Advances in digital psychiatry: Towards an extended definition of major depressive disorder symptomatology (Preprint)

2021 ◽  
Author(s):  
Nayra Anna Martin-Key ◽  
Dan-Mircea Mirea ◽  
Tony Olmert ◽  
Jason Cooper ◽  
Sung Yeon Sarah Han ◽  
...  
Keyword(s):  
Major Depressive Disorder ◽  
Depressive Disorder ◽  
Clinical Decision Making ◽  
Clinical Symptoms ◽  
Model Performance ◽  
Emotional Instability ◽  
Major Depressive ◽  
Digital Assessment ◽  
Wide Range ◽  
Definition Of

BACKGROUND Diagnosing major depressive disorder (MDD) is challenging, with diagnostic manuals failing to capture the wide range of clinical symptoms that are endorsed by individuals with the condition. OBJECTIVE The aim of this study was to provide evidence for an extended definition of MDD symptomatology. METHODS Symptom data were collected via a digital assessment that was developed for the Delta Study [1]. Random forest classification with nested cross-validation was used to distinguish between individuals with MDD and those with subthreshold symptomatology of the disorder using i) disorder-specific symptoms and ii) transdiagnostic symptoms. The diagnostic performance of the Patient Health Questionnaire-9 (PHQ-9) was also examined. RESULTS A depression-specific model demonstrated good predictive performance when distinguishing between individuals with MDD (n = 64) and those with subthreshold depression (n = 140) (AUC = .89; sensitivity = 82.4%; specificity = 81.3%; accuracy = 81.6%). The inclusion of transdiagnostic symptoms of psychopathology, including symptoms of depression, generalized anxiety disorder, insomnia, emotional instability, and panic disorder, improved the model performance (AUC = .95; sensitivity = 86.5%; specificity = 90.8%; accuracy = 89.5%). The PHQ-9 was excellent at identifying MDD but over diagnosed the condition (sensitivity = 92.2%; specificity = 54.3%; accuracy = 66.2%). CONCLUSIONS Our findings are in line with the notion that current diagnostic practices may present an overly narrow conception of mental health. Further, our study provides proof-of-concept support for the clinical utility of a digital assessment to inform clinical decision-making in the evaluation of MDD.

scholarly journals Efficacy of levomilnacipran extended-release in major depressive disorder: pooled analysis of 5 double-blind, placebo-controlled trials

CNS Spectrums ◽  
2014 ◽  
Vol 20 (2) ◽  
pp. 148-156 ◽  
Author(s):  
Stuart A. Montgomery ◽  
Carl P. Gommoll ◽  
Changzheng Chen ◽  
William M. Greenberg
Keyword(s):  
Major Depressive Disorder ◽  
Depressive Disorder ◽  
Extended Release ◽  
Rating Scale ◽  
Pooled Analysis ◽  
Major Depressive ◽  
Double Blind ◽  
Madrs Score ◽  
Wide Range ◽  
Remission Rates

Introduction/ObjectivePost hoc analyses were conducted to evaluate the efficacy of levomilnacipran extended-release (ER) in subgroups of patients with major depressive disorder (MDD).MethodsData were pooled from 5 completed Phase II/III studies. Patients were categorized by sex, age, MDD duration, recurrence of MDD, current episode duration, number of prior episodes, and baseline Montgomery–Åsberg Depression Rating Scale (MADRS) score. Efficacy was evaluated by MADRS least squares (LS) mean change from baseline, response (MADRS improvement ≥50%), and remission (MADRS ≤10).ResultsIn the pooled population, treatment with levomilnacipran ER versus placebo resulted in greater improvement in MADRS score (−15.8 versus −12.9; LS mean difference, −2.9; P < .001) and higher response rates (44.7% versus 34.5%; P < .001). Comparable treatment effects were found in most subgroups. Remission rates in the overall population were higher for levomilnacipran ER versus placebo (27.7% versus 21.5%; P < .05); notably high remission rates were seen in patients with baseline MADRS score < 30 (48.8% versus 28.9%; P < .001).DiscussionClinically meaningful improvements in depressive symptoms were found across subgroups, including statistically significant outcomes for both response and remission.ConclusionLevomilnacipran ER was efficacious across a wide range of MDD patients, including men and women, ages 18–78, with varying histories and symptom severity.

scholarly journals Augmentation Strategies for Patients with Major Depressive Disorder with an Inadequate Response to Antidepressant Monotherapy

2014 ◽  
Vol 60 (2) ◽  
pp. 61-66
Author(s):  
Th Moica ◽  
I Gabos Grecu ◽  
Marieta Gabos Grecu ◽  
Melinda Ferencz ◽  
Elena Gabriela Buicu ◽  
...  
Keyword(s):  
Major Depressive Disorder ◽  
Depressive Disorder ◽  
Depressive Episode ◽  
Physical Symptoms ◽  
Inadequate Response ◽  
Recurrent Depression ◽  
Major Depressive ◽  
Incomplete Response ◽  
Augmentation Strategies ◽  
Wide Range

Abstract Introduction: Major depressive disorder is a chronic and debilitating disease characterized by a wide range of emotional and physical symptoms that coexist during a depressive episode and may reoccur at some point during the progression of the disease for the majority of patients. The purpose of the study was to investigate psychiatrists’ experience regarding the response to antidepressive treatment and their options regarding augmentation strategies in depression with incomplete response to antidepressant monotherapy. Method: We applied an 18-item questionnaire containing multiple choice questions to adult psychiatrists working in ambulatories, hospitals or mental health centers. Results: Fourty-two psychiatrists have agreed to answer the questionnaire. The majority of them were psychiatry specialists, between 35 and 49 years of age, working in an outpatient unit. For the majority of doctors, SSRIs (Serotonin Reuptake Inhibitors) proved to be the first line treatment both for the first depressive episode and for recurrent depression, followed by SNRI (Serotonin and Noradrenalin Reuptake Inhibitors). Regarding the duration of maintenance treatment for the patients who achieved complete remission after the first episode of depression, the results showed a wide spectrum from 4 to 9 months. Conclusions: Incomplete response to antidepressive monotherapy is very frequent both for the first depressive episode and for recurrent depression. Given the pharmacological profile that some atypical antipsychotic have, augmentation with atypical antipsychotics in patients with inadequate response to antidepressant monotherapy is a useful therapeutic strategy that should be considered.

A joint study of whole exome sequencing and structural MRI analysis in major depressive disorder

2019 ◽  
Vol 50 (3) ◽  
pp. 384-395 ◽  
Author(s):  
Yamin Zhang ◽  
Mingli Li ◽  
Qiang Wang ◽  
Jacob Shujui Hsu ◽  
Wei Deng ◽  
...  
Keyword(s):  
Major Depressive Disorder ◽  
Depressive Disorder ◽  
Rare Variants ◽  
Clinical Symptoms ◽  
Gray Matter Volume ◽  
Structural Mri ◽  
Genetic Component ◽  
Major Depressive ◽  
Genetic Components ◽  
Burden Test

AbstractBackgroundMajor depressive disorder (MDD) is a leading cause of disability worldwide and influenced by both environmental and genetic factors. Genetic studies of MDD have focused on common variants and have been constrained by the heterogeneity of clinical symptoms.MethodsWe sequenced the exome of 77 cases and 245 controls of Han Chinese ancestry and scanned their brain. Burden tests of rare variants were performed first to explore the association between genes/pathways and MDD. Secondly, parallel Independent Component Analysis was conducted to investigate genetic underpinnings of gray matter volume (GMV) changes of MDD.ResultsTwo genes (CSMD1, p = 5.32×10−6; CNTNAP5, p = 1.32×10−6) and one pathway (Neuroactive Ligand Receptor Interactive, p = 1.29×10−5) achieved significance in burden test. In addition, we identified one pair of imaging-genetic components of significant correlation (r = 0.38, p = 9.92×10−6). The imaging component reflected decreased GMV in cases and correlated with intelligence quotient (IQ). IQ mediated the effects of GMV on MDD. The genetic component enriched in two gene sets, namely Singling by G-protein coupled receptors [false discovery rate (FDR) q = 3.23×10−4) and Alzheimer Disease Up (FDR q = 6.12×10−4).ConclusionsBoth rare variants analysis and imaging–genetic analysis found evidence corresponding with the neuroinflammation and synaptic plasticity hypotheses of MDD. The mediation of IQ indicates that genetic component may act on MDD through GMV alteration and cognitive impairment.

scholarly journals Indices of Change, Expectations, and Popularity of Biological Treatments for Major Depressive Disorder between 1988 and 2017: A Scientometric Analysis

2019 ◽  
Vol 16 (13) ◽  
pp. 2255 ◽  
Author(s):  
Bach X. Tran ◽  
Giang H. Ha ◽  
Giang T. Vu ◽  
Long H. Nguyen ◽  
Carl A. Latkin ◽  
...  
Keyword(s):  
Major Depressive Disorder ◽  
Depressive Disorder ◽  
Repetitive Transcranial Magnetic Stimulation ◽  
Grey Literature ◽  
Scientometric Analysis ◽  
Major Depressive ◽  
Wide Range ◽  
Biological Treatments ◽  
Meta Analyses ◽  
Positive Index

Background. Major Depressive Disorder (MDD) is the most common psychiatric disorder with high prevalence and disease burden. Biological treatments of MDD over the last several decades include a wide range of antidepressants and neurostimulation therapies. While recent meta-analyses have explored the efficacy and tolerability of antidepressants, the changing trends of biological treatments have not been evaluated. Our study measured the indices of change, expectations, and popularity of biological treatments of MDD between 1988 and 2017. Methods. We performed a scientometric analysis to identify all relevant publications related to biological treatments of MDD from 1988 to 2017. We searched the Web of Science websites for publications from 1 January 1988 to 31 December 2017. We included publications of fluoxetine, paroxetine, citalopram, sertraline, amitriptyline, fluvoxamine, escitalopram, venlafaxine, duloxetine, milnacipran, desvenlafaxine, levomilnacipran, clomipramine, nortriptyline, bupropion, trazodone, nefazodone, mirtazapine, agomelatine, vortioxetine, vilazodone, electroconvulsive therapy (ECT), repetitive transcranial magnetic stimulation (rTMS), vagus nerve stimulation (VNS), deep brain stimulation (DBS), and transcranial direct current stimulation (tDCS). We excluded grey literature, conference proceedings, books/book chapters, and publications with low quality as well as publications not related to medicine or human health. The primary outcomes assessed were indices of change, expectations, and popularity. Results. Of 489,496 publications identified, we included 355,116 publications in this scientometric analysis. For the index of change, fluoxetine, sertraline and ECT demonstrated a positive index of change in 6 consecutive periods. Other neurostimulation therapies including rTMS, VNS, DBS and tDCS had shown a positive index of change since 1998. We calculated the index of change of popularity index (PI), which indicates that from 2013 to 2017, the number of publications on tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs) were reduced by 85.0% and 81.3% respectively, as compared with the period 2008–2012. For the index of expectation, fluoxetine and ECT showed the highest index of expectations in six consecutive periods and remained the highest in 2013–2017. For popularity, the three antidepressants with highest PI were fluoxetine (4.01), paroxetine (2.09), and sertraline (1.66); the three antidepressants with lowest PI were desvenlafaxine (0.08), vilazodone (0.04) and levomilnacipran (0.03). Among neurostimulation therapies, ECT has the highest PI (2.55), and tDCS the lowest PI (0.14). The PI of SSRI remained the highest among all biological treatments of MDD in 2013–2017. In contrast, the PI of ECT was reduced by approximately 50% during the period 2008 to2012 than that in the period 2013 to 2017. Conclusions. This scientometric analysis represents comprehensive evidence on the popularity and change in prospects of biological treatments for MDD from 1988 to 2017. The popularity of SSRI peaked between 1998 and 2002, when their efficacy, tolerability and safety profile allowed them to replace the TCAs and MAOIs. While the newer neurostimulation therapies are gaining momentum, the popularity of ECT has sustained.

A simpler definition of major depressive disorder

2009 ◽  
Vol 40 (3) ◽  
pp. 451-457 ◽  
Author(s):  
M. Zimmerman ◽  
J. N. Galione ◽  
I. Chelminski ◽  
J. B. McGlinchey ◽  
D. Young ◽  
...  
Keyword(s):  
Major Depressive Disorder ◽  
Depressive Disorder ◽  
Somatic Symptoms ◽  
Structured Interview ◽  
Major Depressive ◽  
Medically Ill ◽  
Treatment Providers ◽  
Dsm Iv ◽  
Definition Of ◽  
High Level

BackgroundThe DSM-IV symptom criteria for major depressive disorder (MDD) are somewhat lengthy, with many studies showing that treatment providers have difficulty recalling all nine symptoms. Moreover, the criteria include somatic symptoms that are difficult to apply in patients with medical illnesses. In a previous report, we developed a briefer definition of MDD that was composed of the mood and cognitive symptoms of the DSM-IV criteria, and found high levels of agreement between the simplified and full DSM-IV definitions. The goal of the present study was to replicate these findings in another large sample of psychiatric out-patients and to extend the findings to other patient samples.MethodWe interviewed 1100 psychiatric out-patients and 210 pathological gamblers presenting for treatment and 1200 candidates for bariatric surgery. All patients were interviewed by a diagnostic rater who administered a semi-structured interview. We inquired about all symptoms of depression for all patients.ResultsIn all three samples high levels of agreement were found between the DSM-IV and the simpler definition of MDD. Summing across all 2510 patients, the level of agreement between the two definitions was 95.5% and the κ coefficient was 0.87.ConclusionsAfter eliminating the four somatic criteria from the DSM-IV definition of MDD, a high level of concordance was found between this simpler definition and the original DSM-IV classification. This new definition offers two advantages over the current DSM-IV definition – it is briefer and it is easier to apply with medically ill patients because it is free of somatic symptoms.

Validity of a simpler definition of major depressive disorder

2010 ◽  
Vol 27 (10) ◽  
pp. 977-981 ◽  
Author(s):  
Mark Zimmerman ◽  
Janine N. Galione ◽  
Iwona Chelminski ◽  
Diane Young ◽  
Kristy Dalrymple ◽  
...  
Keyword(s):  
Major Depressive Disorder ◽  
Depressive Disorder ◽  
Major Depressive ◽  
Definition Of

scholarly journals A Framework for Recruiting into a Remote Measurement Technologies (RMTs) study: Experiences from a major depressive disorder cohort

2021 ◽  
Author(s):  
Carolin Oetzmann ◽  
Katie White ◽  
Alina Ivan ◽  
Jessica Julie ◽  
Daniel Leightley ◽  
...  
Keyword(s):  
Major Depressive Disorder ◽  
Depressive Disorder ◽  
Large Scale ◽  
Healthcare Research ◽  
Remote Measurement ◽  
Major Depressive ◽  
Successful Recruitment ◽  
Wide Range ◽  
The Uk ◽  
Common Barriers

The use of remote measurement technologies (RMTs) across mobile health (mHealth) studies is becoming increasingly popular, given their potential for high-frequency symptom monitoring outside of routine clinical appointments. However, many RMT studies fail to report on engagement and recruitment statistics, with the few who do citing a wide range of recruitment rates. There is a need for the standardisation of best practices for successful recruitment into RMT research, critical for both research validity and reproducibility. The current paper aims to create a framework for successful recruitment into RMT studies, reflecting on the experience of RADAR-MDD, a large-scale, multi-site prospective cohort study utilising RMT to explore the clinical course of people with major depressive disorder across the UK, Netherlands, and Spain. More specifically, the paper assesses four key strategies for successful recruitment, alongside a review of the common barriers to participation and how to avoid them. Finally, the strategies and barriers outlined are combined into a single model of recruitment, that can be used as a framework to inform future study design and evaluation. Such a model will be applicable to a variety of stakeholders using RMT in healthcare research and practice.

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