Hebbrecht, Kaat

Abstract: Mood disorders are complex disorders with multiple factors determining their onset and underlying etiopathogenetic mechanisms. It is a great challenge to incorporate this complex, multi-layered thinking in research methods. In this doctoral thesis, we present the results of six original studies and one meta-analysis of the literature that were all aimed at gaining an increased insight in the etiopathogenesis and/or course of MDD and BD. The three studies from Part 1 were founded on more conventional and widely used research paradigms, in which mood disorders are seen as discretely delineated categories and mean sum-scores of (mood or inflammatory) outcome variables are compared on the group-level. Part 2 took upon a different approach by studying dynamics of individual symptoms both at individual-level, as well as aggregated outcomes, to gain a more fine-grained insight in the symptom dynamics of MDE. Part 3 shows another application of a combined individual-level and grouplevel approach, this time to study the cognitive outcomes after treatment with ECT in MDE. This doctoral thesis provides only a glimpse of the complexity of mood disorders. Specifically, we pointed towards the highly complex and idiosyncratic dynamic behavior of symptoms over time and confirmed hereby that the use of sum-scores has important limitations. Furthermore, we showed the importance of individual-level analyses (in addition to group-level analyses) to enlarge the clinical translatability of research findings. Not only depressive symptoms should be considered as highly dynamically complex entities of a larger pathology, but also context, bio-psycho-social, and temperamental variables could be included in further analyses which will likely make a worthwhile endeavor

Exploring paths forward for mood disorder research : embracing heterogeneity, complexity and idiography

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