Using neurocognitive and time series data to improve treatment outcomes in depression

这项研究的目的是调查在开始服用抗抑郁药物和主观情绪感觉改善之间的延迟期间发生了什么。抑郁症患者可能需要等待长达六周的时间才能体验到抗抑郁药物的积极效果。这种延长的等待时间对于有严重抑郁症状的患者来说可能是危险的，在药物无效的情况下会使人失去动力。尽管一些研究表明，抗抑郁药物可能会导致非常早期的神经认知变化，例如对积极面部表情的敏感度增加，但这一事实仍然存在。此前的研究集中在从未服用过抗抑郁药物的健康志愿者服用第一剂抗抑郁药物后数小时内发生的神经认知变化。因此，对于服用较长时间的抗抑郁药如何改变认知能力，以及对抑郁症患者的神经认知影响是否与健康人相同，人们知之甚少。为了解决这个问题，我们将进行一项纵向研究，跟踪首次服用抗抑郁药物的抑郁症初级保健患者。数据收集拟在12周内进行，但要视参与者的负担而定，初步可行性研究将对此进行探讨。我们将使用定期在线测试来跟踪神经认知变化，并随着时间的推移监测患者的情绪以及他们社交互动的质量和频率，因为积极的社交互动被认为是成功的抗抑郁治疗反应的重要贡献因素。将进行诊断性访谈，以确定患者的症状对药物的反应。综合起来，这些措施将被用来建立神经认知变化、社会互动和治疗反应的结果和潜伏期之间的关系(如果有的话)。这项研究将是第一个检查抑郁症患者对抗抑郁药物治疗的神经认知反应并在较长时间内这样做的研究之一。纵向的、受试者内部的、时间序列的方法将使我们能够收集丰富的和生态上有效的数据，这些数据在本研究背景下迄今是稀缺的。这项研究是及时的，因为尽管抑郁症是世界范围内导致残疾的主要原因，抗抑郁药物是一线治疗，但人们对这种药物的作用机制知之甚少。这项研究的好处包括改善了对抗抑郁药物治疗反应的早期标志物的理论理解，以及抗抑郁药物的作用机制。这项研究表明，使用早期神经认知标记物作为抗抑郁药物治疗反应的预测指标的可行性，在实践中可以极大地减少患者知道特定的抗抑郁药物是否适合他们所需的等待时间。通过探索社会互动在抗抑郁药物反应中的作用，本研究还对社会心理健康干预的意义提出了建议。

This research aims to investigate what happens during the delay that is often experienced between starting antidepressant medication and feeling improvements in subjective mood. Patients with depression may have to wait for up to six weeks before experiencing the positive effects of antidepressant medication. This extended waiting time can be dangerous for patients with severe symptoms of depression, and demotivating in cases where the medication does not work. This is despite the fact that some research shows that antidepressant medication may lead to very early neurocognitive changes, such as increased sensitivity to positive facial expressions. Previous studies have focused on neurocognitive changes that occur within hours of taking the first dose of antidepressant medication, in healthy volunteers who have never taken the medication before. Thus, less is known about both how antidepressants modify cognition when taken over longer periods, and if the neurocognitive effects are the same in people with depression as in healthy people. To address this, we will conduct a longitudinal study where we follow primary care patients with depression who are taking antidepressant medication for the first time. Data collection is proposed to take place over a 12 week period, subject to participant burden, which will be explored in a preliminary feasibility study. We will track neurocognitive changes using regular online tests, and monitor patients' mood, and the quality and frequency of their social interactions over time, as positive social interactions have been posited as an important contributor to successful antidepressant treatment response. Diagnostic interviews will be conducted to establish how patients' symptoms responded to the medication. Taken together, these measures will be used to establish the relationship, if any, between neurocognitive changes, social interactions, and the outcome and latency of treatment response. This study will be one of the first to examine neurocognitive responses to antidepressant treatment in patients with depression and to do so over an extended duration of time. The longitudinal, within-subjects, timeseries methodology will allow us to collect rich and ecologically valid data which has been scarce thus far in this research context. This research is timely, as although depression is a leading cause of disability worldwide and antidepressant medication is a first-line treatment, little is known about the medication's mechanism of action. Benefits of this research include improved theoretical understanding of early markers of antidepressant treatment response, and antidepressant mechanisms of action. This research holds implications for the feasibility of using early neurocognitive markers as predictors of antidepressant treatment response, which in practice could dramatically reduce the waiting time needed for patients to know if a particular antidepressant medication is suitable for them. By exploring the role of social interaction in antidepressant response, this research also holds implications for the significance of social mental health interventions.