April Research Update: Major Depressive Disorder

Relapse in MDD is associated with morphologic changes in brain regions that are crucial for regulation of emotions and cognitive control.

A study included 37 patients, mean age 37 years, with MDD who had relapsed, and 23 patients, mean age 32.5 years, with MDD without relapse, and 54 age- and sex-matched healthy controls. The patients were examined using whole-brain and region-of-interest changes in gray matter volume and cortical thickness over two years.

The analyses noted decreases in gray matter volume in the right insula and dorsolateral prefrontal cortex in relapsing patients, but not in non-relapsing patients or healthy controls.

Clinical Implications for Study 1: “Relapse is associated with brain structures that are crucial for regulation of emotions and thus needs to be prevented. This study might be a step to guide future prognosis and maintenance treatment in patients with recurrent MDD,” stated the researchers, led by Dario Zaremba, MSc, of the University of Münster in Münster, Germany.

Source. Zaremba D, et al. Association of Brain Cortical Changes With Relapse in Patients With Major Depressive Disorder. JAMA Psychiatry. March 28, 2018. doi:10.1001/jamapsychiatry.2018.0123.

Ceasing regular exercise increases depressive symptoms in healthy adults, more so in women than men. A literature review found six studies of 152 adults who exercised for at least 30 minutes, three times a week, for a minimum of three months.

In some cases, ceasing this amount of exercise induced significant increases in depressive symptoms after just three days. Other studies showed that depressive symptoms increased after the first one or two weeks. Female participants had significantly more depressive symptoms after stopping exercise than male participants.

Clinical Implications for Study 2: “For now, it is important that people understand the potential impact on their mental well-being when they suddenly cease regular exercise,” said senior author Bernhard Baune, MD, Head of Psychiatry at the University of Adelaide. He noted the depressive symptoms arising from stopping exercise occurred in the absence of the typical biological markers commonly involved with depressive symptoms. “This suggests some kind of novel effect in these cases, although we should add some caution here, as the number of people included in the studies we examined was small. Such findings would need to be replicated in additional trials,” said Baune.

Source: Morgan JA et al. Does ceasing exercise induce depressive symptoms? A systematic review of experimental trials including immunological and neurogenic markers. J Affect Disord. 2018;234:180-192.

Levels of interleukin-6 (IL-6) and C-reactive protein (CRP) may be useful in identifying treatment-resistant depressed patients most likely to benefit from ECT treatment.

A study included 29 patients who had a current MDD episode and were scheduled to undergo ECT. Their levels of IL-6, CRP, IL-8, and tumor necrosis factor-α and severity of depressive symptoms were prospectively evaluated before ECT treatment, after the second ECT session, and again at the completion of the index treatment series.

In multivariate analyses, higher levels of IL-6 at baseline, but not other inflammatory markers or clinical variables, were associated with lower end-of-treatment depression rating scores. When stratified by sex, IL-6 remained a significant predictor of end-of-treatment depression for women, but not for men, and CRP emerged as a significant predictor for women, but not men.

Clinical Implications for Study 3: “Assessment of pretreatment inflammatory biomarkers, especially in women, might be useful in guiding treatment decision-making in treatment-resistant depression,” stated the researchers, led by Jennifer L. Kruse, MD of the Cousins Center for Psychoneuroimmunology at the University of California Los Angeles.

Source: Kruse JL, et al. Inflammation and Improvement of Depression Following Electroconvulsive Therapy in Treatment-Resistant Depression. J Clin Psychiatry. 2018;79:17m11597, 10.4088/JCP.17m11597 http://www.psychiatrist.com/JCP/article/Pages/2018/v79n02/17m11597.aspx