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McCarthy MJ, Wei H, Nievergelt CM, Stautland A, Maihofer AX, Welsh DK, Shilling P, Alda M, Alliey-Rodriguez N, Anand A, Andreasson OA, Balaraman Y, Berrettini WH, Bertram H, Brennand KJ, Calabrese JR, Calkin CV, Claasen A, Conroy C, Coryell WH, Craig DW, D’Arcangelo N, Demodena A, Djurovic S, Feeder S, Fisher C, Frazier N, Frye MA, Gage FH, Gao K, Garnham J, Gershon ES, Glazer K, Goes F, Goto T, Harrington G, Jakobsen P, Kamali M, Karberg E, Kelly M, Leckband SG, Lohoff F, McInnis MG, Mondimore F, Morken G, Nurnberger JI, Obral S, Oedegaard KJ, Ortiz A, Ritchey M, Ryan K, Schinagle M, Schoeyen H, Schwebel C, Shaw M, Shekhtman T, Slaney C, Stapp E, Szelinger S, Tarwater B, Zandi PP, Kelsoe JR. Chronotype and cellular circadian rhythms predict the clinical response to lithium maintenance treatment in patients with bipolar disorder. Neuropsychopharmacology 2019; 44:620-628. [PMID: 30487653 PMCID: PMC6333516 DOI: 10.1038/s41386-018-0273-8] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 10/17/2018] [Accepted: 10/24/2018] [Indexed: 12/12/2022]
Abstract
Bipolar disorder (BD) is a serious mood disorder associated with circadian rhythm abnormalities. Risk for BD is genetically encoded and overlaps with systems that maintain circadian rhythms. Lithium is an effective mood stabilizer treatment for BD, but only a minority of patients fully respond to monotherapy. Presently, we hypothesized that lithium-responsive BD patients (Li-R) would show characteristic differences in chronotype and cellular circadian rhythms compared to lithium non-responders (Li-NR). Selecting patients from a prospective, multi-center, clinical trial of lithium monotherapy, we examined morning vs. evening preference (chronotype) as a dimension of circadian rhythm function in 193 Li-R and Li-NR BD patients. From a subset of 59 patient donors, we measured circadian rhythms in skin fibroblasts longitudinally over 5 days using a bioluminescent reporter (Per2-luc). We then estimated circadian rhythm parameters (amplitude, period, phase) and the pharmacological effects of lithium on rhythms in cells from Li-R and Li-NR donors. Compared to Li-NRs, Li-Rs showed a difference in chronotype, with higher levels of morningness. Evening chronotype was associated with increased mood symptoms at baseline, including depression, mania, and insomnia. Cells from Li-Rs were more likely to exhibit a short circadian period, a linear relationship between period and phase, and period shortening effects of lithium. Common genetic variation in the IP3 signaling pathway may account for some of the individual differences in the effects of lithium on cellular rhythms. We conclude that circadian rhythms may influence response to lithium in maintenance treatment of BD.
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Affiliation(s)
- Michael J. McCarthy
- 0000 0001 2107 4242grid.266100.3Department of Psychiatry and Center for Circadian Biology, University of California, San Diego, 3350 La Jolla Village Dr. MC 116A, San Diego, CA 92161 USA ,0000 0004 0419 2708grid.410371.0Psychiatry Service, VA San Diego Healthcare, San Diego, CA 92161 USA
| | - Heather Wei
- 0000 0004 0419 2708grid.410371.0Psychiatry Service, VA San Diego Healthcare, San Diego, CA 92161 USA
| | - Caroline M. Nievergelt
- 0000 0001 2107 4242grid.266100.3Department of Psychiatry and Center for Circadian Biology, University of California, San Diego, 3350 La Jolla Village Dr. MC 116A, San Diego, CA 92161 USA
| | - Andrea Stautland
- 0000 0004 1936 7443grid.7914.bDepartment of Clinical Medicine, Section for Psychiatry, University of Bergen, Bergen, Norway
| | - Adam X. Maihofer
- 0000 0001 2107 4242grid.266100.3Department of Psychiatry and Center for Circadian Biology, University of California, San Diego, 3350 La Jolla Village Dr. MC 116A, San Diego, CA 92161 USA
| | - David K. Welsh
- 0000 0001 2107 4242grid.266100.3Department of Psychiatry and Center for Circadian Biology, University of California, San Diego, 3350 La Jolla Village Dr. MC 116A, San Diego, CA 92161 USA ,0000 0004 0419 2708grid.410371.0Psychiatry Service, VA San Diego Healthcare, San Diego, CA 92161 USA
| | - Paul Shilling
- 0000 0001 2107 4242grid.266100.3Department of Psychiatry and Center for Circadian Biology, University of California, San Diego, 3350 La Jolla Village Dr. MC 116A, San Diego, CA 92161 USA
| | - Martin Alda
- 0000 0004 1936 8200grid.55602.34Department of Psychiatry, Dalhousie University, Halifax, Canada
| | - Ney Alliey-Rodriguez
- 0000 0004 1936 7822grid.170205.1Department of Psychiatry, University of Chicago, Chicago, USA
| | - Amit Anand
- 0000 0001 0790 959Xgrid.411377.7Department of Psychiatry, Indiana University, Bloomington, USA
| | - Ole A. Andreasson
- 0000 0004 1936 8921grid.5510.1Jebsen Centre for Psychosis Research, University of Oslo, Oslo, Norway
| | - Yokesh Balaraman
- 0000 0001 0790 959Xgrid.411377.7Department of Psychiatry, Indiana University, Bloomington, USA
| | - Wade H. Berrettini
- 0000 0004 1936 8972grid.25879.31Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104 USA
| | - Holli Bertram
- 0000000086837370grid.214458.eDepartment of Psychiatry, University of Michigan, Ann Arbor, MI USA
| | - Kristen J. Brennand
- 0000 0001 0670 2351grid.59734.3cDepartments of Neuroscience and Psychiatry, Icahn School of Medicine at Mt Sinai, New York, USA
| | - Joseph R. Calabrese
- 0000 0001 2164 3847grid.67105.35Department of Psychiatry, Case Western Reserve University, Cleveland, OH USA
| | - Cynthia V. Calkin
- 0000 0004 1936 8200grid.55602.34Department of Psychiatry, Dalhousie University, Halifax, Canada
| | - Ana Claasen
- 0000 0004 0507 3225grid.250942.8Neurogenomics Division, Translational Genomics Research Institute, Phoenix, USA
| | - Clara Conroy
- 0000 0001 2164 3847grid.67105.35Department of Psychiatry, Case Western Reserve University, Cleveland, OH USA
| | - William H. Coryell
- 0000 0004 1936 8294grid.214572.7Department of Psychiatry, University of Iowa, Iowa City, USA
| | - David W. Craig
- 0000 0004 0507 3225grid.250942.8Neurogenomics Division, Translational Genomics Research Institute, Phoenix, USA
| | - Nicole D’Arcangelo
- 0000 0001 2164 3847grid.67105.35Department of Psychiatry, Case Western Reserve University, Cleveland, OH USA
| | - Anna Demodena
- 0000 0004 0419 2708grid.410371.0Psychiatry Service, VA San Diego Healthcare, San Diego, CA 92161 USA
| | - Srdjan Djurovic
- 0000 0004 1936 8921grid.5510.1Jebsen Centre for Psychosis Research, University of Oslo, Oslo, Norway
| | - Scott Feeder
- 0000 0004 0459 167Xgrid.66875.3aDepartment of Psychiatry, The Mayo Clinic, Rochester, USA
| | - Carrie Fisher
- 0000 0001 0790 959Xgrid.411377.7Department of Psychiatry, Indiana University, Bloomington, USA
| | - Nicole Frazier
- 0000000086837370grid.214458.eDepartment of Psychiatry, University of Michigan, Ann Arbor, MI USA
| | - Mark A. Frye
- 0000 0004 0459 167Xgrid.66875.3aDepartment of Psychiatry, The Mayo Clinic, Rochester, USA
| | - Fred H. Gage
- 0000 0001 0662 7144grid.250671.7Laboratory of Genetics, Salk Institute for Biological Studies, La Jolla, USA
| | - Keming Gao
- 0000 0001 2164 3847grid.67105.35Department of Psychiatry, Case Western Reserve University, Cleveland, OH USA
| | - Julie Garnham
- 0000 0004 1936 8200grid.55602.34Department of Psychiatry, Dalhousie University, Halifax, Canada
| | - Elliot S. Gershon
- 0000 0004 1936 7822grid.170205.1Department of Psychiatry, University of Chicago, Chicago, USA
| | - Kara Glazer
- 0000 0001 2171 9311grid.21107.35Department of Psychiatry, Johns Hopkins University, Baltimore, USA
| | - Fernando Goes
- 0000 0001 2171 9311grid.21107.35Department of Psychiatry, Johns Hopkins University, Baltimore, USA
| | - Toyomi Goto
- 0000 0001 2164 3847grid.67105.35Department of Psychiatry, Case Western Reserve University, Cleveland, OH USA
| | - Gloria Harrington
- 0000000086837370grid.214458.eDepartment of Psychiatry, University of Michigan, Ann Arbor, MI USA
| | - Petter Jakobsen
- 0000 0000 9753 1393grid.412008.fNorment and KG Jebsen Centre for Neuropsychiatry, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Masoud Kamali
- 0000000086837370grid.214458.eDepartment of Psychiatry, University of Michigan, Ann Arbor, MI USA
| | - Elizabeth Karberg
- 0000 0001 2164 3847grid.67105.35Department of Psychiatry, Case Western Reserve University, Cleveland, OH USA
| | - Marisa Kelly
- 0000000086837370grid.214458.eDepartment of Psychiatry, University of Michigan, Ann Arbor, MI USA
| | - Susan G. Leckband
- 0000 0004 0419 2708grid.410371.0Psychiatry Service, VA San Diego Healthcare, San Diego, CA 92161 USA
| | - Falk Lohoff
- 0000 0004 1936 8972grid.25879.31Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104 USA
| | - Melvin G. McInnis
- 0000000086837370grid.214458.eDepartment of Psychiatry, University of Michigan, Ann Arbor, MI USA
| | - Francis Mondimore
- 0000 0001 2171 9311grid.21107.35Department of Psychiatry, Johns Hopkins University, Baltimore, USA
| | - Gunnar Morken
- 0000 0001 1516 2393grid.5947.fDivision of Psychiatry, St. Olav University Hospital of Trondheim and Department of Mental Health Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - John I. Nurnberger
- 0000 0001 0790 959Xgrid.411377.7Department of Psychiatry, Indiana University, Bloomington, USA
| | - Sarah Obral
- 0000 0001 2164 3847grid.67105.35Department of Psychiatry, Case Western Reserve University, Cleveland, OH USA
| | - Ketil J. Oedegaard
- 0000 0004 1936 7443grid.7914.bDepartment of Clinical Medicine, Section for Psychiatry, University of Bergen, Bergen, Norway ,0000 0000 9753 1393grid.412008.fNorment and KG Jebsen Centre for Neuropsychiatry, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Abigail Ortiz
- 0000 0001 2182 2255grid.28046.38Department of Psychiatry, University of Ottawa, Ottawa, ON Canada
| | - Megan Ritchey
- 0000 0001 2171 9311grid.21107.35Department of Psychiatry, Johns Hopkins University, Baltimore, USA
| | - Kelly Ryan
- 0000000086837370grid.214458.eDepartment of Psychiatry, University of Michigan, Ann Arbor, MI USA
| | - Martha Schinagle
- 0000 0001 2164 3847grid.67105.35Department of Psychiatry, Case Western Reserve University, Cleveland, OH USA
| | - Helle Schoeyen
- 0000 0004 1936 7443grid.7914.bDepartment of Clinical Medicine, Section for Psychiatry, University of Bergen, Bergen, Norway
| | - Candice Schwebel
- 0000 0004 1936 8972grid.25879.31Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104 USA
| | - Martha Shaw
- 0000 0004 1936 7822grid.170205.1Department of Psychiatry, University of Chicago, Chicago, USA
| | - Tatyana Shekhtman
- 0000 0001 2107 4242grid.266100.3Department of Psychiatry and Center for Circadian Biology, University of California, San Diego, 3350 La Jolla Village Dr. MC 116A, San Diego, CA 92161 USA ,0000 0004 0419 2708grid.410371.0Psychiatry Service, VA San Diego Healthcare, San Diego, CA 92161 USA
| | - Claire Slaney
- 0000 0004 1936 8200grid.55602.34Department of Psychiatry, Dalhousie University, Halifax, Canada
| | - Emma Stapp
- 0000 0001 2171 9311grid.21107.35Department of Psychiatry, Johns Hopkins University, Baltimore, USA
| | - Szabolcs Szelinger
- 0000 0004 0507 3225grid.250942.8Neurogenomics Division, Translational Genomics Research Institute, Phoenix, USA
| | - Bruce Tarwater
- 0000 0004 0507 3225grid.250942.8Neurogenomics Division, Translational Genomics Research Institute, Phoenix, USA
| | - Peter P. Zandi
- 0000 0001 2171 9311grid.21107.35Department of Psychiatry, Johns Hopkins University, Baltimore, USA
| | - John R. Kelsoe
- 0000 0001 2107 4242grid.266100.3Department of Psychiatry and Center for Circadian Biology, University of California, San Diego, 3350 La Jolla Village Dr. MC 116A, San Diego, CA 92161 USA ,0000 0004 0419 2708grid.410371.0Psychiatry Service, VA San Diego Healthcare, San Diego, CA 92161 USA
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Kemp DE, Ismail-Beigi F, Ganocy SJ, Conroy C, Gao K, Obral S, Fein E, Findling RL, Calabrese JR. Use of insulin sensitizers for the treatment of major depressive disorder: a pilot study of pioglitazone for major depression accompanied by abdominal obesity. J Affect Disord 2012; 136:1164-73. [PMID: 21782251 PMCID: PMC3225727 DOI: 10.1016/j.jad.2011.06.033] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2011] [Revised: 06/07/2011] [Accepted: 06/23/2011] [Indexed: 12/21/2022]
Abstract
OBJECTIVE This study was conducted to examine the safety and efficacy of pioglitazone, a thiazolidinedione insulin sensitizer, in adult outpatients with major depressive disorder. METHOD In a 12-week, open-label, flexible-dose study, 23 patients with major depressive disorder received pioglitazone monotherapy or adjunctive therapy initiated at 15 mg daily. Subjects were required to meet criteria for abdominal obesity (waist circumference>35 in. in women and >40 in. in men) or metabolic syndrome. The primary efficacy measure was the change from baseline to Week 12 on the Inventory of Depressive Symptomatology (IDS) total score. Partial responders (≥25% decrease in IDS total score) were eligible to participate in an optional extension phase for an additional three months. RESULTS Pioglitazone decreased depression symptom severity from a total IDS score of 40.3±1.8 to 19.2±1.8 at Week 12 (p<.001). Among partial responders (≥25% decrease in IDS total score), an improvement in depressive symptoms was maintained during an additional 3-month extension phase (total duration=24 weeks) according to IDS total scores (p<.001). Patients experienced a reduction in insulin resistance from baseline to Week 12 according to the log homeostasis model assessment (-0.8±0.75; p<.001) and a significant reduction in inflammation as measured by log highly- sensitive C-reactive protein (-0.87±0.72; p<.001). During the current episode, the majority of participants (74%, n=17), had already failed at least one antidepressant trial. The most common side effects were headache and dizziness; no patient discontinued due to side effects. LIMITATIONS These data are limited by a small sample size and an open-label study design with no placebo control. CONCLUSION Although preliminary, pioglitazone appears to reduce depression severity and improve several markers of cardiometabolic risk, including insulin resistance and inflammation. Larger, placebo-controlled studies are indicated.
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Affiliation(s)
- David E. Kemp
- Case Western Reserve University, University Hospitals Case Medical Center, Department of Psychiatry, Cleveland, OH, USA
| | - Faramarz Ismail-Beigi
- University Hospitals Case Medical Center and Cleveland VA Medical Center, Cleveland, OH, USA
| | - Stephen J. Ganocy
- Case Western Reserve University, University Hospitals Case Medical Center, Department of Psychiatry, Cleveland, OH, USA
| | - Carla Conroy
- Case Western Reserve University, University Hospitals Case Medical Center, Department of Psychiatry, Cleveland, OH, USA
| | - Keming Gao
- Case Western Reserve University, University Hospitals Case Medical Center, Department of Psychiatry, Cleveland, OH, USA
| | - Sarah Obral
- Case Western Reserve University, University Hospitals Case Medical Center, Department of Psychiatry, Cleveland, OH, USA
| | - Elizabeth Fein
- Case Western Reserve University, University Hospitals Case Medical Center, Department of Psychiatry, Cleveland, OH, USA
| | - Robert L. Findling
- Case Western Reserve University, University Hospitals Case Medical Center, Department of Psychiatry, Cleveland, OH, USA
| | - Joseph R. Calabrese
- Case Western Reserve University, University Hospitals Case Medical Center, Department of Psychiatry, Cleveland, OH, USA
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