The ability of early changes in motivation to predict later antidepressant treatment response

Abstract

IntroductionBaseline values and early changes of emotional reactivity, cognitive speed, psychomotor function, motivation, and sensory perception have not been studied to any extent in unipolar depression, although they could help to characterize different dimensions of illness that are harder to capture by clinicians, give new insights on how patients improve, and offer new early clinical markers for later treatment response.MethodsAbout 1,565 adult outpatients with major depressive disorder receiving agomelatine completed the clinician-rated 16-item quick inventory of depressive symptoms, Clinical Global Impression, and Multidimensional Assessment of Thymic States (MAThyS) rating scales at inclusion, Week 2 and Week 6. The MAThyS includes a 20-item self-rated visual analog scale (from inhibition [0] to activation [10], with [5] representing the usual state) leading to five a priori dimensions (emotional reactivity, cognitive speed, psychomotor function, motivation, and sensory perception).ResultsAll MAThyS dimension scores increased from inclusion to Week 2 and from inclusion to Week 6 (P<0.001). Improvement was around 2 points (out of 10) for motivation, 1.5 points for psychomotor function, and 0.5 points for other dimensions. Motivation showed a trend to being more severely impaired at inclusion in future nonresponders (t=1.25, df=1,563, P=0.10). Its improvement at Week 2 was the most discriminating MAThyS dimension between future responders and nonresponders, and represents the best predictor of future response, with the highest area under the receptor operating characteristic curve (area under curve =0.616, 95% confidence interval [0.588–0.643], P<0.001). Finally, improvements in motivation correlated the most strongly with clinician-rated 16-item quick inventory of depressive symptoms improvement (r=−0.491, df=1,563, P<0.001).ConclusionMotivation had the most capacity for early improvement, the best predictive value for response, and the largest global margin of progress in depressed outpatients. Assessing the evolution of self-reported motivation over time in major depressive disorder could offer an interesting complementary approach to predict response.

Variance of the global signal as a pretreatment predictor of antidepressant treatment response in drug-naïve major depressive disorder

“…For example, a prior study demonstrated that an increase in joy after 2 weeks of treatment is strongly specific for later antidepressant response and remission in MDD (Gorwood et al 2015a ). Gorwood et al found that motivation is the most impaired in depressed patients, responds best to treatment and shows the best predictive value for antidepressant treatment response in the Multidimensional Assessment of Thymic States (MAThyS) rating scales (Gorwood et al 2015b ). Early improvement in depressive symptoms assessed by the Hamilton Rating Scale for Depression (Vermeiden et al 2015 ) or the 16-item Quick Inventory of Depressive Symptomatology (Sakurai et al 2013 ) can also predict eventual response.…”

“…Predicting a prognosis in an early phase of antidepressant treatment may facilitate an effort to find an appropriate drug for individuals with MDD at the earliest opportunity (Nakajima et al 2010 ). Previous studies have demonstrated that early changes in joy, motivation, depressive symptoms, plasma catecholamine metabolites, repeated cortisol awakening response, quantitative electroencephalography biomarkers after a short time of ADM (e.g., 2 weeks) could predict eventual antidepressant treatment outcomes in depressed patients (Beck et al 2015 ; Gorwood et al 2015a , b ; Hunter et al 2010 ; Sakurai et al 2013 ; Ueda et al 2002 ; Vermeiden et al 2015 ). Furthermore, evidence from neuroimaging studies suggests that interhemispheric asynchrony and disrupted network topological configurations could also serve as pretreatment predictors of early antidepressant response in MDD (Hou et al 2016a , b ).…”

Behavioral and Functional Brain Activity Alterations Induced by TMS Coils with Different Spatial Distributions

“…This experiment included an fMRI arm, in which subjects performed the Iowa gambling task (IGT) task inside the scanner, and a behavioral arm, in which questionnaire were completed to evaluate motivation (motivational VAS; mVAS (Gorwood et al, 2015;Stubbs et al, 2000)), affect (positive and negative affect schedule; PANAS (Watson et al, 1988)), or both (modified achievement goal questionnaire; AGQ (Elliot and Sheldon, 1997)). It should be noted that different sets of subjects were used in each stage of the experiment and for the behavioral and neuroimaging studies.…”

“…The main experiment employed the obtained parameters to investigate the neuronal correlates and behavioral consequences of alterations induced by acute stimulation with the different coils. This experiment included an functional MRI (fMRI) arm, in which subjects performed the Iowa Gambling Task (IGT) task inside the scanner, and a behavioral arm, in which questionnaire were completed to evaluate motivation [motivational VAS (mVAS); Stubbs et al, 2000 ; Gorwood et al, 2015 ], affect [positive and negative affect schedule (PANAS); Watson et al, 1988 ], or both [modified achievement goal questionnaire (AGQ); Elliot and Sheldon, 1997 ]. It should be noted that different sets of subjects were used in each stage of the experiment and for the behavioral and neuroimaging studies.…”

“…The questionnaires were identical to those used in the feasibility study (see Figure 6-1 in the extended material for a description). They included the mVAS questionnaire, which assesses motivation to undertake various actions (Gorwood et al, 2015;Stubbs et al, 2000); the AGQ, which evaluates 2 goal orientations towards a specific reward (Elliot and Sheldon, 1997); and the PANAS, which assesses emotional state (Watson et al, 2000). Subjects were asked to answer the items in the questionnaires according to how they felt at that moment in order to prevent, to as great an extent as possible, any effects of expectation or learning in the POST condition.…”