1
|
Liou YJ, Chen MH, Hsu JW, Huang KL, Huang PH, Bai YM. Dysfunction of circulating endothelial progenitor cells in major depressive disorder. Acta Neuropsychiatr 2024; 36:153-161. [PMID: 38178721 DOI: 10.1017/neu.2023.49] [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: 01/06/2024]
Abstract
OBJECTIVES Despite mounting evidence demonstrates circulating endothelial progenitor cells (cEPCs) quantitative changes in depression, no study has investigated cEPC functions in major depressive disorder (MDD). We investigated the role of cEPC adhesive and apoptotic functions in MDD. METHODS We recruited 68 patients with MDD and 56 healthy controls (HCs). The depression symptoms, anxiety, psychosomatic symptoms, subjective cognitive dysfunction, quality of life, and functional disability were evaluated using the Hamilton Depression Rating Scale and Montgomery-Åsberg Depression Rating Scale, Hamilton Anxiety Rating Scale, Depression and Somatic Symptoms Scale (DSSS), Perceived Deficits Questionnaire-Depression, 12-Item Short Form Health Survey (SF-12), and Sheehan Disability Scale (SDS), respectively. Working memory and executive function were assessed using a 2-back task and Wisconsin Card Sorting Test (WCST). Inflammatory marker (soluble interleukin-6 receptor, C-reactive protein, and tumor necrosis factor-α receptor-1), cEPC adhesive, and apoptotic levels were measured using in vitro assays. RESULTS The MDD patients showed significantly lower cEPC adhesive levels than the HCs, and this difference in adhesive function remained statistically significant even after adjusting for inflammatory marker levels. The cEPC adhesion levels were in inverse correlations with commission and omission errors in 2-back task, the percent perseverative response and percent perseverative errors in WCST, and the DSSS and SDS scores, but in positive correlations with SF-12 physical and mental component scores. cEPC apoptotic levels did not differ significantly between the groups. CONCLUSION The findings indicate that cEPC adhesive function is diminished in MDD and impacts various aspects of cognitive and psychosocial functions associated with the disorder.
Collapse
Affiliation(s)
- Ying-Jay Liou
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Psychiatry, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Mu-Hong Chen
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Psychiatry, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ju-Wei Hsu
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Psychiatry, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Kai-Lin Huang
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Psychiatry, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Po-Hsun Huang
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Critical Care Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ya-Mei Bai
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Psychiatry, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan
| |
Collapse
|
2
|
Chen MH, Su TP, Li CT, Lin WC, Wu HJ, Tsai SJ, Bai YM, Mao WC, Tu PC. Effects of melancholic features on positive and negative suicidal ideation in patients with treatment-resistant depression and strong suicidal ideation receiving low-dose ketamine infusion. Eur Arch Psychiatry Clin Neurosci 2024; 274:759-766. [PMID: 38052767 DOI: 10.1007/s00406-023-01735-2] [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] [Received: 07/15/2023] [Accepted: 11/24/2023] [Indexed: 12/07/2023]
Abstract
The role of melancholic features on the antisuicidal effect of 0.5 mg/kg ketamine infusion has remained unclear in patients with treatment-resistant depression (TRD) and strong suicidal ideation (SI). Whether ketamine diminishes suicidal ideation in patients with TRD-SI was also unknown. We enrolled 84 patients with TRD-SI, including 27 with melancholic features and 57 without, and then randomly administered a single infusion of 0.5 mg/kg ketamine or 0.045 mg/kg midazolam. The clinician-rated Montgomery-Åsberg Depression Rating Scale (MADRS) item 10, Columbia Suicide Severity Rating Scale-Ideation Severity Subscale (CSSRS-ISS), and self-reported Positive and Negative Suicide Ideation Inventory (PANSI) were used to assess suicidal symptoms from baseline to day 7. Generalized estimating equation models showed that only patients without melancholic features (MADRS item 10: infusion group effect, p = 0.017; CSSRS-ISS: infusion group × time effect, p = 0.008; PANSI-negative suicidal ideation: infusion group effect, p = 0.028) benefited from the antisuicidal effect of low-dose ketamine. The PANSI-positive ideation scores were higher in the ketamine group than in the midazolam group (p = 0.038) for patients with melancholic features. Additional studies are necessary to clarify the neuromechanisms underlying the ketamine-related positive effect against SI and antisuicidal effects among patients with TRD-SI. Additional studies are necessary to clarify the neuromechanisms underlying the ketamine-related positive effect against SI and antisuicidal effects among patients with TRD-SI.
Collapse
Affiliation(s)
- Mu-Hong Chen
- Department of Psychiatry, Taipei Veterans General Hospital, No. 201, Sec.2, Shih-Pai Road, Beitou District, Taipei, 112, Taiwan.
- Division of Psychiatry, Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
- Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan.
| | - Tung-Ping Su
- Department of Psychiatry, Taipei Veterans General Hospital, No. 201, Sec.2, Shih-Pai Road, Beitou District, Taipei, 112, Taiwan
- Division of Psychiatry, Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Psychiatry, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Cheng-Ta Li
- Department of Psychiatry, Taipei Veterans General Hospital, No. 201, Sec.2, Shih-Pai Road, Beitou District, Taipei, 112, Taiwan
- Division of Psychiatry, Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Wei-Chen Lin
- Department of Psychiatry, Taipei Veterans General Hospital, No. 201, Sec.2, Shih-Pai Road, Beitou District, Taipei, 112, Taiwan
- Division of Psychiatry, Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Hui-Ju Wu
- Department of Psychiatry, Taipei Veterans General Hospital, No. 201, Sec.2, Shih-Pai Road, Beitou District, Taipei, 112, Taiwan
| | - Shih-Jen Tsai
- Department of Psychiatry, Taipei Veterans General Hospital, No. 201, Sec.2, Shih-Pai Road, Beitou District, Taipei, 112, Taiwan
- Division of Psychiatry, Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ya-Mei Bai
- Department of Psychiatry, Taipei Veterans General Hospital, No. 201, Sec.2, Shih-Pai Road, Beitou District, Taipei, 112, Taiwan
- Division of Psychiatry, Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Wei-Chung Mao
- Department of Psychiatry, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Pei-Chi Tu
- Department of Psychiatry, Taipei Veterans General Hospital, No. 201, Sec.2, Shih-Pai Road, Beitou District, Taipei, 112, Taiwan
- Division of Psychiatry, Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan
| |
Collapse
|
3
|
Amin-Esmaeili M, Farokhnia M, Susukida R, Leggio L, Johnson RM, Crum RM, Mojtabai R. Reduced drug use as an alternative valid outcome in individuals with stimulant use disorders: Findings from 13 multisite randomized clinical trials. Addiction 2024; 119:833-843. [PMID: 38197836 PMCID: PMC11009085 DOI: 10.1111/add.16409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 11/10/2023] [Indexed: 01/11/2024]
Abstract
BACKGROUND AND AIMS Total abstinence has historically been the goal of treatment for substance use disorders; however, there is a growing recognition of the health benefits associated with reduced use as a harm reduction measure in stimulant use disorders treatment. We aimed to assess the validity of reduced stimulant use as an outcome measure in randomized controlled trials (RCTs) of pharmacological interventions for stimulant use disorder. DESIGN We conducted a secondary analysis of a pooled dataset of 13 RCTs. SETTING AND PARTICIPANTS Participants were individuals seeking treatment for cocaine or methamphetamine use disorders (N = 2062) in a wide range of treatment facilities in the United States. MEASUREMENTS We validated reduced stimulant use against a set of clinical indicators drawn from harmonized measurements, including severity of problems caused by drug use, comorbid depression, global severity of substance use and improvement, severity of drug-seeking behavior, craving and high-risk behaviors, all assessed at the end of the trial, as well as follow-up urine toxicology. A series of mixed effect regression models was conducted to validate reduction in frequency of use against no reduction in use and abstinence. FINDINGS More participants reduced frequency of primary drug use than achieved abstinence (18.0% vs. 14.2%, respectively). Reduced use was significantly associated with decreases in craving for the primary drug [60.1%, 95% confidence interval (CI) = 54.3%-64.7%], drug seeking behaviors (41.0%, 95% CI = 36.6%-45.7%), depression severity (39.9%, 95% CI = 30.9%-48.3%), as well as multiple measures of global improvement in psychosocial functioning and severity of drug-related problems, albeit less strongly so than abstinence. Moreover, reduced use was associated with sustained clinical benefit at follow-up, as confirmed by negative urine tests (adjusted odds ratio compared with those with no reduction in use: 0.50, 95% CI = 0.35-0.71). CONCLUSION Reduced frequency of stimulant use appears to be associated with meaningful improvement in various clinical indicators of recovery. Assessment of reduced use, in addition to abstinence, could broaden the scope of outcomes measured in randomized controlled trials of stimulant use disorders and facilitate the development of more diverse treatment approaches.
Collapse
Affiliation(s)
- Masoumeh Amin-Esmaeili
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran
| | - Mehdi Farokhnia
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Clinical Psychoneuroendocrinology and Neuropsychopharmacology Section, Translational Addiction Medicine Branch, National Institute on Drug Abuse Intramural Research Program and National Institute on Alcohol Abuse and Alcoholism Division of Intramural Clinical and Biological Research, National Institutes of Health, Baltimore, MD, USA
| | - Ryoko Susukida
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Lorenzo Leggio
- Clinical Psychoneuroendocrinology and Neuropsychopharmacology Section, Translational Addiction Medicine Branch, National Institute on Drug Abuse Intramural Research Program and National Institute on Alcohol Abuse and Alcoholism Division of Intramural Clinical and Biological Research, National Institutes of Health, Baltimore, MD, USA
- Medication Development Program, National Institute on Drug Abuse Intramural Research Program, National Institutes of Health, Baltimore, MD, USA
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University, Providence, RI, USA
- Division of Addiction Medicine, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Renee M Johnson
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Rosa M Crum
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ramin Mojtabai
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| |
Collapse
|
4
|
Poletti S, Zanardi R, Mandelli A, Aggio V, Finardi A, Lorenzi C, Borsellino G, Carminati M, Manfredi E, Tomasi E, Spadini S, Colombo C, Drexhage HA, Furlan R, Benedetti F. Low-dose interleukin 2 antidepressant potentiation in unipolar and bipolar depression: Safety, efficacy, and immunological biomarkers. Brain Behav Immun 2024; 118:52-68. [PMID: 38367846 DOI: 10.1016/j.bbi.2024.02.019] [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] [Received: 09/11/2023] [Revised: 02/01/2024] [Accepted: 02/08/2024] [Indexed: 02/19/2024] Open
Abstract
Immune-inflammatory mechanisms are promising targets for antidepressant pharmacology. Immune cell abnormalities have been reported in mood disorders showing a partial T cell defect. Following this line of reasoning we defined an antidepressant potentiation treatment with add-on low-dose interleukin 2 (IL-2). IL-2 is a T-cell growth factor which has proven anti-inflammatory efficacy in autoimmune conditions, increasing thymic production of naïve CD4 + T cells, and possibly correcting the partial T cell defect observed in mood disorders. We performed a single-center, randomised, double-blind, placebo-controlled phase II trial evaluating the safety, clinical efficacy and biological responses of low-dose IL-2 in depressed patients with major depressive (MDD) or bipolar disorder (BD). 36 consecutively recruited inpatients at the Mood Disorder Unit were randomised in a 2:1 ratio to receive either aldesleukin (12 MDD and 12 BD) or placebo (6 MDD and 6 BD). Active treatment significantly potentiated antidepressant response to ongoing SSRI/SNRI treatment in both diagnostic groups, and expanded the population of T regulatory, T helper 2, and percentage of Naive CD4+/CD8 + immune cells. Changes in cell frequences were rapidly induced in the first five days of treatment, and predicted the later improvement of depression severity. No serious adverse effect was observed. This is the first randomised control trial (RCT) evidence supporting the hypothesis that treatment to strengthen the T cell system could be a successful way to correct the immuno-inflammatory abnormalities associated with mood disorders, and potentiate antidepressant response.
Collapse
Affiliation(s)
- Sara Poletti
- Psychiatry and Clinical Psychobiology, Division of Neuroscience, Scientific Institute Ospedale San Raffaele, Milano, Italy; Vita-Salute San Raffaele University, Milano, Italy.
| | - Raffaella Zanardi
- Vita-Salute San Raffaele University, Milano, Italy; Mood Disorder Unit, Scientific Institute Ospedale San Raffaele, Milano, Italy
| | - Alessandra Mandelli
- Clinical Neuroimmunology, Institute of Experimental Neurology, Division of Neuroscience, Scientific Institute Ospedale San Raffaele, Milano, Italy
| | - Veronica Aggio
- Psychiatry and Clinical Psychobiology, Division of Neuroscience, Scientific Institute Ospedale San Raffaele, Milano, Italy; Vita-Salute San Raffaele University, Milano, Italy
| | - Annamaria Finardi
- Clinical Neuroimmunology, Institute of Experimental Neurology, Division of Neuroscience, Scientific Institute Ospedale San Raffaele, Milano, Italy
| | - Cristina Lorenzi
- Psychiatry and Clinical Psychobiology, Division of Neuroscience, Scientific Institute Ospedale San Raffaele, Milano, Italy
| | | | - Matteo Carminati
- Vita-Salute San Raffaele University, Milano, Italy; Mood Disorder Unit, Scientific Institute Ospedale San Raffaele, Milano, Italy
| | - Elena Manfredi
- Vita-Salute San Raffaele University, Milano, Italy; Mood Disorder Unit, Scientific Institute Ospedale San Raffaele, Milano, Italy
| | - Enrico Tomasi
- Hospital Pharmacy, Scientific Institute Ospedale San Raffaele, Milano, Italy
| | - Sara Spadini
- Psychiatry and Clinical Psychobiology, Division of Neuroscience, Scientific Institute Ospedale San Raffaele, Milano, Italy
| | - Cristina Colombo
- Vita-Salute San Raffaele University, Milano, Italy; Mood Disorder Unit, Scientific Institute Ospedale San Raffaele, Milano, Italy
| | - Hemmo A Drexhage
- Coordinator EU consortium MoodStratification, Department of Immunology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Roberto Furlan
- Vita-Salute San Raffaele University, Milano, Italy; Clinical Neuroimmunology, Institute of Experimental Neurology, Division of Neuroscience, Scientific Institute Ospedale San Raffaele, Milano, Italy
| | - Francesco Benedetti
- Psychiatry and Clinical Psychobiology, Division of Neuroscience, Scientific Institute Ospedale San Raffaele, Milano, Italy; Vita-Salute San Raffaele University, Milano, Italy
| |
Collapse
|
5
|
Sadeghzadeh S, Swaminathan A, Bhanot P, Steeman S, Xu A, Shah V, Purger DA, Buch VP. Emerging Outlook on Personalized Neuromodulation for Depression: Insights from Tractography-Based Targeting. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2024:S2451-9022(24)00109-5. [PMID: 38679323 DOI: 10.1016/j.bpsc.2024.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 03/07/2024] [Accepted: 04/11/2024] [Indexed: 05/01/2024]
Abstract
BACKGROUND Deep brain stimulation (DBS) has shown individual promise in treating treatment resistant depression (TRD), but larger-scale trials have been less successful. Here, we create the largest meta-analysis with individual patient data (IPD) to date to explore if the use of tractography enhances the efficacy of DBS for TRD. METHODS We systematically reviewed 1823 articles, selecting 32 that contributed data from 366 patients. We stratified the IPD based on stimulation target and use of tractography. Utilizing two-way type III Analysis of Variance (ANOVA), Welch Two Sample t-tests, and mixed-effects linear regression models, we evaluated changes in depression severity 9-15 months post-surgery (1-Y) and at last follow-up (LFU) (4 weeks - 8 years) as assessed by depression scales. RESULTS Tractography was used for medial forebrain bundle (MFB, n=17/32), subcallosal cingulate (SCC, n=39/241), and ventral capsule/ventral striatum (VC/VS, n=3/41) targets; and not used for bed nucleus of stria terminalis (n=11), lateral habenula (n=10), and inferior thalamic peduncle (n=1). Across all patients, tractography significantly improved mean depression scores at 1-Y (p<0.001) and LFU (p=0.009). Within the target cohorts, tractography improved depression scores at 1-Y for both MFB and SCC, though significance was only met at the alpha = 0.1 level (SCC: β=15.8%, p=0.09; MFB: β=52.4%, p=0.10). Within the tractography cohort, MFB with tractography patients showed greater improvement than those with SCC with tractography (72.42±7.17% versus 54.78±4.08%) at 1-Y (p=0.044). CONCLUSIONS Our findings underscore the promise of tractography in DBS for TRD as a methodology for personalization of therapy, supporting its inclusion in future trials.
Collapse
Affiliation(s)
| | | | - Priya Bhanot
- Icahn School of Medicine at Mount Sinai, New York City, NY.
| | | | - Audrey Xu
- Department of Biology, Stanford University, Stanford, CA.
| | - Vaibhavi Shah
- Stanford University School of Medicine, Stanford, CA.
| | - David A Purger
- Department of Neurosurgery, Stanford University, Stanford, CA.
| | - Vivek P Buch
- Department of Neurosurgery, Stanford University, Stanford, CA.
| |
Collapse
|
6
|
Singh B, Vande Voort JL, Pazdernik VK, Frye MA, Kung S. Treatment-resistant depression patients with baseline suicidal ideation required more treatments to achieve therapeutic response with ketamine/esketamine. J Affect Disord 2024; 351:534-540. [PMID: 38302067 DOI: 10.1016/j.jad.2024.01.262] [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] [Received: 10/26/2023] [Revised: 01/19/2024] [Accepted: 01/29/2024] [Indexed: 02/03/2024]
Abstract
BACKGROUND There is an urgent need to identify interventions to reduce suicidality. We investigated the antisuicidal effects of intravenous (IV) ketamine and intranasal (IN) esketamine among patients with treatment-resistant depression (TRD) in a historical cohort study. METHODS The Quick Inventory of Depressive Symptomatology self-report (QIDS-SR) question 12 was used to measure suicidal ideation (SI). Cox proportional hazards models were used to evaluate associations between the number of treatments to response and baseline SI (yes, Q12 > 0 versus no, Q12 = 0), adjusting for covariates and modified baseline QIDS-SR score. We evaluated associations between the number of treatments to a 50 % reduction in SI score between IV and IN treatment. RESULTS Fifty-two adults (62.5 % female, median age 49.1 years) received IV ketamine (71 %, n = 37) or IN esketamine (29 %, n = 15). Eighty-one percent of patients reported SI at baseline. Among those with baseline SI, 60 % had improved SI scores while 38 % did not change, and among those with no SI, 80 % did not change. After adjusting for covariates, the hazard ratios (HR) of response were significantly lower among those with baseline SI (HR = 0.36, 95 % CI, 0.14-0.92, p = 0.03). The number of treatments to achieve a 50 % reduction in SI score did not depend on group (IN esketamine vs. IV ketamine HR = 0.74 [95 % CI, 0.27-2.05]; p = 0.57). LIMITATIONS Small sample size and lack of a placebo group. CONCLUSIONS This study suggests that patients with baseline suicidal ideation require more treatments to achieve a response with ketamine or esketamine. The antisuicidal response seemed similar between IV ketamine and IN esketamine.
Collapse
Affiliation(s)
- Balwinder Singh
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States of America.
| | - Jennifer L Vande Voort
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States of America
| | - Vanessa K Pazdernik
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, United States of America
| | - Mark A Frye
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States of America
| | - Simon Kung
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States of America
| |
Collapse
|
7
|
Demyttenaere K, Costa T, Kavakbasi E, Jiang M, Scheltens A, Dibué M, Hall BE, Andrade P, McAllister-Williams RH, Baune BT, Young AH. Baseline characteristics of a European patient population with difficult-to-treat depression (RESTORE-LIFE) treated with adjunctive vagus nerve stimulation. J Affect Disord 2024; 344:284-291. [PMID: 37838271 DOI: 10.1016/j.jad.2023.10.054] [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] [Received: 06/01/2023] [Revised: 09/09/2023] [Accepted: 10/08/2023] [Indexed: 10/16/2023]
Abstract
BACKGROUND Major depressive disorder is a complex heterogeneous disorder. Treatment is especially challenging for patients with "difficult-to-treat depression" (DTD): a less stigmatizing and more clinically relevant framework defining depression that continues to cause significant burden despite usual treatment efforts. METHODS RESTORE-LIFE is a prospective, observational, multicenter, post-market study being conducted in Europe and is designed to reflect real-world clinical application of adjunctive Vagus Nerve Stimulation Therapy (VNS) for DTD. Baseline characteristics of RESTORE-LIFE patients were analyzed and compared to published treatment-resistant depression (TRD) trials. RESULTS This analysis includes the initial 98 RESTORE-LIFE patients who commenced treatment with VNS. Patients had a mean of 11.4 failed anti-depressant treatments, 1.1 suicide attempts, 87 % had prior electroconvulsive therapy, and 36 % had an endocrine/metabolic comorbidity. On average, disease severity was comparable to that in TRD trials (n = 15,463). However, RESTORE-LIFE patients appear to have been experiencing DTD for a longer duration and their DTD was characterized by a lack of positive mental health and meaningfulness of life, to a greater degree than by excess of negative mood. Despite high comorbidity rates in RESTORE-LIFE, VNS implantation was performed safely with no discontinuations due to surgical adverse events. LIMITATIONS RESTORE-LIFE enrolls any patient receiving adjunctive VNS for DTD. Prescription of VNS may be biased by differences in practices amongst sites and countries. CONCLUSIONS The present analysis offers insight into contemporary real-world use of VNS Therapy for DTD in Europe representing a comprehensive characterization of DTD and how this population may differ from those in the TRD literature.
Collapse
Affiliation(s)
| | - Tiago Costa
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, United Kingdom; Northern Centre for Mood Disorders, Newcastle University; Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, United Kingdom; National Institute for Health and Care Research (NIHR) Newcastle Biomedical Research Centre, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle upon Tyne, United Kingdom
| | - Erhan Kavakbasi
- Department of Psychiatry, University of Münster, Münster, Germany
| | - Mei Jiang
- LivaNova PLC (or a subsidiary), London, Great Britain, United Kingdom
| | - An Scheltens
- LivaNova PLC (or a subsidiary), London, Great Britain, United Kingdom
| | - Maxine Dibué
- LivaNova PLC (or a subsidiary), London, Great Britain, United Kingdom
| | - Beth E Hall
- Northern Centre for Mood Disorders, Newcastle University; Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Pablo Andrade
- Department of Stereotactic and Functional Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - R Hamish McAllister-Williams
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, United Kingdom; Northern Centre for Mood Disorders, Newcastle University; Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, United Kingdom; National Institute for Health and Care Research (NIHR) Newcastle Biomedical Research Centre, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle upon Tyne, United Kingdom
| | - Bernhard T Baune
- Department of Psychiatry, University of Münster, Münster, Germany; Department of Psychiatry, Melbourne Medical School, University of Melbourne, Melbourne, Australia; The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Victoria, Australia
| | - Allan H Young
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Beckenham, United Kingdom.
| |
Collapse
|
8
|
Ben ÂJ, van Dongen JM, Finch AP, Alili ME, Bosmans JE. To what extent does the use of crosswalks instead of EQ-5D value sets impact reimbursement decisions?: a simulation study. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2023; 24:1253-1270. [PMID: 36371791 PMCID: PMC10533624 DOI: 10.1007/s10198-022-01539-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 10/05/2022] [Indexed: 06/16/2023]
Abstract
PURPOSE Inconsistent results have been found on the impact of using crosswalks versus EQ-5D value sets on reimbursement decisions. We sought to further investigate this issue in a simulation study. METHODS Trial-based economic evaluation data were simulated for different conditions (depression, low back pain, osteoarthritis, cancer), severity levels (mild, moderate, severe), and effect sizes (small, medium, large). For all 36 scenarios, utilities were calculated using 3L and 5L value sets and crosswalks (3L to 5L and 5L to 3L crosswalks) for the Netherlands, the United States, and Japan. Utilities, quality-adjusted life years (QALYs), incremental QALYs, incremental cost-effectiveness ratios (ICERs), and probabilities of cost-effectiveness (pCE) obtained from values sets and crosswalks were compared. RESULTS Differences between value sets and crosswalks ranged from -0.33 to 0.13 for utilities, from -0.18 to 0.13 for QALYs, and from -0.01 to 0.08 for incremental QALYs, resulting in different ICERs. For small effect sizes, at a willingness-to-pay of €20,000/QALY, the largest pCE difference was found for moderate cancer between the Japanese 5L value set and 5L to 3L crosswalk (difference = 0.63). For medium effect sizes, the largest difference was found for mild cancer between the Japanese 3L value set and 3L to 5L crosswalk (difference = 0.06). For large effect sizes, the largest difference was found for mild osteoarthritis between the Japanese 3L value set and 3L to 5L crosswalk (difference = 0.08). CONCLUSION The use of crosswalks instead of EQ-5D value sets can impact cost-utility outcomes to such an extent that this may influence reimbursement decisions.
Collapse
Affiliation(s)
- Ângela Jornada Ben
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
| | - Johanna M van Dongen
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
| | - Aureliano Paolo Finch
- EuroQol Office, EuroQol Research Foundation, Marten Meesweg 107, 3068 AV, Rotterdam, The Netherlands
| | - Mohamed El Alili
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
| | - Judith E Bosmans
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
| |
Collapse
|
9
|
Lavin P, Rej S, Olagunju AT, Teixeira AL, Dols A, Alda M, Almeida OP, Altinbas K, Balanzá-Martínez V, Barbosa IG, Blumberg HP, Briggs F, Calkin C, Cassidy K, Forester BP, Forlenza OV, Hajek T, Haarman BCM, Jimenez E, Lafer B, Mulsant B, Oluwaniyi SO, Patrick R, Radua J, Schouws S, Sekhon H, Simhandl C, Soares JC, Tsai SY, Vieta E, Villa LM, Sajatovic M, Eyler LT. Essential data dimensions for prospective international data collection in older age bipolar disorder (OABD): Recommendations from the GAGE-BD group. Bipolar Disord 2023; 25:554-563. [PMID: 36843436 DOI: 10.1111/bdi.13312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
BACKGROUND By 2030, over 50% of individuals living with bipolar disorder (BD) are expected to be aged ≥50 years. However, older age bipolar disorder (OABD) remains understudied. There are limited large-scale prospectively collected data organized in key dimensions capable of addressing several fundamental questions about BD affecting this subgroup of patients. METHODS We developed initial recommendations for the essential dimensions for OABD data collection, based on (1) a systematic review of measures used in OABD studies, (2) a Delphi consensus of international OABD experts, (3) experience with harmonizing OABD data in the Global Aging & Geriatric Experiments in Bipolar Disorder Database (GAGE-BD, n ≥ 4500 participants), and (4) critical feedback from 34 global experts in geriatric mental health. RESULTS We identified 15 key dimensions and variables within each that are relevant for the investigation of OABD: (1) demographics, (2) core symptoms of depression and (3) mania, (4) cognition screening and subjective cognitive function, (5) elements for BD diagnosis, (6) descriptors of course of illness, (7) treatment, (8) suicidality, (9) current medication, (10) psychiatric comorbidity, (11) psychotic symptoms, (12) general medical comorbidities, (13) functioning, (14) family history, and (15) other. We also recommend particular instruments for capturing some of the dimensions and variables. CONCLUSION The essential data dimensions we present should be of use to guide future international data collection in OABD and clinical practice. In the longer term, we aim to establish a prospective consortium using this core set of dimensions and associated variables to answer research questions relevant to OABD.
Collapse
Affiliation(s)
- Paola Lavin
- Department of Geriatric Psychiatry, Department of Psychiatry, Jewish General Hospital/Lady Davis Institute, McGill University, Montreal, Quebec, Canada
| | - Soham Rej
- Department of Geriatric Psychiatry, Department of Psychiatry, Jewish General Hospital/Lady Davis Institute, McGill University, Montreal, Quebec, Canada
| | - Andrew T Olagunju
- Department of Psychiatry and Behavioral Neurosciences, McMaster University/St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Antonio L Teixeira
- Department of Psychiatry and Behavioral Sciences, University of Texas/McGovern Medical School, Houston, Texas, USA
| | - Annemieke Dols
- Department of Old Age Psychiatry, GGZ inGeest, Amsterdam, The Netherlands
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Martin Alda
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Osvaldo P Almeida
- Medical School, University of Western Australia, Perth, Western Australia, Australia
| | - Kursat Altinbas
- Selçuk University Medical Faculty, Department of Psychiatry, Mazhar Osman Mood Clinic, Konya, Turkey
| | - Vicent Balanzá-Martínez
- Teaching Unit of Psychiatry and Psychological Medicine, Department of Medicine, University of Valencia, CIBERSAM, Valencia, Spain
| | - Izabela G Barbosa
- Laboratório Interdisciplinar de Investigação Médica da Faculdad de Medicina, Universidad Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Hilary P Blumberg
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Farren Briggs
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Cynthia Calkin
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Kristin Cassidy
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Brent P Forester
- Division of Geriatric Psychiatry, McLean Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Orestes V Forlenza
- Laboratory of Neuroscience (LIM-27), Department and Institute of Psychiatry, HCFMUSP, Faculdad de Medicina da Universidad de São Paulo, São Paulo, Brazil
| | - Tomas Hajek
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
- National Institute of Mental Health, Klecany, Czech Republic
| | - Barthomeus C M Haarman
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Esther Jimenez
- Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Beny Lafer
- Department of Psychiatry, University of Sao Paulo, São Paulo, Brazil
| | - Benoit Mulsant
- Department of Psychiatry, University of Toronto, Center for Addiction and Mental Health, Toronto, Ontario, Canada
| | | | - Regan Patrick
- Division of Geriatric Psychiatry, McLean Hospital, Belmont, Massachusetts, USA
| | - Joaquim Radua
- Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
- Department of Clinical Neuroscience, Centre for Psychiatric Research and Education, Karolinska Institutet, Solna, Sweden
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Sigfried Schouws
- Department of Old Age Psychiatry, GGZ inGeest, Amsterdam, The Netherlands
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Harmehr Sekhon
- Department of Geriatric Psychiatry, Department of Psychiatry, Jewish General Hospital/Lady Davis Institute, McGill University, Montreal, Quebec, Canada
- Division of Geriatric Psychiatry, McLean Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Christian Simhandl
- Medical Faculty, Bipolar Center Wiener Neustadt, Sigmund Freud University, Wien, Austria
| | - Jair C Soares
- Teaching Unit of Psychiatry and Psychological Medicine, Department of Medicine, University of Valencia, CIBERSAM, Valencia, Spain
- Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, UTHealth Houston, Texas, USA
| | - Shang-Ying Tsai
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Luca M Villa
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Martha Sajatovic
- Departments of Psychiatry and of Neurology, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Lisa T Eyler
- Department of Psychiatry, University of California San Diego, San Diego, California, USA
- Desert-Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System, San Diego, California, USA
| |
Collapse
|
10
|
Vairavan S, Rashidisabet H, Li QS, Ness S, Morrison RL, Soares CN, Uher R, Frey BN, Lam RW, Kennedy SH, Trivedi M, Drevets WC, Narayan VA. Personalized relapse prediction in patients with major depressive disorder using digital biomarkers. Sci Rep 2023; 13:18596. [PMID: 37903878 PMCID: PMC10616277 DOI: 10.1038/s41598-023-44592-8] [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: 04/03/2023] [Accepted: 10/10/2023] [Indexed: 11/01/2023] Open
Abstract
Major depressive disorder (MDD) is a chronic illness wherein relapses contribute to significant patient morbidity and mortality. Near-term prediction of relapses in MDD patients has the potential to improve outcomes by helping implement a 'predict and preempt' paradigm in clinical care. In this study, we developed a novel personalized (N-of-1) encoder-decoder anomaly detection-based framework of combining anomalies in multivariate actigraphy features (passive) as triggers to utilize an active concurrent self-reported symptomatology questionnaire (core symptoms of depression and anxiety) to predict near-term relapse in MDD. The framework was evaluated on two independent longitudinal observational trials, characterized by regular bimonthly (every other month) in-person clinical assessments, weekly self-reported symptom assessments, and continuous activity monitoring data with two different wearable sensors for ≥ 1 year or until the first relapse episode. This combined passive-active relapse prediction framework achieved a balanced accuracy of ≥ 71%, false alarm rate of ≤ 2.3 alarm/patient/year with a median relapse detection time of 2-3 weeks in advance of clinical onset in both studies. The study results suggest that the proposed personalized N-of-1 prediction framework is generalizable and can help predict a majority of MDD relapses in an actionable time frame with relatively low patient and provider burden.
Collapse
Affiliation(s)
- Srinivasan Vairavan
- Janssen Research & Development, LLC, 1125 Trenton Harbourton Road, Titusville, NJ, 08560, USA.
| | - Homa Rashidisabet
- Department of Bioengineering, University of Illinois Chicago, Chicago, IL, USA
| | - Qingqin S Li
- Janssen Research & Development, LLC, 1125 Trenton Harbourton Road, Titusville, NJ, 08560, USA
| | - Seth Ness
- Janssen Research & Development, LLC, 1125 Trenton Harbourton Road, Titusville, NJ, 08560, USA
| | - Randall L Morrison
- Janssen Research & Development, LLC, 1125 Trenton Harbourton Road, Titusville, NJ, 08560, USA
| | - Claudio N Soares
- Department of Psychiatry, Queen's University School of Medicine, Kingston, ON, Canada
| | - Rudolf Uher
- Department of Psychiatry, Dalhousie University, Halifax, Canada
| | - Benicio N Frey
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
- Mood Disorders Program, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Raymond W Lam
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Sidney H Kennedy
- Centre for Depression and Suicide Studies, Unity Health Toronto, Toronto, Canada
- Krembil Neurosciences, University Health Network, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Madhukar Trivedi
- Peter O'Donnell Jr. Brain Institute and the Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA
| | - Wayne C Drevets
- Janssen Research & Development, LLC, 1125 Trenton Harbourton Road, Titusville, NJ, 08560, USA
| | - Vaibhav A Narayan
- Janssen Research & Development, LLC, 1125 Trenton Harbourton Road, Titusville, NJ, 08560, USA
- Davos Alzheimer's Collaborative, Geneva, Switzerland
| |
Collapse
|
11
|
Otto ME, Bergmann KR, de Kam ML, Recourt K, Jacobs GE, van Esdonk MJ. Item response theory in early phase clinical trials: Utilization of a reference model to analyze the Montgomery-Åsberg Depression Rating Scale. CPT Pharmacometrics Syst Pharmacol 2023; 12:1425-1436. [PMID: 37551774 PMCID: PMC10583236 DOI: 10.1002/psp4.13018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 07/03/2023] [Accepted: 07/06/2023] [Indexed: 08/09/2023] Open
Abstract
In clinical trials, Montgomery-Åsberg Depression Rating Scale (MADRS) questionnaire data are added up to total scores before analysis, assuming equal contribution of each separate question. Item Response Theory (IRT)-based analysis avoids this by using individual question responses to determine the latent variable (ψ), which represents a measure of depression severity. However, utilization of IRT in early phase trials remains difficult, because large datasets are needed to develop IRT models. Therefore, we aimed to evaluate the application and assumptions of a reference IRT model for analysis of an early phase trial. A cross-over, placebo-controlled study investigating the effect of intravenous racemic ketamine on MADRS scores in patients with treatment-resistant major depressive disorder was used as a case study. One hundred forty-seven MADRS responses were measured in 17 patients at five timepoints (predose to 2 weeks after dosing). Two reference IRT models based on different patient populations were selected from literature and used to determine ψ, while testing multiple approaches regarding assumed data distribution. Use of ψ versus total score to determine treatment effect was compared through linear mixed model analysis. Results showed that determined ψ values did not differ significantly between assumed distributions, but were significantly different when changing reference IRT model. Estimated treatment effect size was not significantly affected by chosen approach nor reference population. Finally, increased precision to determine treatment effect was achieved by using IRT versus total scores. This demonstrates the usefulness of reference IRT model application for analysis of questionnaire data in early phase clinical trials.
Collapse
Affiliation(s)
- Marije E. Otto
- Centre for Human Drug Research (CHDR)LeidenThe Netherlands
- Leiden Academic Centre for Drug Research (LACDR)Leiden UniversityLeidenThe Netherlands
| | | | | | - Kasper Recourt
- Centre for Human Drug Research (CHDR)LeidenThe Netherlands
| | - Gabriël E. Jacobs
- Centre for Human Drug Research (CHDR)LeidenThe Netherlands
- Department of PsychiatryLeiden University Medical Center (LUMC)LeidenThe Netherlands
| | | |
Collapse
|
12
|
Liou YJ, Chen MH, Hsu JW, Huang KL, Huang PH, Bai YM. Circulating endothelial progenitor cell dysfunction in patients with bipolar disorder. Eur Arch Psychiatry Clin Neurosci 2023; 273:1255-1265. [PMID: 36527490 DOI: 10.1007/s00406-022-01530-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 11/29/2022] [Indexed: 12/23/2022]
Abstract
Dysfunction in circulating endothelial progenitor cells (cEPCs) plays a crucial role in cardiovascular disorders (CVDs). Patients with bipolar disorder (BPD) are at increased risk of developing CVDs. This study examined the associations of the functional properties of cEPCs with BPD and its clinical and cognitive characteristics. We recruited 69 patients with BPD and 41 healthy controls (HCs). The levels of manic, depressive, anxiety, psychosomatic symptoms, subjective cognitive dysfunction, quality of life, and functional disability of the BPD group were evaluated using the Young Mania Rating Scale (YMRS), Clinical Global Impression for BPD (CGI-BP), Hamilton Depression Rating Scale, Montgomery-Åsberg Depression Rating Scale, Hamilton Anxiety Rating Scale, Depression and Somatic Symptoms Scale, Perceived Deficits Questionnaire-Depression, 12-Item Short-Form Health Survey, and Sheehan Disability Scale, respectively. Cognitive function was assessed using 2-back and Go/No-Go tasks. Through in vitro assays, the adhesion to fibronectin and the percentage of apoptosis of cEPCs were examined. Under correction for multiple comparisons, the adhesive function of cEPCs in BPD was significantly lower than that in the HCs (corrected P [Pcorr] = 0.027). The reduced adhesive function of cEPCs correlated significantly with increased scores in the YMRS (Pcorr = 0.0002) and the CGI-BP (Pcorr = 0.0009). A lower percentage of apoptotic cEPC cells was associated with greater commission errors in the 2-back (Pcorr = 0.028) and Go/No-Go tasks (Pcorr = 0.029). The cEPCs of the BPD group exhibited attenuated adhesive function. The altered adhesive and apoptotic functions of cEPCs are associated with manic symptom severity and response inhibition deficits in patients with BPD.
Collapse
Affiliation(s)
- Ying-Jay Liou
- Department of Psychiatry, Taipei Veterans General Hospital, No. 201, Shih-Pai Road, Sec. 2, 11217, Taipei, Taiwan
- Department of Psychiatry, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Mu-Hong Chen
- Department of Psychiatry, Taipei Veterans General Hospital, No. 201, Shih-Pai Road, Sec. 2, 11217, Taipei, Taiwan
- Department of Psychiatry, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ju-Wei Hsu
- Department of Psychiatry, Taipei Veterans General Hospital, No. 201, Shih-Pai Road, Sec. 2, 11217, Taipei, Taiwan
- Department of Psychiatry, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Kai-Lin Huang
- Department of Psychiatry, Taipei Veterans General Hospital, No. 201, Shih-Pai Road, Sec. 2, 11217, Taipei, Taiwan
- Department of Psychiatry, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Po-Hsun Huang
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Shih-Pai Road, Sec. 2, 11217, Taipei, Taiwan.
- Department of Critical Care Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
- Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan.
| | - Ya-Mei Bai
- Department of Psychiatry, Taipei Veterans General Hospital, No. 201, Shih-Pai Road, Sec. 2, 11217, Taipei, Taiwan.
- Department of Psychiatry, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
- Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan.
| |
Collapse
|
13
|
Luttenberger K, Donath C, Graessel E, Kornhuber J, Schlüter A, Dorscht L, Kind L. Treating depression in an outpatient setting: Predictors of patient response to bouldering psychotherapy, cognitive behavioural therapy or exercise alone. Clin Psychol Psychother 2023. [PMID: 37642328 DOI: 10.1002/cpp.2898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 06/20/2023] [Accepted: 08/01/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND Bouldering psychotherapy (BPT) for depression has proven effective, but nothing is known about its potential predictors of response. This study should identify predictors of response to BPT, cognitive behavioural therapy (CBT) and an active control (home-based exercise programme; EP) using a literature-based model. METHODS In a multicentre randomised controlled trial, 233 outpatients were assigned to BPT, CBT or EP. Response (reduction of at least 46% on the Montgomery-Åsberg Depression Rating Scale [MADRS]) and remission (≤7 MADRS points) were defined as suggested by the literature. Predictors of response were identified twofold: (1) univariate analyses followed by logistic regression analyses in each group with all predictors yielding a univariate p-value <.20 and (2) a backward regression analysis with all potential predictors. Only variables that emerged as predictors in both types of analyses were interpreted. RESULTS There was a significantly greater proportion of responders (p = .035) in the BPT than in the EP. The chance of response in the BPT was higher for patients with a higher health-related quality of life. In the EP, response was higher for patients with lower interpersonal sensitivity, suffering from their first episode and living with a partner. CONCLUSIONS Response rates in BPT are similar to or even higher than in other outpatient psychotherapy group therapies. BPT and CBT are suitable for a wide range of patients, but patients with higher functionality could start with psychoeducation and exercise.
Collapse
Affiliation(s)
- Katharina Luttenberger
- Centre for Health Services Research in Medicine, Department of Psychiatry and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Carolin Donath
- Centre for Health Services Research in Medicine, Department of Psychiatry and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Elmar Graessel
- Centre for Health Services Research in Medicine, Department of Psychiatry and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Johannes Kornhuber
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Annika Schlüter
- Centre for Health Services Research in Medicine, Department of Psychiatry and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Lisa Dorscht
- Centre for Health Services Research in Medicine, Department of Psychiatry and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Leona Kind
- Centre for Health Services Research in Medicine, Department of Psychiatry and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| |
Collapse
|
14
|
Seemüller F, Schennach R, Musil R, Obermeier M, Adli M, Bauer M, Brieger P, Laux G, Gaebel W, Falkai P, Riedel M, Möller HJ. A factor analytic comparison of three commonly used depression scales (HAMD, MADRS, BDI) in a large sample of depressed inpatients. BMC Psychiatry 2023; 23:548. [PMID: 37507656 PMCID: PMC10386606 DOI: 10.1186/s12888-023-05038-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 07/19/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Quantifying depression mainly relies on the use of depression scales, and understanding their factor structure is crucial for evaluating their validity. METHODS This post-hoc analysis utilized prospectively collected data from a naturalistic study of 1014 inpatients with major depression. Confirmatory and exploratory factor analyses were performed to test the psychometric abilities of the Hamilton Depression Rating Scale, the Montgomery Asberg Depression Rating Scale, and the self-rated Beck Depression Inventory. A combined factor analysis was also conducted including all items of all scales. RESULTS All three scales showed good to very good internal consistency. The HAMD-17 had four factors: an "anxiety" factor, a "depression" factor, an "insomnia" factor, and a "somatic" factor. The MADRS also had four factors: a "sadness" factor, a neurovegetative factor, a "detachment" factor and a "negative thoughts" factor, while the BDI had three factors: a "negative attitude towards self" factor, a "performance impairment" factor, and a "somatic" factor. The combined factor analysis suggested that self-ratings might reflect a distinct illness dimension within major depression. CONCLUSIONS The factors obtained in this study are comparable to those found in previous research. Self and clinician ratings are complementary and not redundant, highlighting the importance of using multiple measures to quantify depression.
Collapse
Affiliation(s)
- Florian Seemüller
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilians-University, Nussbaumstrasse 7, 80336, Munich, Germany.
- Department of Psychiatry, Psychotherapy and Psychosomatics, Kbo-Lech-Mangfall-Klinik, Auenstrasse 6, 82467, Garmisch-Partenkirchen, Germany.
| | - Rebecca Schennach
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilians-University, Nussbaumstrasse 7, 80336, Munich, Germany
- Schoen Clinic Roseneck, Am Roseneck 6, 83209, Prien am Chiemsee, Germany
| | - Richard Musil
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilians-University, Nussbaumstrasse 7, 80336, Munich, Germany
| | - Michael Obermeier
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilians-University, Nussbaumstrasse 7, 80336, Munich, Germany
| | - Mazda Adli
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Charité Mitte (CCM), CampusCharitéplatz 1, 10117, Berlin, Germany
- Center for Psychiatry, Psychotherapy and Psychosomatic Medicine, Fliedner Klinik Berlin, Markgrafenstrasse 34, 10117, Berlin, Germany
| | - Michael Bauer
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital Dresden, Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Peter Brieger
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilians-University, Nussbaumstrasse 7, 80336, Munich, Germany
- Department of Psychiatry and Psychotherapy, Kbo-Isar-Amper-Klinikum Region Munich, Vockestrasse 72, 85540, Haar, Germany
| | - Gerd Laux
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilians-University, Nussbaumstrasse 7, 80336, Munich, Germany
- Institute of Psychological Medicine (IPM), Nussbaumstrasse 9, 83564, Soyen, Germany
| | - Wolfgang Gaebel
- Department of Psychiatry and Psychotherapy, University of Düsseldorf, Bergische Landstrasse 2, 40629, Düsseldorf, Germany
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilians-University, Nussbaumstrasse 7, 80336, Munich, Germany
| | - Michael Riedel
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilians-University, Nussbaumstrasse 7, 80336, Munich, Germany
- Centre for Disturbance of Memory and Demetia, Marion von Tessin Memory-Centre, Nymphenburgerstrasse 45, 80636, Munich, Germany
| | - Hans-Jürgen Möller
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilians-University, Nussbaumstrasse 7, 80336, Munich, Germany
| |
Collapse
|
15
|
Cai DB, Qin ZJ, Lan XJ, Liu QM, Qin XD, Wang JJ, Goya-Maldonado R, Huang XB, Ungvari GS, Ng CH, Zheng W, Xiang YT. Accelerated intermittent theta burst stimulation for major depressive disorder or bipolar depression: A systematic review and meta-analysis. Asian J Psychiatr 2023; 85:103618. [PMID: 37201381 DOI: 10.1016/j.ajp.2023.103618] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 05/02/2023] [Accepted: 05/05/2023] [Indexed: 05/20/2023]
Abstract
We aimed to systematically evaluate the clinical efficacy and safety of accelerated intermittent theta burst stimulation (aiTBS) for patients with major depressive disorder (MDD) or bipolar depression (BD). A random-effects model was adopted to analyze the primary and secondary outcomes using the Review Manager, Version 5.3 software. This meta-analysis (MA) identified five double-blind randomized controlled trials (RCTs) comprising 239 MDD or BD patients with a major depressive episode. Active aiTBS overperformed sham stimulation in the study-defined response. This MA found preliminary evidence that active aiTBS resulted in a greater response in treating major depressive episodes in MDD or BD patients than sham stimulation.
Collapse
Affiliation(s)
- Dong-Bin Cai
- Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China; The Fourth Clinical College, Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Zhen-Juan Qin
- The Brain Hospital of Guangxi Zhuang Autonomous Region, Liuzhou, China
| | - Xian-Jun Lan
- The Brain Hospital of Guangxi Zhuang Autonomous Region, Liuzhou, China
| | - Qi-Man Liu
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xiu-De Qin
- Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China; The Fourth Clinical College, Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Jian-Jun Wang
- Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China; The Fourth Clinical College, Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Roberto Goya-Maldonado
- Laboratory of Systems Neuroscience and Imaging in Psychiatry (SNIP-Lab), Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Göttingen, Germany
| | - Xing-Bing Huang
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Gabor S Ungvari
- University of Notre Dame Australia, Fremantle, Australia; Division of Psychiatry, School of Medicine, University of Western Australia/Graylands Hospital, Perth, Australia
| | - Chee H Ng
- Department of Psychiatry, The Melbourne Clinic and St Vincent's Hospital, University of Melbourne, Richmond, Victoria, Australia.
| | - Wei Zheng
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China.
| | - Yu-Tao Xiang
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, & Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao SAR, China; Centre for Cognitive and Brain Sciences, University of Macau, Macao SAR, China.
| |
Collapse
|
16
|
Zeifman RJ, Wagner AC, Monson CM, Carhart-Harris RL. How does psilocybin therapy work? An exploration of experiential avoidance as a putative mechanism of change. J Affect Disord 2023; 334:100-112. [PMID: 37146908 DOI: 10.1016/j.jad.2023.04.105] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 04/17/2023] [Accepted: 04/28/2023] [Indexed: 05/07/2023]
Abstract
BACKGROUND Psilocybin therapy is receiving attention as a mental health intervention with transdiagnostic potential. In line with psychotherapeutic research, qualitative research has highlighted the role of reductions in experiential avoidance (and increases in connectedness) within psilocybin therapy. However, no quantitative research has examined experiential avoidance as a mechanism underlying psilocybin therapy's therapeutic effects. METHOD Data was used from a double-blind randomized controlled trial that compared psilocybin therapy (two 25 mg psilocybin session plus daily placebo for six weeks) with escitalopram (two 1 mg psilocybin sessions plus 10-20 mg daily escitalopram for six weeks) among individuals with major depressive disorder (N = 59). All participants received psychological support. Experiential avoidance, connectedness, and treatment outcomes were measured at pre-treatment and at a 6 week primary endpoint. Acute psilocybin experiences and psychological insight were also measured. RESULTS With psilocybin therapy, but not escitalopram, improvements in mental health outcomes (i.e., well-being, depression severity, suicidal ideation, and trait anxiety) occurred via reductions in experiential avoidance. Exploratory analyses suggested that improvements in mental health (except for suicidal ideation) via reduction in experiential avoidance were serially mediated through increases in connectedness. Additionally, experiences of ego dissolution and psychological insight predicted reductions in experiential avoidance following psilocybin therapy. LIMITATIONS Difficulties inferring temporal causality, maintaining blindness to condition, and reliance upon self-report. CONCLUSIONS These results provide support for the role of reduced experiential avoidance as a putative mechanism underlying psilocybin therapy's positive therapeutic outcomes. The present findings may help to tailor, refine, and optimize psilocybin therapy and its delivery.
Collapse
Affiliation(s)
- Richard J Zeifman
- Department of Psychology, Toronto Metropolitan University, Toronto, Canada; Centre for Psychedelic Research, Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, UK; NYU Langone Centre for Psychedelic Medicine, Department of Psychiatry, NYU Grossman School of Medicine, New York, USA.
| | - Anne C Wagner
- Department of Psychology, Toronto Metropolitan University, Toronto, Canada; Remedy Institute, Toronto, Canada
| | - Candice M Monson
- Department of Psychology, Toronto Metropolitan University, Toronto, Canada
| | - Robin L Carhart-Harris
- Centre for Psychedelic Research, Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, UK; Psychedelics Division, Neuroscape, University of California, San Francisco, USA
| |
Collapse
|
17
|
Nikolin S, Moffa A, Razza L, Martin D, Brunoni A, Palm U, Padberg F, Bennabi D, Haffen E, Blumberger DM, Salehinejad MA, Loo CK. Time-course of the tDCS antidepressant effect: An individual participant data meta-analysis. Prog Neuropsychopharmacol Biol Psychiatry 2023; 125:110752. [PMID: 36931456 DOI: 10.1016/j.pnpbp.2023.110752] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 03/13/2023] [Accepted: 03/14/2023] [Indexed: 03/19/2023]
Abstract
INTRODUCTION Prefrontal transcranial direct current stimulation (tDCS) shows promise as an effective treatment for depression. However, factors influencing treatment and the time-course of symptom improvements remain to be elucidated. METHODS Individual participant data was collected from ten randomised controlled trials of tDCS in depression. Depressive symptom scores were converted to a common scale, and a linear mixed effects individual growth curve model was fit to the data using k-fold cross-validation to prevent overfitting. RESULTS Data from 576 participants were analysed (tDCS: n = 311; sham: n = 265), of which 468 were unipolar and 108 had bipolar disorder. tDCS effect sizes reached a peak at approximately 6 weeks, and continued to diverge from sham up to 10 weeks. Significant predictors associated with worse response included higher baseline depression severity, treatment resistance, and those associated with better response included bipolar disorder and anxiety disorder. CONCLUSIONS Our findings suggest that longer treatment courses, lasting at least 6 weeks in duration, may be indicated. Further, our results show that tDCS is effective for depressive symptoms in bipolar disorder. Compared to unipolar depression, participants with bipolar disorder may require additional maintenance sessions to prevent rapid relapse.
Collapse
Affiliation(s)
- Stevan Nikolin
- School of Psychiatry, University of New South Wales, Sydney, Australia; Black Dog Institute, Sydney, Australia.
| | - Adriano Moffa
- School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Lais Razza
- Serviço Interdisciplinar de Neuromodulação (SIN), Instituto de Psiquiatria, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, SP, Brazil; Ghent Experimental Psychiatry (GHEP) Lab, Ghent, Belgium; Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Donel Martin
- School of Psychiatry, University of New South Wales, Sydney, Australia; Black Dog Institute, Sydney, Australia
| | - Andre Brunoni
- Laboratory of Neurosciences (LIM-27), Instituto Nacional de Biomarcadores em Neuropsiquiatria (INBioN), Department and Institute of Psychiatry, Faculdade de Medicina da Universidade de São Paulo, Brazil; Department of Internal Medicine, Faculdade de Medicina da Universidade de São Paulo & Hospital Universitário, Universidade de São Paulo, Brazil
| | - Ulrich Palm
- Department of Psychiatry and Psychotherapy, University Hospital LMU, Munich, Germany
| | - Frank Padberg
- Department of Psychiatry and Psychotherapy, University Hospital LMU, Munich, Germany; Medical Park Chiemseeblick, Bernau-Felden, Germany
| | - Djamila Bennabi
- Centre d'Investigation Clinique, CIC-INSERM-1431, Centre Hospitalier Universitaire de Besançon CHU, Besançon, France
| | - Emmanuel Haffen
- Centre d'Investigation Clinique, CIC-INSERM-1431, Centre Hospitalier Universitaire de Besançon CHU, Besançon, France
| | - Daniel M Blumberger
- Temerty Centre for Therapeutic Brain Intervention and Campbell Family Research Institute, Centre for Addiction and Mental Health and Department of Psychiatry, University of Toronto, Ontario, Canada
| | - Mohammad Ali Salehinejad
- Department of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany
| | - Colleen K Loo
- School of Psychiatry, University of New South Wales, Sydney, Australia; Black Dog Institute, Sydney, Australia
| |
Collapse
|
18
|
Tsai SJ, Kao CF, Su TP, Li CT, Lin WC, Hong CJ, Bai YM, Tu PC, Chen MH. Cytokine- and Vascular Endothelial Growth Factor-Related Gene-Based Genome-Wide Association Study of Low-Dose Ketamine Infusion in Patients with Treatment-Resistant Depression. CNS Drugs 2023; 37:243-253. [PMID: 36763263 DOI: 10.1007/s40263-023-00989-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/15/2023] [Indexed: 02/11/2023]
Abstract
BACKGROUND AND OBJECTIVE Ketamine may work as an anti-inflammatory agent, and it increases the levels of vascular endothelial growth factor (VEGF) in patients with treatment-resistant depression. However, whether genes related to pro-inflammatory and anti-inflammatory cytokines and VEGF may predict the treatment response to ketamine remains unknown.Therefore the aim of this study was to analyze whether specific genes related to inflammatory processes and VEGF were associated with treatment response to low-dose ketamine in patients with treatment-resistant depression. METHODS Based on the genome data from our clinical trial, this study was a secondary analysis of candidate genes correlated with different timepoints of depressive symptoms. In total, 65 patients with treatment-resistant depression (n = 21 for ketamine 0.5 mg/kg, 20 for ketamine 0.2 mg/kg, and 24 for normal saline) were genotyped for 684,616 single nucleotide polymorphisms. Genes associated with 80 cytokines (i.e., interleukin [IL]-1, IL-6, tumor necrosis factor-α, and adiponectin) and VEGF (i.e., VEGF and VEGF receptors) were selected for the gene-based genome-wide association study on the antidepressant effect of a ketamine infusion. RESULTS Specific single nucleotide polymorphisms, including rs2540315 and rs75746675 in IL1R1 and rs79568085 in VEGFC, were related to the rapid (within 240 min) antidepressant effect of a ketamine infusion; specific single nucleotide polymorphisms, such as Affx-20131665 in PIGF and rs8179353, rs8179353, and rs8179353 in TNFRSF8, were associated with the sustained (up to 2 weeks) antidepressant effect of low-dose (combined 0.5 mg/kg and 0.2 mg/kg) ketamine. CONCLUSIONS Our findings further revealed that genes related to both anti-inflammatory and pro-inflammatory cytokines (i.e., IL-1, IL-2, IL-6, tumor necrosis factor-α, C-reactive protein, and adiponectin) and VEGF-FLK signaling predicted the treatment response to a ketamine infusion in patients with treatment-resistant depression. The synergic modulation of inflammatory and VEGF systems may contribute to the antidepressant effect of ketamine. CLINICAL TRIAL REGISTRATION University Hospital Medical Information Network Clinical Trials Registry (UMIN-CTR) number: UMIN000016985.
Collapse
Affiliation(s)
- Shih-Jen Tsai
- Department of Psychiatry, Taipei Veterans General Hospital, No. 201, Shih-Pai Road, Sec. 2, 11217, Taipei, Taiwan
- Division of Psychiatry, Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chung-Feng Kao
- Department of Agronomy, College of Agriculture and Natural Resources, National Chung Hsing University, Taichung, Taiwan
- Advanced Plant Biotechnology Center, National Chung Hsing University, Taichung, Taiwan
| | - Tung-Ping Su
- Department of Psychiatry, Taipei Veterans General Hospital, No. 201, Shih-Pai Road, Sec. 2, 11217, Taipei, Taiwan
- Division of Psychiatry, Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Psychiatry, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Cheng-Ta Li
- Department of Psychiatry, Taipei Veterans General Hospital, No. 201, Shih-Pai Road, Sec. 2, 11217, Taipei, Taiwan
- Division of Psychiatry, Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Wei-Chen Lin
- Department of Psychiatry, Taipei Veterans General Hospital, No. 201, Shih-Pai Road, Sec. 2, 11217, Taipei, Taiwan
- Division of Psychiatry, Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chen-Jee Hong
- Department of Psychiatry, Taipei Veterans General Hospital, No. 201, Shih-Pai Road, Sec. 2, 11217, Taipei, Taiwan
- Division of Psychiatry, Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ya-Mei Bai
- Department of Psychiatry, Taipei Veterans General Hospital, No. 201, Shih-Pai Road, Sec. 2, 11217, Taipei, Taiwan
- Division of Psychiatry, Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Pei-Chi Tu
- Department of Psychiatry, Taipei Veterans General Hospital, No. 201, Shih-Pai Road, Sec. 2, 11217, Taipei, Taiwan
- Division of Psychiatry, Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Mu-Hong Chen
- Department of Psychiatry, Taipei Veterans General Hospital, No. 201, Shih-Pai Road, Sec. 2, 11217, Taipei, Taiwan.
- Division of Psychiatry, Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
- Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan.
| |
Collapse
|
19
|
Terpstra AR, Vila-Rodriguez F, LeMoult J, Chakrabarty T, Nair M, Humaira A, Gregory EC, Todd RM. Cognitive-affective processes and suicidality in response to repetitive transcranial magnetic stimulation for treatment resistant depression. J Affect Disord 2023; 321:182-190. [PMID: 36341803 DOI: 10.1016/j.jad.2022.10.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 10/19/2022] [Accepted: 10/22/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Repetitive transcranial magnetic stimulation (rTMS) can elicit 45-55 % response rates and may alleviate suicidality symptoms in treatment resistant depression (TRD). Blunted anticipatory reward sensitivity and negatively biased self-referential processing may predict trajectories of depressive and suicidality symptoms in rTMS for TRD and be modulated during treatment. METHODS Fifty-five individuals with TRD received four weeks of low-frequency rTMS applied to the right dorsolateral prefrontal cortex (LFR-rTMS) and were followed until 17 weeks post-baseline. Participants completed behavioral measures of anticipatory reward sensitivity and self-referential processing at baseline and five weeks post-baseline (approximately one-week post-treatment). We examined whether baseline anticipatory reward sensitivity and self-referential processing predicted trajectories of depressive and suicidality symptoms from baseline to follow-up and whether these cognitive-affective variables showed change from baseline to week five. RESULTS Anticipatory reward sensitivity and negative self-referential encoding at baseline were associated with higher overall depressive symptoms and suicidality from baseline to 17 weeks post-baseline. At week five, participants self-attributed a higher number of positive traits and a lower number of negative traits and had a lesser tendency to remember negative relative to positive traits they had self-attributed, compared to baseline. LIMITATIONS The specificity of these results to LFR-rTMS is unknown in the absence of a comparison group, and our relatively small sample size precluded the interpretation of null results. CONCLUSIONS Baseline blunted anticipatory reward sensitivity and negative biases in self-referential processing may be risk factors for higher depressive symptoms and suicidality during and after LFR-rTMS, and LFR-rTMS may modulate self-referential processing.
Collapse
Affiliation(s)
- Alex R Terpstra
- Department of Psychology, The University of British Columbia, Vancouver, BC, Canada.
| | - Fidel Vila-Rodriguez
- Non-Invasive Neurostimulation Therapies (NINET) Laboratory, Department of Psychiatry, The University of British Columbia, Vancouver, BC, Canada; Djavad Mowafaghian Centre for Brain Health, The University of British Columbia, Vancouver, BC, Canada
| | - Joelle LeMoult
- Department of Psychology, The University of British Columbia, Vancouver, BC, Canada
| | - Trisha Chakrabarty
- Department of Psychiatry, The University of British Columbia, Vancouver, BC, Canada
| | - Medha Nair
- Department of Psychology, The University of British Columbia, Vancouver, BC, Canada
| | - Afifa Humaira
- Non-Invasive Neurostimulation Therapies (NINET) Laboratory, Department of Psychiatry, The University of British Columbia, Vancouver, BC, Canada
| | - Elizabeth C Gregory
- Non-Invasive Neurostimulation Therapies (NINET) Laboratory, Department of Psychiatry, The University of British Columbia, Vancouver, BC, Canada
| | - Rebecca M Todd
- Department of Psychology, The University of British Columbia, Vancouver, BC, Canada; Djavad Mowafaghian Centre for Brain Health, The University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
20
|
Sackeim HA, Rush AJ, Greco T, Jiang M, Badejo S, Bunker MT, Aaronson ST, Conway CR, Demyttenaere K, Young AH, McAllister-Williams RH. Alternative metrics for characterizing longer-term clinical outcomes in difficult-to-treat depression: I. Association with change in quality of life. Psychol Med 2023; 53:1-13. [PMID: 36601813 PMCID: PMC10600942 DOI: 10.1017/s0033291722003798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 10/24/2022] [Accepted: 11/29/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND In difficult-to-treat depression (DTD) the outcome metrics historically used to evaluate treatment effectiveness may be suboptimal. Metrics based on remission status and on single end-point (SEP) assessment may be problematic given infrequent symptom remission, temporal instability, and poor durability of benefit in DTD. METHODS Self-report and clinician assessment of depression symptom severity were regularly obtained over a 2-year period in a chronic and highly treatment-resistant registry sample (N = 406) receiving treatment as usual, with or without vagus nerve stimulation. Twenty alternative metrics for characterizing symptomatic improvement were evaluated, contrasting SEP metrics with integrative (INT) metrics that aggregated information over time. Metrics were compared in effect size and discriminating power when contrasting groups that did (N = 153) and did not (N = 253) achieve a threshold level of improvement in end-point quality-of-life (QoL) scores, and in their association with continuous QoL scores. RESULTS Metrics based on remission status had smaller effect size and poorer discrimination of the binary QoL outcome and weaker associations with the continuous end-point QoL scores than metrics based on partial response or response. The metrics with the strongest performance characteristics were the SEP measure of percentage change in symptom severity and the INT metric quantifying the proportion of the observation period in partial response or better. Both metrics contributed independent variance when predicting end-point QoL scores. CONCLUSIONS Revision is needed in the metrics used to quantify symptomatic change in DTD with consideration of INT time-based measures as primary or secondary outcomes. Metrics based on remission status may not be useful.
Collapse
Affiliation(s)
- Harold A. Sackeim
- Departments of Psychiatry and Radiology, Columbia University, New York, NY, USA
| | - A. John Rush
- Duke-NUS Medical School, Singapore
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
| | - Teresa Greco
- LivaNova PLC, Milan, Italy
- Jazz Pharmaceuticals PLC, Milan, Italy
| | - Mei Jiang
- LivaNova USA PLC, Minneapolis, MN, USA
| | | | | | - Scott T. Aaronson
- Department of Clinical Research, Sheppard Pratt Health System, Baltimore, MD, USA
| | - Charles R. Conway
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, USA
| | - Koen Demyttenaere
- Faculty of Medicine KU Leuven, University Psychiatric Center KU Leuven, Leuven, Belgium
| | - Allan H. Young
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Beckenham, UK
| | - R. Hamish McAllister-Williams
- Northern Centre for Mood Disorders, Translational and Clinical Research Institute, Newcastle University, UK, and Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| |
Collapse
|
21
|
Kumar PNS, Suresh R, Menon V. An Open-Label Rater-Blinded Randomized Trial of Vilazodone versus Escitalopram in Major Depression. Indian J Psychol Med 2023; 45:19-25. [PMID: 36778613 PMCID: PMC9896102 DOI: 10.1177/02537176221127162] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Vilazodone, a novel selective serotonin reuptake inhibitor and 5-HT1A partial agonist, was approved in 2011 for treatment for major depression. We aimed to compare the efficacy and safety of vilazodone versus escitalopram in patients with major depression at 4 weeks. METHODS Participants (n = 52) were adult major depressive disorder outpatients who were randomized to receive either oral escitalopram (modal endpoint dose 20 mg/day; n = 26) or oral vilazodone (modal endpoint dose 40 mg/day; n = 26). Rater-blinded assessments of depression scores (primary outcome) and clinical severity of illness (secondary outcome) were obtained at baseline, 2 weeks, and 4 weeks. Adverse effects such as weight gain, sexual dysfunction, and diarrhea were recorded at each visit. The primary analysis was performed on the Intention-to-treat sample. RESULTS No significant difference was noted between groups on depression scores at study endpoint (F = 2.80, df = 1,50, P = 0.10); however, the vilazodone group had significantly lower endpoint clinical severity of illness (F = 7.69, df = 1,50, P = 0.01). At 2 weeks, there were no significant between-group differences on depression scores (F = 0.006, df = 1,50, P = 0.94). Instances of diarrhea (P = 0.001) were significantly higher in the vilazodone group. CONCLUSION Clinical ratings of major depression did not differ significantly between vilazodone and escitalopram groups at the end of 4 weeks. Our findings are limited by lack of statistical power to detect smaller differences between groups, should they exist.
Collapse
Affiliation(s)
| | - Rohith Suresh
- Dept. of Medicine, Government Medical College, Ernakulum, Kerala, India
| | - Vikas Menon
- Dept. of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| |
Collapse
|
22
|
White matter changes following electroconvulsive therapy for depression: a multicenter ComBat harmonization approach. Transl Psychiatry 2022; 12:517. [PMID: 36526624 PMCID: PMC9758171 DOI: 10.1038/s41398-022-02284-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 11/23/2022] [Accepted: 12/07/2022] [Indexed: 12/23/2022] Open
Abstract
ECT is proposed to exert a therapeutic effect on WM microstructure, but the limited power of previous studies made it difficult to highlight consistent patterns of change in diffusion metrics. We initiated a multicenter analysis and sought to address whether changes in WM microstructure occur following ECT. Diffusion tensor imaging (DTI) data (n = 58) from 4 different sites were harmonized before pooling them by using ComBat, a batch-effect correction tool that removes inter-site technical variability, preserves inter-site biological variability, and maximizes statistical power. Downstream statistical analyses aimed to quantify changes in Fractional Anisotropy (FA), Mean Diffusivity (MD), Radial Diffusivity (RD) and Axial Diffusivity (AD), by employing whole-brain, tract-based spatial statistics (TBSS). ECT increased FA in the right splenium of the corpus callosum and the left cortico-spinal tract. AD in the left superior longitudinal fasciculus and the right inferior fronto-occipital fasciculus was raised. Increases in MD and RD could be observed in overlapping white matter structures of both hemispheres. At baseline, responders showed significantly smaller FA values in the left forceps major and smaller AD values in the right uncinate fasciculus compared with non-responders. By harmonizing multicenter data, we demonstrate that ECT modulates altered WM microstructure in important brain circuits that are implicated in the pathophysiology of depression. Furthermore, responders appear to present a more decreased WM integrity at baseline which could point toward a specific subtype of patients, characterized by a more altered neuroplasticity, who are especially sensitive to the potent neuroplastic effects of ECT.
Collapse
|
23
|
Borentain S, Gogate J, Williamson D, Carmody T, Trivedi M, Jamieson C, Cabrera P, Popova V, Wajs E, DiBernardo A, Daly EJ. Montgomery-Åsberg Depression Rating Scale factors in treatment-resistant depression at onset of treatment: Derivation, replication, and change over time during treatment with esketamine. Int J Methods Psychiatr Res 2022; 31:e1927. [PMID: 35749277 PMCID: PMC9720209 DOI: 10.1002/mpr.1927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 05/16/2022] [Accepted: 05/27/2022] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE Derive and confirm factor structure of the Montgomery-Åsberg Depression Rating Scale (MADRS) in patients with treatment-resistant depression (TRD) and evaluate how the factors evident at baseline change over 4 weeks of esketamine treatment. METHODS Two similarly-designed, short-term TRANSFORM trials randomized adults to esketamine or matching placebo nasal spray, each with a newly-initiated oral antidepressant, for 4 weeks (TRANSFORM-1: N = 342 patients; TRANSFORM-2: N = 223 patients). The factor structure of MADRS item scores at baseline was determined by exploratory factor analysis in TRANSFORM-2 and corroborated by confirmatory factor analysis in TRANSFORM-1. Change in MADRS factor scores from baseline (day 1) to the end of the 28-day double-blind treatment phase of TRANSFORM-2 was analyzed using a mixed-effects model for repeated measures (MMRM). RESULTS Three factors were identified based on analysis of MADRS items: Factor 1 labeled affective and anhedonic symptoms (apparent sadness, reported sadness, lassitude, inability to feel), Factor 2 labeled anxiety and vegetative symptoms (inner tension, reduced sleep, reduced appetite, concentration difficulties), and Factor 3 labeled hopelessness (pessimistic thoughts, suicidal thoughts). The three-factor structure observed in TRANSFORM-2 was verified in TRANSFORM-1. Treatment benefit at 24 h with esketamine versus placebo was observed on all 3 factors and continued throughout the 4-week double-blind treatment period. CONCLUSIONS A three-factor structure for MADRS appears to generalize to TRD. All three factors improved over 4 weeks of treatment with esketamine nasal spray.
Collapse
Affiliation(s)
- Stephane Borentain
- Department of Global Medical Affairs, Janssen Research & Development, LLC, Titusville, New Jersey, USA
| | - Jagadish Gogate
- Department of Statistics & Decision Sciences, Janssen Research & Development LLC, Raritan, New Jersey, USA
| | - David Williamson
- Clinical Medical Affairs, Janssen Scientific Affairs LLC, Titusville, New Jersey, USA
| | - Thomas Carmody
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Madhukar Trivedi
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Carol Jamieson
- Patient Reported Outcomes, Janssen Research & Development LLC, Milpitas, California, USA
| | - Patricia Cabrera
- Department of Global Medical Affairs, Janssen Global Services LLC, Titusville, New Jersey, USA
| | - Vanina Popova
- Department of Neuroscience, Janssen Research & Development, Beerse, Belgium
| | - Ewa Wajs
- Department of Neuroscience, Janssen Research & Development, Beerse, Belgium
| | - Allitia DiBernardo
- Department of Global Medical Affairs, Janssen Research & Development, LLC, Titusville, New Jersey, USA
| | - Ella J Daly
- Clinical Medical Affairs, Janssen Scientific Affairs LLC, Titusville, New Jersey, USA
| |
Collapse
|
24
|
Ekbäck E, Blomqvist I, Dennhag I, Henje E. Psychometric properties of the Swedish version of the Reynolds Adolescent Depression Scale second edition (RADS-2) in a clinical sample. Nord J Psychiatry 2022; 77:383-392. [PMID: 36332154 DOI: 10.1080/08039488.2022.2128409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Objective: Observed and predicted increases in the global burden of disease caused by major depressive disorder (MDD) highlight the need for psychometrically robust multi-dimensional measures to use for clinical and research purposes. Reynolds Adolescent Depression Scale second edition (RADS-2) is an internationally well-validated scale measuring different dimensions of adolescent depression. The Swedish version has previously only been evaluated in a normative sample.Methods: We collected data from patients in child and adolescent psychiatry and primary care and performed: (1) Confirmatory factor analysis (CFA) to evaluate the established four-factor structure, (2) Analyses of reliability and measurement invariance, (3) Analyses of convergent and discriminant validity using the Montgomery-Asberg Depression Rating Scale, the depression subscales of the Beck Youth Inventories and the Revised Child Anxiety and Depression Scale, as well as the Patient Reported Outcome Measurements Information System, peer-relationships and physical activity item banks.Results: Recruited participants (n = 536, 129 male and 407 female, mean age 16.45 years, SD = 2.47, range 12 - 22 years) had a variety of psychiatric diagnoses. We found support for the four-factor structure and acceptable to good reliability for the subscale and total scores. Convergent and discriminant validity were good. Measurement invariance was demonstrated for age, sex, and between the present sample and a previously published normative sample. The RADS-2-scores were significantly higher in the present sample than in the normative sample. In this clinical study, the Swedish RADS-2 demonstrated good validity and acceptable to good reliability. Our findings support the use of RADS-2 in Swedish clinical and research contexts.
Collapse
Affiliation(s)
- Erik Ekbäck
- Department of Clinical Science, Umeå University, Umeå, Sweden
| | - Ida Blomqvist
- Department of Clinical Science, Umeå University, Umeå, Sweden
| | - Inga Dennhag
- Department of Clinical Science, Umeå University, Umeå, Sweden
| | - Eva Henje
- Department of Clinical Science, Umeå University, Umeå, Sweden
| |
Collapse
|
25
|
Berko A, Bar-Sella A, Fisher H, Sobolev M, Pollak JP, Zilcha-Mano S. Development and evaluation of the HRSD-D, an image-based digital measure of the Hamilton rating scale for depression. Sci Rep 2022; 12:14342. [PMID: 35995828 PMCID: PMC9395406 DOI: 10.1038/s41598-022-18434-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 08/11/2022] [Indexed: 11/09/2022] Open
Abstract
The Hamilton rating scale for depression (HRSD) is considered the gold standard for the assessment of major depressive disorder. Nevertheless, it has drawbacks such as reliance on retrospective reports and a relatively long administration time. Using a combination of an experience sampling method with mobile health technology, the present study aimed at developing and conducting initial validation of HRSD-D, the first digital image-based assessment of the HRSD. Fifty-three well-trained HRSD interviewers selected the most representative image for each item from an initial sample of images. Based on their responses, we developed the prototype of HRSD-D in two versions: trait-like (HRSD-DT) and state-like (HRSD-DS). HRSD-DT collects one-time reports on general tendencies to experience depressive symptoms; HRSD-DS collects daily reports on the experience of symptoms. Using a total of 1933 responses collected in a preclinical sample (N = 86), we evaluated the validity and feasibility of HRSD-D, based on participant reports of HRSD-DT at baseline, and 28 consecutive daily reports of HRSD-DS, using smartphone devices. HRSD-D showed good convergent validity with respect to the original HRSD, as evident in high correlations between HRSD-DS and HRSD (up to Bstd = 0.80). Our combined qualitative and quantitative analyses indicate that HRSD-D captured both dynamic and stable features of symptomatology, in a user-friendly monitoring process. HRSD-D is a promising tool for the assessment of trait and state depression and contributes to the use of mobile technologies in mental health research and practice.
Collapse
Affiliation(s)
- Adi Berko
- The Department of Psychology, University of Haifa, Mount Carmel, 31905, Haifa, Israel
| | - Avigail Bar-Sella
- The Department of Psychology, University of Haifa, Mount Carmel, 31905, Haifa, Israel
| | - Hadar Fisher
- The Department of Psychology, University of Haifa, Mount Carmel, 31905, Haifa, Israel
| | - Michael Sobolev
- Feinstein Institutes for Medical Research, Northwell Health, New York, USA.,Cornell Tech, Cornell University, New York, USA
| | - J P Pollak
- Cornell Tech, Cornell University, New York, USA
| | - Sigal Zilcha-Mano
- The Department of Psychology, University of Haifa, Mount Carmel, 31905, Haifa, Israel.
| |
Collapse
|
26
|
A Chinese adaptation of six items, self-report Hamilton Depression Scale: Factor structure and psychometric properties. Asian J Psychiatr 2022; 73:103104. [PMID: 35447536 DOI: 10.1016/j.ajp.2022.103104] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 03/24/2022] [Accepted: 04/02/2022] [Indexed: 12/17/2022]
Abstract
OBJECTIVES The objective of this research was to verify the psychometric characteristics of the Chinese Adaptation of self-report HAMD-6. METHODS Outpatients and inpatients who met the DSM-5 criterion for major depressive disorder (MDD) were evaluated by the Chinese self-report HAMD-6, seventeen items of Hamilton Depression Rating Scale (HAMD-17), Patient Health Questionnaire Depression Scale (PHQ-9) and Improved Clinical Global Impression Scale (iCGI-S). The internal consistency reliability, retest reliability, criterion validity and construct validity of the Chinese self-report HAMD-6 were tested. Pearson correlation coefficient was used to assess the correlativity between the total score and the item scores. By drawing the Receiver Operating Characteristics (ROC) curve, the best cut-off value, sensitivity and specificity of Chinese Adaptation self-report HAMD-6 were obtained. RESULTS Cronbach's alpha coefficient of the Chinese self-report HAMD-6 was 0.91, and the intra-group correlation coefficient (ICC) of retest reliability was 0.81(P < 0.01). The Spearman correlation coefficients of the Chinese self-report HAMD-6, Chinese clinician version of HAMD-6, PHQ-9 and HAMD-17 were 0.86, 0.81 and 0.86, respectively (all P < 0.01). Results of the confirmatory factor analysis (CFA) supported a unidimensional construct. In addition, HAMD-17 ≤ 7 and iCGI-S= 1 were taken as the remission criteria for depression disorder, and the ROC curves of the Chinese self-report HAMD-6 were plotted with a cut-off value of 3/4, the specificity and sensitivity were 0.85/0.92 and 0.96/0.93 respectively. CONCLUSION These results suggested that the abbreviated Chinese self-report HAMD-6 has good reliability and validity among the Chinese population. This study suggested that the remission cut-off value of the scale is 3/4.
Collapse
|
27
|
Liou YJ, Chen MH, Hsu JW, Huang KL, Huang PH, Bai YM. Levels of circulating endothelial progenitor cells inversely correlate with manic and positive symptom severity in patients with bipolar disorder. Brain Behav 2022; 12:e2570. [PMID: 35481989 PMCID: PMC9226848 DOI: 10.1002/brb3.2570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 02/02/2022] [Accepted: 03/19/2022] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES Patients with bipolar disorder (BPD) are at high risk of cardiovascular diseases (CVDs) that are attributed to endothelial dysfunction. Circulating endothelial progenitor cells (cEPCs) are proposed as indicators of endothelial dysfunction. This study examined the relationship of cEPC numbers with BPD diagnosis and its clinical symptoms in patients with BPD. METHODS We recruited 48 patients with BPD and 50 healthy controls (HCs). All the patients had scores of <13 on the Young Mania Rating Scale (YMRS). In addition to the YMRS and Clinical Global Impression for BPD (CGI-BP), bipolar patients were assessed using relevant measurements for their depression, anxiety, general psychopathology, cognitive dysfunction and deficit, somatic symptoms, quality of life, and level of disability. cEPC counts were measured using flow cytometry. RESULTS The numbers of immature and mature cEPCs in the bipolar patients did not significantly differ from those in the HCs. After correction for multiple comparisons and controlling for body mass index and smokers, the number of immature cEPCs was observed to be inversely correlated with CGI-BP (corrected p [pcorr ] = .00018) and positive scores in the positive and negative syndrome scale (PANSS-P; pcorr = .0049). The number of mature cEPCs was inversely correlated with YMRS (pcorr = .014), CGI-BP (pcorr = .00022), and PANSS-P (pcorr = .0049) scores. In multivariate stepwise analysis, numbers of both types of cEPCs were associated with CGI-BP. CONCLUSIONS cEPC levels, an indicator of endothelial dysfunction and risk of CVDs, may be associated manic and positive symptom severities in patients with BPD.
Collapse
Affiliation(s)
- Ying-Jay Liou
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Psychiatry, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Mu-Hong Chen
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Psychiatry, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ju-Wei Hsu
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Psychiatry, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Kai-Lin Huang
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Psychiatry, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Po-Hsun Huang
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Critical Care Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ya-Mei Bai
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Psychiatry, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan
| |
Collapse
|
28
|
Thase ME. Commentary on the Hamilton Rating Scale for Depression: 60+ Years Old and Still Relevant to the Assessment of Antidepressant Treatment Outcomes. PSYCHOPHARMACOLOGY BULLETIN 2022; 52:154-156. [PMID: 35721815 PMCID: PMC9172556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
|
29
|
Ouerhani N, Maalel A, Ben Ghézala H. SMAD: SMart assistant during and after a medical emergency case based on deep learning sentiment analysis: The pandemic COVID-19 case. CLUSTER COMPUTING 2022; 25:3671-3681. [PMID: 35571977 PMCID: PMC9082471 DOI: 10.1007/s10586-022-03601-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 02/06/2022] [Accepted: 04/13/2022] [Indexed: 06/15/2023]
Abstract
The huge cost of emergency situations could have fatal effects on humanity and society, and it could present a genuine threat to both of them. In fact, most people confronted with an emergency could feel psychological trauma, which will, for the most part, change over time as they can exhibit chaotic or even turbulent behaviours. The situation could worsen in the case of a pandemic as fear and anxiety invade and spread in addition to isolation and quarantine. In this paper, we propose to build a smart assistant, called SMAD, that could detect the symptoms of an emergency case as well as symptoms of a mental disorder while analysing the natural language speech of an ordinary citizen, during and after an emergency situation using natural language processing and deep learning sentiment analysis model to track the patient's mental state during an ongoing conversation. Our proposed smart assistant is an online human-bot interaction that could handle a variety of physical and mental circumstances of any emergency situation. The proposed approach is a smart healthcare service that consists of four interconnected modules: The information understanding module, the data collector module, the action generator module, and the mental analysis module, which is based on the sentiment analysis model performed on a social media dataset using a pre-trained word-embedding model.
Collapse
Affiliation(s)
- Nourchène Ouerhani
- RIADI Laboratory, National School of Computer Sciences, University of Manouba, 2010 Manouba, Tunisia
| | - Ahmed Maalel
- RIADI Laboratory, National School of Computer Sciences, University of Manouba, 2010 Manouba, Tunisia
- Higher Institute of Applied Sciences and Technology, University of Sousse, 4003 Sousse, Tunisia
| | - Henda Ben Ghézala
- RIADI Laboratory, National School of Computer Sciences, University of Manouba, 2010 Manouba, Tunisia
| |
Collapse
|
30
|
Rabin EE, Kim M, Mozny A, Cardoza K, Bell AC, Zhai L, Bommi P, Lauing KL, King AL, Armstrong TS, Walunas TL, Fang D, Roy I, Peipert JD, Sieg E, Mi X, Amidei C, Lukas RV, Wainwright DA. A systematic review of pharmacologic treatment efficacy for depression in older patients with cancer. Brain Behav Immun Health 2022; 21:100449. [PMID: 35368609 PMCID: PMC8968450 DOI: 10.1016/j.bbih.2022.100449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 03/03/2022] [Accepted: 03/12/2022] [Indexed: 12/19/2022] Open
|
31
|
Hengartner MP, Plöderl M. Estimates of the minimal important difference to evaluate the clinical significance of antidepressants in the acute treatment of moderate-to-severe depression. BMJ Evid Based Med 2022; 27:69-73. [PMID: 33593736 DOI: 10.1136/bmjebm-2020-111600] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/22/2021] [Indexed: 12/27/2022]
Abstract
The efficacy of antidepressants in the acute treatment of moderate-to-severe depression remains a controversial issue. The minimal important difference (MID) is relevant to judge the clinical significance of treatment effects. In this analysis paper, we discuss estimates of the MID for common depression outcome measures.For the Hamilton Depression Rating Scale 17-item Version (HDRS-17), according to both anchor-based and distribution-based approaches, MID estimates range from 3 to 8 points, and the most accurate values are likely between 3 and 5 points. For the 6-item version (HDRS-6), MID estimates range between 2 and 4 points. For both the Montgomery-Åsberg Depression Rating Scale (MADRS) and the Beck Depression Inventory II (BDI-II), MID estimates range between 3 and 9 points, with estimates of 3-6 points likely being the most accurate. Quality of life appears to be more important to patients than core depression symptoms. We thus also evaluated the Short-Form 36 (SF-36) mental component score, a popular mental-health-related quality of life measure. Its MID estimate is likely about 5 points. By contrast, the average treatment effects of antidepressants on the HDRS-17, HDRS-6, MADRS, BDI-II and SF-36 are 2 points, 1.5 points, 3 points, 2 points and 3-5 points, respectively.In conclusion, the efficacy of antidepressants in the acute treatment of moderate-to-severe depression consistently fails to exceed the lower bound of the MID estimates for common depression outcome measures. The clinical significance of antidepressants thus remains uncertain and we call for more research on quality of life measures, which are the patients' most valued outcome domains.
Collapse
Affiliation(s)
- Michael P Hengartner
- Department of Applied Psychology, Zurich University of Applied Sciences, Zurich, Switzerland
| | - Martin Plöderl
- Department of Crisis Intervention and Suicide Prevention, Paracelsus Medical University Salzburg, Salzburg, Salzburg, Austria
| |
Collapse
|
32
|
Hajduska-Dér B, Kiss G, Sztahó D, Vicsi K, Simon L. The applicability of the Beck Depression Inventory and Hamilton Depression Scale in the automatic recognition of depression based on speech signal processing. Front Psychiatry 2022; 13:879896. [PMID: 35990073 PMCID: PMC9385975 DOI: 10.3389/fpsyt.2022.879896] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 07/18/2022] [Indexed: 11/25/2022] Open
Abstract
Depression is a growing problem worldwide, impacting on an increasing number of patients, and also affecting health systems and the global economy. The most common diagnostical rating scales of depression are self-reported or clinician-administered, which differ in the symptoms that they are sampling. Speech is a promising biomarker in the diagnostical assessment of depression, due to non-invasiveness and cost and time efficiency. In our study, we try to achieve a more accurate, sensitive model for determining depression based on speech processing. Regression and classification models were also developed using a machine learning method. During the research, we had access to a large speech database that includes speech samples from depressed and healthy subjects. The database contains the Beck Depression Inventory (BDI) score of each subject and the Hamilton Rating Scale for Depression (HAMD) score of 20% of the subjects. This fact provided an opportunity to compare the usefulness of BDI and HAMD for training models of automatic recognition of depression based on speech signal processing. We found that the estimated values of the acoustic model trained on BDI scores are closer to HAMD assessment than to the BDI scores, and the partial application of HAMD scores instead of BDI scores in training improves the accuracy of automatic recognition of depression.
Collapse
Affiliation(s)
- Bálint Hajduska-Dér
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
| | - Gábor Kiss
- Department of Telecommunications and Media Informatics, Budapest University of Technology and Economics, Budapest, Hungary
| | - Dávid Sztahó
- Department of Telecommunications and Media Informatics, Budapest University of Technology and Economics, Budapest, Hungary
| | - Klára Vicsi
- Department of Telecommunications and Media Informatics, Budapest University of Technology and Economics, Budapest, Hungary
| | - Lajos Simon
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
| |
Collapse
|
33
|
Nery FG, Li W, DelBello MP, Welge JA. N-acetylcysteine as an adjunctive treatment for bipolar depression: A systematic review and meta-analysis of randomized controlled trials. Bipolar Disord 2021; 23:707-714. [PMID: 33354859 DOI: 10.1111/bdi.13039] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 11/19/2020] [Accepted: 12/20/2020] [Indexed: 02/05/2023]
Abstract
OBJECTIVES Previous studies and meta-analyses suggested that N-acetylcysteine (NAC) was superior to placebo in improving depression in bipolar disorder. However, more recent data, including two larger trials, found that NAC was no more effective than placebo. We conducted a meta-analysis to appraise the possible efficacy of NAC in treating bipolar depression. METHODS A systematic review and meta-analysis of double-blind, placebo-controlled trials of NAC as a treatment augmentation strategy for bipolar depression was carried out in PubMed (1966-2020). We utilized random-effect analysis to evaluate improvement in depressive symptoms from baseline to endpoint as the primary efficacy measure. RESULTS Six trials including 248 patients were included. Treatment augmentation with NAC showed a moderate effect size favoring NAC over placebo (d = 0.45, 95% C.I.: 0.06-0.84). There was substantial heterogeneity (I2 = 49%). Meta-regression analyses did not identify any moderator that might explain variation in heterogeneity, including baseline depressive symptom scores, mean NAC dose, or duration of study. CONCLUSIONS Results from six clinical trials suggest that treatment augmentation with NAC for bipolar depression appears to be superior to placebo, with a moderate effect size, but a large confidence interval. Larger clinical trials, investigating possible moderating factors, such as NAC dose, treatment duration, baseline depression severity, or chronicity of illness, are warranted.
Collapse
Affiliation(s)
- Fabiano G Nery
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Wenbin Li
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Department of Radiology, Functional and Molecular Imaging Key Laboratory of Sichuan Province, Huaxi MR Research Center, West China Hospital, Sichuan University, Sichuan, China
| | - Melissa P DelBello
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Jeffrey A Welge
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| |
Collapse
|
34
|
Associations between increased circulating endothelial progenitor cell levels and anxiety/depressive severity, cognitive deficit and function disability among patients with major depressive disorder. Sci Rep 2021; 11:18221. [PMID: 34521977 PMCID: PMC8440504 DOI: 10.1038/s41598-021-97853-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 05/31/2021] [Indexed: 12/11/2022] Open
Abstract
The association of major depressive disorder (MDD) with cardiovascular diseases (CVDs) through endothelial dysfunction is bidirectional. Circulating endothelial progenitor cells (cEPCs), essential for endothelial repair and function, are associated with risks of various CVDs. Here, the relationship of cEPC counts with MDD and the related clinical presentations were investigated in 50 patients with MDD and 46 healthy controls. In patients with MDD, a battery of clinical domains was analysed: depressed mood with Hamilton Depression Rating Scale (HAMD) and Montgomery–Åsberg Depression Rating Scale (MADRS), anxiety with Hamilton Anxiety Rating Scale (HAMA), cognitive dysfunction and deficit with Digit Symbol Substitution Test (DSST) and Perceived Deficits Questionnaire-Depression (PDQ-D), somatic symptoms with Depressive and Somatic Symptom Scale (DSSS), quality of life with 12-Item Short Form Health Survey (SF-12) and functional disability with Sheehan Disability Scale (SDS). Immature and mature cEPC counts were measured through flow cytometry. Increased mature and immature cEPC counts were significantly associated with higher anxiety after controlling the confounding effect of systolic blood pressure, and potentially associated with more severe depressive symptoms, worse cognitive performance and increased cognitive deficit, higher social disability, and worse mental health outcomes. Thus, cEPCs might have pleiotropic effects on MDD-associated symptoms and psychosocial outcomes.
Collapse
|
35
|
Kim TT, Xu C, Derubeis RJ. Patients' judgments of the importance of treatment-induced reductions in symptoms of depression: The role of specific symptoms, magnitudes of change, and post-treatment levels. Psychother Res 2021; 32:404-413. [PMID: 34121629 DOI: 10.1080/10503307.2021.1938731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Objective: An implicit assumption in the use of depressive severity measures to assess change during treatment, such as the Hamilton Rating Scale for Depression (HRSD), is that reductions from pre- to post-treatment that are equal to each other are of equal value. However, stakeholders' valuations of changes might depart substantially from this assumption. Method: Vignettes were constructed that reflected the six possible 1, 2, and 3-point reductions on five cognitive and four somatic symptoms derived from the HRSD. Former or currently depressed patients provided judgments of the importance of the symptom reductions. Mean importance ratings were modeled using symptom category and the pre/post-treatment combination. Differences were explored using the Tukey method. Results: Results indicated that mean ratings, from most to least important, were: Anxiety, Suicide, Depressed Mood, Work, and Guilt (the cognitive symptoms) followed by Somatic, Sleep, Appetite & Weight, and Retardation (the somatic symptoms). Participants valued reductions that resulted in posttreatment scores of zero more than expected, given the magnitude of the reductions. Conclusions: The value of reductions in symptoms captured by the HRSD, as judged by patients, appears to differ as a function of symptom category and the post-treatment score. Similar patterns might characterize other measures of depression severity.
Collapse
Affiliation(s)
- Thomas T Kim
- Department of Psychology, University of Pennsylvania, Philadelphia, PA, USA
| | - Colin Xu
- Department of Psychology, University of Pennsylvania, Philadelphia, PA, USA
| | - Robert J Derubeis
- Department of Psychology, University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
36
|
Yang Y, Li X, Chen S, Xiao M, Liu Z, Li J, Cheng Y. Mechanism and therapeutic strategies of depression after myocardial infarction. Psychopharmacology (Berl) 2021; 238:1401-1415. [PMID: 33594503 DOI: 10.1007/s00213-021-05784-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 02/04/2021] [Indexed: 01/08/2023]
Abstract
Depression resulted as an important factor associated with the myocardial infarction (MI) prognosis. Patients with MI also have a higher risk for developing depression. Although the issue of depression after MI has become a matter of clinical concern, the molecular mechanism underlying depression after MI remains unclear, whereby several strategies suggested have not got ideal effects, such as selective serotonin reuptake inhibitors. In this review, we summarized and discussed the occurrence mechanism of depression after MI, such as 5-hydroxytryptamine (5-HT) dysfunction, altered hypothalamus-pituitary-adrenal (HPA) axis function, gut microbiota imbalance, exosomal signal transduction, and inflammation. In addition, we offered a succinct overview of treatment, as well as some promising molecules especially from natural products for the treatment of depression after MI.
Collapse
Affiliation(s)
- Ying Yang
- Guangdong Key Laboratory for Translational Cancer Research of Chinese Medicine, Joint Laboratory for Translational Cancer Research of Chinese Medicine of the Ministry of Education of the People's Republic of China, International Institute for Translational Chinese Medicine, School of Pharmaceutical Science, Guangzhou University of Chinese Medicine, Guangzhou, 510006, Guangdong, China
| | - Xuping Li
- Guangdong Key Laboratory for Translational Cancer Research of Chinese Medicine, Joint Laboratory for Translational Cancer Research of Chinese Medicine of the Ministry of Education of the People's Republic of China, International Institute for Translational Chinese Medicine, School of Pharmaceutical Science, Guangzhou University of Chinese Medicine, Guangzhou, 510006, Guangdong, China
| | - Sixuan Chen
- Guangdong Key Laboratory for Translational Cancer Research of Chinese Medicine, Joint Laboratory for Translational Cancer Research of Chinese Medicine of the Ministry of Education of the People's Republic of China, International Institute for Translational Chinese Medicine, School of Pharmaceutical Science, Guangzhou University of Chinese Medicine, Guangzhou, 510006, Guangdong, China
| | - Mingzhu Xiao
- Guangdong Key Laboratory for Translational Cancer Research of Chinese Medicine, Joint Laboratory for Translational Cancer Research of Chinese Medicine of the Ministry of Education of the People's Republic of China, International Institute for Translational Chinese Medicine, School of Pharmaceutical Science, Guangzhou University of Chinese Medicine, Guangzhou, 510006, Guangdong, China
| | - Zhongqiu Liu
- Guangdong Key Laboratory for Translational Cancer Research of Chinese Medicine, Joint Laboratory for Translational Cancer Research of Chinese Medicine of the Ministry of Education of the People's Republic of China, International Institute for Translational Chinese Medicine, School of Pharmaceutical Science, Guangzhou University of Chinese Medicine, Guangzhou, 510006, Guangdong, China
| | - Jingyan Li
- Guangdong Key Laboratory for Translational Cancer Research of Chinese Medicine, Joint Laboratory for Translational Cancer Research of Chinese Medicine of the Ministry of Education of the People's Republic of China, International Institute for Translational Chinese Medicine, School of Pharmaceutical Science, Guangzhou University of Chinese Medicine, Guangzhou, 510006, Guangdong, China.
| | - Yuanyuan Cheng
- Guangdong Key Laboratory for Translational Cancer Research of Chinese Medicine, Joint Laboratory for Translational Cancer Research of Chinese Medicine of the Ministry of Education of the People's Republic of China, International Institute for Translational Chinese Medicine, School of Pharmaceutical Science, Guangzhou University of Chinese Medicine, Guangzhou, 510006, Guangdong, China.
| |
Collapse
|
37
|
Amoretti S, Verdolini N, Mezquida G, Rabelo-da-Ponte FD, Cuesta MJ, Pina-Camacho L, Gomez-Ramiro M, De-la-Cámara C, González-Pinto A, Díaz-Caneja CM, Corripio I, Vieta E, de la Serna E, Mané A, Solé B, Carvalho AF, Serra M, Bernardo M. Identifying clinical clusters with distinct trajectories in first-episode psychosis through an unsupervised machine learning technique. Eur Neuropsychopharmacol 2021; 47:112-129. [PMID: 33531261 DOI: 10.1016/j.euroneuro.2021.01.095] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 01/04/2021] [Accepted: 01/18/2021] [Indexed: 12/22/2022]
Abstract
The extreme variability in symptom presentation reveals that individuals diagnosed with a first-episode psychosis (FEP) may encompass different sub-populations with potentially different illness courses and, hence, different treatment needs. Previous studies have shown that sociodemographic and family environment factors are associated with more unfavorable symptom trajectories. The aim of this study was to examine the dimensional structure of symptoms and to identify individuals' trajectories at early stage of illness and potential risk factors associated with poor outcomes at follow-up in non-affective FEP. One hundred and forty-four non-affective FEP patients were assessed at baseline and at 2-year follow-up. A Principal component analysis has been conducted to identify dimensions, then an unsupervised machine learning technique (fuzzy clustering) was performed to identify clinical subgroups of patients. Six symptom factors were extracted (positive, negative, depressive, anxiety, disorganization and somatic/cognitive). Three distinct clinical clusters were determined at baseline: mild; negative and moderate; and positive and severe symptoms, and five at follow-up: minimal; mild; moderate; negative and depressive; and severe symptoms. Receiving a low-dose antipsychotic, having a more severe depressive symptomatology and a positive family history for psychiatric disorders were risk factors for poor recovery, whilst having a high cognitive reserve and better premorbid adjustment may confer a better prognosis. The current study provided a better understanding of the heterogeneous profile of FEP. Early identification of patients who could likely present poor outcomes may be an initial step for the development of targeted interventions to improve illness trajectories and preserve psychosocial functioning.
Collapse
Affiliation(s)
- Silvia Amoretti
- Barcelona Clinic Schizophrenia Unit, Hospital Clinic of Barcelona, August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Neuroscience Institute, University of Barcelona, Spain; Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Spain; Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, Institute of Neuroscience, IDIBAPS, CIBERSAM, 170 Villarroel st, 12-0, 08036, Barcelona, Catalonia, Spain
| | - Norma Verdolini
- Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Spain; Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, Institute of Neuroscience, IDIBAPS, CIBERSAM, 170 Villarroel st, 12-0, 08036, Barcelona, Catalonia, Spain
| | - Gisela Mezquida
- Barcelona Clinic Schizophrenia Unit, Hospital Clinic of Barcelona, August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Neuroscience Institute, University of Barcelona, Spain; Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Spain
| | | | - Manuel J Cuesta
- Department of Psychiatry, Complejo Hospitalario de Navarra, Pamplona, Spain; Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Laura Pina-Camacho
- Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Spain; Department of Child and Adolescent Psychiatry, Institute of Psychatry and Mental Health, Hospital General Universitario Gregorio Marañon, IiSGM, School of Medicine, Universidad Complutense, Madrid, Spain
| | - Marta Gomez-Ramiro
- Barcelona Clinic Schizophrenia Unit, Hospital Clinic of Barcelona, August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Neuroscience Institute, University of Barcelona, Spain
| | - Concepción De-la-Cámara
- Barcelona Clinic Schizophrenia Unit, Hospital Clinic of Barcelona, August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Neuroscience Institute, University of Barcelona, Spain; Hospital Clínico Universitario and Instituto de Investigación Sanitaria (IIS), Department of Medicine and Psychiatry. Universidad de Zaragoza, Zaragoza, Spain
| | - Ana González-Pinto
- Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Spain; Department of Psychiatry, Araba University Hospital, Bioaraba Research Institute, Department of Neurociences, University of the Basque Country, Vitoria, Spain
| | - Covadonga M Díaz-Caneja
- Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Spain; Department of Child and Adolescent Psychiatry, Institute of Psychatry and Mental Health, Hospital General Universitario Gregorio Marañon, IiSGM, School of Medicine, Universidad Complutense, Madrid, Spain
| | - Iluminada Corripio
- Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Spain; Psychiatry Department, Institut d'Investigació Biomèdica-Sant Pau (IIB-SANT PAU), Hospital de la Santa Creu i Sant Pau; Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Eduard Vieta
- Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Spain; Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, Institute of Neuroscience, IDIBAPS, CIBERSAM, 170 Villarroel st, 12-0, 08036, Barcelona, Catalonia, Spain.
| | - Elena de la Serna
- Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Spain; Department of Child and Adolescent Psychiatry and Psychology, Clínic Institute of Neurosciences, Hospital Clínic de Barcelona, 2017SGR881, University of Barcelona, IDIBAPS, Barcelona, Spain
| | - Anna Mané
- Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Spain; Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain; Autonomous University of Barcelona (UAB), Barcelona, Spain
| | - Brisa Solé
- Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Spain; Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, Institute of Neuroscience, IDIBAPS, CIBERSAM, 170 Villarroel st, 12-0, 08036, Barcelona, Catalonia, Spain
| | - André F Carvalho
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Maria Serra
- Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, Institute of Neuroscience, IDIBAPS, CIBERSAM, 170 Villarroel st, 12-0, 08036, Barcelona, Catalonia, Spain
| | - Miguel Bernardo
- Barcelona Clinic Schizophrenia Unit, Hospital Clinic of Barcelona, August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Neuroscience Institute, University of Barcelona, Spain; Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Spain
| |
Collapse
|
38
|
Thase ME, Harrington A, Calabrese J, Montgomery S, Niu X, Patel MD. Evaluation of MADRS severity thresholds in patients with bipolar depression. J Affect Disord 2021; 286:58-63. [PMID: 33677183 DOI: 10.1016/j.jad.2021.02.043] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 02/08/2021] [Accepted: 02/12/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND The Montgomery-Åsberg Depression Rating Scale (MADRS) is commonly used to assess depression symptom changes in clinical trials; however, the score itself can be difficult to interpret without clinical context. Categories of depression severity corresponding to MADRS total score have not been established for bipolar depression, which was the objective of this study. METHODS Data were pooled from 3 randomized, double-blind, placebo-controlled trials of cariprazine in patients with bipolar I depression; placebo and cariprazine arms were pooled. An anchor-based approach was used to map MADRS total score to the clinician-rated, 7-category Clinical Global Impression of Severity scale (CGI-S). Spearman's correlation coefficient was used to assess associations between MADRS total and CGI-S scores. Optimal MADRS severity thresholds for each CGI-S category was determined via Youden index using receiver operating characteristic (ROC) analyses. RESULTS Using data from 1523 patients with bipolar depression, mean MADRS total scores were positively correlated with mean CGI-S scores at week 6 (r = 0.87; P<.0001). Using ROC curves, MADRS severity thresholds corresponding to each CGI-S category were estimated with high sensitivity and specificity: 0-6 for "normal, not at all ill", 7-12 for "borderline mentally ill", 13-18 for "mildly ill", 19-23 for "moderately ill", 24-36 for "markedly ill", 37-39 for "severely ill", and ≥40 for "extremely ill". CONCLUSIONS Utilizing data from 3 clinical trials of patients with bipolar depression, MADRS severity thresholds were identified. These empirical findings may help clinicians contextualize MADRS results from bipolar clinical research and apply to their practice. TRIAL REGISTRATION clinicaltrials.gov NCT01396447, NCT02670538, NCT02670551.
Collapse
Affiliation(s)
| | | | - Joseph Calabrese
- University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | | | | | | |
Collapse
|
39
|
Kim H, Rhee SJ, Lee H, Han D, Lee TY, Kim M, Kim EY, Kwon JS, Shin H, Kim H, Ahn YM, Ha K. Identification of altered protein expression in major depressive disorder and bipolar disorder patients using liquid chromatography-tandem mass spectrometry. Psychiatry Res 2021; 299:113850. [PMID: 33711561 DOI: 10.1016/j.psychres.2021.113850] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 02/28/2021] [Indexed: 01/07/2023]
Abstract
Emerging high-throughput proteomic technologies have recently been considered as a powerful means of identifying substrates involved in mood disorders. We performed proteomic profiling using liquid chromatography-tandem mass spectrometry to identify dysregulated proteins in plasma samples of 42 and 45 patients with major depressive disorder (MDD) and bipolar disorder (BD), respectively, in comparison to 51 healthy controls (HCs). Fourteen and six proteins in MDD and BD patients, respectively, were differentially expressed compared to HCs, among which coagulation factor XIII A chain (F13A1), platelet basic protein (PPBP), platelet facor 4 (PF4), glyceraldehyde-3-phosphate dehydrogenase (GAPDH), and thymosin beta-4 (TMSB4X) were altered in both disorders. For proteins dysregulated in both, except F13A1, higher fold changes were observed in MDD than in BD patients. These findings may help identify candidate biomarkers of mood disorders and elucidate their underlying pathophysiology and biochemical abnormalities.
Collapse
Affiliation(s)
- Hyeyoung Kim
- Department of Psychiatry, Inha University Hospital, Incheon, Republic of Korea; Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sang Jin Rhee
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyunju Lee
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea
| | - Dohyun Han
- Proteomics Core Facility, Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
| | - Tae Young Lee
- Department of Neuropsychiatry, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Minah Kim
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Eun Young Kim
- Department of Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jun Soo Kwon
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea; Institute of Human Behavioral Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea; Department of Brain and Cognitive Sciences, College of Natural Sciences, Seoul National University, Seoul, Republic of Korea
| | - Hyunsuk Shin
- Proteomics Core Facility, Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyeyoon Kim
- Proteomics Core Facility, Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea; Department of Pathology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yong Min Ahn
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea; Institute of Human Behavioral Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea.
| | - Kyooseob Ha
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea; Institute of Human Behavioral Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea.
| |
Collapse
|
40
|
Dauwan M, Begemann MJH, Slot MIE, Lee EHM, Scheltens P, Sommer IEC. Physical exercise improves quality of life, depressive symptoms, and cognition across chronic brain disorders: a transdiagnostic systematic review and meta-analysis of randomized controlled trials. J Neurol 2021; 268:1222-1246. [PMID: 31414194 PMCID: PMC7990819 DOI: 10.1007/s00415-019-09493-9] [Citation(s) in RCA: 90] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 07/29/2019] [Accepted: 07/30/2019] [Indexed: 01/20/2023]
Abstract
We performed a meta-analysis to synthesize evidence on the efficacy and safety of physical exercise as an add-on therapeutic intervention for quality of life (QoL), depressive symptoms and cognition across six chronic brain disorders: Alzheimer's disease, Huntington's disease, multiple sclerosis, Parkinson's disease, schizophrenia and unipolar depression. 122 studies ( = k) (n = 7231) were included. Exercise was superior to treatment as usual in improving QoL (k = 64, n = 4334, ES = 0.40, p < 0.0001), depressive symptoms (k = 60, n = 2909, ES = 0.78, p < 0.0001), the cognitive domains attention and working memory (k = 21, n = 1313, ES = 0.24, p < 0.009), executive functioning (k = 14, n = 977, ES = 0.15, p = 0.013), memory (k = 12, n = 994, ES = 0.12, p = 0.038) and psychomotor speed (k = 16, n = 896, ES = 0.23, p = 0.003). Meta-regression showed a dose-response effect for exercise time (min/week) on depressive symptoms (β = 0.007, p = 0.012). 69% of the studies that reported on safety, found no complications. Exercise is an efficacious and safe add-on therapeutic intervention showing a medium-sized effect on QoL and a large effect on mood in patients with chronic brain disorders, with a positive dose-response correlation. Exercise also improved several cognitive domains with small but significant effects.
Collapse
Affiliation(s)
- Meenakshi Dauwan
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Postbus 85500, 3508 GA Utrecht, The Netherlands
- Department of Clinical Neurophysiology and MEG Center, Amsterdam UMC, VU University Medical Center Amsterdam, Neuroscience Campus, Postbus 7057, 1007 MB Amsterdam, The Netherlands
- Department of Biomedical Sciences of Cells and Systems Section, University of Groningen, University Medical Center Groningen, Neuroimaging Center 3111, Deusinglaan 2, 9713 AW Groningen, The Netherlands
| | - Marieke J. H. Begemann
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Postbus 85500, 3508 GA Utrecht, The Netherlands
| | - Margot I. E. Slot
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Postbus 85500, 3508 GA Utrecht, The Netherlands
| | - Edwin H. M. Lee
- Department of Psychiatry, 2/F, New Clinical Building, University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Philip Scheltens
- Alzheimer Center and Department of Neurology, Neuroscience Campus Amsterdam, VU University Medical Center, Postbus 7057, 1007 MB Amsterdam, The Netherlands
| | - Iris E. C. Sommer
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Postbus 85500, 3508 GA Utrecht, The Netherlands
- Department of Biomedical Sciences of Cells and Systems Section, University of Groningen, University Medical Center Groningen, Neuroimaging Center 3111, Deusinglaan 2, 9713 AW Groningen, The Netherlands
- Department of Biological and Medical Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway
| |
Collapse
|
41
|
Goldwaser EL, Daddario K, Aaronson ST. A retrospective analysis of bipolar depression treated with transcranial magnetic stimulation. Brain Behav 2020; 10:e01805. [PMID: 33169946 PMCID: PMC7749511 DOI: 10.1002/brb3.1805] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 07/22/2020] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Treatment options are limited for patients with bipolar depression. Antidepressants added to mood stabilizers even carry risks of precipitating mixed/manic episodes. Transcranial magnetic stimulation (TMS) may provide a safe and effective option for these patients. METHODS Database analysis of the TMS Service at Sheppard Pratt Health System identified patients with bipolar disorder type I (BD1) or II (BD2) in a pure depressive phase at initiation of TMS. Records were reviewed for response and remission rates based on MADRS scores, time to effect, and adverse events, notably treatment-emergent affective switching. All had failed at least two prior treatments for depression, were currently on at least one mood stabilizer and off antidepressants. Stimulation parameters targeted left dorsolateral prefrontal cortex: 120% motor threshold, 10 pulses per second (pps) × 4s, intertrain interval (ITI) 26s, 75 trains (37.5 min/session) for 3,000 pps total, 5 sessions/week for 30 total treatments, or until remission criteria were met. RESULTS A total of 44 patients with BD were identified, representing 15% of the total TMS population. 77% of those who completed a course of TMS met response criteria, and 41% of subjects who completed at least 25 treatments met remission criteria. Subjects with BD1 were more likely to respond, remit, or suffer an adverse event than those with BD2. No patient met clinical criteria for a manic/mixed episode, but four (10%) discontinued due to concerns of activation. CONCLUSIONS TMS is effective in the bipolar depressed population where episode focused intervention can be specifically offered. Risk of psychomotor agitation must be closely monitored.
Collapse
Affiliation(s)
- Eric L Goldwaser
- Department of Psychiatry, University of Maryland Medical Center and Sheppard Pratt Health System, Baltimore, Maryland, USA
| | - Kathy Daddario
- Clinical Research, Sheppard Pratt Health System, Baltimore, Maryland, USA
| | - Scott T Aaronson
- Clinical Research, Sheppard Pratt Health System, Baltimore, Maryland, USA
| |
Collapse
|
42
|
Application of antidepressants in depression: A systematic review and meta-analysis. J Clin Neurosci 2020; 80:169-181. [PMID: 33099342 DOI: 10.1016/j.jocn.2020.08.013] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 08/09/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND The type and quantities of antidepressants are increasing, but the efficacy and safety of first-line and emerging drugs vary between studies. In this article, we estimated the efficacy and safety of first-line and emerging antidepressants (anti-inflammatory drugs and ketamine). METHOD ystematic search of EMBASE, ERIC, MEDLINE, psycARTICLES, and psycINFO without language restriction for studies on the depression, depressive symptoms, antidepressants, fluoxetine (Prozac), paroxetine, escitalopram, sertraline, fluvoxamine, venlafaxine, duloxetine, NSAIDs, anti-cytokine drugs or pioglitazone published before May 1st, 2019. Information on study characteristics, depression or depressive symptoms, antidepressants and the descriptive statistics (including efficacy and safety of antidepressants) was extracted independently by 2 investigators. Estimates were pooled using random-effects meta-analysis. Differences by study-level characteristics were estimated using stratified meta-analysis and meta-regression. The response and remission of antidepressants were used as clinical evaluation indicators, and the evaluation criteria were clinical depression scales. OR value of antidepressants as assessed by meta-analysis. RESULTS The literature search retrieved 5529 potentially relevant articles of which 49 studies were finally included. We compared the efficacy of antidepressants (seven first-line antidepressants (fluoxetine, paroxetine, escitalopram, sertraline, fluvoxamine, venlafaxine, duloxetine), there kinds of anti-inflammatory drugs(NASIDs, cytokine-inhibitor, pioglitazone) and ketamine) by comparing the OR values. CONCLUSION The three drugs with the highest OR value in response were NASID (OR = 3.62(1.58, 8.32)), venlafaxin (OR = 3.50(1.83, 6.70)) and ketamine (OR = 3.28(1.89, 5.68)), while the highest OR value in remission were NASID (OR = 3.17(1.60, 6.29)), ketamine (OR = 2.99(1.58, 5.67)) and venlafaxin (OR = 2.55(1.72, 3.78)). Through reading the literature, we found 69 SNPs associated with depression. Major depression was a debilitating disorder that could ultimately lead to enormous societal and economical challenge [1]. The number of person which affected by depression was up to 16% of the population worldwide. More than 300 million individuals were estimated to suffer depression these days [1,2]. Therefore, it is apparent that safety and effective treatments for depression are necessary. In the 1930 s, the first drug for schizophrenia was discovered. This finding was a landmark for the emerging of biological psychiatry. In the 1950 s, pharmacologists had stumbled upon the antidepressant effect of imipramine. Since then, every 30 years, the use of antidepressants had made a pulsatile leap. Selective serotonin reuptake inhibitors (SSRIs) are the most widely-prescribed psychiatric drugs for the treatment of depression. However, the efficacy was variable and incomplete: 60%-70% of the patients do not experience remission, while 30%-40% do not show a significant response [3,4]. Nevertheless, SSRIs, SNRIs (selective serotonin-norepinephrine reuptake inhibitors, which can block norepinephrine at the same time) and NaSSAs (norepinephrine and selective serotonin receptor agonist), constituted the first-line clinical drugs. Nearly 30 years after the outbreak of SSRIs, antidepressants have ushered in a new chapter. It has been found that anti-inflammatory drugs could also have the small and moderate antidepressant effect and it's widely discussed [5]. More than 40 anti-inflammatory drugs have been certificated to have antidepressant effects in preclinical and clinical studies [6]. The antidepressant that has been approved for use recently is ketamine. There is no comprehensive comparison of the efficacy of all these drugs. In this review, we tried to estimate the efficacy and safety of first-line antidepressants, anti-inflammatory drugs and ketamine. On the other hand, with the development of GWAS, SNPs related to depression have been reported, and the corresponding mechanisms have been elaborated, respectively. However, patients with these SNPs have not been treated with individualized drugs according to the mechanisms. We hope to push this process forward through the summary of this article. METHODS Search Strategy and Study Eligibility.
Collapse
|
43
|
Ntini I, Vadlin S, Olofsdotter S, Ramklint M, Nilsson KW, Engström I, Sonnby K. The Montgomery and Åsberg Depression Rating Scale - self-assessment for use in adolescents: an evaluation of psychometric and diagnostic accuracy. Nord J Psychiatry 2020; 74:415-422. [PMID: 32125211 DOI: 10.1080/08039488.2020.1733077] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Background: The Montgomery-Åsberg Depression Rating Scale - Self Assessment (MADRS-S) is used to assess symptom severity in major depressive disorder (MDD) among adolescents, but its psychometric properties and diagnostic accuracy are unclear.Aim: The aim of this study was to explore psychometric properties, including diagnostic accuracy, of the MADRS-S in adolescent psychiatric outpatients.Method: Adolescent psychiatric outpatients (N = 105, mean age 16 years, 46 boys) completed the MADRS-S and were interviewed using the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children (K-SADS).Results: In principal component analysis, two components with eigenvalues of 4.6 and 1.3 explained 51.1% and 14.4% of the variance, respectively. On the first component loaded items assessing Mood, Feelings of unease, Appetite, Initiative, Pessimism, and Zest for life. On the second component loaded items assessing Sleep, Ability to concentrate, and Emotional involvement. Cronbach's alpha (internal consistency) for all items was 0.87. Spearman's rho was 0.68 for concurrent validity (correlation between total MADRS-S-score and K-SADS MDD severity score). In receiver-operating characteristic analysis, the area under the curve was 0.86 (95% confidence interval 0.78-0.93, p < .001). For all the participants, the highest combined sensitivity and specificity were reached using cut-offs of 15 and 16 (sensitivity 0.82, specificity 0.86). Optimizing sensitivity for MDD, with specificity still ≥0.5, cut off for all was 9, for boys 7 and for girls 10.Conclusion: Psychometric properties of MADRS-S showed good reliability and validity as well as satisfying diagnostic accuracy, indicating good to excellent properties for MDD screening of adolescent psychiatric patients.
Collapse
Affiliation(s)
- I Ntini
- University Health Care Research Center, Faculty of Medicine and Health, Universitetssjukvårdens forskningscentrum (UFC), Örebro University, Örebro, Sweden
| | - S Vadlin
- Center for Clinical Research, Uppsala University, County of Västmanland, Hospital of Region Västmanland, Västerås, Sweden
| | - S Olofsdotter
- Center for Clinical Research, Uppsala University, County of Västmanland, Hospital of Region Västmanland, Västerås, Sweden
| | - M Ramklint
- Psychiatry - Department of Neuroscience, Uppsala University, Uppsala, Sweden
| | - K W Nilsson
- Center for Clinical Research, Uppsala University, County of Västmanland, Hospital of Region Västmanland, Västerås, Sweden
| | - I Engström
- University Health Care Research Center, Faculty of Medicine and Health, Universitetssjukvårdens forskningscentrum (UFC), Örebro University, Örebro, Sweden
| | - K Sonnby
- Center for Clinical Research, Uppsala University, County of Västmanland, Hospital of Region Västmanland, Västerås, Sweden
| |
Collapse
|
44
|
Vaccarino AL, Kalali AH, Blier P, Gilbert Evans S, Engelhardt N, Foster JA, Frey BN, Greist JH, Kobak KA, Lam RW, MacQueen G, Milev R, Müller DJ, Parikh SV, Placenza FM, Rizvi SJ, Rotzinger S, Sheehan DV, Sills T, Soares CN, Turecki G, Uher R, Williams JBW, Kennedy SH, Evans KR. THE DEPRESSION INVENTORY DEVELOPMENT SCALE: Assessment of Psychometric Properties Using Classical and Modern Measurement Theory in a CAN-BIND Trial. INNOVATIONS IN CLINICAL NEUROSCIENCE 2020; 17:30-40. [PMID: 33520402 PMCID: PMC7839654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Objective: The goal of the Depression Inventory Development (DID) project is to develop a comprehensive and psychometrically sound rating scale for major depressive disorder (MDD) that reflects current diagnostic criteria and conceptualizations of depression. We report here the evaluation of the current DID item bank using Classical Test Theory (CTT), Item Response Theory (IRT) and Rasch Measurement Theory (RMT). Methods: The present study was part of a larger multisite, open-label study conducted by the Canadian Biomarker Integration Network in Depression (ClinicalTrials.gov: NCT01655706). Trained raters administered the 32 DID items at each of two visits (MDD: baseline, n=211 and Week 8, n=177; healthy participants: baseline, n=112 and Week 8, n=104). The DID's "grid" structure operationalizes intensity and frequency of each item, with clear symptom definitions and a structured interview guide, with the current iteration assessing symptoms related to anhedonia, cognition, fatigue, general malaise, motivation, anxiety, negative thinking, pain, and appetite. Participants were also administered the Montgomery- Åsberg Depression Rating Scale (MADRS) and Quick Inventory of Depressive Symptomatology-Self-Report (QIDS-SR) that allowed DID items to be evaluated against existing "benchmark" items. CTT was used to assess data quality/reliability (i.e., missing data, skewness, scoring frequency, internal consistency), IRT to assess individual item performance by modelling an item's ability to discriminate levels of depressive severity (as assessed by the MADRS), and RMT to assess how the items perform together as a scale to capture a range of depressive severity (item targeting). These analyses together provided empirical evidence to base decisions on which DID items to remove, modify, or advance. Results: Of the 32 DID items evaluated, eight items were identified by CTT as problematic, displaying low variability in the range of responses, floor effects, and/or skewness; and four items were identified by IRT to show poor discriminative properties that would limit their clinical utility. Five additional items were deemed to be redundant. The remaining 15 DID items all fit the Rasch model, with person and item difficulty estimates indicating satisfactory item targeting, with lower precision in participants with mild levels of depression. These 15 DID items also showed good internal consistency (alpha=0.95 and inter-item correlations ranging from r=0.49 to r=0.84) and all items were sensitive to change following antidepressant treatment (baseline vs. Week 8). RMT revealed problematic item targeting for the MADRS and QIDSSR, including an absence of MADRS items targeting participants with mild/moderate depression and an absence of QIDS-SR items targeting participants with mild or severe depression. Conclusion: The present study applied CTT, IRT, and RMT to assess the measurement properties of the DID items and identify those that should be advanced, modified, or removed. Of the 32 items evaluated, 15 items showed good measurement properties. These items (along with previously evaluated items) will provide the basis for validation of a penultimate DID scale assessing anhedonia, cognitive slowing, concentration, executive function, recent memory, drive, emotional fatigue, guilt, self-esteem, hopelessness, tension, rumination, irritability, reduced appetite, insomnia, sadness, worry, suicidality, and depressed mood. The strategies adopted by the DID process provide a framework for rating scale development and validation.
Collapse
Affiliation(s)
- Anthony L Vaccarino
- Drs. Vaccarino, Evans and Gilbert Evans are with Indoc Research in Toronto, Ontario, Canada
- Dr Kalali is with the International Society for CNS Drug Development in San Diego, California
- Dr. Blier is with the Departments of Psychiatry and Cellular & Molecular Medicine at the University of Ottawa Institute of Mental Health Research in Ottawa, Ontario, Canada
- Dr. Engelhardt is with Intra-Cellular Therapies in New York, New York
- Dr. Foster is with Department of Psychiatry & Behavioural Neurosciences at McMaster University in Hamilton, Ontario, Canada
- Dr. Frey is with the Department of Psychiatry and Behavioural Neurosciences at McMaster University and Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare in Hamilton, Ontario, Canada
- Dr. Greist is with the Department of Psychiatry at the University of Wisconsin School of Medicine and Public Health in Madison, Wisconsin
- Dr. Kobak is with the Center for Telepsychology in Madison, Wisconsin
- Dr. Lam is with the Department of Psychiatry at the University of British Columbia in Vancouver, British Columbia, Canada
- Dr. MacQueen is with Mathison Centre for Mental Health Research and Education at the Department of Psychiatry, University of Calgary in Calgary, Alberta, Canada
- Dr. Milev is with the Department of Psychiatry and the Department of Psychology, and Centre for Neuroscience Studies at Queen's University in Kingston, Ontario, Canada
- Dr. Müller is with the Centre for Addiction and Mental Health and the Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada. Parikh is with the Department of Psychiatry at the University of Michigan in Ann Arbor, Michigan
- Dr. Placenza is with the Department of Psychiatry at the Krembil Research Centre, University Health Network, University of Toronto in Toronto, Ontario, Canada
- Dr. Rizvi is with Arthur Sommer Rotenberg Program for Suicide and Depression Studies at St. Michael's Hospital in Toronto, Ontario, Canada
- Dr. Rotzinger is with St. Michael's Hospital (Unity Health Toronto) and Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada
- Dr. Sheehan is with the University of South Florida College of Medicine in Tampa, Florida
- Dr. Sills was with OCBN in Toronto, Ontario, Canada
- Dr. Soares is with the Department of Psychiatry at Queen's University and Providence Care Hospital in Kingston, Ontario, Canada
- Dr. Turecki is with the Department of Psychiatry at McGill University in Montreal, Quebec, Canada
- Dr. Uher is with the Department of Psychiatry at Dalhousie University in Halifax, Nova Scotia, Canada
- Dr. Williams is with the Departments of Psychiatry and Neurology at Columbia University in New York, New York
- Dr. Kennedy is with the Department of Psychiatry at the University of Toronto and Centre for Depression and Suicide, St. Michael's Hospital in Toronto, Ontario, Canada
| | - Amir H Kalali
- Drs. Vaccarino, Evans and Gilbert Evans are with Indoc Research in Toronto, Ontario, Canada
- Dr Kalali is with the International Society for CNS Drug Development in San Diego, California
- Dr. Blier is with the Departments of Psychiatry and Cellular & Molecular Medicine at the University of Ottawa Institute of Mental Health Research in Ottawa, Ontario, Canada
- Dr. Engelhardt is with Intra-Cellular Therapies in New York, New York
- Dr. Foster is with Department of Psychiatry & Behavioural Neurosciences at McMaster University in Hamilton, Ontario, Canada
- Dr. Frey is with the Department of Psychiatry and Behavioural Neurosciences at McMaster University and Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare in Hamilton, Ontario, Canada
- Dr. Greist is with the Department of Psychiatry at the University of Wisconsin School of Medicine and Public Health in Madison, Wisconsin
- Dr. Kobak is with the Center for Telepsychology in Madison, Wisconsin
- Dr. Lam is with the Department of Psychiatry at the University of British Columbia in Vancouver, British Columbia, Canada
- Dr. MacQueen is with Mathison Centre for Mental Health Research and Education at the Department of Psychiatry, University of Calgary in Calgary, Alberta, Canada
- Dr. Milev is with the Department of Psychiatry and the Department of Psychology, and Centre for Neuroscience Studies at Queen's University in Kingston, Ontario, Canada
- Dr. Müller is with the Centre for Addiction and Mental Health and the Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada. Parikh is with the Department of Psychiatry at the University of Michigan in Ann Arbor, Michigan
- Dr. Placenza is with the Department of Psychiatry at the Krembil Research Centre, University Health Network, University of Toronto in Toronto, Ontario, Canada
- Dr. Rizvi is with Arthur Sommer Rotenberg Program for Suicide and Depression Studies at St. Michael's Hospital in Toronto, Ontario, Canada
- Dr. Rotzinger is with St. Michael's Hospital (Unity Health Toronto) and Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada
- Dr. Sheehan is with the University of South Florida College of Medicine in Tampa, Florida
- Dr. Sills was with OCBN in Toronto, Ontario, Canada
- Dr. Soares is with the Department of Psychiatry at Queen's University and Providence Care Hospital in Kingston, Ontario, Canada
- Dr. Turecki is with the Department of Psychiatry at McGill University in Montreal, Quebec, Canada
- Dr. Uher is with the Department of Psychiatry at Dalhousie University in Halifax, Nova Scotia, Canada
- Dr. Williams is with the Departments of Psychiatry and Neurology at Columbia University in New York, New York
- Dr. Kennedy is with the Department of Psychiatry at the University of Toronto and Centre for Depression and Suicide, St. Michael's Hospital in Toronto, Ontario, Canada
| | - Pierre Blier
- Drs. Vaccarino, Evans and Gilbert Evans are with Indoc Research in Toronto, Ontario, Canada
- Dr Kalali is with the International Society for CNS Drug Development in San Diego, California
- Dr. Blier is with the Departments of Psychiatry and Cellular & Molecular Medicine at the University of Ottawa Institute of Mental Health Research in Ottawa, Ontario, Canada
- Dr. Engelhardt is with Intra-Cellular Therapies in New York, New York
- Dr. Foster is with Department of Psychiatry & Behavioural Neurosciences at McMaster University in Hamilton, Ontario, Canada
- Dr. Frey is with the Department of Psychiatry and Behavioural Neurosciences at McMaster University and Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare in Hamilton, Ontario, Canada
- Dr. Greist is with the Department of Psychiatry at the University of Wisconsin School of Medicine and Public Health in Madison, Wisconsin
- Dr. Kobak is with the Center for Telepsychology in Madison, Wisconsin
- Dr. Lam is with the Department of Psychiatry at the University of British Columbia in Vancouver, British Columbia, Canada
- Dr. MacQueen is with Mathison Centre for Mental Health Research and Education at the Department of Psychiatry, University of Calgary in Calgary, Alberta, Canada
- Dr. Milev is with the Department of Psychiatry and the Department of Psychology, and Centre for Neuroscience Studies at Queen's University in Kingston, Ontario, Canada
- Dr. Müller is with the Centre for Addiction and Mental Health and the Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada. Parikh is with the Department of Psychiatry at the University of Michigan in Ann Arbor, Michigan
- Dr. Placenza is with the Department of Psychiatry at the Krembil Research Centre, University Health Network, University of Toronto in Toronto, Ontario, Canada
- Dr. Rizvi is with Arthur Sommer Rotenberg Program for Suicide and Depression Studies at St. Michael's Hospital in Toronto, Ontario, Canada
- Dr. Rotzinger is with St. Michael's Hospital (Unity Health Toronto) and Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada
- Dr. Sheehan is with the University of South Florida College of Medicine in Tampa, Florida
- Dr. Sills was with OCBN in Toronto, Ontario, Canada
- Dr. Soares is with the Department of Psychiatry at Queen's University and Providence Care Hospital in Kingston, Ontario, Canada
- Dr. Turecki is with the Department of Psychiatry at McGill University in Montreal, Quebec, Canada
- Dr. Uher is with the Department of Psychiatry at Dalhousie University in Halifax, Nova Scotia, Canada
- Dr. Williams is with the Departments of Psychiatry and Neurology at Columbia University in New York, New York
- Dr. Kennedy is with the Department of Psychiatry at the University of Toronto and Centre for Depression and Suicide, St. Michael's Hospital in Toronto, Ontario, Canada
| | - Susan Gilbert Evans
- Drs. Vaccarino, Evans and Gilbert Evans are with Indoc Research in Toronto, Ontario, Canada
- Dr Kalali is with the International Society for CNS Drug Development in San Diego, California
- Dr. Blier is with the Departments of Psychiatry and Cellular & Molecular Medicine at the University of Ottawa Institute of Mental Health Research in Ottawa, Ontario, Canada
- Dr. Engelhardt is with Intra-Cellular Therapies in New York, New York
- Dr. Foster is with Department of Psychiatry & Behavioural Neurosciences at McMaster University in Hamilton, Ontario, Canada
- Dr. Frey is with the Department of Psychiatry and Behavioural Neurosciences at McMaster University and Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare in Hamilton, Ontario, Canada
- Dr. Greist is with the Department of Psychiatry at the University of Wisconsin School of Medicine and Public Health in Madison, Wisconsin
- Dr. Kobak is with the Center for Telepsychology in Madison, Wisconsin
- Dr. Lam is with the Department of Psychiatry at the University of British Columbia in Vancouver, British Columbia, Canada
- Dr. MacQueen is with Mathison Centre for Mental Health Research and Education at the Department of Psychiatry, University of Calgary in Calgary, Alberta, Canada
- Dr. Milev is with the Department of Psychiatry and the Department of Psychology, and Centre for Neuroscience Studies at Queen's University in Kingston, Ontario, Canada
- Dr. Müller is with the Centre for Addiction and Mental Health and the Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada. Parikh is with the Department of Psychiatry at the University of Michigan in Ann Arbor, Michigan
- Dr. Placenza is with the Department of Psychiatry at the Krembil Research Centre, University Health Network, University of Toronto in Toronto, Ontario, Canada
- Dr. Rizvi is with Arthur Sommer Rotenberg Program for Suicide and Depression Studies at St. Michael's Hospital in Toronto, Ontario, Canada
- Dr. Rotzinger is with St. Michael's Hospital (Unity Health Toronto) and Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada
- Dr. Sheehan is with the University of South Florida College of Medicine in Tampa, Florida
- Dr. Sills was with OCBN in Toronto, Ontario, Canada
- Dr. Soares is with the Department of Psychiatry at Queen's University and Providence Care Hospital in Kingston, Ontario, Canada
- Dr. Turecki is with the Department of Psychiatry at McGill University in Montreal, Quebec, Canada
- Dr. Uher is with the Department of Psychiatry at Dalhousie University in Halifax, Nova Scotia, Canada
- Dr. Williams is with the Departments of Psychiatry and Neurology at Columbia University in New York, New York
- Dr. Kennedy is with the Department of Psychiatry at the University of Toronto and Centre for Depression and Suicide, St. Michael's Hospital in Toronto, Ontario, Canada
| | - Nina Engelhardt
- Drs. Vaccarino, Evans and Gilbert Evans are with Indoc Research in Toronto, Ontario, Canada
- Dr Kalali is with the International Society for CNS Drug Development in San Diego, California
- Dr. Blier is with the Departments of Psychiatry and Cellular & Molecular Medicine at the University of Ottawa Institute of Mental Health Research in Ottawa, Ontario, Canada
- Dr. Engelhardt is with Intra-Cellular Therapies in New York, New York
- Dr. Foster is with Department of Psychiatry & Behavioural Neurosciences at McMaster University in Hamilton, Ontario, Canada
- Dr. Frey is with the Department of Psychiatry and Behavioural Neurosciences at McMaster University and Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare in Hamilton, Ontario, Canada
- Dr. Greist is with the Department of Psychiatry at the University of Wisconsin School of Medicine and Public Health in Madison, Wisconsin
- Dr. Kobak is with the Center for Telepsychology in Madison, Wisconsin
- Dr. Lam is with the Department of Psychiatry at the University of British Columbia in Vancouver, British Columbia, Canada
- Dr. MacQueen is with Mathison Centre for Mental Health Research and Education at the Department of Psychiatry, University of Calgary in Calgary, Alberta, Canada
- Dr. Milev is with the Department of Psychiatry and the Department of Psychology, and Centre for Neuroscience Studies at Queen's University in Kingston, Ontario, Canada
- Dr. Müller is with the Centre for Addiction and Mental Health and the Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada. Parikh is with the Department of Psychiatry at the University of Michigan in Ann Arbor, Michigan
- Dr. Placenza is with the Department of Psychiatry at the Krembil Research Centre, University Health Network, University of Toronto in Toronto, Ontario, Canada
- Dr. Rizvi is with Arthur Sommer Rotenberg Program for Suicide and Depression Studies at St. Michael's Hospital in Toronto, Ontario, Canada
- Dr. Rotzinger is with St. Michael's Hospital (Unity Health Toronto) and Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada
- Dr. Sheehan is with the University of South Florida College of Medicine in Tampa, Florida
- Dr. Sills was with OCBN in Toronto, Ontario, Canada
- Dr. Soares is with the Department of Psychiatry at Queen's University and Providence Care Hospital in Kingston, Ontario, Canada
- Dr. Turecki is with the Department of Psychiatry at McGill University in Montreal, Quebec, Canada
- Dr. Uher is with the Department of Psychiatry at Dalhousie University in Halifax, Nova Scotia, Canada
- Dr. Williams is with the Departments of Psychiatry and Neurology at Columbia University in New York, New York
- Dr. Kennedy is with the Department of Psychiatry at the University of Toronto and Centre for Depression and Suicide, St. Michael's Hospital in Toronto, Ontario, Canada
| | - Jane A Foster
- Drs. Vaccarino, Evans and Gilbert Evans are with Indoc Research in Toronto, Ontario, Canada
- Dr Kalali is with the International Society for CNS Drug Development in San Diego, California
- Dr. Blier is with the Departments of Psychiatry and Cellular & Molecular Medicine at the University of Ottawa Institute of Mental Health Research in Ottawa, Ontario, Canada
- Dr. Engelhardt is with Intra-Cellular Therapies in New York, New York
- Dr. Foster is with Department of Psychiatry & Behavioural Neurosciences at McMaster University in Hamilton, Ontario, Canada
- Dr. Frey is with the Department of Psychiatry and Behavioural Neurosciences at McMaster University and Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare in Hamilton, Ontario, Canada
- Dr. Greist is with the Department of Psychiatry at the University of Wisconsin School of Medicine and Public Health in Madison, Wisconsin
- Dr. Kobak is with the Center for Telepsychology in Madison, Wisconsin
- Dr. Lam is with the Department of Psychiatry at the University of British Columbia in Vancouver, British Columbia, Canada
- Dr. MacQueen is with Mathison Centre for Mental Health Research and Education at the Department of Psychiatry, University of Calgary in Calgary, Alberta, Canada
- Dr. Milev is with the Department of Psychiatry and the Department of Psychology, and Centre for Neuroscience Studies at Queen's University in Kingston, Ontario, Canada
- Dr. Müller is with the Centre for Addiction and Mental Health and the Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada. Parikh is with the Department of Psychiatry at the University of Michigan in Ann Arbor, Michigan
- Dr. Placenza is with the Department of Psychiatry at the Krembil Research Centre, University Health Network, University of Toronto in Toronto, Ontario, Canada
- Dr. Rizvi is with Arthur Sommer Rotenberg Program for Suicide and Depression Studies at St. Michael's Hospital in Toronto, Ontario, Canada
- Dr. Rotzinger is with St. Michael's Hospital (Unity Health Toronto) and Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada
- Dr. Sheehan is with the University of South Florida College of Medicine in Tampa, Florida
- Dr. Sills was with OCBN in Toronto, Ontario, Canada
- Dr. Soares is with the Department of Psychiatry at Queen's University and Providence Care Hospital in Kingston, Ontario, Canada
- Dr. Turecki is with the Department of Psychiatry at McGill University in Montreal, Quebec, Canada
- Dr. Uher is with the Department of Psychiatry at Dalhousie University in Halifax, Nova Scotia, Canada
- Dr. Williams is with the Departments of Psychiatry and Neurology at Columbia University in New York, New York
- Dr. Kennedy is with the Department of Psychiatry at the University of Toronto and Centre for Depression and Suicide, St. Michael's Hospital in Toronto, Ontario, Canada
| | - Benicio N Frey
- Drs. Vaccarino, Evans and Gilbert Evans are with Indoc Research in Toronto, Ontario, Canada
- Dr Kalali is with the International Society for CNS Drug Development in San Diego, California
- Dr. Blier is with the Departments of Psychiatry and Cellular & Molecular Medicine at the University of Ottawa Institute of Mental Health Research in Ottawa, Ontario, Canada
- Dr. Engelhardt is with Intra-Cellular Therapies in New York, New York
- Dr. Foster is with Department of Psychiatry & Behavioural Neurosciences at McMaster University in Hamilton, Ontario, Canada
- Dr. Frey is with the Department of Psychiatry and Behavioural Neurosciences at McMaster University and Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare in Hamilton, Ontario, Canada
- Dr. Greist is with the Department of Psychiatry at the University of Wisconsin School of Medicine and Public Health in Madison, Wisconsin
- Dr. Kobak is with the Center for Telepsychology in Madison, Wisconsin
- Dr. Lam is with the Department of Psychiatry at the University of British Columbia in Vancouver, British Columbia, Canada
- Dr. MacQueen is with Mathison Centre for Mental Health Research and Education at the Department of Psychiatry, University of Calgary in Calgary, Alberta, Canada
- Dr. Milev is with the Department of Psychiatry and the Department of Psychology, and Centre for Neuroscience Studies at Queen's University in Kingston, Ontario, Canada
- Dr. Müller is with the Centre for Addiction and Mental Health and the Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada. Parikh is with the Department of Psychiatry at the University of Michigan in Ann Arbor, Michigan
- Dr. Placenza is with the Department of Psychiatry at the Krembil Research Centre, University Health Network, University of Toronto in Toronto, Ontario, Canada
- Dr. Rizvi is with Arthur Sommer Rotenberg Program for Suicide and Depression Studies at St. Michael's Hospital in Toronto, Ontario, Canada
- Dr. Rotzinger is with St. Michael's Hospital (Unity Health Toronto) and Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada
- Dr. Sheehan is with the University of South Florida College of Medicine in Tampa, Florida
- Dr. Sills was with OCBN in Toronto, Ontario, Canada
- Dr. Soares is with the Department of Psychiatry at Queen's University and Providence Care Hospital in Kingston, Ontario, Canada
- Dr. Turecki is with the Department of Psychiatry at McGill University in Montreal, Quebec, Canada
- Dr. Uher is with the Department of Psychiatry at Dalhousie University in Halifax, Nova Scotia, Canada
- Dr. Williams is with the Departments of Psychiatry and Neurology at Columbia University in New York, New York
- Dr. Kennedy is with the Department of Psychiatry at the University of Toronto and Centre for Depression and Suicide, St. Michael's Hospital in Toronto, Ontario, Canada
| | - John H Greist
- Drs. Vaccarino, Evans and Gilbert Evans are with Indoc Research in Toronto, Ontario, Canada
- Dr Kalali is with the International Society for CNS Drug Development in San Diego, California
- Dr. Blier is with the Departments of Psychiatry and Cellular & Molecular Medicine at the University of Ottawa Institute of Mental Health Research in Ottawa, Ontario, Canada
- Dr. Engelhardt is with Intra-Cellular Therapies in New York, New York
- Dr. Foster is with Department of Psychiatry & Behavioural Neurosciences at McMaster University in Hamilton, Ontario, Canada
- Dr. Frey is with the Department of Psychiatry and Behavioural Neurosciences at McMaster University and Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare in Hamilton, Ontario, Canada
- Dr. Greist is with the Department of Psychiatry at the University of Wisconsin School of Medicine and Public Health in Madison, Wisconsin
- Dr. Kobak is with the Center for Telepsychology in Madison, Wisconsin
- Dr. Lam is with the Department of Psychiatry at the University of British Columbia in Vancouver, British Columbia, Canada
- Dr. MacQueen is with Mathison Centre for Mental Health Research and Education at the Department of Psychiatry, University of Calgary in Calgary, Alberta, Canada
- Dr. Milev is with the Department of Psychiatry and the Department of Psychology, and Centre for Neuroscience Studies at Queen's University in Kingston, Ontario, Canada
- Dr. Müller is with the Centre for Addiction and Mental Health and the Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada. Parikh is with the Department of Psychiatry at the University of Michigan in Ann Arbor, Michigan
- Dr. Placenza is with the Department of Psychiatry at the Krembil Research Centre, University Health Network, University of Toronto in Toronto, Ontario, Canada
- Dr. Rizvi is with Arthur Sommer Rotenberg Program for Suicide and Depression Studies at St. Michael's Hospital in Toronto, Ontario, Canada
- Dr. Rotzinger is with St. Michael's Hospital (Unity Health Toronto) and Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada
- Dr. Sheehan is with the University of South Florida College of Medicine in Tampa, Florida
- Dr. Sills was with OCBN in Toronto, Ontario, Canada
- Dr. Soares is with the Department of Psychiatry at Queen's University and Providence Care Hospital in Kingston, Ontario, Canada
- Dr. Turecki is with the Department of Psychiatry at McGill University in Montreal, Quebec, Canada
- Dr. Uher is with the Department of Psychiatry at Dalhousie University in Halifax, Nova Scotia, Canada
- Dr. Williams is with the Departments of Psychiatry and Neurology at Columbia University in New York, New York
- Dr. Kennedy is with the Department of Psychiatry at the University of Toronto and Centre for Depression and Suicide, St. Michael's Hospital in Toronto, Ontario, Canada
| | - Kenneth A Kobak
- Drs. Vaccarino, Evans and Gilbert Evans are with Indoc Research in Toronto, Ontario, Canada
- Dr Kalali is with the International Society for CNS Drug Development in San Diego, California
- Dr. Blier is with the Departments of Psychiatry and Cellular & Molecular Medicine at the University of Ottawa Institute of Mental Health Research in Ottawa, Ontario, Canada
- Dr. Engelhardt is with Intra-Cellular Therapies in New York, New York
- Dr. Foster is with Department of Psychiatry & Behavioural Neurosciences at McMaster University in Hamilton, Ontario, Canada
- Dr. Frey is with the Department of Psychiatry and Behavioural Neurosciences at McMaster University and Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare in Hamilton, Ontario, Canada
- Dr. Greist is with the Department of Psychiatry at the University of Wisconsin School of Medicine and Public Health in Madison, Wisconsin
- Dr. Kobak is with the Center for Telepsychology in Madison, Wisconsin
- Dr. Lam is with the Department of Psychiatry at the University of British Columbia in Vancouver, British Columbia, Canada
- Dr. MacQueen is with Mathison Centre for Mental Health Research and Education at the Department of Psychiatry, University of Calgary in Calgary, Alberta, Canada
- Dr. Milev is with the Department of Psychiatry and the Department of Psychology, and Centre for Neuroscience Studies at Queen's University in Kingston, Ontario, Canada
- Dr. Müller is with the Centre for Addiction and Mental Health and the Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada. Parikh is with the Department of Psychiatry at the University of Michigan in Ann Arbor, Michigan
- Dr. Placenza is with the Department of Psychiatry at the Krembil Research Centre, University Health Network, University of Toronto in Toronto, Ontario, Canada
- Dr. Rizvi is with Arthur Sommer Rotenberg Program for Suicide and Depression Studies at St. Michael's Hospital in Toronto, Ontario, Canada
- Dr. Rotzinger is with St. Michael's Hospital (Unity Health Toronto) and Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada
- Dr. Sheehan is with the University of South Florida College of Medicine in Tampa, Florida
- Dr. Sills was with OCBN in Toronto, Ontario, Canada
- Dr. Soares is with the Department of Psychiatry at Queen's University and Providence Care Hospital in Kingston, Ontario, Canada
- Dr. Turecki is with the Department of Psychiatry at McGill University in Montreal, Quebec, Canada
- Dr. Uher is with the Department of Psychiatry at Dalhousie University in Halifax, Nova Scotia, Canada
- Dr. Williams is with the Departments of Psychiatry and Neurology at Columbia University in New York, New York
- Dr. Kennedy is with the Department of Psychiatry at the University of Toronto and Centre for Depression and Suicide, St. Michael's Hospital in Toronto, Ontario, Canada
| | - Raymond W Lam
- Drs. Vaccarino, Evans and Gilbert Evans are with Indoc Research in Toronto, Ontario, Canada
- Dr Kalali is with the International Society for CNS Drug Development in San Diego, California
- Dr. Blier is with the Departments of Psychiatry and Cellular & Molecular Medicine at the University of Ottawa Institute of Mental Health Research in Ottawa, Ontario, Canada
- Dr. Engelhardt is with Intra-Cellular Therapies in New York, New York
- Dr. Foster is with Department of Psychiatry & Behavioural Neurosciences at McMaster University in Hamilton, Ontario, Canada
- Dr. Frey is with the Department of Psychiatry and Behavioural Neurosciences at McMaster University and Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare in Hamilton, Ontario, Canada
- Dr. Greist is with the Department of Psychiatry at the University of Wisconsin School of Medicine and Public Health in Madison, Wisconsin
- Dr. Kobak is with the Center for Telepsychology in Madison, Wisconsin
- Dr. Lam is with the Department of Psychiatry at the University of British Columbia in Vancouver, British Columbia, Canada
- Dr. MacQueen is with Mathison Centre for Mental Health Research and Education at the Department of Psychiatry, University of Calgary in Calgary, Alberta, Canada
- Dr. Milev is with the Department of Psychiatry and the Department of Psychology, and Centre for Neuroscience Studies at Queen's University in Kingston, Ontario, Canada
- Dr. Müller is with the Centre for Addiction and Mental Health and the Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada. Parikh is with the Department of Psychiatry at the University of Michigan in Ann Arbor, Michigan
- Dr. Placenza is with the Department of Psychiatry at the Krembil Research Centre, University Health Network, University of Toronto in Toronto, Ontario, Canada
- Dr. Rizvi is with Arthur Sommer Rotenberg Program for Suicide and Depression Studies at St. Michael's Hospital in Toronto, Ontario, Canada
- Dr. Rotzinger is with St. Michael's Hospital (Unity Health Toronto) and Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada
- Dr. Sheehan is with the University of South Florida College of Medicine in Tampa, Florida
- Dr. Sills was with OCBN in Toronto, Ontario, Canada
- Dr. Soares is with the Department of Psychiatry at Queen's University and Providence Care Hospital in Kingston, Ontario, Canada
- Dr. Turecki is with the Department of Psychiatry at McGill University in Montreal, Quebec, Canada
- Dr. Uher is with the Department of Psychiatry at Dalhousie University in Halifax, Nova Scotia, Canada
- Dr. Williams is with the Departments of Psychiatry and Neurology at Columbia University in New York, New York
- Dr. Kennedy is with the Department of Psychiatry at the University of Toronto and Centre for Depression and Suicide, St. Michael's Hospital in Toronto, Ontario, Canada
| | - Glenda MacQueen
- Drs. Vaccarino, Evans and Gilbert Evans are with Indoc Research in Toronto, Ontario, Canada
- Dr Kalali is with the International Society for CNS Drug Development in San Diego, California
- Dr. Blier is with the Departments of Psychiatry and Cellular & Molecular Medicine at the University of Ottawa Institute of Mental Health Research in Ottawa, Ontario, Canada
- Dr. Engelhardt is with Intra-Cellular Therapies in New York, New York
- Dr. Foster is with Department of Psychiatry & Behavioural Neurosciences at McMaster University in Hamilton, Ontario, Canada
- Dr. Frey is with the Department of Psychiatry and Behavioural Neurosciences at McMaster University and Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare in Hamilton, Ontario, Canada
- Dr. Greist is with the Department of Psychiatry at the University of Wisconsin School of Medicine and Public Health in Madison, Wisconsin
- Dr. Kobak is with the Center for Telepsychology in Madison, Wisconsin
- Dr. Lam is with the Department of Psychiatry at the University of British Columbia in Vancouver, British Columbia, Canada
- Dr. MacQueen is with Mathison Centre for Mental Health Research and Education at the Department of Psychiatry, University of Calgary in Calgary, Alberta, Canada
- Dr. Milev is with the Department of Psychiatry and the Department of Psychology, and Centre for Neuroscience Studies at Queen's University in Kingston, Ontario, Canada
- Dr. Müller is with the Centre for Addiction and Mental Health and the Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada. Parikh is with the Department of Psychiatry at the University of Michigan in Ann Arbor, Michigan
- Dr. Placenza is with the Department of Psychiatry at the Krembil Research Centre, University Health Network, University of Toronto in Toronto, Ontario, Canada
- Dr. Rizvi is with Arthur Sommer Rotenberg Program for Suicide and Depression Studies at St. Michael's Hospital in Toronto, Ontario, Canada
- Dr. Rotzinger is with St. Michael's Hospital (Unity Health Toronto) and Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada
- Dr. Sheehan is with the University of South Florida College of Medicine in Tampa, Florida
- Dr. Sills was with OCBN in Toronto, Ontario, Canada
- Dr. Soares is with the Department of Psychiatry at Queen's University and Providence Care Hospital in Kingston, Ontario, Canada
- Dr. Turecki is with the Department of Psychiatry at McGill University in Montreal, Quebec, Canada
- Dr. Uher is with the Department of Psychiatry at Dalhousie University in Halifax, Nova Scotia, Canada
- Dr. Williams is with the Departments of Psychiatry and Neurology at Columbia University in New York, New York
- Dr. Kennedy is with the Department of Psychiatry at the University of Toronto and Centre for Depression and Suicide, St. Michael's Hospital in Toronto, Ontario, Canada
| | - Roumen Milev
- Drs. Vaccarino, Evans and Gilbert Evans are with Indoc Research in Toronto, Ontario, Canada
- Dr Kalali is with the International Society for CNS Drug Development in San Diego, California
- Dr. Blier is with the Departments of Psychiatry and Cellular & Molecular Medicine at the University of Ottawa Institute of Mental Health Research in Ottawa, Ontario, Canada
- Dr. Engelhardt is with Intra-Cellular Therapies in New York, New York
- Dr. Foster is with Department of Psychiatry & Behavioural Neurosciences at McMaster University in Hamilton, Ontario, Canada
- Dr. Frey is with the Department of Psychiatry and Behavioural Neurosciences at McMaster University and Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare in Hamilton, Ontario, Canada
- Dr. Greist is with the Department of Psychiatry at the University of Wisconsin School of Medicine and Public Health in Madison, Wisconsin
- Dr. Kobak is with the Center for Telepsychology in Madison, Wisconsin
- Dr. Lam is with the Department of Psychiatry at the University of British Columbia in Vancouver, British Columbia, Canada
- Dr. MacQueen is with Mathison Centre for Mental Health Research and Education at the Department of Psychiatry, University of Calgary in Calgary, Alberta, Canada
- Dr. Milev is with the Department of Psychiatry and the Department of Psychology, and Centre for Neuroscience Studies at Queen's University in Kingston, Ontario, Canada
- Dr. Müller is with the Centre for Addiction and Mental Health and the Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada. Parikh is with the Department of Psychiatry at the University of Michigan in Ann Arbor, Michigan
- Dr. Placenza is with the Department of Psychiatry at the Krembil Research Centre, University Health Network, University of Toronto in Toronto, Ontario, Canada
- Dr. Rizvi is with Arthur Sommer Rotenberg Program for Suicide and Depression Studies at St. Michael's Hospital in Toronto, Ontario, Canada
- Dr. Rotzinger is with St. Michael's Hospital (Unity Health Toronto) and Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada
- Dr. Sheehan is with the University of South Florida College of Medicine in Tampa, Florida
- Dr. Sills was with OCBN in Toronto, Ontario, Canada
- Dr. Soares is with the Department of Psychiatry at Queen's University and Providence Care Hospital in Kingston, Ontario, Canada
- Dr. Turecki is with the Department of Psychiatry at McGill University in Montreal, Quebec, Canada
- Dr. Uher is with the Department of Psychiatry at Dalhousie University in Halifax, Nova Scotia, Canada
- Dr. Williams is with the Departments of Psychiatry and Neurology at Columbia University in New York, New York
- Dr. Kennedy is with the Department of Psychiatry at the University of Toronto and Centre for Depression and Suicide, St. Michael's Hospital in Toronto, Ontario, Canada
| | - Daniel J Müller
- Drs. Vaccarino, Evans and Gilbert Evans are with Indoc Research in Toronto, Ontario, Canada
- Dr Kalali is with the International Society for CNS Drug Development in San Diego, California
- Dr. Blier is with the Departments of Psychiatry and Cellular & Molecular Medicine at the University of Ottawa Institute of Mental Health Research in Ottawa, Ontario, Canada
- Dr. Engelhardt is with Intra-Cellular Therapies in New York, New York
- Dr. Foster is with Department of Psychiatry & Behavioural Neurosciences at McMaster University in Hamilton, Ontario, Canada
- Dr. Frey is with the Department of Psychiatry and Behavioural Neurosciences at McMaster University and Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare in Hamilton, Ontario, Canada
- Dr. Greist is with the Department of Psychiatry at the University of Wisconsin School of Medicine and Public Health in Madison, Wisconsin
- Dr. Kobak is with the Center for Telepsychology in Madison, Wisconsin
- Dr. Lam is with the Department of Psychiatry at the University of British Columbia in Vancouver, British Columbia, Canada
- Dr. MacQueen is with Mathison Centre for Mental Health Research and Education at the Department of Psychiatry, University of Calgary in Calgary, Alberta, Canada
- Dr. Milev is with the Department of Psychiatry and the Department of Psychology, and Centre for Neuroscience Studies at Queen's University in Kingston, Ontario, Canada
- Dr. Müller is with the Centre for Addiction and Mental Health and the Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada. Parikh is with the Department of Psychiatry at the University of Michigan in Ann Arbor, Michigan
- Dr. Placenza is with the Department of Psychiatry at the Krembil Research Centre, University Health Network, University of Toronto in Toronto, Ontario, Canada
- Dr. Rizvi is with Arthur Sommer Rotenberg Program for Suicide and Depression Studies at St. Michael's Hospital in Toronto, Ontario, Canada
- Dr. Rotzinger is with St. Michael's Hospital (Unity Health Toronto) and Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada
- Dr. Sheehan is with the University of South Florida College of Medicine in Tampa, Florida
- Dr. Sills was with OCBN in Toronto, Ontario, Canada
- Dr. Soares is with the Department of Psychiatry at Queen's University and Providence Care Hospital in Kingston, Ontario, Canada
- Dr. Turecki is with the Department of Psychiatry at McGill University in Montreal, Quebec, Canada
- Dr. Uher is with the Department of Psychiatry at Dalhousie University in Halifax, Nova Scotia, Canada
- Dr. Williams is with the Departments of Psychiatry and Neurology at Columbia University in New York, New York
- Dr. Kennedy is with the Department of Psychiatry at the University of Toronto and Centre for Depression and Suicide, St. Michael's Hospital in Toronto, Ontario, Canada
| | - Sagar V Parikh
- Drs. Vaccarino, Evans and Gilbert Evans are with Indoc Research in Toronto, Ontario, Canada
- Dr Kalali is with the International Society for CNS Drug Development in San Diego, California
- Dr. Blier is with the Departments of Psychiatry and Cellular & Molecular Medicine at the University of Ottawa Institute of Mental Health Research in Ottawa, Ontario, Canada
- Dr. Engelhardt is with Intra-Cellular Therapies in New York, New York
- Dr. Foster is with Department of Psychiatry & Behavioural Neurosciences at McMaster University in Hamilton, Ontario, Canada
- Dr. Frey is with the Department of Psychiatry and Behavioural Neurosciences at McMaster University and Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare in Hamilton, Ontario, Canada
- Dr. Greist is with the Department of Psychiatry at the University of Wisconsin School of Medicine and Public Health in Madison, Wisconsin
- Dr. Kobak is with the Center for Telepsychology in Madison, Wisconsin
- Dr. Lam is with the Department of Psychiatry at the University of British Columbia in Vancouver, British Columbia, Canada
- Dr. MacQueen is with Mathison Centre for Mental Health Research and Education at the Department of Psychiatry, University of Calgary in Calgary, Alberta, Canada
- Dr. Milev is with the Department of Psychiatry and the Department of Psychology, and Centre for Neuroscience Studies at Queen's University in Kingston, Ontario, Canada
- Dr. Müller is with the Centre for Addiction and Mental Health and the Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada. Parikh is with the Department of Psychiatry at the University of Michigan in Ann Arbor, Michigan
- Dr. Placenza is with the Department of Psychiatry at the Krembil Research Centre, University Health Network, University of Toronto in Toronto, Ontario, Canada
- Dr. Rizvi is with Arthur Sommer Rotenberg Program for Suicide and Depression Studies at St. Michael's Hospital in Toronto, Ontario, Canada
- Dr. Rotzinger is with St. Michael's Hospital (Unity Health Toronto) and Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada
- Dr. Sheehan is with the University of South Florida College of Medicine in Tampa, Florida
- Dr. Sills was with OCBN in Toronto, Ontario, Canada
- Dr. Soares is with the Department of Psychiatry at Queen's University and Providence Care Hospital in Kingston, Ontario, Canada
- Dr. Turecki is with the Department of Psychiatry at McGill University in Montreal, Quebec, Canada
- Dr. Uher is with the Department of Psychiatry at Dalhousie University in Halifax, Nova Scotia, Canada
- Dr. Williams is with the Departments of Psychiatry and Neurology at Columbia University in New York, New York
- Dr. Kennedy is with the Department of Psychiatry at the University of Toronto and Centre for Depression and Suicide, St. Michael's Hospital in Toronto, Ontario, Canada
| | - Franca M Placenza
- Drs. Vaccarino, Evans and Gilbert Evans are with Indoc Research in Toronto, Ontario, Canada
- Dr Kalali is with the International Society for CNS Drug Development in San Diego, California
- Dr. Blier is with the Departments of Psychiatry and Cellular & Molecular Medicine at the University of Ottawa Institute of Mental Health Research in Ottawa, Ontario, Canada
- Dr. Engelhardt is with Intra-Cellular Therapies in New York, New York
- Dr. Foster is with Department of Psychiatry & Behavioural Neurosciences at McMaster University in Hamilton, Ontario, Canada
- Dr. Frey is with the Department of Psychiatry and Behavioural Neurosciences at McMaster University and Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare in Hamilton, Ontario, Canada
- Dr. Greist is with the Department of Psychiatry at the University of Wisconsin School of Medicine and Public Health in Madison, Wisconsin
- Dr. Kobak is with the Center for Telepsychology in Madison, Wisconsin
- Dr. Lam is with the Department of Psychiatry at the University of British Columbia in Vancouver, British Columbia, Canada
- Dr. MacQueen is with Mathison Centre for Mental Health Research and Education at the Department of Psychiatry, University of Calgary in Calgary, Alberta, Canada
- Dr. Milev is with the Department of Psychiatry and the Department of Psychology, and Centre for Neuroscience Studies at Queen's University in Kingston, Ontario, Canada
- Dr. Müller is with the Centre for Addiction and Mental Health and the Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada. Parikh is with the Department of Psychiatry at the University of Michigan in Ann Arbor, Michigan
- Dr. Placenza is with the Department of Psychiatry at the Krembil Research Centre, University Health Network, University of Toronto in Toronto, Ontario, Canada
- Dr. Rizvi is with Arthur Sommer Rotenberg Program for Suicide and Depression Studies at St. Michael's Hospital in Toronto, Ontario, Canada
- Dr. Rotzinger is with St. Michael's Hospital (Unity Health Toronto) and Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada
- Dr. Sheehan is with the University of South Florida College of Medicine in Tampa, Florida
- Dr. Sills was with OCBN in Toronto, Ontario, Canada
- Dr. Soares is with the Department of Psychiatry at Queen's University and Providence Care Hospital in Kingston, Ontario, Canada
- Dr. Turecki is with the Department of Psychiatry at McGill University in Montreal, Quebec, Canada
- Dr. Uher is with the Department of Psychiatry at Dalhousie University in Halifax, Nova Scotia, Canada
- Dr. Williams is with the Departments of Psychiatry and Neurology at Columbia University in New York, New York
- Dr. Kennedy is with the Department of Psychiatry at the University of Toronto and Centre for Depression and Suicide, St. Michael's Hospital in Toronto, Ontario, Canada
| | - Sakina J Rizvi
- Drs. Vaccarino, Evans and Gilbert Evans are with Indoc Research in Toronto, Ontario, Canada
- Dr Kalali is with the International Society for CNS Drug Development in San Diego, California
- Dr. Blier is with the Departments of Psychiatry and Cellular & Molecular Medicine at the University of Ottawa Institute of Mental Health Research in Ottawa, Ontario, Canada
- Dr. Engelhardt is with Intra-Cellular Therapies in New York, New York
- Dr. Foster is with Department of Psychiatry & Behavioural Neurosciences at McMaster University in Hamilton, Ontario, Canada
- Dr. Frey is with the Department of Psychiatry and Behavioural Neurosciences at McMaster University and Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare in Hamilton, Ontario, Canada
- Dr. Greist is with the Department of Psychiatry at the University of Wisconsin School of Medicine and Public Health in Madison, Wisconsin
- Dr. Kobak is with the Center for Telepsychology in Madison, Wisconsin
- Dr. Lam is with the Department of Psychiatry at the University of British Columbia in Vancouver, British Columbia, Canada
- Dr. MacQueen is with Mathison Centre for Mental Health Research and Education at the Department of Psychiatry, University of Calgary in Calgary, Alberta, Canada
- Dr. Milev is with the Department of Psychiatry and the Department of Psychology, and Centre for Neuroscience Studies at Queen's University in Kingston, Ontario, Canada
- Dr. Müller is with the Centre for Addiction and Mental Health and the Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada. Parikh is with the Department of Psychiatry at the University of Michigan in Ann Arbor, Michigan
- Dr. Placenza is with the Department of Psychiatry at the Krembil Research Centre, University Health Network, University of Toronto in Toronto, Ontario, Canada
- Dr. Rizvi is with Arthur Sommer Rotenberg Program for Suicide and Depression Studies at St. Michael's Hospital in Toronto, Ontario, Canada
- Dr. Rotzinger is with St. Michael's Hospital (Unity Health Toronto) and Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada
- Dr. Sheehan is with the University of South Florida College of Medicine in Tampa, Florida
- Dr. Sills was with OCBN in Toronto, Ontario, Canada
- Dr. Soares is with the Department of Psychiatry at Queen's University and Providence Care Hospital in Kingston, Ontario, Canada
- Dr. Turecki is with the Department of Psychiatry at McGill University in Montreal, Quebec, Canada
- Dr. Uher is with the Department of Psychiatry at Dalhousie University in Halifax, Nova Scotia, Canada
- Dr. Williams is with the Departments of Psychiatry and Neurology at Columbia University in New York, New York
- Dr. Kennedy is with the Department of Psychiatry at the University of Toronto and Centre for Depression and Suicide, St. Michael's Hospital in Toronto, Ontario, Canada
| | - Susan Rotzinger
- Drs. Vaccarino, Evans and Gilbert Evans are with Indoc Research in Toronto, Ontario, Canada
- Dr Kalali is with the International Society for CNS Drug Development in San Diego, California
- Dr. Blier is with the Departments of Psychiatry and Cellular & Molecular Medicine at the University of Ottawa Institute of Mental Health Research in Ottawa, Ontario, Canada
- Dr. Engelhardt is with Intra-Cellular Therapies in New York, New York
- Dr. Foster is with Department of Psychiatry & Behavioural Neurosciences at McMaster University in Hamilton, Ontario, Canada
- Dr. Frey is with the Department of Psychiatry and Behavioural Neurosciences at McMaster University and Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare in Hamilton, Ontario, Canada
- Dr. Greist is with the Department of Psychiatry at the University of Wisconsin School of Medicine and Public Health in Madison, Wisconsin
- Dr. Kobak is with the Center for Telepsychology in Madison, Wisconsin
- Dr. Lam is with the Department of Psychiatry at the University of British Columbia in Vancouver, British Columbia, Canada
- Dr. MacQueen is with Mathison Centre for Mental Health Research and Education at the Department of Psychiatry, University of Calgary in Calgary, Alberta, Canada
- Dr. Milev is with the Department of Psychiatry and the Department of Psychology, and Centre for Neuroscience Studies at Queen's University in Kingston, Ontario, Canada
- Dr. Müller is with the Centre for Addiction and Mental Health and the Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada. Parikh is with the Department of Psychiatry at the University of Michigan in Ann Arbor, Michigan
- Dr. Placenza is with the Department of Psychiatry at the Krembil Research Centre, University Health Network, University of Toronto in Toronto, Ontario, Canada
- Dr. Rizvi is with Arthur Sommer Rotenberg Program for Suicide and Depression Studies at St. Michael's Hospital in Toronto, Ontario, Canada
- Dr. Rotzinger is with St. Michael's Hospital (Unity Health Toronto) and Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada
- Dr. Sheehan is with the University of South Florida College of Medicine in Tampa, Florida
- Dr. Sills was with OCBN in Toronto, Ontario, Canada
- Dr. Soares is with the Department of Psychiatry at Queen's University and Providence Care Hospital in Kingston, Ontario, Canada
- Dr. Turecki is with the Department of Psychiatry at McGill University in Montreal, Quebec, Canada
- Dr. Uher is with the Department of Psychiatry at Dalhousie University in Halifax, Nova Scotia, Canada
- Dr. Williams is with the Departments of Psychiatry and Neurology at Columbia University in New York, New York
- Dr. Kennedy is with the Department of Psychiatry at the University of Toronto and Centre for Depression and Suicide, St. Michael's Hospital in Toronto, Ontario, Canada
| | - David V Sheehan
- Drs. Vaccarino, Evans and Gilbert Evans are with Indoc Research in Toronto, Ontario, Canada
- Dr Kalali is with the International Society for CNS Drug Development in San Diego, California
- Dr. Blier is with the Departments of Psychiatry and Cellular & Molecular Medicine at the University of Ottawa Institute of Mental Health Research in Ottawa, Ontario, Canada
- Dr. Engelhardt is with Intra-Cellular Therapies in New York, New York
- Dr. Foster is with Department of Psychiatry & Behavioural Neurosciences at McMaster University in Hamilton, Ontario, Canada
- Dr. Frey is with the Department of Psychiatry and Behavioural Neurosciences at McMaster University and Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare in Hamilton, Ontario, Canada
- Dr. Greist is with the Department of Psychiatry at the University of Wisconsin School of Medicine and Public Health in Madison, Wisconsin
- Dr. Kobak is with the Center for Telepsychology in Madison, Wisconsin
- Dr. Lam is with the Department of Psychiatry at the University of British Columbia in Vancouver, British Columbia, Canada
- Dr. MacQueen is with Mathison Centre for Mental Health Research and Education at the Department of Psychiatry, University of Calgary in Calgary, Alberta, Canada
- Dr. Milev is with the Department of Psychiatry and the Department of Psychology, and Centre for Neuroscience Studies at Queen's University in Kingston, Ontario, Canada
- Dr. Müller is with the Centre for Addiction and Mental Health and the Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada. Parikh is with the Department of Psychiatry at the University of Michigan in Ann Arbor, Michigan
- Dr. Placenza is with the Department of Psychiatry at the Krembil Research Centre, University Health Network, University of Toronto in Toronto, Ontario, Canada
- Dr. Rizvi is with Arthur Sommer Rotenberg Program for Suicide and Depression Studies at St. Michael's Hospital in Toronto, Ontario, Canada
- Dr. Rotzinger is with St. Michael's Hospital (Unity Health Toronto) and Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada
- Dr. Sheehan is with the University of South Florida College of Medicine in Tampa, Florida
- Dr. Sills was with OCBN in Toronto, Ontario, Canada
- Dr. Soares is with the Department of Psychiatry at Queen's University and Providence Care Hospital in Kingston, Ontario, Canada
- Dr. Turecki is with the Department of Psychiatry at McGill University in Montreal, Quebec, Canada
- Dr. Uher is with the Department of Psychiatry at Dalhousie University in Halifax, Nova Scotia, Canada
- Dr. Williams is with the Departments of Psychiatry and Neurology at Columbia University in New York, New York
- Dr. Kennedy is with the Department of Psychiatry at the University of Toronto and Centre for Depression and Suicide, St. Michael's Hospital in Toronto, Ontario, Canada
| | - Terrence Sills
- Drs. Vaccarino, Evans and Gilbert Evans are with Indoc Research in Toronto, Ontario, Canada
- Dr Kalali is with the International Society for CNS Drug Development in San Diego, California
- Dr. Blier is with the Departments of Psychiatry and Cellular & Molecular Medicine at the University of Ottawa Institute of Mental Health Research in Ottawa, Ontario, Canada
- Dr. Engelhardt is with Intra-Cellular Therapies in New York, New York
- Dr. Foster is with Department of Psychiatry & Behavioural Neurosciences at McMaster University in Hamilton, Ontario, Canada
- Dr. Frey is with the Department of Psychiatry and Behavioural Neurosciences at McMaster University and Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare in Hamilton, Ontario, Canada
- Dr. Greist is with the Department of Psychiatry at the University of Wisconsin School of Medicine and Public Health in Madison, Wisconsin
- Dr. Kobak is with the Center for Telepsychology in Madison, Wisconsin
- Dr. Lam is with the Department of Psychiatry at the University of British Columbia in Vancouver, British Columbia, Canada
- Dr. MacQueen is with Mathison Centre for Mental Health Research and Education at the Department of Psychiatry, University of Calgary in Calgary, Alberta, Canada
- Dr. Milev is with the Department of Psychiatry and the Department of Psychology, and Centre for Neuroscience Studies at Queen's University in Kingston, Ontario, Canada
- Dr. Müller is with the Centre for Addiction and Mental Health and the Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada. Parikh is with the Department of Psychiatry at the University of Michigan in Ann Arbor, Michigan
- Dr. Placenza is with the Department of Psychiatry at the Krembil Research Centre, University Health Network, University of Toronto in Toronto, Ontario, Canada
- Dr. Rizvi is with Arthur Sommer Rotenberg Program for Suicide and Depression Studies at St. Michael's Hospital in Toronto, Ontario, Canada
- Dr. Rotzinger is with St. Michael's Hospital (Unity Health Toronto) and Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada
- Dr. Sheehan is with the University of South Florida College of Medicine in Tampa, Florida
- Dr. Sills was with OCBN in Toronto, Ontario, Canada
- Dr. Soares is with the Department of Psychiatry at Queen's University and Providence Care Hospital in Kingston, Ontario, Canada
- Dr. Turecki is with the Department of Psychiatry at McGill University in Montreal, Quebec, Canada
- Dr. Uher is with the Department of Psychiatry at Dalhousie University in Halifax, Nova Scotia, Canada
- Dr. Williams is with the Departments of Psychiatry and Neurology at Columbia University in New York, New York
- Dr. Kennedy is with the Department of Psychiatry at the University of Toronto and Centre for Depression and Suicide, St. Michael's Hospital in Toronto, Ontario, Canada
| | - Claudio N Soares
- Drs. Vaccarino, Evans and Gilbert Evans are with Indoc Research in Toronto, Ontario, Canada
- Dr Kalali is with the International Society for CNS Drug Development in San Diego, California
- Dr. Blier is with the Departments of Psychiatry and Cellular & Molecular Medicine at the University of Ottawa Institute of Mental Health Research in Ottawa, Ontario, Canada
- Dr. Engelhardt is with Intra-Cellular Therapies in New York, New York
- Dr. Foster is with Department of Psychiatry & Behavioural Neurosciences at McMaster University in Hamilton, Ontario, Canada
- Dr. Frey is with the Department of Psychiatry and Behavioural Neurosciences at McMaster University and Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare in Hamilton, Ontario, Canada
- Dr. Greist is with the Department of Psychiatry at the University of Wisconsin School of Medicine and Public Health in Madison, Wisconsin
- Dr. Kobak is with the Center for Telepsychology in Madison, Wisconsin
- Dr. Lam is with the Department of Psychiatry at the University of British Columbia in Vancouver, British Columbia, Canada
- Dr. MacQueen is with Mathison Centre for Mental Health Research and Education at the Department of Psychiatry, University of Calgary in Calgary, Alberta, Canada
- Dr. Milev is with the Department of Psychiatry and the Department of Psychology, and Centre for Neuroscience Studies at Queen's University in Kingston, Ontario, Canada
- Dr. Müller is with the Centre for Addiction and Mental Health and the Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada. Parikh is with the Department of Psychiatry at the University of Michigan in Ann Arbor, Michigan
- Dr. Placenza is with the Department of Psychiatry at the Krembil Research Centre, University Health Network, University of Toronto in Toronto, Ontario, Canada
- Dr. Rizvi is with Arthur Sommer Rotenberg Program for Suicide and Depression Studies at St. Michael's Hospital in Toronto, Ontario, Canada
- Dr. Rotzinger is with St. Michael's Hospital (Unity Health Toronto) and Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada
- Dr. Sheehan is with the University of South Florida College of Medicine in Tampa, Florida
- Dr. Sills was with OCBN in Toronto, Ontario, Canada
- Dr. Soares is with the Department of Psychiatry at Queen's University and Providence Care Hospital in Kingston, Ontario, Canada
- Dr. Turecki is with the Department of Psychiatry at McGill University in Montreal, Quebec, Canada
- Dr. Uher is with the Department of Psychiatry at Dalhousie University in Halifax, Nova Scotia, Canada
- Dr. Williams is with the Departments of Psychiatry and Neurology at Columbia University in New York, New York
- Dr. Kennedy is with the Department of Psychiatry at the University of Toronto and Centre for Depression and Suicide, St. Michael's Hospital in Toronto, Ontario, Canada
| | - Gustavo Turecki
- Drs. Vaccarino, Evans and Gilbert Evans are with Indoc Research in Toronto, Ontario, Canada
- Dr Kalali is with the International Society for CNS Drug Development in San Diego, California
- Dr. Blier is with the Departments of Psychiatry and Cellular & Molecular Medicine at the University of Ottawa Institute of Mental Health Research in Ottawa, Ontario, Canada
- Dr. Engelhardt is with Intra-Cellular Therapies in New York, New York
- Dr. Foster is with Department of Psychiatry & Behavioural Neurosciences at McMaster University in Hamilton, Ontario, Canada
- Dr. Frey is with the Department of Psychiatry and Behavioural Neurosciences at McMaster University and Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare in Hamilton, Ontario, Canada
- Dr. Greist is with the Department of Psychiatry at the University of Wisconsin School of Medicine and Public Health in Madison, Wisconsin
- Dr. Kobak is with the Center for Telepsychology in Madison, Wisconsin
- Dr. Lam is with the Department of Psychiatry at the University of British Columbia in Vancouver, British Columbia, Canada
- Dr. MacQueen is with Mathison Centre for Mental Health Research and Education at the Department of Psychiatry, University of Calgary in Calgary, Alberta, Canada
- Dr. Milev is with the Department of Psychiatry and the Department of Psychology, and Centre for Neuroscience Studies at Queen's University in Kingston, Ontario, Canada
- Dr. Müller is with the Centre for Addiction and Mental Health and the Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada. Parikh is with the Department of Psychiatry at the University of Michigan in Ann Arbor, Michigan
- Dr. Placenza is with the Department of Psychiatry at the Krembil Research Centre, University Health Network, University of Toronto in Toronto, Ontario, Canada
- Dr. Rizvi is with Arthur Sommer Rotenberg Program for Suicide and Depression Studies at St. Michael's Hospital in Toronto, Ontario, Canada
- Dr. Rotzinger is with St. Michael's Hospital (Unity Health Toronto) and Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada
- Dr. Sheehan is with the University of South Florida College of Medicine in Tampa, Florida
- Dr. Sills was with OCBN in Toronto, Ontario, Canada
- Dr. Soares is with the Department of Psychiatry at Queen's University and Providence Care Hospital in Kingston, Ontario, Canada
- Dr. Turecki is with the Department of Psychiatry at McGill University in Montreal, Quebec, Canada
- Dr. Uher is with the Department of Psychiatry at Dalhousie University in Halifax, Nova Scotia, Canada
- Dr. Williams is with the Departments of Psychiatry and Neurology at Columbia University in New York, New York
- Dr. Kennedy is with the Department of Psychiatry at the University of Toronto and Centre for Depression and Suicide, St. Michael's Hospital in Toronto, Ontario, Canada
| | - Rudolph Uher
- Drs. Vaccarino, Evans and Gilbert Evans are with Indoc Research in Toronto, Ontario, Canada
- Dr Kalali is with the International Society for CNS Drug Development in San Diego, California
- Dr. Blier is with the Departments of Psychiatry and Cellular & Molecular Medicine at the University of Ottawa Institute of Mental Health Research in Ottawa, Ontario, Canada
- Dr. Engelhardt is with Intra-Cellular Therapies in New York, New York
- Dr. Foster is with Department of Psychiatry & Behavioural Neurosciences at McMaster University in Hamilton, Ontario, Canada
- Dr. Frey is with the Department of Psychiatry and Behavioural Neurosciences at McMaster University and Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare in Hamilton, Ontario, Canada
- Dr. Greist is with the Department of Psychiatry at the University of Wisconsin School of Medicine and Public Health in Madison, Wisconsin
- Dr. Kobak is with the Center for Telepsychology in Madison, Wisconsin
- Dr. Lam is with the Department of Psychiatry at the University of British Columbia in Vancouver, British Columbia, Canada
- Dr. MacQueen is with Mathison Centre for Mental Health Research and Education at the Department of Psychiatry, University of Calgary in Calgary, Alberta, Canada
- Dr. Milev is with the Department of Psychiatry and the Department of Psychology, and Centre for Neuroscience Studies at Queen's University in Kingston, Ontario, Canada
- Dr. Müller is with the Centre for Addiction and Mental Health and the Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada. Parikh is with the Department of Psychiatry at the University of Michigan in Ann Arbor, Michigan
- Dr. Placenza is with the Department of Psychiatry at the Krembil Research Centre, University Health Network, University of Toronto in Toronto, Ontario, Canada
- Dr. Rizvi is with Arthur Sommer Rotenberg Program for Suicide and Depression Studies at St. Michael's Hospital in Toronto, Ontario, Canada
- Dr. Rotzinger is with St. Michael's Hospital (Unity Health Toronto) and Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada
- Dr. Sheehan is with the University of South Florida College of Medicine in Tampa, Florida
- Dr. Sills was with OCBN in Toronto, Ontario, Canada
- Dr. Soares is with the Department of Psychiatry at Queen's University and Providence Care Hospital in Kingston, Ontario, Canada
- Dr. Turecki is with the Department of Psychiatry at McGill University in Montreal, Quebec, Canada
- Dr. Uher is with the Department of Psychiatry at Dalhousie University in Halifax, Nova Scotia, Canada
- Dr. Williams is with the Departments of Psychiatry and Neurology at Columbia University in New York, New York
- Dr. Kennedy is with the Department of Psychiatry at the University of Toronto and Centre for Depression and Suicide, St. Michael's Hospital in Toronto, Ontario, Canada
| | - Janet B W Williams
- Drs. Vaccarino, Evans and Gilbert Evans are with Indoc Research in Toronto, Ontario, Canada
- Dr Kalali is with the International Society for CNS Drug Development in San Diego, California
- Dr. Blier is with the Departments of Psychiatry and Cellular & Molecular Medicine at the University of Ottawa Institute of Mental Health Research in Ottawa, Ontario, Canada
- Dr. Engelhardt is with Intra-Cellular Therapies in New York, New York
- Dr. Foster is with Department of Psychiatry & Behavioural Neurosciences at McMaster University in Hamilton, Ontario, Canada
- Dr. Frey is with the Department of Psychiatry and Behavioural Neurosciences at McMaster University and Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare in Hamilton, Ontario, Canada
- Dr. Greist is with the Department of Psychiatry at the University of Wisconsin School of Medicine and Public Health in Madison, Wisconsin
- Dr. Kobak is with the Center for Telepsychology in Madison, Wisconsin
- Dr. Lam is with the Department of Psychiatry at the University of British Columbia in Vancouver, British Columbia, Canada
- Dr. MacQueen is with Mathison Centre for Mental Health Research and Education at the Department of Psychiatry, University of Calgary in Calgary, Alberta, Canada
- Dr. Milev is with the Department of Psychiatry and the Department of Psychology, and Centre for Neuroscience Studies at Queen's University in Kingston, Ontario, Canada
- Dr. Müller is with the Centre for Addiction and Mental Health and the Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada. Parikh is with the Department of Psychiatry at the University of Michigan in Ann Arbor, Michigan
- Dr. Placenza is with the Department of Psychiatry at the Krembil Research Centre, University Health Network, University of Toronto in Toronto, Ontario, Canada
- Dr. Rizvi is with Arthur Sommer Rotenberg Program for Suicide and Depression Studies at St. Michael's Hospital in Toronto, Ontario, Canada
- Dr. Rotzinger is with St. Michael's Hospital (Unity Health Toronto) and Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada
- Dr. Sheehan is with the University of South Florida College of Medicine in Tampa, Florida
- Dr. Sills was with OCBN in Toronto, Ontario, Canada
- Dr. Soares is with the Department of Psychiatry at Queen's University and Providence Care Hospital in Kingston, Ontario, Canada
- Dr. Turecki is with the Department of Psychiatry at McGill University in Montreal, Quebec, Canada
- Dr. Uher is with the Department of Psychiatry at Dalhousie University in Halifax, Nova Scotia, Canada
- Dr. Williams is with the Departments of Psychiatry and Neurology at Columbia University in New York, New York
- Dr. Kennedy is with the Department of Psychiatry at the University of Toronto and Centre for Depression and Suicide, St. Michael's Hospital in Toronto, Ontario, Canada
| | - Sidney H Kennedy
- Drs. Vaccarino, Evans and Gilbert Evans are with Indoc Research in Toronto, Ontario, Canada
- Dr Kalali is with the International Society for CNS Drug Development in San Diego, California
- Dr. Blier is with the Departments of Psychiatry and Cellular & Molecular Medicine at the University of Ottawa Institute of Mental Health Research in Ottawa, Ontario, Canada
- Dr. Engelhardt is with Intra-Cellular Therapies in New York, New York
- Dr. Foster is with Department of Psychiatry & Behavioural Neurosciences at McMaster University in Hamilton, Ontario, Canada
- Dr. Frey is with the Department of Psychiatry and Behavioural Neurosciences at McMaster University and Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare in Hamilton, Ontario, Canada
- Dr. Greist is with the Department of Psychiatry at the University of Wisconsin School of Medicine and Public Health in Madison, Wisconsin
- Dr. Kobak is with the Center for Telepsychology in Madison, Wisconsin
- Dr. Lam is with the Department of Psychiatry at the University of British Columbia in Vancouver, British Columbia, Canada
- Dr. MacQueen is with Mathison Centre for Mental Health Research and Education at the Department of Psychiatry, University of Calgary in Calgary, Alberta, Canada
- Dr. Milev is with the Department of Psychiatry and the Department of Psychology, and Centre for Neuroscience Studies at Queen's University in Kingston, Ontario, Canada
- Dr. Müller is with the Centre for Addiction and Mental Health and the Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada. Parikh is with the Department of Psychiatry at the University of Michigan in Ann Arbor, Michigan
- Dr. Placenza is with the Department of Psychiatry at the Krembil Research Centre, University Health Network, University of Toronto in Toronto, Ontario, Canada
- Dr. Rizvi is with Arthur Sommer Rotenberg Program for Suicide and Depression Studies at St. Michael's Hospital in Toronto, Ontario, Canada
- Dr. Rotzinger is with St. Michael's Hospital (Unity Health Toronto) and Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada
- Dr. Sheehan is with the University of South Florida College of Medicine in Tampa, Florida
- Dr. Sills was with OCBN in Toronto, Ontario, Canada
- Dr. Soares is with the Department of Psychiatry at Queen's University and Providence Care Hospital in Kingston, Ontario, Canada
- Dr. Turecki is with the Department of Psychiatry at McGill University in Montreal, Quebec, Canada
- Dr. Uher is with the Department of Psychiatry at Dalhousie University in Halifax, Nova Scotia, Canada
- Dr. Williams is with the Departments of Psychiatry and Neurology at Columbia University in New York, New York
- Dr. Kennedy is with the Department of Psychiatry at the University of Toronto and Centre for Depression and Suicide, St. Michael's Hospital in Toronto, Ontario, Canada
| | - Kenneth R Evans
- Drs. Vaccarino, Evans and Gilbert Evans are with Indoc Research in Toronto, Ontario, Canada
- Dr Kalali is with the International Society for CNS Drug Development in San Diego, California
- Dr. Blier is with the Departments of Psychiatry and Cellular & Molecular Medicine at the University of Ottawa Institute of Mental Health Research in Ottawa, Ontario, Canada
- Dr. Engelhardt is with Intra-Cellular Therapies in New York, New York
- Dr. Foster is with Department of Psychiatry & Behavioural Neurosciences at McMaster University in Hamilton, Ontario, Canada
- Dr. Frey is with the Department of Psychiatry and Behavioural Neurosciences at McMaster University and Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare in Hamilton, Ontario, Canada
- Dr. Greist is with the Department of Psychiatry at the University of Wisconsin School of Medicine and Public Health in Madison, Wisconsin
- Dr. Kobak is with the Center for Telepsychology in Madison, Wisconsin
- Dr. Lam is with the Department of Psychiatry at the University of British Columbia in Vancouver, British Columbia, Canada
- Dr. MacQueen is with Mathison Centre for Mental Health Research and Education at the Department of Psychiatry, University of Calgary in Calgary, Alberta, Canada
- Dr. Milev is with the Department of Psychiatry and the Department of Psychology, and Centre for Neuroscience Studies at Queen's University in Kingston, Ontario, Canada
- Dr. Müller is with the Centre for Addiction and Mental Health and the Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada. Parikh is with the Department of Psychiatry at the University of Michigan in Ann Arbor, Michigan
- Dr. Placenza is with the Department of Psychiatry at the Krembil Research Centre, University Health Network, University of Toronto in Toronto, Ontario, Canada
- Dr. Rizvi is with Arthur Sommer Rotenberg Program for Suicide and Depression Studies at St. Michael's Hospital in Toronto, Ontario, Canada
- Dr. Rotzinger is with St. Michael's Hospital (Unity Health Toronto) and Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada
- Dr. Sheehan is with the University of South Florida College of Medicine in Tampa, Florida
- Dr. Sills was with OCBN in Toronto, Ontario, Canada
- Dr. Soares is with the Department of Psychiatry at Queen's University and Providence Care Hospital in Kingston, Ontario, Canada
- Dr. Turecki is with the Department of Psychiatry at McGill University in Montreal, Quebec, Canada
- Dr. Uher is with the Department of Psychiatry at Dalhousie University in Halifax, Nova Scotia, Canada
- Dr. Williams is with the Departments of Psychiatry and Neurology at Columbia University in New York, New York
- Dr. Kennedy is with the Department of Psychiatry at the University of Toronto and Centre for Depression and Suicide, St. Michael's Hospital in Toronto, Ontario, Canada
| |
Collapse
|
45
|
Zhang MM, Zou Y, Li SM, Wang L, Sun YH, Shi L, Lu L, Bao YP, Li SX. The efficacy and safety of omega-3 fatty acids on depressive symptoms in perinatal women: a meta-analysis of randomized placebo-controlled trials. Transl Psychiatry 2020; 10:193. [PMID: 32555188 PMCID: PMC7299975 DOI: 10.1038/s41398-020-00886-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 06/05/2020] [Accepted: 06/08/2020] [Indexed: 11/14/2022] Open
Abstract
Omega-3 fatty acids (FA), as a nutrient, has been proven effective in major depressive disorder (MDD), however, the results of monotherapy in perinatal depression (PND) remain unclear. To examine the efficacy and safety of omega-3 fatty acids (FA) monotherapy for perinatal depression (PND) compared with placebo. PubMed, Embase, PsycINFO, MEDLINE, Cochrane Library, and CINAHL were searched from inception up to November 2019. The reference lists of relevant review articles and included studies were also reviewed. Randomized placebo-controlled trials examining the efficacy and safety of omega-3 FA monotherapy in perinatal women with depressive symptoms were included. Pooled standard mean differences (SMD) were calculated and random-effects models were adopted for all analyses. Subgroups analyses and meta-regression were performed to quantify characteristics of the subjects and trials influencing the omega-3 response. In addition, meta-regression was conducted to identify the source of heterogeneity. The study protocol was registered at PROSPERO, CRD42020159542. Eight eligible randomized placebo-controlled trials were included involving 638 participants. There was a significant effect of omega-3 FA on perinatal depression. Omega-3 with higher ratio of EPA/DHA (≥1.5) had significant efficacy both in mild-to-moderate pregnant and postpartum depression with low incidence of side effects. Among the included trials reporting adverse effects, there was no significant difference in incidence of gastrointestinal and neurologic events between the omega-3 and placebo groups. There was no evidence of publication bias. Our findings suggested that omega-3 FA significantly improved depressive symptoms in perinatal women regardless of pregnant or postpartum and well-tolerated. Furthermore, the omega-3 response was linked to higher EPA proportion in omega-3 formula and mild- to-moderate depression.
Collapse
Affiliation(s)
- Mi-Mi Zhang
- grid.11135.370000 0001 2256 9319National Institute on Drug Dependence, Peking University, Beijing, 100191 China ,grid.12955.3a0000 0001 2264 7233Department of Obstetrics and Gynecology, Xiang’ an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, 361102 China
| | - Yan Zou
- grid.453135.50000 0004 1769 3691Department of Female Clinical Research, National Research Institute for Family Planning, Beijing, 100081 China
| | - Su-Min Li
- grid.414252.40000 0004 1761 8894Department of Gynecology, the 305 Hospital of PLA, Beijing, 100017 China
| | - Li Wang
- grid.414252.40000 0004 1761 8894Department of Gynecology, the 305 Hospital of PLA, Beijing, 100017 China
| | - Yu-Hui Sun
- grid.412596.d0000 0004 1797 9737Department of Obstetrics and Gynecology, the First Affiliated Hospital of Harbin Medical University, Harbin, 150001 China
| | - Le Shi
- grid.11135.370000 0001 2256 9319Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, 100191 China
| | - Lin Lu
- grid.11135.370000 0001 2256 9319National Institute on Drug Dependence, Peking University, Beijing, 100191 China ,grid.11135.370000 0001 2256 9319Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, 100191 China
| | - Yan-Ping Bao
- National Institute on Drug Dependence, Peking University, Beijing, 100191, China.
| | - Su-Xia Li
- National Institute on Drug Dependence, Peking University, Beijing, 100191, China.
| |
Collapse
|
46
|
Dinoff A, Lynch ST, Sekhri N, Klepacz L. A meta-analysis of the potential antidepressant effects of buprenorphine versus placebo as an adjunctive pharmacotherapy for treatment-resistant depression. J Affect Disord 2020; 271:91-99. [PMID: 32479336 DOI: 10.1016/j.jad.2020.03.089] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 01/26/2020] [Accepted: 03/25/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Numerous reports have suggested that buprenorphine may have antidepressant effects. Many individuals with depressive disorders don't respond to first-line treatment and are classified with treatment-resistant depression (TRD). Novel therapies for depression are required to better treat this population. This meta-analysis of randomized placebo-controlled trials sought to evaluate the potential antidepressant effects of buprenorphine as an adjunctive pharmacological treatment for individuals with TRD. METHODS PubMed, Embase, CINAHL, Web of Science, and ClinicalTrials.gov databases were searched until June 2019 for original peer-reviewed reports of buprenorphine used for the treatment of depression. Standardized mean differences (SMD) were generated from random effects models. Risk of publication bias was assessed using a funnel plot. Potential sources of heterogeneity were explored in subgroup analyses. RESULTS In six studies that met inclusion criteria, depression symptom severity in individuals with TRD was not significantly decreased after an adjunctive intervention with buprenorphine when compared to placebo (SMD = -0.07, 95% CI: -0.21-0.06, p = 0.30). Five of the six studies utilized a combination of buprenorphine/samidorphan. In these studies, depression symptom severity was also not significantly reduced after intervention compared to placebo (SMD = -0.08, 95% CI: -0.21 - 0.05, p = 0.23). LIMITATIONS Five included studies were performed by the same research group with significant conflicts of interest. CONCLUSIONS This meta-analysis did not reveal a significant reduction in depression symptom severity in individuals with TRD after an adjunctive intervention with buprenorphine when compared to placebo. However, more optimal doses of buprenorphine (2 mg/day) and longer treatment lengths should be explored.
Collapse
Affiliation(s)
- Adam Dinoff
- New York Medical College School of Medicine, 40 Sunshine Cottage Rd, Valhalla, NY, 10595 USA.
| | - Sean T Lynch
- New York Medical College School of Medicine, 40 Sunshine Cottage Rd, Valhalla, NY, 10595 USA
| | - Nitin Sekhri
- New York Medical College School of Medicine, 40 Sunshine Cottage Rd, Valhalla, NY, 10595 USA; Department of Anesthesiology, Westchester Medical Center, Valhalla, NY, 10595, USA
| | - Lidia Klepacz
- New York Medical College School of Medicine, 40 Sunshine Cottage Rd, Valhalla, NY, 10595 USA; Department of Psychiatry, Westchester Medical Center, Valhalla, NY, 10595, USA
| |
Collapse
|
47
|
The association between polymorphism of norepinephrine transporter G1287A and major depressive disorder, antidepressant response: a meta-analysis. Psychiatr Genet 2020; 30:101-109. [PMID: 32459709 DOI: 10.1097/ypg.0000000000000254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Massive research has examined the cause of major depressive disorder (MDD) and accumulating evidence has revealed that the gene for the norepinephrine transporter (NET) is involved in MDDs etiology as well as the antidepressant response. The G1287A (rs5569, GRCh38, Chromosome 16, 55697923) is located in the exon 9 region of the SLC6A2 gene. It was found to be connected with MDD and antidepressant response in people of different genetic ancestries. However, the results are still inconsistent. METHODS A meta-analysis was conducted to evaluate the overall association of rs5569 polymorphisms with MDD and the antidepressant response. RESULTS Sixteen articles that studied the connection between the G1287A polymorphism and MDD or antidepressant response were identified, and their outcomes revealed there was a significant connection between the polymorphisms and MDD and antidepressant response. Our study indicated that the GG genotype may be a protection factor against the development of MDD [odds ratio (OR = 0.78, 95% confidence interval (CI) = 0.64-0.96, P = 0.02 for Asian population; OR = 0.79, 95% CI = 0.63-0.98, P = 0.03 for Han Chinese population] while the GG genotype had a worse antidepressant response (OR = 0.49, 95% CI = 0.25-0.94, P = 0.03). CONCLUSIONS NET G1287A polymorphisms are involved in the etiology of MDD and antidepressant response.
Collapse
|
48
|
Hamilton scale and MADRS are interchangeable in meta-analyses but can disagree at trial level. J Clin Epidemiol 2020; 124:106-117. [PMID: 32387423 DOI: 10.1016/j.jclinepi.2020.04.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Revised: 04/13/2020] [Accepted: 04/29/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND OBJECTIVE Major depressive disorder is a multidimensional disease, in which demonstrating the efficacy of treatments is difficult. The Hamilton Rating Scale for Depression (HRSD) and the Montgomery-Asberg Depression Rating Scale (MADRS) cover different domains but are used interchangeably as primary measures of the outcome in trials and-with standardized measures-in meta-analyses. We aimed at understanding (i) whether the choice of the outcome measurement tool can influence the outcome of a trial, and if so, (ii) whether one systematically outperforms the other, and (iii) whether using standardized measures of the effect in meta-analysis is justified. METHODS Short-term randomized trials in patients with major depressive disorder that used both the scales were systematically searched and the results were collected. To quantify the differences in the results-both in terms of the standardized mean difference (SMD) and odds ratio (OR) for response-and their range, data were analyzed and plotted with the Bland-Altman method. RESULTS 161 comparisons from 80 studies were included, involving a total of 18,189 patients. Neither of the two scales appears systematically more sensitive to the treatment effect than the other in terms of SMDs (P-value = 0.06, 95% CI -0.044 to 0.001) or ORs (P-value = 0.15, 95% CI -0.25 to 0.04). However, the variability of differences between the HRSD and MADRS largely depends on the number of patients included in the comparison. CONCLUSION No systematic differences between the two scales were found supporting the use of standardized measures in meta-analyses. However, the same trial may give very different results with either scale, especially in small trials. Further research is needed to understand the causes of this variability.
Collapse
|
49
|
McAllister-Williams RH, Sousa S, Kumar A, Greco T, Bunker MT, Aaronson ST, Conway CR, Rush AJ. The effects of vagus nerve stimulation on the course and outcomes of patients with bipolar disorder in a treatment-resistant depressive episode: a 5-year prospective registry. Int J Bipolar Disord 2020; 8:13. [PMID: 32358769 PMCID: PMC7195501 DOI: 10.1186/s40345-020-0178-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 01/17/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To compare illness characteristics, treatment history, response and durability, and suicidality scores over a 5-year period in patients with treatment-resistant bipolar depression participating in a prospective, multicenter, open-label registry and receiving Vagus Nerve Stimulation Therapy (VNS Therapy) plus treatment-as-usual (VNS + TAU) or TAU alone. METHODS Response was defined as ≥ 50% decrease from baseline Montgomery-Åsberg Depression Rating Scale (MADRS) total score at 3, 6, 9, or 12 months post-baseline. Response was retained while MADRS score remained ≥ 40% lower than baseline. Time-to-events was estimated using Kaplan-Meier (KM) analysis and compared using log-rank test. Suicidality was assessed using the MADRS Item 10 score. RESULTS At baseline (entry into registry), the VNS + TAU group (N = 97) had more episodes of depression, psychiatric hospitalizations, lifetime suicide attempts and higher suicidality score, more severe symptoms (based on MADRS and other scales), and higher rate of prior electroconvulsive therapy than TAU group (N = 59). Lifetime use of medications was similar between the groups (a mean of 9) and was consistent with the severe treatment-resistant nature of their depression. Over 5 years, 63% (61/97) in VNS + TAU had an initial response compared with 39% (23/59) in TAU. The time-to-initial response was significantly quicker for VNS + TAU than for TAU (p < 0.03). Among responders in the first year after implant, the KM estimate of the median time-to-relapse from initial response was 15.2 vs 7.6 months for VNS + TAU compared with TAU (difference was not statistically significant). The mean reduction in suicidality score across the study visits was significantly greater in the VNS + TAU than in the TAU group (p < 0.001). CONCLUSIONS The patients who received VNS + TAU included in this analysis had severe bipolar depression that had proved extremely difficult to treat. The TAU comparator group were similar though had slightly less severe illnesses on some measures and had less history of suicide attempts. Treatment with VNS + TAU was associated with a higher likelihood of attaining a response compared to TAU alone. VNS + TAU was also associated with a significantly greater mean reduction in suicidality. LIMITATIONS In this registry study, participants were not randomized to the study treatment group, VNS Therapy stimulation parameters were not controlled, and there was a high attrition rate over 5 years. Trial registration ClinicalTrials.gov NCT00320372. Registered 3 May 2006, https://clinicaltrials.gov/ct2/show/NCT00320372 (retrospectively registered).
Collapse
Affiliation(s)
- R Hamish McAllister-Williams
- Northern Centre for Mood Disorders, Newcastle University, Newcastle upon Tyne, UK. .,Regional Affective Disorders Service, Cumbria, Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK.
| | - Soraia Sousa
- Northern Centre for Mood Disorders, Newcastle University, Newcastle upon Tyne, UK.,Regional Affective Disorders Service, Cumbria, Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | | | | | | | - Scott T Aaronson
- Department of Clinical Research, Sheppard Pratt Health System, Baltimore, MD, USA
| | - Charles R Conway
- Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - A John Rush
- Duke-National University of Singapore, Singapore, Singapore.,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA.,Department of Psychiatry, Health Sciences Center, Texas Tech University Permian Basin, Midland, TX, USA
| |
Collapse
|
50
|
Sawamura D, Narita H, Hashimoto N, Nakagawa S, Hamaguchi H, Fujima N, Kudo K, Shirato H, Tha KK. Microstructural Alterations in Bipolar and Major Depressive Disorders: A Diffusion Kurtosis Imaging Study. J Magn Reson Imaging 2020; 52:1187-1196. [PMID: 32329208 DOI: 10.1002/jmri.27174] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 04/06/2020] [Accepted: 04/06/2020] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Identifying structural and functional abnormalities in bipolar (BD) and major depressive disorders (MDD) is important for understanding biological processes. HYPOTHESIS Diffusion kurtosis imaging (DKI) may be able to detect the brain's microstructural alterations in BD and MDD and any differences between the two. STUDY TYPE Prospective. SUBJECTS In all, 16 BD patients, 19 MDD patients, and 20 age- and gender-matched healthy volunteers. FIELD STRENGTH/SEQUENCE DKI at 3.0T. ASSESSMENT The major DKI indices of the brain were compared voxel-by-voxel among the three groups. Significantly different voxels were tested for correlation with clinical variables (ie, Young Mania Rating Scale [YMRS], 17-item Hamilton Depression Rating Scale [17-HDRS], Montgomery-Åsberg Depression Rating Scale, total disease duration, duration of current episode, and the number of past manic/depressive episodes). The performance of the DKI indices in identifying microstructural alterations was estimated. STATISTICAL TESTS One-way analysis of variance (ANOVA) was used for group comparison of DKI indices. The performance of these indices in detecting microstructural alterations was determined by receiver operating characteristic (ROC) analysis. Pearson's product-moment correlation analyses were used to test the correlations of these indices with clinical variables. RESULTS DKI revealed widespread microstructural alterations across the brain in each disorder (P < 0.05). Some were significantly different between the two disorders. Mean kurtosis (MK) in the gray matter of the right inferior parietal lobe was able to distinguish BD and MDD with an accuracy of 0.906. A strong correlation was revealed between MK in that region and YMRS in BD patients (r = -0.641, corrected P = 0.042) or 17-HDRS in MDD patients (r = -0.613, corrected P = 0.030). There were also strong correlations between a few other DKI indices and disease duration (r = -0.676 or 0.626, corrected P < 0.05). DATA CONCLUSION DKI detected microstructural brain alterations in BD and MDD. Its indices may be useful to distinguish the two disorders or to reflect disease severity and duration. LEVEL OF EVIDENCE 2 TECHNICAL EFFICACY STAGE: 3 J. Magn. Reson. Imaging 2020;52:1187-1196.
Collapse
Affiliation(s)
- Daisuke Sawamura
- Department of Biomarker Imaging Science, Graduate School of Medical Science and Engineering, Hokkaido University, Sapporo, Japan.,Department of Functioning and Disability, Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
| | - Hisashi Narita
- Department of Psychiatry, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Naoki Hashimoto
- Department of Psychiatry, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Shin Nakagawa
- Department of Psychiatry, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Hiroyuki Hamaguchi
- Department of Biomarker Imaging Science, Graduate School of Medical Science and Engineering, Hokkaido University, Sapporo, Japan.,Department of Radiological Technology, Hokkaido University Hospital, Sapporo, Japan
| | - Noriyuki Fujima
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Sapporo, Japan.,Department of Radiology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Kohsuke Kudo
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Sapporo, Japan.,Global Station for Quantum Medical Science and Engineering, Global Institution for Collaborative Research and Education, Hokkaido University, Sapporo, Japan
| | - Hiroki Shirato
- Global Station for Quantum Medical Science and Engineering, Global Institution for Collaborative Research and Education, Hokkaido University, Sapporo, Japan.,Global Center for Biomedical Science and Engineering, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Khin K Tha
- Department of Biomarker Imaging Science, Graduate School of Medical Science and Engineering, Hokkaido University, Sapporo, Japan.,Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Sapporo, Japan.,Global Station for Quantum Medical Science and Engineering, Global Institution for Collaborative Research and Education, Hokkaido University, Sapporo, Japan.,Global Center for Biomedical Science and Engineering, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| |
Collapse
|