Individual and common patterns in the order of symptom improvement during outpatient treatment for major depression

BACKGROUND: Research so far provided few clues on the order in which depressive symptoms typically remit during treatment. This study examined which depressive symptoms improve first, and whether symptoms changed before, simultaneous with, or after the core symptoms of depression (i.e., sad mood, loss of pleasure, and loss of interest). METHODS: Participants were 176 patients with Major Depressive Disorder (MDD) receiving outpatient treatment (a combination of pharmacotherapy and psychological interventions) for depression. Participants filled out the Inventory of Depressive Symptomatology - Self Report (IDS-SR) for 16 to 20 consecutive weeks. For each symptom, the timing of onset of a persistent improvement was determined for each single-subject separately. RESULTS: Which symptoms improved first differed markedly across patients. The core depression symptoms improved 1.5 to 2 times more often before (48% - 60%) than after (19% -28%) depressive cognitions ('view of myself' and 'view of the future'), anxiety symptoms ('feeling irritable' and 'feeling anxious / tense') and vegetative symptoms ('loss of energy', 'slowed down', and 'physical energy'). Only improvements in suicidal thoughts were more likely to occur before (46% - 48%) than after (29%) improvements in the depression core symptoms. LIMITATIONS: Not all 'core depression-non-core symptom' combinations could be tested because some symptoms did not improve in a sufficient number of patients. CONCLUSIONS: Which improvements mark the start of symptom remission differed between patients. Improvements in the core depression symptoms 'sad mood', 'loss of interest', and 'loss of pleasure' were more likely to occur before than after improvements in non-core symptoms

Mutual Information of Population Codes and Distance Measures in Probability Space

We studied the mutual information between a stimulus and a large system consisting of stochastic, statistically independent elements that respond to a stimulus. The Mutual Information (MI) of the system saturates exponentially with system size. A theory of the rate of saturation of the MI is developed. We show that this rate is controlled by a distance function between the response probabilities induced by different stimuli. This function, which we term the {\it Confusion Distance} between two probabilities, is related to the Renyi $\alpha$-Information.Comment: 11 pages, 3 figures, accepted to PR

Critical slowing down in momentary affect as early warning signal of impending transitions in depression

Based on dynamical systems theory, the current study aimed to investigate if recurrence of depression is systematically preceded by within-person early warning signals (EWS) in positive and negative affect. Ecological momentary assessments were collected 5 times a day for a period of 4 months (averaging 524 assessments per individual) in 37 formerly depressed individuals discontinuing antidepressant medication. EWS (increases in window autocorrelation and variance) preceded recurrence of depression in 32.9% of the participants across robustness checks. Compared to participants that remained in remission, participants with a recurrence showed (1) significantly more positive trends in the variance, but not in autocorrelation, and (2) the average number of significant EWS was over three times larger across tested affect variables. Although the results provide the first systematic evidence that EWS occur more often before the recurrence of depression, the low sensitivity of EWS poses a substantial challenge for clinical applications

Vacuum structure of CP^N sigma models at theta=pi

We show that parity symmetry is not spontaneously broken in the CP^N sigma model for any value of N when the coefficient of the $\theta$--term becomes $\theta=\pi$ (mod $2\pi$). The result follows from a non-perturbative analysis of the nodal structure of the vacuum functional $\psi_0(z)$. The dynamical role of sphalerons turns out to be very important for the argument. The result introduces severe constraints on the possible critical behavior of the models at $\theta=\pi$ (mod $2\pi$).Comment: 8 pages, revtex, to appear in Phys. Rev. Let

Detecting impending symptom transitions using early warning signals in individuals receiving treatment for depression

Background: The path to depressive symptom improvement during therapy is often complex, as many individuals experience periods of instability and discontinuous symptom change. If the process of remission follows complex dynamic systems principles, early warning signals (EWS) may precede such depressive symptom transitions. Aims: We aimed to test whether EWS, in the form of rises in lag-1 autocorrelation and variance, occur in momentary affect time series preceding transitions towards lower levels of depressive symptoms during therapy. We also investigated the presence of EWS in patients without symptom transitions. Methods: In a sample of 41 depressed individuals who were starting psychological treatment, positive affect and negative affect (high and low arousal) were measured five times a day using ecological momentary assessments (EMA) for four months (521 observations per individual on average; yielding 25,197 observations in total), and depressive symptoms were assessed weekly over six months. We used a moving window method and time-varying autoregressive generalized additive modeling (TV-AR GAM) to determine whether EWS occurred in these momentary affect measures, within-persons. Results: For the moving-window autocorrelation, 89% of individuals with transitions showed at least one EWS in one of the variables (versus 62.5% in the no-transition group), and the proportion of EWS in the separate variables was consistently higher (~44% across affect measures) than for individuals without transitions (~27%). Rising variance was found for few individuals, both preceding transitions (~11%) and for individuals without a transition (~12%). Conclusions: The process of symptom remission showed critical slowing down in at least part of our sample. Our findings indicate that EWS are not generic across all affect measures and may have limited value as a personalized prediction method

Exploring the emotional dynamics of subclinically depressed individuals with and without anhedonia:An experience sampling study

Background: Anhedonia has been linked to worse prognosis of depression. The present study aimed to construct personalized models to elucidate the emotional dynamics of subclinically depressed individuals with versus without symptoms of anhedonia. Methods: Matched subclinically depressed individuals with and without symptoms of anhedonia (N = 40) of the HowNutsAreTheDutch sample completed three experience sampling methodology assessments per day for 30 days. For each individual, the impact of physical activity, stress experience, and high/low arousal PA/NA on each other was estimated through automated impulse response function analysis (IRF). These individual IRF associations were combined to compare anhedonic versus non-anhedonic individuals. Results: Physical activity had low impact on affect in both groups. In non-anhedonic individuals, stress experience increased NA and decreased PA and physical activity more strongly. In anhedonic individuals, PA high arousal showed a diminished favorable impact on affect (increasing NA/stress experience, decreasing PA/physical activity). Finally, large heterogeneity in the personalized models of emotional dynamics were found. Limitations: Stress experience was measured indirectly by assessing level of distress; the timeframe in between measurements was relatively long with 6 h; and only information on one of the two hallmarks of anhedonia, loss of interest, was gathered. Conclusions: Our results suggest different pathways of emotional dynamics underlie depressive symptomatology. Subclinically depressed individuals with anhedonic complaints are more strongly characterized by diminished favorable impact of PA high arousal and heightened NA reactivity, whereas subclinically depressed individuals without these anhedonic complaints seem more characterized by heightened stress reactivity. The automatically generated personalized models may offer patient-specific insights in emotional dynamics, which may show clinical relevance