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Ramos-Cejudo J, Corrigan JK, Zheng C, Swinnerton KN, Jacobson SR, La J, Betensky RA, Osorio RS, Madanes S, Pomara N, Iosifescu D, Brophy M, Do NV, Fillmore NR. Antidepressant exposure and long-term dementia risk in a nationwide retrospective study on US veterans with midlife major depressive disorder. Alzheimers Dement 2024; 20:4106-4114. [PMID: 38717046 DOI: 10.1002/alz.13853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 03/11/2024] [Accepted: 03/28/2024] [Indexed: 06/18/2024]
Abstract
INTRODUCTION The use of antidepressants in major depressive disorder (MDD) has been reported to influence long-term risk of Alzheimer's disease (AD) and AD-related dementias (AD/ADRD), but studies are conflicting. METHODS We used inverse probability weighted (IPW) Cox models with time-varying covariates in a retrospective cohort study among midlife veterans with MDD within the US Veterans Affairs healthcare system from January 1, 2000 to June 1, 2022. RESULTS A total of 35,200 patients with MDD were identified. No associations were seen regarding the effect of being exposed to any antidepressant versus no exposure on AD/ADRD risk (events = 1,056, hazard ratio = 0.94, 95% confidence interval: 0.81 to 1.09) or the exposure to specific antidepressant classes versus no exposure. A risk reduction was observed for female patients in a stratified analysis; however, the number of cases was small. DISCUSSION Our study suggests that antidepressant exposure has no effect on AD/ADRD risk. The association in female patients should be interpreted with caution and requires further attention. HIGHLIGHTS We studied whether antidepressant use was associated with future dementia risk. We specifically focused on patients after their first-ever diagnosis of depression. We used IPW Cox models with time-varying covariates and a large observation window. Our study did not identify an effect of antidepressant use on dementia risk. A risk reduction was observed in female patients, but the number of cases was small.
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Affiliation(s)
- Jaime Ramos-Cejudo
- VA Boston Cooperative Studies Program, MAVERIC, VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Psychiatry, New York University (NYU) Grossman School of Medicine, New York, New York, USA
| | - June K Corrigan
- VA Boston Cooperative Studies Program, MAVERIC, VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Chunlei Zheng
- VA Boston Cooperative Studies Program, MAVERIC, VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Kaitlin N Swinnerton
- VA Boston Cooperative Studies Program, MAVERIC, VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Sean R Jacobson
- VA Boston Cooperative Studies Program, MAVERIC, VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Psychiatry, New York University (NYU) Grossman School of Medicine, New York, New York, USA
| | - Jennifer La
- VA Boston Cooperative Studies Program, MAVERIC, VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Rebecca A Betensky
- Department of Biostatistics, NYU School of Global Public Health, New York, New York, USA
| | - Ricardo S Osorio
- Department of Psychiatry, New York University (NYU) Grossman School of Medicine, New York, New York, USA
- Nathan Kline Institute, Orangeburg, New York, USA
| | - Sharon Madanes
- Department of Psychiatry, New York University (NYU) Grossman School of Medicine, New York, New York, USA
| | - Nunzio Pomara
- Department of Psychiatry, New York University (NYU) Grossman School of Medicine, New York, New York, USA
- Nathan Kline Institute, Orangeburg, New York, USA
| | - Dan Iosifescu
- Department of Psychiatry, New York University (NYU) Grossman School of Medicine, New York, New York, USA
- Nathan Kline Institute, Orangeburg, New York, USA
| | - Mary Brophy
- VA Boston Cooperative Studies Program, MAVERIC, VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Nhan V Do
- VA Boston Cooperative Studies Program, MAVERIC, VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Nathanael R Fillmore
- VA Boston Cooperative Studies Program, MAVERIC, VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Ainsworth NJ, Marawi T, Maslej MM, Blumberger DM, McAndrews MP, Perivolaris A, Pollock BG, Rajji TK, Mulsant BH. Cognitive Outcomes After Antidepressant Pharmacotherapy for Late-Life Depression: A Systematic Review and Meta-Analysis. Am J Psychiatry 2024; 181:234-245. [PMID: 38321915 DOI: 10.1176/appi.ajp.20230392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
OBJECTIVE The authors evaluated whether treatment of late-life depression (LLD) with antidepressants leads to changes in cognitive function. METHODS A systematic review and meta-analysis of prospective studies of antidepressant pharmacotherapy for adults age 50 or older (or mean age of 65 or older) with LLD was conducted. MEDLINE, EMBASE, and PsycInfo were searched through December 31, 2022. The primary outcome was a change on cognitive test scores from baseline to after treatment. Secondary outcomes included the effects of specific medications and the associations between changes in depressive symptoms and cognitive test scores. Participants with bipolar disorder, psychotic depression, dementia, or neurological disease were excluded. Findings from all eligible studies were synthesized at a descriptive level, and a random-effects model was used to pool the results for meta-analysis. RESULTS Twenty-two studies were included. Thirteen of 19 studies showed an improvement on at least one cognitive test after antidepressant pharmacotherapy, with the most robust evidence for the memory and learning (nine of 16 studies) and processing speed (seven of 10 studies) domains and for sertraline (all five studies). Improvements in depressive symptoms were associated with improvement in cognitive test scores in six of seven relevant studies. The meta-analysis (eight studies; N=493) revealed a statistically significant overall improvement in memory and learning (five studies: effect size=0.254, 95% CI=0.103-0.404, SE=0.077); no statistically significant changes were seen in other cognitive domains. The evaluated risk of publication bias was low. CONCLUSION Antidepressant pharmacotherapy of LLD appears to improve certain domains of cognitive function, particularly memory and learning. This effect may be mediated by an improvement in depressive symptoms. Studies comparing individuals receiving pharmacotherapy with untreated control participants are needed.
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Affiliation(s)
- Nicholas J Ainsworth
- Centre for Addiction and Mental Health (CAMH), Toronto (Ainsworth, Marawi, Maslej, Blumberger, Pollock, Rajji, Mulsant); Department of Psychiatry, Temerty Faculty of Medicine (Ainsworth, Blumberger, Pollock, Mulsant), Institute of Medical Science, Temerty Faculty of Medicine (Marawi, Perivolaris), and Department of Psychology (McAndrews), University of Toronto, Toronto; Krembil Brain Institute, University Health Network, Toronto (McAndrews); Department of Surgery, St. Michael's Hospital, Unity Health Toronto, Toronto (Perivolaris); Toronto Dementia Research Alliance, Toronto (Rajji)
| | - Tulip Marawi
- Centre for Addiction and Mental Health (CAMH), Toronto (Ainsworth, Marawi, Maslej, Blumberger, Pollock, Rajji, Mulsant); Department of Psychiatry, Temerty Faculty of Medicine (Ainsworth, Blumberger, Pollock, Mulsant), Institute of Medical Science, Temerty Faculty of Medicine (Marawi, Perivolaris), and Department of Psychology (McAndrews), University of Toronto, Toronto; Krembil Brain Institute, University Health Network, Toronto (McAndrews); Department of Surgery, St. Michael's Hospital, Unity Health Toronto, Toronto (Perivolaris); Toronto Dementia Research Alliance, Toronto (Rajji)
| | - Marta M Maslej
- Centre for Addiction and Mental Health (CAMH), Toronto (Ainsworth, Marawi, Maslej, Blumberger, Pollock, Rajji, Mulsant); Department of Psychiatry, Temerty Faculty of Medicine (Ainsworth, Blumberger, Pollock, Mulsant), Institute of Medical Science, Temerty Faculty of Medicine (Marawi, Perivolaris), and Department of Psychology (McAndrews), University of Toronto, Toronto; Krembil Brain Institute, University Health Network, Toronto (McAndrews); Department of Surgery, St. Michael's Hospital, Unity Health Toronto, Toronto (Perivolaris); Toronto Dementia Research Alliance, Toronto (Rajji)
| | - Daniel M Blumberger
- Centre for Addiction and Mental Health (CAMH), Toronto (Ainsworth, Marawi, Maslej, Blumberger, Pollock, Rajji, Mulsant); Department of Psychiatry, Temerty Faculty of Medicine (Ainsworth, Blumberger, Pollock, Mulsant), Institute of Medical Science, Temerty Faculty of Medicine (Marawi, Perivolaris), and Department of Psychology (McAndrews), University of Toronto, Toronto; Krembil Brain Institute, University Health Network, Toronto (McAndrews); Department of Surgery, St. Michael's Hospital, Unity Health Toronto, Toronto (Perivolaris); Toronto Dementia Research Alliance, Toronto (Rajji)
| | - Mary Pat McAndrews
- Centre for Addiction and Mental Health (CAMH), Toronto (Ainsworth, Marawi, Maslej, Blumberger, Pollock, Rajji, Mulsant); Department of Psychiatry, Temerty Faculty of Medicine (Ainsworth, Blumberger, Pollock, Mulsant), Institute of Medical Science, Temerty Faculty of Medicine (Marawi, Perivolaris), and Department of Psychology (McAndrews), University of Toronto, Toronto; Krembil Brain Institute, University Health Network, Toronto (McAndrews); Department of Surgery, St. Michael's Hospital, Unity Health Toronto, Toronto (Perivolaris); Toronto Dementia Research Alliance, Toronto (Rajji)
| | - Argyrios Perivolaris
- Centre for Addiction and Mental Health (CAMH), Toronto (Ainsworth, Marawi, Maslej, Blumberger, Pollock, Rajji, Mulsant); Department of Psychiatry, Temerty Faculty of Medicine (Ainsworth, Blumberger, Pollock, Mulsant), Institute of Medical Science, Temerty Faculty of Medicine (Marawi, Perivolaris), and Department of Psychology (McAndrews), University of Toronto, Toronto; Krembil Brain Institute, University Health Network, Toronto (McAndrews); Department of Surgery, St. Michael's Hospital, Unity Health Toronto, Toronto (Perivolaris); Toronto Dementia Research Alliance, Toronto (Rajji)
| | - Bruce G Pollock
- Centre for Addiction and Mental Health (CAMH), Toronto (Ainsworth, Marawi, Maslej, Blumberger, Pollock, Rajji, Mulsant); Department of Psychiatry, Temerty Faculty of Medicine (Ainsworth, Blumberger, Pollock, Mulsant), Institute of Medical Science, Temerty Faculty of Medicine (Marawi, Perivolaris), and Department of Psychology (McAndrews), University of Toronto, Toronto; Krembil Brain Institute, University Health Network, Toronto (McAndrews); Department of Surgery, St. Michael's Hospital, Unity Health Toronto, Toronto (Perivolaris); Toronto Dementia Research Alliance, Toronto (Rajji)
| | - Tarek K Rajji
- Centre for Addiction and Mental Health (CAMH), Toronto (Ainsworth, Marawi, Maslej, Blumberger, Pollock, Rajji, Mulsant); Department of Psychiatry, Temerty Faculty of Medicine (Ainsworth, Blumberger, Pollock, Mulsant), Institute of Medical Science, Temerty Faculty of Medicine (Marawi, Perivolaris), and Department of Psychology (McAndrews), University of Toronto, Toronto; Krembil Brain Institute, University Health Network, Toronto (McAndrews); Department of Surgery, St. Michael's Hospital, Unity Health Toronto, Toronto (Perivolaris); Toronto Dementia Research Alliance, Toronto (Rajji)
| | - Benoit H Mulsant
- Centre for Addiction and Mental Health (CAMH), Toronto (Ainsworth, Marawi, Maslej, Blumberger, Pollock, Rajji, Mulsant); Department of Psychiatry, Temerty Faculty of Medicine (Ainsworth, Blumberger, Pollock, Mulsant), Institute of Medical Science, Temerty Faculty of Medicine (Marawi, Perivolaris), and Department of Psychology (McAndrews), University of Toronto, Toronto; Krembil Brain Institute, University Health Network, Toronto (McAndrews); Department of Surgery, St. Michael's Hospital, Unity Health Toronto, Toronto (Perivolaris); Toronto Dementia Research Alliance, Toronto (Rajji)
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Wu F, Lu Q, Kong Y, Zhang Z. A Comprehensive Overview of the Role of Visual Cortex Malfunction in Depressive Disorders: Opportunities and Challenges. Neurosci Bull 2023; 39:1426-1438. [PMID: 36995569 PMCID: PMC10062279 DOI: 10.1007/s12264-023-01052-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 01/30/2023] [Indexed: 03/31/2023] Open
Abstract
Major depressive disorder (MDD) is a highly heterogeneous mental disorder, and its complex etiology and unclear mechanism are great obstacles to the diagnosis and treatment of the disease. Studies have shown that abnormal functions of the visual cortex have been reported in MDD patients, and the actions of several antidepressants coincide with improvements in the structure and synaptic functions of the visual cortex. In this review, we critically evaluate current evidence showing the involvement of the malfunctioning visual cortex in the pathophysiology and therapeutic process of depression. In addition, we discuss the molecular mechanisms of visual cortex dysfunction that may underlie the pathogenesis of MDD. Although the precise roles of visual cortex abnormalities in MDD remain uncertain, this undervalued brain region may become a novel area for the treatment of depressed patients.
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Affiliation(s)
- Fangfang Wu
- Department of Pharmacology, School of Medicine & Holistic Integrative Medicine, Nanjing University of Chinese Medicine, Nanjing, 210023, China
| | - Qingbo Lu
- Department of Neurology, Affiliated Zhongda Hospital, School of Medicine, Institute of Neuropsychiatry, Key Laboratory of Developmental Genes and Human Disease, Southeast University, Nanjing, 210009, China
| | - Yan Kong
- Department of Biochemistry and Molecular Biology, School of Medicine, Southeast University, Nanjing, 210009, China
| | - Zhijun Zhang
- Department of Neurology, Affiliated Zhongda Hospital, School of Medicine, Institute of Neuropsychiatry, Key Laboratory of Developmental Genes and Human Disease, Southeast University, Nanjing, 210009, China.
- Department of Mental Health and Public Health, Faculty of Life and Health Sciences, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055, China.
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Gudayol-Ferré E, Duarte-Rosas P, Peró-Cebollero M, Guàrdia-Olmos J. The effect of second-generation antidepressant treatment on the attention and mental processing speed of patients with major depressive disorder: A meta-analysis study with structural equation models. Psychiatry Res 2022; 314:114662. [PMID: 35689972 DOI: 10.1016/j.psychres.2022.114662] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 05/20/2022] [Accepted: 05/31/2022] [Indexed: 10/18/2022]
Abstract
Major depressive disorder (MDD) has been linked to attention and mental processing speed deficits that can be improved after pharmacological treatment. However, it is unclear whether a class of antidepressants is more effective than others to ameliorate these deficits in MDD. Additionally, the possible effects of clinical and demographic variables on improving MDD attention and processing speed deficits after antidepressant treatment are unknown. We aimed to study the possible neuropsychological effects of second-generation antidepressant classes on the attention and processing speed of MDD patients and the potential influences of clinical and demographic variables as moderators of these effects using a meta-analytic approach. Twenty-five papers were included in our study. A structural equation model meta-analysis was performed. The improvement of attention and processing speed after pharmacological treatment is clinically relevant but incomplete. Selective serotonin reuptake inhibitors (SSRIs) and dual inhibitors are the drugs causing the greatest improvement in the processing speed of MDD patients. Antidepressant class is an important variable linked to processing speed improvement after MDD treatment. However, the degree of improvement in both cognitive functions is strongly influenced by some clinical and demographic variables of depressed patients, such are age and education of the MDD patients, the duration of the antidepressant treatment, and the depression status of the patients.
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Affiliation(s)
- Esteve Gudayol-Ferré
- Facultad de Psicología. Universidad Michoacana San Nicolás de Hidalgo, Gral. Francisco Villa 450, 58110, Morelia, Mexico.
| | - Patricia Duarte-Rosas
- Doctorado de Psicología Clínica y de la Salud. Facultat de Psicologia. Universitat de Barcelona, Spain
| | - Maribel Peró-Cebollero
- Facultat de Psicologia, Institut de Neurociències, UB Institute of Complex Systems, Universitat de Barcelona, Spain
| | - Joan Guàrdia-Olmos
- Facultat de Psicologia, Institut de Neurociències, UB Institute of Complex Systems, Universitat de Barcelona, Spain
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Schulkens JEM, Deckers K, Jenniskens M, Blokland A, Verhey FRJ, Sobczak S. The effects of selective serotonin reuptake inhibitors on memory functioning in older adults: A systematic literature review. J Psychopharmacol 2022; 36:578-593. [PMID: 35486412 PMCID: PMC9112622 DOI: 10.1177/02698811221080462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
INTRODUCTION Selective serotonin reuptake inhibitors (SSRIs) are commonly prescribed to older adults. In contrast to young subjects, it is unclear whether older adults may be vulnerable to cognitive side effects. Serotonin is involved in cognitive functions (e.g. memory). It is of great importance to examine the effects of SSRIs on memory functioning in older adults. OBJECTIVES The objective of this systematic literature review is to summarize studies in which the effects of SSRI treatment on all aspects of memory functioning in older adults are investigated. METHODS PubMed, PsycINFO, CINAHL, and Embase were searched for all studies published until 18th of October 2021. Articles were included if they fulfilled the inclusion criteria as follows: (1) study design is (randomized) controlled trial, cross-sectional, or prospective cohort study; (2) study population consists of older adults (mean age ⩾65 years), or results for this age-group are reported separately; (3) intervention is use of an SSRI; and (4) effects on performance of any memory domain are measured and clearly described. RESULTS The search yielded 1888 articles, of which 136 were included for the full-text review. Eventually, 40 articles were included. Most studies reported no association between SSRI use and memory functioning. The studies that found a positive association mainly investigated older adults with mental or neurological disorders (e.g. depression or stroke). A few studies found a negative association in the following subgroups: non-responders (depression), patients with frontal brain disease, and women. CONCLUSION Overall, no consistent negative effects of SSRIs on memory functioning in older adults were found after SSRI treatment. Most studies reported no change in memory functioning after SSRI use. Some studies even showed an improvement in memory performance. Positive effects of SSRIs on memory functioning were especially found in older adults with mental or neurological disorders, such as subjects with depression or stroke.
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Affiliation(s)
- Julie EM Schulkens
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNs), Alzheimer Centre Limburg (ACL), Maastricht University, Maastricht, The Netherlands,Department of Old Age Psychiatry, Mondriaan Hospital, Heerlen, The Netherlands,Julie EM Schulkens, Department of Old Age Psychiatry, Mondriaan Hospital, Kloosterkensweg 10, 6419 PJ Heerlen, The Netherlands.
| | - Kay Deckers
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNs), Alzheimer Centre Limburg (ACL), Maastricht University, Maastricht, The Netherlands
| | - Maud Jenniskens
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNs), Alzheimer Centre Limburg (ACL), Maastricht University, Maastricht, The Netherlands
| | - Arjan Blokland
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Frans RJ Verhey
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNs), Alzheimer Centre Limburg (ACL), Maastricht University, Maastricht, The Netherlands
| | - Sjacko Sobczak
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNs), Alzheimer Centre Limburg (ACL), Maastricht University, Maastricht, The Netherlands,Department of Old Age Psychiatry, Mondriaan Hospital, Heerlen, The Netherlands
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Smith GS, Kuwabara H, Gould NF, Nassery N, Savonenko A, Joo JH, Bigos KL, Kraut M, Brasic J, Holt DP, Hall AW, Mathews WB, Dannals RF, Nandi A, Workman CI. Molecular imaging of the serotonin transporter availability and occupancy by antidepressant treatment in late-life depression. Neuropharmacology 2021; 194:108447. [PMID: 33450276 PMCID: PMC8716112 DOI: 10.1016/j.neuropharm.2021.108447] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 12/04/2020] [Accepted: 12/30/2020] [Indexed: 12/17/2022]
Abstract
Patients with late-life depression (LLD) have a more variable response to pharmacotherapy relative to patients with mid-life depression. Degeneration of the serotonergic system and lower occupancy of the initial target for antidepressant medications, the serotonin transporter (5-HTT), may contribute to variability in treatment response. The focus of this study was to test the hypotheses that lower cortical and limbic serotonin transporter (5-HTT) availability in LLD patients relative to controls and less 5-HTT occupancy by antidepressant medications would be associated with less improvement in mood and cognition with treatment in LLD patients. Twenty LLD patients meeting DSM-IV criteria for a current major depressive episode and 20 non-depressed controls underwent clinical and neuropsychological assessments, magnetic resonance imaging to measure gray matter volumes and high-resolution positron emission tomography (PET) scanning to measure 5-HTT before and after 10-12 weeks of treatment with Citalopram or Sertraline (patients only). Prior to treatment, 5-HTT was lower in LLD patients relative to controls in mainly temporal cortical and limbic (amygdala and hippocampus) regions. Gray matter volumes were not significantly different between groups. 5-HTT occupancy was detected throughout cortical, striatal, thalamic and limbic regions. The magnitude of regional 5-HTT occupancy by antidepressants was 70% or greater across cortical and sub-cortical regions, consistent with the magnitude of 5-HTT occupancy observed in mid-life depressed patients. Greater regional 5-HTT occupancy correlated with greater improvement in depressive symptoms and visual-spatial memory performance. These data support the hypothesis that serotonin degeneration and variability in 5-HTT occupancy may contribute to heterogeneity in treatment response in LLD patients.
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Affiliation(s)
- Gwenn S Smith
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Division of Nuclear Medicine and Molecular Imaging, Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Hiroto Kuwabara
- Division of Nuclear Medicine and Molecular Imaging, Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Neda F Gould
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Najilla Nassery
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Alena Savonenko
- Department of Pathology (Neuropathology), Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jin Hui Joo
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kristin L Bigos
- Department of Medicine, Division of Clinical Pharmacology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Pharmacology and Molecular Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael Kraut
- Division of Neuroradiology, Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - James Brasic
- Division of Nuclear Medicine and Molecular Imaging, Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Daniel P Holt
- Division of Nuclear Medicine and Molecular Imaging, Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Andrew W Hall
- Division of Nuclear Medicine and Molecular Imaging, Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - William B Mathews
- Division of Nuclear Medicine and Molecular Imaging, Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Robert F Dannals
- Division of Nuclear Medicine and Molecular Imaging, Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ayon Nandi
- Division of Nuclear Medicine and Molecular Imaging, Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Clifford I Workman
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Gudayol-Ferré E, Duarte-Rosas P, Peró-Cebollero M, Guàrdia-Olmos J. THE EFFECT OF SECOND-GENERATION ANTIDEPRESSANT TREATMENT ON THE EXECUTIVE FUNCTIONS OF PATIENTS WITH MAJOR DEPRESSIVE DISORDER: A META-ANALYSIS STUDY WITH STRUCTURAL EQUATION MODELS. Psychiatry Res 2021; 296:113690. [PMID: 33387749 DOI: 10.1016/j.psychres.2020.113690] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 12/25/2020] [Indexed: 10/22/2022]
Abstract
Major depressive disorder (MDD) has been linked to executive functions (EF) deficits that can be improved after pharmacological treatment, but it is unclear whether there is a class of antidepressants that is more effective than others to ameliorate these deficits in MDD. Additionally, the possible effects of clinical and demographic variables on the improvement of MDD EF deficits after pharmacological treatment are currently unknown. Our aim was to study the possible neuropsychological effects of second-generation antidepressant classes on the EF of MDD patients and the potential influence of clinical and demographic variables as moderators of these effects through a meta-analytic approach. Twenty-one papers were included in our study. A structural equation model meta-analysis was performed. The improvement of EF after pharmacological treatment is clinically relevant, but it is incomplete. This effect is influenced by age and years of education of the patients. Selective serotonin reuptake inhibitors (SSRIs) and dual inhibitors are the drugs causing the greatest improvement in EF of MDD patients. Antidepressant class is an important variable linked to EF improvement after MDD treatment, but the degree of improvement in these cognitive functions is strongly influenced by some clinical and demographic variables of patients with depression.
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Affiliation(s)
- Esteve Gudayol-Ferré
- Facultad de Psicología. Universidad Michoacana San Nicolás de Hidalgo, Morelia, México.
| | - Patricia Duarte-Rosas
- Doctorado de Psicología Clínica y de la Salud. Facultat de Psicologia. Universitat de Barcelona, Barcelona Spain
| | - Maribel Peró-Cebollero
- Facultat de Psicologia, Institut de Neurociències, UB Institute of Complex Systems, Universitat de Barcelona, Barcelona, Spain
| | - Joan Guàrdia-Olmos
- Facultat de Psicologia, Institut de Neurociències, UB Institute of Complex Systems, Universitat de Barcelona, Barcelona, Spain
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8
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Molecular imaging of beta-amyloid deposition in late-life depression. Neurobiol Aging 2021; 101:85-93. [PMID: 33592548 DOI: 10.1016/j.neurobiolaging.2021.01.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 12/16/2020] [Accepted: 01/06/2021] [Indexed: 12/11/2022]
Abstract
Late-life depression (LLD) is associated with an increased risk of all-cause dementia and may involve Alzheimer's disease pathology. Twenty-one LLD patients who met the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, criteria for a current major depressive episode and 21 healthy controls underwent clinical and neuropsychological assessments, magnetic resonance imaging to measure gray matter volumes, and high-resolution positron emission tomography to measure beta-amyloid (Aβ) deposition. Clinical and neuropsychological assessments were repeated after 10-12 weeks of Citalopram or Sertraline treatment (LLD patients only). LLD patients did not differ from healthy controls in baseline neuropsychological function, although patients improved in both depressive symptoms and visual-spatial memory during treatment. Greater Aβ in the left parietal cortex was observed in LLD patients compared with controls. Greater Aβ was correlated with greater depressive symptoms and poorer visual-spatial memory, but not with improvement with treatment. The study of LLD patients with prospective measurements of mood and cognitive responses to antidepressant treatment is an opportunity to understand early neurobiological mechanisms underlying the association between depression and subsequent cognitive decline.
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Neurotransmitters and Neurometabolites in Late-Life Depression: A Preliminary Magnetic Resonance Spectroscopy Study at 7T. J Affect Disord 2021; 279:417-425. [PMID: 33120242 PMCID: PMC8606178 DOI: 10.1016/j.jad.2020.10.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 09/27/2020] [Accepted: 10/05/2020] [Indexed: 01/12/2023]
Abstract
BACKGROUND Magnetic resonance spectroscopy (MRS) methods have quantified changes in levels of neurotransmitters and neurometabolites in patients with major depression across the lifespan. The application of 7T field strengths and greater have not been a major focus of study in patients with late-life depression (LLD). METHODS Nine LLD patients who met DSM-IV criteria for a current major depressive episode and nine non-depressed, healthy, age-matched controls underwent clinical and neuropsychological assessment and single-voxel 7T 1H-MRS at baseline and after 10-12 weeks of antidepressant treatment (Citalopram; patients only). Spectra were acquired from two brain regions implicated in both depressive symptoms and neuropsychological deficits in LLD, the anterior (ACC) and posterior cingulate (PCC). Levels of γ-aminobutyric acid (GABA), glutamate (Glu), glutathione (GSH), N-acetylaspartylglutamate (NAAG), N-acetylaspartate (NAA), and myo-inositol (mI) were quantified relative to total creatine (tCr) using linear-combination modeling. RESULTS Baseline Glu/tCr levels were not significantly different between groups. Decreased Glu/tCr levels after Citalopram treatment were observed in a subset of LLD patients. Exploratory analyses showed that LLD patients had lower NAA levels in the PCC relative to controls. Higher levels of ml in the LLD patients relative to the controls and decreases after Citalopram treatment had large effect sizes but were not statistically significant. Further, decreases in PCC Glu/tCr and increases in ACC GSH/tCr were associated with improvement in depressive symptoms. LIMITATIONS Sample size. CONCLUSIONS These preliminary results suggest a role of neurochemicals and neurometabolites in the neurobiology of LLD and antidepressant treatment response.
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The Effect of Second-Generation Antidepressant Treatment on the Memory of Patients With Major Depressive Disorder: A Meta-analysis Study With Structural Equation Models. J Clin Psychopharmacol 2020; 40:54-62. [PMID: 31834095 DOI: 10.1097/jcp.0000000000001150] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Major depressive disorder (MDD) has been linked to episodic memory deficits that may be improved after pharmacological treatment, but it is unclear whether there is a class of antidepressants that is more effective than others to ameliorate these deficits in MDD. In addition, the possible effects of clinical and sociodemographic variables on the improvement of MDD memory deficits after pharmacological treatment are currently unknown. Our aims are to study the possible neuropsychological effects of second-generation antidepressant classes on the episodic memory of MDD patients and to study the potential effects of clinical and demographic variables as moderators of the effects of antidepressants on the memory of depressed patients through a meta-analysis approach. PROCEDURES Nine articles were included in our study. A structural equation model meta-analysis was performed. RESULTS Our results suggest that selective serotonin reuptake inhibitors and serotonine-noradrenaline reuptake inhibitors would bring about a substantial improvement in the memory of depressed patients, whereas other antidepressant classes would cause rather modest effects. Our results also suggest that clinical and demographic variables play a very important role as mediators of memory improvement after MDD treatment. Thus, a relatively low level of symptom severity, a high degree of clinical improvement, a younger age, and more years of education were positively related to memory improvement after MDD treatment. CONCLUSIONS Although antidepressant class is an important variable linked to memory improvement in MDD, overall, the degree of memory amelioration in depression is very closely related to clinical and demographic variables of patients with depression.
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Hanseeuw BJ, Jonas V, Jackson J, Betensky RA, Rentz DM, Johnson KA, Sperling RA, Donovan NJ. Association of anxiety with subcortical amyloidosis in cognitively normal older adults. Mol Psychiatry 2020; 25:2599-2607. [PMID: 30116029 PMCID: PMC6377864 DOI: 10.1038/s41380-018-0214-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 05/30/2018] [Accepted: 06/20/2018] [Indexed: 01/05/2023]
Abstract
Late-life anxiety has been associated with increased progression from normal cognition to amnestic MCI, suggesting that anxiety may be a neuropsychiatric symptom of Alzheimer's disease (AD) pathological changes and a possible marker of anatomical progression in preclinical AD. This study examined whether cortical or subcortical amyloidosis, indicating earlier or later stages of preclinical AD, was associated with greater self-reported anxiety among 118 cognitively normal volunteers, aged 65-90 years, and whether this association was stronger in APOEε4 carriers. Participants underwent Pittsburgh Compound B Positron Emission Tomography (PiB-PET) to assess fibrillar amyloid-β burden in cortical and subcortical regions, and measurement of anxiety using the Hospital Anxiety and Depression Scale-anxiety subscale. Higher PiB-PET measures in the subcortex (striatum, amygdala, and thalamus), but not in the cortex, were associated with greater anxiety, adjusting for demographics, cognition, and depression. Findings were similar using a cortico-striatal staging system and continuous PET measurements. Anxiety was highest in APOEε4 carriers with subcortical amyloidosis. This work supports in vivo staging of amyloid-β deposition in both cortical and subcortical regions as a promising approach to the study of neuropsychiatric symptoms such as anxiety in cognitively normal older individuals. Elevated anxiety symptoms in combination with high-risk biological factors such as APOEε4 and subcortical amyloid-β may identify participants closest to MCI for secondary prevention trials.
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Affiliation(s)
- Bernard J. Hanseeuw
- grid.32224.350000 0004 0386 9924Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114 USA ,grid.32224.350000 0004 0386 9924Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114 USA ,grid.7942.80000 0001 2294 713XDepartment of Neurology, Cliniques Universitaires Saint-Luc, Institute of Neurosciences, Université Catholique de Louvain, Brussels, Belgium
| | - Victoria Jonas
- grid.32224.350000 0004 0386 9924Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114 USA
| | - Jonathan Jackson
- grid.32224.350000 0004 0386 9924Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114 USA
| | - Rebecca A. Betensky
- grid.38142.3c000000041936754XDepartment of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA 02115 USA
| | - Dorene M. Rentz
- grid.32224.350000 0004 0386 9924Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114 USA ,Center for Alzheimer Research and Treatment, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115 USA ,Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115 USA ,Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115 USA
| | - Keith A. Johnson
- grid.32224.350000 0004 0386 9924Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114 USA ,grid.32224.350000 0004 0386 9924Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114 USA ,Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115 USA
| | - Reisa A. Sperling
- grid.32224.350000 0004 0386 9924Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114 USA ,Center for Alzheimer Research and Treatment, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115 USA ,Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115 USA
| | - Nancy J. Donovan
- Center for Alzheimer Research and Treatment, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115 USA ,Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115 USA ,Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115 USA ,grid.32224.350000 0004 0386 9924Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114 USA
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Huguet G, Kadar E, Temel Y, Lim LW. Electrical Stimulation Normalizes c-Fos Expression in the Deep Cerebellar Nuclei of Depressive-like Rats: Implication of Antidepressant Activity. THE CEREBELLUM 2017; 16:398-410. [PMID: 27435250 DOI: 10.1007/s12311-016-0812-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The electrical stimulation of specific brain targets has been shown to induce striking antidepressant effects. Despite that recent data have indicated that cerebellum is involved in emotional regulation, the mechanisms by which stimulation improved mood-related behaviors in the cerebellum remained largely obscure. Here, we investigated the stimulation effects of the ventromedial prefrontal cortex (vmPFC), nucleus accumbens (NAc), and lateral habenular nucleus on the c-Fos neuronal activity in various deep cerebellar and vestibular nuclei using the unpredictable chronic mild stress (CMS) animal model of depression. Our results showed that stressed animals had increased number of c-Fos cells in the cerebellar dentate and fastigial nuclei, as well as in the spinal vestibular nucleus. To examine the stimulation effects, we found that vmPFC stimulation significantly decreased the c-Fos activity within the cerebellar fastigial nucleus as compared to the CMS sham. Similarly, there was also a reduction of c-Fos expression in the magnocellular part of the medial vestibular nucleus in vmPFC- and NAc core-stimulated animals when compared to the CMS sham. Correlational analyses showed that the anxiety measure of home-cage emergence escape latency was positively correlated with the c-Fos neuronal activity of the cerebellar fastigial and magnocellular and parvicellular parts of the interposed nuclei in CMS vmPFC-stimulated animals. Interestingly, there was a strong correlation among activation in these cerebellar nuclei, indicating that the antidepressant-like behaviors were possibly mediated by the vmPFC stimulation-induced remodeling within the forebrain-cerebellar neurocircuitry.
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Affiliation(s)
- Gemma Huguet
- Department of Biology, University of Girona, Girona, Spain
| | - Elisabet Kadar
- Department of Biology, University of Girona, Girona, Spain.
| | - Yasin Temel
- Departments of Neuroscience and Neurosurgery, Maastricht University, Maastricht, The Netherlands
| | - Lee Wei Lim
- School of Biomedical Sciences, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong, China. .,Department of Biological Sciences, Sunway University, Bandar Sunway, Malaysia.
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De Crescenzo F, Ciliberto M, Menghini D, Treglia G, Ebmeier KP, Janiri L. Is 18F-FDG-PET suitable to predict clinical response to the treatment of geriatric depression? A systematic review of PET studies. Aging Ment Health 2017; 21:889-894. [PMID: 27792402 DOI: 10.1080/13607863.2016.1247413] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Geriatric depression is one of the most common psychiatric disorders in later life. It differs from earlier depression in its presentation, etiology, risk factors, protective factors and outcome. Positron emission tomography (PET) can be used to detect changes in neural circuitry in neuropsychiatric disorders, and several authors have assessed its role in the diagnosis and follow-up of patients with geriatric depression. We reviewed the current evidence on the use of fluorine-18-fluorodeoxyglucose positron emission tomography (18F-FDG-PET) in geriatric depressed patients to find predictors of treatment response. METHODS We searched PubMed/MEDLINE, Scopus, Embase, Cochrane Library, CINAHL and the PsycINFO databases to find relevant peer-reviewed articles on PET in geriatric depression using the search terms ('PET' or 'positron emission tomography') and ('mood' or 'affective disorder' or 'affective disorders' or 'depression' or 'dysthymia' or 'seasonal affective disorder'). RESULTS Eleven articles comprising 128 patients were included. We extracted data on glucose uptake of depressed patients and controls at baseline and after different types of intervention (total sleep deprivation followed by a recovery sleep and treatment with selective serotonin reuptake inhibitors). CONCLUSIONS 18F-FDG-PET showed significant alterations of glucose uptake in several brain areas, in particular the anterior cingulate cortex, which showed reduced metabolism after treatment, and was a predictor of treatment response.
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Affiliation(s)
- Franco De Crescenzo
- a Department of Psychiatry , Catholic University of Sacred Heart , Rome , Italy
| | - Mario Ciliberto
- b Department of Radiology , Catholic University of Sacred Heart , Rome , Italy
| | - Deny Menghini
- c Department of Neuroscience , Bambino Gesù Children's Hospital , Rome , Italy
| | - Giorgio Treglia
- d Department of Nuclear Medicine and PET/CT Center , Oncology Institute of Southern Switzerland , Bellinzona , Switzerland
| | - Klaus P Ebmeier
- e Department of Psychiatry , University of Oxford , Oxford , United Kingdom
| | - Luigi Janiri
- a Department of Psychiatry , Catholic University of Sacred Heart , Rome , Italy
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Yang XH, Tian K, Wang DF, Wang Y, Cheung EFC, Xie GR, Chan RCK. Anhedonia correlates with abnormal functional connectivity of the superior temporal gyrus and the caudate nucleus in patients with first-episode drug-naive major depressive disorder. J Affect Disord 2017; 218:284-290. [PMID: 28478357 DOI: 10.1016/j.jad.2017.04.053] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 04/24/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND Recent empirical findings have suggested that imbalanced neural networks may underlie the pathophysiology of major depressive disorder (MDD). However, the contribution of the superior temporal gyrus (STG) and the caudate nucleus to its pathophysiology remains unclear. METHODS Functional magnetic resonance imaging (MRI) date were acquired from 40 patients with first-episode drug-naive MDD and 36 matched healthy controls during wakeful rest. We used whole-brain voxel-wise statistical maps to quantify within-group resting state functional connectivity (RSFC) and between-group differences of bilateral caudate and STG seeds. RESULTS Compared with healthy controls, first-episode MDD patients were found to have reduced connectivity between the ventral caudate and several brain regions including the superior frontal gyrus (SFG), the superior parietal lobule (SPL) and the middle temporal gyrus (MTG), as well as increased connectivity with the cuneus. We also found increased connectivity between the left STG and the precuneus, the angular gyrus and the cuneus. Moreover, we found that increased anhedonia severity was correlated with the magnitude of ventral caudate functional connectivity with the cuneus and the MTG in MDD patients. LIMITATIONS Due to our small sample size, we did not correct the statistical threshold in the correlation analyses between clinical variables and connectivity abnormalities. CONCLUSIONS The present study suggests that anhedonia is mainly associated with altered ventral caudate-cortical connectivity and highlights the importance of the ventral caudate in the neurobiology of MDD.
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Affiliation(s)
- Xin-Hua Yang
- Institute of Education, Rural Children and Adolescents Research Center for Health Promotion, Key Research Institute of Philosophies and Social Sciences in Hunan Province, Hunan Agricultural University, Changsha, China; Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China
| | - Kai Tian
- Institute of Education, Rural Children and Adolescents Research Center for Health Promotion, Key Research Institute of Philosophies and Social Sciences in Hunan Province, Hunan Agricultural University, Changsha, China
| | - Dong-Fang Wang
- Institute of Education, Rural Children and Adolescents Research Center for Health Promotion, Key Research Institute of Philosophies and Social Sciences in Hunan Province, Hunan Agricultural University, Changsha, China
| | - Yi Wang
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China
| | - Eric F C Cheung
- Castle Peak Hospital, Hong Kong Special Administrative Region, China
| | - Guang-Rong Xie
- Mental Health Institute of the Second Xiangya Hospital, National Technology Institute of Psychiatry, Key Laboratory of Psychiatry and Mental Health of Hunan Province, Central South University, Changsha, Hunan, China
| | - Raymond C K Chan
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China.
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Harper DG, Joe EB, Jensen JE, Ravichandran C, Forester BP. Brain levels of high-energy phosphate metabolites and executive function in geriatric depression. Int J Geriatr Psychiatry 2016; 31:1241-1249. [PMID: 26891040 DOI: 10.1002/gps.4439] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 12/29/2015] [Accepted: 01/05/2016] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Depression in late life has been associated with difficulties in cognitive processing, particularly in the domains of executive function, processing speed and memory, and increases the risk of developing dementia suggesting a neurodegenerative phenotype. Mitochondrial dysfunction is frequently an early event in neurodegenerative illnesses and may be operative in patients with late life depression. Phosphorus magnetic resonance spectroscopy (31P MRS) allows for the quantification of bioenergetic molecules produced by mitochondria. METHODS Ten patients with late life depression and eight normal elderly controls were studied with Stroop color and interference tests, which are widely used measures of processing speed and executive function, respectively, followed by (31P) MRS 3-dimensional chemical-shift imaging measuring levels of adenosine triphosphate, phosphocreatine, inorganic phosphate, and pH over the whole brain. RESULTS In all subjects, gray matter phosphocreatine was positively associated with Stroop interference. Levels of white matter adenosine triphosphate were associated with Stroop interference in subjects with late life depression but not normal elderly. There was also a complementary association between white matter inorganic phosphate and Stroop interference in late life depression patients. CONCLUSIONS These findings suggest two independent sources of executive function dependence on bioenergetic state in the aging brain. The dependence of executive function performance in subjects with late life depression on ATP in white matter may be associated with mitochondrial impairment and is consistent with predictions of the vascular depression hypothesis. Further research with wider neuropsychological testing targeting bioenergetic markers could help clarify the scope of these effects. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- David G Harper
- Geriatric Psychiatry Program, McLean Hospital, Belmont, MA, USA. .,Harvard Medical School, Boston, MA, USA.
| | | | - J Eric Jensen
- Neuroimaging Center, McLean Hospital, Belmont, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Caitlin Ravichandran
- Laboratory for Psychiatric Biostatistics, McLean Hospital, Belmont, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Brent P Forester
- Geriatric Psychiatry Program, McLean Hospital, Belmont, MA, USA.,Harvard Medical School, Boston, MA, USA
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Shehab AAS, Brent D, Maalouf FT. Neurocognitive Changes in Selective Serotonin Reuptake Inhibitors-Treated Adolescents with Depression. J Child Adolesc Psychopharmacol 2016; 26:713-720. [PMID: 26974181 DOI: 10.1089/cap.2015.0190] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVES Adolescents with major depressive disorder (MDD) were found to have deficits in executive function, attention, and memory. Despite the fact that some neurocognitive functions have been shown to be present in acute stage of the illness, but not in remission, longitudinal studies are lacking. The current study aimed to investigate the changes in neurocognitive functioning in adolescents with depression during an acute treatment course with selective serotonin reuptake inhibitor. METHODS Twenty-four adolescents with current MDD and 24 healthy controls (HCs) were administered subtests of the Cambridge Neuropsychological Test Automated Battery as well as clinical scales at baseline and were retested at weeks 6 and 12. Those with MDD were started on fluoxetine after the baseline assessment. RESULTS Despite considerable improvement in depressive symptoms in the MDD group, there was a persistent deficit in visual memory in the MDD group over time compared with HCs (p = 0.001). On a task of sustained attention and inhibition, HCs became better at detecting target sequences at week 12 while there were residual sustained attention deficits in MDD (p = 0.01). On an executive function (planning) task, while HCs learned the task and improved substantially in performance over 12 weeks, MDD performance did not significantly change (p = 0.04). CONCLUSION When treating depressed adolescents, clinicians need to also monitor cognitive symptoms as they appear to lag behind mood symptoms in improvement.
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Affiliation(s)
- Al Amira Safa Shehab
- 1 The Graduate Center, Queens College, City University of New York , New York, New York
| | - David Brent
- 2 Western Psychiatric Institute and Clinic, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - Fadi T Maalouf
- 3 Child and Adolescent Psychiatry Program, Department of Psychiatry, Faculty of Medicine, American University of Beirut , Beirut, Lebanon
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Insights into Intrinsic Brain Networks based on Graph Theory and PET in right- compared to left-sided Temporal Lobe Epilepsy. Sci Rep 2016; 6:28513. [PMID: 27349503 PMCID: PMC4923886 DOI: 10.1038/srep28513] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 06/03/2016] [Indexed: 11/08/2022] Open
Abstract
The human brain exhibits marked hemispheric differences, though it is not fully understood to what extent lateralization of the epileptic focus is relevant. Preoperative [(18)F]FDG-PET depicts lateralization of seizure focus in patients with temporal lobe epilepsy and reveals dysfunctional metabolic brain connectivity. The aim of the present study was to compare metabolic connectivity, inferred from inter-regional [(18)F]FDG PET uptake correlations, in right-sided (RTLE; n = 30) and left-sided TLE (LTLE; n = 32) with healthy controls (HC; n = 31) using graph theory based network analysis. Comparing LTLE and RTLE and patient groups separately to HC, we observed higher lobar connectivity weights in RTLE compared to LTLE for connections of the temporal and the parietal lobe of the contralateral hemisphere (CH). Moreover, especially in RTLE compared to LTLE higher local efficiency were found in the temporal cortices and other brain regions of the CH. The results of this investigation implicate altered metabolic networks in patients with TLE specific to the lateralization of seizure focus, and describe compensatory mechanisms especially in the CH of patients with RTLE. We propose that graph theoretical analysis of metabolic connectivity using [(18)F]FDG-PET offers an important additional modality to explore brain networks.
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Darcet F, Gardier AM, Gaillard R, David DJ, Guilloux JP. Cognitive Dysfunction in Major Depressive Disorder. A Translational Review in Animal Models of the Disease. Pharmaceuticals (Basel) 2016; 9:ph9010009. [PMID: 26901205 PMCID: PMC4812373 DOI: 10.3390/ph9010009] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 01/28/2016] [Accepted: 02/01/2016] [Indexed: 02/07/2023] Open
Abstract
Major Depressive Disorder (MDD) is the most common psychiatric disease, affecting millions of people worldwide. In addition to the well-defined depressive symptoms, patients suffering from MDD consistently complain about cognitive disturbances, significantly exacerbating the burden of this illness. Among cognitive symptoms, impairments in attention, working memory, learning and memory or executive functions are often reported. However, available data about the heterogeneity of MDD patients and magnitude of cognitive symptoms through the different phases of MDD remain difficult to summarize. Thus, the first part of this review briefly overviewed clinical studies, focusing on the cognitive dysfunctions depending on the MDD type. As animal models are essential translational tools for underpinning the mechanisms of cognitive deficits in MDD, the second part of this review synthetized preclinical studies observing cognitive deficits in different rodent models of anxiety/depression. For each cognitive domain, we determined whether deficits could be shared across models. Particularly, we established whether specific stress-related procedures or unspecific criteria (such as species, sex or age) could segregate common cognitive alteration across models. Finally, the role of adult hippocampal neurogenesis in rodents in cognitive dysfunctions during MDD state was also discussed.
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Affiliation(s)
- Flavie Darcet
- Université Paris-Saclay, University Paris-Sud, Faculté de Pharmacie, CESP, INSERM UMRS1178, Chatenay-Malabry 92296, France.
| | - Alain M Gardier
- Université Paris-Saclay, University Paris-Sud, Faculté de Pharmacie, CESP, INSERM UMRS1178, Chatenay-Malabry 92296, France.
| | - Raphael Gaillard
- Laboratoire de "Physiopathologie des maladies Psychiatriques", Centre de Psychiatrie et Neurosciences U894, INSERM, Université Paris Descartes, Sorbonne Paris Cité, Paris 75014, France.
- Service de Psychiatrie, Centre Hospitalier Sainte-Anne, Faculté de Médecine Paris Descartes, Université Paris Descartes, Sorbonne Paris Cité, Paris 75014, France.
- Human Histopathology and Animal Models, Infection and Epidemiology Department, Institut Pasteur, Paris 75015, France.
| | - Denis J David
- Université Paris-Saclay, University Paris-Sud, Faculté de Pharmacie, CESP, INSERM UMRS1178, Chatenay-Malabry 92296, France.
| | - Jean-Philippe Guilloux
- Université Paris-Saclay, University Paris-Sud, Faculté de Pharmacie, CESP, INSERM UMRS1178, Chatenay-Malabry 92296, France.
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[MEG]PLS: A pipeline for MEG data analysis and partial least squares statistics. Neuroimage 2016; 124:181-193. [DOI: 10.1016/j.neuroimage.2015.08.045] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 08/17/2015] [Accepted: 08/20/2015] [Indexed: 11/18/2022] Open
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20
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Bethea CL, Kohama SG, Reddy AP, Urbanski HF. Ovarian steroids regulate gene expression in the dorsal raphe of old female macaques. Neurobiol Aging 2015; 37:179-191. [PMID: 26686671 DOI: 10.1016/j.neurobiolaging.2015.10.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Revised: 09/18/2015] [Accepted: 10/05/2015] [Indexed: 11/18/2022]
Abstract
With extended life spans in modern humans, menopause has become a significant risk factor for depression, anxiety, loss of cognitive functions, weight gain, metabolic disease, osteoporosis, cardiovascular disease, and neurodegenerative diseases. Clinical studies have found beneficial neural effects of ovarian steroid hormone therapy (HT) during the menopausal transition and data are emerging that it can be continued long term. To further understand molecular underpinnings of the clinical studies, we used quantitative reverse transcriptase-polymerase chain reaction (qRT-PCR) to examine gene expression in the serotonergic dorsal raphe of old (>18 years) rhesus macaques, focusing on genes related to depression, cellular resilience, and neurodegenerative diseases. The animals were ovariectomized (Ovx, surgically menopausal) and subjected to either estradiol or estradiol plus progesterone HT, or to placebo, starting 2 months after Ovx and continuing for ∼ 4 years. Significant changes were observed in 36 of 48 genes examined that encode proteins supporting serotonin neurotransmission, synapse assembly, glutamate neurotransmission, DNA repair, chaperones, ubiquinases and transport motors, as well as genes encoding proteins that have potential to delay the onset of neuropathologies. The data reveal important gene targets for chronic HT that contribute to neural health. Alternatively, the loss of ovarian steroids may lead to loss of functions at the gene level that contribute to many of the observable neural deficits after menopause.
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Affiliation(s)
- Cynthia L Bethea
- Division of Reproductive Sciences, Oregon National Primate Research Center, Beaverton, OR, USA; Division of Neuroscience, Oregon National Primate Research Center, Beaverton, OR, USA; Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR, USA.
| | - Steven G Kohama
- Division of Neuroscience, Oregon National Primate Research Center, Beaverton, OR, USA
| | - Arubala P Reddy
- Division of Reproductive Sciences, Oregon National Primate Research Center, Beaverton, OR, USA; Department of Internal Medicine, Texas Tech Health Science Center, Lubbock, TX, USA
| | - Henryk F Urbanski
- Division of Reproductive Sciences, Oregon National Primate Research Center, Beaverton, OR, USA; Division of Neuroscience, Oregon National Primate Research Center, Beaverton, OR, USA; Department of Behavioral Neuroscience, Oregon Health and Science University, Portland, OR, USA
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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: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [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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22
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Benedetti F, Bollettini I, Poletti S, Locatelli C, Lorenzi C, Pirovano A, Smeraldi E, Colombo C. White matter microstructure in bipolar disorder is influenced by the serotonin transporter gene polymorphism 5-HTTLPR. GENES BRAIN AND BEHAVIOR 2015; 14:238-50. [PMID: 25704032 DOI: 10.1111/gbb.12206] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 02/04/2015] [Accepted: 02/05/2015] [Indexed: 12/24/2022]
Affiliation(s)
- F. Benedetti
- Department of Clinical Neurosciences, Scientific Institute; Milano Italy
- C.E.R.M.A.C. (Centro di Eccellenza Risonanza Magnetica ad Alto Campo); University Vita-Salute San Raffaele; Milano Italy
| | - I. Bollettini
- Department of Clinical Neurosciences, Scientific Institute; Milano Italy
- C.E.R.M.A.C. (Centro di Eccellenza Risonanza Magnetica ad Alto Campo); University Vita-Salute San Raffaele; Milano Italy
| | - S. Poletti
- Department of Clinical Neurosciences, Scientific Institute; Milano Italy
- C.E.R.M.A.C. (Centro di Eccellenza Risonanza Magnetica ad Alto Campo); University Vita-Salute San Raffaele; Milano Italy
| | - C. Locatelli
- Department of Clinical Neurosciences, Scientific Institute; Milano Italy
- C.E.R.M.A.C. (Centro di Eccellenza Risonanza Magnetica ad Alto Campo); University Vita-Salute San Raffaele; Milano Italy
| | - C. Lorenzi
- Department of Clinical Neurosciences, Scientific Institute; Milano Italy
| | - A. Pirovano
- Department of Clinical Neurosciences, Scientific Institute; Milano Italy
| | - E. Smeraldi
- Department of Clinical Neurosciences, Scientific Institute; Milano Italy
- C.E.R.M.A.C. (Centro di Eccellenza Risonanza Magnetica ad Alto Campo); University Vita-Salute San Raffaele; Milano Italy
| | - C. Colombo
- Department of Clinical Neurosciences, Scientific Institute; Milano Italy
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23
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Marano CM, Workman CI, Lyman CH, Munro CA, Kraut MA, Smith GS. Structural imaging in late-life depression: association with mood and cognitive responses to antidepressant treatment. Am J Geriatr Psychiatry 2015; 23:4-12. [PMID: 24238925 PMCID: PMC3997617 DOI: 10.1016/j.jagp.2013.10.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Revised: 09/27/2013] [Accepted: 10/01/2013] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Recent positron emission tomography studies of cerebral glucose metabolism have identified the functional neural circuitry associated with mood and cognitive responses to antidepressant treatment in late life depression (LLD). The structural alterations in these networks are not well understood. The present study used magnetic resonance (MR) imaging and voxel-based morphometry to evaluate the association between gray matter volumes and changes in mood symptoms and cognitive function with treatment with the antidepressant citalopram. DESIGN Open-label trial with baseline brain MR scan. Mood and cognitive assessments performed at baseline and during citalopram treatment. SETTING Outpatient clinics of an academic medical center. PARTICIPANTS 17 previously unmedicated patients age 55 years or older with a major depressive episode and 17 non-depressed comparison subjects. INTERVENTION 12-week trial of flexibly dosed citalopram. MEASUREMENTS Gray matter volumes, Hamilton Depression Rating Scale, California Verbal Learning Test, Delis-Kaplan Executive Function System. RESULTS In LLD, higher gray matter volumes in the cingulate gyrus, superior and middle frontal gyri, middle temporal gyrus, and precuneus was associated with greater mood improvement. Higher gray matter volumes in primarily frontal areas were associated with greater improvement in verbal memory and verbal fluency performance. CONCLUSIONS Associations with antidepressant induced improvements in mood and cognition were observed in several brain regions previously correlated with normalization of glucose metabolism after citalopram treatment in LLD. Future studies will investigate molecular mechanisms underlying these associations (e.g., beta-amyloid, inflammation, glutamate).
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Affiliation(s)
- Christopher M. Marano
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Clifford I. Workman
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Christopher H. Lyman
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Cynthia A. Munro
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Michael A. Kraut
- Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Gwenn S. Smith
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
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24
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Soczynska JK, Ravindran LN, Styra R, McIntyre RS, Cyriac A, Manierka MS, Kennedy SH. The effect of bupropion XL and escitalopram on memory and functional outcomes in adults with major depressive disorder: results from a randomized controlled trial. Psychiatry Res 2014; 220:245-50. [PMID: 25124683 DOI: 10.1016/j.psychres.2014.06.053] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 06/30/2014] [Indexed: 10/25/2022]
Abstract
Decrements in cognitive function are a common feature of Major Depressive Disorder (MDD), and whether distinct classes of antidepressants differentially affect memory in these individuals has not been sufficiently evaluated. In this study we sought to determine the effect of escitalopram and bupropion XL on memory and psychosocial function. Forty-one individuals (18-50 years) with MDD were enrolled in an 8-week, double-blind, double-dummy, randomized controlled comparative trial of bupropion XL and escitalopram. Thirty-six participants completed pre and post memory assessments. Verbal, non-verbal and working memory were evaluated with a comprehensive neuropsychological battery. Psychosocial function was assessed with the Sheehan Disability Scale and Endicott Work Productivity Scale. Escitalopram and bupropion XL significantly improved immediate as well as delayed verbal and nonverbal memory, global function (all p≤0.001), and work productivity (p=0.045), with no significant between-group differences. Improvement in immediate verbal memory exerted a direct influence on improvement in global function (p=0.006). Treatment with either escitalopram or bupropion XL was associated with improvement in memory and psychosocial function in adults with MDD.
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Affiliation(s)
- Joanna K Soczynska
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Ontario, Canada
| | - Lakshmi N Ravindran
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Centre for Addiction & Mental Health, Toronto, Ontario, Canada
| | - Rima Styra
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Roger S McIntyre
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Department of Pharmacology and Toxicology, University of Toronto, Ontario, Canada
| | - Anna Cyriac
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Ontario, Canada
| | | | - Sidney H Kennedy
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
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25
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Marano CM, Workman CI, Lyman CH, Kramer E, Hermann CR, Ma Y, Dhawan V, Chaly T, Eidelberg D, Smith GS. The relationship between fasting serum glucose and cerebral glucose metabolism in late-life depression and normal aging. Psychiatry Res 2014; 222:84-90. [PMID: 24650451 PMCID: PMC4388739 DOI: 10.1016/j.pscychresns.2014.01.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Revised: 12/15/2013] [Accepted: 01/21/2014] [Indexed: 12/16/2022]
Abstract
Evidence exists for late-life depression (LLD) as both a prodrome of and risk factor for Alzheimer׳s disease (AD). The underlying neurobiological mechanisms are poorly understood. Impaired peripheral glucose metabolism may explain the association between depression and AD given the connection between type 2 diabetes mellitus with both depression and AD. Positron emission tomography (PET) measures of cerebral glucose metabolism are sensitive to detecting changes in neural circuitry in LLD and AD. Fasting serum glucose (FSG) in non-diabetic young (YC; n=20) and elderly controls (EC; n=12) and LLD patients (n=16) was correlated with PET scans of cerebral glucose metabolism on a voxel-wise basis. The negative correlations were more extensive in EC versus YC and in LLD patients versus EC. Increased FSG correlated with decreased cerebral glucose metabolism in LLD patients to a greater extent than in EC in heteromodal association cortices involved in mood symptoms and cognitive deficits observed in LLD and dementia. Negative correlations in YC were observed in sensory and motor regions. Understanding the neurobiological consequences of diabetes and associated conditions will have substantial public health significance given that this is a modifiable risk factor for which prevention strategies could have an important impact on lowering dementia risk.
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Affiliation(s)
- Christopher M. Marano
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21224
| | - Clifford I. Workman
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21224
| | - Christopher H. Lyman
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21224
| | - Elisse Kramer
- Department of Geriatric Psychiatry, the Zucker Hillside Hospital, Glen Oaks, New York 11004
| | - Carol R. Hermann
- Department of Geriatric Psychiatry, the Zucker Hillside Hospital, Glen Oaks, New York 11004
| | - Yilong Ma
- Center for Neurosciences, The Feinstein Institute for Medical Research, North Shore - Long Island Jewish Health System, Manhasset, New York 11030
| | - Vijay Dhawan
- Center for Neurosciences, The Feinstein Institute for Medical Research, North Shore - Long Island Jewish Health System, Manhasset, New York 11030
| | - Thomas Chaly
- Center for Neurosciences, The Feinstein Institute for Medical Research, North Shore - Long Island Jewish Health System, Manhasset, New York 11030
| | - David Eidelberg
- Center for Neurosciences, The Feinstein Institute for Medical Research, North Shore - Long Island Jewish Health System, Manhasset, New York 11030
| | - Gwenn S. Smith
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21224
,Corresponding Author: Gwenn S. Smith, Ph.D., Department of Psychiatry and Behavioral Sciences, Division of Geriatric Psychiatry and Neuropsychiatry, Johns Hopkins University School of Medicine, Johns Hopkins Bayview Medical Center, 5300 Alpha Commons Drive, Fourth Floor, Baltimore, MD 21224, 410-550-8696 (phone), 410-550-1407 (fax),
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26
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Improvement in subjective and objective neurocognitive functions in patients with major depressive disorder: a 12-week, multicenter, randomized trial of tianeptine versus escitalopram, the CAMPION study. J Clin Psychopharmacol 2014; 34:218-25. [PMID: 24525660 DOI: 10.1097/jcp.0000000000000072] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Although many patients with major depressive disorder (MDD) complain of neurocognitive impairment, the effects of antidepressant medications on neurocognitive functions remain unclear. This study compares neurocognitive effects of tianeptine and escitalopram in MDD. Patients with MDD (N = 164) were randomly assigned in a 1:1 ratio to either tianeptine (37.5 mg/d) or escitalopram (10 mg/d) for 12 weeks. Outcome measures included clinical improvement, subjective cognitive impairment on memory and concentration, the Mini-Mental State Examination, the Continuous Performance Test, the Verbal Learning Test, and the Raven Progressive Matrices, assessed every 4 weeks. After 12 weeks, the tianeptine group showed significant improvement in commission errors (P = 0.002), verbal immediate memory (P < 0.0001), Mini-Mental State Examination (P < 0.0001), delayed memory (P < 0.0001), and reasoning ability (P = 0.0010), whereas the escitalopram group improved in delayed memory and reasoning ability but not in the other measures. Both groups significantly improved in subjective cognitive impairment in memory (P < 0.0001) and concentration (P < 0.0001). Mixed effects model repeated measures analyses revealed that the tianeptine group had a significant improvement in scores of commission errors (F = 6.64, P = 0.011) and verbal immediate memory (F = 4.39, P = 0.038) from baseline to 12 weeks, compared with the escitalopram group, after controlling for age, sex, education years, baseline scores, and changes of depression severity. The treatment of MDD with tianeptine led to more improvements in neurocognitive functions, especially in commission errors and verbal immediate memory, compared with escitalopram, after controlling for changes in depression severity. Both drugs improved subjective cognitive impairment of memory and concentration.
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27
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A potential ethnic difference in the association between 5-HTTLPR polymorphisms and the brain default mode network. ACTA ACUST UNITED AC 2014. [DOI: 10.1007/s11434-014-0185-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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28
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Abstract
Molecular imaging represents a bridge between basic and clinical neuroscience observations and provides many opportunities for translation and identifying mechanisms that may inform prevention and intervention strategies in late-life depression (LLD). Substantial advances in instrumentation and radiotracer chemistry have resulted in improved sensitivity and spatial resolution and the ability to study in vivo an increasing number of neurotransmitters, neuromodulators, and, importantly, neuropathological processes. Molecular brain imaging studies in LLD will be reviewed, with a primary focus on positron emission tomography. Future directions for the field of molecular imaging in LLD will be discussed, including integrating molecular imaging with genetic, neuropsychiatric, and cognitive outcomes and multimodality neuroimaging.
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Affiliation(s)
- Kentaro Hirao
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD, USA
- Department of Geriatric Medicine, Tokyo Medical University, Tokyo, Japan
| | - Gwenn S. Smith
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD, USA
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29
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Ajilore O, Lamar M, Leow A, Zhang A, Yang S, Kumar A. Graph theory analysis of cortical-subcortical networks in late-life depression. Am J Geriatr Psychiatry 2014; 22:195-206. [PMID: 23831171 PMCID: PMC3858393 DOI: 10.1016/j.jagp.2013.03.005] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Revised: 02/26/2013] [Accepted: 03/07/2013] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Late-life major depression (LLD) is characterized by distinct epidemiologic and psychosocial factors, as well as medical comorbidities that are associated with specific neuroanatomical differences. The purpose of this study was to use interregional correlations of cortical and subcortical volumes to examine cortical-subcortical structural network properties in subjects with LLD compared with healthy comparison subjects. METHODS This was a cross-sectional neuroimaging study conducted in the general community. We recruited 73 healthy elderly comparison subjects and 53 subjects with LLD who volunteered in response to advertisements. Brain network connectivity measures were generated by correlating regional volumes after controlling for age, gender, and intracranial volume by using the Brain Connectivity Toolbox. RESULTS Results for overall network strength revealed that LLD networks showed a greater magnitude of associations for both positive and negative correlation weights compared with healthy elderly networks. LLD networks also demonstrated alterations in brain network structure compared with healthy comparison subjects. LLD networks were also more vulnerable to targeted attacks compared with healthy elderly comparison subjects, and this vulnerability was attenuated when controlling for white matter alterations. CONCLUSIONS Overall, this study demonstrates that cortical-subcortical network properties are altered in LLD and may reflect the underlying neuroanatomical vulnerabilities of the disorder.
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Affiliation(s)
- Olusola Ajilore
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL.
| | - Melissa Lamar
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | - Alex Leow
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | - Aifeng Zhang
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | - Shaolin Yang
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA,Department of Radiology, University of Illinois at Chicago, Chicago, IL, USA
| | - Anand Kumar
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
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30
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Salomons TV, Dunlop K, Kennedy SH, Flint A, Geraci J, Giacobbe P, Downar J. Resting-state cortico-thalamic-striatal connectivity predicts response to dorsomedial prefrontal rTMS in major depressive disorder. Neuropsychopharmacology 2014; 39:488-98. [PMID: 24150516 PMCID: PMC3870791 DOI: 10.1038/npp.2013.222] [Citation(s) in RCA: 212] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Revised: 08/06/2013] [Accepted: 08/06/2013] [Indexed: 01/03/2023]
Abstract
Despite its high toll on society, there has been little recent improvement in treatment efficacy for major depressive disorder (MDD). The identification of biological markers of successful treatment response may allow for more personalized and effective treatment. Here we investigate whether resting-state functional connectivity predicted response to treatment with repetitive transcranial magnetic stimulation (rTMS) to dorsomedial prefrontal cortex (dmPFC). Twenty-five individuals with treatment-refractory MDD underwent a 4-week course of dmPFC-rTMS. Before and after treatment, subjects received resting-state functional MRI scans and assessments of depressive symptoms using the Hamilton Depresssion Rating Scale (HAMD17). We found that higher baseline cortico-cortical connectivity (dmPFC-subgenual cingulate and subgenual cingulate to dorsolateral PFC) and lower cortico-thalamic, cortico-striatal, and cortico-limbic connectivity were associated with better treatment outcomes. We also investigated how changes in connectivity over the course of treatment related to improvements in HAMD17 scores. We found that successful treatment was associated with increased dmPFC-thalamic connectivity and decreased subgenual cingulate cortex-caudate connectivity, Our findings provide insight into which individuals might respond to rTMS treatment and the mechanisms through which these treatments work.
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Affiliation(s)
- Tim V Salomons
- MRI-Guided rTMS Clinic, Toronto Western Hospital, Toronto, ON, Canada,Department of Psychiatry, University Health Network, Toronto, ON, Canada,School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Katharine Dunlop
- MRI-Guided rTMS Clinic, Toronto Western Hospital, Toronto, ON, Canada,Faculty of Arts and Sciences, University of Toronto, Toronto, ON, Canada
| | - Sidney H Kennedy
- Department of Psychiatry, University Health Network, Toronto, ON, Canada,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Alastair Flint
- Department of Psychiatry, University Health Network, Toronto, ON, Canada,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Joseph Geraci
- Department of Psychiatry, University Health Network, Toronto, ON, Canada,Department of Pathology and Molecular Medicine, Queen's University, Kingston, ON, Canada
| | - Peter Giacobbe
- MRI-Guided rTMS Clinic, Toronto Western Hospital, Toronto, ON, Canada,Department of Psychiatry, University Health Network, Toronto, ON, Canada,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Jonathan Downar
- MRI-Guided rTMS Clinic, Toronto Western Hospital, Toronto, ON, Canada,Department of Psychiatry, University Health Network, Toronto, ON, Canada,Department of Psychiatry, University of Toronto, Toronto, ON, Canada,MRI-Guided rTMS Clinic, University Health Network, 7M-432 399 Bathurst Street, Toronto, ON M5T 2S8, Canada, Tel: +416 603 5667, Fax: +416 603 5292, E-mail
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31
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Abstract
Neuroimaging, both structural and functional, serve as useful adjuncts to clinical assessment, and can provide objective, reliable means of assessing disease presence and process in the aging population. In the following review we briefly explain current imaging methodologies. Then, we analyze recent developments in developing neuroimaging biomarkers for two highly prevalent disorders in the elderly population- Alzheimer's disease (AD) and late-life depression (LLD). In AD, efforts are focused on early diagnosis through in vivo visualization of disease pathophysiology. In LLD, recent imaging evidence supports the role of white matter ischemic changes in the pathogenesis of depression in the elderly, the "vascular hypothesis." Finally, we discuss potential roles for neuroimaging biomarkers in geriatric psychiatry in the future.
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Affiliation(s)
- Abhisek C Khandai
- University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
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32
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Gabbay V, Ely BA, Li Q, Bangaru SD, Panzer AM, Alonso CM, Castellanos FX, Milham MP. Striatum-based circuitry of adolescent depression and anhedonia. J Am Acad Child Adolesc Psychiatry 2013; 52:628-41.e13. [PMID: 23702452 PMCID: PMC3762469 DOI: 10.1016/j.jaac.2013.04.003] [Citation(s) in RCA: 161] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Revised: 02/19/2013] [Accepted: 04/01/2013] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Striatum-based circuits have been implicated in both major depressive disorder (MDD) and anhedonia, a symptom that reflects deficits of reward processing. Yet adolescents with MDD often exhibit a wide range of anhedonia severity. Addressing this clinical phenomenon, we aimed to use intrinsic functional connectivity (iFC) to study striatum-based circuitry in relation to categorical diagnosis of MDD and anhedonia severity. METHOD A total of 21 psychotropic medication-free adolescents with MDD and 21 healthy controls (HC), group-matched for age and sex, underwent resting-state functional magnetic resonance imagining (fMRI) scans. Voxelwise maps indicating correlation strengths of spontaneous blood-oxygenation-level-dependent (BOLD) signals among 6 bilateral striatal seeds (dorsal caudate, ventral caudate, nucleus accumbens, dorsal-rostral putamen, dorsal-caudal putamen, ventral-rostral putamen) and the remaining brain regions were compared between groups. Relationships between striatal iFC and severity of MDD and anhedonia were examined in the MDD group. Analyses were corrected for multiple comparisons. RESULTS Adolescents with MDD manifested increased iFC between all striatal regions bilaterally and the dorsomedial prefrontal cortex (dmPFC), as well as between the right ventral caudate and the anterior cingulate cortex (ACC). MDD severity was associated with iFC between the striatum and midline structures including the precuneus, posterior cingulate cortex, and dmPFC. However, distinct striatal iFC patterns involving the pregenual ACC, subgenual ACC, supplementary motor area, and supramarginal gyrus were associated with anhedonia severity. CONCLUSIONS Although MDD diagnosis and severity were related to striatal networks involving midline cortical structures, distinct circuits within the reward system were associated with anhedonia. Findings support the incorporation of both categorical and dimensional approaches in neuropsychiatric research.
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Affiliation(s)
- Vilma Gabbay
- Department of Psychiatry, Mount Sinai School of Medicine, New York, NY 10029-6574, USA.
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33
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A machine learning approach using EEG data to predict response to SSRI treatment for major depressive disorder. Clin Neurophysiol 2013; 124:1975-85. [PMID: 23684127 DOI: 10.1016/j.clinph.2013.04.010] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2011] [Revised: 03/16/2013] [Accepted: 04/05/2013] [Indexed: 12/28/2022]
Abstract
OBJECTIVE The problem of identifying, in advance, the most effective treatment agent for various psychiatric conditions remains an elusive goal. To address this challenge, we investigate the performance of the proposed machine learning (ML) methodology (based on the pre-treatment electroencephalogram (EEG)) for prediction of response to treatment with a selective serotonin reuptake inhibitor (SSRI) medication in subjects suffering from major depressive disorder (MDD). METHODS A relatively small number of most discriminating features are selected from a large group of candidate features extracted from the subject's pre-treatment EEG, using a machine learning procedure for feature selection. The selected features are fed into a classifier, which was realized as a mixture of factor analysis (MFA) model, whose output is the predicted response in the form of a likelihood value. This likelihood indicates the extent to which the subject belongs to the responder vs. non-responder classes. The overall method was evaluated using a "leave-n-out" randomized permutation cross-validation procedure. RESULTS A list of discriminating EEG biomarkers (features) was found. The specificity of the proposed method is 80.9% while sensitivity is 94.9%, for an overall prediction accuracy of 87.9%. There is a 98.76% confidence that the estimated prediction rate is within the interval [75%, 100%]. CONCLUSIONS These results indicate that the proposed ML method holds considerable promise in predicting the efficacy of SSRI antidepressant therapy for MDD, based on a simple and cost-effective pre-treatment EEG. SIGNIFICANCE The proposed approach offers the potential to improve the treatment of major depression and to reduce health care costs.
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34
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Marano CM, Workman CI, Kramer E, Hermann CR, Ma Y, Dhawan V, Chaly T, Eidelberg D, Smith GS. Longitudinal studies of cerebral glucose metabolism in late-life depression and normal aging. Int J Geriatr Psychiatry 2013; 28:417-23. [PMID: 22740289 PMCID: PMC3974580 DOI: 10.1002/gps.3840] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Accepted: 05/01/2012] [Indexed: 01/23/2023]
Abstract
OBJECTIVE Late-life depression (LLD) has a substantial public health impact and is both a risk factor for and a prodrome of dementia. Positron emission tomography (PET) studies of cerebral glucose metabolism have demonstrated sensitivity in evaluating neural circuitry involved in depression, aging, incipient cognitive decline, and dementia. The present study evaluated the long term effects of a course of antidepressant treatment on glucose metabolism in LLD patients. METHODS Nine LLD patients and seven non-depressed control subjects underwent clinical and cognitive evaluations as well as brain magnetic resonance imaging and PET studies of cerebral glucose metabolism at baseline, after 8 weeks of treatment with citalopram for a major depressive episode (patients only), and at an approximately 2-year follow-up. RESULTS The majority of LLD patients were remitted at follow-up (7/9). Neither patients nor controls showed significant cognitive decline. The patients showed greater increases in glucose metabolism than the controls in regions associated with mood symptoms (anterior cingulate and insula). Both groups showed decreases in metabolism in posterior association cortices implicated in dementia. CONCLUSIONS Longitudinal changes in cerebral glucose metabolism are observed in controls and in LLD patients without significant cognitive decline that are more extensive than the decreases in brain volume. Longer duration follow-up studies and the integration of other molecular imaging methods will have implications for understanding the clinical and neurobiological significance of these metabolic changes.
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Affiliation(s)
- Christopher M. Marano
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21224
| | - Clifford I. Workman
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21224
| | - Elisse Kramer
- Department of Geriatric Psychiatry, the Zucker Hillside Hospital, Glen Oaks, New York 11004
| | - Carol R. Hermann
- Department of Geriatric Psychiatry, the Zucker Hillside Hospital, Glen Oaks, New York 11004
| | - Yilong Ma
- Center for Neurosciences, The Feinstein Institute for Medical Research, North Shore - Long Island Jewish Health System, Manhasset, New York 11030
| | - Vijay Dhawan
- Center for Neurosciences, The Feinstein Institute for Medical Research, North Shore - Long Island Jewish Health System, Manhasset, New York 11030
| | - Thomas Chaly
- Center for Neurosciences, The Feinstein Institute for Medical Research, North Shore - Long Island Jewish Health System, Manhasset, New York 11030
| | - David Eidelberg
- Center for Neurosciences, The Feinstein Institute for Medical Research, North Shore - Long Island Jewish Health System, Manhasset, New York 11030
| | - Gwenn S. Smith
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21224
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Lenze EJ, Dixon D, Nowotny P, Lotrich FE, Doré PM, Pollock BG, Hinrichs AL, Butters MA. Escitalopram reduces attentional performance in anxious older adults with high-expression genetic variants at serotonin 2A and 1B receptors. Int J Neuropsychopharmacol 2013; 16:279-88. [PMID: 22717018 PMCID: PMC3967864 DOI: 10.1017/s1461145712000351] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Older adults are among the most vulnerable to adverse cognitive effects of psychotropic medications and, therefore, the personalization of psychotropic treatment based on adverse drug reactions in this demographic is of great importance. We examined changes on neuropsychological tests of attention attributable to selective serotonin reuptake inhibitor (SSRI) treatment in anxious older adults. We also examined whether variation in serotonin receptor genes was associated with reduced attentional performance with SSRIs. We examined change from pre- to post-treatment in two attention measures - digit span and coding - in 133 adults aged ≥60 yr with generalized anxiety disorder in a 12-wk trial of escitalopram vs. placebo. We also examined attentional change in relation to genetic variability in four central serotonin receptors: the serotonin transporter and serotonin 1A, 2A and 1B receptors. Digit span scores were significantly lowered in patients receiving escitalopram relative to placebo, indicating reduced attentional performance attributable to the SSRI. Individuals with high-transcription variants in the receptors 5-HTR2A rs6311 and 5-HTR1B rs11568817 had greater reductions in attention with SSRI treatment compared to placebo. We conclude that SSRIs reduce attention in older adults, particularly in those with high-expression genetic variants at the serotonin 2A and 1B receptors. Analysing neuropsychological changes with SSRIs in relation to genetic variation in the serotonin system may be a useful strategy for detecting subgroups of older adults who are more susceptible to side-effects of SSRIs. These results, if confirmed, could lead to the personalization of SSRI use to reduce adverse neurocognitive effects.
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Affiliation(s)
- Eric J Lenze
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA.
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Haller CS, Stone WS, Walder B. Small but continuous progress in the research of preoperative and postoperative cognitive dysfunction. Eur J Anaesthesiol 2012; 29:307-308. [PMID: 22694817 DOI: 10.1097/eja.0b013e328355a3f9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Naismith SL, Norrie LM, Mowszowski L, Hickie IB. The neurobiology of depression in later-life: Clinical, neuropsychological, neuroimaging and pathophysiological features. Prog Neurobiol 2012; 98:99-143. [DOI: 10.1016/j.pneurobio.2012.05.009] [Citation(s) in RCA: 169] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Revised: 05/03/2012] [Accepted: 05/09/2012] [Indexed: 02/07/2023]
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Lenze EJ, Dixon D, Mantella RC, Dore PM, Andreescu C, Reynolds CF, Newcomer JW, Butters MA. Treatment-related alteration of cortisol predicts change in neuropsychological function during acute treatment of late-life anxiety disorder. Int J Geriatr Psychiatry 2012; 27:454-62. [PMID: 21681817 PMCID: PMC4601802 DOI: 10.1002/gps.2732] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2011] [Accepted: 03/14/2011] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Older adults with anxiety disorders are burdened by impairment in neurocognition, which may be mediated by elevated circulating cortisol levels. In a randomized controlled trial of acute serotonin-reuptake inhibitor treatment for late-life anxiety disorder, we examined whether change in salivary cortisol concentrations during treatment predicted improvements in measures of memory and executive function. METHODS We examined 60 adults aged 60 years and older, who took part in a 12-week trial of escitalopram versus placebo for generalized anxiety disorder. All subjects had pre-treatment and post-treatment assessments that included monitoring of peak and total daily cortisol and a comprehensive neuropsychological evaluation. RESULTS Salivary cortisol changes during treatment showed significant associations with changes in immediate and delayed memory but no association with executive tasks (measures of working memory and set shifting). Analyses suggested that a decrease in cortisol due to serotonin-reuptake inhibitor treatment was responsible for the memory changes: memory improvement was seen with cortisol reduction among patients receiving escitalopram but not among patients receiving placebo. CONCLUSION Serotonin-reuptake inhibitor-induced alteration in circulating cortisol during treatment of generalized anxiety disorder predicted changes in immediate and delayed memory. This finding suggests a novel treatment strategy in late-life anxiety disorders: targeting hypothalamic-pituitary- adrenal axis dysfunction to improve memory.
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Affiliation(s)
- Eric J Lenze
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA.
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Diminished performance on neuropsychological testing in late life depression is correlated with microstructural white matter abnormalities. Neuroimage 2012; 60:2182-90. [PMID: 22487548 DOI: 10.1016/j.neuroimage.2012.02.044] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2011] [Revised: 02/15/2012] [Accepted: 02/16/2012] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Traditional T2 weighted MR imaging results are non-specific for the extent of underlying white matter structural abnormalities present in late life depression (LLD). Diffusion tensor imaging provides a unique opportunity to investigate the extent and nature of structural injury, but has been limited by examining only a subset of regions of interest (ROI) and by confounds common to the study of an elderly population, including comorbid vascular pathology. Furthermore, comprehensive correlation of diffusion tensor imaging (DTI) measurements, including axial and radial diffusivity measurements, has not been demonstrated in the late life depression population. METHODS 51 depressed and 16 non-depressed, age- and cerebrovascular risk factor-matched elderly subjects underwent traditional anatomic T1 and T2 weight imaging, as well as DTI. The DTI data were skeletonized using tract based spatial statistics (TBSS), and both regional and global analyses were performed. RESULTS Widespread structural abnormalities within white matter were detected in the LLD group, accounting for age, gender and education and matched for cerebrovascular risk factors and global T2 white matter hyperintensities (T2WMH). Regional differences were most prominent in uncinate and cingulate white matter and were generally characterized by an increase in radial diffusivity. Age-related changes particularly in the cingulate bundle were more advanced in individuals with LLD relative to controls. Regression analysis demonstrated significant correlations of regional fractional anisotropy and radial diffusivity with five different neuropsychological factor scores. TBSS analysis demonstrated a greater extent of white matter abnormalities in LLD not responsive to treatment, as compared to controls. CONCLUSIONS White matter integrity is compromised in late life depression, largely manifested by increased radial diffusivity in specific regions, suggesting underlying myelin injury. A possible mechanism for underlying myelin injury is chronic white matter ischemia related to intrinsic cerebrovascular disease. In some regions such as the cingulate bundle, the white matter injury related to late life depression appears to be independent of and compounded by age-related changes. The correlations with neuropsychological testing indicate the essential effects of white matter injury on functional status. Lastly, response to treatment may depend on the extent of white matter injury, suggesting a need for intact functional networks.
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Abstract
Abnormalities in specific cerebral networks likely confer vulnerability that increases the susceptibility for development of geriatric depression and affect the course of symptoms. Functional neuroimaging enables the in vivo identification of alterations in cerebral function that characterize disease vulnerability and contribute to variability in depressive symptoms and antidepressant response. Judicious use of functional neuroimaging tools can advance pathophysiologic models of geriatric depression. Furthermore, geriatric depression provides a logical context within which to study the role of specific functional abnormalities in both antidepressant response and key behavioral and cognitive abnormalities of mood disorders.
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Affiliation(s)
- Faith M. Gunning
- Institute of Geriatric Psychiatry, Weill Cornell Medical College, 21 Bloomingdale Road; White Plains, N.Y. 10605; Tel. (914) 997-8643; Fax Number (914) 682-6979
| | - Gwenn S. Smith
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins Bayview Medical Center, Alpha Commons Bldg. 4th floor, 5300 Alpha Commons Drive, Baltimore, MD 21224, USA. Phone Number: 410-550-8696, Fax Number: 410-550-0564
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