Major depressive disorder (MDD) is a significant neurological disorder that imposes a substantial burden on society, characterized by its high recurrence rate and associated suicide risk. Clinical diagnosis, which relies on interviews with psychiatrists and questionnaires used as auxiliary diagnostic tools, lacks precision and objectivity in diagnosing MDD. To address these challenges, this study proposes an assessment method based on EEG. It involves calculating the phase lag index (PLI) in alpha and gamma bands to construct functional brain connectivity. This method aims to find biomarkers to assess the severity of MDD and suicidal ideation. The convolutional inception with shuffled attention network (CISANET) was introduced for this purpose. The study included 61 patients with MDD, who were classified into mild, moderate, and severe levels based on depression scales, and the presence of suicidal ideation was evaluated. Two paradigms were designed for the study, with EEG analysis focusing on 32 selected electrodes to extract alpha and gamma bands. In the gamma band, the classification accuracy reached 77.37% in the visual paradigm and 80.12% in the auditory paradigm. The average accuracy in classifying suicidal ideation was 93.60%. The findings suggest that gamma bands can be used as potential biomarkers differentiating illness severity and identifying suicidal ideation of MDD, and that objective assessment methods can effectively assess MDD The objective assessment method can effectively assess the severity of MDD and identify suicidal ideation of MDD patients, which provides a valuable theoretical basis for understanding the biological characteristics of MDD.

Background: The study was designed to investigate the associations between social withdrawal, emotional symptoms, and suicide ideation in patients with major depressive disorder (MDD).Methods: This cross-sectional study included 2678 MDD patients from the National Survey on Symptomatology of Depression (NSSD). Differences in the sociodemographic factors, clinical characteristics, suicide ideation, and emotional symptoms were compared in patients with different frequencies of social withdrawal. Pearson correlation, multiple linear regression analysis, and mediation analysis were employed to assess the contribution of social withdrawal to suicide ideation.Results: MDD patients with a higher frequency of social withdrawal were prone to have a higher frequency of suicide ideation (p for trend <0.001) and history of suicide behavior (p for trend <0.001). Multiple linear regression analysis showed that there was a dose-response relationship between social withdrawal and suicide ideation in MDD patients, but this association became insignificant after adjusting for emotional symptoms. Mediation analysis suggested that all of the emotional symptoms had significant mediating effects on the association between social withdrawal and suicide ideation in MDD patients (p < 0.05). The magnitude of mediation varied between 4.3 % and 64.3 %, with the largest mediating effect in the feeling of despair (64.3 %), helplessness (41.2 %), and loneliness (40.0 %). Conclusion: Our study provides evidence that social withdrawal was a common clinical presentation and it may increase the risk for suicide through emotional symptoms in MDD patients. Limitations: Causal conclusions could not be drawn between social withdrawal, emotional symptoms, and suicide ideation because of the cross-sectional design of the study.

To the Editor: Major depressive disorder (MDD) is a mood disorder characterized by complex patterns of emotional, cognitive, and behavioral symptomology and deficits in daily functioning. Genital symptoms, including a reduction in libido and menstrual disturbances, have been considered to be a classic symptom of MDD for many decades. Previous evidence has drawn a broad consensus that the incidence of genital symptoms is higher in patients with MDD than in the general population. A systematic review and meta-analysis found a bidirectional association between MDD and genital symptoms, with patients with MDD showing a 50–70% increased risk of developing genital symptoms, while individuals with genital symptoms had a 130–210% increased risk of developing MDD.[1] As previously reported, 50–70% of people with MDD experience sexual dysfunction.[2] To date, few studies have focused on the comparison of clinical features between patients with MDD with and without genital symptoms, and the longitudinal prognosis. Data were from the Algorithm Guided Treatment Strategies for Major Depressive Disorder (AGTs-MDD) study, which was registered with ClinicalTrials.gov (https://clinicaltrials.gov/; NCT01764867). The research was approved by the Institutional Review Board of Shanghai Mental Health Center (No.2012-42), and all respondents provided written informed consent. In brief, 1746 subjects were screened from eight mental health institutes from 2012 to 2014, of which 964 were diagnosed with MDD according to the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition Text Revision (DSM-IV-TR) criteria. Finally, 845 subjects were enrolled and randomized into the AGT (escitalopram or mirtazapine treatment) or TAU (treatment as usual) group, as described in previous publication.[3] All patients completed the Depression and Somatic Symptoms Scale (DSSS), the 17-item Hamilton Depression Rating Scale (HAM-D), the Hamilton Anxiety Rating Scale (HAM-A), the Quality of Life (QoL) scale, and the Global Assessment Function (GAF) scale at baseline. The DSSS, HAM-D, HAM-A, and QoL scales were completed at every follow-up timepoint. In this study, individuals with a HAM-D score below 14 or a lack of major baseline data were excluded. Subjects experiencing first MDD episode were included. We examined the genital symptoms of subjects using the 14th item of the HAM-D scale. Those who scored 0 points were defined as patients with no genital symptoms (NGS), while those who scored ≥1 point were included in the genital symptoms group (GS). Finally, 325 patients (GS = 177, NGS = 148) with completed baseline information were included, of whom 243 participants completed the 2-week follow-up (GS = 136, NGS = 107), 208 completed the 4-week follow-up (GS = 115, NGS = 93), 176 completed the 6-week follow-up (GS = 99, NGS = 77), 136 completed the 8-week follow-up (GS = 73, NGS = 63), and 125 completed the 12-week follow-up (GS = 67, NGS = 58). The total HAM-D score and its score reduction rate were used to assess the treatment responses of subjects. All continuous data are expressed as mean and standard deviation (SD) or median with interquartile range as appropriate, and all categorical data are expressed by frequency and percentage. Where data were normally distributed, a parametric Student’s t-test was used to statistically analyze the data. Otherwise, a Mann–Whitney U test was used. Chi-square tests were applied to categorical data. A univariate binary logistic regression was used to analyze the associations between patients’ genital symptoms and other clinical characteristics. Then, a multivariate logistic regression was used with adjustment of age, sex, and body mass index (BMI). Generalized linear mixed models (GLMM) were adopted to analyze treatment outcomes during the 12-week longitudinal follow-up, and a pairwise contrast was performed using the Bonferroni method. Two-sided tests and an overall alpha level of 0.05 were employed for all primary hypotheses. IBM SPSS Statistics 25 software (IBM Corp, Armonk, NY, USA) was used to conduct statistical analyses. In total, 325 patients with MDD were enrolled in this study, with 177 in the GS group and 148 in the NGS group, with a median age of 31.0 (14.0) years and 29.0 (26.0) years, respectively. BMI and education years showed no statistical difference between the GS and NGS groups. There was no statistical difference in the sex distribution (male: 37.3% [66/177] vs. 40.5% [60/148], χ2 = 0.359, P = 0.549) or medication types (χ2 = 2.278, P = 0.320) between the two groups. Compared with the NGS group, subjects in the GS group had higher scores on the HAM-D (22.0 [7.0] vs. 19.0 [5.0], Z = 4.969, P <0.001), HAM-A (17.0 [9.0] vs. 16.0 [7.0], Z = 2.755, P = 0.006), and DSSS (26.0 [18.0] vs. 22.0 [8.0], Z = 4.074, P <0.001), and lower scores on the GAF (55.0 [10.0] vs. 60.0 [13.0], Z = 2.804, P = 0.005) and QoL (14.67 ± 3.08 vs. 15.54 ± 2.90, t = 2.612, P = 0.009) scales [Supplementary Table 1, https://links.lww.com/CM9/B826]. A univariate binary logistic regression analysis was used to investigate the association between baseline genital symptoms and other clinical characteristics from each item of the HAM-D, HAM-A, and QoL scales. Among all the features, guilt (odd ratio [OR] = 1.46, 95% confidence interval [CI]: 1.15–1.87, P = 0.002), anxiety-somatic (OR = 1.24, 95% CI: 1.01–1.54, P = 0.045), loss of weight (OR = 1.32, 95% CI: 1.01–1.74, P = 0.045), intelligence (OR = 1.37, 95% CI: 1.08–1.74, P = 0.010), cardiovascular symptoms (OR = 1.41, 95% CI: 1.12–1.78, P = 0.003), respiratory symptoms (OR = 1.36, 95% CI: 1.08–1.70, P = 0.009), mental condition (OR = 0.68, 95% CI: 0.47–0.99, P = 0.043), and family relationship (OR = 0.71, 95% CI: 0.56–0.90, P = 0.004) showed statistically significant associations with genital symptoms in patients with MDD. The associations were subsequently adjusted for age, sex, and BMI via a multivariate logistic regression analysis. After adjustment, guilt (OR = 1.48, 95% CI: 1.16–1.90, P = 0.002), anxiety-somatic (OR = 1.25, 95% CI: 1.00–1.55, P = 0.046), loss of weight (OR = 1.33, 95% CI: 1.01–1.77, P = 0.045), intelligence (OR = 1.38, 95% CI: 1.08–1.76, P = 0.009), cardiovascular symptoms (OR = 1.41, 95% CI: 1.12–1.78, P = 0.004), respiratory symptoms (OR = 1.38, 95% CI: 1.09–1.73, P = 0.007), mental condition (OR = 0.66, 95% CI: 0.45–0.97, P = 0.034), and family relationship (OR = 0.71, 95% CI: 0.56–0.91, P = 0.007) displayed significant correlations with patients’ genital symptoms, which was similar to the results of the non-adjusted analysis [Supplementary Table 2, https://links.lww.com/CM9/B826]. Four GLMMs were conducted with the outcome measurements (scores of HAM-D, HAMA, DSSS and HAM-D score reduction rate) as dependent variable respectively. Compared with NGS, GS is associated with higher scores of DSSS (F = 8.415, P <0.004) and HAM-D (F = 9.558, P <0.002), while no significance of the interaction effect of group and time was found. During the 2nd week of the study, the HAM-D score of the GS group was higher than that of the NGS group (15.07 ± 6.51 vs. 12.65 ± 5.83, t = 2.293, P = 0.004). Moreover, both the HAM-A (13.57 ± 7.16 vs. 11.35 ± 6.10, t = 2.538, P = 0.011) and DSSS (19.61 ± 10.41 vs. 15.35 ± 8.81, t = 3.194, P = 0.001) scores of the GS group were higher than those of the NGS group. At the 4-week follow-up, the GS group still had higher HAM-D and DSSS scores compared to the NGS group (11.30 ± 5.89 vs. 8.92 ± 4.94, t = 2.337, P = 0.002; 14.89 ± 8.96 vs. 11.68 ± 8.63, t = 2.850, P = 0.004; respectively). At the 6-week follow-up, the two groups showed no difference in the results of the clinical scales. The score reduction rate of the HAM-D displayed no difference between GS and NGS groups during the entire follow-up period [Supplementary Figure 1, https://links.lww.com/CM9/B826]. We analyzed the changes in genital symptoms in GS group over the follow-up period according to medication choices by the method of GLMM. The model showed significant difference with time as the fixed effect (F = 26.439, P <0.001), while no differences were found when it came to medication (F = 2.377, P = 0.094) and the interaction of time and medication (F = 0.982, P = 0.457). Pairwise contrast exhibited that the TAU group had a better improvement from genital symptoms than escitalopram (t = 2.111, P = 0.035) and mirtazapine (t = 2.277, P = 0.023) groups afrer 2-week treatment, as well as better recovery than the escitalopram (t = 2.502, P = 0.013) group after 4-week treatment. The study yielded three important findings. First, in comparison to patients without genital symptoms, those with GS had higher HAM-D, HAM-A, and DSSS scores, as well as lower GAF and QoL scores. Second, guilt, loss of weight, intelligence, cardiovascular symptoms, and respiratory symptoms on the HAM-D and HAM-A scales, and the mental condition and family relation item on the QoL scale were associated with genital symptoms in MDD patients. Finally, the GS group exhibited higher HAM-D and DSSS scores after two weeks of treatment, as well as at the 4-week follow-up, indicating that those with genital symptoms would experience a slower recovery from depressive and somatic symptoms in the acute phase of treatment. For both men and women, antidepressants may induce genital symptoms, involving all phases of sexual activity, including desire, arousal, and orgasm. Antidepressant-induced sexual dysfunction is one of the most under-reported adverse effects of antidepressants. The mechanism underlying antidepressant-induced sexual dysfunction is complex. Among major antidepressant mechanism related neurotransmitters, serotonin (5-HT) is considered to negatively affect sexual function, while dopamine and noradrenaline agonism have been reported to have positive effects on sexual function. Therefore, selective 5-HT reuptake inhibitors (SSRIs) are reported to have a high risk of inducing sexual dysfunction.[4] A previous meta-analysis concluded that escitalopram and paroxetine conferred a higher risk of sexual dysfunction than fluoxetine, mirtazapine, venlafaxine, or bupropion.[5] Therefore, for better implementation of individualized treatment, it is important to assess genital symptoms before and after treatment with antidepressants, which might provide psychiatrists with some clues for antidepressant selection. This study found that MDD patients with genital symptoms experience more severe depressive symptoms, which remind physicians of paying attention to the genital symptoms of patients with MDD and the clinical decision-making and strategies associated with medication choices. There are several limitations in this study that should be addressed. Except item 14 of the HAM-D scale, no specific genital symptoms assessment scales were included, such as the Female Sexual Function Index (FSFI) and Arizona Sexual Experience Scale (ASEX), to divide patients with or without genital symptoms. An additional study design is needed to further explore sexual-related conditions in patients with MDD. Second, a bias may not be ruled out because HAM-D scores were used as the outcome measurement, while patients were grouped according to item 14 of the HAM-D scale. To reduce the bias, we also used DSSS and HAM-A scores as outcome variables. Finally, the sample size of this study was relatively small. In conclusion, among MDD patients, those with genital symptoms had more severe depressive and somatic symptoms, and experienced worse QoL than those without such symptoms. In clinical practice, psychiatrists should pay attention to the genital-related symptoms of patients with MDD and ensure they complete a full course of medication. Conflicts of interest None.

The study aimed to explore the influence of gender on the prevalence of various somatic symptoms and their associations with suicidal ideation (SI) among patients with major depressive disorder (MDD). We recruited 3,275 patients with MDD from the National Survey on Symptomatology of Depression (NSSD), among whom 1,745 patients had SI. The clinical characteristics and the prevalence of somatic symptoms across 20 dimensions in MDD patients with SI were compared between male and female patients. Spearman correlation analysis and logistic regression analysis were used to explore the relationship between somatic symptoms and SI. In patients with SI, 32.2

BACKGROUND:To explore the demographic and clinical features of current depressive episode that discriminate patients diagnosed with major depressive disorder (MDD) from those with bipolar I (BP-I) and bipolar II (BP-II) disorder who were misdiagnosed as having MDD . METHODS:The Mini-International Neuropsychiatric Interview (MINI) assessment was performed to establish DSM-IV diagnoses of MDD, and BP-I and BP-II, previously being misdiagnosed as MDD. Demographics, depressive symptoms and psychiatric comorbidities were compared between 1463 patients with BP-I, BP-II and MDD from 8 psychiatric settings in mainland China. A multinomial logistic regression model was performed to assess clinical correlates of diagnoses. RESULTS:A total of 14.5% of the enrolled patients initially diagnosed with MDD were eventually diagnosed with BP. Broad illness characteristics including younger age, higher prevalence of recurrence, concurrent dysthymia, suicidal attempts, agitation, psychotic features and psychiatric comorbidities, as well as lower prevalence of insomnia, weight loss and somatic symptoms were featured by patients with BP-I and/or BP-I, compared to those with MDD. Comparisons between BP-I and BP-II versus MDD indicated distinct symptom profiles and comorbidity patterns with more differences being observed between BP-II and MDD, than between BP-I and MDD . CONCLUSION:The results provide evidence of clinically distinguishing characteristics between misdiagnosed BP-I and BP- II versus MDD. The findings have implications for guiding more accurate diagnoses of bipolar disorders.

Background This study aimed to explore gender differences in associations between cognitive symptoms and suicidal ideation (SI) among patients with recurrent major depressive disorder (MDD). Methods We recruited 1222 patients with recurrent MDD from the National Survey on Symptomatology of Depression (NSSD), a survey designed to investigate the symptoms experienced during current major depressive episodes in China. A four-point Likert questionnaire was used to assess the frequency of cognitive symptoms and SI in the past two weeks. Results Gender differences in clinical features and cognitive symptoms of participants with recurrent MDD were found. Specifically, male patients had a higher prevalence of memory loss, decreased verbal output, indecisiveness, and impaired interpersonal relationships, while female patients exhibited a higher prevalence of impaired social and occupational functioning (all P < 0.05). No significant difference in SI prevalence was found between male and female patients. The logistic regression analysis revealed that in male patients, SI was associated with indecisiveness and impaired interpersonal relationships. In female patients, reduced verbal output and impaired social and professional functions were also associated with SI in addition to the above-mentioned variables. Conclusion The findings of gender differences in associations between cognitive symptoms and SI highlight the need to carefully assess gender-specific cognitive predictors of SI in patients with recurrent MDD. This has further implications for more targeted prevention and treatment strategies for SI based on gender.

Patients with treatment-resistant depression (TRD) have fewer treatment options and worse prognoses than those without TRD. Although the etiology or pathophysiology of TRD remains unclear, certain clinical variables have been found to be related to its severity and prognosis. Therefore, 1151 patients with recurrent depression were recruited from the National Survey on Symptomatology of Depression (NSSD) and their depressive symptoms were assessed by using the doctor-rating assessment questionnaire. Then, the differences between patients with or without TRD were compared by parametric or nonparametric tests and the risk factors for TRD were explored by logistic regression. The results showed there were differences in clinical variables between patients with and without TRD. Additionally, we found depression with more somatic symptoms had a higher risk for TRD. Further analysis by stepwise logistic regression showed that age, gender, religious belief, drinking habit, the total course of depression, the number of hospitalizations, characteristics of seasonal episode remission, depressed mood, hypersexuality, emotionally incoherent psychotic symptoms, psychomotor agitation, respiratory system symptoms and history of suicide attempts were strongly associated with TRD. So, it is crucial for clinicians to identify these clinical features and adjust treatments timely.

Background: The age of onset (AOO) is a key factor for heterogeneity in major depressive disorder (MDD). Looking at the effect of AOO on symptomatology may improve clinical outcomes. This study aims to examine whether and how AOO affects symptomatology using a machine learning approach and latent profile analysis (LPA). Methods: The study enrolled 915 participants diagnosed with MDD from eight hospitals across China. Depressive symptoms were assessed using the 17-item Hamilton Depression Rating Scale. The relationship between symp-tom profiles and AOO was explored using Random Forest. The effect of AOO on symptom clusters and subtypes was investigated using multiple linear regression and LPA. A continuous AOO indicator was used to conduct the analyses.Results: Based on the Random Forest, symptom profiles were closely associated with AOO. The regression model showed that the severity of neurovegetative symptoms was positively associated with AOO (beta = 0.18, p < 0.001), and the severity of cognitive-behavioral symptoms was negatively associated with AOO (beta =-0.12, p < 0.001). LPA demonstrated that the subgroups characterized by suicide and guilt had earlier onset of depression. The subgroup with the lowest global severity of depression had the latest onset.Limitations: AOO was recalled retrospectively. The relative scarcity of participants with childhood and adoles-cence onset depression.Conclusions: AOO has an important impact on symptomatology. The findings may enhance clinical evaluations for MDD and assist clinicians in promoting earlier detection and individualized care in vulnerable individuals.

Background: Anhedonia and cognitive impairment are core features of major depressive disorder (MDD), and are essential to the treatment and prognosis. Here, we aimed to investigate anhedonia and its cognitive correlates between first episode of depression (FED) and recurrent depression (RD), which was part of the National Survey on Symptomatology of Depression. Methods: In this study, 1400 drug naive FED patients and 487 on medicine RD patients were included. Differences of anhedonia, cognitive symptoms and other clinical characteristics between groups were compared via Student's t-test, or the chi-square test as appropriate. Partial correlation analysis was used to analyze the correlations between anhedonia and cognitive symptoms after adjusting for potential confounders. A stepwise logistic regression analysis was performed to identify relapse risk factors among symptomatic variables, demographic factors, clinical characteristics and medication use. Results: Compared to FED, RD patients displayed more comprehensive depressive, impaired cognitive and anhedonia symptoms. Cognitive symptoms were significantly related with the anhedonia symptoms with varying aspects. Patients taking emotional stabilizers displayed more abnormal cognitive symptoms, followed by benzodiazepines, and finally SSRIs, SNRIs and TCAs. The effect of drug use on anhedonia is not as extensive as that of cognitive symptoms. Conclusion: Collectively, the results of this investigation advance the knowledge on changes in anhedonia and cognitive symptoms in MDD. Limitations: As this is a cross sectional study, it is difficult to draw any causal conclusions between cognitive impairment and anhedonia in MDD, and to ascertain the worse cognitive performances identified here were induced by current drug use.

Background: This research was designed to investigate Algorithm Guided Treatment (AGT) and clinical traits for the prediction of antidepressant treatment outcomes in Chinese patients with major depressive disorder (MDD).Methods: This study included 581 patients who had reached treatment response and 406 patients remained non-responded observed after three months of treatment. Sociodemographic factors, clinical traits, and psychiatric rating scales for evaluating therapeutic responses between the two groups were compared. Logistic regression analysis was adopted to determine the risk factors of unresponsive to antidepressant (URA) in MDD. Kaplan-Meier survival analysis was utilized to compare the therapeutic response between AGT and treatment as usual (TAU).Results: Compared to the MDD responsive to antidepressant (RA) group, the URA group had significantly lower rates of the following clinical traits: married status, anxious distress, moderate to severe depressive symptoms, and higher rates of comorbidity (p-value < 0.05). Logistic Regression Analysis showed that eight clinical traits from psychiatric rating scales, such as anxious characteristics, were correlated positively with URA, while the other eight symptoms, such as autonomic symptoms, were negatively correlated. Time to symptomatic remission was longer in TAU without statistically significant (p-value = 0.11) by log-rank testing.Conclusions: The factors may affect the therapeutic responses and compliance of patients, increasing the non-response risk for antidepressants. Therapeutic responses might be improved by increasing the clarification and elucidation of different symptom clusters of patients. Benefits on treatment response to AGT were not found in our study, indicating a one-size-fits-all approach may not work.

Objective: To explore clinical characteristics and symptomatology of major depressive disorder (MDD) with atypical features based on DSM criteria or only reversed vegetative symptoms. Method: A total of 3187 patients who met DSM-IV TR criteria for MDD were enrolled. Demographics and symptomatology covering multiple symptom domains were assessed and compared between three groups of cases: those who met DSM criteria for atypical specifier (the DAD group), those who had at least one reversed vegetative symptoms (hypersomnia or hyperphagia) (the SAD group) without meeting DSM atypical specifier criteria, and those without any reversed vegetative symptoms (the NAD group). Results: The DAD and SAD group accounted for 4.4% and 14.4% of the participants, respectively. The DAD cases were characterized by a highest proportion of hospitalizations, longest duration of current episode and worst quality of life. The DAD and SAD cases were more likely to adopt unhealthy behaviors (smoking and alcohol drinking). Most depressive symptoms related to higher illness severity and treatment resistance were more frequent in the DAD cases, followed by the SAD cases, and least frequent in the NAD cases. Limitations: A cross-sectional design and a non-validated questionnaire were used. Conclusions: The findings support the role of DSM defined atypical depression as a valid MDD subtype and provide evidence for clinical utility of the simplified approach of defining atypical features based on only reversed vegetative symptoms. This has implications for illness screening, public health, suicide prevention and better treatment planning for depressed individuals with atypical features even below syndromal level.

Objective This survey aims to explore the current medical treatment of major depressive disorder (MDD) in China and match its degree with Canadian Network for Mood and Anxiety Treatments (CANMAT). Methods A total of 3275 patients were recruited from 16 mental health centers and 16 general hospitals in China. Descriptive statistics presented the total number and percentage of drugs, as well as all kinds of treatments. Results Selective serotonin reuptake inhibitors (SSRIs) accounted for the largest proportion (57.2%), followed by serotonin-noradrenaline reuptake inhibitors (SNRIs) (22.8%) and mirtazapine (7.0%) in the first therapy, while that of SNRIs (53.9%) followed by SSRIs (39.2%) and mirtazapine (9.8%) in the follow-up therapy. An average of 1.85 medications was administered to each MDD patient. Conclusion SSRIs were the first choice in the first therapy, while the proportion of those drugs decreased during the follow-up therapy and were replaced by SNRIs. Plenty of combined pharmacotherapies were directly selected as the first trial of patients, which was inconsistent with guideline recommendations.

Background: In spite of numerous options, the most efficacious treatment for major depressive disorder (MDD) remains elusive. Algorithm-guided treatments (AGTs) are proposed to address inadequate remission and optimize treatment delivery. This study aimed to evaluate the clinical benefit of AGTs for MDD, and to explore specific moderators of treatment outcomes for individual patients. Methods: The study recruited 987 patients with MDD across eight hospitals who were randomly assigned to AGT with escitalopram (AGT-E), AGT with mirtazapine (AGT-M), or treatment-as-usual (TAU). The outcomes were symptom remission, response rate, early improvement rate, subsymptom clusters improvement over time, the mean time to first remission, relapse rate at 6-months posttreatment follow-up, quality of life (QOL), and adverse events. Resutls: No significant differences were observed across groups in outcome, except that TAU showed significantly poorer QOL, higher relapse rates at 6-months posttreatment follow-up, and marginally significantly worse maximal burden of adverse events than the AGT groups. After 6 weeks of treatment initiation, remission rate did not significantly increase with extended treatment. AGT-M outperformed the TAU and AGT-E in treating sleep symptoms. AGT-E was less effective than AGT-M and TAU in patients with severe depression and somatic symptoms (DSSS). The superiority of TAU over AGTs was observed in recurrent MDD patients. Conclusion: Although the superiority of AGTs over TAU was limited by failure of alternative subsequent treatment, AGTs outperformed in QOL and relapse rate. Types of disease episode and DSSS were regarded as specific moderators in treatment of depression. These findings might contribute to future research on targeted antidepressant treatment.

Background:Two-thirds of major depressive disorder (MDD) patients initially present with somatic symptoms, yet no study has used approaches based on somatic symptoms to subtype MDD. This study aimed to classify MDD via somatic symptoms and tracked the prognosis of each subtype.Methods:Data were obtained from the study of Algorithm Guided Treatment Strategies for Major Depressive Disorder (AGTs-MDD). We recruited 395 subjects who received monotherapy of mirtazapine or escitalopram and conducted 2-, 4-, 6-, 8-, and 12-week follow-up assessments (n = 311, 278, 251, 199, and 178, respectively). Latent profile analysis (LPA) was performed on somatic symptom items of the depression and somatic symptoms scale (DSSS). Generalized linear mixed models (GLMM) were used to study the longitudinal prognosis of the subtypes classed by LPA. Primary outcome measures were the Hamilton Depression Rating Scale (HAMD), HAMD score reduction rate, as well as somatic and depressive items of DSSS.Results:Three subtypes of MDD were found, namely, depression with mild somatic symptoms (68.9%), depression with moderate somatic symptoms (19.2%), and depression with severe somatic symptoms (11.9%). Scores of HAMD (F = 3.175, p = 0.001), somatic (F = 23.594, p < 0.001), and depressive (F = 4.163, p < 0.001) DSSS items throughout the 12-week follow-up showed statistical difference among the three subtypes. The moderate group displayed a higher HAMD-17 score and a lower reduction rate at the 6th week, and more severe depressive symptoms both at the 4th and 6th weeks.Conclusion:The results indicate that somatic symptoms should be emphasized in patients with MDD, and more attention is needed for those with moderate somatic symptoms, which may be relevant to a worse prognosis.

Background: Biological rhythm plays an important role in major depressive disorder (MDD). The efficacy of antidepressant in biological rhythm remains unclear. This study is designed to explore the efficiency of escitalopram and mirtazapine in improving circadian rhythm, diurnal mood variation(DMV) and daily activity in MDD patients. Methods: Four-hundred and fifty participants diagnosed with MDD were randomized to receive treatment with escitalopram (TWE), treatment with mirtazapine (TWM) or treatment as usual (TAU). Biological rhythm symptoms were assessed by relevant biological subscale in the Hamilton depression scale (HAMD) and the quick inventory of depressive symptomatology self-report (QIDS). The participants were assessed by trained evaluators at baseline and week 2, 4, 6 and 8. Results: The differences of HAMD score among TWE(58%, 69%, 72%), TWM(56%, 64%, 76%) and TAU(49%, 57%, 68%) were significant(P<0.05). But the differences were significant only in patients without DMV; (2) Sleep rhythm items (difficulty falling asleep and early-wake) were significantly improved in TWM (P <0.05) for both HAMD and QIDS. Decreased appetite and weight were significantly improved in TWM (P<0 .05) for both scales. (3) For daily activity-related items, feeling slowed down and concentration were significantly improved in TWE. And the retardation was significantly improved in TWE and in TWM. Conclusions: Both escitalopram and mirtazapine have superior anti-depressive effect, especially for MDD patients without DMV. Escitalopram was significantly more effective in daily activity, feeling slowed down and concentration difficulty, while mirtazapine was significantly more effective in improving sleep, appetite and weight of MDD.

Background: The study was designed to investigate the associations between gastrointestinal (GI) symptoms, medication use, and spontaneous drug discontinuation (SDD) in patients with major depressive disorder (MDD).Methods: This cross-sectional study included 3256 MDD patients from the National Survey on Symptomatology of Depression (NSSD). Differences in the sociodemographic factors, clinical characteristics, medication use, and self-reported reasons for SDD were compared in patients with different frequencies of GI symptoms. A multiple logistic regression analysis was employed to assess the contribution of GI symptoms to the risk of spontaneous drug discontinuation.Results: MDD patients with a higher frequency of GI symptoms were prone to have higher proportions of mood stabilizer and benzodiazepine uses (ps for trend < 0.001) but a lower proportion of SNRI use (pfor trend < 0.001). With the increase in GI symptoms, patients were prone to report worries about long-term side effects (pfor trend < 0.001), with the patients stating ineffective treatments (pfor trend = 0.002) and intolerance of adverse drug reactions (pfor trend = 0.022) as the reasons for SDD. Compared with those patients without GI symptoms, all of the MDD patients with GI symptom frequencies of several days (OR = 1.317; 95 % CI: 1.045-1.660), more than half of all days (OR = 1.305; 95 % CI: 1.005-1.695), and nearly every day (OR = 1.820; 95 %: 1.309-2.531) had an increased risk of SDD.Conclusion: GI symptoms are highly associated with drug discontinuation in MDD patients. These findings may have important implications for clinical treatment options, as well as for drug adherence management, in MDD patients.

Purpose: This study examines health literacy among older outpatients in two Community Healthcare Service Centers in Shanghai, China to facilitate the design of public education programs for the aged population on mood disorders (both depression and mania). Patients and Methods: A total of 173 outpatients aged 60 years or more with a chronic physical illness were randomly sampled. A health literacy questionnaire was used to assess participants' awareness of depression and mania. Participants were then asked to label two vignettes depicting depression and mania and to give their recommendations for how to seek help for those in the vignettes and how mood disorders should be managed. Results: In all, 86.1 and 36.4% of participants had heard of depression and mania, respectively, with the most common source of information being relatives and friends. Over half of the participants attributed the possible causes of mood disorders to psychological trauma, pressure or stress in daily life, taking things too hard, and personality problems. Almost two-thirds of participants correctly labeled the depression vignette, but only 26.6% correctly labeled the mania vignette. The most common methods recommended by the participants as being helpful for the individuals portrayed in the vignettes were “traveling” and help-seeking from a psychological therapist/counselor, a psychiatrist, or a close family member or friend. Conclusion: The older individuals attending community healthcare service settings in Shanghai have good depression literacy but relatively poor mania literacy. However, most participants had a positive attitude toward psychiatric treatment for mood disorders.

<span id="ChDivSummary" name="ChDivSummary" class="abstract-text">临床心理评估中的治疗性效应受到国外心理学工作者的重视,在研究中得以证实并临床实践应用。本文介绍临床心理评估中治疗性评估（Therapeutic Assessment,TA）的提出与发展、特点、实施步骤,目前研究状况及应用范围等内容,探讨了治疗性效应的机制,启发我国当前心理评估及临床实践重视治疗性效应。</span>

忧郁/快感缺失型抑郁症是抑郁症的重要类型之一,临床表现以兴趣或愉快感缺失为主,其病理机制、治疗反应与非忧郁型抑郁症可能不同.本指导建议通过系统复习文献,为忧郁/快感缺失型抑郁症的评估、诊断和治疗提供循证依据,其中治疗推荐是基于证据质量和临床专家共识.阿戈美拉汀、氟西汀、舍曲林、文拉法辛、度洛西汀、安非他酮、伏硫西汀和重复经颅磁刺激(辅助治疗)可以考虑作为忧郁/快感缺失型抑郁症患者治疗的一线推荐.