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Pre-treatment allostatic load and metabolic dysregulation predict SSRI response in major depressive disorder : A preliminary report

Hough, Christina M. ; Bersani, F. Saverio ; Mellon, Synthia H. ; Morford, Alexandra E. ; Lindqvist, Daniel LU ; Reus, Victor I. ; Epel, Elissa S. and Wolkowitz, Owen M. LU (2020) In Psychological Medicine
Abstract

BackgroundMajor depressive disorder (MDD) is associated with increased allostatic load (AL; a measure of physiological costs of repeated/chronic stress-responding) and metabolic dysregulation (MetD; a measure of metabolic health and precursor to many medical illnesses). Though AL and MetD are associated with poor somatic health outcomes, little is known regarding their relationship with antidepressant-treatment outcomes.MethodsWe determined pre-treatment AL and MetD in 67 healthy controls and 34 unmedicated, medically healthy MDD subjects. Following this, MDD subjects completed 8-weeks of open-label selective serotonin reuptake inhibitor (SSRI) antidepressant treatment and were categorized as 'Responders' (≥50% improvement in depression... (More)

BackgroundMajor depressive disorder (MDD) is associated with increased allostatic load (AL; a measure of physiological costs of repeated/chronic stress-responding) and metabolic dysregulation (MetD; a measure of metabolic health and precursor to many medical illnesses). Though AL and MetD are associated with poor somatic health outcomes, little is known regarding their relationship with antidepressant-treatment outcomes.MethodsWe determined pre-treatment AL and MetD in 67 healthy controls and 34 unmedicated, medically healthy MDD subjects. Following this, MDD subjects completed 8-weeks of open-label selective serotonin reuptake inhibitor (SSRI) antidepressant treatment and were categorized as 'Responders' (≥50% improvement in depression severity ratings) or 'Non-responders' (<50% improvement). Logistic and linear regressions were performed to determine if pre-treatment AL or MetD scores predicted SSRI-response. Secondary analyses examined cross-sectional differences between MDD and control groups.ResultsPre-treatment AL and MetD scores significantly predicted continuous antidepressant response (i.e. absolute decreases in depression severity ratings) (p = 0.012 and 0.014, respectively), as well as post-treatment status as a Responder or Non-responder (p = 0.022 and 0.040, respectively), such that higher pre-treatment AL and MetD were associated with poorer SSRI-treatment outcomes. Pre-treatment AL and MetD of Responders were similar to Controls, while those of Non-responders were significantly higher than both Responders (p = 0.025 and 0.033, respectively) and Controls (p = 0.039 and 0.001, respectively).ConclusionsThese preliminary findings suggest that indices of metabolic and hypothalamic-pituitary-adrenal-axis dysregulation are associated with poorer SSRI-treatment response. To our knowledge, this is the first study to demonstrate that these markers of medical disease risk also predict poorer antidepressant outcomes.

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organization
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Contribution to journal
publication status
epub
subject
keywords
Allostatic load, antidepressant response, major depressive disorder, metabolic dysregulation, metabolic syndrome, treatment prediction, treatment response
in
Psychological Medicine
publisher
Cambridge University Press
external identifiers
  • scopus:85085484156
  • pmid:32438932
ISSN
0033-2917
DOI
10.1017/S0033291720000896
language
English
LU publication?
yes
id
09b16234-f43e-4a87-b3e3-2e38d5536465
date added to LUP
2020-06-17 12:28:31
date last changed
2021-05-11 03:16:44
@article{09b16234-f43e-4a87-b3e3-2e38d5536465,
  abstract     = {<p>BackgroundMajor depressive disorder (MDD) is associated with increased allostatic load (AL; a measure of physiological costs of repeated/chronic stress-responding) and metabolic dysregulation (MetD; a measure of metabolic health and precursor to many medical illnesses). Though AL and MetD are associated with poor somatic health outcomes, little is known regarding their relationship with antidepressant-treatment outcomes.MethodsWe determined pre-treatment AL and MetD in 67 healthy controls and 34 unmedicated, medically healthy MDD subjects. Following this, MDD subjects completed 8-weeks of open-label selective serotonin reuptake inhibitor (SSRI) antidepressant treatment and were categorized as 'Responders' (≥50% improvement in depression severity ratings) or 'Non-responders' (&lt;50% improvement). Logistic and linear regressions were performed to determine if pre-treatment AL or MetD scores predicted SSRI-response. Secondary analyses examined cross-sectional differences between MDD and control groups.ResultsPre-treatment AL and MetD scores significantly predicted continuous antidepressant response (i.e. absolute decreases in depression severity ratings) (p = 0.012 and 0.014, respectively), as well as post-treatment status as a Responder or Non-responder (p = 0.022 and 0.040, respectively), such that higher pre-treatment AL and MetD were associated with poorer SSRI-treatment outcomes. Pre-treatment AL and MetD of Responders were similar to Controls, while those of Non-responders were significantly higher than both Responders (p = 0.025 and 0.033, respectively) and Controls (p = 0.039 and 0.001, respectively).ConclusionsThese preliminary findings suggest that indices of metabolic and hypothalamic-pituitary-adrenal-axis dysregulation are associated with poorer SSRI-treatment response. To our knowledge, this is the first study to demonstrate that these markers of medical disease risk also predict poorer antidepressant outcomes.</p>},
  author       = {Hough, Christina M. and Bersani, F. Saverio and Mellon, Synthia H. and Morford, Alexandra E. and Lindqvist, Daniel and Reus, Victor I. and Epel, Elissa S. and Wolkowitz, Owen M.},
  issn         = {0033-2917},
  language     = {eng},
  month        = {05},
  publisher    = {Cambridge University Press},
  series       = {Psychological Medicine},
  title        = {Pre-treatment allostatic load and metabolic dysregulation predict SSRI response in major depressive disorder : A preliminary report},
  url          = {http://dx.doi.org/10.1017/S0033291720000896},
  doi          = {10.1017/S0033291720000896},
  year         = {2020},
}