APA Roundup: Depression & Loss of Joy; Long-COVID Brain; Mood Disorders & Suicide

NEW YORK CITY — Some of the latest research advancements in the field of psychiatry presented at the American Psychiatric Association annual meeting this year included an LSD-containing drug for anxiety, psychiatric issues after semaglutide (Ozempic), and nomophobia in healthcare providers.

Below are some more scientific poster highlights from this year’s meeting:

Anhedonia a Predictor of Persistent Depression

People with a recent major depressive episode (MDE) and anhedonia (a complete loss of physical or psychic joy) may have more persistent depression, according to findings from a longitudinal interview-based study.

Among more than 10,000 U.S. adults in the general population, 9% reported having anhedonia during an initial interview and 6.1% reported an MDE within the past month, found Maurice M. Ohayon, MD, DSc, PhD, of Stanford University School of Medicine in California, and colleagues.

In the 667 respondents with a recent MDE, the individuals with either physical anhedonia, social anhedonia, or both were more likely to report taking antidepressants than those without anhedonia (up to 79.5% vs 17.4%, respectively), and also consulted with a mental health professional more frequently on average (up to 8.2 vs 1.4 consultations over the prior year).

At a follow-up interview 3 years later, MDE patients with both physical and social anhedonia were about half as likely to achieve full remission of depression compared with those with an MDE episode but without anhedonic features (31.9% vs 69.4%, P<0.001). Full remission was achieved by 39.2% of those with physical anhedonia only during their episode and by 51.9% of those with social anhedonia only.

“These data indicate that non-anhedonic depressives commonly demonstrate resolution of their symptoms even without somatic therapy,” the researchers noted.

People with an MDE with anhedonic features tended to be older and have a higher rate of unemployment. The study included 10,931 participants from eight states who were interviewed twice via phone from 2002 through 2015. Of those, 1.5% (n=169) had an MDE and physical anhedonia at the initial interview, 1.1% (n=119) had an MDE with social anhedonia, and 1.6% (n=180) had an MDE with both forms of anhedonia.

Test Performance With Long COVID

Many people with long COVID who subjectively report cognitive complaints continue to perform poorly on neuropsychological (NP) tests 6 months later, a small single-center study found.

On an initial assessment of 75 people with post-acute sequelae of COVID-19, 38.7% scored “low” on NP tests and over 20% scored “extremely low.” Memory and executive function domains appeared to be the areas most affected, Sean T. Lynch, MD, of Westchester Medical Center in New York, and colleagues found.

But for the 63 who came to a 6-month follow-up visit — occurring 14 months after the initial COVID infection, on average — 29.7% showed improvement in NP test scores. However, 51% ranked as either low or extremely low on NP test performance at both visits.

The researchers advised these patients to be evaluated and serially re-examined on the NP tests to monitor cognition long-term.

Lynch and colleagues used the following tests: Test of Premorbid Function, Patient Assessment of Own Function, Repeatable Battery for the Assessment of Neuropsychological Status Form A, Trail Making Test Parts A and B, verbal fluency (letter and category), and the Stroop Color-Word Test.

Participants in the study showed significant improvement in fatigue after 6 months, but other medical and psychiatric measures didn’t budge. “This is somewhat unexpected, as prior reports have indicated that psychiatric symptoms, such as depression and anxiety, may improve more quickly than cognitive symptoms,” according to the poster.

The sample included adults with a confirmed history of COVID-19 infection during the Alpha and Delta strain eras. More than half had clinically significant depression, a third had anxiety and post-traumatic stress disorder, and on average they tended to have a moderately diminished quality of life.

Findings from the study were recently published in the Journal of the Academy of Consultation-Liaison Psychiatry.

Lynch’s group detailed plans to re-evaluate the cohort 18 months after the original assessment.

Suicidality in Early-Onset Mood Disorders

Several factors — including prior hospitalizations, a history of alcohol abuse, or a family history of psychiatric disease — were significantly associated with increased risk of suicidality in young patients with early-onset mood disorders, data from the South Korea study indicated.

Among more than 400 patients with early-onset mood disorders who were evaluated for suicidality at a hospital visit, 39.9% had a previous suicide attempt, according to Yaerim Nam, of Korea University College of Medicine in Seoul, and colleagues. Of those with a previous suicide attempt, the average number of attempts was 2.5 and the average age was 18 years at the time of the first attempt.

“Higher socioeconomic status, fewer years of education, earlier onset of mood symptoms, longer intervals between episode onset and treatment, histories of smoking or alcohol issues, a parental history of mental illness, and elevated scores on the HCL-32, Beck Hopelessness Scale, and BIS [Barratt Impulsiveness Scale] are all linked to more frequent suicide attempts,” the poster stated.

The cohort included 429 individuals with early-onset mood disorders under the age of 35 years who were evaluated at eight hospitals in South Korea: 146 with MDD, 128 with bipolar I disorder, and 155 with bipolar II disorder. Those with bipolar II tended to have their first mood symptoms manifest at the earliest age (16.7 years).

Specifically for the group with MDD, the number of prior hospitalizations was the top predictor in suicide (OR 4.62), followed by a history of alcohol abuse (OR 4.42) and smoking (OR 2.57). For those with bipolar I and II, having a family member with psychiatric disease was the biggest predictor (OR 2.82 and OR 2.07, respectively; P<0.05 for all).

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