Category Archives: Major depression

Predicting Early Antidepressant Outcomes For Children and Adolescents with MDD Using AI

Mayo Clinic researchers have taken the first step in using artificial intelligence (AI) to predict early outcomes with antidepressants in children and adolescents with major depressive disorder, in a study published in The Journal of Child Psychology and Psychiatry.

In the study, researchers identified variation in six depressive symptoms: difficulty having fun, social withdrawal, excessive fatigue, irritability, low self-esteem and depressed feelings.

They assessed these symptoms with the Children’s Depression Rating Scale-Revised to predict outcomes to 10 to 12 weeks of antidepressant pharmacotherapy:

  • The six symptoms predicted 10- to 12-week outcomes at four to six weeks in fluoxetine testing datasets, with an average accuracy of 73%.
  • The same six symptoms predicted 10- to 12-week outcomes at four to six weeks in duloxetine testing datasets, with an average accuracy of 76%.
  • In placebo-treated patients, predicting response and remission accuracy was significantly lower than for antidepressants at 67%.

According to the researchers, ‘these outcomes show the potential of AI and patient data to ensure children and adolescents receive treatment that has the highest likelihood of delivering therapeutic benefits with minimized side effects. We designed the algorithm to mimic a clinician’s logic of treatment management at an interim time point based on their estimated guess of whether a patient will likely or not benefit from pharmacotherapy at the current dose,” says Dr. Athreya, lead author. “Hence, it was essential for me as a computer engineer to embed and observe the practice closely to not only understand the needs of the patient, but also how AI can be consumed and useful to the clinician to benefit the patient.”

This preliminary work suggests that AI has promise for assisting clinical decisions by informing physicians on the selection, use and dosing of antidepressants for children and adolescents with major depressive disorder,” says Paul Croarkin, D.O., a Mayo Clinic psychiatrist and senior author of the study. “We saw improved predictions of treatment outcomes in samples of children and adolescents across two classes of antidepressants.”

Key points from the study

  • The optimal treatment of depression in children and adolescent is a substantial public health problem.
  • Machine learning and probabilistic graphical models were used to predict treatment outcomes with antidepressants in a training and testing databases.
  • Variation in six depression symptoms predicted outcomes with fluoxetine or duloxetine.
  • Future work should augment probabilistic graphical models with biological data to refine tools to assist decision making in clinical practice.

This work was a collaborative effort between the departments of Molecular Pharmacology and Experimental Therapeutics, and Psychiatry and Psychology, at Mayo Clinic, with support from Mayo Clinic’s Center for Individualized Medicine.

Study:
Athreya AP, Vande Voort JL, Shekunov J, et al. The Journal of Child Psychology and Psychiatry. 15 March 2022

Long-term Risks of Mental Health Outcomes Post-Covid-19

The short-term consequences from COVID-19 have been described after the initial “acute” infection passes. These have included not only a variety of physical symptoms, but also psychiatric symptoms have been reported. A team of VA researches has been shining a light on various dangerous and enduring consequences that can arise following the initial COVID bout. These COVID complications include mental health disorders.

A study published this week in the British Medical Journal (BMJ) by researchers with the VA St. Louis Health Care System focused on mental health disorders following COVID-19 infection.  They found that, even in people not needing hospitalization while infected with COVID-19, serious health issues related to mental health could persist, or pop up, in the weeks and months following the acute stage. They describe that the reasons for the increased mental health risks after COVID are not completely clear. Biologic changes may occur in the body that affect the brain, and nonbiologic changes such as social isolation and trauma may also be at play.

The researchers analyzed medical records in a database within VA, which operates the largest integrated health care system in the United States. The analysis included nearly 154,000 patients who had tested positive for COVID-19 in a defined time frame from March 2020 into January 2021. (The time frame predated the delta and omicron variants, as well as wide availability of vaccines.) A comparison was made of these patients’ health information with data from more than 11 million people who had not had COVID-19 infection—about half of them from the same time frame and the other half from a pre-pandemic timespan.

The research group compared the mental health risks for those who had COVID-19 and survived the first 30 days of infection with the same health outcomes among those who were not infected. Over a study period of about a year, the researchers identified elevated risks for issues such as anxiety, depression, stress disorders, opioid use, substance use disorders, and sleep conditions. 

“We’ve all suffered some sort of distress from this pandemic—maybe a measure of anxiety or difficulty sleeping,” says lead investigator Al-Aly. “But these challenges are magnified, especially in those who were admitted to the hospital during the acute part of their COVID battle but also in many who experienced only mild or moderate symptoms.”

Compared to those who did not have COVID, those in the COVID group had a 60 percent higher risk of having any mental health disorder or mental health-related prescriptions.

Findings by the type of mental health issue were:

  • Anxiety: 35 percent higher risk in the COVID-19 group
  • Depression: 39 percent higher risk
  • Sleep disorder: 41 percent higher risk
  • Opioid use: 76 percent higher risk
  • Opioid use disorder: 34 percent higher risk
  • Non-opioid substance use disorders: 20 percent higher risk.
Hospitalized COVID-19 patients fared the worst. (BMJ 2022)

Given the large number of people with COVID-19, these findings could translate into a huge impact in the United States and around the world, the authors point out. A strength of our research was the large number of patients and the ability to leverage the breadth and depth of the VA’s electronic health records system,” highlights Al-Aly. As a pioneer in the use of electronic health records, VA “can offer answers to questions about areas including the pandemic that would be hard for others to address.”

The researchers were a multidisciplinary research team for making the rigorous analysis possible brought together public health experts from across disciplines, successfully marrying the medical and research perspectives. An Editorial in the BMJ by lead researcher points out that mental health disorders represent one part of the multifaceted nature of long covid which can affect nearly every organ system (including the brain, heart, and kidneys). Our results should be used to promote awareness of this risk among people with covid-19 and to guide efforts for the early identification and treatment of affected individuals.

Research Article: Xie Y, Xu E, Al-Aly Z. Risks of mental health outcomes in people with covid-19: cohort study. BMJ 2022; 376 (Published 16 February 2022)

A Virtual Reality Shopping Environment Could Help Evaluate Cognitive Deficits or Decline in Adults

New research published in the Journal of Medical Internet Research, uses a novel virtual reality shopping task called “VStore” to measure cognition, which asks participants to take part in tests designed to mirror the real world. Researchers hope that it will be able to test for age-related cognitive deficits and future cognitive decline.

In the ‘VStore’, participants “go to the shops” to navigate a shopping scenario as a way of assessing functional cognition, as well as the thinking and processing skills needed to accomplish complex everyday activities. The immersive environment (a virtual shop) mirrored actiities encountered in everyday life and meant that participants were better able to engage brain structures that are associated with spatial navigation, such as the hippocampus and entorhinal cortex, both of which can be affected in the early stages of Alzheimer disease.

The trial recruited 142 healthy individuals aged 20-79 years. Each participant was asked to “go to the shops,” first verbally recalling a list of 12 items, before being assessed for the amount of time it took to collect the items, as well as select the corresponding items on a virtual self-checkout machine, pay, and order coffee.

Cognition tests, such as those used to measure the deficits present in several neuropsychiatric disorders including Alzheimer’s disease, schizophrenia, and depression, are traditionally time-consuming and onerous. Vstore—the technology that the researchers used in this study—is designed to overcome these limitations to provide a more accurate, engaging, and cost-effective process to explore a person’s cognitive health.

Researchers were able to establish that Vstore effectively engages a range of key neuropsychological functions simultaneously, suggesting that the functional tasks embedded in virtual reality may engage a greater range of cognitive domains than standard assessments.

Reference:
Lilla Alexandra Porffy, Mitul A. Mehta, Joel Patchitt, Celia Boussebaa, Jack Brett, Teresa D’Oliveira, Elias Mouchlianitis, Sukhi S. Shergill. A Novel Virtual Reality Assessment of Functional Cognition (VStore): Validation Study (Preprint)Journal of Medical Internet Research, 2021; DOI: 10.2196/27641

Social media use shown to be linked to depression in adults

Data shows that individuals over age 35 were mostly likely to be negatively affected by highly visual apps, such as TikTok and Snapchat.

A number of recent studies have focused on adolescents and young adults being negatively affected by frequent use of social media. Symptoms of diminished well-being and greater levels of anxiety and depression were commonly reported. A research question asked if these same symptoms might apply to older consumers of social media.

To investigate this question, data from multiple waves of an ongoing 50-state US survey as used. The surveys, conducted from May 2020 through May 2021, were initially focused on learning more about how adults were coping during the Covid-19 pandemic. Over time, researchers increasingly became interested in whether social media use might be linked to changes in mental health.

The survey initially asked people who were not expressing depressed feelings about their social media use, with subsequent queries to see if the people who were using certain kinds of social media were more likely to be depressed. The research does not prove social media causes depression. Indeed, it is possible that people already prone to feeling sad were more likely to log on to such sites.

Compared to adults who did not use social media, “people who were using Facebook, people who were using TikTok, and people who were using Snapchat were substantially more likely to come back and tell us they felt depressed the next time they filled out the survey,” reported Roy H Perlis, MD, a professor of psychiatry at Harvard Medical School and Massachusetts General Hospital.

The research also found age differences in how certain platforms impacted mental health. Depressive symptoms were more commonly reported among Facebook users under age 35 than older adults. The opposite was true for users of Snapchat and TikTok more depressive symptoms were reported among people over age 35.

The reasons for such findings were unclear. It could be that because Snapchat and TikTok are more visual mediums, perhaps affecting older adults differently. Or it could suggest that a person is out of sync with his or her peers. Perlis said more research is needed to interpret the results appropriately. Ultimately, experts recommend remaining mindful of time spent on social media.

The authors concluded that  “Among survey respondents who did not report depressive symptoms initially, social media use was associated with greater likelihood of subsequent increase in depressive symptoms after adjustment for sociodemographic features and news sources. These data cannot elucidate the nature of this association, but suggest the need for further study to understand how social media use may factor into depression among adults.”

Mitch Prinstein, PhD, chief science officer for the American Psychological Association commenting on this research pointed out that “Our brains were not built for this kind of social interaction. And social media is kind of hijacking the need for social interaction with something very artificial and insufficient,” he said. “Social media is the empty calories of social interaction.”

Sources:

Perils RH, Green J, Simonsson M, et al. Association Between Social Media Use and Self-reported Symptoms of Depression in US Adults. JAMA Netw Open. 2021;4(11):e2136113. doi:10.1001/jamanetworkopen.2021.36113

NBC News

FCC Votes to Allow Texting ‘988’ to Reach the National Suicide Prevention Lifeline Beginning July 2022

On July 16, 2020, the FCC adopted rules to establish 988 as the new, nationwide, easy-to-remember 3-digit phone number for Americans in crisis to connect with suicide prevention and mental health crisis counselors.

Texting will be able to access suicide hotline help

This week, U.S. communications regulators will require that phone companies allow people to text as well as call a new “988” number for the suicide-prevention hotline. In recognition of the changing trend in technology use by youth, texting 988 will also be a way to reach the hotline. This would also benefit those who are deaf, have hearing loss or speech disabilities.

According to FCC Acting Chairwoman Jessica Rosenworcel, “For millions of us, especially young people and those with disabilities — they are more likely to text than they are to call when they are in crisis. The bottom line is it should not matter when you make a voice call or send a text message, because we should connect people in crisis to the resources they need, no matter how they communicate.”

Currently, the National Suicide Prevention Lifeline uses a 10-digit number, 800-273-TALK (8255), which routes calls to about 170 crisis centers. Phone companies have until July 2022 to implement the 988 number for both calling and texting. The FCC said Thursday that the country’s largest cellphone companies already support calling 988. The implementation of a three-digit number for the National Suicide Prevention Lifeline comes as suicide is a growing public health problem in the United States, with risk factors compounded by the Covid-19 pandemic.

It is estimated that nearly 6,000 Americans call the Lifeline on an average day. The most recent report (2020) by the National Center for Health Statistics, describes more than 45,000 suicide deaths in the US. While there was an overall decrease in suicides by 3% from 2019 to 2020 — suicide rates increased for non-Hispanic Black, non-Hispanic American Indian and Alaska Native, and Hispanic men, according to the NCHS report

Sources:

FCC News

FCC Report and Order

NCHS suicide report 2020

988 Fact Sheet: [ English | Spanish ]

Columbia University Psychiatry Develops a Mobile Depression App

A major gap in diagnosing and managing major depression is that the frontline in the recognition of depression is staffed by primary care clinicians. Since depression is one of the leading causes of disability worldwide, busy PCPs can benefit from the latest tools and information to assist them in the assessment and treatment of patients who present with symptoms.

The app known as Columbia Psychiatry Pathways — supports and strengthens the ability of clinicians to provide critical mental health services in an outpatient setting. It was co-developed by Columbia Psychiatry faculty John Mann, MD and Ravi N. Shah, MD. in collaboration with avoMD, a next-gen clinical decision support platform, as an interactive smartphone application that provides point-of-care treatment algorithms for major depression. 

This clinical decision support tool, is available as a mobile and desktop app. It has been developed for use by psychiatrists, primary care physicians, nurse practitioners, physician assistants, medical students, residents, and trainees in outpatient settings as they treat patients with major depression. The evidence-based platform updates prior depression treatment guidelines and uses algorithms that focus on faster medication adjustments with emphasis on the best-tolerated generic antidepressants. It measures symptom severity using built-in calculators based on the Columbia Depression Scale and includes screenings for bipolar disorder and suicide risk. 

The division of primary care at Columbia welcomes the Psychiatry Pathways app and highlight that ‘it is challenging to treat major depression, especially in a primary care setting, especially in a patient with comorbid conditions. A point of care app that can serve as virtual consult can help to validate a PCP’s knowledge in the best possibl care for patients.’

Sources:

Columbia Psychiatry

avoMD