Investigating depression diagnosis and treatment

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Depression is a common yet serious condition in children and adults with and without disabilities. In one study, a psychiatrist/neuroscientist explores an innovative diagnostic approach. In another study, a psychologist and colleagues investigate effectiveness of combining cognitive therapy with antidepressant medicine.

Skin biopsy to diagnose depression?*

Author: Dikshya Bastakoty

Sensitive and specific peripheral biomarkers for major depressive disorders–derived from organs outside of the central nervous system–could help non-invasively diagnose and monitor progression of these disorders.

Karoly Mirnics, M.D., Ph.D., and colleagues investigated whether dermal fibroblasts obtained from skin biopsy can be used as peripheral biomarkers for depression. Mirnics is James G. Blakemore Chair and vice chair for Basic Science Research in Psychiatry and associate director of the Vanderbilt Kennedy Center (VKC).

The investigators reported in the journal Biological Psychiatry that gene expression patterns in cultured dermal fibroblasts from patients with major depressive disorder differed significantly from healthy controls.

The researchers found parallel changes in expression of both messenger RNAs (mRNAs), which code for proteins, and micro-RNAs, which alter mRNA expression. These changes occurred in pathways affecting cell-to-cell communication, innate and adaptive immunity, and cell proliferation signals. These observations support previous studies conducted with patient autopsy specimens.

The findings support the notion that major depressive disorder affects cells outside the brain, and suggest potential for developing effective and easy-to-use peripheral biomarkers, the researchers concluded.

The study was supported in part by National Institutes of Health grants MH067234, MH079299, MH001741, MH052339 and MH073630.*

Combined drugs and therapy most effective for severe nonchronic depression**

Author: David Salisbury

The odds that a person who experiences from severe, nonchronic depression will recover are improved by as much as 30 percent if they are treated with a combination of cognitive therapy and antidepressant medicine rather than by antidepressants alone. However, a person with chronic or less severe depression does not receive the same additional benefit from combining the two.

That is the result of a major new clinical trial published online by the journal JAMA Psychiatry on Aug. 20.

In North America, about 1 in 5 women and 1 in 10 men suffer from major depression in her or his lifetime.

“Our results indicate that combining cognitive therapy with antidepressant medicine can make a much bigger difference than we had thought to about one-third of patients suffering from major depressive disorder,” said Steven Hollon, the Gertrude Conaway Professor of Psychology and VKC member, who directed the study. “On the other hand, it does not appear to provide any additional benefit for the other two-thirds.”

Previous studies have found that about two-thirds of all patients with major depressive disorder will improve on antidepressant medications and about one-third of patients will achieve full remission, but half then relapse before fully recovering. Cognitive therapy has proven to be about as effective as medication alone but its effects tend to be longer lasting. Combining the two has been estimated to improve recovery rates by 6 to 33 percent.

“Now, we have to reconsider our general rule of thumb that combining the two treatments keeps the benefits of both,” said Hollon.

The new study was a randomized clinical trial involving 452 adult outpatients with chronic or recurrent major depressive disorder. Unlike previous studies that followed subjects for a set period of time, this study treated them for as long as it took first to remission (full normalization of symptoms) and then to recovery (6 months without relapse), which in some cases took as long as 3 years.

“This provided us with enough data so that we could drill down and see how the combined treatment was working for patients with different types and severity of depression: chronic, recurrent, severe, and moderate,” Hollon said.

According to Hollon, the results could have a major impact on how major depressive disorder is treated. The most immediate effect is likely to be in the United Kingdom, which, he said, is 10 years ahead of the United States in treatment of depression. The use of combined cognitive therapy and antidepressive medicine is standard for severe cases in the UK, and the English National Health Service is actively training its therapists in cognitive therapy and other empirically supported psychotherapies.

Collaborators in the study were Robert DeRubeis and Jay Amsterdam, University of Pennsylvania;Jan Fawcett, University of New Mexico, Albuquerque; Richard Shelton, University of Alabama, Birmingham; John Zajecka and Paula Young, Rush University; and Robert Gallop, West Chester University.

The study was supported by grants MH60713, MH01697, MH60998 and MH060768 from the National Institute of Mental Health.**

*Reprinted from ResearchNews@Vanderbilt, Aug. 29, 2014

**Reprinted from ResearchNews@Vanderbilt, Aug. 20, 2014

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