A Study of Individualized Diagnosis and Treatment for Major Depressive Disorder With Atypical Features
A Study of Individualized Diagnosis and Treatment for Major Depressive Disorder With Atypical Features
The lifetime prevalence of major depressive disorder (MDD) is 10%~20%. Worldwide, nearly 340
 million individuals have suffered the torture of depression. World Health Organization has
 reported that MDD would become the most serious global burden of disease and eventually turn
 into a public health problem in 2030. Varied clinical symptoms, inappropriate treatment,
 unclear pathogenesis, and lack of recurrent risk early-warning predictors cause a series of
 clinical problems, such as low diagnostic rate, low effective treatment rate, and high
 recurrent rate. Hence, this study aims to search multidimensional markers for early diagnosis
 of MDD, to establish optimized personalized therapy, and to explore sensitive recurrence
 predictors.

 Based on the criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fifth
 Edition (DSM-5), MDD is subdivided into eight different clinical specifiers, one of which the
 incident rate of MDD with atypical features reaches 30%~38%. However, there is still a lack
 of meta-evidence for the clinical treatment strategy in MDD with atypical features. And 45.4
 percentage of MDD with atypical features convert to bipolar disorder. Therefore, this study
 will focus on three issues about what's the objective endophenotype in MDD with atypical
 features, how to select appropriate personalized treatment for MDD with atypical features,
 what's the predictive biomarker of conversion to bipolar disorder.

 Based on the investigators' previous findings, this study will investigate adult depression
 at a cross-sectional study and a prospective cohort study. Multivariate informatics analysis
 was performed from three research dimensions (cognitive neuropsychology, metabonomics, and
 multimodal neuroimaging), including atypical features, "cold/hot" cognition assessment, KP
 (kynurenine pathway) metabolomics and inflammatory factors, multimodal MRI robust property.
 Referring guidelines for the diagnosis and treatment of depression and evidence-based
 medicine evidence, MDD with atypical features are divided into f groups (antidepressants,
 antidepressants+mood stabilizers, mood stabilizers, treat as usual). Then, the investigators
 perform follow-up to verify optimized treatment strategies and to explore risk factors of
 conversion from MDD with atypical features to bipolar disorder. Furthermore, this study
 performs correlation analysis to analyze cross-omics data, weight coefficient analysis to
 analyze multidimensional indexes, clustering analysis to analyze multivariate bio-information
 data, and artificial intelligence technologies (such as pattern recognition, and machine
 learning) to realize the transformation from medical data to practical transformation.
 Eventually, this study builds three specific models (the multidimensional early diagnosis
 models for MDD with atypical features, the optimized personalized therapy model, and the
 recurrence and conversion risk early-warning model), which form the integrated intelligent
 platform for multidimensional diagnosis, personalized treatment, recovery management of MDD
 with atypical features.
Inclusion Criteria:

 1. 16-60 years old;

 2. Meeting with the criteria of major depressive disorder in the Diagnostic and
 Statistical Manual of Mental Disorders (DSM)-5;

 3. Scored 20 or higher on the Hamilton's Depression Scale with 24 items (HAMD-24);

 4. With enough audio-visual ability and comprehensive ability to accomplish the visits;

 5. Be necessary and suitable to accept the treatment of antidepressants;

 6. Scored less than 14 on Hamilton's Anxiety Scale (HAMA) and scored less than 14 on the
 Hypomania Symptom Checklist-32 (HCL-32);

 7. With 2 or more atypical symptoms including significant weight gain or increase in
 appetite, hypersomnia, leaden paralysis, and a long-standing pattern of interpersonal
 rejection sensitivity that results in significant social or occupational impairment.

 Exclusion Criteria:

 1. Severe medical or neurological problems;

 2. Previous mania or hypomania episodes;

 3. Female patients who are pregnant, planning to be pregnant or breastfeeding;

 4. Actively suicide ascertained by research psychiatrist or 3rd item of HAMD
 scored≥3(suicidality);

 5. Had ECT, MECT or rTMS in the past 6 months;

 6. Experienced severe personality disorder, mental retardation, anorexia/bulimia nervosa.