Psychometric Assessment of an Item Bank for Adaptive Testing on Patient-Reported Experience of Care Environment for Severe Mental Illness: Validation Study

BACKGROUND

The care environment significantly influences the experiences of patients with severe mental illness and the quality of their care. While a welcoming and stimulating environment enhances patient satisfaction and health outcomes, psychiatric facilities often prioritize staff workflow over patient needs. Addressing these challenges is crucial to improving patient experiences and outcomes in mental health care.

OBJECTIVE

This study is part of the Patient-Reported Experience Measure for Improving Quality of Care in Mental Health (PREMIUM) project and aims to establish an item bank (PREMIUM-CE) and to develop computerized adaptive tests (CATs) to measure the experience of the care environment of adult patients with schizophrenia, bipolar disorder, or major depressive disorder.

METHODS

We performed psychometric analyses including assessments of item response theory (IRT) model assumptions, IRT model fit, differential item functioning (DIF), item bank validity, and CAT simulations.

RESULTS

In this multicenter cross-sectional study, 498 patients were recruited from outpatient and inpatient settings. The final PREMIUM-CE 13-item bank was sufficiently unidimensional (root mean square error of approximation=0.082, 95% CI 0.067-0.097; comparative fit index=0.974; Tucker-Lewis index=0.968) and showed an adequate fit to the IRT model (infit mean square statistic ranging between 0.7 and 1.0). DIF analysis revealed no item biases according to gender, health care settings, diagnosis, or mode of study participation. PREMIUM-CE scores correlated strongly with satisfaction measures (r=0.69-0.78; P<.001) and weakly with quality-of-life measures (r=0.11-0.21; P<.001). CAT simulations showed a strong correlation (r=0.98) between CAT scores and those of the full item bank, and around 79.5% (396/498) of the participants obtained a reliable score with the administration of an average of 7 items.

CONCLUSIONS

The PREMIUM-CE item bank and its CAT version have shown excellent psychometric properties, making them reliable measures for evaluating the patient experience of the care environment among adults with severe mental illness in both outpatient and inpatient settings. These measures are a valuable addition to the existing landscape of patient experience assessment, capturing what truly matters to patients and enhancing the understanding of their care experiences.

TRIAL REGISTRATION

ClinicalTrials.gov NCT02491866; https://clinicaltrials.gov/study/NCT02491866.

Outcomes of electroconvulsive therapy in patients with depressive symptoms with versus without comorbid personality disorders/traits: A systematic review and meta-analysis

AIMS

To assess electroconvulsive therapy (ECT) outcomes in patients affected by depressive symptoms with versus without additional comorbid personality disorders/traits.

METHODS

We identified observational studies investigating ECT clinical outcomes in patients affected by depressive symptoms with versus without comorbid personality disorders/traits in Embase/Medline in 11/2022. Our protocol was registered with PROSPERO (CRD42023390833). Study quality was evaluated using the Newcastle-Ottawa-Scale. Our primary outcomes were ECT response and remission rates. Meta-regression analyses included effects of in/outpatient percentages, age, number of ECT sessions, and electrode placement; subgroup analyses included the assessment methods for personality disorders/traits. We performed sensitivity analyses after excluding poor-quality studies.

RESULTS

A total of 20 studies (n = 11,390) were included in our analysis. Patients with comorbid personality disorders/traits had lower remission rates (OR = 0.42, 95% CI = 0.31, 0.58, p < 0.001) with substantial heterogeneity (I2  = 93.0%) as well as lower response rates (OR = 0.35, 95% CI = 0.24, 0.51, n = 5129, p < 0.001) with substantial heterogeneity (I2  = 93.0%) compared with patients without comorbid personality disorders/traits. Relapse rates were higher in patients with versus without comorbid personality disorders/traits (OR = 3.23, 95% CI = 1.40, 7.45, k = 4, n = 239, p = 0.006) with moderate heterogeneity (I2  = 75.0%) and post-ECT memory impairment was more frequent in patients with versus without comorbid personality disorders/traits (OR = 1.41, 95% CI = 1.36, 1.46, k = 4, n = 471, p < 0.001) with minimal heterogeneity (I2  = 0.0%). Dropout rates were higher in patients with versus without comorbid personality disorders/traits (OR = 1.58, 95% CI = 1.13, 2.21, k = 3, n = 6145, p = 0.008).

CONCLUSIONS

Patients with comorbid personality disorders/traits treated with ECT are reported to have lower response and remission rates and higher rates of side effects and relapse rates compared with patients without personality disorders/traits.

The Importance of Adverse Childhood Experiences in Depressive Symptoms and Their Biological Consequences in Healthy Adults: Results of a Polish University Student Study

Adverse childhood experiences (ACEs) have a long-lasting effect on both physical and mental health. The aim of this study was to assess the consequences of ACEs and experienced stress on depression and the role of biological disturbances in this relationship in a student population. Potential participants filled out a screening questionnaire; 60 of 126 students met the inclusion criteria and were tested for the severity of stress and depressive symptoms, ACEs, dietary habits, and serum concentrations of biological markers. Depressive symptoms were related to a younger age (p = 0.012), a higher severity of stress (p = 0.001), ACEs (p = 0.007), and lower triglyceride (p = 0.01) and cortisol concentrations (p = 0.01). An inverse relationship between the triglyceride concentration and emotional abuse (R = -0.38) and emotional neglect (R = -0.33) was found. Occludin was positively associated with physical abuse (R = 0.31). Cortisol was inversely associated with emotional abuse (R = -0.35). Emotional neglect was associated with lipopolysaccharide binding protein (R = 0.38) and insulin levels (R = -0.31). The most promising multi-panel of biomarkers for recognizing mood symptoms included triglycerides, tight junction protein 1, and cortisol (cut-offs of ≤ 95.5 mg/dL, 0.72 ng/mL, and 134.63 ng/mL, respectively). This study confirmed the association between ACEs and depressive symptoms and the importance of psychological stress in developing mood disorders. ACEs could affect biological dysregulation. Some of the biological markers could be helpful in early detection of depression.

Adverse effects of 21 antidepressants on sleep during acute-phase treatment in major depressive disorder: a systemic review and dose-effect network meta-analysis

STUDY OBJECTIVES

Sleep-related adverse effects during acute treatment with antidepressants undermine adherence and impede remission. We aimed to address subtypes of sleep-related adverse effects and depict the relationship between dose and sleep-related adverse events.

METHODS

We searched PubMed, Embase, Cochrane Central Register of Controlled Trials, and Web of Science for double-blind randomized controlled trials of depression published before April 30th, 2023. Eligible studies reporting sleep-related adverse effects during short-term monotherapy were included. The odds ratios (ORs) for sleep-related adverse effects were addressed with network meta-analysis. A Bayesian approach was used to depict the dose-effect relationship. Heterogeneity among studies was assessed using the τ2 and I2 statistics. Sensitivity analyses were performed without studies featuring high risk of bias.

RESULTS

Studies with 64 696 patients were examined from 216 trials. Compared to placebo, 13 antidepressants showed higher ORs for somnolence, of which fluvoxamine (OR = 6.32; 95% CI: 3.56 to 11.21) ranked the top. Eleven had higher risks for insomnia, reboxetine ranked the top (OR = 3.47; 95% CI: 2.77 to 4.36). The dose-effect relationships curves between somnolence or insomnia and dose included linear shape, inverted U-shape, and other shapes. There was no significant heterogeneity among individual studies. The quality of evidence for results in network meta-analyses was rated as very low to moderate by Grading of Recommendations Assessment, Development, and Evaluation.

CONCLUSIONS

Most antidepressants had higher risks for insomnia or somnolence than placebo. The diverse relationship curves between somnolence or insomnia and dose of antidepressants can guide clinicians to adjust the doses. These findings suggest clinicians pay more attention to sleep-related adverse effects during acute treatment with antidepressants.

Lipids in major depressive disorder: new kids on the block or old friends revisited?

Major depressive disorder (MDD) is a psychiatric mood disorder that results in substantial functional impairment and is characterized by symptoms such as depressed mood, diminished interest, impaired cognitive function, and vegetative symptoms such as disturbed sleep. Although the exact etiology of MDD is unclear, several underlying mechanisms (disturbances in immune response and/or stress response) have been associated with its development, with no single mechanism able to account for all aspects of the disorder. Currently, about 1 in 3 patients are resistant to current antidepressant therapies. Providing an alternative perspective on MDD could therefore pave the way for new, unexplored diagnostic and therapeutic solutions. The central nervous system harbors an enormous pool of lipids and lipid intermediates that have been linked to a plethora of its physiological functions. The aim of this review is therefore to provide an overview of the implications of lipids in MDD and highlight certain MDD-related underlying mechanisms that involve lipids and/or their intermediates. Furthermore, we will also focus on the bidirectional relationship between MDD and the lipid-related disorders obesity and type 2 diabetes.

Investigating the effectiveness of a smart mental health intervention (inMind) for stress reduction during pharmacological treatment for mild to moderate major depressive disorders: Study protocol for a randomized control trial

Background

Although psychological interventions for stress relief, such as cognitive behavioral therapy (CBT) and mindfulness-based stress reduction (MBSR), have been developed, they have not been widely used in treating depression. The use of mobile devices can increase the possibility of actual use by integrating interventions and reducing the difficulty and cost burden of treatment application. This study aims to determine whether "inMind," an integrated mobile application for stress reduction, developed for the general population, decreases stress for patients with mild to moderate major depressive disorder during the pharmacological treatment period.

Methods

This study is a single-blind, multicenter, randomized, controlled crossover trial. The App, developed in Republic of Korea, provides integrated interventions for stress reduction for the general population through three modules based on mindfulness-based stress reduction, cognitive behavior therapy, and relaxation sounds that are known to be effective in stress reduction ("meditation," "cognitive approach," and "relaxation sounds," respectively). Participants (n = 215) recruited via medical practitioner referral will be randomized to an App first group (fAPP) or a wait list crossover group (dAPP). The study will be conducted over 8 weeks; the fAPP group will use the App for the first 4 weeks and the dAPP group for the next 4 weeks. During all study periods, participants will receive their usual pharmacological treatment. The Depression Anxiety Stress Scale-21 is the primary outcome measure. The analysis will employ repeated measurements using a mixed-model approach.

Discussion

The App can potentially be an important addition to depression treatment because of its applicability and the comprehensive nature of the interventions that covers diverse stress-relieving models.

Clinical trial registration

https://clinicaltrials.gov/ct2/show/NCT05312203, identifier 2021GR0585.

Efficacy, Tolerability, and Safety of Toludesvenlafaxine for the Treatment of Major Depressive Disorder-A Narrative Review

The estimated rate of treatment-resistant major depressive disorder (TRD) remains higher than 30%, even after the discovery of multiple classes of antidepressants in the last 7 decades. Toludesvenlafaxine (ansofaxine, LY03005, or LPM570065) is a first-in-class triple monoaminergic reuptake inhibitor (TRI) that has reached clinical use. The objective of this narrative review was to summarize clinical and preclinical evidence about the efficacy, tolerability, and safety of toludesvenlafaxine. Based on the results of 17 reports retrieved in the literature, the safety and tolerability profiles of toludesvenlafaxine were good in all clinical trials, and the pharmacokinetic parameters were well described in the phase 1 trials. The efficacy of toludesvenlafaxine was demonstrated in one phase 2 and one phase 3 trial, both on primary and secondary outcomes. In conclusion, this review highlights the favorable clinical results of toludesvenlafaxine in only two short-term trials that enrolled patients with major depressive disorder (MDD) (efficacy and tolerability were good for up to eight weeks), indicating the need for more good quality, larger-sample, and longer-term trials. Exploring new antidepressants, such as TRI, can be considered a priority for clinical research due to the high rates of TRD, but also due to the significant percentages of relapse in patients with MDD.

Hampered gamma oscillations induced by sad emotion underlying suicide attempt in major depressive disorder

AIM

Major depressive disorder (MDD) is associated with high suicidality, especially for those with suicide attempt (SA). Although impaired oscillatory activity has been previously reported in patients with SA, little is known about precise temporal-spatial variability of its neural dynamics. To solve this, the current study probed the spectral power and network interactions underlying SA in MDD.

METHODS

The present study recruited 104 subjects including 56 subjects with MDD (30 with SA and 26 without SA) and 48 healthy controls, who performed sad expressions recognition task during magnetoencephalography (MEG) recording. By investigating source-reconstructed MEG-data, brain states representing different task stages were estimated from a Hidden Markov model. Spectrum power and network connectivity were compared via Gaussian Mixture Models, and fractional occupancy (FO) of states were compared via an independent F-test.

RESULTS

Brain states were corresponding to various frequencies (theta/beta/low gamma/ high gamma). In low gamma band (35-45 Hz), the early visual state exhibited increased activation and hyper inter-network connectivity between visual regions and the limbic system, while the middle fronto-parietal state exhibited attenuated activation and decreased intra-network connectivity within fronto-parietal regions in SA group. Crucially, FO values of these two states were significantly correlated with the suicide risks.

CONCLUSIONS

Suicide behavior of patients with MDD was significantly associated with aberrant oscillations in low gamma band. Elevated oscillations in occipital cortices and attenuated oscillations in fronto-parietal cortices were significantly associated with SA. Manifesting sadness indulging and reckless decision-making, the hampered temporal characteristics could help explain the neural-electric basis of SA.

Possible role of the NLRP3 inflammasome and the gut-brain axis in multiple sclerosis-related depression

Multiple sclerosis (MS) is an autoimmune and demyelinating disease of the central nervous system that results from complex interactions between genetic and environmental determinants. Patients with MS exhibit a high risk of depression, however, the exact pathomechanisms remain largely unknown. It is becoming widely accepted that the gut-brain axis (GBA) disorders may exert an influence on neuroinflammation and psychiatric symptoms, including so-called MS-related depression. The element suggested as a bridge between intestinal disorders, depression, and MS is an inflammatory response with the central role of the NLR family pyrin domain containing 3 (NLRP3) inflammasome. The pro-inflammatory activity of effector cytokines of the NLRP3 inflammasome forms the hypothesis that it is actively involved in the development of inflammatory and autoimmune diseases. Despite extensive reviews considering the possible origins of MS-related depression, its complex pathophysiology prevents any easy determination of its underlying mechanisms. This paper aims to discuss molecular mechanisms related to the GBA axis that can mediate dysbiosis, intestinal barrier dysfunction, disruption of blood-brain barrier integrity, neuroinflammation, and subsequent manifestation of MS-related major depressive disorder.

Adherence to, and Persistence of, Antidepressant Therapy in Patients with Major Depressive Disorder: Results from a Population-based Study in Italy

BACKGROUND

Major depressive disorders represent a significant burden to society, and it is recommended that antidepressant therapy should last at least 6 months. In Italy, antidepressant use in clinical practice was reported to increase by 1.7% in 2020 compared to 2019, but only 40% of new prescriptions are characterized by a treatment duration longer than 3 months.

OBJECTIVE

The study aims to describe adherence and persistence to therapy in a subset of antidepressants (citalopram, duloxetine, escitalopram, paroxetine, sertraline, venlafaxine) vs. vortioxetine in Italy during a 2-year period from 2017 to 2019.

METHODS

A retrospective analysis of the longitudinal patient database reporting data from general practitioners on drug prescriptions in Italy was carried out in a cohort of 8,235 adult patients who were prescribed antidepressants.

RESULTS

Overall, 32.4% of the patients adhered to treatment for ≥6 months over a 1-year period. Vortioxetine had a lower risk of low adherence compared to duloxetine, paroxetine, and venlafaxine and a higher risk compared to citalopram, escitalopram, and sertraline. 68.7% of patients discontinued treatment during follow-up. The greatest percentage of patients continuing therapy was seen with duloxetine, while citalopram was associated with the highest proportion of patients discontinuing therapy. No significant differences in discontinuation were observed when comparing vortioxetine to the other antidepressants.

CONCLUSION

Adherence results were considerably less than the 6-month recommendation in this real- world analysis of antidepressant therapies. Also, persistence to therapy was low, with most patients discontinuing treatment. Thus, there is a need for interventions to help patients adhere to their planned therapy.

Patients with Schizophrenia Showed Worse Cognitive Performance than Bipolar and Major Depressive Disorder in a Sample with Comorbid Substance Use Disorders

Comorbidity of substance use disorders (SUD) and severe mental illness (SMI) is highly frequent in patients, the most common diagnoses being schizophrenia (SZ), bipolar disorder (BD) and major depressive disorder (MDD). Since comorbidity has its own clinical features, and neurocognitive functioning is not always similar to psychiatric symptoms the present study explores the cognitive performance of patients with dual disorders. A neuropsychological battery of tests was used to assess 120 under treatment male patients, 40 for each group considered (SZ + SUD, BD + SUD and MDD + SUD) who were mainly polyconsumers. Significant differences (with premorbid IQ as a covariate) were found among the groups, with SZ + SUD having a worse performance in attention, verbal learning, short term memory and recognition. The consideration of a global Z score for performance evidenced an impaired neurocognitive pattern for SZ + SUD compared with BD + SUD and MDD + SUD. According to norms, all patients showed difficulties in verbal learning, short-term memory and recognition. Our research indicated that the neurocognitive functioning of dual disorder patients was influenced by the comorbid SMI, with SZ + SUD presenting major difficulties. Future studies should thoroughly explore the role of such difficulties as indicators or endophenotypes for dual schizophrenia disorders, and their usefulness for prevention and treatment.

Omega-3 Polyunsaturated Fatty Acids Supplementation Alleviate Anxiety Rather Than Depressive Symptoms Among First-Diagnosed, Drug-Naïve Major Depressive Disorder Patients: A Randomized Clinical Trial

Background

Omega-3 polyunsaturated fatty acids (n-3 PUFAs) augmentation of antidepressants has shown great potential in the prevention and treatment of major depressive disorders (MDD).

Objective

To investigate the effect of n-3 PUFAs plus venlafaxine in patients with first-diagnosed, drug-naïve depression.

Method

A total of 72 outpatients with first-diagnosed depression were recruited. The daily dose of 2.4 g/day n-3 PUFAs or placebo plus venlafaxine was used for over 12 weeks. The outcomes were assessed by the Hamilton depression scale (HAMD), Hamilton anxiety scale (HAMA), Beck depression inventory (BDI), and Self-rating anxiety scale (SAS).

Results

Both groups exhibited improvement on clinical characteristics at week 4 and week 12 compared with baseline. The rate of responders for anxiety in n-3 PUFAs group (44.44%) was significantly higher than that in placebo group (21.21%) at week 4 (χ² = 4.182, p = 0.041), while week 12 did not show a difference (χ² = 0.900, p = 0.343). The rate of responders for depression at both week 4 (χ² = 0.261, p = 0.609) and week 12 (χ² = 1.443, p = 0.230) showed no significant difference between two groups. Further analysis found that Childhood Trauma Questionnaire (CTQ) had positive correlation with HAMA (r = 0.301, p = 0.012), SAS (r = 0.246, p = 0.015), HAMD (r = 0.252, p = 0.038) and BDI (r = 0.233, p = 0.022) with Pearson correlation analysis. Social Support Rating Scale (SSRS) had negative correlation with SAS (r = -0.244, p = 0.015) and BDI (r = -0.365, p = 0.000).

Conclusion

This trial found that n-3 PUFAs supplementation in favor of venlafaxine alleviated the anxiety symptoms rather than depressive symptoms at the early stage of treatment (4 weeks) for first-diagnosed, drug-naïve depressed patients. However, the advantage disappeared in long-term treatment. Furthermore, childhood abuse and social support are closely related to the clinical and biological characteristics of depression. Both childhood trauma and lack of social support might be predictors of poor prognosis in depression.

Clinical Trial Registration

[clinicaltrials.gov], identifier [NCT03295708].

Interoception Dysfunction Contributes to the Negative Emotional Bias in Major Depressive Disorder

Background

Previous research studies have demonstrated that impaired interoception is involved in emotional information processing in major depressive disorder (MDD). Heartbeat-evoked potential (HEP) amplitudes, an index for interoception, could be manipulated by emotional faces in healthy people. Considering negative emotional bias is the core characteristic in MDD, we hypothesized that interoception dysfunction was associated with the negative emotional bias in MDD.

Methods

An electroencephalogram (EEG) study under an emotional faces task was applied to explore the relationship between interoception and emotional bias. HEPs before emotional faces stimuli were used to predict the late positive potential (LPP) amplitudes and it worked as an index of emotional bias. Twenty-seven patients with MDD and 27 healthy controls (HCs) participated in this study. Source analysis gave an auxiliary description for results in sensory level.

Results

Major depressive disorders (MDDs) had poor performance in the heartbeat count task (HCT) and attenuate HEP average amplitudes (455-550 ms). Compared with HCs, cluster-based permutation t-tests revealed that MDDs had attenuated LPP amplitudes (300-1,000 ms) over centroparietal regions and enhanced LPP amplitudes over frontocentral regions. Furthermore, abnormal attenuated HEPs could predict aberrant LPPs under sad face stimuli in MDDs, which could be associated with the dysfunction of the anterior cingulate cortex (ACC) and right insula.

Conclusion

Mediated by ACC and insula, interoception dysfunction contributes to the negative emotional bias of MDD, highlighting the importance of interoception in the disorder.

Pilot project for a recovery-oriented, DBT-informed skill-building education course for families of adults with borderline personality, bipolar or major depressive disorders

There are a variety of educational interventions for families who have a relative with a mental health disorder. However, for those with one or more emotion dysregulation disorders, there are limited options. This article reports on the results of a pilot project using a quasi-experimental design with a sample of 270 (intervention = 217, control = 53) to assess an intervention, Getting Off the Emotional Roller Coaster Skill-Building Family Education Course (GOER Family Course), for families coping with and managing emotion regulation disorders in a loved one which are often misdiagnosed or co-occurring. This intervention was effective in reducing caregiver burden [F(1, 120) = 12.25, p = 0.001], while improving attitudes, knowledge, and skills [F(1, 170) = 6.16, p = 0.014]. It fills an important gap in available resources for families faced with challenges and responsibilities that these disorders can present, especially when inaccurately diagnosed or receiving ineffective treatment. While there is a need for further research and adaptation to virtual learning, the preliminary results show positive effects.

Therapeutic potential of pregnenolone and pregnenolone methyl ether on depressive and CDKL5 deficiency disorders: Focus on microtubule targeting

Pregnenolone methyl-ether (PME) is a synthetic derivative of the endogenous neuroactive steroid pregnenolone (PREG), which is an important modulator of several brain functions. In addition to being the precursor of steroids, PREG acts directly on various targets including microtubules (MTs), the functioning of which is fundamental for the development and homeostasis of nervous system. The coordination of MT dynamics is supported by a plethora of MT-associated proteins (MAPs) and by a specific MT code that is defined by the post-translational modifications of tubulin. Defects associated with MAPs or tubulin post-translational modifications are linked to different neurological pathologies including mood and neurodevelopmental disorders. In this review, we describe the beneficial effect of PME in major depressive disorders (MDDs) and in CDKL5 deficiency disorder (CDD), two pathologies that are joint by defective MT dynamics. Growing evidence indeed suggests that PME, as well as PREG, is able to positively affect the MT-binding of MAP2 and the plus-end tracking protein CLIP170 that are both found to be deregulated in the above mentioned pathologies. Furthermore, PME influences the state of MT acetylation, the deregulation of which is often associated with neurological abnormalities including MDDs. By contrast to PREG, PME is not metabolised into other downstream molecules with specific biological properties, an aspect that makes this compound more suitable for therapeutic strategies. Thus, through the analysis of MDDs and CDD, this work focuses attention on the possible use of PME for neuronal pathologies associated with MT defects.

P300 event-related potentials in patients with different subtypes of depressive disorders

OBJECTIVE

To explore the differences in event-related potentials (ERPs) of the subclinical types of major depressive disorders (MDD): melancholic (MEL), atypical (ATY), and anxious (ANX).

METHODS

Patients with MDD treated in the Clinical Department of Shanghai Mental Health Center between September 2017 and December 2020 were prospectively included. This study was approved by the Ethics Committee of the Shanghai Mental Health Center. They were evaluated using the Mini-International Neuropsychiatric Interview (MINI), 17-item Hamilton Depression Scale (HAMD-17), 30-item Self-rated Inventory of Depressive Symptomatology (IDS-30SR), 16-item Quick Inventory of Negative Symptom Scale (QIDS-16SR), and auditory and visual P300 ERPs.

RESULTS

Finally, 27, 14, and 20 patients with MEL, ATY, and ANX MDD were included in this study, respectively. There were no significant differences in demographic characteristics and HAMD-17, IDS-30SR, and QIDS-16SR total scores among the three groups (all P > 0.05). On the C3 lead, the latency for patients with MEL MDD was the longest, and the latency for patients with ATY MDD was the shortest (MEL vs. ATY vs. ANX: 373.89 ± 6.60 vs. 344.79 ± 9.78 vs. 359.33 ± 7.62, P = 0.039). On the Pz lead, the latency for patients with MEL MDD was the longest, and the latency for patients with ATY MDD was the shortest (MEL vs. ATY vs. ANX: 376.14 ± 6.51 vs. 347.21 ± 9.42 vs. 362.22 ± 8.63, P = 0.047). There were no differences in visual P300 ERPs among the three groups.

CONCLUSION

There are significant differences in auditory C3 and Pz latency among MEL, ATY, and ANX MDD. These differences could help diagnose the subtype of MDD.

The influence of major depressive disorders on neurocognitive function among adults living with HIV/AIDS in a regional referral hospital in Dodoma, Tanzania

OBJECTIVE

To determine the influence of major depressive disorders (MDD) on the cognitive function of adults living with HIV and the prevalence of neurocognitive impairment and major depressive disorders.

METHODS

The study was a cross-sectional design conducted in a referral hospital in Dodoma region central Tanzania, with a sample of 397 participants attained through systematic sampling. Neurocognitive impairment was assessed by Montreal Cognitive Assessment (MoCA), while MDD was assessed using Mini International Neuropsychiatric Interview (M.I.N.I). Two-sample independent t-tests were done to compute the significance of the mean change of MoCA score between those with or without MDD. Univariate and multivariate ordinal logistic regression models were computed to determine the association between MDD and neurocognitive impairment across all cognitive domains.

RESULTS

Of 397 recruited participants, 266 (66.00%) met the criteria for neurocognitive disorder and 22 (5.51%) had major depressive disorder. Participants with MDD performed significantly poorer on cognitive testing than those without MDD (mean difference = 3.74, p-value = 0.0009). Under univariate ordinal regression, impairments in the particular domains of visuospatial-executive function, attention, language, abstraction and orientation were significantly associated with MDD and abstraction (AOR: 3.922, 95% CI: 1.546-9.947, p = 0.0004) remained significant under multivariable regression.

CONCLUSION

Major depressive disorder may negatively influence neurocognitive performance in both severity and pattern of presentation. Routine screening for depressive symptoms in HIV care can be beneficial for the overall patient's outcome. Systematic and well-designed studies in the area are crucial for understanding the interaction of neuropsychiatric disorders in the HIV population.

Mindfulness-Based Cognitive Therapy in Recurrent MDD Patients With Residual Symptoms: Alterations in Resting-State Theta Oscillation Dynamics Associated With Changes in Depression and Rumination

Many patients with major depressive disorder (MDD) suffer from residual symptoms. Rumination is a specific known risk factor for the onset, severity, prolongation, and relapse of MDD. This study aimed to examine the efficacy and EEG substrates of mindfulness-based cognitive therapy (MBCT) in alleviating depression and rumination in an MDD population with residual symptoms. We recruited 26 recurrent MDD individuals who had residual symptoms with their current antidepressants to participate in the 8-week MBCT intervention. We evaluated the efficacy and changes in the dynamics of resting-state theta rhythm after the intervention, as well as the associations between theta alterations and improvements in depression and rumination. The participants showed reduced depression, enhanced adaptive reflective rumination, and increased theta power and phase synchronization after MBCT. The increased theta-band phase synchronizations between the right occipital regions and the right prefrontal, central, and parietal regions were associated with reduced depression, while the increase in theta power in the left parietal region was associated with improvements in reflective rumination. MBCT could alleviate depression and enhance adaptive, reflective rumination in recurrent MDD individuals with residual symptoms through the modulation of theta dynamics in specific brain regions.

Sub-second transient activated patterns to sad expressions in major depressive disorders discovered via hidden Markov model

The pathological mechanisms of major depressive disorders (MDDs) is associated with the overexpression of negative emotions, and the fast transient-activated patterns underlying overrepresentation in depression still remain to be revealed to date. We hypothesized that the aberrant spatiotemporal attributes of the process of sad expressions are related to the neuropathology of MDD and help to detect the depression severity. We enrolled a total of 96 subjects including 47 patients with MDD and 49 healthy controls (HCs), and recorded their magnetoencephalography data under a sad expression recognition task. A hidden Markov model (HMM) was applied to separate the whole neural activity into several brain states, then to characterize the dynamics. To find the disrupted temporal-spatial characteristics, power estimations and fractional occupancy (FO) of each state were estimated and contrasted between MDDs and HCs. Three states were found over the period of emotional stimuli processing procedure. The early visual stage (0-270 ms) was mainly manifested by state 1, and the emotional information processing stage (270-600 ms) was manifested by state 2, while the state 3 remained a steady proportion across the whole period. MDDs activated statistically more in limbic system during state 2 (p = 0.0045) and less in frontoparietal control network during state 3 (p = 5.38 × 10^-5 ) relative to HCs. Hamilton Depression Rating Scale scores were significantly correlated with the predicted disorder severity using FO values (p = 0.0062, r = 0.3933). Relative to HCs, MDDs perceived the sad contents quickly and spent more time overexpressing the negative emotions. These phenomena indicated MDD patients might easily indulge in negative emotion and neglect other things. Furthermore, temporal descriptors built by HMM could be potential biomarkers for identifying the severity of depression disorders.

Polygenic burden could explain high rates of affective disorders in a community with restricted founder population

This study investigates if genetic factors could contribute to the high rate of mood disorders reported in a U.S. community known to have a restricted early founder population (confirmed here through runs of homozygosity analysis). Polygenic scores (PGSs) for eight common diseases, disorders, or traits, including psychiatric disorders, were calculated in 274 participants (125 mood disorder cases) who each reported three or four grandparents born in the community. Ancestry-matched controls were selected from the UK Biobank (UKB; three sets of N = 1,822 each). The mean PGSs were significantly higher in the community for major depression PRS (p = 2.1 × 10^-19 , 0.56 SD units), bipolar disorder (p = 2.5 × 10^-15 , 0.56 SD units), and schizophrenia (p = 3.8 × 10^-21 , 0.64 SD units). The PGSs were not significantly different between the community participants and UKB controls for the traits of body mass index, Type 2 diabetes, coronary artery disease, and chronotype. The mean PGSs for height were significantly lower in the community sample compared to controls (-0.21 SD units, p = 1.2 × 10^-5 ). The results are consistent with enrichment of polygenic risk factors for psychiatric disorders in this community.

Cognition in Recent Suicide Attempts: Altered Executive Function

Background: Neuropsychological alterations can lead to inaccurate perception, interpretation, and response to environmental information, which could be a risk factor for suicide. Methods: Ninety-six subjects were recruited from the Psychiatry Department of the Araba University Hospital-Santiago, including 20 patients with a recent attempt and diagnosis of major depressive disorder (MDD) according to DSM-V, 33 MDD patients with history of attempted suicide, 23 non-attempter MDD patients, and 20 healthy controls. All participants underwent a clinical interview and neuropsychological assessment on the following cognitive domains: working memory, processing speed, decision-making, executive function, and attention. Backward multiple regressions were performed adjusting for significant confounding variables. For group comparisons, ANOVA and Bonferroni post-hoc tests were performed with a p < 0.05 significance level. Results: The patient groups did not differ regarding severity of depression and stressful events in the last 6 months. In comparison to healthy controls, depressed patients with lifetime suicide attempts had more general trauma (p = 0.003), emotional abuse (p = 0.003), emotional negligence (p = 0.006), and physical negligence (p = 0.009), and depressed patients with recent suicide attempts had experienced more child sexual abuse (p = 0.038). Regarding neuropsychological assessment, all patient groups performed significantly worse than did healthy controls in processing speed, decision-making, and attention. Comparisons between patient groups indicated that recent suicide attempters had poorer performance on executive function in comparison to both depressed lifetime attempters and depressed non-attempters (B = 0.296, p = 0.019, and B = 0.301, p = 0.028, respectively). Besides, women with recent attempts had slightly better scores on executive function than males. Regarding the rest of the cognitive domains, there were no significant differences between groups. Conclusion: Executive function performance is altered in recent suicide attempts. As impaired executive function can be risk factor for suicide, preventive interventions on suicide should focus on its assessment and rehabilitation.

Major depressive disorders in young immigrants: A cohort study from primary healthcare settings in Sweden

AIMS

Previous studies on major depressive disorder (MDD) among immigrants have reported mixed results. Using data from primary healthcare settings in Sweden, we compared the incidence of MDD among first- and second-generation immigrants aged 15-39 years with natives.

METHODS

This was a retrospective nationwide open cohort study. Eligible individuals were born 1965-1983, aged 15-39 years at baseline, and resided in Sweden for at least one year during the study period 2000-2015. We identified MDD cases through the Primary Care Registry (PCR). The follow-up for each individual started when they met the inclusion criteria and were registered in the PCR and ended at MDD diagnosis, death, emigration, moving to a county without PCR coverage, or the end of the study period, whichever came first. Results: The final sample included 1,341,676 natives and 785,860 immigrants. The MDD incidence rate per 1000 person-years ranged from 6.1 (95% confidence intervals: 6.1, 6.2) to 16.6 (95% confidence intervals: 16.2, 17.0) in native males and second-generation female immigrants with a foreign-born father, respectively. After adjusting for income, the MDD risk did not differ substantially between first-generation male and female immigrants and natives. However, male and female second-generation immigrants had a 16-29% higher adjusted risk of MDD than natives.

CONCLUSIONS

This cohort study using primary healthcare data in Sweden, albeit incomplete, indicated that second-generation immigrants seem to be at a particularly high risk of MDDs. The underlying mechanisms need further investigation.

Increased Suicidality and Worse Outcomes in MDD Patients With OSA: A Nationwide Inpatient Analysis of 11 Years From 2006 to 2017

BACKGROUND

Major depressive disorder (MDD) is the most common psychiatric disorder characterized by changes in mood, cognition, and physical symptoms. MDD has an approximate 18% prevalence of comorbid OSA. Several studies have looked into plausible mechanisms that have shown a strong relationship between OSA and MDD.

OBJECTIVES

The primary objective of this study was to compare suicidal ideation/attempt among MDD patients with and without a comorbid diagnosis of OSA. The secondary objective was to compare the length of stay, total hospital charge, recurrent or severity of depression, and clinical comorbidities.

METHODS

Data were obtained from the National (Nationwide) Inpatient Sample dataset from 2006 to 2017. For data collection, we queried for all adult patients (age ≥ 18 y), with MDD as a primary indication of admission. Further, we categorized MDD patients with and without a secondary diagnosis of OSA. To reduce the imbalance in baseline characteristics between the groups, we performed one to one age-gender matching between MDD patients with and without OSA.

RESULTS

In the matched cohort, 79,308 patients were included in MDD with OSA and 78,792 patients in the MDD without OSA group. MDD patients with OSA were more likely to be racially white (80% vs 75%, P < 0.001), and to have more clinical comorbidities (hypertension, heart failure, obesity, and chronic lung disease). Prevalence of recurrent type of depression (77% vs 69%, P < 0.001) and moderate to severe depression (72% vs 68%, P < 0.001) was more likely in the MDD with OSA group. Further, suicidality (composite of suicidal ideation/attempt) was more in MDD with OSA (49.5%) compared to MDD without OSA (41.8%) (P < 0.001). In the multivariate analysis, MDD with OSA was associated with higher odds of suicidal ideation/act compared to MDD without OSA (adjusted odds ratio: 1.27, P < 0.001). The total length of stay was longer in the MDD with OSA group (7.4 vs 6.9 d, P < 0.001).

CONCLUSIONS

In our study, poorer outcomes were observed in patients with MDD and OSA. Hence, clinicians should be vigilant for symptoms of OSA in patients with recurrent MDD or treatment-resistant MDD. We recommend that a thorough suicide risk assessment should be conducted in MDD patients with OSA, and validated questionnaires should be a part of the evaluation.

Functional impairment-based segmentation of anterior cingulate cortex in depression and its relationship with treatment effects

In major depressive disorder (MDD), the anterior cingulate cortex (ACC) is widely related to depression impairment and antidepressant treatment response. The multiplicity of ACC subdivisions calls for a fine‐grained investigation of their functional impairment and recovery profiles. We recorded resting state fMRI signals from 59 MDD patients twice before and after 12‐week antidepressant treatment, as well as 59 healthy controls (HCs). With functional connectivity (FC) between each ACC voxel and four regions of interests (bilateral dorsolateral prefrontal cortex [DLPFC] and amygdalae), subdivisions with variable impairment were identified based on groups' dissimilarity values between MDD patients before treatment and HC. The ACC was subdivided into three impairment subdivisions named as MedialACC, DistalACC, and LateralACC according to their dominant locations. Furthermore, the impairment pattern and the recovery pattern were measured based on group statistical analyses. DistalACC impaired more on its FC with left DLPFC, whereas LateralACC showed more serious impairment on its FC with bilateral amygdalae. After treatment, FCs between DistalACC and left DLPFC, and between LateralACC and right amygdala were normalized while impaired FC between LateralACC and left amygdala kept dysfunctional. Subsequently, FC between DistalACC and left DLPFC might contribute to clinical outcome prediction. Our approach could provide an insight into how the ACC was impaired in depression and partly restored after antidepressant treatment, from the perspective of the interaction between ACC subregions and critical frontal and subcortical regions.

The Association of Depressive Symptoms and Intimate Partner Violence Against Women in Northwestern Botswana

Although links between mental health and intimate partner violence (IPV) have been discussed extensively in the scholarly literature, little empirical data exist about these phenomena in Botswana. This study addressed this gap by examining the nature, extent, and risk factors associated with symptoms of major depressive disorders (MDD) using cross-sectional data collected in 2009-2010 in northwestern Botswana. A random sample of 469 women participated in semistructured interviews about their lives, health, and experiences with violence. Thirty-one percent of respondents were found to meet the symptom criteria for MDD. Factors associated with MDD included emotional or physical violence by an intimate partner and being in a relationship in which both partners consumed alcohol. One in five women reported a recent experience of emotional violence, while 37% of respondents reported recent physical IPV. Women who have experienced emotional or physical IPV in the last 12 months have 89% and 82% greater odds, respectively, of having symptoms of MDD (p < .05) than women who have not recently experienced either form of violence. Women in relationships in which both partners consumed alcohol had more than twice the odds of MDD compared with women in relationships where neither partner or only one partner drank. Given the significant association of violence, alcohol, and MDD, screening for all three conditions should be part of routine care in health care settings in Botswana. Interventions to reduce IPV and alcohol consumption may help alleviate the burden of MDD in women in this setting.

Gene-Based Association Analysis Suggests Association of HTR2A With Antidepressant Treatment Response in Depressed Patients

The serotonin [5-hydroxytryptamine (5-HT)] system has been implicated in the pathogenesis of major depressive disorder (MDD). Among the 5-HT receptor subtypes, 5-HT2 is one of the major pharmacological therapeutic targets for MDD. There have been inconsistent findings in previous pharmacogenetic studies investigating the antidepressant therapeutic response using one or several 5-HT2A (HTR2A) genetic polymorphisms. By using gene-based association analysis, we hope to identify genetic variants of HTR2A which are related to MDD susceptibility and its antidepressant therapeutic response. 288 HTR2A single nucleotide polymorphisms in MDD susceptibility have been investigated through a case–control (455 MDD patients and 2, 998 healthy controls) study, as well as in antidepressant efficacy (n = 455) in our current research. The 21-item Hamilton Rating Scale for Depression was used to evaluate measures of antidepressant therapeutic efficacy. From two MDD groups in the antidepressant therapeutic response, by using gene-based analyses, we have identified 14 polymorphisms as suggestive markers for therapeutic response (13 for remission and 1 for response) in both meta- and mega-analyses. All of these HTR2A reported polymorphisms did not reach statistical significance in the case–control association study. This current investigation supported the link between HTR2A variants and antidepressant therapeutic response in MDD but not with MDD susceptibility.

Functional Alterations and Cerebral Variations in Humans Exposed to Early Life Stress

Early life stress can be caused by acute or chronic exposure to childhood events, such as emotional, physical, sexual abuse, and neglect. Early stress is associated with subsequent alterations in physical and mental health, which can extend into adolescence, adulthood, and even old age. The effects of early stress exposure include alterations in cognitive, neuropsychological, and behavioral functions, and can even lead to the development of psychiatric disorders and changes in brain anatomy. The present manuscript provides a review of the main findings on these effects reported in the scientific literature in recent decades. Early life stress is associated with the presence of psychiatric disorders, mainly mood disorders such as depression and risk of suicide, as well as with the presence of post-traumatic stress disorder. At the neuropsychological level, the involvement of different mental processes such as executive functions, abstract reasoning, certain memory modalities, and poor school-skill performance has been reported. In addition, we identified reports of alterations of different subdomains of each of these processes. Regarding neuroanatomical effects, the involvement of cortical regions, subcortical nuclei, and the subcortical white matter has been documented. Among the telencephalic regions most affected and studied are the prefrontal cortex, the hippocampus, the amygdala, and the anterior cingulate cortex. Understanding the impact of early life stress on postnatal brain development is very important for the orientation of therapeutic intervention programs and could help in the formulation and implementation of preventive measures as well as in the reorientation of research targets.

Pretreatment Brain Connectome Fingerprint Predicts Treatment Response in Major Depressive Disorder

Background

Major depressive disorder (MDD) treatment is characterized by low remission rate and often involves weeks to months of treatment. Identification of pretreatment biomarkers of response may play a critical role in novel drug development, in enhanced prognostic predictions, and perhaps in providing more personalized medicine. Using a network restricted strength predictive modeling (NRS-PM) approach, the goal of the current study was to identify pretreatment functional connectome fingerprints (CFPs) that (1) predict symptom improvement regardless of treatment modality and (2) predict treatment specific improvement.

Methods

Functional magnetic resonance imaging and behavioral data from unmedicated patients with MDD (n = 200) were investigated. Participants were randomized to daily treatment of sertraline or placebo for 8 weeks. NRS-PM with 1000 iterations of 10 cross-validation were implemented to identify brain connectivity signatures that predict percent improvement in depression severity at week-8.

Results

The study identified a pretreatment CFP that significantly predicts symptom improvement independent of treatment modality but failed to identify a treatment specific CFP. Regardless of treatment modality, improved antidepressant response was predicted by high pretreatment connectivity between modules in the default mode network and the rest of the brain, but low external connectivity in the executive network. Moreover, high pretreatment internal nodal connectivity in the bilateral caudate predicted better response.

Conclusions

The identified CFP may contribute to drug development and ultimately to enhanced prognostic predictions. However, the results do not assist with providing personalized medicine, as pretreatment functional connectivity failed to predict treatment specific response.

Prediction of Clinical Outcomes With EEG Microstate in Patients With Major Depressive Disorder

Background: The difficulty in timely evaluating patient response to antidepressants has brought great challenge to the treatment of major depressive disorder (MDD). Some studies found that the electroencephalogram (EEG) microstates might be a reliable marker to evaluate patient response to treatment. The present study aims to evaluate the relationship between EEG microstate parameters and MDD symptoms before and after treatment to identify predictive biological markers for patient response. Methods: Thirty drug-naïve MDD patients (20 females and 10 males) were enrolled in this study. All the patients received effective dosages of selective serotonin reuptake inhibitors, and EEG recordings were collected at baseline and 2 weeks of treatment. Brain activities during the eyes-closed state were recorded using 64-channel electroencephalography, and the patients' microstates were clustered into four maps according to their topography (labeled A, B, C, and D). The differences of EEG microstates before and after treatment were compared using paired t-test. Spearman correlation coefficients were calculated to identify the relationships between the improvement of depression and anxiety symptoms and microstate parameters. Results: The mean duration (69.67 ± 10.33 vs. 64.00 ± 7.70, p < 0.001) and occurrence (4.06 ± 0.69, vs. 3.69 ± 0.70, p = 0.002) of microstate B decreased significantly after treatment. The proportion of microstate B also decreased (27.53 ± 5.81, vs. 23.23 ± 4.61, p < 0.001), while the occurrence of microstate A increased after treatment. A significant negative correlation was found between the change of score of Hamilton Rating Scale for Anxiety and the increase of the occurrence of microstate A (r = -0.431, p < 0.05) after 2 weeks of treatment. The reduction of the duration of microstate B was found to be predictive of patient response to antidepressants after 3 months. Conclusion: This study explored the relationship between changes of EEG microstates and patient response to antidepressants. Depression symptoms might be associated with the duration of microstate B and anxiety symptoms related to the occurrence of microstate A. Therefore, the duration of microstate B and the occurrence of microstate A are potential biological markers for MDD patients' early response and further clinical outcomes.

Brain Disorders and Chemical Pollutants: A Gap Junction Link?

The incidence of brain pathologies has increased during last decades. Better diagnosis (autism spectrum disorders) and longer life expectancy (Parkinson's disease, Alzheimer's disease) partly explain this increase, while emerging data suggest pollutant exposures as a possible but still underestimated cause of major brain disorders. Taking into account that the brain parenchyma is rich in gap junctions and that most pollutants inhibit their function; brain disorders might be the consequence of gap-junctional alterations due to long-term exposures to pollutants. In this article, this hypothesis is addressed through three complementary aspects: (1) the gap-junctional organization and connexin expression in brain parenchyma and their function; (2) the effect of major pollutants (pesticides, bisphenol A, phthalates, heavy metals, airborne particles, etc.) on gap-junctional and connexin functions; (3) a description of the major brain disorders categorized as neurodevelopmental (autism spectrum disorders, attention deficit hyperactivity disorders, epilepsy), neurobehavioral (migraines, major depressive disorders), neurodegenerative (Parkinson's and Alzheimer's diseases) and cancers (glioma), in which both connexin dysfunction and pollutant involvement have been described. Based on these different aspects, the possible involvement of pollutant-inhibited gap junctions in brain disorders is discussed for prenatal and postnatal exposures.

A Combined Digital and Biomarker Diagnostic Aid for Mood Disorders (the Delta Trial): Protocol for an Observational Study

Background

Mood disorders affect hundreds of millions of people worldwide, imposing a substantial medical and economic burden. Existing diagnostic methods for mood disorders often result in a delay until accurate diagnosis, exacerbating the challenges of these disorders. Advances in digital tools for psychiatry and understanding the biological basis of mood disorders offer the potential for novel diagnostic methods that facilitate early and accurate diagnosis of patients.

Objective

The Delta Trial was launched to develop an algorithm-based diagnostic aid combining symptom data and proteomic biomarkers to reduce the misdiagnosis of bipolar disorder (BD) as a major depressive disorder (MDD) and achieve more accurate and earlier MDD diagnosis.

Methods

Participants for this ethically approved trial were recruited through the internet, mainly through Facebook advertising. Participants were then screened for eligibility, consented to participate, and completed an adaptive digital questionnaire that was designed and created for the trial on a purpose-built digital platform. A subset of these participants was selected to provide dried blood spot (DBS) samples and undertake a World Health Organization World Mental Health Composite International Diagnostic Interview (CIDI). Inclusion and exclusion criteria were chosen to maximize the safety of a trial population that was both relevant to the trial objectives and generalizable. To provide statistical power and validation sets for the primary and secondary objectives, 840 participants were required to complete the digital questionnaire, submit DBS samples, and undertake a CIDI.

Results

The Delta Trial is now complete. More than 3200 participants completed the digital questionnaire, 924 of whom also submitted DBS samples and a CIDI, whereas a total of 1780 participants completed a 6-month follow-up questionnaire and 1542 completed a 12-month follow-up questionnaire. The analysis of the trial data is now underway.

Conclusions

If a diagnostic aid is able to improve the diagnosis of BD and MDD, it may enable earlier treatment for patients with mood disorders.

International Registered Report Identifier (IRRID)

DERR1-10.2196/18453

RNA Editing and Modifications in Mood Disorders

Major depressive disorder (MDD) is a major health problem with significant limitations in functioning and well-being. The World Health Organization (WHO) evaluates MDD as one of the most disabling disorders in the world and with very high social cost. Great attention has been given to the study of the molecular mechanism underpinning MDD at the genetic, epigenetic and proteomic level. However, the importance of RNA modifications has attracted little attention until now in this field. RNA molecules are extensively and dynamically altered by a variety of mechanisms. Similar to "epigenomic" changes, which modify DNA structure or histones, RNA alterations are now termed "epitranscriptomic" changes and have been predicted to have profound consequences for gene expression and cellular functionality. Two of these modifications, adenosine to inosine (A-to-I) RNA editing and m6A methylations, have fascinated researchers over the last years, showing a new level of complexity in gene expression. In this review, we will summary the studies that focus on the role of RNA editing and m6A methylation in MDD, trying to underline their potential breakthroughs and pitfalls.

Screening Depressive Disorders With Tree-Drawing Test

Objective: Diagnosis of psychiatric disease is still a major issue. Two key reasons are- there are variations in the opinions of the medical doctors and the presentation of a disease among the patients. Here we introduce a kind of mental projective test, tree-drawing test, trying to extract and analyze objective indexes in tree-drawing test in patients with depression. Methods: The tree-drawing test was administered to 43 patients with major depressive disorders, 48 sub-threshold subjects, and 59 healthy subjects. Features of the drawing trees were analyzed using a kind of computer image recognition and data acquisition software. Quantitative indexes collected from pictures drawn by patients with major depression, patients with sub-threshold depression, and control subjects were compared using the ANOVA test. Results: Five quantitative features (canopy area, canopy height, canopy width, trunk width, and total area of trees) were found to be statistically significant among the groups, while seven other features (trunk area, trunk height, root width, root height, root area, ratio of crown to trunk height, and ratio of crown to trunk area) showed no statistical significance. Further analysis with LSD-t test revealed that six quantitative indexes were significantly related to the depression symptoms, and six others were not statistically significant. Eleven quantitative indexes were not statistically significant when the depressive symptoms were compared with the subthreshold depression group, and the only index with statistical significance was canopy width. Conclusion: Five quantitative indexes in the drawing tree are statistically significant in the depression patients were compared with those of the control subjects. Quantitative indexes of the tree-drawing test are of great value in assisting with the diagnosis of psychiatric disorders.

Enhanced Functional Connectivity Within Executive Function Network in Remitted or Partially Remitted MDD Patients

Background: Impaired executive function (EF) is associated with a range of typical clinical characteristics and psychosocial dysfunction in major depressive disorder (MDD). However, because of the lack of objective cognitive tests, inconsistencies in research results, and improvement in patients' subjective experience, few clinicians are concerned with the persistent impairment of EF in euthymia. The study makes a further investigation for EF in remitted and partially remitted MDD patients via multiple EF tests and fMRI, so as to explore the executive function of patients in euthymia. Methods: We recruited 19 MDD patients and 17 age-, gender-, and education-matched healthy controls (HCs). All participants completed EF tests and fMRI scanning. Bilateral dorsolateral prefrontal cortex (dlPFC) regions were selected as the region of interests (ROIs) to conduct seed-based functional connectivity (FC). We conducted fractional amplitude of low-frequency fluctuations (fALFF) analysis for all ROIs and whole brain. Results: All MDD patients were in remission or partial remission, and they were comparable with HCs on all the EF tests. MDD group showed increased positive FC between left dlPFC and cerebellar Crus I, right dlPFC and supramarginal gyrus after 8-weeks treatment, even taking residual depressive symptoms into account. We did not find group difference of fALFF value. Conclusion: MDD patients persisted with EF impairment despite the remission or partially remission of depressive symptoms. Clinicians should focus on residual cognitive symptoms, which may contribute to maximize the efficacy of routine therapy.

Mitochondria could be a potential key mediator linking the intestinal microbiota to depression

The intestinal microbiota has been reported to affect depression, a common mental condition with severe health-related consequences. However, what mediates the effect of the intestinal microbiota on depression has not been well elucidated. We summarize the roles of the mitochondria in eliciting beneficial effects on the gut microbiota to ameliorate symptoms of depression. It is well known that mitochondria play a key role in depression. An important pathogenic factor, namely inflammatory response, may adversely impact mitochondrial functionality to maintain cellular homeostasis. Dysfunction of mitochondria not only affects neuronal function but also reduces neuron cell numbers. We posit that the intestinal microbiota could affect neuronal mitochondrial function through short-chain fatty acids such as butyrate. Brain inflammatory processes could also be affected through the modulation of gut permeability and blood lipopolysaccharide levels. Aberrant mitochondria functionality coupled to adverse cellular homeostasis could be a key mediator for the effect of the intestinal microbiota on the progression of depression.

Effect of probiotic and prebiotic versus placebo on appetite in patients with major depressive disorder: post hoc analysis of a randomised clinical trial

BACKGROUND

Poor appetite and weight loss are common in melancholic depression. Probiotics and prebiotics have the capacity to affect host behaviour, appetite and weight change by modulating the gut microbiome. The aim of this post hoc analysis was to investigate the effect of supplementation with probiotic and prebiotic on appetite, in parallel with body mass index (BMI), weight and energy intake, in patients with major depressive disorder (MDD).

METHODS

We extracted data from a clinical trial with 81 patients. The participants were randomly assigned to receive probiotic (Lactobacillus helveticus and Bifidobacterium longum), prebiotic (galactooligosaccharide) or placebo for 8 weeks. Appetite, weight, BMI, dietary intake, serum leptin and physical activity were measured. Subjective appetite rating was evaluated every 2 weeks using visual analogue scales (VAS) to assess satiety, hunger, fullness and desire to eat. Serum leptin was measured by an enzyme-linked immunosorbent assay. Physical activity was measured using the international physical activity questionnaire. A repeated measures analysis of variance model was used to analyse VAS data and analysis of variance/analysis of covariance models for dietary intake, BMI, weight and leptin data.

RESULTS

VAS data analyses indicated no significant intervention-time interactions but did show a significant increase over time for desire to eat within the probiotic group (P = 0.025). No significant difference in either BMI or weight was seen among the groups. Energy intake and leptin were significantly increased in the probiotic group compared to the prebiotic.

CONCLUSIONS

Overall, probiotic supplementation for 8 weeks among MDD patients resulted in improvement of appetite, whereas prebiotic administration had no significant effect on appetite.

Epigenetic Regulations in Neuropsychiatric Disorders

Precise genetic and epigenetic spatiotemporal regulation of gene expression is critical for proper brain development, function and circuitry formation in the mammalian central nervous system. Neuronal differentiation processes are tightly regulated by epigenetic mechanisms including DNA methylation, histone modifications, chromatin remodelers and non-coding RNAs. Dysregulation of any of these pathways is detrimental to normal neuronal development and functions, which can result in devastating neuropsychiatric disorders, such as depression, schizophrenia and autism spectrum disorders. In this review, we focus on the current understanding of epigenetic regulations in brain development and functions, as well as their implications in neuropsychiatric disorders.

Decreased Task-Related HRV Is Associated With Inhibitory Dysfunction Through Functional Inter-Region Connectivity of PFC in Major Depressive Disorder

The regulation of the autonomic nervous system (ANS) can improve cognitive function in major depressive disorders (MDD). Heart rate variability (HRV) derives from the dynamic control of the ANS and reflects the balance between the activities of the sympathetic and parasympathetic nervous systems by measuring tiny changes in adjacent heart beats. Task-related HRV may reflect the association between the flexibility of cognition and ANS function. The study was to investigate the neural mechanism of interactions between ANS and cognitive function in MDD with Magnetoencephalography (MEG) measurements. Participants included 20 MDD patients and 18 healthy controls (HCs). All participants were measured with a go/no-go task MEG. HRV indices, the standard deviation of the average normal-to-normal (NN) interval calculated over short periods (SDANN) and the square root of the mean squared differences of successive NN intervals (RMSSD), were derived from the raw MEG data. Results showed that MDD patients showed decreased SDANN and RMSSD. In MDD patients, both resting-state and task-related RMSSD were related to inhibitory and control dysfunction. In the go/no-go task, many areas in the prefrontal cortex (PFC) are responsible for an individual's inhibitory function. A brain MEG functional connectivity analysis revealed that there were significant differences in four brain regions within the prefrontal cortex (PFC) between MDD patients and HCs. Task-related RMSSD in HCs were related to the functional connectivity between the left middle frontal gyrus and the anterior cingulate cortex (ACC), while in MDD patients, these values were not related to the above functional connectivity but were related to the functional connectivity between the left middle frontal gyrus and insula. However, the resting-state RMSSD value was not related to these significant difference functional connectivity networks in all participants. It concludes that the decreased task-related HRV is associated with inhibitory dysfunction through functional inter-region connectivity in the PFC in MDD, and the task-related HRV can be used as an index of the association between MDD and autonomic dysregulation.

The association study of CLOCK gene polymorphisms with antidepressant effect in Chinese with major depressive disorder

AIM

Major depressive disorder (MDD) is a common psychiatric disorder with a complicated pathogenesis and genetic predisposition. The objective of this article is to explore the relationship between the four SNPs of circadian locomotor output cycles kaput (CLOCK) gene (rs11932595, rs12504300, rs3805148, rs534654) and the efficacy of antidepressants. Materials & methods: This study enrolled a total of 600 patients, who met the DSM-V diagnostic criteria for MDD. All subjects were treated with single selective serotonin reuptake inhibitors. The HAMD₁₇ and adverse reaction scale (TESS/UKU) were used to assess the efficacy of antidepressants and adverse effects. The PCR and DNA sequencing analysis were used to genotype loci of CLOCK gene.

RESULTS

The antidepressants efficacy of subjects with rs11932595 AA genotype was significantly higher than those with GG+GA genotypes (p = 0.035). But this p-value was not significant after false discovery rate (FDR) adjustment.

CONCLUSION

The variant of CLOCK gene may be associated with the efficacy of selective serotonin reuptake inhibitors in Chinese Han MDD patients.

Economic Evaluation of an Internet-Based Preventive Cognitive Therapy With Minimal Therapist Support for Recurrent Depression: Randomized Controlled Trial

Background

Major depressive disorder (MDD) is highly recurrent and has a significant disease burden. Although the effectiveness of internet-based interventions has been established for the treatment of acute MDD, little is known about their cost effectiveness, especially in recurrent MDD.

Objectives

Our aim was to evaluate the cost effectiveness and cost utility of an internet-based relapse prevention program (mobile cognitive therapy, M-CT).

Methods

The economic evaluation was performed alongside a single-blind parallel group randomized controlled trial. Participants were recruited via media, general practitioners, and mental health care institutions. In total, 288 remitted individuals with a history of recurrent depression were eligible, of whom 264 were randomly allocated to M-CT with minimal therapist support added to treatment as usual (TAU) or TAU alone. M-CT comprised 8 online lessons, and participants were advised to complete 1 lesson per week. The economic evaluation was performed from a societal perspective with a 24-month time horizon. The health outcomes were number of depression-free days according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, (DSM-IV) criteria assessed with the Structured Clinical Interview for DSM-IV axis I disorders by blinded interviewers after 3, 12, and 24 months. Quality-adjusted life years (QALYs) were self-assessed with the three level version of the EuroQol Five Dimensional Questionnaire (EQ-5D-3L). Costs were assessed with the Trimbos and Institute for Medical Technology Assessment Questionnaire on Costs Associated with Psychiatric Illness (TiC-P). Incremental cost-effectiveness ratios were calculated and cost-effectiveness planes and cost-effectiveness acceptability curves were displayed to assess the probability that M-CT is cost effective compared to TAU.

Results

Mean total costs over 24 months were €8298 (US $9415) for M-CT and €7296 (US $8278) for TAU. No statistically significant differences were found between M-CT and TAU regarding depression-free days and QALYs (P=.37 and P=.92, respectively). The incremental costs were €179 (US $203) per depression-free day and €230,816 (US $261,875) per QALY. The cost-effectiveness acceptability curves suggested that for depression-free days, high investments have to be made to reach an acceptable probability that M-CT is cost effective compared to TAU. Regarding QALYs, considerable investments have to be made but the probability that M-CT is cost effective compared to TAU does not rise above 40%.

Conclusions

The results suggest that adding M-CT to TAU is not effective and cost effective compared to TAU alone. Adherence rates were similar to other studies and therefore do not explain this finding. The participants scarcely booked additional therapist support, resulting in 17.3 minutes of mean total therapist support. More studies are needed to examine the cost effectiveness of internet-based interventions with respect to long-term outcomes and the role and optimal dosage of therapist support. Overall, more research is needed on scalable and cost-effective interventions that can reduce the burden of recurrent MDD.

Trial registration

Netherlands Trial Register NTR2503; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2503 (Archived by WebCite at http://www.webcitation.org/73aBn41r3)

[The emotional intelligence in major depressive disorders]

The term emotional intelligence was introduced by Salovey & Mayer. It is the individual's ability to perceive, evaluate and express emotions. It is also a set of abilities which enable an individual to function effectively and they are an important factor affecting the quality of life. The literature also has a synonymous concept of emotional competence which is a collection of already acquired skills used in specific social situations. Major depressive disorder represents an affective disorder having an impact on a human being's ability to regulate emotions. In their course, there are difficulties with adequate recognition of one's emotional states as well as emotional states of other people. Research indicates, among others, the relationship between emotional intelligence and the occurrence of suicidal thoughts and tendencies, prognosis of therapeutic interactions in patients. A high level of emotional intelligence is a protective factor in the occurrence of mental disorders, including depression, affects the treatment process and influences the creation of effective strategies for coping with stress. The paper presents reports on the level of emotional intelligence and its impact on the functioning of patients with major depressive disorders.

Regulatory T Cells As Supporters of Psychoimmune Resilience: Toward Immunotherapy of Major Depressive Disorder

There is growing evidence that inflammation plays a role in major depressive disorder (MDD). As the main role of regulatory T cells (Tregs) is to control inflammation, this might denote a Treg insufficiency in MDD. However, neither a qualitative nor a quantitative defect of Tregs has been ascertained and no causality direction between inflammation and depression has been established. Here, after reviewing the evidence supporting a relation between Treg insufficiency and MDD, we conclude that a novel therapeutic approach based on Treg stimulation could be valuable in at least the subset of patients with inflammatory MDD. Low-dose interleukin-2 appears to be a good candidate as it is not only a safe stimulator of Tregs in humans but also an inhibitor of pro-inflammatory Th17 lymphocytes. Here, we discuss that a thorough immune investigation as well as immunotherapy will be heuristic for deciphering the pathophysiology of MDD.

Vitamin D3 as adjunctive therapy in the treatment of depression in tuberculosis patients: a short-term pilot randomized double-blind controlled study

OBJECTIVE

We aimed to evaluate whether high-dose cholecalciferol has beneficial effects on depression in pulmonary tuberculosis (PTB) patients.

METHODS

This pilot, randomized, and double-blind trial enrolled 123 recurrent PTB patients (aged ≥18 years) meeting Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) criteria of major depressive disorder from four hospitals in Southeast China. Patients were randomly assigned to 8-week oral treatment with 100,000 IU/week cholecalciferol (Vit D group) or a matching placebo (control group). The primary outcome was treatment response, defined as a 50% reduction in symptoms and change in scores of the Chinese version of Beck Depression Inventory (BDI) from baseline to 8 weeks. Relative risks of depression were estimated using multivariable logistic regression.

RESULTS

Finally, 120 patients were enrolled, including 56 test patients and 64 controls. After 8 weeks, the treatment response or BDI scores did not differ significantly between groups. Multivariate logistic regression showed that BDI scores were not significantly improved in the Vit D group after adjustment for age, time to first negative smear, or 25-hydroxyvitamin D level.

CONCLUSION

The use of high-dose Vit D3 supplementation may not be warranted for reducing depressive symptoms in the PTB population. Nevertheless, this finding should be validated by further large-scale studies according to different kinds of depression or Vit D receptor polymorphism genotype.

Rapid Antidepressant Effect of Hydrogen Sulfide: Evidence for Activation of mTORC1-TrkB-AMPA Receptor Pathways

AIMS

We asked whether hydrogen sulfide (H₂S), as the third gaseous mediator, provided fast antidepressant effect on major depressive disorders and underlying mechanisms.

RESULTS

The decreased level of H₂S was detected in the hippocampus of chronic unpredictable mild stress (CUMS)-treated rats. Acute administration of H₂S either by H₂S inhalation or by the donor NaHS produced a rapid antidepressant-like behavioral effect. Further investigation demonstrated that this effect of H₂S was mediated by reversing the CUMS-induced decrease in dendritic spine density and required the activation of mammalian target of rapamycin (mTOR)C1 and neurotrophic TrkB receptors, which proceeded to increase synaptic protein expression, including postsynaptic density protein 95, synaptophysin, and α-amino-3-hydroxy-5-methyl-4-isoxazole-propionic acid receptor GluR1/2 subunit.

INNOVATION

This study provides the first direct evidence for detecting the decreased H₂S in hippocampus of CUMS rats and the biological significance of H₂S in treating major depression.

CONCLUSION

Our data demonstrate that H₂S activates mTORC1 signaling cascades and thereby produces fast-onset antidepressant effect. The study provides a profound insight into H₂S or its donors as potent preventive and therapeutic agents for intervention of depression. Antioxid. Redox Signal. 27, 472-488.

Differential Peripheral Proteomic Biosignature of Fluoxetine Response in a Mouse Model of Anxiety/Depression

The incorporation of peripheral biomarkers in the treatment of major depressive disorders (MDD) could improve the efficiency of treatments and increase remission rate. Peripheral blood mononuclear cells (PBMCs) represent an attractive biological substrate allowing the identification of a drug response signature. Using a proteomic approach with high-resolution mass spectrometry, the present study aimed to identify a biosignature of antidepressant response (fluoxetine, a Selective Serotonin Reuptake Inhibitor) in PBMCs in a mouse model of anxiety/depression. Following determination of an emotionality score, using complementary behavioral analysis of anxiety/depression across three different tests (Elevated Plus Maze, Novelty Suppressed Feeding, Splash Test), we showed that a 4-week corticosterone treatment (35 μg/ml, CORT model) in C57BL/6NTac male mice induced an anxiety/depressive-like behavior. Then, chronic fluoxetine treatment (18 mg/kg/day for 28 days in the drinking water) reduced corticosterone-induced increase in emotional behavior. However, among 46 fluoxetine-treated mice, only 30 of them presented a 50% decrease in emotionality score, defining fluoxetine responders (CORT/Flx-R). To determine a peripheral biological signature of fluoxetine response, proteomic analysis was performed from PBMCs isolated from the “most” affected corticosterone/vehicle (CORT/V), corticosterone/fluoxetine responders and non-responders (CORT/Flx-NR) animals. In comparison to CORT/V, a total of 263 proteins were differently expressed after fluoxetine exposure. Expression profile of these proteins showed a strong similarity between CORT/Flx-R and CORT/Flx-NR (R = 0.827, p < 1e^-7). Direct comparison of CORT/Flx-R and CORT/Flx-NR groups revealed 100 differently expressed proteins, representing a combination of markers associated either with the maintenance of animals in a refractory state, or associated with behavioral improvement. Finally, 19 proteins showed a differential direction of expression between CORT/Flx-R and CORT/Flx-NR that drove them away from the CORT-treated profile. Among them, eight upregulated proteins (RPN2, HSPA9, NPTN, AP2B1, UQCRC2, RACK-1, TOLLIP) and one downregulated protein, TLN2, were previously associated with MDD or antidepressant drug response in the literature. Future preclinical studies will be required to validate whether proteomic changes observed in PBMCs from CORT/Flx-R mice mirror biological changes in brain tissues.

Relationship between the hippocampal shape abnormality and serum cortisol levels in first-episode and drug-naïve major depressive disorder patients

BACKGROUND

We aimed to investigate the relationship between the hippocampal shape deformations and the serum cortisol levels in first-episode and drug-naïve major depression disorder (MDD) patients.

METHODS

Thirty first-episode and drug-naïve MDD patients and 40 healthy subjects were recruited. High-resolution T1-weighted imaging and morning blood samples for cortisol measurement were obtained from all MDD patients and healthy subjects. In the hippocampal shape analysis, we compared the hippocampal shape between MDD patients and healthy subjects and evaluated the linear correlation between hippocampal shape deformations and the serum cortisol levels in MDD patients and healthy subjects.

RESULTS

MDD patients showed significant inward deformations predominantly in the cornu ammonis (CA) 1 and subiculum in bilateral hippocampi compared to healthy subjects (false discovery rate (FDR) corrected, P < .05). Furthermore, in MDD patients, a significant linear correlation between inward deformations and high cortisol levels were found predominantly in the CA1 and subiculum, extending into the CA2-3 (FDR-corrected, P < .05), whereas no significant linear correlation was observed in healthy subjects.

CONCLUSIONS

The serum cortisol levels are therefore considered to be associated with hippocampal shape abnormalities in MDD.

Sleep Quality in an Adult American Indian Community Sample

STUDY OBJECTIVES

Epidemiological studies have found that insufficient sleep (< 7 h/night) is more common among American Indians/Alaska Natives (AI/AN). In this study we sought to identify specific demographic, clinical, and cultural factors that may be associated with reduced sleep quality in an American Indian community sample.

METHODS

Information on demography along with personal medical, psychiatric, and drinking history was obtained using the Semi-Structured Assessment for the Genetics of Alcoholism (SSAGA). Sleep quality was assessed by the Pittsburgh Sleep Quality Index (PSQI).

RESULTS

The adult participants (n = 386, 54% women) had a mean ± standard deviation age of 31.35 ± 14.4 y. Higher degrees of AI ancestry, but not cultural identification, being older than 30 y, and having a high school diploma all were factors predictive of having a short sleep duration (< 6 h). The global score on the PSQI was significantly higher in those participants with a lifetime diagnosis of substance use disorders, anxiety disorders, and affective disorders. Alcohol use disorders and affective disorders were significant predictors of sleep latency whereas anxiety and affective disorders were correlated with waking more often in the night/early morning. Nicotine dependence was associated with having trouble breathing, and alcohol use disorders and anxiety disorders with bad dreams.

CONCLUSIONS

Alcohol use disorders are associated with poorer quality of sleep in this population and substance use disorders were associated with different aspects of sleep than anxiety and depressive disorders. These findings add to the understanding of the interactions between sleep and substance use, anxiety, and affective disorders in an understudied and underserved population.

Preventing Depression in Adults With Subthreshold Depression: Health-Economic Evaluation Alongside a Pragmatic Randomized Controlled Trial of a Web-Based Intervention

Background

Psychological interventions for the prevention of depression might be a cost-effective way to reduce the burden associated with depressive disorders.

Objective

To evaluate the cost-effectiveness of a Web-based guided self-help intervention to prevent major depressive disorder (MDD) in people with subthreshold depression (sD).

Methods

A pragmatic randomized controlled trial was conducted with follow-up at 12 months. Participants were recruited from the general population via a large statutory health insurance company and an open access website. Participants were randomized to a Web-based guided self-help intervention (ie, cognitive-behavioral therapy and problem-solving therapy assisted by supervised graduate students or health care professionals) in addition to usual care or to usual care supplemented with Web-based psycho-education (enhanced usual care). Depression-free years (DFYs) were assessed by blinded diagnostic raters using the telephone-administered Structured Clinical Interview for DSM-IV Axis Disorders at 6- and 12-month follow-up, covering the period to the previous assessment. Costs were self-assessed through a questionnaire. Costs measured from a societal and health care perspective were related to DFYs and quality-adjusted life years (QALYs).

Results

In total, 406 participants were enrolled in the trial. The mean treatment duration was 5.84 (SD 4.37) weeks. On average, participants completed 4.93 of 6 sessions. Significantly more DFYs were gained in the intervention group (0.82 vs 0.70). Likewise, QALY health gains were in favor of the intervention, but only statistically significant when measured with the more sensitive SF-6D. The incremental per-participant costs were €136 (£116). Taking the health care perspective and assuming a willingness-to-pay of €20,000 (£17,000), the intervention’s likelihood of being cost-effective was 99% for gaining a DFY and 64% or 99% for gaining an EQ-5D or a SF-6D QALY.

Conclusions

Our study supports guidelines recommending Web-based treatment for sD and adds that this not only restores health in people with sD, but additionally reduces the risk of developing a MDD. Offering the intervention has an acceptable likelihood of being more cost-effective than enhanced usual care and could therefore reach community members on a wider scale.

Trial registration

German Clinical Trials Register: DRKS00004709; http://www.drks.de/DRKS00004709 (Archived by WebCite at http://www.webcitation.org/6kAZVUxy9)

Kinase-mediated signaling cascades in mood disorders and antidepressant treatment

Kinase-mediated signaling cascades regulate a number of different molecular mechanisms involved in cellular homeostasis, and are viewed as one of the most common intracellular processes that are robustly dysregulated in the pathophysiology of mood disorders such as depression. Newly emerged, rapid acting antidepressants are able to achieve therapeutic improvement, possibly in part, through stimulating activity of kinase-dependent signaling pathways. Thus, advancements in our understanding of how kinases may contribute to development and treatment of depression seem crucial. However, current investigations are limited to a single or small number of kinases and are unable to detect novel kinases. Here, we review fast developing kinome profiling approaches that allow identification of multiple kinases and kinase network connections simultaneously, analyze technical limitation and challenges, and discuss their future applications to mood disorders and antidepressant treatment.

Changes in Muscarinic M2 Receptor Levels in the Cortex of Subjects with Bipolar Disorder and Major Depressive Disorder and in Rats after Treatment with Mood Stabilisers and Antidepressants

BACKGROUND

Increasingly, data are implicating muscarinic receptors in the aetiology and treatment of mood disorders. This led us to measure levels of different muscarinic receptor-related parameters in the cortex from people with mood disorders and the CNS of rats treated with mood stabilisers and antidepressant drugs.

METHODS

We measured [(3)H]AF-DX 384 binding in BA 46 and BA 24 from subjects with bipolar disorders (n = 14), major depressive disorders (n = 19), as well as age- and sex-matched controls (n = 19) and the CNS of rats treated with fluoxetine or imipramine. In addition, we used Western blots to measure levels of CHRM2 protein and oxotremorine-M stimulated [(35)S]GTPγS binding as a measure of CHRM 2 / 4 signaling.

RESULTS

Compared with controls, [(3)H]AF-DX 384 binding was lower in BA 24 and BA 46 in bipolar disorders and major depressive disorders, while CHRM2 protein and oxotremorine-M stimulated [(35)S]GTPγS binding was only lower in BA 24. Compared with vehicle, treatment with mood stabilisers, antidepressant drugs for 10 days, or imipramine for 28 days resulted in higher levels of in [(3)H]AF-DX 384 binding select regions of rat CNS.

CONCLUSIONS

Our data suggest that levels of CHRM2 are lower in BA 24 from subjects with mood disorders, and it is possible that signalling by that receptor is also less in this cortical region. Our data also suggest increasing levels of CHRM2 may be involved in the mechanisms of action of mood stabilisers and tricyclic antidepressants.