in an MDD naturalistic cohort. Moreover, the identification of new genetic variants associated with non-response or side effects will improve the efficacy of the test, leading to further cost-saving. Trial registration number ClinicalTrials.gov NCT04615234. Registered on November 4, 2020. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05775-8.
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Affiliation(s)
- Alessandra Minelli
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy.,Genetics Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Via Pilastroni, 4, 25125, Brescia, Italy
| | - Stefano Barlati
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy.,Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Erika Vitali
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy.,Genetics Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Via Pilastroni, 4, 25125, Brescia, Italy
| | - Stefano Bignotti
- Psychiatry Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Vincenzo Dattilo
- Genetics Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Via Pilastroni, 4, 25125, Brescia, Italy
| | - Giovanni Battista Tura
- Psychiatry Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Elisabetta Maffioletti
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Edoardo Giacopuzzi
- Genetics Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Via Pilastroni, 4, 25125, Brescia, Italy
| | - Vincenza Santoro
- Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Giulia Perusi
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Chiara Cobelli
- Psychiatry Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Chiara Magri
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Silvia Bonizzato
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Luisella Bocchio-Chiavetto
- Genetics Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Via Pilastroni, 4, 25125, Brescia, Italy.,Faculty of Psychology, eCampus University, Novedrate, Como, Italy
| | - Edoardo Spina
- Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Antonio Vita
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy.,Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Massimo Gennarelli
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy. .,Genetics Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Via Pilastroni, 4, 25125, Brescia, Italy.
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14
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Bulubas L, Padberg F, Mezger E, Suen P, Bueno PV, Duran F, Busatto G, Amaro E Jr, Benseñor IM, Lotufo PA, Goerigk S, Gattaz W, Keeser D, Brunoni AR. Prefrontal resting-state connectivity and antidepressant response: no associations in the ELECT-TDCS trial. Eur Arch Psychiatry Clin Neurosci 2021; 271:123-34. [PMID: 32880057 DOI: 10.1007/s00406-020-01187-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 08/20/2020] [Indexed: 12/24/2022]
Abstract
Functional and structural MRI of prefrontal cortex (PFC) may provide putative biomarkers for predicting the treatment response to transcranial direct current stimulation (tDCS) in depression. A recent MRI study from ELECT-TDCS (Escitalopram versus Electrical Direct-Current Theror Depression Study) showed that depression improvement after tDCS was associated with gray matter volumes of PFC subregions. Based thereon, we investigated whether antidepressant effects of tDCS are similarly associated with baseline resting-state functional connectivity (rsFC). A subgroup of 51 patients underwent baseline rsFC-MRI. All patients of ELECT-TDCS were randomized to three treatment arms for 10 weeks (anodal-left, cathodal-right PFC tDCS plus placebo medication; escitalopram 10 mg/day for 3 weeks and 20 mg/day thereafter plus sham tDCS; and placebo medication plus sham tDCS). RsFC was calculated for various PFC regions and analyzed in relation to the individual antidepressant response. There was no significant association between baseline PFC connectivity of essential structural regions, nor any other PFC regions (after correction for multiple comparisons) and patients' individual antidepressant response. This study did not reveal an association between antidepressants effects of tDCS and baseline rsFC, unlike the gray matter volume findings. Thus, the antidepressant effects of tDCS may be differentially related to structural and functional MRI measurements.
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Abstract
Genetic factors play a significant but complex role in antidepressant (AD) response and tolerability. During recent years, there is growing enthusiasm in the promise of pharmacogenetic/pharmacogenomic (PGx) tools for optimizing and personalizing treatment outcomes for patients with major depressive disorder (MDD). The influence of pharmacokinetic and pharmacodynamic genes on response and tolerability has been investigated, including those encoding the cytochrome P450 superfamily, P-glycoprotein, monoaminergic transporters and receptors, intracellular signal transduction pathways, and the stress hormone system. Genome-wide association studies are also identifying new genetic variants associated with AD response phenotypes, which, combined with methods such as polygenic risk scores (PRS), is opening up new avenues for novel personalized treatment approaches for MDD. This chapter describes the basic concepts in PGx of AD response, reviews the major pharmacokinetic and pharmacodynamic genes involved in AD outcome, discusses PRS as a promising approach for predicting AD efficacy and tolerability, and addresses key challenges to the development and application of PGx tests.
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Affiliation(s)
- Farhana Islam
- Pharmacogenetics Research Clinic, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
- Department of Pharmacology & Toxicology, University of Toronto, Toronto, ON, Canada
| | - Ilona Gorbovskaya
- Pharmacogenetics Research Clinic, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
| | - Daniel J Müller
- Pharmacogenetics Research Clinic, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada.
- Department of Pharmacology & Toxicology, University of Toronto, Toronto, ON, Canada.
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
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16
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Benedetti F, Poletti S, Vai B, Mazza MG, Lorenzi C, Brioschi S, Aggio V, Branchi I, Colombo C, Furlan R, Zanardi R. Higher baseline interleukin-1β and TNF-α hamper antidepressant response in major depressive disorder. Eur Neuropsychopharmacol 2021; 42:35-44. [PMID: 33191075 DOI: 10.1016/j.euroneuro.2020.11.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 10/18/2020] [Accepted: 11/06/2020] [Indexed: 01/06/2023]
Abstract
Raised pro-inflammatory immune/inflammatory setpoints, leading to an increased production of peripheral cytokines, have been associated with Major Depressive Disorder (MDD) and with failure to respond to first-line antidepressant drugs. However, the usefulness of these biomarkers in clinical psychopharmacology has been questioned because single findings did not translate into the clinical practice, where patients are prescribed treatments upon clinical need. We studied a panel of 27 inflammatory biomarkers in a sample of 108 inpatients with MDD, treated with antidepressant monotherapy for 4 weeks upon clinical need in a specialized hospital setting, and assessed the predictive effect of baseline peripheral measures of inflammation on antidepressing efficacy (response rates and time-lagged pattern of decrease of depression severity) using a machine-learning approach with elastic net penalized regression, and multivariate analyses in the context of the general linear model. When considering both categorical and continuous measures of response, baseline levels of IL-1β predicted non-response to antidepressants, with the predicted probability to respond being highly dispersed at low levels of IL-1β, and stratifying toward non-response when IL-1β is high. Significant negative effects were also detected for TNF-α, while IL-12 weakly predicted response. These findings support the usefulness of inflammatory biomarkers in the clinical psychopharmacology of depression, and add to ongoing research efforts aiming at defining reliable cutoff values to identify depressed patients in clinical settings with high inflammation, and low probability to respond.
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Affiliation(s)
- Francesco Benedetti
- Psychiatry and Clinical Psychobiology, Division of Neuroscience, IRCCS Scientific Institute Ospedale San Raffaele, Milano, Italy; Vita-Salute San Raffaele University, Milano, Italy.
| | - Sara Poletti
- Psychiatry and Clinical Psychobiology, Division of Neuroscience, IRCCS Scientific Institute Ospedale San Raffaele, Milano, Italy; Vita-Salute San Raffaele University, Milano, Italy
| | - Benedetta Vai
- Psychiatry and Clinical Psychobiology, Division of Neuroscience, IRCCS Scientific Institute Ospedale San Raffaele, Milano, Italy; Vita-Salute San Raffaele University, Milano, Italy; Fondazione Centro San Raffaele, Milano, Italy
| | - Mario Gennaro Mazza
- Psychiatry and Clinical Psychobiology, Division of Neuroscience, IRCCS Scientific Institute Ospedale San Raffaele, Milano, Italy; Vita-Salute San Raffaele University, Milano, Italy
| | - Cristina Lorenzi
- Psychiatry and Clinical Psychobiology, Division of Neuroscience, IRCCS Scientific Institute Ospedale San Raffaele, Milano, Italy
| | - Silvia Brioschi
- Psychiatry and Clinical Psychobiology, Division of Neuroscience, IRCCS Scientific Institute Ospedale San Raffaele, Milano, Italy
| | - Veronica Aggio
- Psychiatry and Clinical Psychobiology, Division of Neuroscience, IRCCS Scientific Institute Ospedale San Raffaele, Milano, Italy; Vita-Salute San Raffaele University, Milano, Italy
| | - Igor Branchi
- Center for Behavioral Sciences and Mental Health, Istituto Superiore di Sanità, Rome, Italy
| | - Cristina Colombo
- Psychiatry and Clinical Psychobiology, Division of Neuroscience, IRCCS Scientific Institute Ospedale San Raffaele, Milano, Italy; Vita-Salute San Raffaele University, Milano, Italy
| | - Roberto Furlan
- Vita-Salute San Raffaele University, Milano, Italy; Clinical Neuroimmunology, Division of Neuroscience, IRCCS Scientific Institute Ospedale San Raffaele, Milano, Italy
| | - Raffaella Zanardi
- Psychiatry and Clinical Psychobiology, Division of Neuroscience, IRCCS Scientific Institute Ospedale San Raffaele, Milano, Italy; Vita-Salute San Raffaele University, Milano, Italy
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Godlewska BR, Harmer CJ. Cognitive neuropsychological theory of antidepressant action: a modern-day approach to depression and its treatment. Psychopharmacology (Berl) 2021; 238:1265-1278. [PMID: 31938879 PMCID: PMC8062380 DOI: 10.1007/s00213-019-05448-0] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 12/27/2019] [Indexed: 12/12/2022]
Abstract
Depression is a leading cause of disability worldwide and improving its treatment is a core research priority for future programmes. A change in the view of psychological and biological processes, from seeing them as separate to complementing one another, has introduced new perspectives on pathological mechanisms of depression and treatment mode of action. This review presents a theoretical model that incorporated this novel approach, the cognitive neuropsychological hypothesis of antidepressant action. This model proposes that antidepressant treatments decrease the negative bias in the processing of emotionally salient information early in the course of antidepressant treatment, which leads to the clinically significant mood improvement later in treatment. The paper discusses the role of negative affective biases in the development of depression and response to antidepressant treatments. It also discusses whether the model can be applied to other antidepressant interventions and its potential translational value, including treatment choice, prediction of response and drug development.
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Affiliation(s)
- Beata R Godlewska
- Department of Psychiatry, Psychopharmacology Research Unit, University Department of Psychiatry (PPRU), University of Oxford, Oxford, UK.
- Department of Psychiatry, Psychopharmacology and Emotion Research Laboratory (PERL), University of Oxford, Oxford, UK.
- Oxford Health Foundation Trust, University Department of Psychiatry, Warneford Hospital, Oxford, OX3 7JX, UK.
| | - Catherine J Harmer
- Department of Psychiatry, Psychopharmacology and Emotion Research Laboratory (PERL), University of Oxford, Oxford, UK
- Oxford Health Foundation Trust, University Department of Psychiatry, Warneford Hospital, Oxford, OX3 7JX, UK
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18
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Ang YS, Kaiser R, Deckersbach T, Almeida J, Phillips ML, Chase HW, Webb CA, Parsey R, Fava M, McGrath P, Weissman M, Adams P, Deldin P, Oquendo MA, McInnis MG, Carmody T, Bruder G, Cooper CM, Fatt CRC, Trivedi MH, Pizzagalli DA. Pretreatment Reward Sensitivity and Frontostriatal Resting-State Functional Connectivity Are Associated With Response to Bupropion After Sertraline Nonresponse. Biol Psychiatry 2020; 88:657-667. [PMID: 32507389 PMCID: PMC7529779 DOI: 10.1016/j.biopsych.2020.04.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 03/24/2020] [Accepted: 04/13/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Standard guidelines recommend selective serotonin reuptake inhibitors as first-line antidepressants for adults with major depressive disorder, but success is limited and patients who fail to benefit are often switched to non-selective serotonin reuptake inhibitor agents. This study investigated whether brain- and behavior-based markers of reward processing might be associated with response to bupropion after sertraline nonresponse. METHODS In a two-stage, double-blinded clinical trial, 296 participants were randomized to receive 8 weeks of sertraline or placebo in stage 1. Individuals who responded continued on another 8-week course of the same intervention in stage 2, while sertraline and placebo nonresponders crossed over to bupropion and sertraline, respectively. Data from 241 participants were analyzed. The stage 2 sample comprised 87 patients with major depressive disorder who switched medication and 38 healthy control subjects. A total of 116 participants with major depressive disorder treated with sertraline in stage 1 served as an independent replication sample. The probabilistic reward task and resting-state functional magnetic resonance imaging were administered at baseline. RESULTS Greater pretreatment reward sensitivity and higher resting-state functional connectivity between bilateral nucleus accumbens and rostral anterior cingulate cortex were associated with positive response to bupropion but not sertraline. Null findings for sertraline were replicated in the stage 1 sample. CONCLUSIONS Pretreatment reward sensitivity and frontostriatal connectivity may identify patients likely to benefit from bupropion following selective serotonin reuptake inhibitor failures. Results call for a prospective replication based on these biomarkers to advance clinical care.
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Affiliation(s)
- Yuen-Siang Ang
- Department of Psychiatry, Harvard Medical School, Boston, 25 Shattuck Street, Boston, MA 02115,Center for Depression, Anxiety and Stress Research, McLean Hospital, 115 Mill Street, Belmont, MA 02478
| | - Roselinde Kaiser
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO 80302
| | - Thilo Deckersbach
- Department of Psychiatry, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114
| | - Jorge Almeida
- Department of Psychiatry, University of Texas at Austin, Dell Medical School, 1601 Trinity St., Austin, TX 78712
| | - Mary L. Phillips
- Department of Psychiatry, University of Pittsburgh, 3811 O’Hara St, Pittsburgh, PA 15213
| | - Henry W. Chase
- Department of Psychiatry, University of Pittsburgh, 3811 O’Hara St, Pittsburgh, PA 15213
| | - Christian A. Webb
- Department of Psychiatry, Harvard Medical School, Boston, 25 Shattuck Street, Boston, MA 02115,Center for Depression, Anxiety and Stress Research, McLean Hospital, 115 Mill Street, Belmont, MA 02478
| | - Ramin Parsey
- Department of Psychiatry, Stony Brook University, Stony Brook, 100 Nicolls Road, Stony Brook, NY 11794
| | - Maurizio Fava
- Department of Psychiatry, Harvard Medical School, Boston, 25 Shattuck Street, Boston, MA 02115,Department of Psychiatry, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114
| | - Patrick McGrath
- New York State Psychiatric Institute & Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, 1051 Riverside Drive, New York, NY 10032
| | - Myrna Weissman
- New York State Psychiatric Institute & Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, 1051 Riverside Drive, New York, NY 10032
| | - Phil Adams
- New York State Psychiatric Institute & Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, 1051 Riverside Drive, New York, NY 10032
| | - Patricia Deldin
- Department of Psychiatry, University of Michigan, 500 S State Street, Ann Arbor, MI 48109
| | - Maria A. Oquendo
- Department of Psychiatry, University of Pennsylvania, Perelman School of Medicine, 3400 Civic Center Blvd, Philadelphia, PA 19104
| | - Melvin G. McInnis
- Department of Psychiatry, University of Michigan, 500 S State Street, Ann Arbor, MI 48109
| | - Thomas Carmody
- Department of Psychiatry, University of Texas, Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390
| | - Gerard Bruder
- New York State Psychiatric Institute & Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, 1051 Riverside Drive, New York, NY 10032
| | - Crystal M. Cooper
- Department of Psychiatry, University of Texas, Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390
| | - Cherise R. Chin Fatt
- Department of Psychiatry, University of Texas, Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390
| | - Madhukar H. Trivedi
- Department of Psychiatry, University of Texas, Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390
| | - Diego A. Pizzagalli
- Department of Psychiatry, Harvard Medical School, Boston, 25 Shattuck Street, Boston, MA 02115,Center for Depression, Anxiety and Stress Research, McLean Hospital, 115 Mill Street, Belmont, MA 02478
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Chin Fatt CR, Cooper C, Jha MK, Aslan S, Grannemann B, Kurian B, Greer TL, Fava M, Weissman M, McGrath PJ, Parsey RV, Etkin A, Phillips ML, Trivedi MH. Dorsolateral Prefrontal Cortex and Subcallosal Cingulate Connectivity Show Preferential Antidepressant Response in Major Depressive Disorder. Biol Psychiatry Cogn Neurosci Neuroimaging 2021; 6:20-8. [PMID: 32921587 DOI: 10.1016/j.bpsc.2020.06.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 06/22/2020] [Accepted: 06/22/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Major depressive disorder is associated with abnormal connectivity across emotion and reward circuits as well as other established circuits that may negatively impact treatment response. The goal of this study was to perform an exploratory reanalysis of archival data from a clinical trial to identify moderators of treatment outcome of sertraline over placebo. METHODS EMBARC (Establishing Moderators and Biosignatures of Antidepressant Response in Clinical Care) study participants completed magnetic resonance imaging before randomization to either sertraline or placebo for 8 weeks (n = 279). Seed-based functional connectivity was computed using 4 bilateral seeds (2 spheres defined bilaterally): amygdala, dorsolateral prefrontal cortex (DLPFC), subcallosal cingulate cortex, and ventral striatum. Functional connectivity maps were generated, principal component analysis was performed, linear mixed effects models were used to determine moderators of treatment outcome, and post hoc analyses were used to determine level of connectivity (low and high, -1 and +1 SD from the mean) that was most sensitive to improved depression severity (baseline to week 8) based on treatment. RESULTS Greater mean reduction in the 17-item Hamilton Rating Scale for Depression score by 8 weeks occurred with sertraline relative to placebo when connectivity in the DLPFC was low (3-way interaction test, p = .05). Conditional on low connectivity in the DLPFC and subcallosal cingulate cortex and high connectivity in the ventral striatum and amygdala, there was on average a 4.8-point greater reduction in the 17-item Hamilton Rating Scale for Depression score with sertraline relative to placebo (p = .003). CONCLUSIONS The level of functional connectivity seeded in both the DLPFC and the subcallosal cingulate cortex networks may play an important role in identifying a favorable response to sertraline over placebo.
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20
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Lee J, Lee KH, Kim SH, Han JY, Hong SB, Cho SC, Kim JW, Brent D. Early changes of serum BDNF and SSRI response in adolescents with major depressive disorder. J Affect Disord 2020; 265:325-332. [PMID: 32090756 DOI: 10.1016/j.jad.2020.01.045] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [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: 06/29/2019] [Revised: 12/11/2019] [Accepted: 01/12/2020] [Indexed: 01/02/2023]
Abstract
BACKGROUND Recent evidence suggests that brain-derived neurotrophic factor (BDNF) levels and their early changes may predict antidepressant response in adults with major depressive disorder (MDD). However, in adolescents, BDNF levels in depression and their changes during antidepressant treatment are relatively unknown. We aimed to investigate whether pre-treatment BDNF levels and their early changes predict antidepressant response in depressed adolescents. METHODS The study included 83 MDD adolescents and 52 healthy controls aged 12 to 17 years. All depressed adolescents were treated with escitalopram in an 8 week, open-label trial. Depression severity and serum BDNF level at baseline, and weeks 2 and 8 were measured with the Children's Depression Rating Scale-Revised (CDRS-R) and ELISA, respectively. RESULTS Responders showed a significant decrease in BDNF levels at week 2 but non-responders and healthy controls had no changes in BDNF levels at week 2. The early decrease (baseline - week 2) of BDNF levels predicted SSRI response with moderate sensitivity and specificity. Logistic regression analysis revealed that early BDNF decrease predicted SSRI response at week 8 after controlling for other demographic and clinical variables. LIMITATIONS The follow-up duration of the study was limited in 8 weeks. It remains possible that serum BDNF levels would have changed with longer treatment. CONCLUSIONS This is the first longitudinal study to investigate the effect of antidepressants on BDNF levels in adolescents with MDD. Our findings suggest that a decrease of serum BDNF levels in early phase of SSRI treatment may be associated later SSRI response in adolescents with MDD.
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Affiliation(s)
- Jung Lee
- Integrative Care Hub, Children's Hospital, Seoul National University Hospital, Seoul, South Korea
| | - Kyung Hwa Lee
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Seoul National University College of Medicine, Seoul, South Korea
| | - Seong Hae Kim
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Seoul National University College of Medicine, Seoul, South Korea
| | - Ji Youn Han
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Seoul National University College of Medicine, Seoul, South Korea
| | - Soon-Beom Hong
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Seoul National University College of Medicine, Seoul, South Korea
| | - Soo-Churl Cho
- Department of Psychiatry, Korea Armed Forces Capital Hospital, Gyenggi-do, South Korea
| | - Jae-Won Kim
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Seoul National University College of Medicine, Seoul, South Korea.
| | - David Brent
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
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21
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Suh JS, Minuzzi L, Raamana PR, Davis A, Hall GB, Harris J, Hassel S, Zamyadi M, Arnott SR, Alders GL, Sassi RB, Milev R, Lam RW, MacQueen GM, Strother SC, Kennedy SH, Frey BN. An investigation of cortical thickness and antidepressant response in major depressive disorder: A CAN-BIND study report. Neuroimage Clin 2020; 25:102178. [PMID: 32036277 PMCID: PMC7011077 DOI: 10.1016/j.nicl.2020.102178] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 11/25/2019] [Accepted: 01/10/2020] [Indexed: 11/28/2022]
Abstract
Major depressive disorder (MDD) is considered a highly heterogeneous clinical and neurobiological mental disorder. We employed a novel layered treatment design to investigate whether cortical thickness features at baseline differentiated treatment responders from non-responders after 8 and 16 weeks of a standardized sequential antidepressant treatment. Secondary analyses examined baseline differences between MDD and controls as a replication analysis and longitudinal changes in thickness after 8 weeks of escitalopram treatment. 181 MDD and 95 healthy comparison (HC) participants were studied. After 8 weeks of escitalopram treatment (10-20 mg/d, flexible dosage), responders (>50% decrease in Montgomery-Åsberg Depression Scale score) were continued on escitalopram; non-responders received adjunctive aripiprazole (2-10 mg/d, flexible dosage). MDD participants were classified into subgroups according to their response profiles at weeks 8 and 16. Baseline group differences in cortical thickness were analyzed with FreeSurfer between HC and MDD groups as well as between response groups. Two-stage longitudinal processing was used to investigate 8-week escitalopram treatment-related changes in cortical thickness. Compared to HC, the MDD group exhibited thinner cortex in the left rostral middle frontal cortex [MNI(X,Y,Z=-29,9,54.5,-7.7); CWP=0.0002]. No baseline differences in cortical thickness were observed between responders and non-responders based on week-8 or week-16 response profile. No changes in cortical thickness was observed after 8 weeks of escitalopram monotherapy. In a two-step 16-week sequential clinical trial we found that baseline cortical thickness does not appear to be associated to clinical response to pharmacotherapy at 8 or 16 weeks.
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Affiliation(s)
- Jee Su Suh
- Neuroscience Graduate Program, McMaster University, Hamilton, ON, Canada; Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Luciano Minuzzi
- Neuroscience Graduate Program, McMaster University, Hamilton, ON, Canada; Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Pradeep Reddy Raamana
- Rotman Research Institute, Baycrest Health Sciences; Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
| | - Andrew Davis
- Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, ON, Canada
| | - Geoffrey B Hall
- Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, ON, Canada
| | - Jacqueline Harris
- Department of Computing Science, University of Alberta, Edmonton, AB, Canada
| | - Stefanie Hassel
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Mathison Centre for Mental Health Research and Education, University of Calgary, Calgary, AB, Canada
| | - Mojdeh Zamyadi
- Rotman Research Institute, Baycrest Health Sciences; Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
| | - Stephen R Arnott
- Rotman Research Institute, Baycrest Health Sciences; Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
| | - Gésine L Alders
- Neuroscience Graduate Program, McMaster University, Hamilton, ON, Canada; Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Roberto B Sassi
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Roumen Milev
- Departments of Psychiatry and Psychology, Queen's University and Providence Care Hospital, Kingston, ON, Canada
| | - Raymond W Lam
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Glenda M MacQueen
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Mathison Centre for Mental Health Research and Education, University of Calgary, Calgary, AB, Canada
| | - Stephen C Strother
- Rotman Research Institute, Baycrest Health Sciences; Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
| | - Sidney H Kennedy
- Canadian Biomarker Integration Network for Depression, St. Michael's Hospital, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Benicio N Frey
- Neuroscience Graduate Program, McMaster University, Hamilton, ON, Canada; Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.
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22
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Ochi T, Vyalova NM, Losenkov IS, Levchuk LA, Osmanova DZ, Mikhalitskaya EV, Loonen AJM, Bosker FJ, Simutkin GG, Bokhan NA, Wilffert B, Ivanova SA. Investigating the potential role of BDNF and PRL genotypes on antidepressant response in depression patients: A prospective inception cohort study in treatment-free patients. J Affect Disord 2019; 259:432-439. [PMID: 31611000 DOI: 10.1016/j.jad.2019.08.058] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 07/13/2019] [Accepted: 08/18/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Brain-derived neurotrophic factor (BDNF) is associated with response to antidepressant drugs in mood and anxiety disorders. Prolactin (PRL) is a pituitary hormone with behavioural effects, acting as a neurotrophic factor within the brain and may be involved in antidepressant response. OBJECTIVES To investigate the relationship between BDNF and PRL genotypes with antidepressant drug response. METHODS Prospective inception cohort of 186 Russian treatment-free participants (28 men and 158 women) between 18 and 70 years clinically diagnosed with depressive disorder who initiated antidepressant medication. DNA polymorphisms were genotyped for PRL rs1341239, BDNF rs6265 and rs7124442. Primary outcome was measured by differences in Hamilton Depression Rating Scale (∆HAM-D) scores between baseline/week two, week two/week four, and baseline/week four. Linear regression and independent t-test determined the significance between polymorphisms and ∆HAM-D. RESULTS Comparisons between genotypes did not reveal any significant differences in scores during the first two weeks of treatment. In the latter two weeks, BDNF rs7124442 homozygous C patients responded significantly worse in comparison to homozygous T patients during this period. Further analysis within women and in post-menopausal women found a similar comparison between alleles. LIMITATIONS Study lasted four weeks, which may be considered short to associate genuine antidepressant effects. CONCLUSIONS Patients taking tricylic antidepressants were noted to have a significant improvement in ∆HAM-D compared to patients taking SSRIs. Homozygous C BDNF rs712442 patients were found to respond significantly worse in the last two weeks of treatment.
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Affiliation(s)
- Taichi Ochi
- University of Groningen, Groningen Research Institute of Pharmacy, Unit of PharmacoTherapy, Epidemiology & Economics, Antonius Deusinglaan 1, 9713AV Groningen, the Netherlands.
| | - Natalya M Vyalova
- Mental Health Research Institute, Tomsk National Research Medical Center of the Russian Academy of Sciences, Aleutskaya street, 4, 634014 Tomsk, Russian Federation
| | - Innokentiy S Losenkov
- Mental Health Research Institute, Tomsk National Research Medical Center of the Russian Academy of Sciences, Aleutskaya street, 4, 634014 Tomsk, Russian Federation
| | - Lyudmila A Levchuk
- Mental Health Research Institute, Tomsk National Research Medical Center of the Russian Academy of Sciences, Aleutskaya street, 4, 634014 Tomsk, Russian Federation
| | - Diana Z Osmanova
- Mental Health Research Institute, Tomsk National Research Medical Center of the Russian Academy of Sciences, Aleutskaya street, 4, 634014 Tomsk, Russian Federation
| | - Ekaterina V Mikhalitskaya
- Mental Health Research Institute, Tomsk National Research Medical Center of the Russian Academy of Sciences, Aleutskaya street, 4, 634014 Tomsk, Russian Federation
| | - Anton J M Loonen
- University of Groningen, Groningen Research Institute of Pharmacy, Unit of PharmacoTherapy, Epidemiology & Economics, Antonius Deusinglaan 1, 9713AV Groningen, the Netherlands; GGZ Westelijk Noord-Brabant, Hoofdlaan 8, 4661AA Halsteren, the Netherlands.
| | - Fokko J Bosker
- University of Groningen, University Medical Centre Groningen, University Centre for Psychiatry, Hanzeplein 1, 9713 GZ Groningen, PO Box 30.001, 9700 RB Groningen, the Netherlands
| | - German G Simutkin
- Mental Health Research Institute, Tomsk National Research Medical Center of the Russian Academy of Sciences, Aleutskaya street, 4, 634014 Tomsk, Russian Federation
| | - Nikolay A Bokhan
- Mental Health Research Institute, Tomsk National Research Medical Center of the Russian Academy of Sciences, Aleutskaya street, 4, 634014 Tomsk, Russian Federation; National Research Tomsk State University, Department of Psychotherapy and Psychological Counseling, Lenin Avenue, 36, 634050 Tomsk, Russian Federation; Siberian State Medical University, Moscowski Trakt, 2, 634050, Tomsk, Russian Federation
| | - Bob Wilffert
- University of Groningen, Groningen Research Institute of Pharmacy, Unit of PharmacoTherapy, Epidemiology & Economics, Antonius Deusinglaan 1, 9713AV Groningen, the Netherlands; University of Groningen, University Medical Center Groningen, Department of Clinical Pharmacy and Pharmacology, Hanzeplein 1, 9713 GZ Groningen, PO Box 30.001, 9700 RB Groningen, the Netherlands
| | - Svetlana A Ivanova
- Mental Health Research Institute, Tomsk National Research Medical Center of the Russian Academy of Sciences, Aleutskaya street, 4, 634014 Tomsk, Russian Federation; Siberian State Medical University, Moscowski Trakt, 2, 634050, Tomsk, Russian Federation; National Research Tomsk Polytechnic University, School of Non-Destructive Testing & Security, Division for Control and Diagnostics, Lenin Avenue, 30, 634050 Tomsk, Russian Federation
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Lopizzo N, Zonca V, Cattane N, Pariante CM, Cattaneo A. miRNAs in depression vulnerability and resilience: novel targets for preventive strategies. J Neural Transm (Vienna) 2019; 126:1241-58. [PMID: 31350592 DOI: 10.1007/s00702-019-02048-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 07/11/2019] [Indexed: 02/06/2023]
Abstract
The exposure to stressful experiences during the prenatal period and through the first years of life is known to affect the brain developmental trajectories, leading to an enhanced vulnerability for the development of several psychiatric disorders later in life. However, not all the subjects exposed to the same stressful experience develop a pathologic condition, as some of them, activating coping strategies, become more resilient. The disclosure of mechanisms associated with stress vulnerability or resilience may allow the identification of novel biological processes and potential molecules that, if properly targeted, may prevent susceptibility or potentiate resilience. Over the last years, miRNAs have been proposed as one of the epigenetic mechanisms mediating the long-lasting effects of stress. Accordingly, they are associated with the development of stress vulnerability or resilience-related strategies. Moreover, miRNAs have been proposed as possible biomarkers able to identify subjects at high risk to develop depression and to predict the response to pharmacological treatments. In this review, we aimed to provide an overview of findings from studies in rodents and humans focused on the involvement of miRNAs in the mechanisms of stress response with the final goal to identify distinct sets of miRNAs involved in stress vulnerability or resilience. In addition, we reviewed studies on alterations of miRNAs in the context of depression, showing data on the involvement of miRNAs in the pathogenesis of the disease and in the efficacy of pharmacological treatments, discussing the potential utility of miRNAs as peripheral biomarkers able to predict the treatment response.
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De Donatis D, Florio V, Porcelli S, Saria A, Mercolini L, Serretti A, Conca A. Duloxetine plasma level and antidepressant response. Prog Neuropsychopharmacol Biol Psychiatry 2019; 92:127-132. [PMID: 30611837 DOI: 10.1016/j.pnpbp.2019.01.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [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: 11/09/2018] [Revised: 12/11/2018] [Accepted: 01/02/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Major Depressive Disorder (MDD) is associated with a high rate of inadequate treatment response, which is mainly due to the large inter-individual genetic variability in pharmacokinetic and pharmacodynamic targets of antidepressant drugs. Little is still known about the exact association between plasma level of first-line antidepressants and clinical response. This is particularly true for duloxetine, a dual serotonin and norepinephrine reuptake inhibitor recommended as first-line treatment for MDD. The aim of this study was to investigate the association between serum concentration of duloxetine (SCD) and antidepressant response (AR). METHODS 66 MDD patients treated with duloxetine 60 mg/day monotherapy were recruited in an outpatient setting and followed for three months. Hamilton Depression Rating Scale - 21 (HAMD-21) was administrated at baseline, at month 1, and at month 3 to assess AR. SCD was measured at steady state. Linear regression analysis and nonlinear least-squares regression were used to estimate association between SCD and AR. RESULTS SCD showed a high inter-individual variability in our sample, despite the duloxetine fixed oral dosage. We found a strong association between SCD and AR following a bell-shaped function at month 1 and at month 3. Nonetheless, within the recommended SCD range of 30-120 ng/mL a more linear correlation between SCD and AR was observed. DISCUSSION Our results suggest that for duloxetine the association between SCD and AR likely follows a bell-shaped quadratic function with poor AR at subtherapeutic SCD and progressive decrease of AR at higher SCD. The maximum antidepressant efficacy seems to require SCD values next to the highest recommended SCD (30-120 ng/mL), probably because of the optimal saturation of both serotonin and norepinephrine transporters. Thus, taking into account the observed high interindividual variability of SCD, our findings suggest that for MDD patients treated with duloxetine, SCD could be a useful tool to guide the treatment by optimizing the oral dosage in order to increase the AR rate.
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Affiliation(s)
- Domenico De Donatis
- Department of Biomedical and Neuromotor Science, University of Bologna, Bologna, Italy
| | | | - Stefano Porcelli
- Department of Biomedical and Neuromotor Science, University of Bologna, Bologna, Italy
| | - Alois Saria
- Experimental Psychiatry Unit, Medical University of Innsbruck, Innsbruck, Austria
| | - Laura Mercolini
- Department of Pharmacy and Biotechnology, University of Bologna, Bologna, Italy
| | - Alessandro Serretti
- Department of Biomedical and Neuromotor Science, University of Bologna, Bologna, Italy.
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25
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Jha MK, Minhajuddin A, Chin-Fatt C, Greer T, Carmody T, Trivedi MH. Sex differences in the association of baseline c-reactive protein (CRP) and acute-phase treatment outcomes in major depressive disorder: Findings from the EMBARC study. J Psychiatr Res 2019; 113:165-171. [PMID: 30959227 PMCID: PMC6506231 DOI: 10.1016/j.jpsychires.2019.03.013] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [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: 01/08/2019] [Revised: 03/07/2019] [Accepted: 03/14/2019] [Indexed: 10/27/2022]
Abstract
Peripheral inflammation is associated with poor response to antidepressant treatments. However, whether sex differentially affects this association remains unknown. Participants of Establishing Moderators and Biosignatures of Antidepressant Response for Clinical Care (EMBARC) with baseline plasma samples were included in this study (n = 220; male n = 75, female n = 145). Depression severity [Hamilton Rating Scale for Depression 17-item (HAMD-17)] was measured at baseline and weeks- 1, 2, 3, 4, 6, and 8. Plasma c-reactive protein (CRP) was measured with commercially-available ELISA kits at baseline, week-1, and week-8. Sex difference in prediction of baseline-to-week-8 HAMD-17 change by baseline CRP was tested with sex-by-baseline-CRP-by-time interaction in mixed model analysis. Additionally, changes in CRP from baseline-to-week-8 CRP and its association with HAMD-17 changes over that period were also evaluated. Covariates included body mass index, site, smoking status, and age. There was a significant sex difference in association of baseline-to-week-8 HAMD-17 reduction with baseline CRP (p = 0.033). Higher baseline CRP was associated with lower baseline-to-week-8 HAMD-17 reduction in females (p < 0.0001) but not in males (p = 0.632). Additionally, CRP was significantly reduced (p = 0.041, effect size = 0.254) from baseline-to-week-8, but there were no sex differences in this reduction (p = 0.249). Baseline-to-week-8 changes in HAMD-17 and CRP were not significantly associated either overall (p = 0.348) or based on sex (p = 0.370). In a large study of depressed outpatients, we replicated previous findings that elevated baseline CRP levels are associated with worse antidepressant treatment outcomes. However, this effect was limited only to females. These findings emphasize the importance of studying sex differences in biological mechanisms linking inflammation and depression.
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Affiliation(s)
- Manish K. Jha
- Center for Depression Research and Clinical Care, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX, U.S.A. 75390-9119
| | - Abu Minhajuddin
- Center for Depression Research and Clinical Care, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, 75390-9119, TX, USA.
| | - Cherise Chin-Fatt
- Center for Depression Research and Clinical Care, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, 75390-9119, TX, USA.
| | - Tracy Greer
- Center for Depression Research and Clinical Care, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX, U.S.A 75390-9119
| | - Thomas Carmody
- Center for Depression Research and Clinical Care, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX, U.S.A 75390-9119
| | - Madhukar H. Trivedi
- Center for Depression Research and Clinical Care, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX, U.S.A 75390-9119
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26
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Affiliation(s)
- Fabio Sambataro
- Department of Neuroscience, Padua Neuroscience Center, University of Padova, Padua, Italy
| | - Robert Christian Wolf
- Department of General Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
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27
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Abstract
New antidepressants and individualized approaches to treatment, matching specific therapies to individual patients, are urgently needed. For this, a better understanding of processes underpinning the development of depressive symptoms and response to medications are required. The cognitive neuropsychological model offers a novel approach uniquely combining biological and psychological approaches to explain how antidepressants exert their effect, why there is a delay in the onset of their clinical effect, and how changes in emotional processing are an essential step for a clinical antidepressant effect to take place. The paper presents the model and its underpinnings in the form of research in both healthy and depressed individuals, as well as the potential for its practical use.
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Affiliation(s)
- Beata R Godlewska
- Psychopharmacology Research Unit, University Department of Psychiatry (PPRU), University of Oxford, Oxford, UK.
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28
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Engel-Yeger B, Bloch B, Gonda X, Canepa G, Pompili M, Sher L, Rihmer Z, Amore M, Serafini G. Sensory profiles in unipolar and bipolar affective disorders: Possible predictors of response to antidepressant medications? A prospective follow-up study. J Affect Disord 2018; 240:237-246. [PMID: 30081295 DOI: 10.1016/j.jad.2018.07.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 05/30/2018] [Accepted: 07/14/2018] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Sensory processing patterns have been proposed as a stable dimension able to characterize individuals with major affective disorders, but to what extent specific impairments in sensory processing may be involved in the pathophysiology of these conditions is poorly understood. We aimed to explore which sensory profiles may better respond to psychoactive medications, with particular regard to antidepressants, according to depression, alexithymia, and hopelessness levels. METHODS A total of 402 outpatients who received maintenance treatment and were in stable psychopathological conditions were recruited and completed the Adolescent/Adult Sensory Profile (AASP), Toronto Alexithymia Scale (TAS-20), second version of the Beck Depression Inventory (BDI-II), and Beck Hopelessness Scale (BHS) according to a longitudinal prospective study design including three time points of measurements. RESULTS Subjects with abnormally reduced sensory seeking, hypersensitivity, enhanced sensory avoidance, and lower ability to register information better responded to antidepressant medications according to their reduced depression levels. Similarly, participants with lower registration better responded to antidepressants as reported by lower hopelessness levels. Regression analyses revealed that the use of antidepressants was the first variable able to predict depression, hopelessness, and alexithymia levels at baseline, and after three and six months of treatment, respectively, but the pattern of sensory sensitivity contribute to the prediction of depression and hopelessness. This pattern together with low registration predicted changes in alexithymia levels. LIMITATIONS The study was limited by the modest sample size at the follow-up assessment points. DISCUSSION Exploring sensory processing patterns may provide intriguing insights into specific illness characteristics and treatment response.
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Affiliation(s)
- Batya Engel-Yeger
- Department of Occupational Therapy, Faculty of Social Welfare and Health Sciences, University of Haifa, Israel
| | - Boaz Bloch
- Outpatient Psychiatric Unit, The department of Psychiatry, Emek Medical Center, Rapaport Faculty of Medicine, Technion-Israel Institute of Technology, Izhak Rabin Ave, 18000 Afula, Haifa, Israel
| | - Xenia Gonda
- Department of Psychiatry and Psychotherapy, Kutvolgyi Clinical Center, Semmelweis University, Budapest, Hungary; MTA-SE Neuropsychopharmacology Research Group, Hungarian Academy of Sciences and Semmelweis University, Budapest, Hungary; NAP-2-SE New Antidepressant Target Research Group, Semmelweis University, Budapest
| | - Giovanna Canepa
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Section of Psychiatry
| | - Maurizio Pompili
- Department of Neurosciences, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Leo Sher
- James J. Peters Veterans' Administration Medical Center and Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Zoltan Rihmer
- Department of Psychiatry and Psychotherapy, Kutvolgyi Clinical Center, Semmelweis University, Budapest, Hungary
| | - Mario Amore
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Section of Psychiatry; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Gianluca Serafini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Section of Psychiatry; IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
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29
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Oltedal L, Narr KL, Abbott C, Anand A, Argyelan M, Bartsch H, Dannlowski U, Dols A, van Eijndhoven P, Emsell L, Erchinger VJ, Espinoza R, Hahn T, Hanson LG, Hellemann G, Jorgensen MB, Kessler U, Oudega ML, Paulson OB, Redlich R, Sienaert P, Stek ML, Tendolkar I, Vandenbulcke M, Oedegaard KJ, Dale AM. Volume of the Human Hippocampus and Clinical Response Following Electroconvulsive Therapy. Biol Psychiatry 2018; 84:574-81. [PMID: 30006199 DOI: 10.1016/j.biopsych.2018.05.017] [Citation(s) in RCA: 120] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 04/29/2018] [Accepted: 05/13/2018] [Indexed: 01/02/2023]
Abstract
BACKGROUND Hippocampal enlargements are commonly reported after electroconvulsive therapy (ECT). To clarify mechanisms, we examined if ECT-induced hippocampal volume change relates to dose (number of ECT sessions and electrode placement) and acts as a biomarker of clinical outcome. METHODS Longitudinal neuroimaging and clinical data from 10 independent sites participating in the Global ECT-Magnetic Resonance Imaging Research Collaboration (GEMRIC) were obtained for mega-analysis. Hippocampal volumes were extracted from structural magnetic resonance images, acquired before and after patients (n = 281) experiencing a major depressive episode completed an ECT treatment series using right unilateral and bilateral stimulation. Untreated nondepressed control subjects (n = 95) were scanned twice. RESULTS The linear component of hippocampal volume change was 0.28% (SE 0.08) per ECT session (p < .001). Volume change varied by electrode placement in the left hippocampus (bilateral, 3.3 ± 2.2%, d = 1.5; right unilateral, 1.6 ± 2.1%, d = 0.8; p < .0001) but not the right hippocampus (bilateral, 3.0 ± 1.7%, d = 1.8; right unilateral, 2.7 ± 2.0%, d = 1.4; p = .36). Volume change for electrode placement per ECT session varied similarly by hemisphere. Individuals with greater treatment-related volume increases had poorer outcomes (Montgomery-Åsberg Depression Rating Scale change -1.0 [SE 0.35], per 1% volume increase, p = .005), although the effects were not significant after controlling for ECT number (slope -0.69 [SE 0.38], p = .069). CONCLUSIONS The number of ECT sessions and electrode placement impacts the extent and laterality of hippocampal enlargement, but volume change is not positively associated with clinical outcome. The results suggest that the high efficacy of ECT is not explained by hippocampal enlargement, which alone might not serve as a viable biomarker for treatment outcome.
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30
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Menchón JM, Espadaler J, Tuson M, Saiz-Ruiz J, Bobes J, Vieta E, Álvarez E, Pérez V. Patient characteristics driving clinical utility in psychiatric pharmacogenetics: a reanalysis from the AB-GEN multicentric trial. J Neural Transm (Vienna) 2018; 126:95-99. [PMID: 29728861 DOI: 10.1007/s00702-018-1879-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 03/26/2018] [Indexed: 12/28/2022]
Abstract
Clinical utility of commercial multi-gene pharmacogenetic tests in depression is starting to be studied with some promising results on efficacy and tolerability. Among the next steps is the definition of the patient profile that is most likely to benefit from testing. Here we present a reanalysis of data from the AB-GEN randomized clinical trial showing that clinical utility of pharmacogenetic testing can be markedly influenced by patient characteristics such as age, baseline severity and duration of current depressive episode.Trial registration ClinicalTrials.gov NCT02529462.
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Affiliation(s)
- J M Menchón
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.,Departament de Psiquiatria, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain.,Departament de Ciències Clíniques, Facultat de Medicina, Universitat de Barcelona, Barcelona, Spain
| | | | - M Tuson
- AB-Biotics SA, Barcelona, Spain
| | - J Saiz-Ruiz
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.,Departamento de Psiquiatría, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, Spain
| | - J Bobes
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.,Área de Psiquiatría, Facultad de Medicina, Universidad de Oviedo, Oviedo, Spain.,Instituto Universitario de Neurociencias del Principado de Asturias (INEUROPA), Oviedo, Spain
| | - E Vieta
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.,Institut Clínic de Neurociències, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - E Álvarez
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.,Servei de Psiquiatria, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Institut d'Investigació Biomèdica Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - V Pérez
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain. .,Institut de Neuropsiquiatria i Addiccions (INAD), Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain.
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31
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Abstract
Major Depression Disorder (MDD) has a highly variable treatment response due to the large inter-individual variation in the pharmacokinetics and pharmacodynamics of drug treatments. In detail the correlation between plasma level and efficacy has been much debated. Among first-line drugs for MDD, one of the most used is escitalopram. In the present study we investigated the association between serum concentration of escitalopram (SCE) and antidepressant response (AR). 70 MDD patients treated with escitalopram monotherapy were recruited and followed for three months. Hamilton Depression Rating Scale - 21 (HAMD-21) was administrated at baseline, month 1, and month 3 to assess AR. SCE was measured at steady state. Linear regression analysis and nonlinear least-squares regression were used to estimate association between SCE and AR. We found an association between SCE and AR both at month 1 (p<0.001) and month 3 (p=0.0003), which persists also excluding 3 patients with SCE equal to 0. Interestingly, by excluding patients with SCE < 20ng/mL, i.e. with a SCE lower than the putative therapeutic threshold, these associations disappeared. The curvilinear function AR = a + (SCE-SCE2) explained a higher proportion of variance compared to the linear other models (p<0.001). Our results suggest that for escitalopram the association between SCE and AR likely follows a nearly-asymptotic function, with poor AR at sub-therapeutic SCE and stable AR response at therapeutic SCE. Thus, when a patient reaches the therapeutic SCE range, further increase of escitalopram dosage seems to be useless, although further studies are needed to confirm our findings.
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Affiliation(s)
| | - Stefano Porcelli
- Department of Biomedical and Neuromotor Science, University of Bologna, Bologna, Italy
| | - Alois Saria
- Experimental Psychiatry Unit, Medical University of Innsbruck, Innsbruck, Austria
| | - Alessandro Serretti
- Department of Biomedical and Neuromotor Science, University of Bologna, Bologna, Italy.
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32
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Pérez V, Salavert A, Espadaler J, Tuson M, Saiz-Ruiz J, Sáez-Navarro C, Bobes J, Baca-García E, Vieta E, Olivares JM, Rodriguez-Jimenez R, Villagrán JM, Gascón J, Cañete-Crespillo J, Solé M, Saiz PA, Ibáñez Á, de Diego-Adeliño J, Menchón JM. Efficacy of prospective pharmacogenetic testing in the treatment of major depressive disorder: results of a randomized, double-blind clinical trial. BMC Psychiatry 2017; 17:250. [PMID: 28705252 PMCID: PMC5513031 DOI: 10.1186/s12888-017-1412-1] [Citation(s) in RCA: 124] [Impact Index Per Article: 17.7] [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: 01/30/2017] [Accepted: 06/29/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND A 12-week, double-blind, parallel, multi-center randomized controlled trial in 316 adult patients with major depressive disorder (MDD) was conducted to evaluate the effectiveness of pharmacogenetic (PGx) testing for drug therapy guidance. METHODS Patients with a CGI-S ≥ 4 and requiring antidepressant medication de novo or changes in their medication regime were recruited at 18 Spanish public hospitals, genotyped with a commercial PGx panel (Neuropharmagen®), and randomized to PGx-guided treatment (n = 155) or treatment as usual (TAU, control group, n = 161), using a computer-generated random list that locked or unlocked psychiatrist access to the results of the PGx panel depending on group allocation. The primary endpoint was the proportion of patients achieving a sustained response (Patient Global Impression of Improvement, PGI-I ≤ 2) within the 12-week follow-up. Patients and interviewers collecting the PGI-I ratings were blinded to group allocation. Between-group differences were evaluated using χ2-test or t-test, as per data type. RESULTS Two hundred eighty patients were available for analysis at the end of the 12-week follow-up (PGx n = 136, TAU n = 144). A difference in sustained response within the study period (primary outcome) was not observed (38.5% vs 34.4%, p = 0.4735; OR = 1.19 [95%CI 0.74-1.92]), but the PGx-guided treatment group had a higher responder rate compared to TAU at 12 weeks (47.8% vs 36.1%, p = 0.0476; OR = 1.62 [95%CI 1.00-2.61]), and this difference increased after removing subjects in the PGx-guided group when clinicians explicitly reported not to follow the test recommendations (51.3% vs 36.1%, p = 0.0135; OR = 1.86 [95%CI 1.13-3.05]). Effects were more consistent in patients with 1-3 failed drug trials. In subjects reporting side effects burden at baseline, odds of achieving a better tolerability (Frequency, Intensity and Burden of Side Effects Rating Burden subscore ≤2) were higher in the PGx-guided group than in controls at 6 weeks and maintained at 12 weeks (68.5% vs 51.4%, p = 0.0260; OR = 2.06 [95%CI 1.09-3.89]). CONCLUSIONS PGx-guided treatment resulted in significant improvement of MDD patient's response at 12 weeks, dependent on the number of previously failed medication trials, but not on sustained response during the study period. Burden of side effects was also significantly reduced. TRIAL REGISTRATION European Clinical Trials Database 2013-002228-18 , registration date September 16, 2013; ClinicalTrials.gov NCT02529462 , retrospectively registered: August 19, 2015.
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Affiliation(s)
- Víctor Pérez
- grid.469673.9Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Av. Monforte de Lemos, 3-5, Madrid, Spain ,grid.7080.fInstitut de Neuropsiquiatria i Addiccions (INAD), Hospital del Mar, Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Departament de Psiquiatria, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | | | | | - Jerónimo Saiz-Ruiz
- grid.469673.9Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Av. Monforte de Lemos, 3-5, Madrid, Spain ,0000 0000 9248 5770grid.411347.4Departament of Psychiatry, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Universidad de Alcalá, Madrid, Spain
| | - Cristina Sáez-Navarro
- grid.469673.9Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Av. Monforte de Lemos, 3-5, Madrid, Spain ,0000 0001 2284 9230grid.410367.7University Psychiatric Hospital, Institut Pere Mata, IISPV, Universitat Rovira Virgili, Reus, Spain
| | - Julio Bobes
- grid.469673.9Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Av. Monforte de Lemos, 3-5, Madrid, Spain ,0000 0001 2164 6351grid.10863.3cÁrea de Psiquiatría, Facultad de Medicina, Universidad de Oviedo, Instituto Universitario de Neurociencias del Principado de Asturias (INEUROPA), Oviedo, Spain
| | - Enrique Baca-García
- grid.469673.9Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Av. Monforte de Lemos, 3-5, Madrid, Spain ,grid.419651.eDepartamento de Psiquiatría, Fundación Jiménez Díaz, IIS FJD, Madrid, Spain ,0000000119578126grid.5515.4Hospital Universitario Rey Juan Carlos, Hospital Universitario Infanta Elena, Hospital General de Villalba, Universidad Autónoma de Madrid, Madrid, Spain ,0000000419368729grid.21729.3fColumbia University, New York, USA
| | - Eduard Vieta
- grid.469673.9Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Av. Monforte de Lemos, 3-5, Madrid, Spain ,Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - José M. Olivares
- 0000 0004 1757 0405grid.411855.cDepartment of Psychiatry, Hospital Álvaro Cunqueiro, Complejo Hospitalario Universitario de Vigo, Instituto Biomédico Galicia Sur, Vigo, Spain
| | - Roberto Rodriguez-Jimenez
- grid.469673.9Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Av. Monforte de Lemos, 3-5, Madrid, Spain ,0000 0001 1945 5329grid.144756.5Department of Psychiatry, Instituto de Investigación Hospital 12 de Octubre (i+12), Madrid, Spain
| | - José M. Villagrán
- Psychiatric Hospitalization Unit, Hospital General de Jerez de la Frontera, Jerez de la Frontera, Cádiz Spain
| | - Josep Gascón
- 0000 0004 1794 4956grid.414875.bPsychiatric Unit, Hospital Universitari Mútua Terrassa, Terrassa, Spain
| | - Josep Cañete-Crespillo
- 0000 0004 1770 3861grid.466613.0Mental Health Department, Hospital de Mataró, Consorci Sanitari del Maresme, Mataró, Spain
| | - Montse Solé
- grid.469673.9Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Av. Monforte de Lemos, 3-5, Madrid, Spain ,0000 0001 2284 9230grid.410367.7University Psychiatric Hospital, Institut Pere Mata, IISPV, Universitat Rovira Virgili, Reus, Spain
| | - Pilar A. Saiz
- grid.469673.9Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Av. Monforte de Lemos, 3-5, Madrid, Spain ,0000 0001 2164 6351grid.10863.3cÁrea de Psiquiatría, Facultad de Medicina, Universidad de Oviedo, Instituto Universitario de Neurociencias del Principado de Asturias (INEUROPA), Oviedo, Spain
| | - Ángela Ibáñez
- grid.469673.9Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Av. Monforte de Lemos, 3-5, Madrid, Spain ,0000 0000 9248 5770grid.411347.4Departament of Psychiatry, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Universidad de Alcalá, Madrid, Spain
| | - Javier de Diego-Adeliño
- grid.469673.9Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Av. Monforte de Lemos, 3-5, Madrid, Spain ,grid.7080.fServei de Psiquiatria, Hospital de la Santa Creu i Sant Pau, Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - José M. Menchón
- grid.469673.9Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Av. Monforte de Lemos, 3-5, Madrid, Spain ,Department of Psychiatry, Hospital Universitari de Bellvitge, Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), Carretera de la Feixa Llarga s/n, 08907 Hospitalet de Llobregat, Barcelona, Spain ,0000 0004 1937 0247grid.5841.8Departament de Ciències Clíniques, Facultat de Medicina, Universitat de Barcelona, Barcelona, Spain
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Jha MK, Minhajuddin A, Gadad BS, Greer T, Grannemann B, Soyombo A, Mayes TL, Rush AJ, Trivedi MH. Can C-reactive protein inform antidepressant medication selection in depressed outpatients? Findings from the CO-MED trial. Psychoneuroendocrinology 2017; 78:105-13. [PMID: 28187400 DOI: 10.1016/j.psyneuen.2017.01.023] [Citation(s) in RCA: 125] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 01/21/2017] [Accepted: 01/23/2017] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Currently, no valid measures inform treatment selection for depressed patients. Whether C-reactive protein (CRP) in particular and two other acute phase reactants (inflammatory markers) could differentiate between patients responding to either of two treatments with different mechanisms of action was assessed. METHOD Subjects included Combining Medications to Enhance Depression Outcomes (CO-MED) trial participants randomly assigned to either escitalopram plus placebo (SSRI monotherapy, n=51) or bupropion plus escitalopram combination (bupropion-SSRI combination, n=55) with baseline plasma samples. CRP, serum amyloid P component, and alpha-2-macroglobulin were measured using the Bioplex Pro™ human acute-phase 4-plex panel. We conducted mixed model analyses of depressive symptom (Quick Inventory of Depressive Symptomatology Self-Report) and side-effect burden (Frequency, Intensity, and Burden of Side-Effects Rating Scale) obtained weekly or every other week over the 12-week acute-phase of CO-MED trial to evaluate the relationship between these outcomes and baseline CRP and other acute-phase reactants. RESULTS The treatment arms did not differ in depressive symptom or side effect outcomes. Most participants (69.8%, 74/106) had baseline CRP levels greater than 1mg/L (indicative of systemic inflammatory activity). Higher baseline CRP levels were associated lower depression severity (correlation coefficient=-0.63) with bupropion-SSRI combination but not with SSRI monotherapy (correlation coefficient=0.40). The overall remission rate was 41.5%. The estimated remission rate with CRP threshold based assignment (SSRI monotherapy for <1mg/L and Bupropion-SSRI for ≥1mg/L) was 53.1%, with a number needed to treat of 8.6. Side effect burden was unrelated to any baseline inflammatory marker. CONCLUSIONS Baseline CRP levels relate differentially to antidepressant treatment outcomes in persons with major depressive disorder. Clinicaltrials.gov identifier: NCT00590863.
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Faron-Górecka A, Kuśmider M, Szafran-Pilch K, Kolasa M, Żurawek D, Gruca P, Papp M, Solich J, Pabian P, Dziedzicka-Wasylewska M. Basal prolactin levels in rat plasma correlates with response to antidepressant treatment in animal model of depression. Neurosci Lett 2017; 647:147-152. [PMID: 28336340 DOI: 10.1016/j.neulet.2017.03.034] [Citation(s) in RCA: 5] [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] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 03/17/2017] [Accepted: 03/18/2017] [Indexed: 10/19/2022]
Abstract
Prolactin (PRL) has been shown to be altered by psychotropic drugs, including antidepressant drugs (ADs). Many studies have focused on the response to antidepressant treatment (especially related to the serotonergic system) using the fenfluramine test (PRF), however some data suggest lack of correlation between PRF and prediction of clinical response to ADs. In our study we have investigated the hypothesis that basal plasma level of prolactin is a better predictor of antidepressant treatment. We have used Chronic Mild Stress (CMS) - the animal model of depression. Rats are exposed to CMS in combination with imipramine (IMI) treatment for 5 consecutive weeks. Blood samples were collected from the rat tail vein three times: before the CMS procedure, after 2 weeks of stress and after the complete CMS procedure (after 5 weeks of stress and IMI treatment). The PRL level in plasma was determined using the commercially available ELISA kit. In CMS, anhedonia in rats is manifested by reduced consumption of sucrose solution while administration of antidepressant drugs reverses anhedonia. Some animals (ca.30%) did not respond to antidepressant therapy and were considered treatment-resistant. There was no correlation between basal PRL levels and stress response, however, from the results obtained by Spearman Rank Correlation analysis we have observed a significant negative correlation between basal PRL levels before the CMS procedure and behavioral response to IMI administration. The obtained results indicate that the basal PRL level in rat plasma correlates with a good response to treatment in the animal model of depression.
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Affiliation(s)
- A Faron-Górecka
- Department of Pharmacology, Institute of Pharmacology, Polish Academy of Sciences, Smętna Street 12, Kraków 31-343, Poland.
| | - M Kuśmider
- Department of Pharmacology, Institute of Pharmacology, Polish Academy of Sciences, Smętna Street 12, Kraków 31-343, Poland
| | - K Szafran-Pilch
- Department of Pharmacology, Institute of Pharmacology, Polish Academy of Sciences, Smętna Street 12, Kraków 31-343, Poland
| | - M Kolasa
- Department of Pharmacology, Institute of Pharmacology, Polish Academy of Sciences, Smętna Street 12, Kraków 31-343, Poland
| | - D Żurawek
- Department of Pharmacology, Institute of Pharmacology, Polish Academy of Sciences, Smętna Street 12, Kraków 31-343, Poland
| | - P Gruca
- Department of Pharmacology, Institute of Pharmacology, Polish Academy of Sciences, Smętna Street 12, Kraków 31-343, Poland
| | - M Papp
- Department of Pharmacology, Institute of Pharmacology, Polish Academy of Sciences, Smętna Street 12, Kraków 31-343, Poland
| | - J Solich
- Department of Pharmacology, Institute of Pharmacology, Polish Academy of Sciences, Smętna Street 12, Kraków 31-343, Poland
| | - P Pabian
- Department of Pharmacology, Institute of Pharmacology, Polish Academy of Sciences, Smętna Street 12, Kraków 31-343, Poland
| | - M Dziedzicka-Wasylewska
- Department of Pharmacology, Institute of Pharmacology, Polish Academy of Sciences, Smętna Street 12, Kraków 31-343, Poland
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Hough CM, Lindqvist D, Epel ES, Denis MS, Reus VI, Bersani FS, Rosser R, Mahan L, Burke HM, Wolkowitz OM, Mellon SH. Higher serum DHEA concentrations before and after SSRI treatment are associated with remission of major depression. Psychoneuroendocrinology 2017; 77:122-130. [PMID: 28038403 PMCID: PMC5336487 DOI: 10.1016/j.psyneuen.2016.11.035] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 11/18/2016] [Accepted: 11/28/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Dehydroepiandrosterone (DHEA) and its sulfated ester DHEA-sulfate (DHEA-S), (together DHEA[S]), are the most abundant adrenal steroids in humans and are found in blood and the brain, where they function as neurosteroids with direct receptor affinities. Preclinical studies suggest that DHEA(S) has antidepressant/neuroprotective properties, and exogenously administered DHEA has shown antidepressant efficacy in humans. Nonetheless, the role of endogenous DHEA(S) levels in major depressive disorder (MDD) and antidepressant outcomes remains unclear. METHODS Morning fasting serum DHEA(S) concentrations were determined in 36 healthy, unmedicated MDD adults with Hamilton Depression (HDRS) ratings ≥17, and 75 healthy controls. MDD participants then completed eight weeks of open-label SSRI treatment before DHEA(S) levels were re-sampled; those with post-treatment HDRS ratings ≤7 were classified as "Remitters." Pre- and post-treatment DHEA(S) levels of Remitters and Non-remitters were compared, controlling for age, sex, and BMI. RESULTS Pre-treatment HDRS ratings did not differ between Remitters and Non-remitters (p=0.179). Baseline DHEA levels of Remitters were significantly higher than both Non-remitters (p=0.008) and controls (p=0.004); baseline DHEA-S levels of Remitters were also higher than Non-remitters (p=0.040) but did not significantly differ from controls (p=0.096). Non-remitters did not significantly differ from controls. Post-treatment DHEA(S) levels remained higher in Remitters compared to Non-remitters (DHEA: p=0.013; DHEA-S: p=0.040). CONCLUSIONS These data suggest that higher circulating DHEA(S) levels (while unmedicated and after eight weeks of SSRI treatment) predict SSRI-associated remission in MDD. This raises the possibility that endogenous DHEA(S) abundance is a physiological adjunct to SSRI efficacy, as suggested by prior preclinical and clinical studies.
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Affiliation(s)
- Christina M Hough
- Department of Psychiatry, UCSF Weill Institute for Neurosciences, University of California, San Francisco (UCSF) School of Medicine, San Francisco, CA, USA
| | - Daniel Lindqvist
- Department of Psychiatry, UCSF Weill Institute for Neurosciences, University of California, San Francisco (UCSF) School of Medicine, San Francisco, CA, USA; Department of Clinical Sciences, Section for Psychiatry, Lund University, Lund, Sweden
| | - Elissa S Epel
- Department of Psychiatry, UCSF Weill Institute for Neurosciences, University of California, San Francisco (UCSF) School of Medicine, San Francisco, CA, USA
| | - Molly St Denis
- Department of Psychiatry, UCSF Weill Institute for Neurosciences, University of California, San Francisco (UCSF) School of Medicine, San Francisco, CA, USA
| | - Victor I Reus
- Department of Psychiatry, UCSF Weill Institute for Neurosciences, University of California, San Francisco (UCSF) School of Medicine, San Francisco, CA, USA
| | - F Saverio Bersani
- Department of Psychiatry, UCSF Weill Institute for Neurosciences, University of California, San Francisco (UCSF) School of Medicine, San Francisco, CA, USA; Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - Rebecca Rosser
- Department of Psychiatry, UCSF Weill Institute for Neurosciences, University of California, San Francisco (UCSF) School of Medicine, San Francisco, CA, USA
| | - Laura Mahan
- Department of Psychiatry, UCSF Weill Institute for Neurosciences, University of California, San Francisco (UCSF) School of Medicine, San Francisco, CA, USA
| | - Heather M Burke
- Department of Psychiatry, UCSF Weill Institute for Neurosciences, University of California, San Francisco (UCSF) School of Medicine, San Francisco, CA, USA
| | - Owen M Wolkowitz
- Department of Psychiatry, UCSF Weill Institute for Neurosciences, University of California, San Francisco (UCSF) School of Medicine, San Francisco, CA, USA
| | - Synthia H Mellon
- Department of OB/GYN and Reproductive Sciences, UCSF School of Medicine, San Francisco, 513 Parnassus Ave., San Francisco, CA 94143-0556, USA.
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Lindqvist D, Dhabhar FS, James SJ, Hough CM, Jain FA, Bersani FS, Reus VI, Verhoeven JE, Epel ES, Mahan L, Rosser R, Wolkowitz OM, Mellon SH. Oxidative stress, inflammation and treatment response in major depression. Psychoneuroendocrinology 2017; 76:197-205. [PMID: 27960139 PMCID: PMC5272818 DOI: 10.1016/j.psyneuen.2016.11.031] [Citation(s) in RCA: 297] [Impact Index Per Article: 42.4] [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: 09/13/2016] [Revised: 11/24/2016] [Accepted: 11/28/2016] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Increased inflammation and oxidative stress have been shown in Major Depressive Disorder (MDD), although there is significant heterogeneity across studies. Whether markers of inflammation and oxidative stress are associated with antidepressant treatment response in MDD is currently unclear. The goals of the present study are to investigate markers of inflammation and oxidative stress in unmedicated MDD subjects and controls and test the relationship between these markers and antidepressant response in MDD subjects. METHODS Interleukin (IL)-6, tumor necrosis factor (TNF)-α, C-reactive protein, F2-isoprostanes, 8-OH 2-deoxyguanosine (8-OHdG), glutathione peroxidase, glutathione, and vitamin C were quantified in blood samples from 50 unmedicated MDD subjects and 55 healthy controls. Depression symptom severity was rated with the 17-item Hamilton Depression Rating Scale (HDRS). All subjects were somatically healthy and free from medications that could interfere with inflammation and oxidative stress markers. A subgroup of 22 MDD subjects underwent open-label selective serotonin reuptake inhibitor (SSRI) antidepressant treatment for eight weeks, after which blood sampling and the HDRS were repeated. Antidepressant treatment "response" was defined as ≥50% decrease in HDRS ratings over 8 weeks of treatment. RESULTS After controlling for the effects of age, sex, body mass index and smoking, MDD subjects had significantly higher levels of IL-6 (p<0.001), TNF-α (p<0.001), 8-OHdG (p=0.018), and F2-isoprostanes (p=0.012). Compared to Responders, Non-responders to SSRI antidepressant treatment had higher levels of F2-isoprostanes at baseline (p=0.006), and after eight weeks of treatment (p=0.031). Non-responders showed a significant increase in 8-OHdG over the course of treatment (p=0.021), whereas Responders showed a significant decrease in IL-6 over the course of treatment (p=0.019). CONCLUSION Our results are in line with previous reports of increased levels of markers of inflammation and oxidative stress in MDD. Moreover, poorer antidepressant treatment response was related to higher baseline levels of the major oxidative stress marker, F2-isoprostanes, in vivo. Further, antidepressant response was associated with changes in oxidative (8-OHdG) and inflammatory (IL-6) markers.
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Affiliation(s)
- Daniel Lindqvist
- Department of Psychiatry, UCSF Weill Institute for Neurosciences, University of California San Francisco (UCSF) School of Medicine, San Francisco, CA, United States; Lund University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry, Lund, Sweden.
| | - Firdaus S. Dhabhar
- Department of Psychiatry & Behavioral Sciences, Sylvester Comprehensive Cancer Center, University of Miami, Florida, United States of America
| | - S. Jill James
- Arkansas Children's Research Institute, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States of America
| | - Christina M. Hough
- Department of Psychiatry, University of California San Francisco (UCSF) School of Medicine, San Francisco, California, United States of America
| | - Felipe A. Jain
- Department of Psychiatry, University of California San Francisco (UCSF) School of Medicine, San Francisco, California, United States of America
| | - F. Saverio Bersani
- Department of Psychiatry, University of California San Francisco (UCSF) School of Medicine, San Francisco, California, United States of America,Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - Victor I. Reus
- Department of Psychiatry, University of California San Francisco (UCSF) School of Medicine, San Francisco, California, United States of America
| | - Josine E. Verhoeven
- Department of Psychiatry, University of California San Francisco (UCSF) School of Medicine, San Francisco, California, United States of America,Department of Psychiatry and EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
| | - Elissa S. Epel
- Department of Psychiatry, University of California San Francisco (UCSF) School of Medicine, San Francisco, California, United States of America
| | - Laura Mahan
- Department of Psychiatry, University of California San Francisco (UCSF) School of Medicine, San Francisco, California, United States of America
| | - Rebecca Rosser
- Department of Psychiatry, University of California San Francisco (UCSF) School of Medicine, San Francisco, California, United States of America
| | - Owen M. Wolkowitz
- Department of Psychiatry, University of California San Francisco (UCSF) School of Medicine, San Francisco, California, United States of America
| | - Synthia H. Mellon
- Department of OB/GYN and Reproductive Sciences, University of California San Francisco (UCSF) School of Medicine, San Francisco, California, United States of America
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Macías-Cortés EDC, Llanes-González L, Aguilar-Faisal L, Asbun-Bojalil J. Is metabolic dysregulation associated with antidepressant response in depressed women in climacteric treated with individualized homeopathic medicines or fluoxetine? The HOMDEP-MENOP Study. HOMEOPATHY 2017; 106:3-10. [PMID: 28325221 DOI: 10.1016/j.homp.2016.11.002] [Citation(s) in RCA: 7] [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] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 11/30/2016] [Accepted: 11/30/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND Climacteric is associated with both depression and metabolic dysregulation. Scarce evidence suggests that metabolic dysregulation may predict poor response to conventional antidepressants. Response to depression treatment has not been studied in homeopathic medicine. The aim of this study was to investigate the prevalence of metabolic disorders in depressed climacteric women treated with homeopathic medicines, fluoxetine or placebo, and if these alterations have any association with response to depression treatment. METHODS One hundred and thirty-three Mexican women (40-65 years) with depression, enrolled in the HOMDEP-MENOP study, a randomized, placebo-controlled, double-blind, double-dummy, three-arm trial with a 6 week follow-up, underwent a complete medical history and clinical examination. Metabolic parameters were assessed at baseline. Association between baseline metabolic parameters and response to depression treatment was analyzed with bivariate analysis in the three groups. Odds ratios (OR) with their 95% confidence interval (95% CI) were calculated. Metabolic parameters were considered for inclusion in the logistic regression model if they had a statistically significant relationship with response rate on bivariate analysis at p<0.05 or if they were clinically relevant. RESULTS Overall combined prevalence (obesity and overweight) was 86.5%; 52.3% had hypertriglyceridemia; 44.7% hypercholesterolemia; 46.7% insulin resistance; and 16% subclinical hypothyroidism. There was no statistically significant association between dyslipidemia, overweight, or insulin resistance and non-response in the homeopathy group [OR (95% CI) 1.57 (0.46-5.32), p=0.467; 0.37 (0.003-1.11), p=0.059; 0.67 (0.16-2.7), p=0.579, respectively]. CONCLUSION Metabolic dysregulation was not significantly associated with response to depression treatment in depressed climacteric women treated with individualized homeopathic treatment (IHT), fluoxetine or placebo. Due to the high prevalence of metabolic disorders and its relationship with depression in the climacteric, further investigation should be focused on whether individualized prescriptions based on classical homeopathy for depressed climacteric women have an effect on metabolic parameters, and/or if treating the metabolic disorders at the same time could lead to higher response rates. ClinicalTrials.gov Identifier: NCT01635218 URL: http://clinicaltrials.gov/ct2/show/NCT01635218?term=depression+homeopathy&rank=1.
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Affiliation(s)
- Emma Del Carmen Macías-Cortés
- Consulta Externa de Homeopatía, Hospital Juárez de México, Secretaría de Salud, Ave. Instituto Politécnico Nacional 5160, Col. Magdalena de las Salinas, CP 7760, Ciudad de México, Mexico; Jefatura de Enseñanza e Investigación, Hospital Nacional Homeopático, Secretaría de Salud, Ave Chimalpopoca 135, Col. Obrera, CP 06800, Ciudad de México, Mexico.
| | - Lidia Llanes-González
- Unidad de Salud Mental, Hospital Juárez de México, Secretaría de Salud, Ave. Instituto Politécnico Nacional 5160, Col. Magdalena de las Salinas, CP 7760, Ciudad de México, Mexico
| | - Leopoldo Aguilar-Faisal
- División de Posgrado, Escuela Superior de Medicina, Instituto Politécnico Nacional, Ave. Plan de San Luis y Salvador Díaz Mirón, Casco de Santo Tomás, CP 11340, Ciudad de México, Mexico
| | - Juan Asbun-Bojalil
- División de Posgrado, Escuela Superior de Medicina, Instituto Politécnico Nacional, Ave. Plan de San Luis y Salvador Díaz Mirón, Casco de Santo Tomás, CP 11340, Ciudad de México, Mexico
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Abstract
Major depressive disorder (MDD) is a common psychiatric disorder affecting millions of people worldwide, yet its etiology remains elusive. The last decades have seen great advances in our understanding of the genome structure and functional organization. Noncoding RNAs (ncRNAs) are RNAs that do not code for proteins but have important regulatory roles. The investigation of ncRNAs as regulators of gene expression has been a topic of growing interest in health research, including in studies investigating etiological and therapeutic factors in major depression. Several different species of ncRNAs have been identified in association to and have shown to be dysregulated in depressed individuals or in animal models of depression. This review will detail the complex relation between ncRNAs and major depression and the studies that propose mechanisms and pathways that specific ncRNAs may be involved in major depression.
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Meyer JD, Koltyn KF, Stegner AJ, Kim JS, Cook DB. Relationships between serum BDNF and the antidepressant effect of acute exercise in depressed women. Psychoneuroendocrinology 2016; 74:286-294. [PMID: 27697714 DOI: 10.1016/j.psyneuen.2016.09.022] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [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: 05/26/2016] [Revised: 09/01/2016] [Accepted: 09/27/2016] [Indexed: 01/14/2023]
Abstract
OBJECTIVE Brain-derived neurotrophic factor (BDNF) has recently emerged as one potential mechanism with which exercise improves mood in major depressive disorder (MDD). This study examined the relationship between changes in serum total BDNF and mood following acute exercise in MDD. It was hypothesized that acute exercise would increase BDNF in an intensity-dependent manner and that changes in BDNF would be significantly related to improvement in depressed mood post-exercise. METHODS Twenty-four women (age: 38.6±14.0years) with MDD exercised for 30min on a stationary bicycle at light, moderate and hard exercise intensities and performed a quiet rest session using a within-subjects, randomized and counter-balanced design. Before, 10 and 30min after each session, participants completed the profile of mood states (POMS). Blood was drawn before and within 10min after completion of each session and serum total BDNF (sBDNF) was measured by enzyme-linked immunosorbent assay. Acute exercise-induced changes in POMS Depression and sBDNF were analyzed via 4 session (quiet rest, light, moderate, hard) by 2 measurement (pre, post) ANOVA. Secondary analyses examined the effects of baseline mood and antidepressant usage on sBDNF. RESULTS Exercise resulted in an acute improvement in depressed mood that was not intensity dependent (p>0.05), resulting in significant acute increases in sBDNF (p=0.006) that were also not intensity-dependent (p>0.05). Acute changes in sBDNF were not significantly correlated to changes in POMS depression at 10m (r=-0.171, p=0.161) or 30m (r=-0.151, p=0.215) post-exercise. The fourteen participants taking antidepressant medications exhibited lower post-exercise sBDNF (p=0.015) than the participants not currently taking antidepressants, although mood responses were similar. CONCLUSION Acute exercise is an effective mood-enhancing stimulus, although sBDNF does not appear to play a role in this short-term response. Patients who are not currently taking antidepressant medications and those who have greater pre-exercise depression may experience a greater sBDNF response to exercise, but the clinical significance of this is currently unclear. Circulating BDNF levels are unlikely to be altered by steady-state acute exercise in a linear dose-dependent manner. This does not eliminate its potential relevance in the antidepressant response to chronic exercise training, but suggests that other mechanisms are involved in the acute affective response to exercise in depression.
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Affiliation(s)
- Jacob D Meyer
- Department of Kinesiology, University of Wisconsin-Madison, 2000 Observatory Drive, Madison, WI 53706, USA.
| | - Kelli F Koltyn
- Department of Kinesiology, University of Wisconsin-Madison, 2000 Observatory Drive, Madison, WI 53706, USA
| | - Aaron J Stegner
- William S. Middleton Memorial Veterans Hospital, 2500 Overlook Terrace, Madison, WI 53705, USA; Department of Kinesiology, University of Wisconsin-Madison, 2000 Observatory Drive, Madison, WI 53706, USA
| | - Jee-Seon Kim
- Department of Educational Psychology, University of Wisconsin-Madison, 1025 West Johnson Street Madison, WI 53706, USA
| | - Dane B Cook
- William S. Middleton Memorial Veterans Hospital, 2500 Overlook Terrace, Madison, WI 53705, USA; Department of Kinesiology, University of Wisconsin-Madison, 2000 Observatory Drive, Madison, WI 53706, USA
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Trivedi MH, McGrath PJ, Fava M, Parsey RV, Kurian BT, Phillips ML, Oquendo MA, Bruder G, Pizzagalli D, Toups M, Cooper C, Adams P, Weyandt S, Morris DW, Grannemann BD, Ogden RT, Buckner R, McInnis M, Kraemer HC, Petkova E, Carmody TJ, Weissman MM. Establishing moderators and biosignatures of antidepressant response in clinical care (EMBARC): Rationale and design. J Psychiatr Res 2016; 78:11-23. [PMID: 27038550 PMCID: PMC6100771 DOI: 10.1016/j.jpsychires.2016.03.001] [Citation(s) in RCA: 180] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 03/02/2016] [Accepted: 03/03/2016] [Indexed: 12/28/2022]
Abstract
UNLABELLED Remission rates for Major Depressive Disorder (MDD) are low and unpredictable for any given antidepressant. No biological or clinical marker has demonstrated sufficient ability to match individuals to efficacious treatment. Biosignatures developed from the systematic exploration of multiple biological markers, which optimize treatment selection for individuals (moderators) and provide early indication of ultimate treatment response (mediators) are needed. The rationale and design of a multi-site, placebo-controlled randomized clinical trial of sertraline examining moderators and mediators of treatment response is described. The target sample is 300 participants with early onset (≤30 years) recurrent MDD. Non-responders to an 8-week trial are switched double blind to either bupropion (for sertraline non-responders) or sertraline (for placebo non-responders) for an additional 8 weeks. Clinical moderators include anxious depression, early trauma, gender, melancholic and atypical depression, anger attacks, Axis II disorder, hypersomnia/fatigue, and chronicity of depression. Biological moderator and mediators include cerebral cortical thickness, task-based fMRI (reward and emotion conflict), resting connectivity, diffusion tensor imaging (DTI), arterial spin labeling (ASL), electroencephalograpy (EEG), cortical evoked potentials, and behavioral/cognitive tasks evaluated at baseline and week 1, except DTI, assessed only at baseline. The study is designed to standardize assessment of biomarkers across multiple sites as well as institute replicable quality control methods, and to use advanced data analytic methods to integrate these markers. A Differential Depression Treatment Response Index (DTRI) will be developed. The data, including biological samples (DNA, RNA, and plasma collected before and during treatment), will become available in a public scientific repository. CLINICAL TRIAL REGISTRATION Establishing Moderators and Biosignatures of Antidepressant Response for Clinical Care for Depression (EMBARC). Identifier: NCT01407094. URL: http://clinicaltrials.gov/show/NCT01407094.
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Affiliation(s)
| | - Patrick J McGrath
- New York State Psychiatric Institute & Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY, USA
| | | | | | - Benji T Kurian
- University of Texas, Southwestern Medical Center, Dallas, TX, USA
| | | | - Maria A Oquendo
- New York State Psychiatric Institute & Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY, USA
| | - Gerard Bruder
- New York State Psychiatric Institute & Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY, USA
| | | | - Marisa Toups
- University of Texas, Southwestern Medical Center, Dallas, TX, USA
| | - Crystal Cooper
- University of Texas, Southwestern Medical Center, Dallas, TX, USA
| | - Phil Adams
- New York State Psychiatric Institute & Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY, USA
| | - Sarah Weyandt
- University of Texas, Southwestern Medical Center, Dallas, TX, USA
| | - David W Morris
- University of Texas, Southwestern Medical Center, Dallas, TX, USA
| | | | | | | | | | | | | | - Thomas J Carmody
- University of Texas, Southwestern Medical Center, Dallas, TX, USA
| | - Myrna M Weissman
- New York State Psychiatric Institute & Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY, USA
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Lin KW, Wroolie TE, Robakis T, Rasgon NL. Adjuvant pioglitazone for unremitted depression: Clinical correlates of treatment response. Psychiatry Res 2015; 230:846-52. [PMID: 26602230 PMCID: PMC4978223 DOI: 10.1016/j.psychres.2015.10.013] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [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: 06/04/2015] [Revised: 09/23/2015] [Accepted: 10/09/2015] [Indexed: 10/22/2022]
Abstract
Previous studies suggest that insulin-sensitizing agents could play a significant role in the treatment of major depression, particularly depression in patients with documented insulin resistance or those who are resistant to standard psychopharmacological approaches. This study aimed to assess the effects on depressive symptoms with adjuvant treatment with the PPARγ-agonist pioglitazone. Patients (N=37) with non-psychotic, non-remitting depression receiving standard psychiatric regimens for depression were randomized across an insulin sensitivity spectrum in a 12-week double blind, randomized controlled trial of pioglitazone or placebo. Improvement in depression was associated with improvement in glucose metabolism but only in patients with insulin resistance. An age effect was also shown in that response to pioglitazone was more beneficial in younger aged patients. Study findings suggest differential improvement in depression severity according to both glucose metabolic status and level of depression at baseline. A greater understanding of the reciprocal links between depression and IR may lead to a dramatic shift in the way in which depression is conceptualized and treated, with a greater focus on treating and/or preventing metabolic dysfunction.
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Affiliation(s)
| | | | | | - Natalie L. Rasgon
- Corresponding author: Natalie Rasgon M.D Ph.D., Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA 94305-5723, Phone: (650) 724-6689, Fax: (650) 724-3144,
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Gudayol-Ferré E, Guàrdia-Olmos J, Peró-Cebollero M. Effects of remission speed and improvement of cognitive functions of depressed patients. Psychiatry Res 2015; 226:103-12. [PMID: 25619432 DOI: 10.1016/j.psychres.2014.11.079] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [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: 04/17/2014] [Revised: 10/16/2014] [Accepted: 11/29/2014] [Indexed: 12/19/2022]
Abstract
Major depressive disorder (MDD) presents neuropsychological alterations which improve after the treatment, but it might be mediated by clinical variables. Our goal is to study whether the speed of remission of MDD bears any relation to the improvement of the patients' cognitive functioning after a successful treatment. We carried out clinical and neuropsychological assessments of 51 patients with MDD. After these procedures they underwent a 24-week treatment with fluoxetine, and were assessed again with the same battery used prior to treatment. They were arranged into three groups according to how rapid their symptoms remitted. The patients with a rapid remission presented improvements in working memory, speed of information processing, and some executive functions, unlike the other groups. Rapid remitters also improved in episodic memory and executive functions more than the other patients.
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Affiliation(s)
- Esteve Gudayol-Ferré
- Facultad de Psicología, Universidad Michoacana de San Nicolás de Hidalgo, Morelia, Michoacán, Mexico; Clínica de Enfermedades Crónicas y Procedimientos Especiales CECYPE, Morelia, Michoacán, Mexico.
| | - Joan Guàrdia-Olmos
- Departament de Metodologia, Facultat de Psicologia, Universitat de Barcelona, Institut de Recerca en Cervell, Cognició i Conducta IR3C, Barcelona, Spain
| | - Maribel Peró-Cebollero
- Departament de Metodologia, Facultat de Psicologia, Universitat de Barcelona, Institut de Recerca en Cervell, Cognició i Conducta IR3C, Barcelona, Spain
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Day CV, John Rush A, Harris AWF, Boyce PM, Rekshan W, Etkin A, DeBattista C, Schatzberg AF, Arnow BA, Williams LM. Impairment and distress patterns distinguishing the melancholic depression subtype: an iSPOT-D report. J Affect Disord 2015; 174:493-502. [PMID: 25554994 DOI: 10.1016/j.jad.2014.10.046] [Citation(s) in RCA: 13] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Revised: 10/23/2014] [Accepted: 10/24/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND This study seeks to provide a comprehensive and systematic evaluation of baseline clinical and psychological features and treatment response characteristics that differentiate Major Depressive Disorder (MDD) outpatients with and without melancholic features. Reflecting the emphasis in DSM-5, we also include impairment and distress. METHODS Participants were assessed pre-treatment on clinical features (severity, risk factors, comorbid conditions, illness course), psychological profile (personality, emotion regulation), functional capacity (social and occupational function, quality of life) and distress/coping (negativity bias, emotional resilience, social skills, satisfaction with life). Participants were randomized to sertraline, escitalopram or venlafaxine extended-release and re-assessed post-treatment at 8 weeks regarding remission, response, and change in impairment and distress. RESULTS Patients with melancholic features (n=339; 33.7%) were distinguished clinically from non-melancholics by more severe depressive symptoms and greater exposure to abuse in childhood. Psychologically, melancholic patients were defined by introversion, and a greater use of suppression to regulate negative emotion. Melancholics also had poorer capacity for social and occupational function, and physical and psychological quality of life, along with poorer coping, reflected in less emotional resilience and capacity for social skills. Post-treatment, melancholic patients had lower remission and response, but some of this effect was due to the more severe symptoms pre-treatment. The distress/coping outcome measure of capacity for social skills remained significantly lower for melancholic participants. LIMITATIONS Due to the cross-sectional nature of this study, causal pathways cannot be concluded. CONCLUSIONS Findings provide new insights into a melancholic profile of reduced ability to function interpersonally or effectively deal with one׳s emotions. This distinctly poorer capacity for social skills remained post-treatment. The pre-treatment profile may account for some of the difficulty in achieving remission or response with treatment.
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Affiliation(s)
- Claire V Day
- Brain Dynamics Center, Psychiatry, University of Sydney Medical School, Sydney, NSW 2145 Australia; Discipline of Psychiatry, Sydney Medical School, University of Sydney, Westmead Clinical School, Australia; Brain Resource Ltd., 235 Jones Street, Sydney, NSW, Australia; Brain Resource Inc., 1000 Sansome Street, San Francisco, CA 94111, USA.
| | - A John Rush
- Duke-National University of Singapore, Graduate Medical School Singapore, 8 College Road, Singapore 169857, Singapore
| | - Anthony W F Harris
- Brain Dynamics Center, Psychiatry, University of Sydney Medical School, Sydney, NSW 2145 Australia; Discipline of Psychiatry, Sydney Medical School, University of Sydney, Westmead Clinical School, Australia
| | - Philip M Boyce
- Discipline of Psychiatry, Sydney Medical School, University of Sydney, Westmead Clinical School, Australia
| | - William Rekshan
- Brain Resource Ltd., 235 Jones Street, Sydney, NSW, Australia; Brain Resource Inc., 1000 Sansome Street, San Francisco, CA 94111, USA
| | - Amit Etkin
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA; Sierra-Pacific Mental Illness Research, Education, and Clinical Center (MIRECC) Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304, USA
| | - Charles DeBattista
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Alan F Schatzberg
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Bruce A Arnow
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Leanne M Williams
- Brain Dynamics Center, Psychiatry, University of Sydney Medical School, Sydney, NSW 2145 Australia; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA; Sierra-Pacific Mental Illness Research, Education, and Clinical Center (MIRECC) Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304, USA
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Riva-Posse P, Choi KS, Holtzheimer PE, McIntyre CC, Gross RE, Chaturvedi A, Crowell AL, Garlow SJ, Rajendra JK, Mayberg HS. Defining critical white matter pathways mediating successful subcallosal cingulate deep brain stimulation for treatment-resistant depression. Biol Psychiatry 2014; 76:963-9. [PMID: 24832866 PMCID: PMC4487804 DOI: 10.1016/j.biopsych.2014.03.029] [Citation(s) in RCA: 290] [Impact Index Per Article: 29.0] [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: 10/02/2013] [Revised: 03/18/2014] [Accepted: 03/19/2014] [Indexed: 12/16/2022]
Abstract
BACKGROUND Subcallosal cingulate white matter (SCC) deep brain stimulation (DBS) is an evolving investigational treatment for depression. Mechanisms of action are hypothesized to involve modulation of activity within a structurally defined network of brain regions involved in mood regulation. Diffusion tensor imaging was used to model white matter connections within this network to identify those critical for successful antidepressant response. METHODS Preoperative high-resolution magnetic resonance imaging data, including diffusion tensor imaging, were acquired in 16 patients with treatment-resistant depression, who then received SCC DBS. Computerized tomography was used postoperatively to locate DBS contacts. The activation volume around the contacts used for chronic stimulation was modeled for each patient retrospectively. Probabilistic tractography was used to delineate the white matter tracts traveling through each activation volume. Patient-specific tract maps were calculated using whole-brain analysis. Clinical evaluations of therapeutic outcome from SCC DBS were defined at 6 months and 2 years. RESULTS Whole-brain activation volume tractography demonstrated that all DBS responders at 6 months (n = 6) and 2 years (n = 12) shared bilateral pathways from their activation volumes to 1) medial frontal cortex via forceps minor and uncinate fasciculus; 2) rostral and dorsal cingulate cortex via the cingulum bundle; and 3) subcortical nuclei. Nonresponders did not consistently show these connections. Specific anatomical coordinates of the active contacts did not discriminate responders from nonresponders. CONCLUSIONS Patient-specific activation volume tractography modeling may identify critical tracts that mediate SCC DBS antidepressant response. This suggests a novel method for patient-specific target and stimulation parameter selection.
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Affiliation(s)
| | - Ki Sueng Choi
- Department of Psychiatry and Behavioral Sciences, Emory University
,The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University
,Biomedical Imaging Technology Center, Georgia Institute of Technology and Emory University
| | - Paul E. Holtzheimer
- Department of Psychiatry and Behavioral Sciences, Emory University
,Departments of Psychiatry and Surgery, Geisel School of Medicine at Dartmouth
| | | | - Robert E. Gross
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University
,Department of Neurology, Emory University
,Department of Neurosurgery, Emory University
| | | | | | - Steven J. Garlow
- Department of Psychiatry and Behavioral Sciences, Emory University
| | | | - Helen S. Mayberg
- Department of Psychiatry and Behavioral Sciences, Emory University
,Department of Neurology, Emory University
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Shen X, Wu Y, Guan T, Wang X, Qian M, Lin M, Shen Z, Sun J, Zhong H, Yang J, Li L, Yuan Y. Association analysis of COMT/MTHFR polymorphisms and major depressive disorder in Chinese Han population. J Affect Disord 2014; 161:73-8. [PMID: 24751310 DOI: 10.1016/j.jad.2014.03.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [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: 08/08/2013] [Revised: 12/18/2013] [Accepted: 03/05/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND In several previous biochemical and genetic studies, the Val158Met polymorphism of the gene encoding catechol-O-methyltransferase (COMT) and the C677T polymorphism of Methylenetetrahydrofolate reductase (MTHFR) have been suggested to be involved in the pathogenesis as well as the treatment response of major depressive disorder (MDD), but the results have been inconsistent. In this study, we investigate the association of COMT/MTHFR and their interactions with MDD and antidepressant response in Chinese Han population. METHODS Three hundred and sixty eight depressed patients who met DSM-IV criteria for MDD were recruited for the study. Two hundred and nineteen normal controls were recruited from the local community. Patients and normal controls were genotyped for the functional COMT val158met and MTHFR C677T polymorphisms. Patients were characterized for clinical response to antidepressant treatment as measured by intra-individual changes of Hamilton Depression (HAMD-17) scores over 6 weeks. RESULTS The T allele (OR=1.81; CI95%=1.40-2.34, P<0.001) and C/T genotype (OR=3.66; CI95% =2.53-5.28, P<0.001) of MTHFR C677T were significantly different between case and control groups. The COMT Met/Val genotype was more common among depressed individuals than among controls (OR=1.52, CI95%=1.04-2.21, P=0.02). LIMITATION There is disequilibrium in age and sex between case and control groups. Though we control the two variables in the statistic analysis, to be more accurate, we need to increase sample size in further study. CONCLUSION Individuals with the genotype COMT Met/Val and MTHFR C/T have more probability of suffering from MDD. However, there is no association between gene polymorphism and treatment response.
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Affiliation(s)
- Xinhua Shen
- Department of Neurosis and Psychosomatic Diseases, Huzhou 3rd Hospital, Huzhou, Zhejiang 313000, PR China
| | - Yanfeng Wu
- Department of Neurology, The Second Affiliated Hospital of Nanjing Medical University, Nanjing 210003, PR China
| | - Tiefeng Guan
- Department of Neurosis and Psychosomatic Diseases, Huzhou 3rd Hospital, Huzhou, Zhejiang 313000, PR China
| | - Xiaoquan Wang
- Department of Psychiatry, The Fourth People׳s Hospital of Wuhu, Wuhu 241000, PR China
| | - Mincai Qian
- Department of Neurosis and Psychosomatic Diseases, Huzhou 3rd Hospital, Huzhou, Zhejiang 313000, PR China
| | - Min Lin
- Department of Neurosis and Psychosomatic Diseases, Huzhou 3rd Hospital, Huzhou, Zhejiang 313000, PR China
| | - Zhongxia Shen
- Department of Neurosis and Psychosomatic Diseases, Huzhou 3rd Hospital, Huzhou, Zhejiang 313000, PR China
| | - Jushui Sun
- Department of Neurosis and Psychosomatic Diseases, Huzhou 3rd Hospital, Huzhou, Zhejiang 313000, PR China
| | - Hua Zhong
- Department of Neurosis and Psychosomatic Diseases, Huzhou 3rd Hospital, Huzhou, Zhejiang 313000, PR China
| | - Jianhong Yang
- Department of Neurosis and Psychosomatic Diseases, Huzhou 3rd Hospital, Huzhou, Zhejiang 313000, PR China
| | - Liang Li
- Department of Neurosis and Psychosomatic Diseases, Huzhou 3rd Hospital, Huzhou, Zhejiang 313000, PR China
| | - Yonggui Yuan
- Department of Psychosomatics and Psychiatry, Affiliated ZhongDa Hospital of Southeast University, Nanjing 210009, PR China.
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de Aguiar Ferreira A, Vasconcelos AG, Neves FS, Correa H. Affective temperaments and antidepressant response in the clinical management of mood disorders. J Affect Disord 2014; 155:138-41. [PMID: 24215897 DOI: 10.1016/j.jad.2013.10.038] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [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: 09/25/2013] [Accepted: 10/22/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND The aim of this study was to investigate the presence of a relationship between affective temperament and antidepressant treatment response in mood disorder patients. METHODS The lifetime history of antidepressant response of 90 bipolar disorder patients and 88 major depressive disorder patients were retrospectively evaluated and then assigned to one of four subgroups: complete response (CR), partial response (PR), no response (NR), and antidepressant associated mania response (AAMR). Using TEMPS-Rio de Janeiro - the brief Brazilian version of TEMPS-A - we compared affective temperament subscale scores across these groups. RESULTS We observed a statistically significant relationship between depressive and anxious affective temperaments and no antidepressant response. In bipolar disorder patients, cyclothymic temperament (p<0.01) and hyperthymic temperament (p<0.05) were associated with antidepressant-associated mania. Hyperthymic temperament was associated with complete antidepressant responses in major depressive disorder patients. LIMITATIONS The evaluation of antidepressant response was retrospective. CONCLUSIONS Our data are consistent with the theory that affective temperament traits are factors that can influence the antidepressant response and the recovery from depressive episodes, but more longitudinal studies are needed to confirm this theory and our findings.
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Affiliation(s)
- Alexandre de Aguiar Ferreira
- Neuroscience Program, Federal University, Minas Gerais (UFMG), Belo Horizonte, MG, Brazil; Raul Soares Institute - FHEMIG, Belo Horizonte, MG, Brazil; Faculty of Medical Sciences of Minas Gerais - FCMMG, Belo Horizonte, MG, Brazil
| | | | - Fernando Silva Neves
- Neuroscience Program, Federal University, Minas Gerais (UFMG), Belo Horizonte, MG, Brazil; Department of Mental Health, Faculty of Medicine, Federal University, Minas Gerais, Av. Alfredo Balena, 190, Belo Horizonte, MG 30130-100, Brazil
| | - Humberto Correa
- Neuroscience Program, Federal University, Minas Gerais (UFMG), Belo Horizonte, MG, Brazil; Department of Mental Health, Faculty of Medicine, Federal University, Minas Gerais, Av. Alfredo Balena, 190, Belo Horizonte, MG 30130-100, Brazil.
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Geng LY, Ye DQ, Shi YY, Xu Z, Pu MJ, Li ZY, Li XL, Li Y, Zhang ZJ. Influence of genetic polymorphisms involved in the hypothalamic-pituitary-adrenal axis and their interactions with environmental factors on antidepressant response. CNS Neurosci Ther 2014; 20:237-43. [PMID: 24422887 DOI: 10.1111/cns.12201] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2013] [Revised: 09/30/2013] [Accepted: 10/06/2013] [Indexed: 12/20/2022] Open
Abstract
AIMS To investigate the role of genetic polymorphisms in candidate genes associated with the HPA axis and their interactions with environmental stressors in antidepressant response. METHODS The remission of depressive symptoms after 8 weeks of antidepressant treatment was tested against 21 single nucleotide polymorphisms (SNPs) in five candidate genes associated with the HPA axis in a Chinese Han sample suffering from unipolar depression (n = 273). Any history of childhood trauma and recent negative life events were measured using the Childhood Trauma Questionnaire-Short Form (CTQ-SF) (n = 206) and the Life Event Scale (48 item, LES) (n = 207), respectively. Reporter gene assays were used to evaluate the possible effects of the most significant SNP on gene expression. RESULTS A functional polymorphism at 3'UTR of the corticotropin-releasing hormone receptor 1 (CRHR1) gene (rs28364032) and three haplotypes containing it showed significant relationships with antidepressant remission. Further laboratory-based genomic studies showed that the G-to-A change of rs28364032 resulted in a 10-12% decrease in the intensity of luciferase activity. However, we failed to find association of environments and their interaction with HPA system-related genes with antidepressant remission. CONCLUSIONS Our results support a definite role for CRHR1 in the pharmacogenetics of antidepressant drugs. This may contribute to interpatient differences in their responses to antidepressant drugs.
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Affiliation(s)
- Lei-Yu Geng
- Neurologic Department of Affiliated ZhongDa Hospital, Neuropsychiatric Institute and Medical School of Southeast University, Nanjing, China
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Gudayol-Ferré E, Guàrdia-Olmos J, Peró-Cebollero M, Herrera-Guzmán I, Camarena B, Cortés-Penagos C, Herrera-Abarca JE, Martínez-Medina P. Prediction of the time-course pattern of remission in depression by using clinical, neuropsychological, and genetic variables. J Affect Disord 2013; 150:1082-90. [PMID: 23787408 DOI: 10.1016/j.jad.2013.04.024] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Accepted: 04/19/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND The prediction of remission in pharmacologically-treated MDD patients has been scarcely studied. The goal of our work is to study the possible effect of clinical variables, neuropsychological performance, and the 5HTTLPR, the rs25531 of the SLC6A4 gene, and the val108/58Met of the COMT gene polymorphisms on the prediction of the speed of remission in MDD patients. METHODS Seventy-two depressed patients were genotyped according to the aforementioned polymorphisms and were clinically and neuropsychologically assessed before a 12-week fluoxetine treatment. RESULTS From this original sample 51 patients were considered as remitters at the end of week 12. Thirteen out of those showed a rapid response pattern, 24 showed an oscillating response pattern, and 14 showed a slow response pattern. The following variable combination is capable of showing a statistically significant relationship with the pattern of remission of patients with MDD: initial Hamilton score, age at first depressive episode, AG and GG alleles of the val108/58Met COMT polymorphism, Stroop PC, and SWM Strategy. LIMITATIONS We have a slightly small sample size, which came to prominence during the data analysis since we were working with 3 subgroups. In this study, the placebo effect has not been controlled. DISCUSSION Our data suggest that the patients with MDD who remit after a 12-week treatment with fluoxetine show one of the following time-course patterns: a rapid symptomatic improvement, or a slow or oscillating pattern of remission. A combination of clinical, neuropsychological, and genetic variables allows us to predict these response patterns.
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Affiliation(s)
- Esteve Gudayol-Ferré
- Facultad de Psicología, Universidad Michoacana de San Nicolás de Hidalgo, Morelia, Mich., Mexico.
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