Immune Dysregulation in Treatment-Resistant Depression: Precision Approaches to Treatment Selection and Development of Novel Treatments

摘要

Major depressive disorder (MDD) affects one in six adults in the United States during their lifetime and is one of the biggest causes of disability worldwide. Owing to the heterogeneity of MDD, the symptom profile is quite different from person to person, and although it is a single disorder, it may be more appropriate to view MDD as composed of multiple subtypes. According to the Diagnostic and Statistical Manual of Mental Disorders - Fifth Edition (DSM-5), five out of nine symptoms (low mood, anhedonia, weight loss or gain, insomnia or hypersomnia, psychomotor agitation, fatigue, feeling worthless or excessive/inappropriate guilt, decreased concentration, and thoughts of death/suicide) need to be met for the diagnosis of MDD. If we consider the compounding criteria separately (such as weight loss or gain) this may result in over 900 unique symptom profiles. In fact, a study by Fried and Nesse of 3703 depressed outpatients identified 1030 unique symptom profiles underscoring the heterogeneous nature of MDD.