First-episode Depressive Patients Research Articles

The Different Impact of Depressive or Manic First-episode on Pediatric Bipolar Disorder Patients: Evidence From Resting-state fMRI

Bipolar disorder may begin as depression or mania, which can affect the treatment and prognosis of bipolar disorder. However, the physiological and pathological differences of pediatric bipolar disorder (PBD) patients with different onset symptoms are not clear. The purpose of this study was to investigate the differences of clinical, cognitive function and intrinsic brain networks in PBD patients with first-episode depression and first-episode mania. A total of 63 participants, including 43 patients and 20 healthy controls, underwent resting-state fMRI scans. PBD patients were classified as first-episode depressive and first-episode manic based on their first-episode symptoms. Cognitive tests were used to measure attention and memory of all participants. Independent component analysis (ICA) was used to extract the salience network (SN), default-mode network (DMN), central executive network (ECN) and limbic network (LN) for each participant. Spearman rank correlation analysis was performed between abnormal activation and clinical and cognitive measures. The results showed that there were differences in cognitive functions such as attention and visual memory between first-episode depression and mania, as well as differences activation in anterior cingulate cortex (ACC), posterior cingulate cortex (PCC), precuneus, inferior parietal cortex and parahippocampus. And significant associations of brain activity with clinical assessments or cognition were found in different patients. In conclusion, we found differential impairments in cognitive and brain network activation in first-episode depressive and first-episode manic PBD patients, and correlations were found between these impairments. These evidences may shed light on the different developmental paths of bipolar disorder.

Brain structural correlates of recurrence following the first episode in patients with major depressive disorder

Former prospective studies showed that the occurrence of relapse in Major Depressive Disorder (MDD) is associated with volume loss in the insula, hippocampus and dorsolateral prefrontal cortex (DLPFC). However, these studies were confounded by the patient’s lifetime disease history, as the number of previous episodes predict future recurrence. In order to analyze neural correlates of recurrence irrespective of prior disease course, this study prospectively examined changes in brain structure in patients with first-episode depression (FED) over 2 years. N = 63 FED patients and n = 63 healthy controls (HC) underwent structural magnetic resonance imaging at baseline and after 2 years. According to their disease course during the follow-up interval, patients were grouped into n = 21 FED patients with recurrence (FEDrec) during follow-up and n = 42 FED patients with stable remission (FEDrem). Gray matter volume changes were analysed using group by time interaction analyses of covariance for the DLPFC, hippocampus and insula. Significant group by time interactions in the DLPFC and insula emerged. Pairwise comparisons showed that FEDrec had greater volume decline in the DLPFC and insula from baseline to follow-up compared with FEDrem and HC. No group by time interactions in the hippocampus were found. Cross-sectional analyses at baseline and follow-up revealed no differences between groups. This longitudinal study provides evidence for neural alterations in the DLPFC and insula related to a detrimental course in MDD. These effects of recurrence are already detectable at initial stages of MDD and seem to occur without any prior disease history, emphasizing the importance of early interventions preventing depressive recurrence.

首发抑郁症伴焦虑特征患者血清脑源性神经因子水平及临床意义

首发抑郁症伴焦虑特征患者血清脑源性神经因子水平及临床意义

Comparison of Residual Depressive Symptoms, Functioning, and Quality of Life Between Patients with Recurrent Depression and First Episode Depression After Acute Treatment in China.

ObjectiveThis prospective study aimed to investigate the prognosis and rehabilitation of patients with recurrent depression and first episode depression after acute treatment in China.MethodsA total of 434 patients with first-episode or recurrent depression who received acute treatment respectively from sixteen hospitals in thirteen cities in China were enrolled in this prospective study. All patients were followed up for 6 months after acute treatment. The following data were collected at baseline period and 1, 3, and 6 months after acute treatment: general information of patients, medication information and patient’s condition changes, brief 16-item quick inventory of depressive symptomatology self-report (QIDS-SR16), patient health questionnaire-15 (PHQ-15), quality of life enjoyment and satisfaction questionnaire-short form (Q-LES-Q-SF), Sheehan disability scale (SDS) and digit symbol substitution test (DSST).ResultsDuring the baseline period, there was a significant difference in QIDS-SR16 between recurrent patients and first-episode patients (p < 0.05), and there was no significant difference in other indicators (p > 0.05). At one month after acute treatment, there were significant differences in the total QIDS-SR16 score, the total Q-LES-SF score, the social life score, and the family life/home responsibilities score of SDS in patients with recurrent depression and first-episode depression (p < 0.05). At three months after acute treatment, there were significant differences in the total Q-LES-SF score and social life score of SDS in patients with recurrent depression and first-episode depression (p < 0.05). At six months after acute treatment, there were significant differences in the total QIDS-SR16 score, the social life score, and the total Q-LES-SF score in patients with recurrent depression and first-episode depression (p < 0.05). Compared with that data during the baseline period, the QIDS-SR16 scores and the SDS scores of all patients decreased, and the Q-LES-SF scores of all patients gradually increased as time went on during the consolidation period.ConclusionThe recurrent patients have more severe social function impairment, depressive symptoms, and lower life quality than that of the first-episode depressed patients. Given the negative impact of depressed symptom on recurrent patient, more attention should be paid to the treatment of recurrent patient and recurrence prevention of first episode patient.

Brain structural network alterations related to serum cortisol levels in drug-na\xefve, first-episode major depressive disorder patients: a source-based morphometric study

Higher cortisol levels due to a hyperactive hypothalamic–pituitary–adrenal axis have been reported in patients with major depressive disorder (MDD). Increased cortisol levels change both the brain morphology and function in MDD patients. The multivariate source-based morphometry (SBM) technique has been applied to investigate neuroanatomical changes in some neuropsychiatric diseases, but not MDD. We aimed to examine the alterations in gray matter (GM) networks and their relationship with serum cortisol levels in first-episode, drug-naïve MDD patients using SBM. Forty-two patients with MDD and 39 controls were recruited via interviews. Morning serum cortisol levels were measured, and high-resolution T1-weighted imaging followed by SBM analysis was performed in all participants. The patients had significantly higher serum cortisol levels than the controls. We found two GM sources, which were significantly different between patients with MDD and controls (prefrontal network, p < .01; insula-temporal network, p < .01). Serum cortisol levels showed a statistically significant negative correlation with the loading coefficients of the prefrontal network (r = − 0.354, p = 0.02). In conclusion, increased serum cortisol levels were associated with reductions in the prefrontal network in the early stage of MDD, and SBM may be a useful approach for analyzing structural MRI data.

Effects of SSRI Antidepressants on Attentional Bias toward Emotional Scenes in First-Episode Depressive Patients: Evidence from an Eye-Tracking Study.

Objective Attentional biases toward emotional scenes may represent vulnerability and maintenance factors in depression. Antidepressant therapy may improve cognitive function and reduce depression, and is considered as the mechanism of action of antidepressants. Therefore, we conducted an eye-tracking test to examine whether selective serotonin re-uptake inhibitor (SSRI) antidepressants can reduce negative attentional biases and elicit clinical responses in depression. Methods Twenty first-episode depressive patients freely viewed three types of pictures that depicted different emotional scenes (i.e., positive-control, neutral-control, and negative-control) for 4,000 ms while their eye movements were monitored. The attentional bias to different emotional scenes was assessed before and after eight weeks of SSRI treatment using the eye-tracking method. The control group included a group of healthy individuals. Results The results revealed that first-episode depressive patients oriented their gaze more frequently to negative images and less to happy images, compared to controls. Importantly, the attentional bias in depressive patients was regulated after eight weeks of SSRI treatment. Patients showed an increased tendency to fixate on positive images and a decreased tendency to focus on negative images. Conclusion This suggests that SSRI antidepressants decrease vulnerability to negative images, while having an effect on attention in respect to positive images.

Abnormal functional connectivity of habenula in untreated patients with first-episode major depressive disorder

Major depressive disorder (MDD) is associated with abnormalities in emotional/cognitive processing and low reward sensitivity. The habenula has a pivotal role in these processes that may contribute to depression. However, there has been little research on the abnormal connectivity between the habenula and whole brain of first-onset MDD. We aimed to explore the differences of functional connectivity between patients and healthy controls using functional magnetic resonance imaging. We used seed-based resting-state fMRI to examine functional connectivity between the habenula and whole-brain in 49 first-episode depressive patients and 25 healthy controls. Compared to controls, patients with MDD demonstrated significant increases in functional connectivity between the habenula and the dorsolateral prefrontal cortex (dlPFC). Furthermore, the receiver operating characteristic (ROC) curve proved that connectivity between the habenula and dlPFC was highly predictive. Additionally, there was a positive correlation between Hamilton Rating Scale for Depression (HAMD) score and functional connectivity between the habenula and right dlPFC. We found that the aberrant functional connectivity to the habenula and dlPFC can distinguish MDD patients from the normal.

Comparative Study of Cognitive Function Between Treatment-Resistant Depressive Patients and First-Episode Depressive Patients.

ObjectiveDespite reports of cognitive dysfunction during the acute phase of depression, there is a lack of studies in patients with treatment-resistant depression (TRD). The aim of this study was to investigate the cognitive function profile of TRD and compare cognitive dysfunction between subjects with TRD and first-episode depression.Patients and methodsThe study included 31 patients with TRD and 53 with first-episode depression. Cognitive function was assessed by a series of neuropsychological tools such as the verbal fluency test, Modified Wisconsin Card Sorting Test (M-WCST), Tower of Hanoi test, Chinese-revision of the Wechsler Adult Intelligence Scale (WAIS-RC), and Trail Making Test A and B.ResultsThere were no significant demographic differences between the TRD, first-episode depression, and normal control groups (gender, age, years of education). The full-scale, verbal, and performance intelligence quotients measured with the WAIS-RC were also not significantly different (p>0.05). The normal group scores were all significantly better than TRD and first-episode depression, and the TRD group performed significantly worse than subjects with first-episode depression on Trail Making Test B, two WCST subscales, and the profile score of the Tower of Hanoi test (all p<0.05).ConclusionPatients with depression exhibited global impairments in cognitive function, and these were more common in TRD. Poor executive function may play an important role in TRD.

Correlation of metabolic parameters, neurotrophin-3, and neurotrophin-4 serum levels in women with schizophrenia and first-onset depression

Background: Neurotrophin-3 (NTF3) and neurotrophin-4 (NTF4) play a crucial role in the neurodevelopment, differentiation, survival, and protection of neurons in different brain regions. Schizophrenia and depression are highly associated with metabolic abnormalities. Longitudinal and cross-sectional comparisons of NTF3 and NTF4 levels, as well as clinical and metabolic parameters, were studied in schizophrenia, first-episode depression, and control groups.Materials and methods: Serum NTF3 and NTF4 levels, body mass index (BMI), fasting serum glucose and lipid profile: cholesterol, triglyceride, high-density lipoprotein (HDL-C) and low-density lipoprotein (LDL-C) were measured at baseline and week 8 in 133 women: 55 patients with schizophrenia (19 with first-episode and 36 chronic), 30 patients with a first-episode depression and 48 healthy controls. The severity of the symptoms was evaluated with the Positive and Negative Syndrome Scale, 17-item Hamilton Depression Rating Scale and the Beck Depression Inventory.Results: Longitudinal and cross-sectional comparisons did not detect any differences in the serum levels of NTF3 and NTF4 between studied groups. NTF3 and NTF4 levels were strongly correlated. Correlation of NTF3 and HDL-C levels at baseline was observed. Significant changes in cholesterol and fasting serum glucose levels in first-episode depression patients during 8 weeks of treatment were detected. Significant differences in BMI and LDL-C levels between schizophrenia and first-episode depression patients were discovered.Conclusions: To our knowledge, this is the first research which correlates NTF3 and NTF4 with metabolic parameters. Our study does not support the theory that the peripheral levels of NTF3 and NTF4 are disturbed in schizophrenia or first-episode depression.

Altered white matter volumes in first-episode depression: Evidence from cross-sectional and longitudinal voxel-based analyses

BackgroundMajor depressive disorder (MDD) is accompanied by atypical brain structure affecting grey and white matter from the early stages. Neuroimaging studies of first-episode depression (FED) have provided evidence on this regard, but most of the studies are cross-sectional. The aim of this longitudinal study was to test potential changes in grey matter (GM) and white matter (WM) volumes in FED. MethodsThirty-three untreated FED patients (DSM-IV criteria) and 33 healthy controls (HC) underwent a 3T structural magnetic resonance imaging (sMRI) at baseline and after 2 years. Depressive symptoms were assessed at baseline and throughout the study with the 17-item Hamilton Depressive Rating Scale (HDRS-17). Recurrences of FED patients were also collected along the follow-up. To analyze GM and WM differences, whole-brain voxel-based morphometry (VBM, SPM12) was employed (FWE corrected). ResultsFED patients showed significant reductions compared to HC in WM volumes of prefrontal cortex (left anterior corona radiata). No differences were found in GM volumes. Full factorial longitudinal analysis of the whole sample revealed no significant effect in GM nor in WM, while the full factorial longitudinal analysis comparing recurrent and non-recurrent patients showed increments in WM volumes of left posterior corona radiata and right posterior thalamic radiation in the recurrent group. LimitationsLimited sample size, especially in the follow-up. ConclusionsThe present findings provided some new evidence of the role of white matter alterations in the early stages of MDD and in the progression of the illness.

Aberrant patterns of brain cerebral blood flow in Chinese han first-episode drug-naïve depressive patients with and without a family history of depression.

A positive family history plays a key role in the brain pathology of depression patients and previous research has confirmed that disturbed mood maintenance may be related to abnormal regional cerebral blood flow (rCBF). However, little is known about whether the rCBF is different between depression patients with and without family histories. To address this question, we examined the rCBF in drug-naïve, first-episode depression patients with and without family histories of depression using a 3D pseudo-continuous arterial spin-labelling technique. We found that decreased rCBF was predominantly observed in the patients without family histories, while decreased and increased rCBF co-existed in patients with family histories. The observed brain regions with altered rCBF were associated with affection processing, such as the prefrontal, occipital and insular areas. However the patterns of rCBF alteration observed in the present study were different from those found in previous studies where patients were compared with healthy controls. Our present findings, together with the findings from previous studies have prompted the need of a long-term follow-up study to characterize the brain features of the developmental trajectory of depression and investigate the targets for precise, personalized treatments.

Randomized controlled trial of repetitive transcranial magnetic stimulation combined with paroxetine for the treatment of patients with first-episode major depressive disorder

Repetitive transcranial magnetic stimulation (rTMS) has been introduced as a new and effective treatment option for major depression. This paper examined the effectiveness of rTMS on first episode depressed patients when combined with antidepressant drugs. A random sample of forty-three first-episode depressed patients received active or sham rTMS to the left dorsolateral prefrontal cortex, and concomitantly took paroxetine for 4 weeks, and paroxetine monotherapy for 4 weeks afterwards. Response was defined as a ≥50% decrease on the total Hamilton Depression Rating Scale (HDRS) from the baseline, and remission was defined as an HDRS total residual score <8. The dosage of paroxetine was the average dose per day in each week. Repeated-measures ANOVA revealed a significant improvement in the HDRS with active compared with sham rTMS from the end of the 1st week to the 4th week. At the end of the 4th week, response rate was 95.5% with active and 71.4% with sham rTMS, remission rate was 68.2% with active and 38.1% with sham rTMS, while these significant differences disappeared at the endpoint of the study. These findings indicate that rTMS at 10-Hz accelerated the onset of action and augmented the response to paroxetine for first-episode depressed patients.

The cognitive impairment in depression patients with anxiety symptom

Objective To investigate the cognitive impairment in depression with anxiety symptom and its influencing factors. Methods 458 first-episode depression patients were assessed with Hamilton Anxiety Scale (HAMA). According to the score of HAMA, the patients with depression were divided into with anxiety symptom group (n=266) and without anxiety symptom group (n=76). Using Wisconsin Card Sorting Test (WCST), Stroop Color-Word Test, Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) to assess neuropsychological function. Results (1)The group without anxiety symptom had higher scores on categories completed(2.88±2.14), learning to learned(64.16±24.20), immediately memory(81.78±17.16), visual span(84.08±15.41), attention(106.45±20.72) and delayed memory (86.12±13.06) than the group with anxiety symptom had((2.07±1.98), (54.33±27.05), (70.47±17.61), (79.76±14.63), ( 98.25±17.11), (79.97±16.10) respectively), and all these differences were significant (P<0.01 or P<0.05). The group without anxiety symptom had lower scores on response error(61.21±21.50), perseverative error percentage(17.11±6.10), monochrome time(19.04±6.57), time of meaning interference(15.01±9.11) and time of color interference(2.79±2.82) than the group with anxiety symptom had((67.20±21.87), (19.21±7.18), (21.03±7.69), (17.92±10.64), (3.86±5.61)respectively), and all these differences were significant (P<0.05). (2)The combination of educational years, age, somatic anxiety and psychic anxiety explained the 28.1% variances of immediately memory(F=25.015, P<0.01); the combination of educational years and psychic anxiety explained the 19.8% variances of delayed memory(F=31.625, P<0.01); and the combination of age and psychic anxiety explained the 13.6% variances of time of meaning interference(F=20.293, P<0.01). Conclusion Depression with anxiety symptom has more severe impairment on executive function, processing speed, memory and attention.Educational years, age, psychic anxiety and somatic anxiety are influencing factors. Key words: Depression; Anxiety symptom; Neuropsychological function

The course of social cognitive and metacognitive ability in depression: Deficit are only partially normalized after full remission of first episode major depression.

Research has suggested that patients suffering from major depressive disorder (MDD) experience deficits in the related domains of social cognition and metacognition. Most research has focused on detecting deficits among persons who are acutely symptomatic. Thus, little is known about whether these deficits persist after symptoms have remitted. As a first, this study investigated social cognitive and metacognitive deficits in patients with MDD in the acute and remitted state. Longitudinal case-control. Forty-four drug-naïve depressed patients and an equal number of matched healthy controls were assessed in multiple domains of social cognition including theory of mind, social perception, and metacognition. Additionally, a comprehensive neurocognitive (non-social) test battery was utilized. Following baseline assessment, patients were enrolled in an outpatient treatment programme. Patients reaching remission within 6months (n=29) were reassessed 6months post-remission. Included for analysis were only patients who followed a course of remission (n=29) and their paired healthy controls (n=29). Analyses of variance revealed that remitted patients performed significantly better at retest than at baseline on nearly all measures. These effects withstood adjusting for test-retest effects. Moreover, remitted patients performed up to level of healthy controls on some but not all social cognitive tasks and metacognition at retest. Overall, results suggests that social cognitive and metacognitive ability may improve with symptom remission in major depression although it may not reach a level equal to persons who have never experienced depression. Many with first-episode depression experience deficits in social cognition. When first-episode depression remits, social cognition may improve. After remission, first-episode depressed patients may still experience deficits in social cognition. We have yet to determine whether social cognitive deficits existed prior to the onset of depression. Longer-term longitudinal studies of social cognition in depression are needed. Treatment was pharmacological and non-manualized psychotherapy, the effects of which were not controlled for. Sample sizes were modest, which must caution against generalization of the results.

Resting-state fMRI study on alteration of amplitude of low frequency fluctuation and its relationship with aggressive behaviors in first-episode major depressive disorder patients

Objective To investigate the alterations of the amplitude of low frequency fluctuation(ALFF)by the restingstate fMRI in first-episode major depressive disorder(MDD)patients,and to analyze the relationship between brain area of different ALFF alterations with their aggressive behaviors.Methods Thirty first-episode MDD patients receiving no treatment or stopping treatment for 2weeks and 30sex-,age-,and education-matched healthy controls were included in this study.All the participants were scanned with 3.0Tresting-state fMRI scanner and the blood oxygenation level dependent(BOLD)signals were acquired to calculate the amplitude of low frequency fluctuation(ALFF).Then we examined the differences in ALFF findings between the two groups and the correlations between the scores of aggressive behavior and ALFF in the brain areas showing significant group differences.Results Our results showed that MDD patients had significantly increased ALFF in the left insula,parietal lobe sub-gyral,precentral gyrus,and the right superior temporal gyrus,precentral gyrus,and inferior frontal gyrus compared with the health controls(P0.001,corrected by Alphasim);while they had decreased ALFF in the left thalamus,precuneus and right lingual gyrus,and fusiform gyrus(P0.001,corrected by Alphasim).The correlation analysis indicated that the increased ALFF in the left precentral gyrus was positively correlated with the scores of physical aggression,self-aggression,and total score of aggressive behaviors(r=0.41,0.49,0.39,P0.05 or 0.01).The increased ALFF in the right inferior frontal gyrus was negatively correlated with anger(r=-0.44,P0.05).Conclusion Spontaneous abnormal neural activities exist in some brain regions of MDD patients in the resting-state fMRI,and the increase of ALFF in regions of frontal is closely related to the aggressive behaviors of patients.

The serum homocysteine levels in patients with first-episode depression and its relationship with P300

Objective To study the relationship between the serum homocysteine （ Hcy ） levels in patients with first-episode depression and event related potentials （ ERP ） P300.Methods 117 first-episode depressive patients were selected as the case group,and 110 healthy volunteers were selected as the health control group,the de-termination of serum Hcy levels in the two groups were detected by enzyme linked immunosorbent assay,measured by the Shenzhen Brain Master brain evoked potential system to complete the visual P300.Results The serum Hcy levels of the case group was （14.0 ±9.8）μmol/L,which was higher than （10.5 ±7.5）μmol/L of the health control group （t=-3.087,P 〈0.05）.The N1,N2 incubation period of the case group were （91.4 ±18.6） ms,（235.4 ± 30.5）ms,respectively,which were longer than （88.6 ±13.0）ms,（204.3 ±20.3）ms of the health control group（t=1.305,8.990,all P〈0.01）;The P3 incubation period of the case group were （359.5 ±30.0）ms,which was longer than （327.2 ±41.8）ms of the health control group（t=6.685,P〈0.05）.The target P3,non-target P2 amplitude of the case group were （4.1 ±2.0）μV,（4.2 ±1.9）μV,respectively,which were singnificantly lower than （6.8 ± 3.8）μV,（6.6 ±3.6） μV of the health control group（ t=-6.694,-6.485,all P〈0.01）.The P2 incubation period of Hcy case group was （194.4 ±13.6） ms,which was longer than （163.1 ±21.8） ms of the non Hcy case group（t=8.486,P〈0.01）.The P3 incubation period of Hcy case group was （357.0 ±24.5）ms,which was longer than （337.1 ±45.5）ms of the non Hcy case group（t=2.645,P〈0.05）.The target P3,non-target P2 amplitude of the Hcy case group were （5.4 ±1.5）μV,（5.2 ±1.2） μV,which were significantly lower than （5.8 ±3.8）μV, （5.4 ±3.2）μV of the Hcy case group（t=-0.745,-0.208,all P〈0.01）.Conclusion The serum Hcy levels in patients with first-episode depression increased, and P300 latency, amplitude decreased, the cognitive function is related to Hcy metabolism disorder and depression damage. Key words: Depressive Disorder Cysteine Event-Related Potentials; P300 Cognition

The combined analysis of susceptibility weighted imaging and proton spectroscopy sequence by high field magnetic resonance in the first-episode depression patients

Objective Combined with susceptibility weighted imaging (SWI) and proton magnetic resonance spectroscopy (1H-MRS) to study the hippocampus in the first-episode depression patients for exploring the causal relationship. Methods 20 first-episode depression patients and 20 healthy volunteers underwent SWI scanning and hippocampal 1H-MRS image, analysis and comparison the changes between the venous system and metabolism of two groups. Results Proton spectroscopy analysis showed that compared with the control group, bilateral hippocampal NAA/Cr(left hippocampus: depression group 0.95±0.77, control group 1.78±0.82; right hippocampus: depression group 1.12±0.74, control group 1.91±0.80) and Cho/Cr(left hippocampus: depression group 1.08±0.83, control group 1.75±0.73; right hippocampus: depression group 0.91±0.68, control group 1.95±0.74)in the depression group was significantly lower, the difference was significant(NAA/Cr: t value in left and right were -3.14, -3.49, P 0.05). Magnetic sensitive scan showed depression group compared with the control group was significantly reduced in lateral vein diameter, length and branches (t value were 3.23, 4.56, 2.66, P<0.05). Conclusion The SWI sequence and 1H-MRS imaging methods can become a new research idea about the central nucleus, and this idea may explain the causal relationship between the hippocampus in depression patients of vascular abnormalities and hippocampal neuronal metabolic abnormalities. Key words: Susceptibility weighted imaging; Proton magnetic resonance spectroscopy; Hippocampus; Depressive disorder

Antidepressant efficacy of theta-burst transcranial magnetic stimulation in treatment of first-episode depression: a randomized, double blind controlled trial

Objective To evaluate the antidepressant efficacy, cognitive effect and safety of theta-burst transcranial magnetic stimulation (TBS) in treatment of first-episode depression. Methods 43 hospitalized patients with first-episode depression meeting with Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition (DSM-IV) were randomly divided into theta-burst stimulation group(TBS group, n=21)and sham-stimulation group(sham group, n=22). All patients were treated at left dorsolateral prefrontal cortex (DLPFC) for 4 weeks, and were concomitantly taking venlafaxine (150-300)mg/d. Hamilton Depression Scale-24 was used to assess the severity of depression before treatment, at week 2 and week 4 in both groups. Wisconsin Card Sorting Test (WCST) and Continuous Performance Test (CPT) were used to estimate cognitive function of depression before and after treatment. Results There was no difference on HAMD score before treatment between two groups((38.2±7.1)vs.(37.5±6.8), t=0.314, P=0.754). The reduction of HAMD score in TBS group showed significantly faster than that in sham group at week 2 ((20.5±4.8)vs.(16.1±5.9), t=2.547, P=0.015) and week 4((30.3±5.2)vs.(26.0±6.3), t=2.318, P=0.026). After 2-week stimulation, the response rate was higher in TBS group than that in sham group (57.9%vs. 25%, χ2 =4.358, P=0.037). The response and remission rates were significantly higher in TBS group than those in sham group after 4-week stimulation period (94.7%vs.65%, χ2 =5.284, P=0.021; 78.9%vs.45%, χ2=4.744, P=0.029). The improvements on WCST and CPT after treatment in TBS group, such as categories completed, correct responses, error responses, perseverative responses errors, nonperseverative responses errors, CPT1, CPT2 and CPT3, were significant than those in sham group (P<0.05). Conclusions Theta-burst stimulation of the left dorsolateral prefrontal cortex is safe and well-tolerated, while offering the potential to enhance early effects and modulate cognition in first-episode depressive patients. Key words: Theta-burst stimulation; Transcranial magnetic stimulation; Depression

A comparison of capacities for social cognition and metacognition in first episode and prolonged depression

There is a growing awareness that social cognition is a valuable construct for understanding the psycho-social disabilities in depressive illness. Numerous studies have linked affective disorders to impairments in social cognition and specifically the processing of discrete emotional stimuli. Only few studies have investigated the relation between the burden of depressive illness and social cognitive ability. To study these issues, we compared a group of first-episode depressed patients with a group of chronically depressed patients (duration >2 years) on a broad array of higher-order social cognitive measures including the metacognition assessment scale abbreviated. Contrary to prediction, deficits in social cognition were roughly equivalent between the two groups and there was no significant link between symptom severity and social cognitive ability. Having moderate to severe major depressive disorder (MDD) could be sufficient to predict the presence of deficits in social cognitive ability.

Amplitude of low frequency fluctuation in first-episode depression and its relationship with the separate symptom clusters: a resting-state fMRI study

Objective To explore the relationship between energy feature of the spontaneous neural activity and separate symptom clusters in first-episode depression. Methods 22 first-episode depression patients and 26 age-, gender-matched healthy controls were scanned with 3.0 T MRI Scanner. The t-test was employed to compare the difference of amplitude of low frequency fluctuation (ALFF) between the two groups, and the correlation analyses were conducted between ALFF of brain regions with significant difference and the severity of depressive symptoms clusters. Results Compared with healthy group, the depression group showed significantly increased ALFF in the right middle frontal gyrus (9, 45, -6; K=18)and the bilateral fusiform gyrus (-34, -19, -12; K=37 and 30, -33, -18; K=31, respectively), and decreased ALFF in the left precuneus(0, -72, 42; K=19) (P<0.05, corrected by Alphasim). The ALFF of the the right middle frontal gyrus, the right fusiform gyrus, and the left precuneus were negative correlated with the scores of weight factor, retardation factor and sleep disturbance factor (r=-0.494, P=0.019; r=-0.486, P=0.022 and r=-0.484, P=0.023, respectively). Conclusion Abnormal energy feature of the spontaneous neural activity may be associated with severity of specific depressive symptoms clusters in first-episode depression patients during resting-state. Key words: Depression; Resting-state; Amplitude of low frequency fluctuation; Clinical symptom