- Email: [email protected]
2.56 Differences of Heart Rate Variability in First-Episode Drug-Naive Adolescents With Major Depressive Disorder
NEW RESEARCH POSTERS 2.56 — 2.58
the serum levels of IL-6, TNF-a, and BDNF between MDD and control subjects; age, gender, and BMI were adjusted. All participants were assessed using Children’s Depression Rating Scale–Revised (CDRS-R), Children’s Depression Inventory (CDI), Beck’s Depression Inventory (BDI), Columbia Suicide Severity Rating Scale (C-SSRS), Screening for Childhood Anxiety Related Emotional Disorders (SCARED), Children’s Behavior Checklist (CBCL), ADHD Rating Scale-IV (ADHD-RS), and Disruptive Behavior Disorder Scale (DBDS). Correlation analysis was used to evaluate associations of serum levels of inflammatory and neurotropic markers with the results of psychiatric rating scales. Results: Mean (SD) levels were 1.1 (0.6) pg/ml for IL-6, 1.3 (0.6) pg/ml for TNF-a, and 23.6 (5.3) ng/ml for BDNF in the MDD group. There were no differences in the IL-6 and BDNF levels between MDD and control subjects. However, the TNF-a level was significantly lower in MDD compared with control subjects after adjusting the covariates (1.3 0.6 vs. 1.6 0.6 pg/ml, Cohen’s d ¼ 0.50, P ¼ 0.02). TNF-a levels were negatively correlated with the scores of CDI (r ¼ 0.25, P ¼ 0.02), BDI (r ¼ 0.24, P ¼ 0.02), and SCARED (r ¼ 0.25, P ¼ 0.02). Conclusions: Our preliminary findings of decreased TNF-a in MDD compared with control subjects and inverse relationships between TNF-a and depressive symptoms were in the opposite direction of most adult studies, suggesting a possibility of different underlying pathophysiology of depression between youth and adults. These findings should be replicated in larger sample groups to understand biological pathways linking inflammation and depression in youth.
ADOL, NI, DDD Supported by Basic Science Research Program through the National Research Foundation of Korea, funded by the Ministry of Science, ICT and Future Planning Grant NRF-2015R1A2A2A01004501 and Seoul National University Promising-Pioneering Research Program http://dx.doi.org/10.1016/j.jaac.2017.09.135
2.56 DIFFERENCES OF HEART RATE VARIABILITY IN FIRST-EPISODE DRUG-NAIVE ADOLESCENTS WITH MAJOR DEPRESSIVE DISORDER Jongha Lee, MD, Korea University College of Medicine, [email protected]; Moon Soo Lee, MD, Korea University Guro Hospital, [email protected]; Sangwon Park, MD, Korea University College of Medicine, [email protected] Objectives: MDD is quite a common mental disorder affecting adolescents. Therefore, understanding the physiological mechanism of adolescent MDD has important clinical implications for this disorder. Heart rate variability (HRV) studies have observed differences between depressed and healthy comparison participants. In general, HRV is known to be decreased in MDD. Some studies concluded that HRV decrease persists even after remission of depression, whereas other studies reported increase of HRV after successful treatment of depression. However, little is known about HRV in adolescents with MDD. The goal of this study was to determine whether HRV is also decreased in adolescents with MDD relative to normal control group and whether HRV changed significantly after treatment of MDD in the adolescent group. Methods: A total of 53 participants were recruited. We recruited patients (ages 13–18 years), who were diagnosed with MDD. We also gathered volunteers from the local community and high school. The participants in the control group have never been treated in psychiatry clinics before. The patients were drug-naïve at the time of the HRV measure. The participants were diagnosed using criteria of the DSM-IV-Text Revision. Subject symptom information for MDD was gathered using the Hamilton Depression Rating Scale (HDRS) and Children’s Depression Inventory (CDI) in all of the participants, including healthy control subjects. Once eligible to participate in our study, we conducted the HRV measure. Each child was individually examined in a quiet room in the supine position for three minutes. Results: In time domain analysis of HRV, MDD group did not show a decrease of HRV compared with the normal control group. However, in frequency domain analysis, MDD group showed a decrease in normalized high
JOURNAL OF THE AMERICAN ACADEMY OF CHILD & ADOLESCENT P SYCHIATRY VOLUME 56 NUMBER 10S OCTOBER 2017
frequency (HF norm) and an increase in normalized low frequency (LF norm); thus, the LF/HF ratio indicated an increase of sympathetic tone. Score of HDRS and CDI showed positive correlation with LF norm and LF/HF ratio and negative correlation with HF norm. There was no significant change in overall HRV parameters after treatment of MDD with antidepressant. Conclusions: In the analysis of HRV of adolescent MDD group, increase of sympathetic tone was significant compared with normal control group. Increase of sympathetic tone might be a meaningful feature of adolescent depression.
ADOL, ADP, DDD Supported by the Basic Science Research Program through the National Research Foundation of Korea, funded by the Ministry of Education Grant NRF-2014R1A1A2054904 http://dx.doi.org/10.1016/j.jaac.2017.09.136
2.57 RESTING STATE FUNCTIONAL CONNECTIVITY OF THE AMYGDALA AND TREATMENT RESPONSE IN DEPRESSED ADOLESCENTS Colm G. Connolly, PhD, University of California, San Francisco, [email protected]; Alan N. Simmons, PhD, University of California, San Diego, [email protected]; Tony T. Yang, MD, PhD, University of California, San Francisco, [email protected] Objectives: Little is currently known about the underlying neural response to treatment in adolescent depression. Identification of the neural correlates of treatment response could do the following: 1) improve our understanding of adolescent depression and treatment response; and 2) provide candidate biomarkers for future research. Methods: Sixteen participants with MDD and eight healthy control subjects underwent functional magnetic resonance imaging to assess the resting-state functional connectivity (RSFC) of the amygdala at baseline and again three months later. The Children’s Depression Rating Scale-Revised (CDRS-R) were gathered at both time points. Whole-brain RSFC of the amygdala and the way it has changed as a function of group-by-time point were assessed using voxelwise linear mixed-effects analysis. Change in CDRS-R score over time in the group with MDD was assessed using a paired t-test. All subjects with MDD underwent CBT between baseline and follow-up. Results: Patients with MDD showed lower CDRS-R scores at follow-up [mean difference ¼ 4.75, t(15) ¼ 2.22, P < 0.05]. Two regions of right amygdala connectivity exhibiting group-by-time point connectivity differences were identified in the left and right dorsolateral prefrontal cortex (DLPFC). In both DLPFC regions, connectivity with the amygdala was lower in the MDD group than in the healthy control subjects at baseline (P < 0.005). This connectivity difference was not observed at follow-up (P > 0.05). Conclusions: Our results suggest that connectivity between the amygdala and DLPFC, a region critical to behavioral regulation, may be important to treatment response. These findings provide new insight in the neural circuits involved in adolescent MDD and the way treatment may impact those circuits needed to yield symptom improvement. This preliminary evidence suggests the presence of a neuroimaging-based biomarker of treatment response in adolescent depression.
ADOL, IMAGS, DDD Supported by NIMH Grant R01MH085734 and Veteran’s Affairs Merit Award I01-CX000715 http://dx.doi.org/10.1016/j.jaac.2017.09.137
2.58 METHYLENE TETRAHYDROFOLATE REDUCTASE (MTHFR) ALLELE FREQUENCY IN A REFRACTORY MAJOR DISRUPTIVE DISORDER POPULATION Thomas J. Zimmer, MD, University of Pittsburgh School of Medicine, [email protected]; Lisa Pan, MD, Western Psychiatric
www.jaacap.org
S197
the serum levels of IL-6, TNF-a, and BDNF between MDD and control subjects; age, gender, and BMI were adjusted. All participants were assessed using Children’s Depression Rating Scale–Revised (CDRS-R), Children’s Depression Inventory (CDI), Beck’s Depression Inventory (BDI), Columbia Suicide Severity Rating Scale (C-SSRS), Screening for Childhood Anxiety Related Emotional Disorders (SCARED), Children’s Behavior Checklist (CBCL), ADHD Rating Scale-IV (ADHD-RS), and Disruptive Behavior Disorder Scale (DBDS). Correlation analysis was used to evaluate associations of serum levels of inflammatory and neurotropic markers with the results of psychiatric rating scales. Results: Mean (SD) levels were 1.1 (0.6) pg/ml for IL-6, 1.3 (0.6) pg/ml for TNF-a, and 23.6 (5.3) ng/ml for BDNF in the MDD group. There were no differences in the IL-6 and BDNF levels between MDD and control subjects. However, the TNF-a level was significantly lower in MDD compared with control subjects after adjusting the covariates (1.3 0.6 vs. 1.6 0.6 pg/ml, Cohen’s d ¼ 0.50, P ¼ 0.02). TNF-a levels were negatively correlated with the scores of CDI (r ¼ 0.25, P ¼ 0.02), BDI (r ¼ 0.24, P ¼ 0.02), and SCARED (r ¼ 0.25, P ¼ 0.02). Conclusions: Our preliminary findings of decreased TNF-a in MDD compared with control subjects and inverse relationships between TNF-a and depressive symptoms were in the opposite direction of most adult studies, suggesting a possibility of different underlying pathophysiology of depression between youth and adults. These findings should be replicated in larger sample groups to understand biological pathways linking inflammation and depression in youth.
ADOL, NI, DDD Supported by Basic Science Research Program through the National Research Foundation of Korea, funded by the Ministry of Science, ICT and Future Planning Grant NRF-2015R1A2A2A01004501 and Seoul National University Promising-Pioneering Research Program http://dx.doi.org/10.1016/j.jaac.2017.09.135
2.56 DIFFERENCES OF HEART RATE VARIABILITY IN FIRST-EPISODE DRUG-NAIVE ADOLESCENTS WITH MAJOR DEPRESSIVE DISORDER Jongha Lee, MD, Korea University College of Medicine, [email protected]; Moon Soo Lee, MD, Korea University Guro Hospital, [email protected]; Sangwon Park, MD, Korea University College of Medicine, [email protected] Objectives: MDD is quite a common mental disorder affecting adolescents. Therefore, understanding the physiological mechanism of adolescent MDD has important clinical implications for this disorder. Heart rate variability (HRV) studies have observed differences between depressed and healthy comparison participants. In general, HRV is known to be decreased in MDD. Some studies concluded that HRV decrease persists even after remission of depression, whereas other studies reported increase of HRV after successful treatment of depression. However, little is known about HRV in adolescents with MDD. The goal of this study was to determine whether HRV is also decreased in adolescents with MDD relative to normal control group and whether HRV changed significantly after treatment of MDD in the adolescent group. Methods: A total of 53 participants were recruited. We recruited patients (ages 13–18 years), who were diagnosed with MDD. We also gathered volunteers from the local community and high school. The participants in the control group have never been treated in psychiatry clinics before. The patients were drug-naïve at the time of the HRV measure. The participants were diagnosed using criteria of the DSM-IV-Text Revision. Subject symptom information for MDD was gathered using the Hamilton Depression Rating Scale (HDRS) and Children’s Depression Inventory (CDI) in all of the participants, including healthy control subjects. Once eligible to participate in our study, we conducted the HRV measure. Each child was individually examined in a quiet room in the supine position for three minutes. Results: In time domain analysis of HRV, MDD group did not show a decrease of HRV compared with the normal control group. However, in frequency domain analysis, MDD group showed a decrease in normalized high
JOURNAL OF THE AMERICAN ACADEMY OF CHILD & ADOLESCENT P SYCHIATRY VOLUME 56 NUMBER 10S OCTOBER 2017
frequency (HF norm) and an increase in normalized low frequency (LF norm); thus, the LF/HF ratio indicated an increase of sympathetic tone. Score of HDRS and CDI showed positive correlation with LF norm and LF/HF ratio and negative correlation with HF norm. There was no significant change in overall HRV parameters after treatment of MDD with antidepressant. Conclusions: In the analysis of HRV of adolescent MDD group, increase of sympathetic tone was significant compared with normal control group. Increase of sympathetic tone might be a meaningful feature of adolescent depression.
ADOL, ADP, DDD Supported by the Basic Science Research Program through the National Research Foundation of Korea, funded by the Ministry of Education Grant NRF-2014R1A1A2054904 http://dx.doi.org/10.1016/j.jaac.2017.09.136
2.57 RESTING STATE FUNCTIONAL CONNECTIVITY OF THE AMYGDALA AND TREATMENT RESPONSE IN DEPRESSED ADOLESCENTS Colm G. Connolly, PhD, University of California, San Francisco, [email protected]; Alan N. Simmons, PhD, University of California, San Diego, [email protected]; Tony T. Yang, MD, PhD, University of California, San Francisco, [email protected] Objectives: Little is currently known about the underlying neural response to treatment in adolescent depression. Identification of the neural correlates of treatment response could do the following: 1) improve our understanding of adolescent depression and treatment response; and 2) provide candidate biomarkers for future research. Methods: Sixteen participants with MDD and eight healthy control subjects underwent functional magnetic resonance imaging to assess the resting-state functional connectivity (RSFC) of the amygdala at baseline and again three months later. The Children’s Depression Rating Scale-Revised (CDRS-R) were gathered at both time points. Whole-brain RSFC of the amygdala and the way it has changed as a function of group-by-time point were assessed using voxelwise linear mixed-effects analysis. Change in CDRS-R score over time in the group with MDD was assessed using a paired t-test. All subjects with MDD underwent CBT between baseline and follow-up. Results: Patients with MDD showed lower CDRS-R scores at follow-up [mean difference ¼ 4.75, t(15) ¼ 2.22, P < 0.05]. Two regions of right amygdala connectivity exhibiting group-by-time point connectivity differences were identified in the left and right dorsolateral prefrontal cortex (DLPFC). In both DLPFC regions, connectivity with the amygdala was lower in the MDD group than in the healthy control subjects at baseline (P < 0.005). This connectivity difference was not observed at follow-up (P > 0.05). Conclusions: Our results suggest that connectivity between the amygdala and DLPFC, a region critical to behavioral regulation, may be important to treatment response. These findings provide new insight in the neural circuits involved in adolescent MDD and the way treatment may impact those circuits needed to yield symptom improvement. This preliminary evidence suggests the presence of a neuroimaging-based biomarker of treatment response in adolescent depression.
ADOL, IMAGS, DDD Supported by NIMH Grant R01MH085734 and Veteran’s Affairs Merit Award I01-CX000715 http://dx.doi.org/10.1016/j.jaac.2017.09.137
2.58 METHYLENE TETRAHYDROFOLATE REDUCTASE (MTHFR) ALLELE FREQUENCY IN A REFRACTORY MAJOR DISRUPTIVE DISORDER POPULATION Thomas J. Zimmer, MD, University of Pittsburgh School of Medicine, [email protected]; Lisa Pan, MD, Western Psychiatric
www.jaacap.org
S197