To date, it remains impossible to guarantee that short-term treatment given to a patient
suffering from a major depressive episode (MDE) will improve long-term efficacy. Objective
biological measurements and biomarkers that could help in predicting the clinical
evolution of MDE are still warranted. To better understand the reason nearly half of MDE
patients respond poorly to current antidepressive treatments, we examined the gene
expression profile of peripheral blood samples collected from 16 severe MDE patients and
13 matched controls. Using a naturalistic and longitudinal design, we ascertained mRNA and
microRNA (miRNA) expression at baseline, 2 and 8 weeks later. On a genome-wide scale, we
detected transcripts with roles in various biological processes as significantly
dysregulated between MDE patients and controls, notably those involved in nucleotide
binding and chromatin assembly. We also established putative interactions between
dysregulated mRNAs and miRNAs that may contribute to MDE physiopathology. We selected a
set of mRNA candidates for quantitative reverse transcriptase PCR (RT-qPCR) to validate
that the transcriptional signatures observed in responders is different from
nonresponders. Furthermore, we identified a combination of four mRNAs (PPT1,
TNF, IL1B and HIST1H1E) that could be predictive of treatment
response. Altogether, these results highlight the importance of studies investigating the
tight relationship between peripheral transcriptional changes and the dynamic clinical
progression of MDE patients to provide biomarkers of MDE evolution and prognosis.
Current treatment recommendations are still based on limited evidence, and there is a clear demand for confirmative studies adopting the DSM-5 specifier with mixed features concept.
National differences in family burden may be related to different healthcare systems in Germany and Britain. Support for patients with schizophrenia may be shifted from the professional to the informal healthcare sector more in Britain than in Germany.
Clozapine showed superior efficacy over risperidone in this patient population. Both treatments were equally well tolerated as demonstrated through their adverse event profiles, although as expected clozapine was associated with a lower risk of extrapyramidal symptoms than risperidone.
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