Abstract
Side effects to antidepressant medications are common and can impact the prognosis of successful treatment outcome in people with major depressive disorder (MDD). However, few studies have ...investigated the severity of side effects over the course of treatment and their association with treatment outcome. Here we assessed the severity of side effects and the impact of treatment type and anxiety symptoms over the course of treatment, as well as whether side effects were associated with treatment outcome. Participants were
N
= 1008 adults with a current diagnosis of single-episode or recurrent, nonpsychotic MDD. Participants were randomised to receive escitalopram, sertraline, or venlafaxine-extended release with equal probability and reassessed at 8 weeks regarding Hamilton Rating Scale Depression (HRSD
17
) and Quick Inventory of Depressive Symptomatology (QIDS-SR
16
) remission and response. Severity of side effects were assessed using the Frequency, Intensity, and Burden of Side Effects Rating (FIBSER) scale and assessed at day 4 and weeks 2, 4, 6, and 8. Frequency, intensity, and burden of side effects were greatest at week 2, then only frequency and intensity of side effects gradually decreased up to week 6. Treatment type and anxiety symptoms did not impact the severity of side effects. A greater burden—but not frequency or intensity—of side effects was associated with poorer treatment outcome and as early as 4 days post-treatment. Together, this work provides an informative mapping of the progression of side effects throughout the treatment course and their association with treatment outcome. Importantly, the burden of side effects that are present as early as 4 days post-treatment predicts poorer treatment outcome and should be monitored closely. iSPOT-D: Registry name: ClinicalTrials.gov. Registration number: NCT00693849.
The INTEGRATE Model draws on the framework of ‘integrative neuroscience’ to bring together brain–body and behavioral concepts of emotion, thinking and feeling and their regulation. The key organizing ...principle is the drive to ‘minimize danger and maximize reward’ that determines what is significant to us at each point in time. Traits of ‘negativity bias’ reflect the tendency to perceive danger rather than reward related information, and this bias influences emotion, thinking and feeling processes.
Here, we examined a self-report measure of Negativity Bias in relation to its impact on brain and body correlates of emotion processing. The contributions of the serotonin transporter (5-HTT-LPR) allelic variants and early life stress to both negativity bias and these correlates were also examined. Data were accessed in collaboration with the Brain Resource International Database (BRID) which provides standardized data across these domains of measurement.
From an initial sample of 303 nonclinical subjects from the BRID, subjects scoring one standard deviation below (n=55) and above (n=47) the mean on the measure of negativity bias were identified as ‘Negativity Bias’ and ‘Positivity Bias’ groups for analysis, respectively. These subjects had been genotyped for 5-HTT-LPR Short allele versus LL homozygote status, and completed the early life stress scale, and recording of startle responses and heart rate for conscious and nonconscious fear conditions. A matched subset (n=39) of BRID subjects completed functional MRI with the same facial emotion tasks.
The Negativity Bias (compared to Positivity Bias) group was distinguished by both arousal and brain function correlates: higher startle amplitude, higher heart rate for conscious and nonconscious fear conditions, and heightened activation in neural circuitry for both fear conditions. Regions of heightened activation included brainstem and bilateral amygdala, anterior cingulate and ventral and dorsal medial prefrontal cortex (mPFC) for conscious fear, and brainstem and right-sided amygdala, anterior cingulate and ventral, mPFC for nonconscious fear. The 5-HTT-LPR Short allele (versus LL) conferred a similar pattern of arousal and neural activation. For those with the 5-HTT-LPR Short allele, the addition of early life stress contributed to enhanced negativity bias, and to further effects on heart rate and neural activation for nonconscious fear in particular.
These findings suggest that traits of negativity bias impact brain–body arousal correlates of fear circuitry. Both genetic variation and life stressors contribute to the impact of negativity bias. Given that negativity bias is a feature of conditions such as depression and associated biological alterations, the findings have implications for translation into clinical decision support.
Abstract In major depressive disorder (MDD), elevated theta current density in the rostral anterior cingulate (rACC), as estimated by source localization of scalp-recorded electroencenphalogram ...(EEG), has been associated with response to antidepressant treatments, whereas elevated frontal theta has been linked to non-response. This study used source localization to attempt to integrate these apparently opposite results and test, whether antidepressant response is associated with elevated rACC theta and non-response with elevated frontal theta and whether theta activity is a differential predictor of response to different types of commonly used antidepressants. In the international Study to Predict Optimized Treatment in Depression (iSPOT-D), a multi-center, international, randomized, prospective practical trial, 1008 MDD participants were randomized to escitalopram, sertraline or venlafaxine-XR. The study also recruited 336 healthy controls. Treatment response and remission were established after eight weeks using the 17-item Hamilton Rating Scale for Depression (HRSD17 ). The resting-state EEG was assessed at baseline with eyes closed and source localization (eLORETA) was employed to extract theta from the rACC and frontal cortex. Patients with MDD had elevated theta in both frontal cortex and rACC, with small effect sizes. High frontal and rACC theta were associated with treatment non-response, but not with non-remission, and this effect was most pronounced in a subgroup with previous treatment failures. Low theta in frontal cortex and rACC are found in responders to antidepressant treatments with a small effect size. Future studies should investigate in more detail the role of previous treatment (failure) in the association between theta and treatment outcome.
A fundamental impediment to an "Integrative Neuroscience" is the sense that scientists building models at one particular scale often see that scale as the epicentre of all brain function. This ...fragmentation has begun to change in a very distinctive way. Multidisciplinary efforts have provided the impetus to break down the boundaries and encourage a freer exchange of information across disciplines and scales. Despite huge deficits of knowledge, sufficient facts about the brain already exist, for an Integrative Neuroscience to begin to lift us clear of the jungle of detail, and shed light upon the workings of the brain as a system. Integrations of brain theory can be tested using judicious paradigm designs and measurement of temporospatial activity reflected in brain imaging technologies. However, to test realistically these new hypotheses requires consistent findings of the normative variability in very large numbers of control subjects, coupled with high sensitivity and specificity of findings in psychiatric disorders. Most importantly, these findings need to be analyzed and modeled with respect to the fundamental mechanisms underlying these measures. Without this convergence of theory, databases, and methodology (including across scale physiologically realistic numerical models), the clinical utility of brain imaging technologies in psychiatry will be significantly impeded. The examples provided in this paper of integration of theory, temporospatial integration of neuroimaging technologies, and a numerical simulation of brain function, bear testimony to the ongoing conversion of an Integrative Neuroscience from an exemplar status into reality.
Abstract Arousal systems are one of the recently announced NIMH Research Domain Criteria to inform future diagnostics and treatment prediction. In major depressive disorder (MDD), altered central ...nervous system (CNS) wakefulness regulation and an increased sympathetic autonomic nervous system (ANS) activity have been identified as biomarkers with possible discriminative value for prediction of antidepressant treatment response. Therefore, the hypothesis of a more pronounced decline of CNS and ANS-arousal being predictive for a positive treatment outcome to selective-serotonin-reuptake-inhibitor (SSRI) treatment was derived from a small, independent exploratory dataset (N = 25) and replicated using data from the randomized international Study to Predict Optimized Treatment Response in Depression (iSPOT-D). There, 1008 MDD participants were randomized to either a SSRI (escitalopram or sertraline) or a serotonin-norepinephrine-reuptake-inhibitor (SNRI-venlafaxine) arm. Treatment response was established after eight weeks using the 17-item Hamilton Rating Scale for Depression. CNS-arousal (i.e. electroencephalogram-vigilance), ANS-arousal (heart rate) and their change across time were assessed during rest. Responders and remitters to SSRI treatment were characterized by a faster decline of CNS-arousal during rest whereas SNRI responders showed a significant increase of ANS-arousal. Furthermore, SSRI responders/remitters showed an association between ANS- and CNS-arousal regulation in comparison to non-responders/non-remitters while this was not the case for SNRI treatment arm. Since positive treatment outcome to SSRI and SNRI was linked to distinct CNS and ANS-arousal profiles, these predictive markers probably are not disorder specific alterations but reflect the responsiveness of the nervous system to specific drugs.
We tested the proposal that signals of potential threat are given precedence over positive and neutral signals, reflected in earlier and more pronounced changes in neural activity. The temporal ...sequence (‘when’) and source localization (‘where’) of event-related potentials (ERPs) elicited by fearful and happy facial expressions, compared to neutral control expressions, were examined for 219 healthy subjects. We scored ERPs over occipito-temporal sites (N80, 50–120 ms; P120, 80–180 ms; N170, 120–220 ms; P230, 180–290 ms; N250, 230–350 ms) and their polarity-reversed counterparts over medial sites (P80, 40–120 ms; N120, 80–150 ms; VPP, 120–220 ms; N200, 150–280 ms; P300, 280–450 ms). In addition to scoring peak amplitude and latency, the anatomical sources of activity were determined using low resolution brain electromagnetic tomography (LORETA). Fearful faces were distinguished by persistent increases in positivity, associated with a dynamical shift from temporo-frontal (first 120 ms) to more distributed cortical sources (120–220 ms) and back (220–450 ms). By contrast, expressions of happiness produced a discrete enhancement of negativity, later in the time course (230–350 ms) and localized to the fusiform region of the temporal cortex. In common, fear and happiness modulated the face-related N170, and produced generally greater right hemisphere activity. These findings support the proposal that fear signals are given precedence in the neural processing systems, such that processing of positive signals may be suppressed until vigilance for potential danger is completed. While fear may be processed via parallel pathways (one initiated prior to structural encoding), neural systems supporting positively valenced input may be more localized and rely on structural encoding.
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