Journal of affective disorders最新文献

{"title":"Consistent differential effects of bupropion and mirtazapine in major depression","authors":"Eric V. Strobl","doi":"10.1016/j.jad.2025.119551","DOIUrl":"10.1016/j.jad.2025.119551","url":null,"abstract":"<div><h3>Background</h3><div>Patients with major depression exhibit heterogeneous symptom profiles and variable responses to antidepressants. Most clinical trials rely on aggregate outcomes such as total symptom severity or remission rates, which often obscure meaningful differences in treatment response.</div></div><div><h3>Methods</h3><div>We applied the Supervised Varimax (SV) algorithm to identify outcome dimensions that maximally differentiate antidepressants based on symptom-level effects. We analyzed all relevant levels of the STAR*D trial and validated findings in the independent CO-MED study. We assessed statistical significance using permutation testing with familywise error rate (FWER) correction.</div></div><div><h3>Results</h3><div>SV consistently identified interpretable and statistically significant differences between bupropion, mirtazapine, and other antidepressants. In STAR*D, bupropion monotherapy produced greater improvement in hypersomnia than venlafaxine in Levels 2 and 2 A (<span><math><mi>n</mi><mo>=</mo><mn>686</mn></math></span>, difference = <span><math><mn>0.384</mn></math></span>, <span><math><msub><mi>p</mi><mi>FWER</mi></msub><mo>=</mo><mn>0.007</mn></math></span>). Bupropion augmentation outperformed buspirone augmentation for increased weight, increased appetite, and fatigue in Level 2 (<span><math><mi>n</mi><mo>=</mo><mn>520</mn></math></span>, difference = <span><math><mo>−</mo><mn>0.322</mn></math></span>, <span><math><msub><mi>p</mi><mi>FWER</mi></msub><mo>=</mo><mn>0.005</mn></math></span>). Mirtazapine monotherapy outperformed nortriptyline for insomnia, decreased weight, and decreased appetite in Level 3 (<span><math><mi>n</mi><mo>=</mo><mn>214</mn></math></span>, difference = <span><math><mn>0.401</mn></math></span>, <span><math><msub><mi>p</mi><mi>FWER</mi></msub><mo>=</mo><mn>0.022</mn></math></span>), and venlafaxine with mirtazapine similarly outperformed tranylcypromine in Level 4 (<span><math><mi>n</mi><mo>=</mo><mn>102</mn></math></span>, difference = <span><math><mo>−</mo><mn>0.722</mn></math></span>, <span><math><msub><mi>p</mi><mi>FWER</mi></msub><mo>=</mo><mn>0.004</mn></math></span>). In CO-MED, escitalopram with bupropion and venlafaxine with mirtazapine demonstrated complementary symptom-specific benefits (<span><math><mi>n</mi><mo>=</mo><mn>640</mn></math></span>, difference = <span><math><mo>−</mo><mn>0.302</mn></math></span>, <span><math><msub><mi>p</mi><mi>FWER</mi></msub><mo>=</mo><mn>0.022</mn></math></span>).</div></div><div><h3>Conclusion</h3><div>Bupropion is most effective for hypersomnia, increased weight, increased appetite, or fatigue, while mirtazapine is preferable for insomnia, decreased weight, or decreased appetite. SV enables statistically rigorous, symptom-level differentiation using only treatment assignment, offering a scalable and clinically aligned framework for guiding antidepressant selection from individual clinical trials.</div></div>","PeriodicalId":14963,"journal":{"name":"Journal of affective disorders","volume":"388 ","pages":"Article 119551"},"PeriodicalIF":4.9,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144191843","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Estimating the longitudinal causal effect of insufficient sleep on depressive symptoms: Evidence from the CHARLS study","authors":"Yaning Feng ,&nbsp;Zhiyuan Yang ,&nbsp;Xiaobo Lai ,&nbsp;Liangying Yin","doi":"10.1016/j.jad.2025.119543","DOIUrl":"10.1016/j.jad.2025.119543","url":null,"abstract":"<div><h3>Background</h3><div>The relationship between sleep and depression has been extensively explored; however, research on the long-term causal effects of chronic sleep insufficiency on depressive symptoms remains limited. This study employs advanced causal inference techniques to assess the longitudinal impact of sleep insufficiency on depressive symptoms, accounting for both time-invariant and time-varying confounders.</div></div><div><h3>Methods</h3><div>Data from the China Health and Retirement Longitudinal Study (CHARLS) were analyzed. Sleep insufficiency was defined as &lt;6 h of sleep per day. Longitudinal targeted maximum likelihood estimation (LTMLE) was used to examine the impact of persistent sleep insufficiency over 2 to 9 years on depressive symptoms, measured by the CESD-10 scale. Subgroup analyses by gender and age, as well as the effects of napping duration, were also conducted.</div></div><div><h3>Results</h3><div>The study included 4362 participants, with a mean age of 55.90 years (SD = 7.71). At baseline, 924 participants reported insufficient sleep. The average treatment effect (ATE) for depressive symptoms increased initially, peaking at 3.75 points at 7 years, then slightly declining to 3.66 points at 9 years. The ATE was higher in females (4.57) than in males (2.80). Napping for over 30 min was associated with reduced depressive symptoms. Sensitivity analyses confirmed the robustness of these findings.</div></div><div><h3>Conclusions</h3><div>This study provides evidence of the longitudinal causal effect of insufficient sleep on depressive symptoms. Over 9 years, ATE initially increased, plateauing after 7 years. Napping for over 30 min was linked to lower depressive symptoms, especially in those with insufficient nighttime sleep. Subgroup analyses showed stronger effects in females.</div></div>","PeriodicalId":14963,"journal":{"name":"Journal of affective disorders","volume":"387 ","pages":"Article 119543"},"PeriodicalIF":4.9,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144189813","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Antidepressants Use on Cancer Morbidity and Mortality: A Propensity Score-Matched Longitudinal Cohort Study","authors":"Yue Ma ,&nbsp;Jing He ,&nbsp;Chen-yang Li ,&nbsp;Fu-bin Liu ,&nbsp;Yao-gang Wang ,&nbsp;Feng-ju Song","doi":"10.1016/j.jad.2025.119554","DOIUrl":"10.1016/j.jad.2025.119554","url":null,"abstract":"<div><h3>Objective</h3><div>To investigate the association between antidepressant use and cancer risk in a large prospective cohort.</div></div><div><h3>Methods</h3><div>A prospective cohort study involving participants without cancer or cardiovascular disease at baseline in the UK Biobank. Antidepressant users were matched to non-users using propensity score matching (PSM). The primary outcomes included overall cancer morbidity and mortality, with site-specific cancer morbidity as a secondary outcome.</div></div><div><h3>Results</h3><div>The median follow-up was 13.6 years. Of the 421,529 participants, 26,796 were antidepressant users, and 394,733 were non-users. After 1:1 PSM, 26,372 matched pairs were identified. Antidepressant use was associated with a reduced risk of overall cancer morbidity (HR 0.89, 95 % CI 0.85–0.94), particularly for CRC (HR 0.75, 95 % CI 0.65–0.86), and a lower risk of cancer-related mortality (HR 0.91, 95 % CI 0.84–0.99) compared to nonusers. Among antidepressant subtypes, selective serotonin reuptake inhibitors (SSRIs) were associated with a lower risk of overall cancer morbidity, especially fluoxetine, citalopram, and sertraline. SSRIs were also associated with a reduced risk of cancer-related mortality, particularly fluoxetine and citalopram. However, tricyclic antidepressants (TCAs) were linked to an increased risk of cancer-related mortality (HR 1.19, 95 % CI 1.07–1.32), especially for amitriptyline.</div></div><div><h3>Conclusion</h3><div>The use of antidepressants, particularly SSRIs, was associated with a lower risk of cancer morbidity and mortality, whereas the use of TCAs, such as amitriptyline, was linked to an increased risk of cancer-related mortality. Although causal relationships cannot be established, these findings should be interpreted with caution and warrant further investigation.</div></div>","PeriodicalId":14963,"journal":{"name":"Journal of affective disorders","volume":"387 ","pages":"Article 119554"},"PeriodicalIF":4.9,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144184780","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ENaC inhibitors for the management of lithium related polyuria: a systematic review.","authors":"Rebecca Strawbridge, Michael Ott, Ursula Werneke, Molly G Abbott, Anusha Prabhu, Allan H Young, Jonathan M Meyer","doi":"10.1016/j.jad.2025.119542","DOIUrl":"https://doi.org/10.1016/j.jad.2025.119542","url":null,"abstract":"<p><strong>Background: </strong>By entering collecting duct principal cells via the epithelial sodium channel (ENaC), lithium is capable of inducing vasopressin insensitivity, resulting in excessive urine production, nephrogenic diabetes insipidus (NDI) and potential for other long-term forms of renal dysfunction. ENaC inhibitors (ENaC-I) such as amiloride have been shown in animal models to minimise this adverse effect, and while ENaC-I are often considered an effective strategy, the literature on ENaC-I for lithium-related polyuria has not yet been synthesised despite the importance of this topic. This review aimed to identify all published evidence for adjunctive use of an ENaC-I for lithium-related polyuria to estimate its effectiveness while also exploring potential moderators of effectiveness.</p><p><strong>Method: </strong>The systematic search covered databases MEDLINE, EMBASE and PsycINFO complemented by handsearches, aiming to identify all studies of ENaC-I interventions in lithium-treated patients with pre- and post-ENaC-I polyuria as outcomes.</p><p><strong>Results: </strong>10 studies totalling 25 participants were eligible for inclusion and were synthesised narratively. Amiloride was the ENaC-I used in 24/25 participants, and triamterene in the other. 8/10 publications were single case reports, 4 of which presented substantial confounding issues. Clear improvements to polyuria were demonstrated in most papers, including the two larger studies.</p><p><strong>Conclusions: </strong>Although it appears very likely that ENaC inhibitors help ameliorate polyuria in lithium-treated patients, the quantity and quality of evidence is low. Heterogeneity in patient characteristics, intervention characteristics and study designs limit conclusions regarding the contribution of factors likely to influence ENaC-I effectiveness for lithium-induced polyuria. Besides, adverse effects require further exploration.</p>","PeriodicalId":14963,"journal":{"name":"Journal of affective disorders","volume":" ","pages":"119542"},"PeriodicalIF":4.9,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144191844","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Child characteristics and parents' risk of depression in old age: The impact of number, sex and educational attainment","authors":"Anna Becker-Larsen ,&nbsp;Else Foverskov ,&nbsp;Merete Osler ,&nbsp;Terese Sara Høj Jørgensen","doi":"10.1016/j.jad.2025.119538","DOIUrl":"10.1016/j.jad.2025.119538","url":null,"abstract":"<div><h3>Introduction</h3><div>Knowledge about the impact of having adult children on the risk of depression in old age is limited. This study aims to examine the association of having children and their characteristics (number, sex, and education) on their parents' risk of depression in old age.</div></div><div><h3>Methods</h3><div>A main study population of all older adults (<em>N</em> = 1,064,652) born 1935–1953 and living in Denmark at the age of 65, were followed for up to 10 years for incident depression diagnosis or incident use of antidepressant medication in nationwide registers. Associations were estimated using adjusted Cox Proportional Hazards models.</div></div><div><h3>Results</h3><div>During the mean follow-up time of 6.7 years, the incidence rate of depression in the main study population was 196 per 10,000 person-years (IR:196, 95 % CI: [195;197]). Compared to having children, not having children was associated with 8 % (HR: 0.92, 95%CI: [0.90;0.94]) lower HR of depression among older adults. For specific characteristics of adult children, having one child was associated with 3 % (HR: 1.03, 95%CI: [1.02;1.05]) higher HR of depression compared to having 2–3 children. 4+ children and sex of children were not associated with depression. Having adult children with a short or medium education, respectively, as the longest educational attainment were associated with 22 % (HR: 1.22, 95%CI: [1.19;1.25]) and 10 % (HR:1.10, 95%CI: [1.08;1.11]) higher HR of depression compared to having adult children with a long education.</div></div><div><h3>Conclusion</h3><div>Availability and characteristics, especially educational attainment, of adult children were identified to be associated with their parent's probability of being with depression in old age.</div></div>","PeriodicalId":14963,"journal":{"name":"Journal of affective disorders","volume":"388 ","pages":"Article 119538"},"PeriodicalIF":4.9,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144191842","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The association between depressive symptoms and emotional recovery after failure: Considering the role of emotional clarity","authors":"Annabelle Gruffy,&nbsp;Adi Moka,&nbsp;Shimrit Daches","doi":"10.1016/j.jad.2025.119539","DOIUrl":"10.1016/j.jad.2025.119539","url":null,"abstract":"<div><div>Experiencing failure can have a detrimental impact on individuals' emotional well-being, particularly among those exhibiting symptoms of depression. Difficulties in emotion regulation may contribute to the emotional impact of failure, yet most research has focused on the later stages of the emotion regulation process (i.e., the selecting and implementing emotion regulation strategies), while comparatively less attention has been paid to earlier stages, such as identification and labeling the experienced emotions (i.e., emotional clarity). This study examined whether emotional clarity plays a role in the relationship between depressive symptoms and emotional recovery following experiences of failure. Eighty-two participants (<em>M</em> = 22.62 years; SD = 2.05) provided mood and state emotional clarity ratings at baseline, immediately after a failure manipulation, and at a subsequent recovery time-point. Additionally, participants completed self-report scales assessing trait emotional clarity and depressive symptoms. Negative mood significantly increased after the manipulated failure. Depressive symptoms were associated with prolonged negative mood at the recovery time-point, whereas trait emotional clarity was associated with better recovery from negative mood. Importantly, trait emotional clarity (but not state emotional clarity) showed a significant indirect effect on the association between depressive symptoms and recovery from negative mood (<em>b</em> = −0.025; 95 % <em>CI</em> [−0.0545, −0.008]). These findings highlight the potential role of emotional clarity as a mechanism linking depressive symptoms to sustained negative mood, suggesting it may serve as a promising target for intervention efforts.</div></div>","PeriodicalId":14963,"journal":{"name":"Journal of affective disorders","volume":"388 ","pages":"Article 119539"},"PeriodicalIF":4.9,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144191847","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gender-specific differences in the association of HDL and HDL-related oxidative stress indicators with the occurrence of major depressive disorder and bipolar disorder: A large-scale study","authors":"Yanyan Wei ,&nbsp;Chenjiao Zhang ,&nbsp;Bo Sun ,&nbsp;Jingyu Lin ,&nbsp;Yanli Zhao ,&nbsp;Yujie Chen ,&nbsp;Huanqin Gao ,&nbsp;Jinhao Li ,&nbsp;Guoguang Li ,&nbsp;Junhui Feng ,&nbsp;Jinbao Ma ,&nbsp;Jingxu Chen","doi":"10.1016/j.jad.2025.119530","DOIUrl":"10.1016/j.jad.2025.119530","url":null,"abstract":"<div><h3>Objective</h3><div>Numerous studies have demonstrated that High-Density Lipoprotein (HDL) has antioxidant and anti-inflammatory roles. Uric acid to HDL ratio (UHR), non-HDL cholesterol to HDL ratio (NHHR), monocyte to HDL ratio (MHR), neutrophil to HDL ratio (NHR), total cholesterol to HDL ratio (TCHR), triglyceride to HDL ratio (TGHR) can serve as inflammation and oxidative stress markers in multiple diseases. However, few studies have estimated the associations of these indicators with major depressive disorder (MDD) and bipolar disorder (BD) in different genders.</div></div><div><h3>Methods</h3><div>Based on 14,266 patients with MDD or BD and 8308 healthy subjects from China, we analyzed the associations between these indicators and diseases as well as gender.</div></div><div><h3>Results</h3><div>8201 MDD patients, 4069 patients with BD manic episodes (BDM) and 1996 patients with BD depressive episodes (BDD) were included. The HDL-related indicators displayed unique variation patterns across different disease groups and genders. In males, the BDM group displayed highest NHR, MHR, UHR and lowest NHHR and TCHR, lower UHR and NHHR were risk factors of MDD, lower NHHR was risk factors of BDD, higher MHR and lower NHHR were risk factors of BDM. In females, the BDM group displayed highest NHR, MHR and UHR, higher TGHR was risk factor of MDD, higher MHR, TGHR and UHR were risk factors of BDD, higher NHR, MHR, TGHR and UHR were risk factors of BDM.</div></div><div><h3>Conclusions</h3><div>Gender-specific differences in HDL-related profile among BDM, BDD and MDD patients were demonstrated, highlighting gender-specific role of HDL-related indicators in the pathophysiology of MDD and BD.</div></div>","PeriodicalId":14963,"journal":{"name":"Journal of affective disorders","volume":"388 ","pages":"Article 119530"},"PeriodicalIF":4.9,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144191845","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The prevalence, clinical impact, and therapeutic considerations of trauma in adults with bipolar disorder: A systematic review.","authors":"Kelei Xiao, Hisham Sayed, Jason Xing, Xin Yi Zhang, Jeffrey Ai, Kayla M Teopiz, Roger Ho, Taeho Greg Rhee, Heidi Ka Ying Lo, Hernan F Guillen-Burgos, Maj Vinberg, Roger S McIntyre","doi":"10.1016/j.jad.2025.119507","DOIUrl":"https://doi.org/10.1016/j.jad.2025.119507","url":null,"abstract":"<p><strong>Background: </strong>Exposure to severe stressful life events (e.g., physical, sexual, emotional abuse and/or physical or emotional neglect) is common among adults with bipolar disorder (BD) and is associated with poor prognosis and clinical outcomes. This systematic review aims to evaluate the prevalence, clinical impact, and therapeutic considerations of trauma in adults with BD.</p><p><strong>Methods: </strong>A systematic review of primary research was conducted using Embase, PsycInfo, MEDLINE, and PubMed databases from inception to January 2025, following PRISMA criteria. Sixteen human studies evaluating the prevalence, clinical impact, and therapeutic considerations of trauma in adults with BD were included.</p><p><strong>Results: </strong>Prevalence rates of trauma range from approximately 40-60 % of adults with BD. Childhood physical maltreatment is highly associated with comorbidities and symptom severity in adults with BD. Childhood emotional maltreatment is associated with an earlier age of onset, greater illness severity, comorbidity and suicidality in BD. The moderating effects of trauma in BD treatment response across disparate modalities of treatment are not adequately characterized.</p><p><strong>Conclusions: </strong>Trauma, particularly childhood trauma, is prevalent and has a severe negative clinical impact on the presentation, progression, treatment, and outcomes of adults with BD. The research strategic priority is to characterize the biosignature of trauma in BD, the impact of trauma on treatment outcomes, and to empirically evaluate integrated models of care in persons with BD with a history of trauma.</p>","PeriodicalId":14963,"journal":{"name":"Journal of affective disorders","volume":" ","pages":"119507"},"PeriodicalIF":4.9,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144191848","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predicting rTMS treatment response in depression: use of machine learning models to identify the roles of metabolic and clinical factors.","authors":"I Chun Liu, Po I Wu, Bui Van San, Tsung-Hua Lu, Huai-Hsuan Tseng, Sheng-Hsiang Lin, Po See Chen","doi":"10.1016/j.jad.2025.119503","DOIUrl":"https://doi.org/10.1016/j.jad.2025.119503","url":null,"abstract":"<p><strong>Background: </strong>Repetitive transcranial magnetic stimulation (rTMS) is an effective treatment for depression in patients with major depressive disorder (MDD) and bipolar disorder (BD), but accurate prediction of treatment response remains a challenge. This study aims to identify key metabolic and clinical factors that serve as predictors of rTMS efficacy in patients with MDD and BD.</p><p><strong>Methods: </strong>Sixty-eight patients (28 with BD) underwent 12 sessions of rTMS targeting the left dorsolateral prefrontal cortex. After treatment, patients were divided into remission and non-remission groups. Recursive feature elimination (RFE) and four decision tree-based machine learning algorithms were applied to develop prediction models.</p><p><strong>Results: </strong>The Extra Trees classifier was the best predictor of remission at Week 4, with an area under the curve (AUC) of 0.766, accuracy of 0.726, and F1-score of 0.768. Key predictors included body mass index (BMI), baseline Hamilton Depression Rating Scale (HDRS) score, ratio of low-density lipoprotein (LDL) to high-density lipoprotein (HDL), systolic blood pressure (SBP), and high-sensitivity C-reactive protein (hsCRP). At Week 12, the Gradient Boosting model performed best (AUC = 0.863, accuracy = 0.773, F1-score = 0.817). Key predictors included homeostasis model assessment of insulin resistance (HOMA-IR), brain-derived neurotrophic factor (BDNF), Homeostasis Model Assessment of Beta-cell Function (HOMA-beta), total cholesterol, and LDL/HDL ratio.</p><p><strong>Conclusion: </strong>These results suggest that metabolic and clinical factors may serve as predictors of rTMS outcomes, and decision tree-based machine learning models may be utilized for individualized treatment prediction.</p>","PeriodicalId":14963,"journal":{"name":"Journal of affective disorders","volume":" ","pages":"119503"},"PeriodicalIF":4.9,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144187085","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Combined impact of depressive and anxiety symptoms and cardiovascular health metrics on major adverse cardiovascular events: A prospective cohort study","authors":"Si You ,&nbsp;Wan-Bing He ,&nbsp;Bao-Zhu Li ,&nbsp;Yang-Wei Cai ,&nbsp;Ze-Gui Huang ,&nbsp;Hai-Feng Zhang ,&nbsp;Yu-Biao Wu ,&nbsp;Xu-Hui Wu ,&nbsp;Zhao-Yu Liu ,&nbsp;Jing-Feng Wang ,&nbsp;Shao-Ling Zhang ,&nbsp;Jing-Wei Gao ,&nbsp;Pin-Ming Liu","doi":"10.1016/j.jad.2025.119508","DOIUrl":"10.1016/j.jad.2025.119508","url":null,"abstract":"<div><h3>Background</h3><div>The interplay between psychological health and traditional cardiovascular health (CVH) metrics, and their joint impact on the risk of major adverse cardiovascular events (MACE), remain unclear.</div></div><div><h3>Methods</h3><div>This study investigated the prospective association of depressive and anxiety symptoms, assessed by Patient Health Questionnaire-4 (PHQ-4) scores, and traditional CVH, measured by Life's Essential 8 (LE8) scores, with MACE risk in the UK Biobank cohort. MACE was defined as a composite of nonfatal myocardial infarction, nonfatal stroke, and cardiovascular mortality. Cox proportional hazards models evaluated the association of LE8 and PHQ-4 with MACE risk.</div></div><div><h3>Results</h3><div>Among 95,098 participants (mean ± SD age, 55.58 ± 7.75 years; 42,526 [44.72 %] male), 3001 (3.2 %) experienced MACE during a mean follow-up of 12.73 years. Participants with low PHQ-4 scores and ideal CVH had the lowest risk of MACE compared to those with high PHQ-4 scores and poor CVH (HR, 0.263 [95 % CI, 0.183–0.377]). Higher CVH scores were consistently associated with reduced MACE risk, regardless of depressive and anxiety symptoms. Each 10-point increase in LE8 scores was associated with a significantly lower MACE risk in both participants with PHQ-4 scores &lt;6 (HR 0.784, 95 % CI [0.759–0.810]) and with PHQ-4 scores ≥6 (HR 0.782, 95 % CI [0.679–0.901]). These findings remained robust across sensitivity analyses and subgroups.</div></div><div><h3>Conclusions</h3><div>Fewer symptoms of depression and anxiety, alongside optimal CVH, are independently and jointly associated with a lower risk of MACE. Integrating psychological health management with CVH optimization may enhance cardiovascular outcomes and reduce the burden of cardiovascular disease.</div></div>","PeriodicalId":14963,"journal":{"name":"Journal of affective disorders","volume":"387 ","pages":"Article 119508"},"PeriodicalIF":4.9,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144184722","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}