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Jakobsen P, Côté-Allard U, Riegler MA, Stabell LA, Stautland A, Nordgreen T, Torresen J, Fasmer OB, Oedegaard KJ. Early warning signals observed in motor activity preceding mood state change in bipolar disorder. Bipolar Disord 2024. [PMID: 38639725 DOI: 10.1111/bdi.13430] [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] [Indexed: 04/20/2024]
Abstract
INTRODUCTION Alterations in motor activity are well-established symptoms of bipolar disorder, and time series of motor activity can be considered complex dynamical systems. In such systems, early warning signals (EWS) occur in a critical transition period preceding a sudden shift (tipping point) in the system. EWS are statistical observations occurring due to a system's declining ability to maintain homeostasis when approaching a tipping point. The aim was to identify critical transition periods preceding bipolar mood state changes. METHODS Participants with a validated bipolar diagnosis were included to a one-year follow-up study, with repeated assessments of the participants' mood. Motor activity was recorded continuously by a wrist-worn actigraph. Participants assessed to have relapsed during follow-up were analyzed. Recognized EWS features were extracted from the motor activity data and analyzed by an unsupervised change point detection algorithm, capable of processing multi-dimensional data and developed to identify when the statistical property of a time series changes. RESULTS Of 49 participants, four depressive and four hypomanic/manic relapses among six individuals occurred, recording actigraphy for 23.8 ± 0.2 h/day, for 39.8 ± 4.6 days. The algorithm detected change points in the time series and identified critical transition periods spanning 13.5 ± 7.2 days. For depressions 11.4 ± 1.8, and hypomania/mania 15.6 ± 10.2 days. CONCLUSION The change point detection algorithm seems capable of recognizing impending mood episodes in continuous flowing data streams. Hence, we present an innovative method for forecasting approaching relapses to improve the clinical management of bipolar disorder.
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Affiliation(s)
- Petter Jakobsen
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | | | | | - Lena Antonsen Stabell
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Andrea Stautland
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Tine Nordgreen
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Jim Torresen
- Department of Informatics, University of Oslo, Oslo, Norway
| | - Ole Bernt Fasmer
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Ketil Joachim Oedegaard
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
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Crouse JJ, Park SH, Byrne EM, Mitchell BL, Chan K, Scott J, Medland SE, Martin NG, Wray NR, Hickie IB. Evening chronotypes with depression report poorer outcomes of SSRIs: A survey-based study of self-ratings. Biol Psychiatry 2024:S0006-3223(24)00002-7. [PMID: 38185236 DOI: 10.1016/j.biopsych.2023.12.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 12/20/2023] [Accepted: 12/28/2023] [Indexed: 01/09/2024]
Abstract
BACKGROUND Preliminary evidence suggests evening chronotype relates to poorer efficacy of selective-serotonin reuptake inhibitors (SSRIs). It is unknown whether this is specific to particular medications, self-rated chronotype, or efficacy. METHODS In the Australian Genetics of Depression Study (N=15,108; 75% female; 18-90 years; 68% with ≥1 other lifetime diagnosis), a survey assessed experiences with 10 antidepressants and the reduced Morningness-Evening Questionnaire; a chronotype polygenic score (PGS) was calculated. Age- and sex-adjusted regression models (Bonferroni-corrected) estimated associations among antidepressants variables ("how well the antidepressant worked" [efficacy], duration of symptom improvement, side effects, discontinuation due to side effects) and self-rated and genetic chronotypes. RESULTS The chronotype-PGS explained 4% of the variance in self-rated chronotype (r=0.21). Higher self-rated eveningness was associated with poorer efficacy of escitalopram (OR=1.04; 95% CI 1.02-1.06; p=0.000035), fluoxetine (OR=1.03; 95% CI 1.01-1.05; p=0.001), sertraline (OR=1.02; 95% CI 1.01-1.04; p=0.0008), and desvenlafaxine (OR=1.03; 95% CI 1.01-1.05; p=0.004), and a profile of increased side effects (80% of those recorded; ORs=0.93-0.98), with 'difficulty getting to sleep' most likely. Self-rated chronotype was not related to duration of improvement or discontinuation due to side effects. The chronotype-PGS was only associated with suicidal thoughts and attempted suicide (self-reported). While our measures are imperfect, and not of circadian phase under controlled conditions, the model coefficients suggest that dysregulation of phenotypic chronotype relative to its genetic proxy was driving relationships with antidepressant outcomes. CONCLUSIONS The idea that variation in circadian factors influences antidepressant responses was supported and encourages exploration of circadian mechanisms of depressive disorders and antidepressant treatments.
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Affiliation(s)
- Jacob J Crouse
- Brain and Mind Centre, The University of Sydney, NSW, Australia.
| | - Shin Ho Park
- Brain and Mind Centre, The University of Sydney, NSW, Australia
| | - Enda M Byrne
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD, Australia; Child Health Research Centre, The University of Queensland, Brisbane, QLD, Australia
| | - Brittany L Mitchell
- Department of Genetics and Computational Biology, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Karina Chan
- Brain and Mind Centre, The University of Sydney, NSW, Australia
| | - Jan Scott
- Brain and Mind Centre, The University of Sydney, Australia; Institute of Neuroscience, Newcastle University, United Kingdom
| | - Sarah E Medland
- Mental Health and Neuroscience Program, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Nicholas G Martin
- Department of Genetics and Computational Biology, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Naomi R Wray
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom; Oxford Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD, Australia
| | - Ian B Hickie
- Brain and Mind Centre, The University of Sydney, NSW, Australia
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Wong TR, Hickie IB, Carpenter JS, Scott EM, Guastella AJ, Vidafar P, Scott J, Hermens DF, Crouse JJ. Dynamic modelling of chronotype and hypo/manic and depressive symptoms in young people with emerging mental disorders. Chronobiol Int 2023; 40:699-709. [PMID: 37132360 DOI: 10.1080/07420528.2023.2203241] [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: 10/17/2022] [Revised: 02/21/2023] [Accepted: 04/11/2023] [Indexed: 05/04/2023]
Abstract
There is significant interest in the possible influence of chronotype on clinical states in young people with emerging mental disorders. We apply a dynamic approach (bivariate latent change score modelling) to examine the possible prospective influence of chronotype on depressive and hypo/manic symptoms in a youth cohort with predominantly depressive, bipolar, and psychotic disorders (N = 118; 14-30-years), who completed a baseline and follow-up assessment of these constructs (mean interval = 1.8-years). Our primary hypotheses were that greater baseline eveningness would predict increases in depressive but not hypo/manic symptoms. We found moderate to strong autoregressive effects for chronotype (β = -0.447 to -0.448, p < 0.001), depressive (β = -0.650, p < 0.001) and hypo/manic symptoms (β = -0.819, p < 0.001). Against our predictions, baseline chronotypes did not predict change in depressive (β = -0.016, p = 0.810) or hypo/manic symptoms (β = 0.077, p = 0.104). Similarly, the change in chronotype did not correlate with the change in depressive symptoms (β = -0.096, p = 0.295) nor did the change in chronotype and the change in hypo/manic symptoms (β = -0.166, p = 0.070). These data suggest that chronotypes may have low utility for predicting future hypo/manic and depressive symptoms in the short term, or that more frequent assessments over longer periods are needed to observe these associations. Future studies should test whether other circadian phenotypes (e.g. sleep-wake variability) are better indicators of illness course.
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Affiliation(s)
| | - Ian B Hickie
- Brain and Mind Centre, University of Sydney, Australia
| | | | | | | | | | - Jan Scott
- Brain and Mind Centre, University of Sydney, Australia
- Academic Psychiatry, Institute of Neuroscience, Newcastle University, UK
- Université de Paris, Paris, France
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - Daniel F Hermens
- Thompson Institute, University of the Sunshine Coast, Sippy Downs, Queensland, Australia
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