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Wilkowska A, Wiglusz MS, Arciszewska-Leszczuk A, Gałuszko-Węgielnik M, Cubała WJ. Anhedonia in bipolar depression treated with ketamine. Bipolar Disord 2024; 26:356-363. [PMID: 38311367 DOI: 10.1111/bdi.13409] [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: 02/10/2024]
Abstract
BACKGROUND Bipolar depression is the major cause of morbidity in patients with bipolar disorder. It affects psychosocial functioning and markedly impairs occupational productivity. Anhedonia is one of the most debilitating symptoms of depression contributing to treatment resistance. It correlates with suicidality, low quality of life, social withdrawal, and poor treatment response. Currently, there is no approved treatment specifically targeting anhedonia. Emerging evidence suggests that ketamine possesses anti-anhedonic properties in individuals with depression. OBJECTIVES The aim of this naturalistic open-label study was to investigate the effect of add-on ketamine treatment on anhedonia in treatment resistant bipolar depression. METHODS Our main interest was the change in patient-reported (Snaith-Hamilton Pleasure Scale) and rater-based anhedonia measure (Montgomery-Åsberg Depression Rating Scale-anhedonia subscale). The secondary aim was to analyze the score change in three Inventory of Depressive Symptomatology-Self Report (IDS-SR) domains: mood/cognition, anxiety/somatic, and sleep. Patients underwent assessments at several time points, including baseline, after the third, fifth, and seventh ketamine infusions. Additionally, a follow-up assessment was conducted 1 week following the final ketamine administration. RESULTS We found improvement in anhedonia symptoms according to both patient-reported and rater-based measures. The improvement in IDS-SR domains was most prominent in anxiety/somatic factor and mood/cognition factor, improvement in sleep factor was not observed. No serious adverse events occurred. CONCLUSION Add-on ketamine seems to be a good choice for the treatment of anhedonia in treatment resistant bipolar depression. It also showed a good effect in reducing symptoms of anxiety in this group of patients. Considering unmet needs and the detrimental effect of anhedonia and anxiety, more studies are needed on ketamine treatment in resistant bipolar depression.
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Affiliation(s)
- Alina Wilkowska
- Department of Psychiatry, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Mariusz S Wiglusz
- Department of Psychiatry, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | | | | | - Wiesław J Cubała
- Department of Psychiatry, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
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Schmidt ME, Kezic I, Popova V, Melkote R, Van Der Ark P, Pemberton DJ, Mareels G, Canuso CM, Fava M, Drevets WC. Efficacy and safety of aticaprant, a kappa receptor antagonist, adjunctive to oral SSRI/SNRI antidepressant in major depressive disorder: results of a phase 2 randomized, double-blind, placebo-controlled study. Neuropsychopharmacology 2024:10.1038/s41386-024-01862-x. [PMID: 38649428 DOI: 10.1038/s41386-024-01862-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 03/18/2024] [Accepted: 04/04/2024] [Indexed: 04/25/2024]
Abstract
This was a double-blind, randomized, phase 2 study of adults (18-64 years) with DSM-5 diagnosis of major depressive disorder (MDD), with moderate-to-severe episode severity (Montgomery-Åsberg Depression Rating Scale [MADRS] ≥25) despite an adequate course with ongoing antidepressant for ≥6 weeks to ≤12 months. Following a double-blind placebo lead-in period (up to 3 weeks), participants were randomized to receive once daily aticaprant 10 mg or continue placebo, added to their ongoing treatment, for 6 weeks. Of 184 participants enrolled, 169 were included in safety analyses (aticaprant n = 85, placebo n = 84) and 166 in full intent-to-treat (fITT) efficacy analyses; 121 placebo lead-in non-responders (<30% reduction in MADRS total score) in fITT were included in enriched ITT (eITT) analyses. Improvement (least squares mean difference [upper limit 1-sided 80% CI] versus placebo) in MADRS total score at week 6 for aticaprant was significant versus placebo (eITT: -2.1 [-1.09], 1-sided p = 0.044; effect size (ES) 0.23; fITT -3.1 [2.21], 1-sided p = 0.002; ES 0.36). The between-group difference was larger among participants with Snaith-Hamilton Pleasure Scale (SHAPS) score greater/equal to versus less than baseline median SHAPS. The most common treatment-emergent adverse events reported for aticaprant (versus placebo) were headache (11.8% versus 7.1%), diarrhea (8.2% versus 2.4%), nasopharyngitis (5.9% versus 2.4%), and pruritus (5.9% versus 0%). One participant (1.2%) in each arm discontinued treatment due to an adverse event. In this study of participants with MDD and inadequate response to SSRI/SNRI, adjunctive treatment with aticaprant significantly reduced depressive symptoms versus placebo, without resulting in significant safety signals, supporting further investigation in larger trials.
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Affiliation(s)
| | - Iva Kezic
- Janssen Research & Development, Beerse, Belgium
| | | | - Rama Melkote
- Janssen Research & Development, LLC, Titusville, NJ, USA
| | | | | | - Guy Mareels
- Janssen Research & Development, Beerse, Belgium
| | - Carla M Canuso
- Janssen Research & Development, LLC, Titusville, NJ, USA
| | - Maurizio Fava
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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Kim KM, Lee KH, Kim H, Kim O, Kim JW. Symptom clusters in adolescent depression and differential responses of clusters to pharmacologic treatment. J Psychiatr Res 2024; 172:59-65. [PMID: 38364553 DOI: 10.1016/j.jpsychires.2024.02.001] [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: 06/16/2023] [Revised: 11/20/2023] [Accepted: 02/01/2024] [Indexed: 02/18/2024]
Abstract
OBJECTIVE Symptoms of depression in adolescents are widely variable, but they are often interactive and clustered. The analysis of interactions and clusters among individual symptoms may help predict treatment outcomes. We aimed to determine clusters of individual symptoms in adolescent depression and their changes in the response to pharmacological treatment. METHOD A total of 95 adolescents, aged 12-17 years, with major depressive disorder were included. Participants were treated with escitalopram, and depressive symptoms were assessed at baseline (V1) and 1, 2, 4, 6, and 8 weeks (V6). The severity of depression was assessed using the Children's Depression Rating Scale-Revised. To construct network and clustering structures among symptoms, the Gaussian graphical model and Exploratory Graph Analysis with the tuning parameter to minimize the extended Bayesian information criterion were adopted. RESULTS Exploratory Graph Analysis revealed that symptoms of depression comprised four clusters: impaired activity, somatic concerns, subjective mood, and observed affect. The main effect of visit with decreased symptom severity was significant in all four clusters; however, the degree of symptom improvement differed among the four clusters. The effect size of score differences from V1 to V6 was the highest in the subjective mood (Cohen's d = 1.075), and lowest in impaired activity (d = 0.501) clusters. CONCLUSION The present study identified four symptom clusters associated with adolescent depression and their differential changes related to antidepressant treatment. This finding suggests that escitalopram was the most effective at improving subjective mood among different clusters. However, other therapeutic modalities may be needed to improve other clusters of symptoms, consequently leading to increased overall improvement of depression in adolescents.
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Affiliation(s)
- Kyoung Min Kim
- Department of Psychiatry, College of Medicine, Dankook University, Cheonan, Republic of Korea; Department of Psychiatry, Dankook University Hospital, Cheonan, Republic of Korea
| | - Kyung Hwa Lee
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Seoul National University Hospital, Seoul, Republic of Korea
| | - Haebin Kim
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ok Kim
- Department of Psychology, Graduate School of Dankook University, Cheonan, Republic of Korea
| | - Jae-Won Kim
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Seoul National University Hospital, Seoul, Republic of Korea; Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea.
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Kong S, Chen Y, Huang H, Yang W, Lyu D, Wang F, Huang Q, Zhang M, Chen S, Wei Z, Shi S, Fang Y, Hong W. Efficacy of transcranial direct current stimulation for treating anhedonia in patients with depression: A randomized, double-blind, sham-controlled clinical trial. J Affect Disord 2024; 350:264-273. [PMID: 38232776 DOI: 10.1016/j.jad.2024.01.041] [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: 10/30/2023] [Revised: 12/11/2023] [Accepted: 01/03/2024] [Indexed: 01/19/2024]
Abstract
BACKGROUND Anhedonia, the core symptom of major depressive disorder (MDD), is highly prevalent in patients with depression. Anhedonia is associated with low efficacy of drug treatment, high suicide rates, and poor social function. Transcranial direct current stimulation (tDCS) is a non-invasive neuromodulation technology that uses constant, low-intensity direct current to treat MDD by regulating cortical activity and neuronal excitability. However, little is known about the efficacy of tDCS for treating anhedonia in patients with depression, and even the existing results of clinical trials are conflicting. In addition, there is no consensus on what brain regions should be targeted by tDCS during the treatment of anhedonia in patients with depression. OBJECTIVE This study aimed to evaluate the efficacy and safety of tDCS over the left dorsolateral prefrontal cortex (DLPFC) and right orbitofrontal cortex (OFC) in the improvement of anhedonia in patients with depression and finally identified suitable brain regions to be stimulated during treatment. METHODS This randomized, double-blind, sham-controlled clinical trial recruited 70 patients with anhedonia and depressive episodes. Patients were randomly assigned to three groups according to the stimulation site: right orbitofrontal cortex (OFC), left dorsolateral prefrontal cortex (DLPFC), and sham stimulation. Each group received twelve 20-min interventions (ten as primary treatment and two for consolidation). The primary outcome was a decrease in Snaith-Hamilton Pleasure Scale (SHAPS) scores after primary treatment. Evaluations were performed at baseline, post-treatment, and 8-week follow-up. RESULTS The depression mood of the three groups of patients at each time point was better than the baseline, but there was no significant difference in the efficacy between the groups (p>0.05). On the basis of the improvement of depression, this study found that tDCS of the DLPFC significantly improved anhedonia (p = 0.028) after primary treatment (2 weeks), and tDCS of the DLPFC and OFC significantly improved social functioning (p = 0.005) at 8-week follow-up. LIMITATIONS The sample size of this study was small, with only about 23/24 patients in each group completing the intervention assessments; due to the impact of the COVID-19 epidemic, data analysis was limited by the lack of patients during the follow-up period. CONCLUSIONS tDCS of the DLPFC significantly improves anhedonia in depressed patients and is thus a potential adjuvant therapy for anhedonia in these patients.
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Affiliation(s)
- Shuqi Kong
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yiming Chen
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Haijing Huang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shenzhen Institute of Advanced Technology, Chinese academy of Science, Shenzhen, China
| | - Weichieh Yang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dongbin Lyu
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fan Wang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qinte Huang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Mengke Zhang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shentse Chen
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zheyi Wei
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shuxiang Shi
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yiru Fang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Department of Psychiatry & Affective Disorders Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China; CAS Center for Excellence in Brain Science and Intelligence Technology, Shanghai, China.
| | - Wu Hong
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China; Mental Health Branch, China Hospital Development Institute, Shanghai Jiao Tong University, Shanghai, China.
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Cogan AB, Persons JB, Kring AM. Using the Beck Depression Inventory to Assess Anhedonia: A Scale Validation Study. Assessment 2024; 31:431-443. [PMID: 37039528 PMCID: PMC10822059 DOI: 10.1177/10731911231164628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
Anhedonia is central to several psychological disorders and a frequent target of psychosocial and pharmacological treatments. We evaluated the psychometric properties of two widely used anhedonia measures derived from the Beck Depression Inventory: a 3-item (BDI-Anh3) and a 4-item version (BDI-Anh4). We evaluated these measures in a large undergraduate sample, a community sample, and a clinical sample. Both the BDI-Anh3 and the BDI-Anh4 showed adequate internal consistency, with BDI-Anh4 performing somewhat better, across the three samples. Both measures showed good convergent and discriminant validity, even after controlling for shared variance with other items on the BDI. These findings indicate that both measures have sufficient reliability and validity to support their use by researchers and clinicians.
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Affiliation(s)
| | - Jacqueline B. Persons
- University of California, Berkeley, USA
- Oakland Cognitive Behavior Therapy Center, CA, USA
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Cheng C, Herr K, Jeon HJ, Kato T, Ng CH, Yang YK, Zhang L. A Delphi consensus on clinical features, diagnosis and treatment of major depressive disorder patients with anhedonia amongst psychiatrists in the Asia-Pacific. Front Psychiatry 2024; 15:1338063. [PMID: 38463427 PMCID: PMC10920342 DOI: 10.3389/fpsyt.2024.1338063] [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: 11/14/2023] [Accepted: 02/01/2024] [Indexed: 03/12/2024] Open
Abstract
Background Anhedonia, a core diagnostic feature for major depressive disorder (MDD), is defined as the loss of pleasure and interest in daily activities. Its prevalence in MDD patients vary from 35 to 70%. Anhedonia in MDD negatively impacts functioning and is associated with treatment resistance and poorer prognosis for various clinical outcomes. Owing to its complexity, there remains considerable heterogeneity in the conceptualization, diagnosis and clinical management of anhedonia in MDD. Methods This modified Delphi panel was conducted to elicit expert opinion and establish consensus on concepts relating to clinical features, diagnosis and treatment of MDD with anhedonia (MDDwA) amongst psychiatrists in the Asia-Pacific region. Seven themes were covered. A three-stage process was adopted for consensus generation (two online survey rounds, followed by a moderated consensus meeting). Statements were developed based on a literature review and input from a steering committee of six regional experts. The panel included 12 psychiatrists practicing in Australia, China, Hong Kong, Japan, South Korea and Taiwan with ≥5 years of specialist clinical experience, including assessment or management of patients with MDDwA. Results Overall, consensus was achieved (median ≥8) on 89/103 statements (86%). About half of the statements (55/103, 53%) achieved consensus in Round 1, and 29/36 modified statements achieved consensus in Round 2. At the moderated consensus meeting, five modified statements were discussed by the steering committee and consensus was achieved on all statements (5/5). The findings highlighted a lack of clear and practical methods in clinical practice for assessing anhedonia in MDD patients and limited physician awareness of anhedonia in Asia-Pacific. Conclusion Insights from this Delphi consensus provide a reference point for psychiatrists in Asia-Pacific to optimize their strategies for personalized diagnosis and management of patients with MDDwA. Identification of distinct and clinically relevant subtypes in MDD may be valuable for guiding personalized diagnosis and management approaches, including type-specific therapies.
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Affiliation(s)
- Calvin Cheng
- Department of Psychiatry, University of Hong Kong, Hong Kong SAR, China
| | - Keira Herr
- Janssen Medical Affairs Asia Pacific, Singapore, Singapore
| | - Hong Jin Jeon
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Tadafumi Kato
- Department of Psychiatry & Behavioral Science, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Chee H. Ng
- The Melbourne Clinic, Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia
| | - Yen Kuang Yang
- Department of Psychiatry, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Ling Zhang
- National Clinical Research Center for Mental Disorders & Mood Disorders Center, Beijing Anding Hospital, Capital Medical University, Beijing, China
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Ging-Jehli NR, Kuhn M, Blank JM, Chanthrakumar P, Steinberger DC, Yu Z, Herrington TM, Dillon DG, Pizzagalli DA, Frank MJ. Cognitive Signatures of Depressive and Anhedonic Symptoms and Affective States Using Computational Modeling and Neurocognitive Testing. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2024:S2451-9022(24)00056-9. [PMID: 38401881 DOI: 10.1016/j.bpsc.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 02/03/2024] [Accepted: 02/09/2024] [Indexed: 02/26/2024]
Abstract
BACKGROUND Deeper phenotyping may improve our understanding of depression. Because depression is heterogeneous, extracting cognitive signatures associated with severity of depressive symptoms, anhedonia, and affective states is a promising approach. METHODS Sequential sampling models decomposed behavior from an adaptive approach-avoidance conflict task into computational parameters quantifying latent cognitive signatures. Fifty unselected participants completed clinical scales and the approach-avoidance conflict task by either approaching or avoiding trials offering monetary rewards and electric shocks. RESULTS Decision dynamics were best captured by a sequential sampling model with linear collapsing boundaries varying by net offer values, and with drift rates varying by trial-specific reward and aversion, reflecting net evidence accumulation toward approach or avoidance. Unlike conventional behavioral measures, these computational parameters revealed distinct associations with self-reported symptoms. Specifically, passive avoidance tendencies, indexed by starting point biases, were associated with greater severity of depressive symptoms (R = 0.34, p = .019) and anhedonia (R = 0.49, p = .001). Depressive symptoms were also associated with slower encoding and response execution, indexed by nondecision time (R = 0.37, p = .011). Higher reward sensitivity for offers with negative net values, indexed by drift rates, was linked to more sadness (R = 0.29, p = .042) and lower positive affect (R = -0.33, p = .022). Conversely, higher aversion sensitivity was associated with more tension (R = 0.33, p = .025). Finally, less cautious response patterns, indexed by boundary separation, were linked to more negative affect (R = -0.40, p = .005). CONCLUSIONS We demonstrated the utility of multidimensional computational phenotyping, which could be applied to clinical samples to improve characterization and treatment selection.
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Affiliation(s)
- Nadja R Ging-Jehli
- Carney Institute for Brain Science, Department of Cognitive, Linguistic, & Psychological Sciences, Brown University, Providence, Rhode Island.
| | - Manuel Kuhn
- Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Jacob M Blank
- Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, Massachusetts
| | - Pranavan Chanthrakumar
- Carney Institute for Brain Science, Department of Cognitive, Linguistic, & Psychological Sciences, Brown University, Providence, Rhode Island; Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - David C Steinberger
- Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, Massachusetts
| | - Zeyang Yu
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Todd M Herrington
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Daniel G Dillon
- Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Diego A Pizzagalli
- Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Michael J Frank
- Carney Institute for Brain Science, Department of Cognitive, Linguistic, & Psychological Sciences, Brown University, Providence, Rhode Island
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Vaccarino SR, Wang S, Rizvi SJ, Lou W, Hassel S, MacQueen GM, Ho K, Frey BN, Lam RW, Milev RV, Rotzinger S, Ravindran AV, Strother SC, Kennedy SH. Functional neuroimaging biomarkers of anhedonia response to escitalopram plus adjunct aripiprazole treatment for major depressive disorder. BJPsych Open 2024; 10:e18. [PMID: 38179598 PMCID: PMC10790221 DOI: 10.1192/bjo.2023.588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 08/21/2023] [Accepted: 09/19/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Identifying neuroimaging biomarkers of antidepressant response may help guide treatment decisions and advance precision medicine. AIMS To examine the relationship between anhedonia and functional neurocircuitry in key reward processing brain regions in people with major depressive disorder receiving aripiprazole adjunct therapy with escitalopram. METHOD Data were collected as part of the CAN-BIND-1 study. Participants experiencing a current major depressive episode received escitalopram for 8 weeks; escitalopram non-responders received adjunct aripiprazole for an additional 8 weeks. Functional magnetic resonance imaging (on weeks 0 and 8) and clinical assessment of anhedonia (on weeks 0, 8 and 16) were completed. Seed-based correlational analysis was employed to examine the relationship between baseline resting-state functional connectivity (rsFC), using the nucleus accumbens (NAc) and anterior cingulate cortex (ACC) as key regions of interest, and change in anhedonia severity after adjunct aripiprazole. RESULTS Anhedonia severity significantly improved after treatment with adjunct aripiprazole.There was a positive correlation between anhedonia improvement and rsFC between the ACC and posterior cingulate cortex, ACC and posterior praecuneus, and NAc and posterior praecuneus. There was a negative correlation between anhedonia improvement and rsFC between the ACC and anterior praecuneus and NAc and anterior praecuneus. CONCLUSIONS Eight weeks of aripiprazole, adjunct to escitalopram, was associated with improved anhedonia symptoms. Changes in functional connectivity between key reward regions were associated with anhedonia improvement, suggesting aripiprazole may be an effective treatment for individuals experiencing reward-related deficits. Future studies are required to replicate our findings and explore their generalisability, using other agents with partial dopamine (D2) agonism and/or serotonin (5-HT2A) antagonism.
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Affiliation(s)
- Sophie R. Vaccarino
- Institute of Medical Science, University of Toronto, Canada; Centre for Depression and Suicide Studies, Unity Health Toronto, Canada; and Cumming School of Medicine, University of Calgary, Canada
| | - Shijing Wang
- Institute of Medical Science, University of Toronto, Canada; and Centre for Depression and Suicide Studies, Unity Health Toronto, Canada
| | - Sakina J. Rizvi
- Institute of Medical Science, University of Toronto, Canada; Centre for Depression and Suicide Studies, Unity Health Toronto, Canada; Department of Psychiatry, University of Toronto, Canada; Department of Psychiatry, Unity Health Toronto, Canada; and Li Ka Shing Knowledge Institute, Unity Health Toronto, Canada
| | - Wendy Lou
- Dalla Lana School of Public Health, University of Toronto, Canada; and Department of Biostatistics, University of Toronto, Canada
| | - Stefanie Hassel
- Cumming School of Medicine, University of Calgary, Canada; and Department of Psychiatry, University of Calgary, Canada
| | - Glenda M. MacQueen
- Cumming School of Medicine, University of Calgary, Canada; and Department of Psychiatry, University of Calgary, Canada
| | - Keith Ho
- Centre for Depression and Suicide Studies, Unity Health Toronto, Canada; Department of Psychiatry, Unity Health Toronto, Canada; and Li Ka Shing Knowledge Institute, Unity Health Toronto, Canada
| | - Benicio N. Frey
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Canada
| | - Raymond W. Lam
- Department of Psychiatry, University of British Columbia, Canada
| | - Roumen V. Milev
- Department of Psychiatry, Providence Care, Queen's University, Canada
| | - Susan Rotzinger
- Centre for Depression and Suicide Studies, Unity Health Toronto, Canada
| | | | - Stephen C. Strother
- Institute of Medical Science, University of Toronto, Canada; Rotman Research Institute, Baycrest Centre, Canada; and Department of Medical Biophysics, University of Toronto, Canada
| | - Sidney H. Kennedy
- Institute of Medical Science, University of Toronto, Canada; Centre for Depression and Suicide Studies, Unity Health Toronto, Canada; Department of Psychiatry, University of Toronto, Canada; Department of Psychiatry, Unity Health Toronto, Canada; Li Ka Shing Knowledge Institute, Unity Health Toronto, Canada; and Krembil Research Institute, University Health Network, Toronto, Canada
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Taraku B, Loureiro JR, Sahib AK, Zavaliangos-Petropulu A, Al-Sharif N, Leaver A, Wade B, Joshi S, Woods RP, Espinoza R, Narr KL. Ketamine treatment modulates habenular and nucleus accumbens static and dynamic functional connectivity in major depression. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.12.01.23299282. [PMID: 38106178 PMCID: PMC10723506 DOI: 10.1101/2023.12.01.23299282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
Dysfunctional reward processing in major depressive disorder (MDD) involves functional circuitry of the habenula (Hb) and nucleus accumbens (NAc). Ketamine elicits rapid antidepressant and alleviates anhedonia in MDD. To clarify how ketamine perturbs reward circuitry in MDD, we examined how serial ketamine infusions (SKI) modulate static and dynamic functional connectivity (FC) in Hb and NAc networks. MDD participants (n=58, mean age=40.7 years, female=28) received four ketamine infusions (0.5mg/kg) 2-3 times weekly. Resting-state fMRI scans and clinical assessments were collected at baseline and 24 hours post-SKI completion. Static FC (sFC) and dynamic FC variability (dFCv) were calculated from left and right Hb and NAc seeds to all other brain regions. Paired t-tests examined changes in FC pre-to-post SKI, and correlations were used to determine relationships between FC changes with mood and anhedonia. Following SKI, significant increases in left Hb-bilateral visual cortex FC, decreases in left Hb-left inferior parietal cortex FC, and decreases in left NAc-right cerebellum FC occurred. Decreased dFCv between left Hb and right precuneus and visual cortex, and decreased dFCv between right NAc and right visual cortex both significantly correlated with improvements in Hamilton Depression Rating Scale. Decreased FC between left Hb and bilateral visual/parietal cortices as well as increased FC between left NAc and right visual/parietal cortices both significantly correlated with improvements in anhedonia. Subanesthetic ketamine modulates functional pathways linking the Hb and NAc with visual, parietal, and cerebellar regions. Overlapping effects between Hb and NAc functional systems were associated with ketamine's therapeutic response.
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Affiliation(s)
- Brandon Taraku
- Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, University of California Los Angeles, Los Angeles, CA, USA
| | - Joana R Loureiro
- Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, University of California Los Angeles, Los Angeles, CA, USA
| | - Ashish K Sahib
- Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, University of California Los Angeles, Los Angeles, CA, USA
| | - Artemis Zavaliangos-Petropulu
- Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, University of California Los Angeles, Los Angeles, CA, USA
| | - Noor Al-Sharif
- Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, University of California Los Angeles, Los Angeles, CA, USA
| | | | - Benjamin Wade
- Division of Neuropsychiatry and Neuromodulation, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Shantanu Joshi
- Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, University of California Los Angeles, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA
| | - Roger P Woods
- Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, University of California Los Angeles, Los Angeles, CA, USA
| | - Randall Espinoza
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA
| | - Katherine L Narr
- Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, University of California Los Angeles, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA
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Pouyan N, Younesi Sisi F, Kargar A, Scheidegger M, McIntyre RS, Morrow JD. The effects of Lysergic Acid Diethylamide (LSD) on the Positive Valence Systems: A Research Domain Criteria (RDoC)-Informed Systematic Review. CNS Drugs 2023; 37:1027-1063. [PMID: 37999867 PMCID: PMC10703966 DOI: 10.1007/s40263-023-01044-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/16/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND AND OBJECTIVES The renewed interest in psychedelic research provides growing evidence of potentially unique effects on various aspects of reward processing systems. Using the Research Domain Criteria (RDoC) framework, as proposed by the National Institute of Mental Health, we aim to synthesize the existing literature concerning the impact of lysergic acid diethylamide (LSD) on the RDoC's Positive Valence Systems (PVS) domain, and to identify potential avenues for further research. METHODS Two LSD-related terms (lysergic acid diethylamide and LSD) and 13 PVS-related terms (reward, happiness, bliss, motivation, reinforcement learning, operant, conditioning, satisfaction, decision making, habit, valence, affect, mood) were used to search electronic databases such as PubMed, Scopus, PsychINFO, and Web of Science for relevant articles. A manual search of the reference list resulted in nine additional articles. After screening, articles and data were evaluated and included based on their relevance to the objective of investigating the effects of LSD on the PVS. Articles and data were excluded if they did not provide information about the PVS, were observational in nature, lacked comparators or reference groups, or were duplicates. A risk of bias assessment was performed using the National Toxicology Program's Office of Health Assessment and Translation (NTP OHAT) risk of bias (RoB) tool. Data from the included articles were collected and structured based on the RDoC bio-behavioral matrix, specifically focusing on the PVS domain and its three constituent constructs: reward responsiveness, reward learning, and reward valuation. RESULTS We reviewed 28 clinical studies with 477 participants. Lysergic acid diethylamide, assessed at self-report (23 studies), molecular (5 studies), circuit (4 studies), and paradigm (3 studies) levels, exhibited dose-dependent mood improvement (20 short-term and 3 long-term studies). The subjective and neural effects of LSD were linked to the 5-HT2A receptor (molecular). Animal studies (14 studies) suggested LSD could mildly reinforce conditioned place preference without aversion and reduce responsiveness to other rewards. Findings on reward learning were inconsistent but hinted at potential associative learning enhancements. Reward valuation measures indicated potential reductions in effort expenditure for other reinforcers. CONCLUSION Our findings are consistent with our previous work, which indicated classical psychedelics, primarily serotonin 2A receptor agonists, enhanced reward responsiveness in healthy individuals and patient populations. Lysergic acid diethylamide exhibits a unique profile in the reward learning and valuation constructs. Using the RDoC-based framework, we identified areas for future research, enhancing our understanding of the impact of LSD on reward processing. However, applying RDoC to psychedelic research faces limitations due to diverse study designs that were not initially RDoC-oriented. Limitations include subjective outcome measure selection aligned with RDoC constructs and potential bias in synthesizing varied studies. Additionally, some human studies were open-label, introducing potential bias compared to randomized, blinded studies.
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Affiliation(s)
- Niloufar Pouyan
- Michigan Psychedelic Center (M-PsyC), and Chronic Pain and Fatigue Research Center (CPFRC), University of Michigan Medical School, Ann Arbor, MI, USA.
- Neuroscience Graduate Program, and Program in Biomedical Sciences (PIBS), University of Michigan Medical School, 1135 Catherine Street, Box 5619, 2960 Taubman Health Science Library, Ann Arbor, MI, USA.
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich, University of Zurich, Zurich, Switzerland.
- Aracell Zist Darou pharmaceutical, Tehran, Iran.
| | - Farnaz Younesi Sisi
- Yaadmaan Institute for Brain, Cognition and Memory Studies, Tehran, Iran
- Cognitive Neurology and Neuropsychiatry Research Center, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Alireza Kargar
- Cognitive Neurology and Neuropsychiatry Research Center, Tehran University of Medical Sciences (TUMS), Tehran, Iran
- Department of Clinical Pharmacy, School of pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Milan Scheidegger
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Neuroscience Center Zurich, University of Zurich and Swiss Federal Institute of Technology Zurich, Zurich, Switzerland
| | - Roger S McIntyre
- Mood Disorders Psychopharmacology Unit (MDPU), University Health Network, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Jonathan D Morrow
- Neuroscience Graduate Program, and Program in Biomedical Sciences (PIBS), University of Michigan Medical School, 1135 Catherine Street, Box 5619, 2960 Taubman Health Science Library, Ann Arbor, MI, USA
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
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11
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Whitton AE, Kumar P, Treadway MT, Rutherford AV, Ironside ML, Foti D, Fitzmaurice G, Du F, Pizzagalli DA. Distinct profiles of anhedonia and reward processing and their prospective associations with quality of life among individuals with mood disorders. Mol Psychiatry 2023; 28:5272-5281. [PMID: 37402852 DOI: 10.1038/s41380-023-02165-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 06/13/2023] [Accepted: 06/23/2023] [Indexed: 07/06/2023]
Abstract
Leading professional health bodies have called for the wider adoption of Patient Reported Outcome Measures, such as quality of life, in research and clinical practice as a means for understanding why the global burden of depression continues to climb despite increased rates of treatment use. Here, we examined whether anhedonia-an often recalcitrant and impairing symptom of depression-along with its neural correlates, was associated with longitudinal changes in patient-reported quality of life among individuals seeking treatment for mood disorders. We recruited 112 participants, including n = 80 individuals with mood disorders (58 unipolar, 22 bipolar) and n = 32 healthy controls (63.4% female). We assessed anhedonia severity along with two electroencephalographic markers of neural reward responsiveness (scalp-level 'Reward Positivity' amplitude and source-localized reward-related activation in the dorsal anterior cingulate cortex), and assessed quality of life at baseline, 3- and 6-month follow-up. Anhedonia emerged as a robust correlate of quality of life cross-sectionally and longitudinally among individuals with mood disorders. Furthermore, increased neural reward responsiveness at baseline was associated with greater improvements in quality of life over time, and this improvement was mediated by longitudinal improvements in anhedonia severity. Finally, differences in quality of life observed between individuals with unipolar and bipolar mood disorders were mediated by differences in anhedonia severity. Our findings indicate that anhedonia and its reward-related neural correlates are linked to variability in quality of life over time in individuals with mood disorders. Treatments capable of improving anhedonia and normalizing brain reward function may be necessary for improving broader health outcomes for individuals seeking treatment for depression.ClinicalTrials.gov identifier: NCT01976975.
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Affiliation(s)
- Alexis E Whitton
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
- McLean Hospital & Harvard Medical School, Belmont, MA, USA
| | - Poornima Kumar
- McLean Hospital & Harvard Medical School, Belmont, MA, USA
| | | | | | | | - Dan Foti
- Purdue University, West Lafayette, IN, USA
| | | | - Fei Du
- McLean Hospital & Harvard Medical School, Belmont, MA, USA
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12
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Lindahl J, Asp M, Ståhl D, Tjernberg J, Eklund M, Björkstrand J, van Westen D, Jensen J, Månsson K, Tornberg Å, Svensson M, Deierborg T, Ventorp F, Lindqvist D. Add-on pramipexole for anhedonic depression: study protocol for a randomised controlled trial and open-label follow-up in Lund, Sweden. BMJ Open 2023; 13:e076900. [PMID: 38035737 PMCID: PMC10689415 DOI: 10.1136/bmjopen-2023-076900] [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: 06/20/2023] [Accepted: 11/03/2023] [Indexed: 12/02/2023] Open
Abstract
INTRODUCTION Many depressed patients do not achieve remission with available treatments. Anhedonia is a common residual symptom associated with treatment resistance as well as low function and quality of life. There are currently no specific and effective treatments for anhedonia. Some trials have shown that dopamine agonist pramipexole is efficacious for treating depression, but more data is needed before it could become ready for clinical prime time. Given its mechanism of action, pramipexole might be a useful treatment for a depression subtype characterised by significant anhedonia and lack of motivation-symptoms associated with dopaminergic hypofunction. We recently showed, in an open-label pilot study, that add-on pramipexole is a feasible treatment for depression with significant anhedonia, and that pramipexole increases reward-related activity in the ventral striatum. We will now confirm or refute these preliminary results in a randomised controlled trial (RCT) and an open-label follow-up study. METHODS AND ANALYSIS Eighty patients with major depression (bipolar or unipolar) or dysthymia and significant anhedonia according to the Snaith Hamilton Pleasure Scale (SHAPS) are randomised to either add-on pramipexole or placebo for 9 weeks. Change in anhedonia symptoms per the SHAPS is the primary outcome, and secondary outcomes include change in core depressive symptoms, apathy, sleep problems, life quality, anxiety and side effects. Accelerometers are used to assess treatment-associated changes in physical activity and sleep patterns. Blood and brain biomarkers are investigated as treatment predictors and to establish target engagement. After the RCT phase, patients continue with open-label treatment in a 6-month follow-up study aiming to assess long-term efficacy and tolerability of pramipexole. ETHICS AND DISSEMINATION The study has been approved by the Swedish Ethical Review Authority and the Swedish Medical Products Agency. The study is externally monitored according to Good Clinical Practice guidelines. Results will be disseminated via conference presentations and peer-reviewed publications. TRIAL REGISTRATION NUMBER NCT05355337 and NCT05825235.
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Affiliation(s)
- Jesper Lindahl
- Unit for Biological and Precision Psychiatry, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Office for Psychiatry and Habilitation, Psychiatric Clinic Lund, Region Skåne, Lund, Sweden
| | - Marie Asp
- Unit for Biological and Precision Psychiatry, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Office for Psychiatry and Habilitation, Psychiatric Clinic Lund, Region Skåne, Lund, Sweden
| | - Darya Ståhl
- Unit for Biological and Precision Psychiatry, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Johanna Tjernberg
- Unit for Biological and Precision Psychiatry, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Office for Psychiatry and Habilitation, Psychiatry Research Skåne, Region Skåne, Lund, Sweden
| | - Moa Eklund
- Unit for Biological and Precision Psychiatry, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Office for Psychiatry and Habilitation, Psychiatric Clinic Lund, Region Skåne, Lund, Sweden
| | | | - Danielle van Westen
- Diagnostic Radiology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Image and Function, Skåne University Hospital, Lund, Sweden
| | - Jimmy Jensen
- Department of Psychology, Kristianstad University, Kristianstad, Sweden
| | - Kristoffer Månsson
- Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Åsa Tornberg
- Department of Health Sciences, Lund University, Lund, Sweden
| | - Martina Svensson
- Experimental Neuroinflammation Laboratory, Department of Experimental Medical Science, Lund University, Lund, Sweden
| | - Tomas Deierborg
- Experimental Neuroinflammation Laboratory, Department of Experimental Medical Science, Lund University, Lund, Sweden
| | - Filip Ventorp
- Unit for Biological and Precision Psychiatry, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Office for Psychiatry and Habilitation, Psychiatric Clinic Lund, Region Skåne, Lund, Sweden
| | - Daniel Lindqvist
- Unit for Biological and Precision Psychiatry, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Office for Psychiatry and Habilitation, Psychiatry Research Skåne, Region Skåne, Lund, Sweden
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13
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Carstens L, Popp M, Keicher C, Hertrampf R, Weigner D, Meiering MS, Luippold G, Süssmuth SD, Beckmann CF, Wunder A, Grimm S. Effects of a single dose of amisulpride on functional brain changes during reward- and motivation-related processing using task-based fMRI in healthy subjects and patients with major depressive disorder - study protocol for a randomized clinical trial. Trials 2023; 24:761. [PMID: 38012795 PMCID: PMC10683198 DOI: 10.1186/s13063-023-07788-x] [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: 05/03/2023] [Accepted: 11/06/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Anhedonia and other deficits in reward- and motivation-related processing in psychiatric patients, including patients with major depressive disorder (MDD), represent a high unmet medical need. Neurobiologically, these deficits in MDD patients are mainly associated with low dopamine function in a frontostriatal network. In this study, alterations in brain activation changes during reward processing and at rest in MDD patients compared with healthy subjects are explored and the effects of a single low dose of the dopamine D2 receptor antagonist amisulpride are investigated. METHODS This is a randomized, controlled, double-blind, single-dose, single-center parallel-group clinical trial to assess the effects of a single dose of amisulpride (100 mg) on blood-oxygenation-level-dependent (BOLD) responses during reward- and motivation-related processing in healthy subjects (n = 60) and MDD patients (n = 60). Using functional magnetic resonance imaging (fMRI), BOLD responses are assessed during the monetary incentive delay (MID) task (primary outcome). Exploratory outcomes include BOLD responses and behavioral measures during the MID task, instrumental learning task, effort-based decision-making task, social incentive delay task, and probabilistic reward task as well as changes in resting state functional connectivity and cerebral blood flow. DISCUSSION This study broadly covers all aspects of reward- and motivation-related processing as categorized by the National Institute of Mental Health Research Domain Criteria and is thereby an important step towards precision psychiatry. Results regarding the immediate effects of a dopaminergic drug on deficits in reward- and motivation-related processing not only have the potential to significantly broaden our understanding of underlying neurobiological processes but might eventually also pave the way for new treatment options. TRIAL REGISTRATION ClinicalTrials.gov NCT05347199. April 12, 2022.
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Affiliation(s)
| | - Margot Popp
- Translational Medicine and Clinical Pharmacology, Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach an Der Riss, Germany
| | | | | | | | | | - Gerd Luippold
- Clinical Development and Operations, Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach an Der Riss, Germany
| | - Sigurd D Süssmuth
- Medicine Therapeutic Area CNS-Retinopathies-Emerging Areas, Boehringer Ingelheim International GmbH, Biberach an Der Riss, Germany
| | - Christian F Beckmann
- Donders Institute, Centre for Medical Neuroscience, Radboud University Medical Centre, Nijmegen, Netherlands
- Centre for Functional MRI of the Brain (FMRIB), Nuffield Department of Clinical Neurosciences, Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, UK
- SBGneuro Ltd, Littlemore, Oxford, UK
| | - Andreas Wunder
- Translational Medicine and Clinical Pharmacology, Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach an Der Riss, Germany
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14
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Guo P, Xu Y, Lv L, Feng M, Fang Y, Huang WQ, Cheng SF, Qian MC, Yang S, Wang SK, Chen HX. A multicenter, randomized controlled study on the efficacy of agomelatine in ameliorating anhedonia, reduced motivation, and circadian rhythm disruptions in patients with major depressive disorder (MDD). Ann Gen Psychiatry 2023; 22:46. [PMID: 37957751 PMCID: PMC10642047 DOI: 10.1186/s12991-023-00473-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 10/13/2023] [Indexed: 11/15/2023] Open
Abstract
OBJECTIVE To evaluate the clinical efficacy and safety of Agomelatine in improving symptoms in patients with major depressive disorder (MDD), providing more scientific evidence for the treatment of depression, and offering more effective therapeutic options for patients. METHODS A total of 180 MDD patients in acute phase from 10 psychiatric hospitals of Grade three in Zhejiang Province were enrolled in this 12-week study with the competitive and consecutive pattern, and they were randomized into two different groups treated with flexible-dosage antidepressants of selective serotonin reuptake inhibitors (SSRI) or agomelatine, respectively. The subjects were evaluated with psychological scales of HAMD-17, HAMA, SHAPS for anhedonia, MFI-20 for fatigue, PQSI for sleep quality and MEQ for disturbances in chronobiologic rhythms at baseline, 2, 4, 8 and 12-weekend points, and TESS was used for side-effect. The results were analyzed with repeated measurement analysis of variance. RESULTS The two groups each had 90 participants, and there were no significant differences at baseline. The scores of various assessment scales showed statistically significant time main effects during the visits (P < 0.01). The Agomelatine group demonstrated faster efficacy within 2 weeks, with better improvement in SHAPS, MEQ, and PSQI compared to the SSRIs group. However, the remission rate at 12 weeks was lower in the Agomelatine group than in the SSRIs group (63.3% and 72.2%), but the difference between the groups was not statistically significant. The Agomelatine group had fewer adverse reactions (14.4% and 16.7%), but there was a slightly higher incidence of liver function impairment (6.7% and 4.4%), with no statistically significant difference between the groups. CONCLUSION Agomelatine, as a novel antidepressant, shows certain advantages in improving depression and anxiety symptoms and is comparable to SSRIs in terms of safety. However, its long-term efficacy and safety on MDD or other depressive subtypes still require further observation and research.
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Affiliation(s)
- Ping Guo
- Department of Psychiatry, Huzhou Third Municipal Hospital Affiliated to Huzhou University, No.2088 of Tiaoxi East Road, Wuxing District, Huzhou, 313000, Zhejiang, China
| | - Yong Xu
- Clinical Psychology Department, Qingdao Hospital, University of Health and Rehabilitation Sciences (Qingdao Municipal Hospital), Qingdao, 266000, China
| | - Liang Lv
- Department of Psychiatry, Huzhou Third Municipal Hospital Affiliated to Huzhou University, No.2088 of Tiaoxi East Road, Wuxing District, Huzhou, 313000, Zhejiang, China
| | - Min Feng
- Department of Psychiatry, Huzhou Third Municipal Hospital Affiliated to Huzhou University, No.2088 of Tiaoxi East Road, Wuxing District, Huzhou, 313000, Zhejiang, China
| | - Yu Fang
- Department of Psychiatry, Huzhou Third Municipal Hospital Affiliated to Huzhou University, No.2088 of Tiaoxi East Road, Wuxing District, Huzhou, 313000, Zhejiang, China
| | - Wei-Quan Huang
- Key Laboratory, Huzhou Third Municipal Hospital Affiliated to Huzhou University, Huzhou, 313000, China
| | - Shan-Fei Cheng
- Department of Anesthesiology, Huzhou Third Municipal Hospital Affiliated to Huzhou University, Huzhou, 313000, China
| | - Min-Cai Qian
- Department of Psychiatry, Huzhou Third Municipal Hospital Affiliated to Huzhou University, No.2088 of Tiaoxi East Road, Wuxing District, Huzhou, 313000, Zhejiang, China.
| | - Shengliang Yang
- Department of Psychiatry, Huzhou Third Municipal Hospital Affiliated to Huzhou University, No.2088 of Tiaoxi East Road, Wuxing District, Huzhou, 313000, Zhejiang, China.
| | - Shi-Kai Wang
- Department of Psychiatry, Huzhou Third Municipal Hospital Affiliated to Huzhou University, No.2088 of Tiaoxi East Road, Wuxing District, Huzhou, 313000, Zhejiang, China.
| | - Huan-Xin Chen
- Key Laboratory, Huzhou Third Municipal Hospital Affiliated to Huzhou University, Huzhou, 313000, China
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15
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Dolan SC, Kambanis PE, Stern CM, Becker KR, Breithaupt L, Gydus J, Smith S, Misra M, Micali N, Lawson EA, Eddy KT, Thomas JJ. Anticipatory and consummatory pleasure in avoidant/restrictive food intake disorder. J Eat Disord 2023; 11:198. [PMID: 37950288 PMCID: PMC10638737 DOI: 10.1186/s40337-023-00921-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 10/31/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Recent research suggests that individuals with eating disorders (EDs) report elevated anhedonia, or loss of pleasure. Although individuals with avoidant/restrictive food intake disorder (ARFID) often express that they do not look forward to eating, it is unclear whether they experience lower pleasure than those without EDs. Thus, identifying whether individuals with ARFID experience anhedonia may yield important insights that inform clinical conceptualization and treatment. METHODS A sample of 71 participants ages 10-23 with full and subthreshold ARFID and 33 healthy controls (HCs) completed the Pica, ARFID, and Rumination Disorder Interview, a diagnostic interview to assess ARFID profile severity (lack of interest in food, sensory sensitivity, fear of aversive consequences) and the Temporal Experience of Pleasure Scale (TEPS), a self-report measure of consummatory and anticipatory pleasure. Statistical analyses were performed using the full TEPS and also the TEPS with food-related items removed. RESULTS The ARFID group reported significantly lower anticipatory and consummatory pleasure compared to HCs, but these differences were no longer significant after controlling for depression, nor after removing food items from the TEPS. Within the ARFID sample, greater ARFID severity was associated with lower anticipatory pleasure across analyses, and greater endorsement of the lack of interest in food profile was related to lower anticipatory pleasure. ARFID severity was also associated with lower consummatory pleasure using the full TEPS, but this relationship was no longer significant with food items removed. CONCLUSIONS These results provide initial evidence for lower pleasure before potentially pleasurable events in individuals with more severe ARFID, particularly those with the lack of interest phenotype. Our findings also suggest that depression is likely to contribute low pleasure in this population. Future research should seek to further characterize how dimensions of pleasure relate to the maintenance and treatment of ARFID symptoms.
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Affiliation(s)
- Sarah C Dolan
- Department of Psychology, Hofstra University, Hempstead, NY, USA
| | - P Evelyna Kambanis
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, 2 Longfellow Place, Suite 200, Boston, MA, 02114, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Casey M Stern
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, 2 Longfellow Place, Suite 200, Boston, MA, 02114, USA
| | - Kendra R Becker
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, 2 Longfellow Place, Suite 200, Boston, MA, 02114, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Lauren Breithaupt
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, 2 Longfellow Place, Suite 200, Boston, MA, 02114, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, USA
| | - Julia Gydus
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Sarah Smith
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Madhusmita Misra
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, USA
| | - Nadia Micali
- Department of Psychiatry, University of Geneva, Geneva, Switzerland
- Department of Pediatrics, Gynecology and Obstetrics, University of Geneva, Geneva, Switzerland
- Eating Disorders Research Unit, Mental Health Center Ballerup, Ballerup, Denmark
| | - Elizabeth A Lawson
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Kamryn T Eddy
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, 2 Longfellow Place, Suite 200, Boston, MA, 02114, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Jennifer J Thomas
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, 2 Longfellow Place, Suite 200, Boston, MA, 02114, USA.
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
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16
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Sudol K, Conway C, Szymkowicz SM, Elson D, Kang H, Taylor WD. Cognitive, Disability, and Treatment Outcome Implications of Symptom-Based Phenotyping in Late-Life Depression. Am J Geriatr Psychiatry 2023; 31:919-931. [PMID: 37385899 PMCID: PMC10592463 DOI: 10.1016/j.jagp.2023.06.003] [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: 01/09/2023] [Revised: 05/31/2023] [Accepted: 06/08/2023] [Indexed: 07/01/2023]
Abstract
OBJECTIVE Late-life depression is associated with substantial heterogeneity in clinical presentation, disability, and response to antidepressant treatment. We examined whether self-report of severity of common symptoms, including anhedonia, apathy, rumination, worry, insomnia, and fatigue were associated with differences in presentation and response to treatment. We also examined whether these symptoms improved during treatment with escitalopram. DESIGN Eighty-nine older adults completed baseline assessments, neuropsychological testing and providing self-reported symptom and disability scales. They then entered an 8-week, placebo-controlled randomized trial of escitalopram, and self-report scales were repeated at the trial's end. Raw symptom scale scores were combined into three standardized symptom phenotypes and models examined how symptom phenotype severity was associated with baseline measures and depression improvement over the trial. RESULTS While rumination/worry appeared independent, severity of apathy/anhedonia and fatigue/insomnia were associated with one another and with greater self-reported disability. Greater fatigue/insomnia was also associated with slower processing speed, while rumination/worry was associated with poorer episodic memory. No symptom phenotype severity score predicted a poorer overall response to escitalopram. In secondary analyses, escitalopram did not improve most phenotypic symptoms more than placebo, aside for greater reductions in worry and total rumination severity. CONCLUSION Deeper symptom phenotype characterization may highlight differences in the clinical presentation of late-life depression. However, when compared to placebo, escitalopram did not improve many of the symptoms assessed. Further work is needed to determine whether symptom phenotypes inform longer-term course of illness, and which treatments may best benefit specific symptoms.
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Affiliation(s)
- Katherin Sudol
- The Vanderbilt Center for Cognitive Medicine (KS, CC, SMS, DE, WDT), Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Catherine Conway
- The Vanderbilt Center for Cognitive Medicine (KS, CC, SMS, DE, WDT), Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Sarah M Szymkowicz
- The Vanderbilt Center for Cognitive Medicine (KS, CC, SMS, DE, WDT), Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Damian Elson
- The Vanderbilt Center for Cognitive Medicine (KS, CC, SMS, DE, WDT), Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Hakmook Kang
- Department of Biostatistics (HK), Vanderbilt University Medical Center, Nashville, TN
| | - Warren D Taylor
- The Vanderbilt Center for Cognitive Medicine (KS, CC, SMS, DE, WDT), Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN; Geriatric Research (WDT), Education and Clinical Center, Veterans Affairs Tennessee Valley Health System, Nashville, TN.
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17
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Costello H, Yamamori Y, Reeves S, Schrag AE, Howard R, Roiser JP. Longitudinal decline in striatal dopamine transporter binding in Parkinson's disease: associations with apathy and anhedonia. J Neurol Neurosurg Psychiatry 2023; 94:863-870. [PMID: 37221053 PMCID: PMC10511995 DOI: 10.1136/jnnp-2022-330790] [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: 11/21/2022] [Accepted: 04/22/2023] [Indexed: 05/25/2023]
Abstract
BACKGROUND Motivational symptoms such as apathy and anhedonia are common in Parkinson's disease (PD), respond poorly to treatment, and are hypothesised to share underlying neural mechanisms. Striatal dopaminergic dysfunction is considered central to motivational symptoms in PD but the association has never been examined longitudinally. We investigated whether progression of dopaminergic dysfunction was associated with emergent apathy and anhedonia symptoms in PD. METHODS Longitudinal cohort study of 412 newly diagnosed patients with PD followed over 5 years as part of the Parkinson's Progression Markers Initiative cohort.Apathy and anhedonia were measured using a composite score derived from relevant items of the 15-item Geriatric Depression Scale (GDS-15) and part I of the MDS-Unified Parkinson's Disease Rating Scale. Dopaminergic neurodegeneration was measured using repeated striatal dopamine transporter (DAT) imaging. RESULTS Linear mixed-effects modelling across all contemporaneous data points identified a significant negative relationship between striatal DAT specific binding ratio (SBR) and apathy/anhedonia symptoms, which emerged as PD progressed (interaction:β=-0.09, 95% CI (-0.15 to -0.03), p=0.002). Appearance and subsequent worsening of apathy/anhedonia symptoms began on average 2 years after diagnosis and below a threshold striatal DAT SBR level. The interaction between striatal DAT SBR and time was specific to apathy/anhedonia symptoms, with no evidence of a similar interaction for general depressive symptoms from the GDS-15 (excluding apathy/anhedonia items) (β=-0.06, 95% CI (-0.13 to 0.01)) or motor symptoms (β=0.20, 95% CI (-0.25 to 0.65)). CONCLUSIONS Our findings support a central role for dopaminergic dysfunction in motivational symptoms in PD. Striatal DAT imaging may be a useful indicator of apathy/anhedonia risk that could inform intervention strategies.
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Affiliation(s)
- Harry Costello
- Institute of Cognitive Neuroscience, University College London, London, UK
| | - Yumeya Yamamori
- Institute of Cognitive Neuroscience, University College London, London, UK
| | - Suzanne Reeves
- Division of Psychiatry, University College London, London, UK
| | | | - Robert Howard
- Division of Psychiatry, University College London, London, UK
| | - Jonathan P Roiser
- Institute of Cognitive Neuroscience, University College London, London, UK
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18
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Koshikawa Y, Onohara A, Wakeno M, Takekita Y, Kinoshita T, Kato M. Characteristics of persistent depression in the long-term: Randomized controlled trial and two-year observational study. Heliyon 2023; 9:e20917. [PMID: 37886758 PMCID: PMC10597827 DOI: 10.1016/j.heliyon.2023.e20917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 10/07/2023] [Accepted: 10/11/2023] [Indexed: 10/28/2023] Open
Abstract
Major depressive disorder is a chronic condition that can recur and relapse. It would be clinically useful to know the patient background to predict the chronicity of depressive symptoms, and the change in diagnosis of bipolar disorder. This study included 197 patients enrolled in a six-week randomized controlled trial with a two-year follow-up. We conducted multiple logistic regression analyses to identify the clinical and sociodemographic characteristics associated with persistent depressive disorder (PDD), relapse, and changes in bipolar disorder diagnosis. The significantly correlated factors were residual symptoms, including insight, work and activity, and general somatic symptoms at week six. We could not identify any factors that contributed to relapse or change in the diagnosis of bipolar disorder. We found that the specific residual symptoms of acute treatment affected long-term treatment outcomes for depression. Attention should be paid to the residual symptoms of depression in the early stages of treatment, and measures should be considered to improve them. There are several limitations to this study, including the fact that PDD may exist among patients who discontinued treatment, treatment was not standardized during the study period, and adherence was confirmed verbally.
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Affiliation(s)
- Yosuke Koshikawa
- Department of Neuropsychiatry, Kansai Medical University, Osaka, Japan
| | - Ai Onohara
- Social Welfare Corporation Uminoko Gakuen Ikejimaryo, Osaka, Japan
| | - Masataka Wakeno
- Department of Neuropsychiatry, Kansai Medical University, Osaka, Japan
| | | | | | - Masaki Kato
- Department of Neuropsychiatry, Kansai Medical University, Osaka, Japan
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19
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Gorostowicz A, Rizvi SJ, Kennedy SH, Chrobak AA, Dudek D, Cyranka K, Piekarska J, Krawczyk E, Siwek M. Polish adaptation of the Dimensional Anhedonia Rating Scale (DARS) - validation in the clinical sample. Front Psychiatry 2023; 14:1268290. [PMID: 37817828 PMCID: PMC10561247 DOI: 10.3389/fpsyt.2023.1268290] [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: 07/27/2023] [Accepted: 09/12/2023] [Indexed: 10/12/2023] Open
Abstract
Background Anhedonia is the core symptom of depression. Its presence has been linked to worsened prognosis. The Dimensional Anhedonia Rating Scale (DARS) is a scale measuring desire, motivation, effort and consummatory pleasure across different domains. The aim of this paper was to confirm factor structure, assess reliability and validity of the Polish adaptation of the DARS in a clinical sample of patients with mood disorders and healthy controls (HC). Methods The study sample included 161 participants aged 18-65 years - 34 HC, 72 patients with bipolar disorder and 55 with major depressive disorder (in depressive episode or remission). Reliability of the Polish adaptation of the DARS was assessed using Cronbach's α and the average inter-item correlation (AIC). Convergent and divergent validity was established by Pearson's correlations between the DARS and the Snaith-Hamilton Pleasure Scale (SHAPS), the Quick Inventory of Depressive Symptomatology- self-report (QIDS-SR), the Hospital Anxiety and Depression Scale (HADS). The structure of the scale was examined by factor analysis. Results The factor structure was consistent with the original scale. Strong internal consistency for the DARS total score (Cronbach's α = 0.95) and all subscales (0.86-0.93) was observed. The DARS demonstrated good convergent (moderate to strong correlations with measures of anhedonia and depression) and divergent validity (weak correlations with anxiety level). Conclusion The Polish DARS demonstrated excellent internal consistency and very good validity. The scale is a valuable contribution to the psychometrics of anhedonia measures in patients with mood disorders.
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Affiliation(s)
| | - Sakina J. Rizvi
- ASR Suicide and Depression Studies Unit, Department of Psychiatry, St. Michael’s Hospital, University of Toronto, Toronto, ON, Canada
| | - Sidney H. Kennedy
- ASR Suicide and Depression Studies Unit, Department of Psychiatry, St. Michael’s Hospital, University of Toronto, Toronto, ON, Canada
| | | | - Dominika Dudek
- Department of Adult Psychiatry, Jagiellonian University Medical College, Kraków, Poland
| | - Katarzyna Cyranka
- Department of Adult Psychiatry, Jagiellonian University Medical College, Kraków, Poland
| | - Joanna Piekarska
- Department of Psychiatry, The Ludwik Rydygier Specialist Hospital in Cracow, Kraków, Poland
| | - Eve Krawczyk
- Department of Adult, Child and Adolescent Psychiatry, University Hospital in Cracow, Kraków, Poland
| | - Marcin Siwek
- Department of Affective Disorders, Jagiellonian University Medical College, Kraków, Poland
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20
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Potsch L, Rief W. Transdiagnostic considerations of the relationship between reward sensitivity and psychopathological symptoms - a cross-lagged panel analysis. BMC Psychiatry 2023; 23:650. [PMID: 37667190 PMCID: PMC10478275 DOI: 10.1186/s12888-023-05139-3] [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: 01/23/2023] [Accepted: 08/25/2023] [Indexed: 09/06/2023] Open
Abstract
BACKGROUND Reward sensitivity constitutes a potential key mechanism regarding the etiology and maintenance of mental disorders, especially depression. However, due to a lack of longitudinal studies, the temporal dynamics are not clear yet. Although some evidence indicates that reward processing could be a transdiagnostic mechanism of disorders, these observations could be also a product of comorbidity with depression. This study aimed at investigating the temporal dynamics of reward sensitivity and the course of psychopathological symptoms in a longitudinal investigation, while taking a possible mediating role of depression into account. METHODS We conducted a three-wave longitudinal online survey with a 4-week interval. A total of N = 453 participants filled out all three questionnaires. Reward sensitivity was assessed with the Positive Valence System Scale-21 (PVSS-21), depression with the Patient Health Questionnaire (PHQ-9), eating disorder symptoms with the Eating Disorder Examination-Questionnaire-8 (EDE-Q-8), social anxiety with the Mini-social phobia inventory (Mini-SPIN) and alcohol consumption with the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C). Cross-lagged panels and mediation analyses were calculated using path analyses. RESULTS Depressive and eating disorder symptoms predicted reward insensitivity at later points in time. Effects were larger from T2 to T3. A bidirectional relationship concerning social anxiety was found. Higher alcohol consumption predicted higher reward sensitivity. Depression at T2 fully mediated the association between psychopathological symptoms at T1 and reward sensitivity at T3 for social anxiety and eating disorder symptoms. CONCLUSIONS Our findings imply that reduced reward sensitivity seems to be a consequence rather than an antecedent of psychopathological symptoms. Comorbid depression plays a crucial role in other mental disorders regarding observed hyposensitivity towards rewards. Therefore, our results do not support a transdiagnostic notion of reward sensitivity, but they indicate a potential role of reward sensitivity for symptom persistence. TRIAL REGISTRATION The study was preregistered at the Open Science Framework (OSF) ( https://archive.org/details/osf-registrations-6n3s8-v1 ; registration DOI https://doi.org/10.17605/OSF.IO/6N3S8 ).
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Affiliation(s)
- L Potsch
- Clinical Psychology and Psychotherapy, Department of Psychology, Philipps-University of Marburg, Gutenbergstr. 18, D-35032, Marburg, Germany.
| | - W Rief
- Clinical Psychology and Psychotherapy, Department of Psychology, Philipps-University of Marburg, Gutenbergstr. 18, D-35032, Marburg, Germany
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21
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Boyle CC, Bower JE, Eisenberger NI, Irwin MR. Stress to inflammation and anhedonia: Mechanistic insights from preclinical and clinical models. Neurosci Biobehav Rev 2023; 152:105307. [PMID: 37419230 DOI: 10.1016/j.neubiorev.2023.105307] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 06/30/2023] [Accepted: 07/04/2023] [Indexed: 07/09/2023]
Abstract
Anhedonia, as evidenced by impaired pleasurable response to reward, reduced reward motivation, and/or deficits in reward-related learning, is a common feature of depression. Such deficits in reward processing are also an important clinical target as a risk factor for depression onset. Unfortunately, reward-related deficits remain difficult to treat. To address this gap and inform the development of effective prevention and treatment strategies, it is critical to understand the mechanisms that drive impairments in reward function. Stress-induced inflammation is a plausible mechanism of reward deficits. The purpose of this paper is to review evidence for two components of this psychobiological pathway: 1) the effects of stress on reward function; and 2) the effects of inflammation on reward function. Within these two areas, we draw upon preclinical and clinical models, distinguish between acute and chronic effects of stress and inflammation, and address specific domains of reward dysregulation. By addressing these contextual factors, the review reveals a nuanced literature which might be targeted for additional scientific inquiry to inform the development of precise interventions.
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Affiliation(s)
- Chloe C Boyle
- Norman Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, UCLA, USA.
| | - Julienne E Bower
- Norman Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, UCLA, USA; Department of Psychology, UCLA, Los Angeles, CA, USA
| | | | - Michael R Irwin
- Norman Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, UCLA, USA
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22
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Sajjadian M, Uher R, Ho K, Hassel S, Milev R, Frey BN, Farzan F, Blier P, Foster JA, Parikh SV, Müller DJ, Rotzinger S, Soares CN, Turecki G, Taylor VH, Lam RW, Strother SC, Kennedy SH. Prediction of depression treatment outcome from multimodal data: a CAN-BIND-1 report. Psychol Med 2023; 53:5374-5384. [PMID: 36004538 PMCID: PMC10482706 DOI: 10.1017/s0033291722002124] [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: 12/20/2021] [Revised: 05/04/2022] [Accepted: 06/20/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Prediction of treatment outcomes is a key step in improving the treatment of major depressive disorder (MDD). The Canadian Biomarker Integration Network in Depression (CAN-BIND) aims to predict antidepressant treatment outcomes through analyses of clinical assessment, neuroimaging, and blood biomarkers. METHODS In the CAN-BIND-1 dataset of 192 adults with MDD and outcomes of treatment with escitalopram, we applied machine learning models in a nested cross-validation framework. Across 210 analyses, we examined combinations of predictive variables from three modalities, measured at baseline and after 2 weeks of treatment, and five machine learning methods with and without feature selection. To optimize the predictors-to-observations ratio, we followed a tiered approach with 134 and 1152 variables in tier 1 and tier 2 respectively. RESULTS A combination of baseline tier 1 clinical, neuroimaging, and molecular variables predicted response with a mean balanced accuracy of 0.57 (best model mean 0.62) compared to 0.54 (best model mean 0.61) in single modality models. Adding week 2 predictors improved the prediction of response to a mean balanced accuracy of 0.59 (best model mean 0.66). Adding tier 2 features did not improve prediction. CONCLUSIONS A combination of clinical, neuroimaging, and molecular data improves the prediction of treatment outcomes over single modality measurement. The addition of measurements from the early stages of treatment adds precision. Present results are limited by lack of external validation. To achieve clinically meaningful prediction, the multimodal measurement should be scaled up to larger samples and the robustness of prediction tested in an external validation dataset.
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Affiliation(s)
- Mehri Sajjadian
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Rudolf Uher
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Keith Ho
- University Health Network, 399 Bathurst Street, Toronto, ON, M5T 2S8, Canada
- Unity Health Toronto, St. Michael's Hospital, 193 Yonge Street, 6th floor, Toronto, ON, M5B 1M4, Canada
| | - Stefanie Hassel
- Department of Psychiatry and Mathison Centre for Mental Health Research and Education, Cumming School of Medicine, University of Calgary, 3330 Hospital Dr NW, Calgary, AB, T2N 4N1, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Roumen Milev
- Departments of Psychiatry and Psychology, Queen's University, Providence Care Hospital, Kingston, ON, Canada
| | - Benicio N. Frey
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
- Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Faranak Farzan
- eBrain Lab, School of Mechatronic Systems Engineering, Simon Fraser University, Surrey, BC, Canada
| | - Pierre Blier
- The Royal's Institute of Mental Health Research, 1145 Carling Avenue, Ottawa, ON, K1Z 7K4, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada
- Department of Psychiatry, University of Ottawa, 1145 Carling Avenue, Ottawa, ON, K1Z 7K4, Canada
| | - Jane A. Foster
- Department of Psychiatry & Behavioural Neurosciences, St Joseph's Healthcare, Hamilton, ON, Canada
| | - Sagar V. Parikh
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Daniel J. Müller
- Campbell Family Mental Health Research Institute, Center for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Susan Rotzinger
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, St Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Claudio N. Soares
- Department of Psychiatry, Queen's University School of Medicine, Kingston, ON, Canada
| | - Gustavo Turecki
- Department of Psychiatry, Douglas Institute, McGill University, Montreal, QC, Canada
| | - Valerie H. Taylor
- Department of Psychiatry, Foothills Medical Centre, University of Calgary, Calgary, AB, Canada
| | - Raymond W. Lam
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Stephen C. Strother
- Rotman Research Center, Baycrest, Toronto, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, Canada
| | - Sidney H. Kennedy
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, St Michael's Hospital, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, University Health Network, Toronto, Ontario, Canada
- Krembil Research Centre, University Health Network, University of Toronto, Toronto, Canada
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23
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Carneiro AM, Pereira DA, Fernandes F, Baptista MN, Brunoni AR, Moreno RA. Distorted thoughts as a mediator of depressive symptoms in patients with major depressive disorder: a longitudinal study. Health Qual Life Outcomes 2023; 21:88. [PMID: 37580739 PMCID: PMC10424419 DOI: 10.1186/s12955-023-02178-y] [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: 05/05/2023] [Accepted: 08/01/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND Distorted thoughts are common in Major Depressive Disorder (MDD), and can impact patients' perceptions of depression severity, and predict chronicity and treatment response. This study aimed to investigate whether distorted thoughts mediate depressive symptoms in MDD over a 6-month period. METHOD These are secondary results from a study that followed 119 patients diagnosed with moderate to severe MDD for 6 months. Diagnoses were confirmed by the Structured Interview for DSM-IV (SCID-CV). The analysis was composed of results from the Hamilton Depression Rating Scale (HAMD-17), the Montgomery-Asberg Depression Rating Scale (MADRS), the second edition of the Beck Depression Inventory (BDI-II), and the Depression Thoughts Scale (DTS) collected at weeks 1, 8, 12 and 24. RESULTS Results showed that the DTS mediated the relationship between depressive symptoms experienced approximately 3 months after starting antidepressant treatment. CONCLUSION Cognitive distortions were linked as a mediator to depressive symptoms, highlighting the importance of early psychological interventions in patients with MDD who exhibit these distortions. TRIAL REGISTRATION NCT02268487.
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Affiliation(s)
- Adriana Munhoz Carneiro
- Mood Disorders Unit, Faculty of Medicine FMUSP, University of Sao Paulo, BR Ovideo Pires de Campos St., São Paulo, SP, 785 05403-010, Brazil.
| | | | - Fernando Fernandes
- Mood Disorders Unit, Faculty of Medicine FMUSP, University of Sao Paulo, BR Ovideo Pires de Campos St., São Paulo, SP, 785 05403-010, Brazil
| | - Makilim Nunes Baptista
- Laboratory of Psychometric Evaluation in Mental Health -LAPSAM III - São Francisco University, Campinas, Brazil
| | - André Russowsky Brunoni
- Department of Internal Medicine, Faculty of Medicine FMUSP, University of Sao Paulo, São Paulo, SP, Brazil
| | - Ricardo Alberto Moreno
- Mood Disorders Unit, Faculty of Medicine FMUSP, University of Sao Paulo, BR Ovideo Pires de Campos St., São Paulo, SP, 785 05403-010, Brazil
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24
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Ng CG, Abousheishaa AA, Low SY, Zainal NZ, Thong KS, Awaluddin AB, Loo TH, Yacob SB, Nik Jaafar NR, Abdul Taib NIB, Mohamad Kamal NAB, Ismail F, Wi WZ. A 6-Month Open-Label Study of Vortioxetine among Cancer Patients with Major Depressive Disorder (MDD). Asian Pac J Cancer Prev 2023; 24:2583-2591. [PMID: 37642043 PMCID: PMC10685216 DOI: 10.31557/apjcp.2023.24.8.2583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 08/05/2023] [Indexed: 08/31/2023] Open
Abstract
OBJECTIVE Vortioxetine is a monoaminergic drug with a novel multimodal mechanism of action. We investigated its efficacy on depressive symptoms, cognitive function, and quality of life among cancer patients. METHODS In this multicenter, open-label, single-arm, observational study, patients received flexible doses of Vortioxetine for a period of six months. All participants were assessed at baseline and scheduled for monitoring at weeks 2, 4, 8, 12, 16, 20, and 24. Depression severity was assessed using Montgomery-Asberg Depression Rating Scale (MADRS) and the Clinical Global Impression (CGI) scale. The Perceived Deficiency Questionnaire (PDQ-5) assessed the perceived cognitive difficulties in concentration, executive functioning, and memory. The European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire (EORTC) was used to assess the patients' quality of life. Side effects of vortioxetine were monitored using the Antidepressant Side-Effect Checklist (ASEC). RESULTS Patients experienced a reduction in MADRS scores from 29.89 ± 5.997 at baseline to 11.59 ± 4.629 by Week 24. The PDQ-5 scores showed significant change from Week-4, whereas the EORTC role, emotional, and cognitive functioning scores showed a significant change from Week 2 onwards. CGI-Severity scores decreased from a baseline of 4.39 ± 0.746 to 2.41 ± 1.085 by Week 24. During the 24-Weeks of therapy, around three-quarters of the patients (73.3%) had one or more adverse events reported on the ASEC. The most frequently reported TEAEs were dry mouth, insomnia, somnolence, and headache, with more than a 30% incidence rate. CONCLUSION Vortioxetine seems promising in the management of depression and enhancement of cognitive function and quality of life of cancer patients with Major Depressive Disorder. .
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Affiliation(s)
- Chong Guan Ng
- Department of Psychological Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
| | - Aya Ahmed Abousheishaa
- Department of Psychological Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
| | - Sue Yin Low
- Department of Psychology, Faculty of Behavioural Sciences, HELP University, Kuala Lumpur, Malaysia.
| | - Nor Zuraida Zainal
- Department of Psychological Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
| | - Kai Shin Thong
- Faculty of Medicine and Health Sciences, Universiti Tunku Abdul Rahman, Selangor, Malaysia.
| | - Azizul Bin Awaluddin
- Department of Psychiatry and Mental Health, Hospital Putrajaya, Kuala Lumpur, Malaysia.
| | - Tsui Huei Loo
- Department of Psychiatry, Hospital Raja Permaisuri Bainun, Perak, Malaysia.
| | - Sapini Binti Yacob
- Department of Psychiatry and Mental Health, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia.
| | - Nik Ruzyanei Nik Jaafar
- Department of Psychiatry, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia.
| | | | | | - Fuad Ismail
- Department of Radiotherapy and Oncology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia.
| | - Wan Zamaniah Wi
- Department of Clinical Oncology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
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25
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Slaney C, Perkins AM, Davis R, Penton-Voak I, Munafò MR, Houghton CJ, Robinson ESJ. Objective measures of reward sensitivity and motivation in people with high v. low anhedonia. Psychol Med 2023; 53:4324-4332. [PMID: 35545891 PMCID: PMC10388304 DOI: 10.1017/s0033291722001052] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 02/18/2022] [Accepted: 03/28/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Anhedonia - a diminished interest or pleasure in activities - is a core self-reported symptom of depression which is poorly understood and often resistant to conventional antidepressants. This symptom may occur due to dysfunction in one or more sub-components of reward processing: motivation, consummatory experience and/or learning. However, the precise impairments remain elusive. Dissociating these components (ideally, using cross-species measures) and relating them to the subjective experience of anhedonia is critical as it may benefit fundamental biology research and novel drug development. METHODS Using a battery of behavioural tasks based on rodent assays, we examined reward motivation (Joystick-Operated Runway Task, JORT; and Effort-Expenditure for Rewards Task, EEfRT) and reward sensitivity (Sweet Taste Test) in a non-clinical population who scored high (N = 32) or low (N = 34) on an anhedonia questionnaire (Snaith-Hamilton Pleasure Scale). RESULTS Compared to the low anhedonia group, the high anhedonia group displayed marginal impairments in effort-based decision-making (EEfRT) and reduced reward sensitivity (Sweet Taste Test). However, we found no evidence of a difference between groups in physical effort exerted for reward (JORT). Interestingly, whilst the EEfRT and Sweet Taste Test correlated with anhedonia measures, they did not correlate with each other. This poses the question of whether there are subgroups within anhedonia; however, further work is required to directly test this hypothesis. CONCLUSIONS Our findings suggest that anhedonia is a heterogeneous symptom associated with impairments in reward sensitivity and effort-based decision-making.
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Affiliation(s)
- Chloe Slaney
- Faculty of Life Sciences, School of Physiology, Pharmacology & Neuroscience, University of Bristol, Bristol BS8 1TD, UK
- School of Psychological Science, University of Bristol, 12a Priory Road, Bristol BS8 1TU, UK
- MRC Integrative Epidemiology Unit at the University of Bristol, Oakfield House, Oakfield Grove, Bristol BS8 2BN, UK
| | - Adam M. Perkins
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, UK
| | - Robert Davis
- Department of Psychology, Goldsmiths, University of London, London SE14 6NW, UK
| | - Ian Penton-Voak
- School of Psychological Science, University of Bristol, 12a Priory Road, Bristol BS8 1TU, UK
- National Institute for Health Research Biomedical Research Centre at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol, UK
| | - Marcus R. Munafò
- School of Psychological Science, University of Bristol, 12a Priory Road, Bristol BS8 1TU, UK
- MRC Integrative Epidemiology Unit at the University of Bristol, Oakfield House, Oakfield Grove, Bristol BS8 2BN, UK
- National Institute for Health Research Biomedical Research Centre at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol, UK
| | - Conor J. Houghton
- Department of Computer Science, Faculty of Engineering, University of Bristol, Bristol BS8 1UB, UK
| | - Emma S. J. Robinson
- Faculty of Life Sciences, School of Physiology, Pharmacology & Neuroscience, University of Bristol, Bristol BS8 1TD, UK
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26
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Costello H, Schrag AE, Howard R, Roiser JP. Dissociable effects of dopaminergic medications on depression symptom dimensions in Parkinson's disease. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.06.30.23292073. [PMID: 37425947 PMCID: PMC10327242 DOI: 10.1101/2023.06.30.23292073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
Background Depression in Parkinson's disease (PD) is common, disabling and responds poorly to standard antidepressant medication. Motivational symptoms of depression, such as apathy and anhedonia, are particularly prevalent in depression in PD and predict poor response to antidepressant treatment. Loss of dopaminergic innervation of the striatum is associated with emergence of motivational symptoms in PD, and mood fluctuations correlate with dopamine availability. Accordingly, optimising dopaminergic treatment for PD can improve depressive symptoms, and dopamine agonists have shown promising effects in improving apathy. However, the differential effect of antiparkinsonian medication on symptom dimensions of depression is not known. Aims We hypothesised that there would be dissociable effects of dopaminergic medications on different depression symptom dimensions. We predicted that dopaminergic medication would specifically improve motivational symptoms, but not other symptoms, of depression. We also hypothesised that antidepressant effects of dopaminergic medications with mechanisms of action reliant on pre-synaptic dopamine neuron integrity would attenuate as pre-synaptic dopaminergic neurodegeneration progresses. Methods We analysed data from a longitudinal study of 412 newly diagnosed PD patients followed over five years in the Parkinson's Progression Markers Initiative cohort. Medication state for individual classes of Parkinson's medications was recorded annually. Previously validated "motivation" and "depression" dimensions were derived from the 15-item geriatric depression scale. Dopaminergic neurodegeneration was measured using repeated striatal dopamine transporter (DAT) imaging. Results Linear mixed-effects modelling was performed across all simultaneously acquired data points. Dopamine agonist use was associated with relatively fewer motivation symptoms as time progressed (interaction: β=-0.07, 95%CI [-0.13,-0.01], p=0.015) but had no effect on the depression symptom dimension (p=0.6). In contrast, monoamine oxidase-B (MAO-B) inhibitor use was associated with relatively fewer depression symptoms across all years (β=-0.41, 95%CI [-0.81,-0.01], p=0.047). No associations were observed between either depression or motivation symptoms and levodopa or amantadine use. There was a significant interaction between striatal DAT binding and MAO-B inhibitor use on motivation symptoms: MAO-B inhibitor use was associated with lower motivation symptoms in patients with higher striatal DAT binding (interaction: β=-0.24, 95%CI [-0.43, -0.05], p=0.012). No other medication effects were moderated by striatal DAT binding measures. Conclusions We identified dissociable associations between dopaminergic medications and different dimensions of depression in PD. Dopamine agonists may be effective for treatment of motivational symptoms of depression. In contrast, MAO-B inhibitors may improve both depressive and motivation symptoms, albeit the latter effect appears to be attenuated in patients with more severe striatal dopaminergic neurodegeneration, which may be a consequence of dependence on pre-synaptic dopaminergic neuron integrity.
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Affiliation(s)
- Harry Costello
- Institute of Cognitive Neuroscience, University College London, London, UK
| | | | - Robert Howard
- Department of Clinical and Movement Neurosciences, Institute of Neurology, University College London, London, UK
| | - Jonathan P. Roiser
- Institute of Cognitive Neuroscience, University College London, London, UK
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Qiu X, Lan Y, Miao J, Pan C, Sun W, Li G, Wang Y, Zhao X, Zhu Z, Zhu S. Depressive symptom dimensions predict the treatment effect of repetitive transcranial magnetic stimulation for post-stroke depression. J Psychosom Res 2023; 171:111382. [PMID: 37285667 DOI: 10.1016/j.jpsychores.2023.111382] [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: 07/02/2022] [Revised: 04/28/2023] [Accepted: 05/17/2023] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Repetitive transcranial magnetic stimulation (rTMS) has attracted considerable attention because of its non-invasiveness, minimal side effects, and treatment efficacy. Despite an adequate duration of rTMS treatment, some patients with post-stroke depression (PSD) do not achieve full symptom response or remission. METHODS This was a prospective randomized controlled trial. Participants receiving rTMS were randomly assigned to the ventromedial prefrontal cortex (VMPFC), left dorsolateral prefrontal cortex (DLPFC), or contralateral motor area (M1) groups in a ratio of 1:1:1. Enrollment assessments and data collection were performed in weeks 0, 2, 4, and 8. The impact of depressive symptom dimensions on treatment outcomes were tested using a linear mixed-effects model fitted with maximum likelihood. Univariate analysis of variance (ANOVA) and back-testing were used to analyze the differences between the groups. RESULTS In total, 276 patients were included in the analysis. Comparisons across groups showed that 17-item Hamilton Rating Scale for Depression (HAMD-17) scores of the DLPFC group significantly differed from those of the VMPFC and M1 groups at 2, 4, and 8 weeks after treatment (p < 0.05). A higher observed mood score (β = -0.44, 95% confidence interval [CI]: -0.85-0.04, p = 0.030) could predict a greater improvement in depressive symptoms in the DLPFC group. Higher neurovegetative scores (β = 0.60, 95% CI: 0.25-0.96, p = 0.001) could predict less improvement of depressive symptoms in the DLPFC group. CONCLUSION Stimulation of the left DLPFC by high-frequency rTMS (HF-rTMS) could significantly improve depressive symptoms in the subacute period of subcortical ischemic stroke, and the dimension of depressive symptoms at admission might predict the treatment effect.
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Affiliation(s)
- Xiuli Qiu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, Hubei, China. 430030
| | - Yan Lan
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, Hubei, China. 430030
| | - Jinfeng Miao
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, Hubei, China. 430030
| | - Chensheng Pan
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, Hubei, China. 430030
| | - Wenzhe Sun
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, Hubei, China. 430030
| | - Guo Li
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, Hubei, China. 430030
| | - Yanyan Wang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, Hubei, China. 430030
| | - Xin Zhao
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, Hubei, China. 430030
| | - Zhou Zhu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, Hubei, China. 430030.
| | - Suiqiang Zhu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, Hubei, China. 430030.
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Verharen JPH, de Jong JW, Zhu Y, Lammel S. A computational analysis of mouse behavior in the sucrose preference test. Nat Commun 2023; 14:2419. [PMID: 37105954 PMCID: PMC10140068 DOI: 10.1038/s41467-023-38028-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 04/12/2023] [Indexed: 04/29/2023] Open
Abstract
The sucrose preference test (SPT) measures the relative preference of sucrose over water to assess hedonic behaviors in rodents. Yet, it remains uncertain to what extent the SPT reflects other behavioral components, such as learning, memory, motivation, and choice. Here, we conducted an experimental and computational decomposition of mouse behavior in the SPT and discovered previously unrecognized behavioral subcomponents associated with changes in sucrose preference. We show that acute and chronic stress have sex-dependent effects on sucrose preference, but anhedonia was observed only in response to chronic stress in male mice. Additionally, reduced sucrose preference induced by optogenetics is not always indicative of anhedonia but can also reflect learning deficits. Even small variations in experimental conditions influence behavior, task outcome and interpretation. Thus, an ostensibly simple behavioral task can entail high levels of complexity, demonstrating the need for careful dissection of behavior into its subcomponents when studying the underlying neurobiology.
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Affiliation(s)
- Jeroen P H Verharen
- Department of Molecular and Cell Biology and Helen Wills Neuroscience Institute, University of California, Berkeley, CA, 94720, USA
| | - Johannes W de Jong
- Department of Molecular and Cell Biology and Helen Wills Neuroscience Institute, University of California, Berkeley, CA, 94720, USA
| | - Yichen Zhu
- Department of Molecular and Cell Biology and Helen Wills Neuroscience Institute, University of California, Berkeley, CA, 94720, USA
| | - Stephan Lammel
- Department of Molecular and Cell Biology and Helen Wills Neuroscience Institute, University of California, Berkeley, CA, 94720, USA.
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Johnston JN, Greenwald MS, Henter ID, Kraus C, Mkrtchian A, Clark NG, Park LT, Gold P, Zarate CA, Kadriu B. Inflammation, stress and depression: An exploration of ketamine's therapeutic profile. Drug Discov Today 2023; 28:103518. [PMID: 36758932 PMCID: PMC10050119 DOI: 10.1016/j.drudis.2023.103518] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 12/13/2022] [Accepted: 01/31/2023] [Indexed: 02/09/2023]
Abstract
Well-established animal models of depression have described a proximal relationship between stress and central nervous system (CNS) inflammation - a relationship mirrored in the peripheral inflammatory biomarkers of individuals with depression. Evidence also suggests that stress-induced proinflammatory states can contribute to the neurobiology of treatment-resistant depression. Interestingly, ketamine, a rapid-acting antidepressant, can partially exert its therapeutic effects via anti-inflammatory actions on the hypothalamic-pituitary adrenal (HPA) axis, the kynurenine pathway or by cytokine suppression. Further investigations into the relationship between ketamine, inflammation and stress could provide insight into ketamine's unique therapeutic mechanisms and stimulate efforts to develop rapid-acting, anti-inflammatory-based antidepressants.
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Affiliation(s)
- Jenessa N Johnston
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA.
| | - Maximillian S Greenwald
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Ioline D Henter
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Christoph Kraus
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Anahit Mkrtchian
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Neil G Clark
- US School of Medicine, Uniformed Services University, Bethesda, MD, USA
| | - Lawrence T Park
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Philip Gold
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Carlos A Zarate
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Bashkim Kadriu
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
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Johnston JN, Kadriu B, Allen J, Gilbert JR, Henter ID, Zarate CA. Ketamine and serotonergic psychedelics: An update on the mechanisms and biosignatures underlying rapid-acting antidepressant treatment. Neuropharmacology 2023; 226:109422. [PMID: 36646310 PMCID: PMC9983360 DOI: 10.1016/j.neuropharm.2023.109422] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 01/09/2023] [Accepted: 01/12/2023] [Indexed: 01/15/2023]
Abstract
The discovery of ketamine as a rapid-acting antidepressant spurred significant research to understand its underlying mechanisms of action and to identify other novel compounds that may act similarly. Serotonergic psychedelics (SPs) have shown initial promise in treating depression, though the challenge of conducting randomized controlled trials with SPs and the necessity of long-term clinical observation are important limitations. This review summarizes the similarities and differences between the psychoactive effects associated with both ketamine and SPs and the mechanisms of action of these compounds, with a focus on the monoaminergic, glutamatergic, gamma-aminobutyric acid (GABA)-ergic, opioid, and inflammatory systems. Both molecular and neuroimaging aspects are considered. While their main mechanisms of action differ-SPs increase serotonergic signaling while ketamine is a glutamatergic modulator-evidence suggests that the downstream mechanisms of action of both ketamine and SPs include mechanistic target of rapamycin complex 1 (mTORC1) signaling and downstream GABAA receptor activity. The similarities in downstream mechanisms may explain why ketamine, and potentially SPs, exert rapid-acting antidepressant effects. However, research on SPs is still in its infancy compared to the ongoing research that has been conducted with ketamine. For both therapeutics, issues with regulation and proper controls should be addressed before more widespread implementation. This article is part of the Special Issue on "Ketamine and its Metabolites".
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Affiliation(s)
- Jenessa N Johnston
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA.
| | - Bashkim Kadriu
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA.
| | - Josh Allen
- The Alfred Centre, Department of Neuroscience, Monash University, Melbourne, Victoria, Australia.
| | - Jessica R Gilbert
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA.
| | - Ioline D Henter
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA.
| | - Carlos A Zarate
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA.
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Mattingly GW, Necking O, Schmidt SN, Reines E, Ren H. Long-term safety and efficacy, including anhedonia, of vortioxetine for major depressive disorder: findings from two open-label studies. Curr Med Res Opin 2023; 39:613-619. [PMID: 36884024 DOI: 10.1080/03007995.2023.2178082] [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] [Indexed: 03/09/2023]
Abstract
OBJECTIVE Evaluate the long-term safety and efficacy of vortioxetine in the management of major depressive disorder (MDD) in two open-label one-year studies, including a post-hoc analysis of its effects on symptoms related to anhedonia. METHODS Both studies were 52-week, open-label, flexible-dose extension studies to evaluate the safety and efficacy of vortioxetine in adult patients with MDD following prior double-blind studies. Patients in the first study (NCT00761306) were flexibly treated with vortioxetine 5 or 10 mg/day (N = 74), and patients in the second study (NCT01323478) received vortioxetine 15 or 20 mg/day (N = 71). RESULTS The safety and tolerability profile of vortioxetine was similar between the two studies; treatment-emergent adverse events with the highest incidence were nausea, dizziness, headache, and nasopharyngitis. Across both studies, improvements achieved during the preceding double-blind studies period were maintained, and additional improvements were observed with open-label treatment. Patients showed a mean ± SD reduction (improvement) in Montgomery and Åsberg Depression Rating Scale (MADRS) total score from open-label baseline to Week 52 of 4.3 ± 9.2 points in the 5-10 mg study, and 10.9 ± 10.0 in the 15-20 mg study. Post-hoc MMRM analyses of MADRS anhedonia factor scores also showed continued improvements over long-term treatment; patients showed a mean ± SE reduction from an open-label baseline to Week 52 of 3.10 ± 0.57 points in the 5-10 mg study, and 5.62 ± 0.60 in the 15-20 mg study. CONCLUSIONS Data from both studies confirm the safety and efficacy of flexibly dosed vortioxetine over 52 weeks of treatment and demonstrate that MADRS anhedonia factor scores continue to improve with long-term maintenance treatment.
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Affiliation(s)
- Gregory W Mattingly
- Midwest Research Group, Washington University School of Medicine, St. Louis, MO, USA
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Christensen MC, Adair M, Loft H, McIntyre RS. The Motivation and Energy Inventory (MEI): Analysis of the clinically relevant response threshold in patients with major depressive disorder and emotional blunting using data from the COMPLETE study. J Affect Disord 2023; 323:547-553. [PMID: 36395989 DOI: 10.1016/j.jad.2022.11.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 11/07/2022] [Accepted: 11/11/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND The Motivation and Energy Inventory (MEI) is a patient-reported scale for assessment of the impact of mental/cognitive energy, social motivation, and physical energy on daily functioning in patients with major depressive disorder (MDD). This analysis was undertaken to establish the clinically relevant response threshold for the MEI in patients with MDD receiving antidepressant treatment. METHODS Patients with MDD experiencing inadequate response and emotional blunting on selective serotonin reuptake inhibitor or serotonin-noradrenaline reuptake inhibitor monotherapy (adequate dose for ≥6 weeks) were switched to vortioxetine 10-20 mg/day for 8 weeks. Anchor- and distribution-based methods were used to determine the minimal clinically important difference (MCID) in MEI total score. RESULTS After 8 weeks of vortioxetine treatment, mean (standard deviation) change in MEI total score from baseline was 33.0 (27.3) points. At week 8, mean change in MEI total score from baseline was 37.5 (27.8) points in patients no longer reporting emotional blunting and 28.3 (26.2) points in those still experiencing emotional blunting. In patients considered minimally improved (i.e. Clinical Global Impression-Improvement [CGI-I] score of 3 after 8 weeks of vortioxetine), mean change in MEI total score from baseline was 14.7 (19.1) points. In patients defined as responders (CGI-I score of 2 at 8 weeks), mean change in MEI total score was 33.0 (24.7) points. LIMITATIONS Short study duration. CONCLUSIONS These results provide further validation of the clinical utility of the MEI for assessing treatment response in patients with MDD. The suggested MCID for MEI total score is 15 points. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT03835715.
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Affiliation(s)
| | | | | | - Roger S McIntyre
- Mood Disorders Psychopharmacology Unit, University Health Network, University of Toronto, Toronto, ON, Canada
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Xiong G, Wang C, Ma X. The Relationship between Physical Activity and Mental Depression in Older Adults during the Prevention and Control of COVID-19: A Mixed Model with Mediating and Moderating Effects. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3225. [PMID: 36833928 PMCID: PMC9965109 DOI: 10.3390/ijerph20043225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 01/31/2023] [Accepted: 02/10/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Several studies have found a strong relationship between physical activity and mental depression in older adults. Despite this, the social isolation, limited physical activity, and decreased social interactions caused by the 2020 COVID-19 pandemic control measures of "home isolation and reduction unnecessary travel" had a significant mental impact on older adults. OBJECTIVE the goal of this study was to look into the complex effects of physical activity participation on mental health in older adults during COVID-19 prevention and control and the relationship between physical activity and mental depression in older adults through the mediating effect of self-efficacy and the moderating effect of social support. METHODS The Physical Activity Rating Scale (PARS-3), the Center for Streaming Depression Scale (CES-D), the Self-Efficacy Scale (GSES), and the Social Support Rating Scale (SSRS) were used to assess 974 older adults in five urban areas of Chengdu, China. The SPSS was used to analyze the collected data using mathematical statistics, linear regression analysis, and the AMOS to construct the research model. RESULTS The study's findings revealed that self-efficacy mediated the relationship between physical activity and mental depression in older adults (β = -0.101, 95%CI (-0.149, -0.058)), and social support moderated the relationship between physical activity and mental depression in older adults (t = -9.144, p < 0.01). CONCLUSIONS Physical activity reduces psychological depressive symptoms in older adults and modulates psychological depression in older adults via the mediation efficacy of self-efficacy and the moderating effect of social support.
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Affiliation(s)
- Guoyan Xiong
- School of Wushu, Chengdu Sport University, Chengdu 610041, China
| | - Caixia Wang
- School of Physical Education, Handan University, Handan 056005, China
| | - Xiujie Ma
- School of Wushu, Chengdu Sport University, Chengdu 610041, China
- Chinese Guoshu Academy, Chengdu Sport University, Chengdu 610041, China
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Costello H, Roiser JP, Howard R. Antidepressant medications in dementia: evidence and potential mechanisms of treatment-resistance. Psychol Med 2023; 53:654-667. [PMID: 36621964 PMCID: PMC9976038 DOI: 10.1017/s003329172200397x] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 10/13/2022] [Accepted: 12/20/2022] [Indexed: 01/10/2023]
Abstract
Depression in dementia is common, disabling and causes significant distress to patients and carers. Despite widespread use of antidepressants for depression in dementia, there is no evidence of therapeutic efficacy, and their use is potentially harmful in this patient group. Depression in dementia has poor outcomes and effective treatments are urgently needed. Understanding why antidepressants are ineffective in depression in dementia could provide insight into their mechanism of action and aid identification of new therapeutic targets. In this review we discuss why depression in dementia may be a distinct entity, current theories of how antidepressants work and how these mechanisms of action may be affected by disease processes in dementia. We also consider why clinicians continue to prescribe antidepressants in dementia, and novel approaches to understand and identify effective treatments for patients living with depression and dementia.
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Affiliation(s)
- Harry Costello
- Institute of Cognitive Neuroscience, University College London, London, UK
| | - Jonathan P. Roiser
- Institute of Cognitive Neuroscience, University College London, London, UK
| | - Robert Howard
- Division of Psychiatry, University College London, London, UK
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Arnsten AFT, Joyce MKP, Roberts AC. The Aversive Lens: Stress effects on the prefrontal-cingulate cortical pathways that regulate emotion. Neurosci Biobehav Rev 2023; 145:105000. [PMID: 36529312 PMCID: PMC9898199 DOI: 10.1016/j.neubiorev.2022.105000] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 12/08/2022] [Accepted: 12/10/2022] [Indexed: 12/23/2022]
Abstract
ARNSTEN, A.F.T., M.K.P. Joyce and A.C. Roberts. The Aversive Lens: Stress effects on the prefrontal-cingulate cortical pathways that regulate emotion. NEUROSCI BIOBEHAV REV XXX-XXX, 2022. The symptoms of major-depressive-disorder include psychic pain and anhedonia, i.e. seeing the world through an "aversive lens". The neurobiology underlying this shift in worldview is emerging. Here these data are reviewed, focusing on how activation of subgenual cingulate (BA25) induces an "aversive lens", and how higher prefrontal cortical (PFC) areas (BA46/10/32) provide top-down regulation of BA25 but are weakened by excessive dopamine and norepinephrine release during stress exposure, and dendritic spine loss with chronic stress exposure. These changes may generate an attractor state, which maintains the brain under the control of BA25, requiring medication or neuromodulatory treatments to return connectivity to a more flexible state. In line with this hypothesis, effective anti-depressant treatments reduce the activity of BA25 and restore top-down regulation by higher circuits, e.g. as seen with SSRI medications, ketamine, deep brain stimulation of BA25, or rTMS to strengthen dorsolateral PFC. This research has special relevance in an era of chronic stress caused by the COVID19 pandemic, political unrest and threat of climate change.
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Affiliation(s)
- Amy F T Arnsten
- Department of Neuroscience, Yale University School of Medicine, New Haven, CT 06510, USA.
| | - Mary Kate P Joyce
- Department of Neuroscience, Yale University School of Medicine, New Haven, CT 06510, USA.
| | - Angela C Roberts
- Department Physiology, Development and Neuroscience, and Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge CB2 3DY, UK.
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Ketamine-Associated Change in Anhedonia and mTOR Expression in Treatment-Resistant Depression. Biol Psychiatry 2023:S0006-3223(22)01699-7. [PMID: 36707268 DOI: 10.1016/j.biopsych.2022.10.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 10/14/2022] [Accepted: 10/17/2022] [Indexed: 01/26/2023]
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Zare Sakhvidi MJ, Lafontaine A, Lequy E, Berr C, de Hoogh K, Vienneau D, Goldberg M, Zins M, Lemogne C, Jacquemin B. Ambient air pollution exposure and depressive symptoms: Findings from the French CONSTANCES cohort. ENVIRONMENT INTERNATIONAL 2022; 170:107622. [PMID: 36384066 DOI: 10.1016/j.envint.2022.107622] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 11/06/2022] [Accepted: 11/07/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND AND AIM Few studies have reported the association between air pollution exposure with different dimensions of depression. We aimed to explore this association across different dimensions of depressive symptoms in a large population. METHODS Data from the enrollment phase of the French CONSTANCES cohort (2012-2020) were analyzed cross-sectionally. Annual concentrations of particulate matter with a diameter < 2.5 µm (PM2.5), black carbon (BC), and nitrogen dioxide (NO2) from the land-use regression models were assigned to the residential addresses of participants. Total depressive symptoms and its four dimensions (depressed affect, disturbed interpersonal relations, low positive affect, somatic complaints) were measured using Centre of Epidemiologic Studies Depression questionnaire (CES-D). We reported results of negative binomial regression models (reported as Incidence Rate Ratio (IRR) and 95 % confidence interval (CI) for an interquartile range (IQR) increase in exposure), for each pollutant separately. Stratified analyses were performed by sex, income, family status, education, and neighborhood deprivation. RESULTS The study included 123,754 participants (mean age, 46.50 ± 13.61 years; 52.4 % women). The mean concentration of PM2.5, BC and NO2 were 17.14 µg/m3 (IQR = 4.89), 1.82 10-5/m (IQR = 0.88) and 26.58 µg/m3 (IQR = 17.41) respectively. Exposures to PM2.5, BC and NO2 were significantly associated with a higher CES-D total (IRR = 1.022; 95 % CI = 1.002: 1.042, IRR = 1.027; 95 % CI = 1.013: 1.040, and IRR = 1.029; 95 % CI = 1.015: 1.042 respectively), and with depressed affect, and somatic complaints. For all pollutants, a higher estimate was observed for depressed affect. We found stronger adverse associations for men, lower-income participants, low and middle education groups, those living in highly deprived areas, and single participants. CONCLUSION Our finding could assist the exploration of the etiological pathway of air pollution on depression and also considering primary prevention strategies in the areas with air pollution.
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Affiliation(s)
- Mohammad Javad Zare Sakhvidi
- Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, F-35000 Rennes, France
| | - Antoine Lafontaine
- Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, F-35000 Rennes, France
| | - Emeline Lequy
- Université Paris Cité, Unité "Cohortes en Population" INSERM, Université Paris Saclay, UVSQ, UMS 011 Paris, France
| | - Claudine Berr
- University of Montpellier, INM, Inserm U1198 Neuropeps team, Montpellier, France; Memory Research and Resources Center, Department of Neurology, Montpellier, France
| | - Kees de Hoogh
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland; University of Basel, Basel, Switzerland
| | - Danielle Vienneau
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland; University of Basel, Basel, Switzerland
| | - Marcel Goldberg
- Université Paris Cité, Unité "Cohortes en Population" INSERM, Université Paris Saclay, UVSQ, UMS 011 Paris, France
| | - Marie Zins
- Université Paris Cité, Unité "Cohortes en Population" INSERM, Université Paris Saclay, UVSQ, UMS 011 Paris, France
| | - Cédric Lemogne
- Université Paris Cité, INSERM U1266, Institut de Psychiatrie et Neurosciences de Paris, F-75014 Paris, France; Service de Psychiatrie de l'adulte, AP-HP, Hôpital Hôtel-Dieu, F-75004 Paris, France
| | - Bénédicte Jacquemin
- Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, F-35000 Rennes, France.
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The importance of a multidimensional approach to the preclinical study of major depressive disorder and apathy. Emerg Top Life Sci 2022; 6:479-489. [PMID: 36413089 PMCID: PMC9788393 DOI: 10.1042/etls20220004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 11/14/2022] [Accepted: 11/15/2022] [Indexed: 11/24/2022]
Abstract
Both the neuropsychiatric syndrome of apathy and major depressive disorder comprise a heterogenous cluster of symptoms which span multiple behavioural domains. Despite this heterogeneity, there is a tendency in the preclinical literature to conclude a MDD or apathy-like phenotype from a single dimensional behavioural task used in isolation, which may lead to inaccurate phenotypic interpretation. This is significant, as apathy and major depressive disorder are clinically distinct with different underlying mechanisms and treatment approaches. At the clinical level, apathy and major depressive disorder can be dissociated in the negative valence (loss) domain of the Research Domain Criteria. Symptoms of MDD in the negative valence (loss) domain can include an exaggerated response to emotionally salient stimuli and low mood, while in contrast apathy is characterised by an emotionally blunted state. In this article, we highlight how using a single dimensional approach can limit psychiatric model interpretation. We discuss how integrating behavioural findings from both the positive and negative (loss) valence domains of the Research Domain Criteria can benefit interpretation of findings. We focus particularly on behaviours relating to the negative valence (loss) domain, which may be used to distinguish between apathy and major depressive disorder at the preclinical level. Finally, we consider how future approaches using home cage monitoring may offer a new opportunity to detect distinct behavioural profiles and benefit the overall translatability of findings.
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Hallford DJ, Rusanov D, Yeow JJE, Austin DW, D’Argembeau A, Fuller-Tyszkiewicz M, Raes F. Reducing Anhedonia in Major Depressive Disorder with Future Event Specificity Training (FEST): A Randomized Controlled Trial. COGNITIVE THERAPY AND RESEARCH 2022. [DOI: 10.1007/s10608-022-10330-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Background
Improving future thinking, such as characteristics of specificity, detail, and use of mental imagery, may be one means to reduce anhedonia, particularly in a Major Depressive Episode (MDE) in which future thinking is impaired. The current study aimed to test this using a validated program, Future Event Specificity Training (FEST).
Methods
Participants (N = 177; 80.8% women; M age = 43.7, SD = 11.8) with a current depressive episode with anhedonia and high symptom severity were randomized to FEST or no FEST. Future thinking, anhedonia-related variables, and other clinical outcomes were assessed at baseline, one- and three-month follow-up.
Results
Relative to the control group, FEST was associated with significantly improved future thinking characteristics, a reduced likelihood of anhedonia (35.1% vs. 61.1%, p = .015), improvements on other anhedonia-related variables such as anticipatory (d = 0.63, p = .004) and anticipated pleasure for future events (d = 0.77, p < .001), and desirable clinical outcomes such as less people meeting criteria for an MDE (37.8% vs. 64.8%, p = .011), higher behavioural activation (d = 0.71, p = .001) and improved global functioning (d = 0.52, p = .017). Changes in future thinking were found to mediate the effect of FEST on anhedonia.
Conclusion
The quality of future thinking can be enhanced in Major Depression, and this leads to a substantially reduced likelihood of anhedonia, other significant clinical effects, and functional gains.
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Vinckier F, Jaffre C, Gauthier C, Smajda S, Abdel-Ahad P, Le Bouc R, Daunizeau J, Fefeu M, Borderies N, Plaze M, Gaillard R, Pessiglione M. Elevated Effort Cost Identified by Computational Modeling as a Distinctive Feature Explaining Multiple Behaviors in Patients With Depression. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2022; 7:1158-1169. [PMID: 35952972 DOI: 10.1016/j.bpsc.2022.07.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 07/14/2022] [Accepted: 07/25/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Motivational deficit is a core clinical manifestation of depression and a strong predictor of treatment failure. However, the underlying mechanisms, which cannot be accessed through conventional questionnaire-based scoring, remain largely unknown. According to decision theory, apathy could result either from biased subjective estimates (of action costs or outcomes) or from dysfunctional processes (in making decisions or allocating resources). METHODS Here, we combined a series of behavioral tasks with computational modeling to elucidate the motivational deficits of 35 patients with unipolar or bipolar depression under various treatments compared with 35 matched healthy control subjects. RESULTS The most striking feature, which was observed independent of medication across preference tasks (likeability ratings and binary decisions), performance tasks (physical and mental effort exertion), and instrumental learning tasks (updating choices to maximize outcomes), was an elevated sensitivity to effort cost. By contrast, sensitivity to action outcomes (reward and punishment) and task-specific processes were relatively spared. CONCLUSIONS These results highlight effort cost as a critical dimension that might explain multiple behavioral changes in patients with depression. More generally, they validate a test battery for computational phenotyping of motivational states, which could orientate toward specific medication or rehabilitation therapy, and thereby help pave the way for more personalized medicine in psychiatry.
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Affiliation(s)
- Fabien Vinckier
- Motivation, Brain & Behavior lab Institut du Cerveau, Hôpital Pitié-Salpêtrière, Paris, France; Université Paris Cité, Paris, France; Department of Psychiatry, Service Hospitalo-Universitaire, GHU Paris Psychiatrie & Neurosciences, Paris, France.
| | - Claire Jaffre
- Motivation, Brain & Behavior lab Institut du Cerveau, Hôpital Pitié-Salpêtrière, Paris, France; Université Paris Cité, Paris, France; Department of Psychiatry, Service Hospitalo-Universitaire, GHU Paris Psychiatrie & Neurosciences, Paris, France
| | - Claire Gauthier
- Université Paris Cité, Paris, France; Department of Psychiatry, Service Hospitalo-Universitaire, GHU Paris Psychiatrie & Neurosciences, Paris, France
| | - Sarah Smajda
- Université Paris Cité, Paris, France; Department of Psychiatry, Service Hospitalo-Universitaire, GHU Paris Psychiatrie & Neurosciences, Paris, France
| | - Pierre Abdel-Ahad
- Université Paris Cité, Paris, France; Department of Psychiatry, Service Hospitalo-Universitaire, GHU Paris Psychiatrie & Neurosciences, Paris, France
| | - Raphaël Le Bouc
- Motivation, Brain & Behavior lab Institut du Cerveau, Hôpital Pitié-Salpêtrière, Paris, France; Urgences cérébro-vasculaires, Pitié-Salpêtrière Hospital, Sorbonne University, Assistance Publique Hôpitaux de Paris, Paris, France; Zurich Center for Neuroeconomics, Department of Economics, University of Zurich, Zurich, Switzerland
| | - Jean Daunizeau
- Motivation, Brain & Behavior lab Institut du Cerveau, Hôpital Pitié-Salpêtrière, Paris, France; Sorbonne Universités, Inserm, CNRS, Paris, France
| | - Mylène Fefeu
- Université Paris Cité, Paris, France; Department of Psychiatry, Service Hospitalo-Universitaire, GHU Paris Psychiatrie & Neurosciences, Paris, France
| | - Nicolas Borderies
- Motivation, Brain & Behavior lab Institut du Cerveau, Hôpital Pitié-Salpêtrière, Paris, France
| | - Marion Plaze
- Université Paris Cité, Paris, France; Department of Psychiatry, Service Hospitalo-Universitaire, GHU Paris Psychiatrie & Neurosciences, Paris, France
| | - Raphaël Gaillard
- Université Paris Cité, Paris, France; Department of Psychiatry, Service Hospitalo-Universitaire, GHU Paris Psychiatrie & Neurosciences, Paris, France; Institut Pasteur, experimental neuropathology unit, Paris, France
| | - Mathias Pessiglione
- Motivation, Brain & Behavior lab Institut du Cerveau, Hôpital Pitié-Salpêtrière, Paris, France; Sorbonne Universités, Inserm, CNRS, Paris, France
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Decreased reward circuit connectivity during reward anticipation in major depression. Neuroimage Clin 2022; 36:103226. [PMID: 36257119 PMCID: PMC9668633 DOI: 10.1016/j.nicl.2022.103226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 09/21/2022] [Accepted: 10/08/2022] [Indexed: 11/11/2022]
Abstract
An important symptom of major depressive disorder (MDD) is the inability to experience pleasure, possibly due to a dysfunction of the reward system. Despite promising insights regarding impaired reward-related processing in MDD, circuit-level abnormalities remain largely unexplored. Furthermore, whereas studies contrasting experimental conditions from incentive tasks have revealed important information about reward processing, temporal difference modeling of reward-related prediction error (PE) signals might give a more accurate representation of the reward system. We used a monetary incentive delay task during functional MRI scanning to explore PE-related striatal and ventral tegmental area (VTA) activation in response to anticipation and delivery of monetary rewards in 24 individuals with MDD versus 24 healthy controls (HCs). Furthermore, we investigated group differences in temporal difference related connectivity with a generalized psychophysiological interaction (gPPI) analysis with the VTA, ventral striatum (VS) and dorsal striatum (DS) as seeds during reward versus neutral, both in anticipation and delivery. Relative to HCs, MDD patients displayed a trend-level (p = 0.052) decrease in temporal difference-related activation in the VS during reward anticipation and delivery combined. Moreover, gPPI analyses revealed that during reward anticipation, MDD patients exhibited decreased functional connectivity between the VS and anterior cingulate cortex / medial prefrontal cortex, anterior cingulate gyrus, angular/middle orbital gyrus, left insula, superior/middle frontal gyrus (SFG/MFG) and precuneus/superior occipital gyrus/cerebellum compared to HC. Moreover, MDD patients showed decreased functional connectivity between the VTA and left insula compared to HC during reward anticipation. Exploratory analysis separating medication free patients from patients using antidepressant revealed that these decreased functional connectivity patterns were mainly apparent in the MDD group that used antidepressants. These results suggest that MDD is characterized by alterations in reward circuit connectivity rather than isolated activation impairments. These findings represent an important extension of the existing literature since improved understanding of neural pathways underlying depression-related reward dysfunctions, may help currently unmet diagnostic and therapeutic efforts.
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Engelmann J, Murck H, Wagner S, Zillich L, Streit F, Herzog DP, Braus DF, Tadic A, Lieb K, Műller MB. Routinely accessible parameters of mineralocorticoid receptor function, depression subtypes and response prediction: a post-hoc analysis from the early medication change trial in major depressive disorder. World J Biol Psychiatry 2022; 23:631-642. [PMID: 34985381 DOI: 10.1080/15622975.2021.2020334] [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: 01/25/2023]
Abstract
OBJECTIVES Previous studies indicated a relationship between aldosterone, the mineralocorticoid receptor (MR), and antidepressant treatment outcome. Physiological indicators of MR function (blood pressure and electrolytes) are easily accessible and may therefore serve as useful predictors. Thus, our aim was to investigate the predictive value of peripheral MR-related markers for antidepressant treatment outcomes. METHODS 826 MDD patients who had participated in the randomised-controlled Early Medication Change (EMC) trial were analysed. Depression severity and MR-related markers were assessed weekly. In 562 patients, genetic variation of five MR-related genes was determined. RESULTS Patients with blood pressure <120mmHg showed higher depression severity (p = 0.005) than patients with blood pressure ≥120mmHg. Patients with a melancholic subtype had significantly lower blood pressures (p = 0.004). Na+/K+ ratio was positively and K+-concentration was negatively correlated to depression severity and to relative changes in HAMD from baseline to day 14, and 56 respectively (p < 0.001). For none of the MR-related genes, genetic variation was associated with treatment outcomes. CONCLUSIONS We confirmed early observations of an altered peripheral MR sensitivity, reflected by lower blood pressure, low K+ or high Na+/K+ ratio in patients with more severe depression. These routinely collected biomarkers may potentially be useful for risk stratification in an early stage of treatment. Trial Registration: clinicaltrials.gov Identifier: NCT00974155; https://www.clinicaltrials.gov/ct2/results?term=NCT00974155.
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Affiliation(s)
- Jan Engelmann
- Department of Psychiatry and Psychotherapy, University Medical Center, Mainz, Germany.,Translational Psychiatry, Department of Psychiatry and Psychotherapy & Focus Program Translational Neuroscience, University Medical Center, Mainz, Germany
| | - Harald Murck
- Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany.,Murck-Neuroscience, Westfield, NJ, United States.,Aptinyx Inc, Evanston, IL, USA
| | - Stefanie Wagner
- Department of Psychiatry and Psychotherapy, University Medical Center, Mainz, Germany
| | - Lea Zillich
- Department of Genetic Epidemiology in Psychiatry, Medical Faculty Mannheim, Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany
| | - Fabian Streit
- Department of Genetic Epidemiology in Psychiatry, Medical Faculty Mannheim, Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany
| | - David P Herzog
- Department of Psychiatry and Psychotherapy, University Medical Center, Mainz, Germany.,Translational Psychiatry, Department of Psychiatry and Psychotherapy & Focus Program Translational Neuroscience, University Medical Center, Mainz, Germany
| | - Dieter F Braus
- Department of Psychiatry and Psychotherapy, Eltville, Germany
| | - Andre Tadic
- Department of Psychiatry and Psychotherapy, University Medical Center, Mainz, Germany.,Department of Psychiatry, Psychosomatics, and Psychotherapy, DR. FONTHEIM Mentale Gesundheit, Liebenburg, Germany
| | - Klaus Lieb
- Department of Psychiatry and Psychotherapy, University Medical Center, Mainz, Germany
| | - Marianne B Műller
- Translational Psychiatry, Department of Psychiatry and Psychotherapy & Focus Program Translational Neuroscience, University Medical Center, Mainz, Germany
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Steinmann LA, Dohm K, Goltermann J, Richter M, Enneking V, Lippitz M, Repple J, Mauritz M, Dannlowski U, Opel N. Understanding the neurobiological basis of anhedonia in major depressive disorder - evidence for reduced neural activation during reward and loss processing. J Psychiatry Neurosci 2022; 47:E284-E292. [PMID: 35948341 PMCID: PMC9377543 DOI: 10.1503/jpn.210180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 04/16/2021] [Accepted: 05/08/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Anhedonia is a key symptom of major depressive disorder (MDD). Anhedonia is associated with aberrant reward processing, but whether it might interfere similarly with the neural processing of aversive stimuli, such as monetary loss, remains unknown. We aimed to investigate potential associations between anhedonia and neural response during reward and loss processing in patients with MDD. METHODS We investigated blood-oxygen-level-dependent response in the orbitofrontal cortex, cingulate cortex, insula and basal ganglia during monetary reward and loss processing in 182 patients with MDD, using a card-guessing paradigm. We measured anhedonia with the Social and Physical Anhedonia Scale (SASPAS), and we tested for the main and interaction effects of SASPAS scores and the experimental condition (reward or loss) in a full factorial model. RESULTS We detected a negative main effect of anhedonia, as well as a significant interaction effect of anhedonia and the experimental condition, on orbitofrontal and insular neural response. Post hoc analyses revealed that the interaction was driven by a significant association between higher anhedonia scores and hypoactivation during loss processing. We observed no significant association between anhedonia and neural response during reward processing. LIMITATIONS This study had a cross-sectional design. CONCLUSION Our findings confirmed that altered neural processing in the orbitofrontal cortex and insula is a neurobiological feature of anhedonic symptomatology in people with MDD. The pronounced association between anhedonia and blunted neural response during loss processing supports a broader concept for the neurobiological basis of anhedonia. Hence, MDD with anhedonic features might be characterized by reduced neural response to external stimuli, potentially because of amotivation.
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Affiliation(s)
- Lavinia A Steinmann
- From the Institute for Translational Psychiatry, University of Münster, Münster, Germany (Steinmann, Dohm, Goltermann, Richter, Enneking, Lippitz, Repple, Mauritz, Dannlowski, Opel); the Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, University Hospital of Frankfurt/Goethe University, Frankfurt am Main, Germany (Repple); and the Department of Psychiatry, Jena University Hospital/Friedrich-Schiller-University Jena, Jena, Germany (Opel).
| | - Katharina Dohm
- From the Institute for Translational Psychiatry, University of Münster, Münster, Germany (Steinmann, Dohm, Goltermann, Richter, Enneking, Lippitz, Repple, Mauritz, Dannlowski, Opel); the Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, University Hospital of Frankfurt/Goethe University, Frankfurt am Main, Germany (Repple); and the Department of Psychiatry, Jena University Hospital/Friedrich-Schiller-University Jena, Jena, Germany (Opel)
| | - Janik Goltermann
- From the Institute for Translational Psychiatry, University of Münster, Münster, Germany (Steinmann, Dohm, Goltermann, Richter, Enneking, Lippitz, Repple, Mauritz, Dannlowski, Opel); the Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, University Hospital of Frankfurt/Goethe University, Frankfurt am Main, Germany (Repple); and the Department of Psychiatry, Jena University Hospital/Friedrich-Schiller-University Jena, Jena, Germany (Opel)
| | - Maike Richter
- From the Institute for Translational Psychiatry, University of Münster, Münster, Germany (Steinmann, Dohm, Goltermann, Richter, Enneking, Lippitz, Repple, Mauritz, Dannlowski, Opel); the Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, University Hospital of Frankfurt/Goethe University, Frankfurt am Main, Germany (Repple); and the Department of Psychiatry, Jena University Hospital/Friedrich-Schiller-University Jena, Jena, Germany (Opel)
| | - Verena Enneking
- From the Institute for Translational Psychiatry, University of Münster, Münster, Germany (Steinmann, Dohm, Goltermann, Richter, Enneking, Lippitz, Repple, Mauritz, Dannlowski, Opel); the Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, University Hospital of Frankfurt/Goethe University, Frankfurt am Main, Germany (Repple); and the Department of Psychiatry, Jena University Hospital/Friedrich-Schiller-University Jena, Jena, Germany (Opel)
| | - Marcia Lippitz
- From the Institute for Translational Psychiatry, University of Münster, Münster, Germany (Steinmann, Dohm, Goltermann, Richter, Enneking, Lippitz, Repple, Mauritz, Dannlowski, Opel); the Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, University Hospital of Frankfurt/Goethe University, Frankfurt am Main, Germany (Repple); and the Department of Psychiatry, Jena University Hospital/Friedrich-Schiller-University Jena, Jena, Germany (Opel)
| | - Jonathan Repple
- From the Institute for Translational Psychiatry, University of Münster, Münster, Germany (Steinmann, Dohm, Goltermann, Richter, Enneking, Lippitz, Repple, Mauritz, Dannlowski, Opel); the Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, University Hospital of Frankfurt/Goethe University, Frankfurt am Main, Germany (Repple); and the Department of Psychiatry, Jena University Hospital/Friedrich-Schiller-University Jena, Jena, Germany (Opel)
| | - Marco Mauritz
- From the Institute for Translational Psychiatry, University of Münster, Münster, Germany (Steinmann, Dohm, Goltermann, Richter, Enneking, Lippitz, Repple, Mauritz, Dannlowski, Opel); the Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, University Hospital of Frankfurt/Goethe University, Frankfurt am Main, Germany (Repple); and the Department of Psychiatry, Jena University Hospital/Friedrich-Schiller-University Jena, Jena, Germany (Opel)
| | - Udo Dannlowski
- From the Institute for Translational Psychiatry, University of Münster, Münster, Germany (Steinmann, Dohm, Goltermann, Richter, Enneking, Lippitz, Repple, Mauritz, Dannlowski, Opel); the Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, University Hospital of Frankfurt/Goethe University, Frankfurt am Main, Germany (Repple); and the Department of Psychiatry, Jena University Hospital/Friedrich-Schiller-University Jena, Jena, Germany (Opel)
| | - Nils Opel
- From the Institute for Translational Psychiatry, University of Münster, Münster, Germany (Steinmann, Dohm, Goltermann, Richter, Enneking, Lippitz, Repple, Mauritz, Dannlowski, Opel); the Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, University Hospital of Frankfurt/Goethe University, Frankfurt am Main, Germany (Repple); and the Department of Psychiatry, Jena University Hospital/Friedrich-Schiller-University Jena, Jena, Germany (Opel)
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Epigenetic signatures in antidepressant treatment response: a methylome-wide association study in the EMC trial. Transl Psychiatry 2022; 12:268. [PMID: 35794104 PMCID: PMC9259740 DOI: 10.1038/s41398-022-02032-7] [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: 01/23/2022] [Revised: 06/14/2022] [Accepted: 06/17/2022] [Indexed: 12/02/2022] Open
Abstract
Although the currently available antidepressants are well established in the treatment of the major depressive disorder (MDD), there is strong variability in the response of individual patients. Reliable predictors to guide treatment decisions before or in an early stage of treatment are needed. DNA-methylation has been proven a useful biomarker in different clinical conditions, but its importance for mechanisms of antidepressant response has not yet been determined. 80 MDD patients were selected out of >500 participants from the Early Medication Change (EMC) cohort with available genetic material based on their antidepressant response after four weeks and stratified into clear responders and age- and sex-matched non-responders (N = 40, each). Early improvement after two weeks was analyzed as a secondary outcome. DNA-methylation was determined using the Illumina EPIC BeadChip. Epigenome-wide association studies were performed and differentially methylated regions (DMRs) identified using the comb-p algorithm. Enrichment was tested for hallmark gene-sets and in genome-wide association studies of depression and antidepressant response. No epigenome-wide significant differentially methylated positions were found for treatment response or early improvement. Twenty DMRs were associated with response; the strongest in an enhancer region in SORBS2, which has been related to cardiovascular diseases and type II diabetes. Another DMR was located in CYP2C18, a gene previously linked to antidepressant response. Results pointed towards differential methylation in genes associated with cardiac function, neuroticism, and depression. Linking differential methylation to antidepressant treatment response is an emerging topic and represents a step towards personalized medicine, potentially facilitating the prediction of patients' response before treatment.
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Olin CC, McDevitt-Murphy ME, Leonard SJ, Acuff SF. Wanting, Liking, and Missing Out: Exploring the Role of Reward Functioning in the Overlap Between PTSD and Depression. J Nerv Ment Dis 2022; 210:497-503. [PMID: 35766543 DOI: 10.1097/nmd.0000000000001456] [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] [Indexed: 11/26/2022]
Abstract
ABSTRACT Diminished reward functioning (anhedonia) is an aspect of multiple psychiatric diagnoses and is a critical component of depression, yet it has rarely been examined in the context of posttraumatic stress disorder (PTSD). Deficits in reward function may be a transdiagnostic factor contributing to the high rate of comorbidity between PTSD and depression. The present study examined the commonality and distinction between PTSD and depression and their relationship to reward functioning using a bifactor model in a sample of 106 trauma-exposed undergraduates. Results indicated a strong commonality factor between PTSD and depression. Of three indices of reward functioning (i.e., hedonic pleasure, reward motivation, and environmental reward availability), environmental reward availability alone was related to unique latent factors for PTSD and depression, and their commonality. Findings suggest that environmental context may be the key to understanding the role of reward in PTSD, depression, and psychopathology broadly.
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Affiliation(s)
- Cecilia C Olin
- Department of Psychology, University of Memphis, Memphis, Tennessee
| | | | | | - Samuel F Acuff
- Department of Psychology, University of Memphis, Memphis, Tennessee
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Arentsen TJ, Stubbs WJ, Lease SH, Adler MC, Ovrebo E, Jacobson JL. The relationship of the clinician-rated Functional Status Interview with executive functioning. APPLIED NEUROPSYCHOLOGY. ADULT 2022:1-13. [PMID: 35694761 DOI: 10.1080/23279095.2022.2084619] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Self/informant-report and performance-based instruments are typically used to measure activities of daily living (ADLs) and instrumental activities of daily living (IADLs). Minimal attention has focused on clinician-rated measures. Executive functioning (EF) contributes significantly to functional independence, and the validity of functional status measures has been examined through its relationship to EF scores. The current study used a clinical sample of older U.S. Veterans who completed a neurocognitive evaluation (n = 266). The psychometric properties of a novel, clinician-rated Functional Status Interview (FSI) and its relationship to EF measures, including the Frontal Assessment Battery (FAB) and Trail Making Test (TMT-A and TMT-B), were explored. Two FSI factors (IADL and ADL) emerged with all items loading strongly onto the subscales as predicted. EF correlated strongly with IADL but had small to medium correlations with ADL. In regression models that controlled for sociodemographic variables, all EF measures uniquely contributed to the IADL model, but only FAB and TMT-A contributed to the model for ADL. Notably, results may have been limited by prominent floor effects on TMT-B. Overall, the FSI is a promising measure with demonstrated content validity. Thus, there is preliminary support for clinicians to incorporate multiple sources of information to rate functional status using the FSI.
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Affiliation(s)
- Timothy J Arentsen
- VA Memphis Medical Center, Mental Health Service, Memphis, TN, USA
- The University of Tennessee Health Science Center, Department of Psychiatry, Memphis, TN, USA
| | - Whitney J Stubbs
- G V Montgomery VA Medical Center, Mental Health Service, Jackson, MS, USA
| | - Suzanne H Lease
- The University of Memphis, Department of Counseling, Educational Psychology and Research, Memphis, TN, USA
| | - Marcy C Adler
- VA Memphis Medical Center, Mental Health Service, Memphis, TN, USA
- The University of Tennessee Health Science Center, Department of Psychiatry, Memphis, TN, USA
| | - Elin Ovrebo
- The University of Memphis, Department of Counseling, Educational Psychology and Research, Memphis, TN, USA
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Rayff da Silva P, Diniz Nunes Pazos N, Karla Silva do Nascimento Gonzaga T, Cabral de Andrade J, Brito Monteiro Á, Caroline Ribeiro Portela A, Fernandes Oliveira Pires H, Dos Santos Maia M, Vilar da Fonsêca D, T Scotti M, Maria Barbosa Filho J, Pergentino de Sousa D, Francisco Bezerra Felipe C, Nóbrega de Almeida R, Scotti L. Anxiolytic and antidepressant-like effects of monoterpene tetrahydrolinalool and in silico approach of new potential targets. Curr Top Med Chem 2022; 22:1530-1552. [PMID: 35524664 DOI: 10.2174/1568026622666220505104726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 02/03/2022] [Accepted: 02/16/2022] [Indexed: 11/22/2022]
Abstract
INTRODUCTION- The drugs currently available for treatment of anxiety and depression act through modulation of the neurotransmission systems involved in the neurobiology of the disorder, yet they of-ten present side effects, which can impair patient adherence to treatment. METHOD- This, has driven the search for new molecules with anxiolytic and antidepressant potential. Aromatic plants are rich in essential oils, and their chemical constituents, such as monoterpenes, are be-ing studied for these disorders. This study aims to evaluate the anxiolytic and antidepressant-like poten-tial of the monoterpene tetrahydrolinalool in in vivo animal models, and review pharmacological targets with validation through molecular docking. Male Swiss mice (Mus musculus) were treated with THL (37.5-600 mg kg-1 p.o.) and submitted to the elevated plus maze, open field, rota rod, and forced swim tests. In the elevated plus-maze, THL at doses of 37.5 and 75 mg kg-1 induced a significant increase in the percentage of entries (72.7 and 64.3% respectively), and lengths of stay (80.3 and 76.8% respective-ly) in the open arms tests. RESULT- These doses did not compromise locomotor activity or motor coordination in the animals. In the open field, rota rod tests, and the forced swimming model, treatment with THL significantly reduced immobility times at doses of 150, 300, and 600 mg kg-1, and by respective percentages of 69.3, 60.9 and 68.7%. CONCLUSION- In molecular docking assay, which investigated potential targets, THL presented sat-isfactory energy values for: nNOs, SGC, IL-6, 5-HT1A, NMDAr, and D1. These demonstrate the po-tential of THL (a derivative of natural origin) in in vivo and in silico models, making it a drug candidate.
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Affiliation(s)
- Pablo Rayff da Silva
- Psychopharmacology Laboratory, Institute of Drugs and Medicines Research, Federal University of Paraíba, 58051-085, Via Ipê Amarelo, S/N, João Pessoa, Paraíba, Brazil
| | - Natalia Diniz Nunes Pazos
- Psychopharmacology Laboratory, Institute of Drugs and Medicines Research, Federal University of Paraíba, 58051-085, Via Ipê Amarelo, S/N, João Pessoa, Paraíba, Brazil
| | | | - Jéssica Cabral de Andrade
- Psychopharmacology Laboratory, Institute of Drugs and Medicines Research, Federal University of Paraíba, 58051-085, Via Ipê Amarelo, S/N, João Pessoa, Paraíba, Brazil
| | - Álefe Brito Monteiro
- Psychopharmacology Laboratory, Institute of Drugs and Medicines Research, Federal University of Paraíba, 58051-085, Via Ipê Amarelo, S/N, João Pessoa, Paraíba, Brazil
| | - Anne Caroline Ribeiro Portela
- Psychopharmacology Laboratory, Institute of Drugs and Medicines Research, Federal University of Paraíba, 58051-085, Via Ipê Amarelo, S/N, João Pessoa, Paraíba, Brazil
| | - Hugo Fernandes Oliveira Pires
- Psychopharmacology Laboratory, Institute of Drugs and Medicines Research, Federal University of Paraíba, 58051-085, Via Ipê Amarelo, S/N, João Pessoa, Paraíba, Brazil
| | - Mayara Dos Santos Maia
- Cheminformatics Laboratory, Institute of Drugs and Medicines Research, Federal University of Paraíba, 58051-900, Via Ipê Amarelo, S/N, João Pessoa, Paraíba, Brazil
| | - Diogo Vilar da Fonsêca
- Collegiate of Medicine, Federal University of São Francisco Valley, 48607-190, Rua Aurora, S/N, Bahia, Brazil
| | - Marcus T Scotti
- Cheminformatics Laboratory, Institute of Drugs and Medicines Research, Federal University of Paraíba, 58051-900, Via Ipê Amarelo, S/N, João Pessoa, Paraíba, Brazil
| | - José Maria Barbosa Filho
- Pharmaceutical Chemistry Laboratory, Department of Pharmaceutical Sciences, Federal University of Paraíba, 58051-900, Via Ipê Amarelo, S/N, João Pessoa, Brazil
| | - Damião Pergentino de Sousa
- Pharmaceutical Chemistry Laboratory, Department of Pharmaceutical Sciences, Federal University of Paraíba, 58051-900, Via Ipê Amarelo, S/N, João Pessoa, Brazil
| | - Cícero Francisco Bezerra Felipe
- Psychopharmacology Laboratory, Institute of Drugs and Medicines Research, Federal University of Paraíba, 58051-085, Via Ipê Amarelo, S/N, João Pessoa, Paraíba, Brazil
| | - Reinaldo Nóbrega de Almeida
- Psychopharmacology Laboratory, Institute of Drugs and Medicines Research, Federal University of Paraíba, 58051-085, Via Ipê Amarelo, S/N, João Pessoa, Paraíba, Brazil
| | - Luciana Scotti
- Cheminformatics Laboratory, Institute of Drugs and Medicines Research, Federal University of Paraíba, 58051-900, Via Ipê Amarelo, S/N, João Pessoa, Paraíba, Brazil
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Effects of stress on endophenotypes of suicide across species: A role for ketamine in risk mitigation. Neurobiol Stress 2022; 18:100450. [PMID: 35685678 PMCID: PMC9170747 DOI: 10.1016/j.ynstr.2022.100450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 04/05/2022] [Accepted: 04/15/2022] [Indexed: 12/28/2022] Open
Abstract
Suicide is a leading cause of death and morbidity worldwide, yet few interventions are available to mitigate its risk. Barriers to effective treatments involve a limited understanding of factors that predict the onset of suicidal thoughts and behaviors. In the context of suicide risk, stress is a precipitating factor that is largely overlooked in the literature. Indeed, the pathophysiology of stress and suicide are heavily interconnected, underscoring the need to target the stress system in suicide prevention. In this review, we integrate findings from the preclinical and clinical literature that links stress and suicide. We focus specifically on the effects of stress on underlying biological functions and processes associated with suicide, allowing for the review of research using animal models. Owing to the rapid anti-suicidal effects of (R,S)-ketamine, we discuss its ability to modulate various stress-related endophenotypes of suicide, as well as its potential role in preventing suicide in those with a history of chronic life stress (e.g., early life adversity). We highlight future research directions that could advance our understanding of stress-related effects on suicide risk, advocating a dimensional, endophenotype approach to suicide research. Suicide and chronic stress pathophysiology are interconnected. Chronic stress has profound impacts on several endophenotypes of suicide. Animal and human research points to stress as a precipitating factor in suicide. Ketamine modulates specific biological processes associated with stress and suicide. Suicide research into endophenotypes can help inform risk-mitigation strategies.
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Associations between different facets of anhedonia and neural response to monetary, social, and food reward in emerging adults. Biol Psychol 2022; 172:108363. [DOI: 10.1016/j.biopsycho.2022.108363] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 05/19/2022] [Accepted: 05/24/2022] [Indexed: 02/02/2023]
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Kennedy SH. Beyond Response: Aiming for Quality Remission in Depression. Adv Ther 2022; 39:20-28. [PMID: 35247185 PMCID: PMC9015986 DOI: 10.1007/s12325-021-02030-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 12/17/2021] [Indexed: 11/23/2022]
Abstract
To define treatment response in depression as at least a 50% reduction in total symptom severity is to accept that up to half of patients will continue to have residual symptoms, most commonly low mood/loss of interest, cognitive problems, lack of energy, and difficulty sleeping. In fact, patients’ goals for treatment are to return to premorbid levels of functioning. This highlights the importance of assessing both functional outcomes and symptom improvement when evaluating the efficacy of antidepressant medication. Not all patients who achieve symptomatic response/remission will achieve a functional response/remission. In two studies (one with agomelatine and one with escitalopram), 54% of patients receiving agomelatine and 47% of those receiving escitalopram achieved a symptomatic response, and 53% of patients in each study achieved a functional response. However, 42% of patients receiving agomelatine and 35% of those receiving escitalopram had both a symptomatic and a functional response. The four symptoms of depression with the most marked effect on function are sad mood, impaired concentration, fatigue, and loss of interest. Low energy is particularly associated with poor occupational functioning, highlighting the importance of ongoing assessment of patients with depression, focusing particular attention on the symptoms that affect their ability to function, such as fatigue. Depending on the type of residual symptoms, some patients may benefit from combination therapy, such as adding dopamine modulator therapy. Antidepressant therapy is only effective if patients continue to take their medication, and high rates of early discontinuation have been reported. Therefore, when selecting treatment for depression, physicians can maximize the likelihood of adherence and persistence by taking into account both the antidepressant efficacy of treatment, its adverse effects and acceptability to patients.
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