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Pan LA, Naviaux JC, Wang L, Li K, Monk JM, Lingampelly SS, Segreti AM, Bloom K, Vockley J, Tarnopolsky MA, Finegold DN, Peters DG, Naviaux RK. Metabolic features of treatment-refractory major depressive disorder with suicidal ideation. Transl Psychiatry 2023; 13:393. [PMID: 38097555 PMCID: PMC10721812 DOI: 10.1038/s41398-023-02696-9] [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: 09/06/2022] [Revised: 10/18/2023] [Accepted: 11/29/2023] [Indexed: 12/17/2023] Open
Abstract
Peripheral blood metabolomics was used to gain chemical insight into the biology of treatment-refractory Major Depressive Disorder with suicidal ideation, and to identify individualized differences for personalized care. The study cohort consisted of 99 patients with treatment-refractory major depressive disorder and suicidal ideation (trMDD-SI n = 52 females and 47 males) and 94 age- and sex-matched healthy controls (n = 48 females and 46 males). The median age was 29 years (IQR 22-42). Targeted, broad-spectrum metabolomics measured 448 metabolites. Fibroblast growth factor 21 (FGF21) and growth differentiation factor 15 (GDF15) were measured as biomarkers of mitochondrial dysfunction. The diagnostic accuracy of plasma metabolomics was over 90% (95%CI: 0.80-1.0) by area under the receiver operator characteristic (AUROC) curve analysis. Over 55% of the metabolic impact in males and 75% in females came from abnormalities in lipids. Modified purines and pyrimidines from tRNA, rRNA, and mRNA turnover were increased in the trMDD-SI group. FGF21 was increased in both males and females. Increased lactate, glutamate, and saccharopine, and decreased cystine provided evidence of reductive stress. Seventy-five percent of the metabolomic abnormalities found were individualized. Personalized deficiencies in CoQ10, flavin adenine dinucleotide (FAD), citrulline, lutein, carnitine, or folate were found. Pathways regulated by mitochondrial function dominated the metabolic signature. Peripheral blood metabolomics identified mitochondrial dysfunction and reductive stress as common denominators in suicidal ideation associated with treatment-refractory major depressive disorder. Individualized metabolic differences were found that may help with personalized management.
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Affiliation(s)
- Lisa A Pan
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
- School of Public Health, Department of Human Genetics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
- Panomics Mental Health Initiative, Pittsburgh, PA, USA.
- New Hope Molecular, LLC, Pittsburgh, PA, USA.
- New Hope Molecular, LLC, 750 Washington Rd, Suite 19, Pittsburgh, PA, 15228, USA.
| | - Jane C Naviaux
- The Mitochondrial and Metabolic Disease Center, University of California, San Diego School of Medicine, San Diego, CA, USA
- Department of Neurosciences, University of California, San Diego School of Medicine, San Diego, CA, USA
| | - Lin Wang
- The Mitochondrial and Metabolic Disease Center, University of California, San Diego School of Medicine, San Diego, CA, USA
- Department of Medicine, University of California, San Diego School of Medicine, San Diego, CA, USA
| | - Kefeng Li
- The Mitochondrial and Metabolic Disease Center, University of California, San Diego School of Medicine, San Diego, CA, USA
- Department of Medicine, University of California, San Diego School of Medicine, San Diego, CA, USA
| | - Jonathan M Monk
- The Mitochondrial and Metabolic Disease Center, University of California, San Diego School of Medicine, San Diego, CA, USA
- Department of Medicine, University of California, San Diego School of Medicine, San Diego, CA, USA
| | - Sai Sachin Lingampelly
- The Mitochondrial and Metabolic Disease Center, University of California, San Diego School of Medicine, San Diego, CA, USA
- Department of Medicine, University of California, San Diego School of Medicine, San Diego, CA, USA
| | - Anna Maria Segreti
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Kaitlyn Bloom
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jerry Vockley
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Mark A Tarnopolsky
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - David N Finegold
- School of Public Health, Department of Human Genetics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Panomics Mental Health Initiative, Pittsburgh, PA, USA
- New Hope Molecular, LLC, Pittsburgh, PA, USA
| | - David G Peters
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- School of Public Health, Department of Human Genetics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Panomics Mental Health Initiative, Pittsburgh, PA, USA
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Robert K Naviaux
- The Mitochondrial and Metabolic Disease Center, University of California, San Diego School of Medicine, San Diego, CA, USA.
- Department of Medicine, University of California, San Diego School of Medicine, San Diego, CA, USA.
- Department of Pediatrics, University of California, San Diego School of Medicine, San Diego, CA, USA.
- Department of Pathology, University of California, San Diego School of Medicine, San Diego, CA, USA.
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Alonso S, Tyborowska A, Ikani N, Mocking RJT, Figueroa CA, Schene AH, Deco G, Kringelbach ML, Cabral J, Ruhé HG. Depression recurrence is accompanied by longer periods in default mode and more frequent attentional and reward processing dynamic brain-states during resting-state activity. Hum Brain Mapp 2023; 44:5770-5783. [PMID: 37672593 PMCID: PMC10619399 DOI: 10.1002/hbm.26475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 07/15/2023] [Accepted: 08/16/2023] [Indexed: 09/08/2023] Open
Abstract
Recurrence in major depressive disorder (MDD) is common, but neurobiological models capturing vulnerability for recurrences are scarce. Disturbances in multiple resting-state networks have been linked to MDD, but most approaches focus on stable (vs. dynamic) network characteristics. We investigated how the brain's dynamical repertoire changes after patients transition from remission to recurrence of a new depressive episode. Sixty two drug-free, MDD-patients with ≥2 episodes underwent a baseline resting-state fMRI scan when in remission. Over 30-months follow-up, 11 patients with a recurrence and 17 matched-remitted MDD-patients without a recurrence underwent a second fMRI scan. Recurrent patterns of functional connectivity were characterized by applying Leading Eigenvector Dynamics Analysis (LEiDA). Differences between baseline and follow-up were identified for the 11 non-remitted patients, while data from the 17 matched-remitted patients was used as a validation dataset. After the transition into a depressive state, basal ganglia-anterior cingulate cortex (ACC) and visuo-attentional networks were detected significantly more often, whereas default mode network activity was found to have a longer duration. Additionally, the fMRI signal in the basal ganglia-ACC areas underlying the reward network, were significantly less synchronized with the rest of the brain after recurrence (compared to a state of remission). No significant changes were observed in the matched-remitted patients who were scanned twice while in remission. These findings characterize changes that may be associated with the transition from remission to recurrence and provide initial evidence of altered dynamical exploration of the brain's repertoire of functional networks when a recurrent depressive episode occurs.
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Affiliation(s)
- Sonsoles Alonso
- Department of Biomedical Sciences of Cells and Systems, Cognitive Neuroscience Center, University Medical Center GroningenUniversity of GroningenGroningenthe Netherlands
- Department of Clinical Medicine, Center for Functionally Integrative NeuroscienceAarhus UniversityAarhusDenmark
| | - Anna Tyborowska
- Department of PsychiatryRadboud University Medical CentreNijmegenthe Netherlands
- Donders Institute for Brain, Cognition and BehaviorRadboud UniversityNijmegenthe Netherlands
| | - Nessa Ikani
- Department of PsychiatryRadboud University Medical CentreNijmegenthe Netherlands
- Depression Expertise CenterProPersona Mental Health CareNijmegenthe Netherlands
- Overwaal Centre of Expertise for Anxiety Disorders, OCD and PTSDPro Persona Mental Health CareNijmegenthe Netherlands
| | - Roel J. T. Mocking
- Department of PsychiatryAmsterdam UMC, Location AMCAmsterdamthe Netherlands
| | - Caroline A. Figueroa
- Department of PsychiatryUniversity Medical Centre UtrechtUtrechtthe Netherlands
- School of Social WelfareUniversity of CaliforniaBerkeleyCaliforniaUSA
| | - Aart H. Schene
- Department of PsychiatryRadboud University Medical CentreNijmegenthe Netherlands
- Donders Institute for Brain, Cognition and BehaviorRadboud UniversityNijmegenthe Netherlands
| | - Gustavo Deco
- Department of Information and Communication Technologies, Center for Brain and Cognition, Computational Neuroscience GroupUniversitat Pompeu FabraBarcelonaSpain
- Institució Catalana de la Recerca i Estudis Avançats (ICREA)BarcelonaSpain
| | - Morten L. Kringelbach
- Centre for Eudaimonia and Human Flourishing, Linacre CollegeUniversity of OxfordOxfordUK
- Center for Music in the BrainAarhus UniversityAarhusDenmark
- Department of PsychiatryUniversity of OxfordOxfordUK
| | - Joana Cabral
- Centre for Eudaimonia and Human Flourishing, Linacre CollegeUniversity of OxfordOxfordUK
- Life and Health Sciences Research Institute (ICVS), School of MedicineUniversity of MinhoBragaPortugal
| | - Henricus G. Ruhé
- Department of PsychiatryRadboud University Medical CentreNijmegenthe Netherlands
- Donders Institute for Brain, Cognition and BehaviorRadboud UniversityNijmegenthe Netherlands
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Goryunov AV, Golubeva NI, Shushpanova OV. [Experience of clinical use of fluvoxamine for the treatment of comorbid depression in childhood and adolescence]. Zh Nevrol Psikhiatr Im S S Korsakova 2023; 123:14-21. [PMID: 38127696 DOI: 10.17116/jnevro202312311214] [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: 12/23/2023]
Abstract
OBJECTIVE To identify the frequency of administration of fluvoxamine, to determine the main targets of the drug and the expediency of its use in depression of various genesis in children and adolescents. MATERIAL AND METHODS To assess the frequency of prescribing fluvoxamine, 195 medical histories of patients who were inpatients in the children's department of the Mental Health Research Center in 2023 were analyzed. To assess the dynamics of depression during treatment with fluvoxamine, a clinical group was formed of 12 patients aged 10 to 15 years (age 13.1±3.6 years) who received fluvoxamine for the treatment of depression with comorbid obsessive-compulsive and anxiety-phobic disorders. Clinical and psychopathological, psychometric (Hamilton Depression Rating Scale - HDRS) and statistical research methods were used. RESULTS In total, in 2023, fluvoxamine was received by 20% (n=37) of all inpatient patients of child age (from 7 to 16 years). All patients received combination therapy. The therapeutic targets were comorbid depressive, obsessive-compulsive and anxiety symptoms developing in the structure of nosologically heterogeneous states, with the dominance of schizophrenic spectrum disorders. Against the background of the use of the drug fluvoxamine for 4 weeks in the clinical group, there was a significant reduction in depressive symptoms on the HDRS. Adverse events during complex therapy were observed in 20% of patients, but were not severe, did not require discontinuation of therapy and were unreliably associated with the use of fluvoxamine. CONCLUSION The use of the fluvoxamine provides reduction of depressive symptoms within the framework of various nosologies, and is characterized by sufficient safety. The variety of therapeutic targets of the fluvoxamine, including antidepressant, anti-anxiety, cognitive effects, is certainly a significant advantage of the studied fluvoxamine for use in childhood.
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Zhang ZQ, Guo ZP, Lv XY, Sörös P, Wang XX, Wang L, Liu CH. Effect and neural mechanisms of the transcutaneous vagus nerve stimulation for relapse prevention in patients with remitted major depressive disorder: protocol for a longitudinal study. BMJ Open 2022; 12:e050446. [PMID: 35193903 PMCID: PMC8867334 DOI: 10.1136/bmjopen-2021-050446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION After the first episode, patients with remitted major depressive disorder (MDD) have a 60% chance of experiencing a second episode. There are currently no accepted, effective methods to prevent the recurrence of MDD in remission. Transcutaneous vagus nerve stimulation (taVNS) is a non-invasive, safe and economical approach based on the efficacy of VNS in improving clinical depression symptoms. This clinical trial will study the efficacy of taVNS in preventing MDD relapse and investigate the underlying mechanisms of this. METHODS AND ANALYSIS We will conduct a multicentre, randomised, patient-blinded and evaluators double-blinded trial. We will randomise 90 eligible participants with recurrent MDD in remission in a 1:1 ratio into a real or sham taVNS group. All participants will be given six biopsychosocial assessments: proinflammatory cytokines, serum monoamine neurotransmitters, cognition, affective neuropsychology, multimodal neuroimaging and endocrinology. After the baseline measurements, all participants will be given corresponding interference for 6 months and then complete a 1-year follow-up. The assessments will be performed three times: at baseline, post-treatment and at the end of 1-year follow-up (except for multimodal MRI scanning, which will be conducted at the first two assessments only). Change in 17-item Hamilton Depression Rating Scale scores for MDD is the primary outcome parameter. ETHICS AND DISSEMINATION The study protocol was approved by the Medical Ethical Committee of Beijing Hospital of Traditional Chinese Medicine on 18 January 2019 (2018BL-076). The trial results will be published in peer-reviewed journals and at conferences. TRIAL REGISTRATION NUMBER ChiCTR1900022618.
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Affiliation(s)
- Zhu-Qing Zhang
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
| | - Zhi-Peng Guo
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
| | - Xue-Yu Lv
- Guang'an men Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Peter Sörös
- Research Center Neurosensory Science, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
| | - Xiao-Xu Wang
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
| | - Lihong Wang
- Department of Psychiatry, University of Connecticut Health Center, Farmington, Connecticut, USA
| | - Chun-Hong Liu
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
- Beijing Institute of Traditional Chinese Medicine, Beijing, China
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5
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Rutherford S, Fraza C, Dinga R, Kia SM, Wolfers T, Zabihi M, Berthet P, Worker A, Verdi S, Andrews D, Han LK, Bayer JM, Dazzan P, McGuire P, Mocking RT, Schene A, Sripada C, Tso IF, Duval ER, Chang SE, Penninx BW, Heitzeg MM, Burt SA, Hyde LW, Amaral D, Wu Nordahl C, Andreasssen OA, Westlye LT, Zahn R, Ruhe HG, Beckmann C, Marquand AF. Charting brain growth and aging at high spatial precision. eLife 2022; 11:72904. [PMID: 35101172 PMCID: PMC8828052 DOI: 10.7554/elife.72904] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 01/26/2022] [Indexed: 11/28/2022] Open
Abstract
Defining reference models for population variation, and the ability to study individual deviations is essential for understanding inter-individual variability and its relation to the onset and progression of medical conditions. In this work, we assembled a reference cohort of neuroimaging data from 82 sites (N=58,836; ages 2-100) and used normative modeling to characterize lifespan trajectories of cortical thickness and subcortical volume. Models are validated against a manually quality checked subset (N=24,354) and we provide an interface for transferring to new data sources. We showcase the clinical value by applying the models to a transdiagnostic psychiatric sample (N=1985), showing they can be used to quantify variability underlying multiple disorders whilst also refining case-control inferences. These models will be augmented with additional samples and imaging modalities as they become available. This provides a common reference platform to bind results from different studies and ultimately paves the way for personalized clinical decision-making.
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Affiliation(s)
- Saige Rutherford
- Donders Institute for Brain, Cognition, and Behavior, Radboud University, Nijmegen, Netherlands.,Department of Cognitive Neuroscience, Radboud University Medical Center, Nijmegen, Netherlands.,Department of Psychiatry, University of Michigan, Ann Arbor, United States
| | - Charlotte Fraza
- Donders Institute for Brain, Cognition, and Behavior, Radboud University, Nijmegen, Netherlands.,Department of Cognitive Neuroscience, Radboud University Medical Center, Nijmegen, Netherlands
| | - Richard Dinga
- Donders Institute for Brain, Cognition, and Behavior, Radboud University, Nijmegen, Netherlands.,Department of Cognitive Neuroscience, Radboud University Medical Center, Nijmegen, Netherlands
| | - Seyed Mostafa Kia
- Donders Institute for Brain, Cognition, and Behavior, Radboud University, Nijmegen, Netherlands.,Department of Cognitive Neuroscience, Radboud University Medical Center, Nijmegen, Netherlands.,Department of Psychiatry, Utrecht University Medical Center, Utrecht, Netherlands
| | - Thomas Wolfers
- Department of Psychology, University of Oslo, Oslo, Norway.,Norwegian Center for Mental Disorders Research (NORMENT), University of Oslo, and Oslo University Hospital, Oslo, Norway
| | - Mariam Zabihi
- Donders Institute for Brain, Cognition, and Behavior, Radboud University, Nijmegen, Netherlands.,Department of Cognitive Neuroscience, Radboud University Medical Center, Nijmegen, Netherlands
| | - Pierre Berthet
- Department of Psychology, University of Oslo, Oslo, Norway.,Norwegian Center for Mental Disorders Research (NORMENT), University of Oslo, and Oslo University Hospital, Oslo, Norway
| | - Amanda Worker
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Serena Verdi
- Centre for Medical Image Computing, Medical Physics and Biomedical Engineering, University College London, London, United Kingdom.,Dementia Research Centre, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Derek Andrews
- The Medical Investigation of Neurodevelopmental Disorders (MIND) Institute and Department of Psychiatry and Behavioral Sciences, UC Davis School of Medicine, University of California, Davis, Sacramento, United States
| | - Laura Km Han
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, Netherlands.,GGZ inGeest, Amsterdam Neuroscience, Amsterdam, Netherlands
| | - Johanna Mm Bayer
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia.,Orygen Youth Health, Melbourne, Australia
| | - Paola Dazzan
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,National Institute for Health Research Mental Health Biomedical Research Centre, South London and Maudsley National Health Service Foundation Trust and King's College London, London, United Kingdom
| | - Phillip McGuire
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, United Kingdom
| | - Roel T Mocking
- Department of Psychiatry, Amsterdam UMC, Location AMC, Amsterdam, Netherlands
| | - Aart Schene
- Donders Institute for Brain, Cognition, and Behavior, Radboud University, Nijmegen, Netherlands.,Department of Psychiatry, Radboud University Medical Center, Nijmegen, Netherlands
| | - Chandra Sripada
- Department of Psychiatry, University of Michigan, Ann Arbor, United States
| | - Ivy F Tso
- Department of Psychiatry, University of Michigan, Ann Arbor, United States
| | - Elizabeth R Duval
- Department of Psychiatry, University of Michigan, Ann Arbor, United States
| | - Soo-Eun Chang
- Department of Psychiatry, University of Michigan, Ann Arbor, United States
| | - Brenda Wjh Penninx
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, Netherlands.,GGZ inGeest, Amsterdam Neuroscience, Amsterdam, Netherlands
| | - Mary M Heitzeg
- Department of Psychiatry, University of Michigan, Ann Arbor, United States
| | - S Alexandra Burt
- Department of Psychology, Michigan State University, East Lansing, United States
| | - Luke W Hyde
- Department of Psychology, University of Michigan, Ann Arbor, United States
| | - David Amaral
- The Medical Investigation of Neurodevelopmental Disorders (MIND) Institute and Department of Psychiatry and Behavioral Sciences, UC Davis School of Medicine, University of California, Davis, Sacramento, United States
| | - Christine Wu Nordahl
- The Medical Investigation of Neurodevelopmental Disorders (MIND) Institute and Department of Psychiatry and Behavioral Sciences, UC Davis School of Medicine, University of California, Davis, Sacramento, United States
| | - Ole A Andreasssen
- Norwegian Center for Mental Disorders Research (NORMENT), University of Oslo, and Oslo University Hospital, Oslo, Norway.,KG Jebsen Centre for Neurodevelopmental Disorders Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Lars T Westlye
- Department of Psychology, University of Oslo, Oslo, Norway.,Norwegian Center for Mental Disorders Research (NORMENT), University of Oslo, and Oslo University Hospital, Oslo, Norway.,KG Jebsen Centre for Neurodevelopmental Disorders Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Roland Zahn
- Centre for Affective Disorders at the Institute of Psychiatry, King's College London, London, United Kingdom
| | - Henricus G Ruhe
- Donders Institute for Brain, Cognition, and Behavior, Radboud University, Nijmegen, Netherlands.,Department of Psychiatry, Radboud University Medical Center, Nijmegen, Netherlands
| | - Christian Beckmann
- Donders Institute for Brain, Cognition, and Behavior, Radboud University, Nijmegen, Netherlands.,Department of Cognitive Neuroscience, Radboud University Medical Center, Nijmegen, Netherlands.,Centre for Functional MRI of the Brain (FMRIB), Nuffield Department of Clinical Neurosciences, Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, United Kingdom
| | - Andre F Marquand
- Donders Institute for Brain, Cognition, and Behavior, Radboud University, Nijmegen, Netherlands.,Department of Cognitive Neuroscience, Radboud University Medical Center, Nijmegen, Netherlands
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Understanding complex functional wiring patterns in major depressive disorder through brain functional connectome. Transl Psychiatry 2021; 11:526. [PMID: 34645783 PMCID: PMC8513388 DOI: 10.1038/s41398-021-01646-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 09/20/2021] [Accepted: 09/29/2021] [Indexed: 02/06/2023] Open
Abstract
Brain function relies on efficient communications between distinct brain systems. The pathology of major depressive disorder (MDD) damages functional brain networks, resulting in cognitive impairment. Here, we reviewed the associations between brain functional connectome changes and MDD pathogenesis. We also highlighted the utility of brain functional connectome for differentiating MDD from other similar psychiatric disorders, predicting recurrence and suicide attempts in MDD, and evaluating treatment responses. Converging evidence has now linked aberrant brain functional network organization in MDD to the dysregulation of neurotransmitter signaling and neuroplasticity, providing insights into the neurobiological mechanisms of the disease and antidepressant efficacy. Widespread connectome dysfunctions in MDD patients include multiple, large-scale brain networks as well as local disturbances in brain circuits associated with negative and positive valence systems and cognitive functions. Although the clinical utility of the brain functional connectome remains to be realized, recent findings provide further promise that research in this area may lead to improved diagnosis, treatments, and clinical outcomes of MDD.
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7
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Mocking RJT, Naviaux JC, Li K, Wang L, Monk JM, Bright AT, Figueroa CA, Schene AH, Ruhé HG, Assies J, Naviaux RK. Metabolic features of recurrent major depressive disorder in remission, and the risk of future recurrence. Transl Psychiatry 2021; 11:37. [PMID: 33431800 PMCID: PMC7801396 DOI: 10.1038/s41398-020-01182-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 12/08/2020] [Accepted: 12/15/2020] [Indexed: 01/29/2023] Open
Abstract
Recurrent major depressive disorder (rMDD) is a relapsing-remitting disease with high morbidity and a 5-year risk of recurrence of up to 80%. This was a prospective pilot study to examine the potential diagnostic and prognostic value of targeted plasma metabolomics in the care of patients with rMDD in remission. We used an established LC-MS/MS platform to measure 399 metabolites in 68 subjects with rMDD (n = 45 females and 23 males) in antidepressant-free remission and 59 age- and sex-matched controls (n = 40 females and 19 males). Patients were then followed prospectively for 2.5 years. Metabolomics explained up to 43% of the phenotypic variance. The strongest biomarkers were gender specific. 80% of the metabolic predictors of recurrence in both males and females belonged to 6 pathways: (1) phospholipids, (2) sphingomyelins, (3) glycosphingolipids, (4) eicosanoids, (5) microbiome, and (6) purines. These changes traced to altered mitochondrial regulation of cellular redox, signaling, energy, and lipid metabolism. Metabolomics identified a chemical endophenotype that could be used to stratify rrMDD patients at greatest risk for recurrence with an accuracy over 0.90 (95%CI = 0.69-1.0). Power calculations suggest that a validation study of at least 198 females and 198 males (99 cases and 99 controls each) will be needed to confirm these results. Although a small study, these results are the first to show the potential utility of metabolomics in assisting with the important clinical challenge of prospectively identifying the patients at greatest risk of recurrence of a depressive episode and those who are at lower risk.
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Affiliation(s)
- Roel J T Mocking
- Department of Psychiatry, Amsterdam UMC, Academic Medical Center, University of Amsterdam, Meibergdreef 5, 1105 AZ, Amsterdam, The Netherlands.
| | - Jane C Naviaux
- The Mitochondrial and Metabolic Disease Center, University of California, San Diego School of Medicine, 214 Dickinson St., Bldg CTF, Rm C107, San Diego, CA, 92103-8467, USA
- Department of Neurosciences, University of California, San Diego School of Medicine, 214 Dickinson St., Bldg CTF, Rm C107, San Diego, CA, 92103-8467, USA
| | - Kefeng Li
- The Mitochondrial and Metabolic Disease Center, University of California, San Diego School of Medicine, 214 Dickinson St., Bldg CTF, Rm C107, San Diego, CA, 92103-8467, USA
- Department of Medicine, University of California, San Diego School of Medicine, 214 Dickinson St., Bldg CTF, Rm C107, San Diego, CA, 92103-8467, USA
| | - Lin Wang
- The Mitochondrial and Metabolic Disease Center, University of California, San Diego School of Medicine, 214 Dickinson St., Bldg CTF, Rm C107, San Diego, CA, 92103-8467, USA
- Department of Medicine, University of California, San Diego School of Medicine, 214 Dickinson St., Bldg CTF, Rm C107, San Diego, CA, 92103-8467, USA
| | - Jonathan M Monk
- The Mitochondrial and Metabolic Disease Center, University of California, San Diego School of Medicine, 214 Dickinson St., Bldg CTF, Rm C107, San Diego, CA, 92103-8467, USA
- Department of Medicine, University of California, San Diego School of Medicine, 214 Dickinson St., Bldg CTF, Rm C107, San Diego, CA, 92103-8467, USA
| | - A Taylor Bright
- The Mitochondrial and Metabolic Disease Center, University of California, San Diego School of Medicine, 214 Dickinson St., Bldg CTF, Rm C107, San Diego, CA, 92103-8467, USA
- Department of Medicine, University of California, San Diego School of Medicine, 214 Dickinson St., Bldg CTF, Rm C107, San Diego, CA, 92103-8467, USA
- Colt Neck Labs, 838 E High St 202., Lexington, KY, 40503, USA
| | - Caroline A Figueroa
- Department of Psychiatry, Amsterdam UMC, Academic Medical Center, University of Amsterdam, Meibergdreef 5, 1105 AZ, Amsterdam, The Netherlands
- School of Social Welfare, University of California, Berkeley, CA, 94720, USA
| | - Aart H Schene
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, the Netherlands
- Donders Institute for Brain, Cognition and Behavior, Radboud University Nijmegen, Nijmegen, the Netherlands
| | - Henricus G Ruhé
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, the Netherlands
- Donders Institute for Brain, Cognition and Behavior, Radboud University Nijmegen, Nijmegen, the Netherlands
| | - Johanna Assies
- Department of Psychiatry, Amsterdam UMC, Academic Medical Center, University of Amsterdam, Meibergdreef 5, 1105 AZ, Amsterdam, The Netherlands.
| | - Robert K Naviaux
- The Mitochondrial and Metabolic Disease Center, University of California, San Diego School of Medicine, 214 Dickinson St., Bldg CTF, Rm C107, San Diego, CA, 92103-8467, USA.
- Department of Medicine, University of California, San Diego School of Medicine, 214 Dickinson St., Bldg CTF, Rm C107, San Diego, CA, 92103-8467, USA.
- Department of Pediatrics, University of California, San Diego School of Medicine, 214 Dickinson St., Bldg CTF, Rm C107, San Diego, CA, 92103-8467, USA.
- Department of Pathology, University of California, San Diego School of Medicine, 214 Dickinson St., Bldg CTF, Rm C107, San Diego, CA, 92103-8467, USA.
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Ivanets NN, Kinkulkina MA, Tikhonova YG, Izumina TA, Lazareva AV. [Clinical and sociodemographic characteristics of patients with the first depressive episode and recurrent depression]. Zh Nevrol Psikhiatr Im S S Korsakova 2020; 120:33-39. [PMID: 33340295 DOI: 10.17116/jnevro202012011133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To comparare socio-demographic and clinical characteristics of patients with the first depressive episode and recurrent depression. MATERIAL AND METHODS Three hundred and twenty one patients with unipolar depression, including 96 patients with first depressive episode and 225 patients with recurrent depression, were examined using clinical and psychometric methods. RESULTS AND CONCLUSION There were differences in clinical characteristics between groups but such factors as gender, marital status, level of education, family history of mental disorders and personality were similar. With each new episode of recurrent depression, the next episode tends to be more severe with more intense pessimistic and suicidal thoughts but fewer anxiety and complaints of depressive mood that affects the differences and requires further research, especially considering the effect of therapy.
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Affiliation(s)
- N N Ivanets
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - M A Kinkulkina
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Y G Tikhonova
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - T A Izumina
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - A V Lazareva
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
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9
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Yuan B, Sun X, Xu Z, Pu M, Yuan Y, Zhang Z. Influence of genetic polymorphisms in homocysteine and lipid metabolism systems on antidepressant drug response. BMC Psychiatry 2020; 20:408. [PMID: 32795354 PMCID: PMC7427977 DOI: 10.1186/s12888-020-02798-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 07/30/2020] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Variation in genes implicated in homocysteine and lipid metabolism systems may influence antidepressant response for patients with major depressive disorder (MDD). This study aimed to investigate whether association of polymorphisms on the MTHFR, ApoE and ApoA4 genes with the treatment response in MDD subjects. METHODS A total of 281 Han Chinese MDD patients received a single antidepressant drug (SSRI or SNRI) for at least 6 weeks, among whom 275 were followed up for 8 weeks. Their response to 6 weeks' treatment and remission to 8 weeks' treatment with antidepressant drugs was determined by changes in the 17-item Hamilton Depression Rating Scale (HARS-17) score. Single SNP and haplotype associations with treatment response were analyzed by UNPHASED 3.0.13. Logistic regression analysis was used to explore the interactions between genotypes and gender or drug type on treatment outcome, only those SNPs that had interactional association with gender or drug type were subjected to further stratified analysis. RESULTS In total group, the haplotype (C-A) in MTHFR (rsl801133 and rs1801131) and the ApoE rs405509 AA genotype were significantly associated with better efficacy of antidepressants; In gender subgroups, only haplotype (C-A) in MTHFR (rsl801133 and rs1801131) was significantly associated with better efficacy of antidepressants in male subgroup; In drug type subgroup, the haplotype (C-A) in MTHFR (rsl801133 and rs1801131) and haplotype (G-C) in ApoE (rs7412 and rs405509) were associated with better efficacy of antidepressants in SNRI treated subgroup; The ApoA4 rs5092 G allele and GG genotype were associated with worse efficacy of antidepressants in SNRI treated subgroup. CONCLUSIONS Genetic polymorphisms in homocysteine and lipid metabolism systems are associated with antidepressant response, particularly for the interactions of the certain genetic with gender or drug type.
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Affiliation(s)
- Baoyu Yuan
- grid.263826.b0000 0004 1761 0489Department of Neurology, Affiliated ZhongDa Hospital, School of Medical, Southeast University, No.87 Ding Jia Qiao Road, Nanjing, 210009 Jiangsu China
| | - Xiaoyan Sun
- grid.263826.b0000 0004 1761 0489Department of Neurology, Affiliated ZhongDa Hospital, School of Medical, Southeast University, No.87 Ding Jia Qiao Road, Nanjing, 210009 Jiangsu China
| | - Zhi Xu
- grid.263826.b0000 0004 1761 0489Institution of Neuropsychiatry, Southeast University, Nanjing, 210009 Jiangsu China ,grid.263826.b0000 0004 1761 0489Department of Psychosomatics and Psychiatry, Affiliated ZhongDa Hospital Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009 Jiangsu China
| | - Mengjia Pu
- grid.263826.b0000 0004 1761 0489Department of Neurology, Affiliated ZhongDa Hospital, School of Medical, Southeast University, No.87 Ding Jia Qiao Road, Nanjing, 210009 Jiangsu China
| | - Yonggui Yuan
- grid.263826.b0000 0004 1761 0489Institution of Neuropsychiatry, Southeast University, Nanjing, 210009 Jiangsu China ,grid.263826.b0000 0004 1761 0489Department of Psychosomatics and Psychiatry, Affiliated ZhongDa Hospital Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009 Jiangsu China
| | - Zhijun Zhang
- Department of Neurology, Affiliated ZhongDa Hospital, School of Medical, Southeast University, No.87 Ding Jia Qiao Road, Nanjing, 210009, Jiangsu, China. .,Institution of Neuropsychiatry, Southeast University, Nanjing, 210009, Jiangsu, China.
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10
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Pahlevan T, Ung C, Segal Z. Cost-Utility Analysis of Mindfulness-Based Cognitive Therapy Versus Antidepressant Pharmacotherapy for Prevention of Depressive Relapse in a Canadian Context: Analyse coût-utilité de la thérapie cognitive basée sur la pleine conscience contre la pharmacothérapie antidépressive pour prévenir la rechute de la dépression en contexte canadien. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2020; 65:568-576. [PMID: 32031000 PMCID: PMC7492890 DOI: 10.1177/0706743720904613] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Patients suffering from major depressive disorder (MDD) experience impaired functioning and reduced quality of life, including an elevated risk of episode return. MDD is associated with high societal burden due to increased healthcare utilization, productivity losses, and suicide-related costs, making the long-term management of this illness a priority. The purpose of this study is to evaluate the cost-effectiveness of mindfulness-based cognitive therapy (MBCT), a first-line preventative psychological treatment, compared to maintenance antidepressant medication (ADM), the current standard of care. METHOD A cost-utility analysis was conducted over a 24-month time horizon to model differences between MBCT and ADM in cost and quality-adjusted life years (QALY). The analysis was conducted using a decision tree analytic model. Intervention efficacy, utility, and costing data estimates were derived from published sources and expert consultation. RESULTS MBCT was found to be cost-effective compared to maintenance ADM over a 24-month time horizon. Antidepressant pharmacotherapy resulted in 1.10 QALY and $17,255.37 per patient on average, whereas MBCT resulted in 1.18 QALY and $15,030.70 per patient on average. This resulted in a cost difference of $2,224.67 and a QALY difference of 0.08, in favor of MBCT. Multiple sensitivity analyses supported these findings. CONCLUSIONS From both a societal and health system perspective, utilizing MBCT as a first-line relapse prevention treatment is potentially cost-effective in a Canadian setting. Future economic evaluations should consider combined treatment (e.g., ADM and psychotherapy) as a comparator and longer time horizons as the literature advances.
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Affiliation(s)
- Tina Pahlevan
- Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | - Christine Ung
- Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | - Zindel Segal
- Graduate Program in Psychological Clinical Science, University of Toronto Scarborough, Ontario, Canada
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11
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Thesing CS, Lok A, Milaneschi Y, Assies J, Bockting CLH, Figueroa CA, Giltay EJ, Penninx BWJH, Ruhé HG, Schene AH, Bot M, Mocking RJT. Fatty acids and recurrence of major depressive disorder: combined analysis of two Dutch clinical cohorts. Acta Psychiatr Scand 2020; 141:362-373. [PMID: 31785112 PMCID: PMC7216896 DOI: 10.1111/acps.13136] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/26/2019] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Omega-3 (n-3) and omega-6 (n-6) polyunsaturated fatty acid (PUFA) alterations in patients with major depressive disorder (MDD) have been shown to persist after remission. Whether these alterations are risk factors for MDD recurrence remains unknown. Here, we examined whether fatty acids predict time until MDD recurrence in remitted MDD patients. METHODS Data were used from remitted MDD patients of the Netherlands Study of Depression and Anxiety (n = 356) and the Depression Evaluation Longitudinal Therapy Assessment studies (n = 118). Associations of FAs with time until MDD recurrence up to 8-year follow-up were analyzed using Cox regression analyses. Study-specific estimates were pooled using mega- and meta-analysis techniques. RESULTS 27.5% (NESDA) and 56.8% (DELTA) participants had an MDD recurrence. Pooled results showed that no FA was significantly associated with time until MDD recurrence (n-3 PUFAs: hazard ratio (HR) = 1.17, 95% confidence interval (CI) = 0.98-1.41, P = 0.082; n-6 PUFAs: HR = 1.08, 95% CI = 0.84-1.38, P = 0.55). CONCLUSION In remitted MDD patients, circulating PUFAs were not associated with prospective risk of MDD recurrence. Consequently, circulating PUFAs are unlikely to reflect a vulnerability marker for recurrence, so correcting n-3 PUFA 'deficits' through supplementation does not seem a promising option to prevent MDD recurrence.
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Affiliation(s)
- C. S. Thesing
- Department of PsychiatryAmsterdam Public Health Research InstituteAmsterdam UMCVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - A. Lok
- Department of PsychiatryAmsterdam Public Health Research InstituteAmsterdam UMCAcademisch Medisch CentrumUniversity of AmsterdamAmsterdamThe Netherlands
| | - Y. Milaneschi
- Department of PsychiatryAmsterdam Public Health Research InstituteAmsterdam UMCVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - J. Assies
- Department of PsychiatryAmsterdam Public Health Research InstituteAmsterdam UMCAcademisch Medisch CentrumUniversity of AmsterdamAmsterdamThe Netherlands
| | - C. L. H. Bockting
- Department of PsychiatryAmsterdam Public Health Research InstituteAmsterdam UMCAcademisch Medisch CentrumUniversity of AmsterdamAmsterdamThe Netherlands
| | - C. A. Figueroa
- Department of PsychiatryAmsterdam Public Health Research InstituteAmsterdam UMCAcademisch Medisch CentrumUniversity of AmsterdamAmsterdamThe Netherlands
| | - E. J. Giltay
- Department of PsychiatryLeiden University Medical CenterLeidenThe Netherlands
| | - B. W. J. H. Penninx
- Department of PsychiatryAmsterdam Public Health Research InstituteAmsterdam UMCVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - H. G. Ruhé
- Department of PsychiatryAmsterdam Public Health Research InstituteAmsterdam UMCAcademisch Medisch CentrumUniversity of AmsterdamAmsterdamThe Netherlands,Department of PsychiatryRadboud University Medical CenterNijmegenThe Netherlands,Donders Institute for Brain, Cognition and BehaviorRadboud University Medical CenterNijmegenThe Netherlands
| | - A. H. Schene
- Department of PsychiatryRadboud University Medical CenterNijmegenThe Netherlands,Donders Institute for Brain, Cognition and BehaviorRadboud University Medical CenterNijmegenThe Netherlands
| | - M. Bot
- Department of PsychiatryAmsterdam Public Health Research InstituteAmsterdam UMCVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - R. J. T. Mocking
- Department of PsychiatryAmsterdam Public Health Research InstituteAmsterdam UMCAcademisch Medisch CentrumUniversity of AmsterdamAmsterdamThe Netherlands
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12
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Figueroa CA, DeJong H, Mocking RJT, Fox E, Rive MM, Schene AH, Stein A, Ruhé HG. Attentional control, rumination and recurrence of depression. J Affect Disord 2019; 256:364-372. [PMID: 31207560 DOI: 10.1016/j.jad.2019.05.072] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 05/27/2019] [Accepted: 05/29/2019] [Indexed: 01/24/2023]
Abstract
BACKGROUND Depressive recurrence is highly prevalent and adds significantly to the burden of depressive disorder. Whilst some clinical predictors of recurrence have been clearly demonstrated (e.g. residual symptoms, previous episodes), the cognitive and psychological processes that may contribute to recurrence risk are less well established. In this study we examine whether cognitive flexibility deficits and rumination are related to recurrence in a remitted clinical sample. METHOD We compared remitted patients with 2 or more previous depressive episodes (N = 69) to a matched group of healthy controls (N = 43). Cognitive flexibility was measured using the Internal Shift Task (IST) and a version of the Exogenous Cueing Task (ECT); rumination was assessed with the Ruminative Responses Scale. RESULTS IST and ECT performance did not differ between remitted patients and controls. Remitted patients had higher levels of rumination than controls. Within the remitted patient group, faster disengagement from angry and happy faces on the ECT was predictive of shorter time to recurrence (hazard ratio for 1 standard deviation, (HRSD) = 0.563 [CI, 0.381-0.832], p = 0.004, (HRSD) = 0.561 [CI, 0.389-0.808], p = 0.002, respectively). Rumination predicted recurrence (HRSD = 1.526 [CI, 1.152-2.202]; p = 0.003) but was not related to emotional disengagement. LIMITATIONS We had low power to detect small effects for the analysis within remitted patients. CONCLUSIONS Whilst cognitive flexibility in remitted patients was not impaired relative to controls, rapid disengagement from emotional stimuli and rumination were independently associated with time to recurrence. Cognitive flexibility may be an important indicator of recurrence risk, and a target for interventions to reduce recurrence.
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Affiliation(s)
- Caroline A Figueroa
- School of Social Welfare, University of California, 102 Haviland Hall, Berkeley, United States; Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
| | - Hannah DeJong
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom.
| | - Roel J T Mocking
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Elaine Fox
- Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom
| | - Maaike M Rive
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Aart H Schene
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, the Netherlands; Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, the Netherlands
| | - Alan Stein
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Henricus G Ruhé
- School of Social Welfare, University of California, 102 Haviland Hall, Berkeley, United States; Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Department of Psychiatry, Radboud University Medical Center, Nijmegen, the Netherlands; Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, the Netherlands
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13
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Geugies H, Mocking RJT, Figueroa CA, Groot PFC, Marsman JBC, Servaas MN, Steele JD, Schene AH, Ruhé HG. Impaired reward-related learning signals in remitted unmedicated patients with recurrent depression. Brain 2019; 142:2510-2522. [PMID: 31280309 PMCID: PMC6734943 DOI: 10.1093/brain/awz167] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 04/11/2019] [Accepted: 04/21/2019] [Indexed: 01/17/2023] Open
Abstract
One of the core symptoms of major depressive disorder is anhedonia, an inability to experience pleasure. In patients with major depressive disorder, a dysfunctional reward-system may exist, with blunted temporal difference reward-related learning signals in the ventral striatum and increased temporal difference-related (dopaminergic) activation in the ventral tegmental area. Anhedonia often remains as residual symptom during remission; however, it remains largely unknown whether the abovementioned reward systems are still dysfunctional when patients are in remission. We used a Pavlovian classical conditioning functional MRI task to explore the relationship between anhedonia and the temporal difference-related response of the ventral tegmental area and ventral striatum in medication-free remitted recurrent depression patients (n = 36) versus healthy control subjects (n = 27). Computational modelling was used to obtain the expected temporal difference errors during this task. Patients, compared to healthy controls, showed significantly increased temporal difference reward learning activation in the ventral tegmental area (PFWE,SVC = 0.028). No differences were observed between groups for ventral striatum activity. A group × anhedonia interaction [t(57) = -2.29, P = 0.026] indicated that in patients, higher anhedonia was associated with lower temporal difference activation in the ventral tegmental area, while in healthy controls higher anhedonia was associated with higher ventral tegmental area activation. These findings suggest impaired reward-related learning signals in the ventral tegmental area during remission in patients with depression. This merits further investigation to identify impaired reward-related learning as an endophenotype for recurrent depression. Moreover, the inverse association between reinforcement learning and anhedonia in patients implies an additional disturbing influence of anhedonia on reward-related learning or vice versa, suggesting that the level of anhedonia should be considered in behavioural treatments.
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Affiliation(s)
- Hanneke Geugies
- University Medical Center Groningen, University Center for Psychiatry, Mood and Anxiety Disorders, University of Groningen, The Netherlands
- University Medical Center Groningen, Department of Neuroscience, Neuroimaging Center, University of Groningen, The Netherlands
| | - Roel J T Mocking
- Department of Psychiatry, Amsterdam University Medical Center, location AMC, University of Amsterdam, The Netherlands
| | - Caroline A Figueroa
- Department of Psychiatry, Amsterdam University Medical Center, location AMC, University of Amsterdam, The Netherlands
- Warneford Hospital, Department of Psychiatry, University of Oxford, UK
| | - Paul F C Groot
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, location AMC, University of Amsterdam, The Netherlands
| | - Jan-Bernard C Marsman
- University Medical Center Groningen, Department of Neuroscience, Neuroimaging Center, University of Groningen, The Netherlands
| | - Michelle N Servaas
- University Medical Center Groningen, Department of Neuroscience, Neuroimaging Center, University of Groningen, The Netherlands
| | - J Douglas Steele
- Medical School (Neuroscience), University of Dundee, Scotland, UK
| | - Aart H Schene
- Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, The Netherlands
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Henricus G Ruhé
- University Medical Center Groningen, University Center for Psychiatry, Mood and Anxiety Disorders, University of Groningen, The Netherlands
- Department of Psychiatry, Amsterdam University Medical Center, location AMC, University of Amsterdam, The Netherlands
- Warneford Hospital, Department of Psychiatry, University of Oxford, UK
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands
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14
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Liu CH, Zhang GZ, Li B, Li M, Woelfer M, Walter M, Wang L. Role of inflammation in depression relapse. J Neuroinflammation 2019; 16:90. [PMID: 30995920 PMCID: PMC6472093 DOI: 10.1186/s12974-019-1475-7] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 04/01/2019] [Indexed: 12/13/2022] Open
Abstract
Major depressive disorder (MDD) is a leading cause of disability worldwide. After the first episode, patients with remitted MDD have a 60% chance of experiencing a second episode. Consideration of therapy continuation should be viewed in terms of the balance between the adverse effects of medication and the need to prevent a possible relapse. Relapse during the early stages of MDD could be prevented more efficiently by conducting individual risk assessments and providing justification for continuing therapy. Our previous work established the neuroimaging markers of relapse by comparing patients with recurrent major depressive disorder (rMDD) in depressive and remitted states. However, it is not known which of these markers are trait markers that present before initial relapse and, consequently, predict disease course. Here, we first describe how inflammation can be translated to subtype-specific clinical features and suggest how this could be used to facilitate clinical diagnosis and treatment. Next, we address the central and peripheral functional state of the immune system in patients with MDD. In addition, we emphasize the important link between the number of depressive episodes and rMDD and use neuroimaging to propose a model for the latter. Last, we address how inflammation can affect brain circuits, providing a possible mechanism for rMDD. Our review suggests a link between inflammatory processes and brain region/circuits in rMDD.
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Affiliation(s)
- Chun-Hong Liu
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing Institute of Traditional Chinese Medicine, Beijing Key Laboratory of Acupuncture Neuromodulation, Beijing, 100010, China
| | - Guang-Zhong Zhang
- Dermatological Department, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, 100010, China
| | - Bin Li
- Acupuncture and Moxibustion Department, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, 100010, China
| | - Meng Li
- Clinical Affective Neuroimaging Laboratory (CANLAB), Otto-von-Guericke-University Magdeburg, Magdeburg, 39120, Germany
| | - Marie Woelfer
- Clinical Affective Neuroimaging Laboratory (CANLAB), Otto-von-Guericke-University Magdeburg, Magdeburg, 39120, Germany.,Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, NJ, 07102, USA
| | - Martin Walter
- Clinical Affective Neuroimaging Laboratory (CANLAB), Otto-von-Guericke-University Magdeburg, Magdeburg, 39120, Germany.,Department of Psychiatry and Psychotherapy, University of Tuebingen, Tubeingen, 72074, Germany.,Leibniz Institute for Neurobiology, Magdeburg, 39118, Germany
| | - Lihong Wang
- Department of Psychiatry, University of Connecticut Health Center, Farmington, CT, 06030, USA.
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15
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Medial prefrontal disengagement during self-focus in formerly depressed patients prone to rumination. J Affect Disord 2019; 247:36-44. [PMID: 30641339 DOI: 10.1016/j.jad.2019.01.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Revised: 12/24/2018] [Accepted: 01/04/2019] [Indexed: 01/10/2023]
Abstract
BACKGROUND Medial prefrontal cortex (MPFC) activity during self-referential processing has been associated with rumination and found aberrant in depression. We investigated whether this aberrant activity reflects a trait marker that persists in remitted patients. METHODS Twenty-five patients fully remitted from major depression for at least 6 months, and 29 matched healthy controls were scanned with fMRI while presented with personality trait words in two conditions: Self condition asked whether the trait described themselves; General condition asked whether the trait was generally desirable. Contrasts-of-interest were examined in a factorial model and rumination correlates were examined in 2-sample t-tests with Ruminative Response Style score as covariate. All findings were reported at a conservative p < 0.05, with whole-brain peak-level family-wise error correction. RESULTS Self-referential processing increased anterior cortical midline activity to a similar extent in both groups. Dorsal anterior cingulate cortex (MNI(x,y,z) = -12,20,26) and dorsal MPFC (MNI(x,y,z) = -6,46,40) activity during self-referential processing was positively associated with rumination in healthy control subjects and negatively associated with rumination in remitted patients. LIMITATIONS A longitudinal design tracking the relationship between rumination and MPFC activity would have aided the interpretation of our findings as to whether high ruminators are exhibiting an adaptive process to maintain remission or whether it represents a maladaptive process considering that high ruminators have an increased vulnerability for relapse. CONCLUSIONS The association between increased anterior cortical midline activity during self-referential processing and rumination differentiated healthy controls from formerly depressed patients. Self-referential neural processing during remission from depression may depend on the cognitive tendencies to ruminate.
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16
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Figueroa CA, Cabral J, Mocking RJT, Rapuano KM, van Hartevelt TJ, Deco G, Expert P, Schene AH, Kringelbach ML, Ruhé HG. Altered ability to access a clinically relevant control network in patients remitted from major depressive disorder. Hum Brain Mapp 2019; 40:2771-2786. [PMID: 30864248 PMCID: PMC6865599 DOI: 10.1002/hbm.24559] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Revised: 01/30/2019] [Accepted: 02/21/2019] [Indexed: 01/01/2023] Open
Abstract
Neurobiological models to explain vulnerability of major depressive disorder (MDD) are scarce and previous functional magnetic resonance imaging studies mostly examined “static” functional connectivity (FC). Knowing that FC constantly evolves over time, it becomes important to assess how FC dynamically differs in remitted‐MDD patients vulnerable for new depressive episodes. Using a recently developed method to examine dynamic FC, we characterized re‐emerging FC states during rest in 51 antidepressant‐free MDD patients at high risk of recurrence (≥2 previous episodes), and 35 healthy controls. We examined differences in occurrence, duration, and switching profiles of FC states after neutral and sad mood induction. Remitted MDD patients showed a decreased probability of an FC state (p < 0.005) consisting of an extensive network connecting frontal areas—important for cognitive control—with default mode network, striatum, and salience areas, involved in emotional and self‐referential processing. Even when this FC state was observed in patients, it lasted shorter (p < 0.005) and was less likely to switch to a smaller prefrontal–striatum network (p < 0.005). Differences between patients and controls decreased after sad mood induction. Further, the duration of this FC state increased in remitted patients after sad mood induction but not in controls (p < 0.05). Our findings suggest reduced ability of remitted‐MDD patients, in neutral mood, to access a clinically relevant control network involved in the interplay between externally and internally oriented attention. When recovering from sad mood, remitted recurrent MDD appears to employ a compensatory mechanism to access this FC state. This study provides a novel neurobiological profile of MDD vulnerability.
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Affiliation(s)
- Caroline A Figueroa
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Brain Imaging Center, Academic Medical Center, Amsterdam, The Netherlands.,School of Social Welfare, University of California Berkeley, Berkeley, California
| | - Joana Cabral
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom.,Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.,Center for Music in the Brain, Aarhus University, Aarhus, Denmark
| | - Roel J T Mocking
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Brain Imaging Center, Academic Medical Center, Amsterdam, The Netherlands
| | - Kristina M Rapuano
- Department of Psychological and Brain Sciences, Dartmouth College, Hanover, New Hampshire
| | | | - Gustavo Deco
- Center for Brain and Cognition, Computational Neuroscience Group, Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Spain.,Institució Catalana de la Recerca i Estudis Avançats (ICREA), Barcelona, Spain.,Department of Neuropsychology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany.,School of Psychological Sciences, Monash University, Melbourne, Australia
| | - Paul Expert
- Centre for Mathematics of Precision Healthcare, Imperial College London, London, United Kingdom.,Department of Mathematics, Imperial College London, London, United Kingdom
| | - Aart H Schene
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands.,Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, The Netherlands
| | - Morten L Kringelbach
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom.,Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.,Center for Music in the Brain, Aarhus University, Aarhus, Denmark
| | - Henricus G Ruhé
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Department of Psychiatry, University of Oxford, Oxford, United Kingdom.,Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands.,Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, The Netherlands
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17
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Cortisol, dehydroepiandrosterone sulfate, fatty acids, and their relation in recurrent depression. Psychoneuroendocrinology 2019; 100:203-212. [PMID: 30388594 DOI: 10.1016/j.psyneuen.2018.10.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 10/14/2018] [Accepted: 10/14/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Alterations in hypothalamic-pituitary-adrenal (HPA)-axis activity, fatty acid metabolism, and their relation have been associated with (recurrent) major depressive disorder (MDD), although conflicting findings exist. AIMS To determine whether alterations in HPA-axis activity and fatty acids in recurrent MDD remain during remission (i.e. reflect a potential trait factor). Furthermore, to test the association between HPA-axis activity and fatty acids in patients versus controls. METHODS We cross-sectionally compared 73 remitted unmedicated recurrent MDD patients with 46 matched never-depressed controls. Measurements included salivary cortisol and dehydroepiandrosterone sulfate (DHEAS) (awakening, evening, and after sad mood induction) and erythrocyte fatty acid parameters: (I) three main fatty acids [omega-3 docosahexaenoic acid (DHA), and the omega-3 eicosapentaenoic acid/omega-6 arachidonic acid (EPA/AA)-ratio], and (II) structural fatty acid indices [chain length, unsaturation and peroxidation]. RESULTS Patients showed higher cortisol awakening responses (p = 0.006) and lower evening cortisol/DHEAS ratios (p = 0.044) compared to matched controls. Fatty acids did not differ between patients and controls, but HPA-axis indicators were significantly associated with fatty acid parameters in both groups (0.001 ≤ p ≤ 0.043). Patients and controls significantly differed in the relations between awakening DHEAS or cortisol/DHEAS ratios and fatty acid parameters, including unsaturation and peroxidation indices (0.001≤ p ≤ 0.034). Significance remained after correction for confounders. CONCLUSIONS Our results further support alterations in HPA-axis activity, i.e. a lower baseline, but higher responsiveness of awakening cortisol, in remitted medication-free recurrent MDD patients. Furthermore, the relationship between HPA-axis and fatty acids showed significant differences in recurrent MDD patients versus controls. Prospective research is needed to determine the predictive value of this relationship for MDD recurrence.
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Ruhe HG, Mocking RJT, Figueroa CA, Seeverens PWJ, Ikani N, Tyborowska A, Browning M, Vrijsen JN, Harmer CJ, Schene AH. Emotional Biases and Recurrence in Major Depressive Disorder. Results of 2.5 Years Follow-Up of Drug-Free Cohort Vulnerable for Recurrence. Front Psychiatry 2019; 10:145. [PMID: 30984039 PMCID: PMC6447719 DOI: 10.3389/fpsyt.2019.00145] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 02/27/2019] [Indexed: 12/24/2022] Open
Abstract
An interesting factor explaining recurrence risk in Major Depressive Disorder (MDD) may be neuropsychological functioning, i.e., processing of emotional stimuli/information. Negatively biased processing of emotional stimuli/information has been found in both acute and (inconclusively) remitted states of MDD, and may be causally related to recurrence of depression. We aimed to investigate self-referent, memory and interpretation biases in recurrently depressed patients in remission and relate these biases to recurrence. We included 69 remitted recurrent MDD-patients (rrMDD-patients), 35-65 years, with ≥2 episodes, voluntarily free of antidepressant maintenance therapy for at least 4 weeks. We tested self-referent biases with an emotional categorization task, bias in emotional memory by free recall of the emotion categorization task 15 min after completing it, and interpretation bias with a facial expression recognition task. We compared these participants with 43 never-depressed controls matched for age, sex and intelligence. We followed the rrMDD-patients for 2.5 years and assessed recurrent depressive episodes by structured interview. The rrMDD-patients showed biases toward emotionally negative stimuli, faster responses to negative self-relevant characteristics in the emotional categorization, better recognition of sad faces, worse recognition of neutral faces with more misclassifications as angry or disgusting faces and less misclassifications as neutral faces (0.001 < p < 0.05). Of these, the number of misclassifications as angry and the overall performance in the emotional memory task were significantly associated with the time to recurrence (p ≤ 0.04), independent of residual symptoms and number of previous episodes. In a support vector machine data-driven model, prediction of recurrence-status could best be achieved (relative to observed recurrence-rate) with demographic and childhood adversity parameters (accuracy 78.1%; 1-sided p = 0.002); neuropsychological tests could not improve this prediction. Our data suggests a persisting (mood-incongruent) emotional bias when patients with recurrent depression are in remission. Moreover, these persisting biases might be mechanistically important for recurrence and prevention thereof.
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Affiliation(s)
- Henricus G Ruhe
- Department of Psychiatry, Radboud University Medical Centre, Nijmegen, Netherlands.,Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, Netherlands.,Department of Psychiatry, Location Academic Medical Center, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Roel J T Mocking
- Department of Psychiatry, Location Academic Medical Center, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Caroline A Figueroa
- Department of Psychiatry, Location Academic Medical Center, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands.,Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Paulien W J Seeverens
- Department of Psychiatry, Location Academic Medical Center, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Nessa Ikani
- Department of Psychiatry, Radboud University Medical Centre, Nijmegen, Netherlands.,ProPersona Mental Health Care, Depression Expertise Center, Nijmegen, Netherlands.,Department of Psychology, Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
| | - Anna Tyborowska
- Department of Psychiatry, Radboud University Medical Centre, Nijmegen, Netherlands.,Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, Netherlands.,Department of Psychology, Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
| | - Michael Browning
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Janna N Vrijsen
- Department of Psychiatry, Radboud University Medical Centre, Nijmegen, Netherlands.,Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, Netherlands.,ProPersona Mental Health Care, Depression Expertise Center, Nijmegen, Netherlands
| | | | - Aart H Schene
- Department of Psychiatry, Radboud University Medical Centre, Nijmegen, Netherlands.,Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, Netherlands
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19
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Temperamental factors in remitted depression: The role of effortful control and attentional mechanisms. J Affect Disord 2018; 235:499-505. [PMID: 29684864 DOI: 10.1016/j.jad.2018.04.064] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 03/15/2018] [Accepted: 04/07/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND Temperamental effortful control and attentional networks are increasingly viewed as important underlying processes in depression and anxiety. However, it is still unknown whether these factors facilitate depressive and anxiety symptoms in the general population and, more specifically, in remitted depressed individuals. METHODS We investigated to what extent effortful control and attentional networks (i.e., Attention Network Task) explain concurrent depressive and anxious symptoms in healthy individuals (n = 270) and remitted depressed individuals (n = 90). Both samples were highly representative of the US population. RESULTS Increased effortful control predicted a substantial decrease in symptoms of both depression and anxiety in the whole sample, whereas decreased efficiency of executive attention predicted a modest increase in depressive symptoms. Remitted depressed individuals did not show less effortful control nor less efficient attentional networks than healthy individuals. Moreover, clinical status did not moderate the relationship between temperamental factors and either depressive or anxiety symptoms. LIMITATIONS Limitations include the cross-sectional nature of the study. CONCLUSIONS Our study shows that temperamental effortful control represents an important transdiagnostic process for depressive and anxiety symptoms in adults.
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20
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Bobrov AE, Krasnoslobodtseva LA, Mutnykh EM. [Procognitive effects of fluvoxamine: preliminary data]. Zh Nevrol Psikhiatr Im S S Korsakova 2018; 118:43-49. [PMID: 30040800 DOI: 10.17116/jnevro20181186143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To identify and investigate procognitive effects of fluvoxamine. MATERIAL AND METHODS A prospective non-comparative trial of fluvoxamine was carried out in 50 patients in the remission phase of recurrent depressive disorder. To assess the efficacy of therapy, the Stroop color and word test, the Revised version of Addenbrooke's Cognitive Examination, the Frontal Assessment Battery, the Hamilton Depression Scale and the Social Adaptation Self-Evaluation Scale were used. Fluvoxamine was administered at doses of 50-150 mg/day for 24-weeks. RESULTS There were the improvement of executive functions, including selective attention and inhibitory control, and recovery of verbal fluency. The procognitive effect of fluvoxamine was dose-dependent and was related to the reduction of residual depressive symptoms. CONCLUSION Fluvoxamine has procognitive effects, stabilizes remission and improves social adaptation of the patients.
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Affiliation(s)
- A E Bobrov
- Pirogov Russian National Research Medical University, Moscow, Russia, Moscow Research Institute of Psychiatry, Serbsky National Medical Research Center of Psychiatry and Narcology, Moscow, Russia
| | - L A Krasnoslobodtseva
- Pirogov Russian National Research Medical University, Moscow, Russia, Moscow Research Institute of Psychiatry, Serbsky National Medical Research Center of Psychiatry and Narcology, Moscow, Russia
| | - E M Mutnykh
- Pirogov Russian National Research Medical University, Moscow, Russia, Moscow Research Institute of Psychiatry, Serbsky National Medical Research Center of Psychiatry and Narcology, Moscow, Russia
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21
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Mocking RJT, Assies J, Ruhé HG, Schene AH. Focus on fatty acids in the neurometabolic pathophysiology of psychiatric disorders. J Inherit Metab Dis 2018. [PMID: 29524021 DOI: 10.1007/s10545-018-0158-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Continuous research into the pathophysiology of psychiatric disorders, such as major depressive disorder (MDD), posttraumatic stress disorder (PTSD), and schizophrenia, suggests an important role for metabolism. This narrative review will provide an up-to-date summary of how metabolism is thought to be involved in the pathophysiology of these psychiatric disorders. We will focus on (I) the important role of fatty acids in these metabolic alterations, (II) whether fatty acid alterations represent epiphenomena or risk factors, and (III) similarities and dissociations in fatty acid alterations between different psychiatric disorders. (Historical) epidemiological evidence links fatty acid intake to psychiatric disorder prevalence, corroborated by altered fatty acid concentrations measured in psychiatric patients. These fatty acid alterations are connected with other concomitant pathophysiological mechanisms, including biological stress (hypothalamic-pituitary-adrenal (HPA)-axis and oxidative stress), inflammation, and brain network structure and function. Metabolomics and lipidomics studies are underway to more deeply investigate this complex network of associated neurometabolic alterations. Supplementation of fatty acids as disease-modifying nutraceuticals has clinical potential, particularly add-on eicosapentaenoic acid (EPA) in depressed patients with markers of increased inflammation. However, by interpreting the observed fatty acid alterations as partly (mal)adaptive phenomena, we attempt to nuance translational expectations and provide new clinical applications for these novel neurometabolic insights, e.g., to predict treatment response or depression recurrence. In conclusion, placing fatty acids in context can contribute to further understanding and optimized treatment of psychiatric disorders, in order to diminish their overwhelming burden of disease.
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Affiliation(s)
- R J T Mocking
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Meibergdreef 5, Amsterdam, 1105 AZ, The Netherlands.
| | - J Assies
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Meibergdreef 5, Amsterdam, 1105 AZ, The Netherlands
| | - H G Ruhé
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Meibergdreef 5, Amsterdam, 1105 AZ, The Netherlands
- Warneford Hospital, Department of Psychiatry, University of Oxford, Oxford, UK
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, the Netherlands
| | - A H Schene
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Meibergdreef 5, Amsterdam, 1105 AZ, The Netherlands
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, the Netherlands
- Donders Institute for Brain, Cognition and Behavior, Radboud University Nijmegen, Nijmegen, the Netherlands
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22
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Figueroa CA, Mocking RJT, van Wingen G, Martens S, Ruhé HG, Schene AH. Aberrant default-mode network-hippocampus connectivity after sad memory-recall in remitted-depression. Soc Cogn Affect Neurosci 2018; 12:1803-1813. [PMID: 28981917 PMCID: PMC5714211 DOI: 10.1093/scan/nsx108] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 09/12/2017] [Indexed: 12/30/2022] Open
Abstract
Rumination and cognitive reactivity (dysfunctional cognitions after sad mood-induction) remain high in remitted Major Depressive Disorder (MDD) and can contribute to new episodes. These factors have been linked to increased fMRI resting-state functional-connectivity within the Default-Mode Network (DMN). It remains unclear whether (I) increased DMN-connectivity persists during MDD-remission, and (II) whether sad mood-induction differentially affects DMN-connectivity in remitted-MDD vs controls. Moreover, DMN-connectivity studies in remitted-MDD were previously confounded by antidepressant-use. Sixty-two MDD-patients remitted from ≥2 episodes, psychotropic-medication free, and 41 controls, participated in two 5-min neutral and sad mood-inductions by autobiographical-recall and neutral/sad music, each followed by 8-min resting-state fMRI-scanning. We identified DMN-components using Independent Component Analysis and entered subject- and sessions-specific components into a repeated measures analysis of variance. Connectivity-differences were extracted and correlated with baseline cognitive reactivity and rumination as measures of vulnerability for recurrence. After sad vs neutral mood-induction, controls, but not remitted-MDD, showed an increase in connectivity between the posterior-DMN and a cluster consisting mostly of the hippocampus (P = 0.006). Less posterior-DMN-hippocampal connectivity was associated with higher cognitive reactivity (r = −0.21, P = 0.046) and rumination (r = −0.27, P = 0.017). After recalling sad autobiographical-memories, aberrant posterior-DMN-hippocampal connectivity, associated with cognitive reactivity and rumination, remains a neural vulnerability in MDD-remission.
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Affiliation(s)
- Caroline A Figueroa
- Department of Psychiatry, Program for Mood Disorders, Academic Medical Center, University of Amsterdam, 1105 AZ, Amsterdam, The Netherlands.,Brain imaging Center, Academic Medical Center, University of Amsterdam, 1105 AZ, Amsterdam, The Netherlands.,Warneford Hospital, Department of Psychiatry, University of Oxford, OX3 7JX, Oxford, United Kingdom
| | - Roel J T Mocking
- Department of Psychiatry, Program for Mood Disorders, Academic Medical Center, University of Amsterdam, 1105 AZ, Amsterdam, The Netherlands.,Brain imaging Center, Academic Medical Center, University of Amsterdam, 1105 AZ, Amsterdam, The Netherlands
| | - Guido van Wingen
- Department of Psychiatry, Program for Mood Disorders, Academic Medical Center, University of Amsterdam, 1105 AZ, Amsterdam, The Netherlands.,Brain imaging Center, Academic Medical Center, University of Amsterdam, 1105 AZ, Amsterdam, The Netherlands
| | - Suzanne Martens
- Department of Psychiatry, Program for Mood Disorders, Academic Medical Center, University of Amsterdam, 1105 AZ, Amsterdam, The Netherlands
| | - Henricus G Ruhé
- Department of Psychiatry, Program for Mood Disorders, Academic Medical Center, University of Amsterdam, 1105 AZ, Amsterdam, The Netherlands.,Brain imaging Center, Academic Medical Center, University of Amsterdam, 1105 AZ, Amsterdam, The Netherlands.,Warneford Hospital, Department of Psychiatry, University of Oxford, OX3 7JX, Oxford, United Kingdom.,Radboud University Medical Center, Department of Psychiatry, 6525 GC, Nijmegen, The Netherlands
| | - Aart H Schene
- Department of Psychiatry, Program for Mood Disorders, Academic Medical Center, University of Amsterdam, 1105 AZ, Amsterdam, The Netherlands.,Radboud University Medical Center, Department of Psychiatry, 6525 GC, Nijmegen, The Netherlands.,Donders Institute for Brain, Cognition and Behavior, Radboud University, 6525 GC, Nijmegen, The Netherlands
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23
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Servaas MN, Riese H, Renken RJ, Wichers M, Bastiaansen JA, Figueroa CA, Geugies H, Mocking RJT, Geerligs L, Marsman JBC, Aleman A, Schene AH, Schoevers RA, Ruhé HG. Associations Between Daily Affective Instability and Connectomics in Functional Subnetworks in Remitted Patients with Recurrent Major Depressive Disorder. Neuropsychopharmacology 2017; 42:2583-2592. [PMID: 28361870 PMCID: PMC5686496 DOI: 10.1038/npp.2017.65] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 03/22/2017] [Accepted: 03/24/2017] [Indexed: 12/12/2022]
Abstract
Remitted patients with major depressive disorder (rMDD) often report more fluctuations in mood as residual symptomatology. It is unclear how this affective instability is associated with information processing related to the default mode (DMS), salience/reward (SRS), and frontoparietal (FPS) subnetworks in rMDD patients at high risk of recurrence (rrMDD). Sixty-two unipolar, drug-free rrMDD patients (⩾2 MDD episodes) and 41 healthy controls (HCs) were recruited. We used experience sampling methodology to monitor mood/cognitions (10 times a day for 6 days) and calculated affective instability using the mean adjusted absolute successive difference. Subsequently, we collected resting-state functional magnetic resonance imaging data and performed graph theory to obtain network metrics of integration within (local efficiency) the DMS, SRS, and FPS, and between (participation coefficient) these subnetworks and others. In rrMDD patients compared with HCs, we found that affective instability was increased in most negative mood/cognition variables and that the DMS had less connections with other subnetworks. Furthermore, we found that rrMDD patients, who showed more instability in feeling down and irritated, had less connections between the SRS and other subnetworks and higher local efficiency coefficients in the FPS, respectively. In conclusion, rrMDD patients, compared with HCs, are less stable in their negative mood and these dynamics are related to differences in information processing within- and between-specific functional subnetworks. These results are a first step to gain a better understanding of how mood fluctuations in real life are represented in the brain and provide insights into the vulnerability profile of MDD.
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Affiliation(s)
- Michelle N Servaas
- Department of Psychiatry, Mood and Anxiety Disorders, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Department of Psychiatry, University Medical Center Groningen, Interdisciplinary Center for Psychopathology and Emotion Regulation, University of Groningen, Groningen, The Netherlands
- Department of Neuroscience, University of Groningen, University Medical Center Groningen, Neuroimaging Center, Groningen, The Netherlands
| | - Harriëtte Riese
- Department of Psychiatry, University Medical Center Groningen, Interdisciplinary Center for Psychopathology and Emotion Regulation, University of Groningen, Groningen, The Netherlands
| | - Remco J Renken
- Department of Neuroscience, University of Groningen, University Medical Center Groningen, Neuroimaging Center, Groningen, The Netherlands
| | - Marieke Wichers
- Department of Psychiatry, University Medical Center Groningen, Interdisciplinary Center for Psychopathology and Emotion Regulation, University of Groningen, Groningen, The Netherlands
| | - Jojanneke A Bastiaansen
- Department of Psychiatry, University Medical Center Groningen, Interdisciplinary Center for Psychopathology and Emotion Regulation, University of Groningen, Groningen, The Netherlands
- Department of Education and Research, Friesland Mental Health Care Services, Leeuwarden, The Netherlands
| | - Caroline A Figueroa
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Hanneke Geugies
- Department of Psychiatry, Mood and Anxiety Disorders, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Department of Neuroscience, University of Groningen, University Medical Center Groningen, Neuroimaging Center, Groningen, The Netherlands
| | - Roel JT Mocking
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Linda Geerligs
- Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, The Netherlands
| | - Jan-Bernard C Marsman
- Department of Neuroscience, University of Groningen, University Medical Center Groningen, Neuroimaging Center, Groningen, The Netherlands
| | - André Aleman
- Department of Neuroscience, University of Groningen, University Medical Center Groningen, Neuroimaging Center, Groningen, The Netherlands
- Department of Psychology, University of Groningen, The Netherlands
| | - Aart H Schene
- Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, The Netherlands
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Robert A Schoevers
- Department of Psychiatry, Mood and Anxiety Disorders, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Department of Psychiatry, University Medical Center Groningen, Interdisciplinary Center for Psychopathology and Emotion Regulation, University of Groningen, Groningen, The Netherlands
| | - Henricus G Ruhé
- Department of Psychiatry, Mood and Anxiety Disorders, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Department of Psychiatry, University Medical Center Groningen, Interdisciplinary Center for Psychopathology and Emotion Regulation, University of Groningen, Groningen, The Netherlands
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- Department of Psychiatry, University of Oxford, Warnford Hospital, Oxford, UK
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24
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Chiu WC, Su YP, Su KP, Chen PC. Recurrence of depressive disorders after interferon-induced depression. Transl Psychiatry 2017; 7:e1026. [PMID: 28170005 PMCID: PMC5438022 DOI: 10.1038/tp.2016.274] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 10/31/2016] [Accepted: 11/28/2016] [Indexed: 01/14/2023] Open
Abstract
Interferon alpha (IFN-α)-treated patients commonly develop depression during the therapy period. Although most IFN-α-induced depressive disorders achieve remission after IFN-α therapy, no studies have examined the long-term mood effects of IFN-α treatment. We conducted a 12-year population-based cohort study of hepatitis C virus (HCV)-infected patients who were older than 20 years and had received IFN-α therapy. The sample was obtained from the Taiwan National Health Insurance Research Database. The cohort included patients with and without IFN-α-induced depression, matched randomly by age, sex and depression history, at a ratio of 1:10. The follow-up started after the last administration of IFN-α and was designed to determine the incidence of recurrent depressive disorder after IFN-α therapy. A total of 156 subjects were identified as having IFN-α-induced depression and achieving full remission after IFN-α therapy. The overall incidence of recurrent depressive disorders among patients with and without IFN-α-induced depression was 56.8 (95% confidence interval (CI), 42.4-76.1) and 4.1 (95% CI, 2.9-5.8) cases, respectively, per 100 000 person-years, P<0.001. The adjusted hazard ratios for recurrent depressive disorder were 13.5 (95% CI, 9.9-18.3) in the IFN-α-treated cohort and 22.2 (95% CI, 11.2-44.2) in the matched cohort for IFN-α-induced depression patients after adjusting for age, sex, income, urbanization and comorbid diseases. IFN-α-induced depression was associated with a high risk of recurrent depression. It was not a transient disease and might be considered an episode of depressive disorder. Continuation therapy might be considered, and further research is needed.
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Affiliation(s)
- W-C Chiu
- Department of Psychiatry, Cathay General Hospital, Taipei, Taiwan,School of Medicine, Fu Jen Catholic University, Taipei, Taiwan
| | - Y-P Su
- Department of Psychiatry, Cathay General Hospital, Taipei, Taiwan,School of Medicine, Fu Jen Catholic University, Taipei, Taiwan
| | - K-P Su
- Graduate Institute of Neural and Cognitive Sciences, China Medical University, Taichung, Taiwan,Department of Psychiatry and Mind-Body Interface Laboratory, China Medical University Hospital, Taichung, Taiwan
| | - P-C Chen
- Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University College of Public Health, Taipei, Taiwan,Department of Environmental and Occupational Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan,Department of Public Health, National Taiwan University College of Public Health, Taipei, Taiwan,Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University College of Public Health, 17 Syujhou Road, Taipei 10055, Taiwan. E-mail:
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25
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The significance of microRNAs in the course of rDD. Pharmacol Rep 2016; 69:206-212. [PMID: 28073061 DOI: 10.1016/j.pharep.2016.10.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Revised: 10/10/2016] [Accepted: 10/12/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND In recent years, special attention in genetic studies dedicated to the development of various diseases, including mental disorders, has been paid to micro ribonucleic acids (miRNA, microRNA). As an object of our analysis we have selected the miRNAs which - due to the profile of their activity - may be significant in the aetiology and course of recurrent depressive disorders, i.e. miRNA-370, miRNA-411, miRNA-433, miRNA-487b and miRNA-539. METHODS The examined population included 138 patients suffering from depression and 95 individuals from the control group (CG). The subjects suffering from depression were divided into two sub-groups: ED-I group (46 patients), rDD group (92 patients). RESULTS No significant statistical differences were observed between the ED-I and rDD group for all the variables included in the analysis. No significant interrelation was noticed between the number of depression episodes, the severity of depressive disorders and the expression of miRNA selected. Results of the analysis indicate statistically significant differences between the control subjects and the patients with symptoms of depression in terms of all the variables analysed. CONCLUSIONS 1. There is no significant difference in miRNAs expression between patients with recurrent depressive disorders and those in the first episode of depression. 2. The differences in terms of expression of the analysed variables between the subjects with symptoms of depression and healthy individuals were confirmed.
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26
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Li Q, Xiao Y, Li Y, Li L, Lu N, Xu Z, Mou X, Mao S, Wang W, Yuan Y. Altered regional brain function in the treatment-naive patients with somatic symptom disorder: a resting-state fMRI study. Brain Behav 2016; 6:e00521. [PMID: 27781136 PMCID: PMC5064334 DOI: 10.1002/brb3.521] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 05/14/2016] [Accepted: 05/24/2016] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Somatic symptom disorder (SSD) is an illness that occurs over a long time and results in significant disruption in daily life. Clinically, SSD patients typically express complaints that involve a variety of organ systems. However, the neural mechanism of SSD remains poorly understood. METHODS Using resting-state functional magnetic resonance imaging, we investigated the characteristics of the regional basal brain function during resting state in patients with SSD. Eleven treatment-naïve SSD patients and 12 age-matched healthy controls were recruited in this study. Between-group differences in regional homogeneity values were analyzed. RESULTS Compared with the healthy control group, the SSD group showed significant increases in regional homogeneity values in the right medial prefrontal cortex, anterior cingulate cortex and supramarginal gyrus, and significant decreases in the bilateral middle occipital gyrus, superior occipital gyrus and right cuneus and left postcentral gyrus and cerebellum. Meanwhile, the regional homogeneity value of the right medial prefrontal cortex positively correlated with the total duration of SSD. CONCLUSIONS The abnormal resting-state patterns in regional brain activity may contribute to understanding the mechanism of SSD.
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Affiliation(s)
- Qiang Li
- Department of Radiology Tangdu Hospital the Fourth Military Medical University Xi'an China
| | - Yong Xiao
- Department of Neurosurgery Fuzhou General Hospital Xiamen University Fuzhou China
| | - Yinghui Li
- Department of Psychosomatics and Psychiatry Affiliated Zhongda Hospital Medical School of Southeast University Nanjing China
| | - Lei Li
- Department of Psychosomatics and Psychiatry Affiliated Zhongda Hospital Medical School of Southeast University Nanjing China
| | - Na Lu
- Department of Psychosomatics and Psychiatry Affiliated Zhongda Hospital Medical School of Southeast University Nanjing China
| | - Zhi Xu
- Department of Psychosomatics and Psychiatry Affiliated Zhongda Hospital Medical School of Southeast University Nanjing China
| | - Xiaodong Mou
- Department of Psychosomatics and Psychiatry Affiliated Zhongda Hospital Medical School of Southeast University Nanjing China
| | - Shenqin Mao
- Department of Psychosomatics and Psychiatry Affiliated Zhongda Hospital Medical School of Southeast University Nanjing China
| | - Wei Wang
- Department of Radiology Tangdu Hospital the Fourth Military Medical University Xi'an China
| | - Yonggui Yuan
- Department of Psychosomatics and Psychiatry Affiliated Zhongda Hospital Medical School of Southeast University Nanjing China
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