More than half of older adults with major depressive disorder fail to respond adequately to first-line treatment. Kaneriya and colleagues studied predictors and moderators of remission in a 12-week clinical trial of aripiprazole in adults 60 years and older who had not remitted with venlafaxine. Poor set-shifting performance at baseline identified a group of patients who were unlikely to benefit from adjunctive aripiprazole treatment. In an editorial, Taylor discusses the implications of identifying moderators of remission in late-life depression.
Magnetic seizure therapy (MST) is a novel therapy for treatment-resistant depression, but no biomarkers are available to predict response to MST. Sun and colleagues treated 33 patients with treatment-resistant depression with MST in an open-label clinical trial, monitored suicidal ideation, and assessed baseline cortical inhibition using TMS-EEG N100. Long interval cortical inhibition in the dorsolateral prefrontal, but not motor, cortex significantly predicted remission of suicidal ideation with 90% sensitivity and 89% specificity, suggesting that stronger inhibitory neurotransmission at baseline is related to therapeutic response to MST.
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The long-term trajectories after an initial episode of major depressive disorder are heterogeneous. Musliner and colleagues followed up a cohort of 11 640 Danish individuals for 10 years after their first major depressive episode. They found 4 trajectory classes: brief contact (77%), prolonged initial contact (13%), later reentry (7%), and persistent contact (3%). Several demographic and risk factors were associated with more severe trajectories. In an editorial, Shelton discusses the relevance of this heterogeneity for the treatment of major depressive disorder.
Psychiatric disorders are the result of a complex interplay between genetic and environmental risk factors. Nordsletten and colleagues studied nonrandom (assortative) mating in a population-based Swedish cohort. Compared with matched populations, the odds of a person with a psychiatric disorder to have an affected mate were significantly elevated. The magnitude of this relationship differed across 11 psychiatric disorders. In an editorial, Plomin and colleagues highlight the importance of this finding for psychiatric genetics.
Changes in the legal status of cannabis across the United States have renewed the debate about mental health consequences of cannabis use. Blanco and colleagues used a survey of a nationally representative sample of US adults who were interviewed twice. Cannabis use at the first interview was associated 3 years later with several substance use disorders, but not with mood or anxiety disorders. Increased risk for substance use disorders should be taken into consideration when assessing the legal status of cannabis.
Highlights. JAMA Psychiatry. 2016;73(4):313. doi:10.1001/jamapsychiatry.2015.1618