PMID- 29448238 OWN - NLM STAT- MEDLINE DCOM- 20180829 LR - 20191220 IS - 1573-2517 (Electronic) IS - 0165-0327 (Print) IS - 0165-0327 (Linking) VI - 231 DP - 2018 Apr 15 TI - Parsing the heterogeneity of depression: An exploratory factor analysis across commonly used depression rating scales. PG - 51-57 LID - S0165-0327(17)31721-4 [pii] LID - 10.1016/j.jad.2018.01.027 [doi] AB - BACKGROUND: Due to the heterogeneity of depressive symptoms-which can include depressed mood, anhedonia, negative cognitive biases, and altered activity levels-researchers often use a combination of depression rating scales to assess symptoms. This study sought to identify unidimensional constructs measured across rating scales for depression and to evaluate these constructs across clinical trials of a rapid-acting antidepressant (ketamine). METHODS: Exploratory factor analysis (EFA) was conducted on baseline ratings from the Beck Depression Inventory (BDI), the Hamilton Depression Rating Scale (HAM-D), the Montgomery-Asberg Depression Rating Scale (MADRS), and the Snaith-Hamilton Pleasure Rating Scale (SHAPS). Inpatients with major depressive disorder (n = 76) or bipolar depression (n = 43) were participating in clinical ketamine trials. The trajectories of the resulting unidimensional scores were evaluated in 41 subjects with bipolar depression who participated in clinical ketamine trials. RESULTS: The best solution, which exhibited excellent fit to the data, comprised eight factors: Depressed Mood, Tension, Negative Cognition, Impaired Sleep, Suicidal Thoughts, Reduced Appetite, Anhedonia, and Amotivation. Various response patterns were observed across the clinical trial data, both in treatment effect (ketamine versus placebo) and in degree of placebo response, suggesting that use of these unidimensional constructs may reveal patterns not observed with traditional scoring of individual instruments. LIMITATIONS: Limitations include: 1) small sample (and related inability to confirm measurement invariance); 2) absence of an independent sample for confirmation of factor structure; and 3) the treatment-resistant nature of the population, which may limit generalizability. CONCLUSIONS: The empirical identification of unidimensional constructs creates more refined scores that may elucidate the connection between specific symptoms and underlying pathophysiology. CI - Published by Elsevier B.V. FAU - Ballard, Elizabeth D AU - Ballard ED AD - Experimental Therapeutics & Pathophysiology Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD 20892, USA. Electronic address: Elizabeth.Ballard@nih.gov. FAU - Yarrington, Julia S AU - Yarrington JS AD - Experimental Therapeutics & Pathophysiology Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD 20892, USA. FAU - Farmer, Cristan A AU - Farmer CA AD - Experimental Therapeutics & Pathophysiology Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD 20892, USA. FAU - Lener, Marc S AU - Lener MS AD - Experimental Therapeutics & Pathophysiology Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD 20892, USA. FAU - Kadriu, Bashkim AU - Kadriu B AD - Experimental Therapeutics & Pathophysiology Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD 20892, USA. FAU - Lally, Niall AU - Lally N AD - Experimental Therapeutics & Pathophysiology Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD 20892, USA; Institute of Cognitive Neuroscience, University College London, London WC1N 3AZ, UK; Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK. FAU - Williams, Deonte AU - Williams D AD - Experimental Therapeutics & Pathophysiology Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD 20892, USA. FAU - Machado-Vieira, Rodrigo AU - Machado-Vieira R AD - Experimental Therapeutics & Pathophysiology Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD 20892, USA; Dept. of Psychiatry and Behavioral Sciences, University of Texas Health Sciences Center, Houston, TX 77021, USA. FAU - Niciu, Mark J AU - Niciu MJ AD - Experimental Therapeutics & Pathophysiology Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD 20892, USA. FAU - Park, Lawrence AU - Park L AD - Experimental Therapeutics & Pathophysiology Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD 20892, USA. FAU - Zarate, Carlos A Jr AU - Zarate CA Jr AD - Experimental Therapeutics & Pathophysiology Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD 20892, USA. LA - eng SI - ClinicalTrials.gov/NCT00088699 GR - Z99 MH999999/Intramural NIH HHS/United States GR - ZIA MH002927/Intramural NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Intramural DEP - 20180205 PL - Netherlands TA - J Affect Disord JT - Journal of affective disorders JID - 7906073 RN - 0 (Antidepressive Agents) RN - 0 (Psychotropic Drugs) RN - 690G0D6V8H (Ketamine) SB - IM MH - Adult MH - Antidepressive Agents/therapeutic use MH - Bipolar Disorder/*diagnosis/drug therapy/psychology MH - Depressive Disorder, Major/*diagnosis/drug therapy/psychology MH - Factor Analysis, Statistical MH - Female MH - Humans MH - Ketamine/therapeutic use MH - Male MH - Middle Aged MH - Psychiatric Status Rating Scales/*statistics & numerical data MH - Psychotropic Drugs/therapeutic use MH - Symptom Assessment/methods/*statistics & numerical data MH - Young Adult PMC - PMC5852677 MID - NIHMS942492 OTO - NOTNLM OT - Clinical trials OT - Depression OT - Factor analysis OT - Ketamine OT - Psychometrics COIS- Declaration of Interest Dr. Zarate is listed as a coinventor on a patent for the use of ketamine and its metabolites in major depression and suicidal ideation. Dr. Zarate is listed as a co-inventor on a patent for the use of (2R,6R)-hydroxynorketamine, (S)-dehydronorketamine, and other stereoisomeric dehydro and hydroxylated metabolites of (R,S)-ketamine metabolites in the treatment of depression and neuropathic pain. Dr. Zarate is listed as co-inventor on a patent application for the use of (2R,6R)-hydroxynorketamine and (2S,6S)-hydroxynorketamine in the treatment of depression, anxiety, anhedonia, suicidal ideation, and post-traumatic stress disorders; he has assigned his patent rights to the U.S. government but will share a percentage of any royalties that may be received by the government. All other authors have no conflict of interest to disclose, financial or otherwise. EDAT- 2018/02/16 06:00 MHDA- 2018/08/30 06:00 PMCR- 2019/04/15 CRDT- 2018/02/16 06:00 PHST- 2017/08/14 00:00 [received] PHST- 2017/12/15 00:00 [revised] PHST- 2018/01/29 00:00 [accepted] PHST- 2018/02/16 06:00 [pubmed] PHST- 2018/08/30 06:00 [medline] PHST- 2018/02/16 06:00 [entrez] PHST- 2019/04/15 00:00 [pmc-release] AID - S0165-0327(17)31721-4 [pii] AID - 10.1016/j.jad.2018.01.027 [doi] PST - ppublish SO - J Affect Disord. 2018 Apr 15;231:51-57. doi: 10.1016/j.jad.2018.01.027. Epub 2018 Feb 5.