Good news! How many subtypes are there? It sure is depressive not to have better treatment options available!
"For the first time, scientists have identified a new subtype of depression that involves more pronounced cognitive dysregulation, with current treatment missing the mark on helping relieve these symptoms. ...
Commonly, selective serotonin reuptake inhibitors (SSRIs) are prescribed, but they are less effective for helping cognitive dysfunction. ...
Commonly, selective serotonin reuptake inhibitors (SSRIs) are prescribed, but they are less effective for helping cognitive dysfunction. ...
After the eight weeks, the team found that 27% of participants had more significant cognitive impairment and reduced activity in specific frontal brain areas – namely, the dorsolateral prefrontal cortex and dorsal anterior cingulate regions. They also showed the least improvement from the SSRIs.
“This study is crucial because psychiatrists have few measurement tools for depression to help make treatment decisions,” ...
further studies on those with this cognitive biotype, using different treatments such as transcranial magnetic stimulation (TMS) and cognitive behavioral therapy (CBT), as well as other medications like guanfacine, which is more commonly associated with attention deficit hyperactivity disorder (ADHD).
Not surprisingly, these same brain regions identified in the study are also the areas impacted by ADHD and the poor executive function associated with it. ..."
further studies on those with this cognitive biotype, using different treatments such as transcranial magnetic stimulation (TMS) and cognitive behavioral therapy (CBT), as well as other medications like guanfacine, which is more commonly associated with attention deficit hyperactivity disorder (ADHD).
Not surprisingly, these same brain regions identified in the study are also the areas impacted by ADHD and the poor executive function associated with it. ..."
From the key points and abstract:
"Key Points
... Findings In this secondary analysis of a randomized clinical trial in 1008 patients with major depression, 27% exhibited pretreatment global cognitive impairment and significantly decreased brain response to a cognitive task as well as worse response to standard pharmacotherapy, defining what may be categorized as a cognitive biotype. Changes in cognitive symptoms over the course of treatment mediated the association between pretreatment cognitive status and improvement in overall symptoms and psychosocial functioning. ...
Abstract
Importance Cognitive deficits in depression have been associated with poor functional capacity, frontal neural circuit dysfunction, and worse response to conventional antidepressants. However, it is not known whether these impairments combine together to identify a specific cognitive subgroup (or “biotype”) of individuals with major depressive disorder (MDD), and the extent to which these impairments mediate antidepressant outcomes. ...
Design, Setting, and Participants This secondary analysis of a randomized clinical trial implemented data-driven clustering in findings from the International Study to Predict Optimized Treatment in Depression, a pragmatic biomarker trial in which patients with MDD were randomized in a 1:1:1 ratio to antidepressant treatment with escitalopram, sertraline, or venlafaxine extended-release and assessed at baseline and 8 weeks on multimodal outcomes between December 1, 2008, and September 30, 2013. Eligible patients were medication-free outpatients with nonpsychotic MDD in at least the moderate range, and were recruited from 17 clinical and academic practices; a subset of these patients underwent functional magnetic resonance imaging. This prespecified secondary analysis was performed between June 10, 2022, and April 21, 2023.
Design, Setting, and Participants This secondary analysis of a randomized clinical trial implemented data-driven clustering in findings from the International Study to Predict Optimized Treatment in Depression, a pragmatic biomarker trial in which patients with MDD were randomized in a 1:1:1 ratio to antidepressant treatment with escitalopram, sertraline, or venlafaxine extended-release and assessed at baseline and 8 weeks on multimodal outcomes between December 1, 2008, and September 30, 2013. Eligible patients were medication-free outpatients with nonpsychotic MDD in at least the moderate range, and were recruited from 17 clinical and academic practices; a subset of these patients underwent functional magnetic resonance imaging. This prespecified secondary analysis was performed between June 10, 2022, and April 21, 2023.
Main Outcomes and Measures Pretreatment and posttreatment behavioral measures of cognitive performance across 9 domains, depression symptoms assessed using 2 standard depression scales, and psychosocial function assessed using the Social and Occupational Functioning Assessment Scale and World Health Organization Quality of Life scale were analyzed. Neural circuit function engaged during a cognitive control task was measured using functional magnetic resonance imaging.
Results A total of 1008 patients (571 [56.6%] female; mean [SD] age, 37.8 [12.6] years) participated in the overall trial and 96 patients participated in the imaging substudy (45 [46.7%] female; mean [SD] age, 34.5 [13.5] years). Cluster analysis identified what may be referred to as a cognitive biotype of 27% of depressed patients with prominent behavioral impairment in executive function and response inhibition domains of cognitive control. This biotype was characterized by a specific profile of pretreatment depressive symptoms, worse psychosocial functioning (d = −0.25; 95% CI, −0.39 to −0.11; P < .001), and reduced activation of the cognitive control circuit (right dorsolateral prefrontal cortex: d = −0.78; 95% CI, −1.28 to −0.27; P = .003). Remission was comparatively lower in the cognitive biotype positive subgroup (73 of 188 [38.8%] vs 250 of 524 [47.7%]; P = .04) and cognitive impairments persisted regardless of symptom change (executive function: ηp2 = 0.241; P < .001; response inhibition: ηp2 = 0.750; P < .001). The extent of symptom and functional change was specifically mediated by change in cognition but not the reverse.
Conclusions and Relevance Our findings suggest the presence of a cognitive biotype of depression with distinct neural correlates, and a functional clinical profile that responds poorly to standard antidepressants and instead may benefit from therapies specifically targeting cognitive dysfunction."
Stanford Medicine-led research identifies a subtype of depression Using surveys, cognitive tests and brain imaging, researchers have identified a type of depression that affects about a quarter of patients. The goal is to diagnose and treat the condition more precisely.
A Cognitive Biotype of Depression and Symptoms, Behavior Measures, Neural Circuits, and Differential Treatment Outcomes A Prespecified Secondary Analysis of a Randomized Clinical Trial (open access)
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