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In This Issue of JAMA Psychiatry
August 2019


JAMA Psychiatry. 2019;76(8):773. doi:10.1001/jamapsychiatry.2018.2995


Despite evidence for immuno-inflammatory activation in bipolar depression, no study has assessed the antidepressant efficacy of infliximab, a monoclonal antibody targeting tumor necrosis factor among patients with this activation. McIntyre and colleagues randomized 60 patients with bipolar depression to 3 adjunctive intravenous infusions of infliximab vs placebo in double-blind fashion and found that infliximab did not significantly reduce depressive symptoms at 12 weeks despite patients having biochemical and/or phenotypic evidence of inflammatory activation. In an Editorial, Berk et al discuss the state of research on biomarker-guided anti-inflammatory therapies in mood disorders.


Continuing Medical Education

Posttraumatic stress disorder (PTSD) commonly co-occurs with alcohol use disorder and often presents as a difficult-to-treat condition. Norman and colleagues randomized 119 veterans to either participate in prolonged exposure therapy or integrated coping skills therapy for 12 to 16 sessions. Exposure therapy reduced PTSD symptoms significantly more than coping skills therapy at posttreatment 3-month and 6-month follow-up. This study provides evidence that exposure therapy is more efficacious in treating comorbid PTSD and alcohol use disorder.

The period prior to 2007 saw significant increases in depression treatment in the United States, but it is not known whether these trends have continued more recently. Hockenberry and colleagues analyzed nationally representative survey data on the use of health services and spending for outpatient treatment of depression from 86 216 individuals and found ongoing but modest increases in both utilization and spending. Despite these increases, treatment rates remain lower than expected, and this suggests that substantial barriers remain to individuals who need treatment for their depression.

Rare copy number variants (CNVs) have played a significant role in the genetics of neurodevelopmental disorders, but their contribution to depression has been unclear. Kendall and colleagues examined the depression phenotype of 502 534 individuals participating in the UK Biobank study and found that about 1.5% of individuals with depression carried a CNV, whereas only 1.1% of comparison individuals did. This study shows that CNVs have wider implications for psychiatric disorders beyond the neurodevelopmental spectrum and could have importance for rare cases in depression.

Prenatal and perinatal exposures to adversities are among the most important risk factors for psychiatric disorders. Leppert and colleagues examined the genotyped individuals, ie, 10 015 mothers and 9912 children, of the Avon Longitudinal Study of Parents and Children and found that polygenic risk score for attention-deficit/hyperactivity disorder (ADHD) among the mothers was associated with a range of early-life exposures linked to neurodevelopmental disorders in offspring. These findings suggest that mothers with a high polygenic risk score for ADHD may have a higher rate of offspring with neurodevelopmental disorders.