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The network structure of core depressive symptom-domains in major depressive disorder following antidepressant treatment: a randomized clinical trial

Published online by Cambridge University Press:  21 April 2020

Marcelo T. Berlim ,
Stephane Richard-Devantoy ,
Nicole Rodrigues dos Santos  and
Gustavo Turecki
Marcelo T. Berlim*
Affiliation:
Depressive Disorders Program & McGill Group for Suicide Studies, McGill University & Douglas Mental Health University Institute, Montréal, Québec, Canada
Stephane Richard-Devantoy
Affiliation:
Depressive Disorders Program & McGill Group for Suicide Studies, McGill University & Douglas Mental Health University Institute, Montréal, Québec, Canada
Nicole Rodrigues dos Santos
Affiliation:
Depressive Disorders Program & McGill Group for Suicide Studies, McGill University & Douglas Mental Health University Institute, Montréal, Québec, Canada
Gustavo Turecki
Affiliation:
Depressive Disorders Program & McGill Group for Suicide Studies, McGill University & Douglas Mental Health University Institute, Montréal, Québec, Canada
*
Authors for correspondence: Marcelo T. Berlim, E-mail: marcelo.berlim@mcgill.ca; Gustavo Turecki, E-mail: gustavo.turecki@mcgill.ca
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Abstract

Background

Network analysis (NA) conceptualizes psychiatric disorders as complex dynamic systems of mutually interacting symptoms. Major depressive disorder (MDD) is a heterogeneous clinical condition, and very few studies to date have assessed putative changes in its psychopathological network structure in response to antidepressant (AD) treatment.

Methods

In this randomized trial with adult depressed outpatients (n = 151), we estimated Gaussian graphical models among nine core MDD symptom-domains before and after 8 weeks of treatment with either escitalopram or desvenlafaxine. Networks were examined with the measures of cross-sectional and longitudinal structure and connectivity, centrality and predictability as well as stability and accuracy.

Results

At baseline, the most connected MDD symptom-domains were fatigue–cognitive disturbance, whereas at week 8 they were depressed mood–suicidality. Overall, the most central MDD symptom-domains at baseline and week 8 were, respectively, fatigue and depressed mood; in contrast, the most peripheral symptom-domain across both timepoints was appetite/weight disturbance. Furthermore, the psychopathological network at week 8 was significantly more interconnected than at baseline, and they were also structurally dissimilar.

Conclusion

Our findings highlight the utility of focusing on the dynamic interaction between depressive symptoms to better understand how the treatment with ADs unfolds over time. In addition, depressed mood, fatigue, and cognitive/psychomotor disturbance seem to be central MDD symptoms that may be viable targets for novel, focused therapeutic interventions.

Keywords

Antidepressant treatmentdepressive symptomsmajor depressionnetwork analysis
Type
Original Article
Information
Psychological Medicine , Volume 51 , Issue 14 , October 2021 , pp. 2399 - 2413
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Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

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Footnotes

*

Co-corresponding authors.

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