Personalized therapy in rheumatoid arthritis (PETRA): a protocol for a randomized controlled trial to test the effect of a psychological intervention in rheumatoid arthritis.

Rheumatoid arthritis (RA) is a chronic autoimmune disease that primarily affects cartilage and bone. Psychological stress can both trigger disease exacerbation and result from disease activity. As standard pharmacological interventions alone have limited success in treating RA, a more comprehensive biopsychosocial approach to treatment has been recommended. In this prospective randomized controlled trial (RCT), a psychotherapeutically guided, group-based intervention program will be conducted with RA patients over a period of 9 months. This program combines a dynamic-interactional model with disorder-specific coping-oriented perspectives to improve patients' social, emotional, and problem-solving competencies as well as stress system functional status. The enrolment of 440 patients, randomly allocated to either an intervention (n = 220) or control group (n = 220), is planned. To evaluate the intervention effect, various indicators of RA disease activity, stress system activity, and psychological condition will be assessed through sets of standardized questionnaires and biochemical analyses of blood and saliva samples. Moreover, healthcare-related costs for each patient will be obtained using routine health insurance data. Outcome variables will be measured in all patients at regular intervals prior to intervention (baseline), during the 9-month intervention (five time points), and during a 9-month follow-up phase (three time points), allowing the comprehensive analysis of within- and between-subject effects, i.e. trajectories of the target variables in the intervention and control groups. In addition, to investigate the intervention effects on real-life stress system functioning in RA, 10 integrative single-case studies (n = 5 from the intervention group, n = 5 from the control group) will be conducted. In each study, once before and after the 9-month intervention, urine samples will be collected, and patients will fill out questionnaires for approximately 1 month at 12-h intervals. Moreover, weekly in-depth interviews will be conducted with patients to determine their previous week's emotionally positive and negative incidents. Using time series analysis, it is then possible to investigate whether and how stress system function in these RA patients has improved from the applied intervention. By using both an investigational macro- and microperspective, this project aims to evaluate a psychological intervention in the routine care of individuals with RA.Trial registration German Clinical Trials Register DRKS00028144. Registered on 1 March 2022.

Individual differences in everyday multitasking behavior and its relation to cognition and personality.

Our ability to multitask-focus on multiple tasks simultaneously-is one of the most critical functions of our cognitive system. This capability has shown to have relations to cognition and personality in empirical studies, which have received much attention recently. This review article integrates the available findings to examine how individual differences in multitasking behavior are linked with different cognitive constructs and personality traits to conceptualize what multitasking behavior represents. In this review, we highlight the methodological differences and theoretical conceptions. Cognitive constructs including executive functions (i.e., shifting, updating, and inhibition), working memory, relational integration, divided attention, reasoning, and prospective memory were investigated. Concerning personality, the traits of polychronicity, impulsivity, and the five-factor model were considered. A total of 43 studies met the inclusion criteria and entered the review. The research synthesis directs us to propose two new conceptual models to explain multitasking behavior as a psychometric construct. The first model demonstrates that individual differences in multitasking behavior can be explained by cognitive abilities. The second model proposes that personality traits constitute a moderating effect on the relation between multitasking behavior and cognition. Finally, we provide possible future directions for the line of research.

Limits of near transfer: Content- and operation-specific effects of working memory training.

Working memory (WM) training typically leads to large performance gains in the practiced tasks, but transfer of these gains to other contexts is elusive. One possible explanation for the inconsistent findings of past research is that transfer may only occur when cognitive strategies acquired during training can also be applied in the transfer tasks. Therefore, we systematically varied the content domains and WM operations assessed by training and transfer tasks and, thereby, the extent to which similar cognitive strategies could be applied. We randomly assigned 171 young adults to one of eight experimental groups who trained one of two WM operations (storage and processing or relational integration) with materials from one of four content domains (verbal, numerical, figural-icon, or figural-pattern) to an active or to a passive control group. Before and after 12 sessions of adaptive training within 2-3 weeks, performance was assessed in all eight WM tasks. Bayesian generalized linear mixed-effects models revealed improved performance in the trained tasks compared to the active control group. However, these improvements did not generalize to tasks measuring the same WM operation with different materials. Moreover, the comparison of the training groups with an active and a passive control group showed considerable differences, thus highlighting the importance of distinguishing between active and passive control groups. Overall, the findings revealed no evidence for transfer between tasks assumed to afford the same strategies. Therefore, the adoption of specific cognitive strategies alone is unlikely to be responsible for transfer of WM training gains between tasks. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Induced neural progenitor cells and iPS-neurons from major depressive disorder patients show altered bioenergetics and electrophysiological properties.

The molecular pathomechanisms of major depressive disorder (MDD) are still not completely understood. Here, we follow the hypothesis, that mitochondria dysfunction which is inevitably associated with bioenergetic disbalance is a risk factor that contributes to the susceptibility of an individual to develop MDD. Thus, we investigated molecular mechanisms related to mitochondrial function in induced neuronal progenitor cells (NPCs) which were reprogrammed from fibroblasts of eight MDD patients and eight non-depressed controls. We found significantly lower maximal respiration rates, altered cytosolic basal calcium levels, and smaller soma size in NPCs derived from MDD patients. These findings are partially consistent with our earlier observations in MDD patient-derived fibroblasts. Furthermore, we differentiated MDD and control NPCs into iPS-neurons and analyzed their passive biophysical and active electrophysiological properties to investigate whether neuronal function can be related to altered mitochondrial activity and bioenergetics. Interestingly, MDD patient-derived iPS-neurons showed significantly lower membrane capacitance, a less hyperpolarized membrane potential, increased Na+ current density and increased spontaneous electrical activity. Our findings indicate that functional differences evident in fibroblasts derived from MDD patients are partially present after reprogramming to induced-NPCs, could relate to altered function of iPS-neurons and thus might be associated with the aetiology of major depressive disorder.

Teacher Well-Being: Teachers' Goals and Emotions for Students Showing Undesirable Behaviors Count More Than That for Students Showing Desirable Behaviors.

Previous findings indicate that the goals of teachers and their experienced emotions when interacting with students play an important role for their well-being. However, studies on the psychological impact of events have shown that the impact of bad events is stronger than the impact of good events. Thus, it may be that teachers' goals and emotions for students showing undesirable behaviors (e.g., students who disrupt the class, do not finish their work, and have a negative attitude to learning) contribute more to their well-being than teachers' goals and emotions for students showing desirable behaviors (e.g., students who pay attention in class, do their work on time, and have a positive attitude to learning), a distinction that has not been made in previous research. To examine this question, we measured teachers' goals and emotions for students showing desirable and undesirable behaviors, and their affective, evaluative, occupational, and psychological well-being (N = 250). The results showed that teachers' well-being was relatively strongly related to their goals and emotions for students showing undesirable behaviors: The higher the goals and the more positive the emotions, the higher the reported well-being. By contrast, the goals and emotions for students showing desirable behaviors were unrelated to teachers' well-being. These results demonstrate that the principle of "bad is stronger than good" holds also for the influence of teachers' goals and emotions on their well-being.

Psychological flexibility as a potential change factor in cognitive behavioural therapy of OCD.

BACKGROUND: To gain a better understanding about which aspects of the treatment work for obsessive-compulsive disorders (OCD), the investigation of possible change factors is essential. Psychological flexibility (PsyF) has been of interest in research on successful OCD therapy for some time. Exposure interventions and cognitive strategies in cognitive behavioural therapy (CBT) for OCD may enhance PsyF. To date, however, no process studies have been published that clarify the role of PsyF as a possible change factor for the reduction of OCD symptoms. AIMS: This study investigates whether PsyF works as a mediator in successful CBT treatment of OCD. METHOD: The study recruited 112 adults diagnosed with OCD in a multi-modal in-patient treatment with specific CBT including exposure and response prevention (ERP). The Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) was used to measure OCD symptoms and three self-constructed items to assess PsyF. PsyF was conceptualised as the capability of patients to accept stressful feelings and thoughts. Data were collected weekly. For statistical analysis at the process level, longitudinal multi-level models (MLMs) with random intercepts and linear growth curves were estimated to test for mediation of PsyF on Y-BOCS. RESULTS: OCD symptoms decreased significantly and PsyF increased in patients throughout the course of therapy. MLM revealed that higher average values in PsyF were associated with lower Y-BOCS sum values, but only values between subjects significantly predicted the degree of obsessions and compulsions. CONCLUSIONS: Although research shows that PsyF is enhanced by CBT and also shows a connection with Y-BOCS values, its role as a mediator could not be confirmed.

The Passage of Years: Not a Matter of Covert Retrieval of Autobiographical Memories.

In current research, variations in retrospective passage of time judgments for long intervals are commonly attributed to differences regarding the number of experiences in these intervals or the accessibility of the respective memories. This seems to imply the assumption of a covert retrieval, where authors presume that memories from the respective interval influence the experience of time without these memories being explicitly activated when judging. However, no studies have systematically investigated the relation between the experience of time and the respective experiences and memories. To this end, we analyzed data from three studies in which participants judged the passage of the last 5 years either before being asked to select outstanding life events from a list (Studies 1a and b; N = 293 and 263) or before recalling as many meaningful personal memories as were spontaneously accessible (Study 2; N = 262). Despite applying a statistically powerful trial-by-trial mixed-effects modeling approach, neither in the separate datasets nor in the combined dataset, passage of time judgments were predicted by the number of reported events or memories. This suggests that people's spontaneous judgments of the passage of multiannual intervals are not necessarily affected by a covert retrieval of memories from the respective period.

Advancing the Understanding of the Factor Structure of Executive Functioning.

There has been considerable debate and interest regarding the factor structure of executive functioning (EF). Therefore, the aim of the current study was to delve into this issue differently, by investigating EF and other cognitive constructs, such as working memory capacity (WMC), relational integration, and divided attention, which may contribute to EF. Here, we examined whether it is possible to provide evidence for a definite model of EF containing the components of updating, shifting, and inhibition. For this purpose, 202 young adults completed a battery of EF, three WMC tests, three relational integration tests, and two divided attention tests. A confirmatory factor analysis on all the cognitive abilities produced a five-factor structure, which included one factor predominately containing shifting tasks, the next factor containing two updating tasks, the third one predominately representing WMC, the fourth factor consisting of relational integration and antisaccade tasks, and finally, the last factor consisting of the divided attention and stop signal tasks. Lastly, a subsequent hierarchical model supported a higher-order factor, thereby representing general cognitive ability.

Tversky and Kahneman's Cognitive Illusions: Who Can Solve Them, and Why?

In the present paper we empirically investigate the psychometric properties of some of the most famous statistical and logical cognitive illusions from the "heuristics and biases" research program by Daniel Kahneman and Amos Tversky, who nearly 50 years ago introduced fascinating brain teasers such as the famous Linda problem, the Wason card selection task, and so-called Bayesian reasoning problems (e.g., the mammography task). In the meantime, a great number of articles has been published that empirically examine single cognitive illusions, theoretically explaining people's faulty thinking, or proposing and experimentally implementing measures to foster insight and to make these problems accessible to the human mind. Yet these problems have thus far usually been empirically analyzed on an individual-item level only (e.g., by experimentally comparing participants' performance on various versions of one of these problems). In this paper, by contrast, we examine these illusions as a group and look at the ability to solve them as a psychological construct. Based on an sample of N = 2,643 Luxembourgian school students of age 16-18 we investigate the internal psychometric structure of these illusions (i.e., Are they substantially correlated? Do they form a reflexive or a formative construct?), their connection to related constructs (e.g., Are they distinguishable from intelligence or mathematical competence in a confirmatory factor analysis?), and the question of which of a person's abilities can predict the correct solution of these brain teasers (by means of a regression analysis).

The cytokine IL-17A as a marker of treatment resistance in major depressive disorder?

Major depression is a complex disease and-among others, inflammation appears to play an important role in its pathophysiology. In this study, we investigated a broad range of cytokines in depressed patients. Plasma levels of interleukin (IL)-12/ IL-23p40, IL-15, IL-16, IL-17A, IL-1α, IL-7, tumor necrosis factorß and vascular endothelial growth factor were compared in 48 patients suffering from major depression before, after one and after six weeks of antidepressive treatment in relation to therapy response. Interestingly, the level of IL-17A turned out to rise significantly in the non-responder group compared to responder during antidepressive treatment. IL-17A is a pro-inflammatory cytokine that initiates the production of other cytokines, thereby inducing and mediating immune response. It is also involved in allergic and autoimmune-related diseases. The database investigating the role of IL-17A in major depressive disorder has grown within the last few years comparing levels of this cytokine in depressed patients versus healthy subjects. However, little is known about the expression of IL-17A during the course of antidepressive treatment. In summary, our study provides valuable evidence that this cytokine might serve as a marker of therapy resistance to antidepressants.

Frequency and level of self-efficacy predict the effectiveness of therapist- and self-guided exposure in obsessive compulsive disorder.

BACKGROUND: While exposure and response prevention (ERP) is the most effective treatment for obsessive compulsive disorder (OCD), less is known about the specific mechanisms underlying symptom change after ERP. AIMS: We tested the hypothesis that the frequency of self- and therapist-guided ERP related to the extent of symptom reduction and that this link is mediated by increased self-efficacy. METHOD: In a sample of 377 in-patients with a primary diagnosis of OCD receiving in-patient CBT, we assessed symptoms (YBOCS-SR) and self-efficacy (General Self-Efficacy Scale), before and after treatment, as well as the frequency of therapist- and self-guided ERP sessions. RESULTS: Patients with more therapist-guided ERP sessions during treatment showed more symptom reduction and the association of self-guided ERP on outcome was mediated by enhanced self-efficacy. CONCLUSIONS: These findings highlight the importance of both therapist- and self-guided ERP sessions and suggest that therapists should conduct a sufficient number of ERP sessions to optimise treatment.

Association of Chemokine (C-C Motif) Receptor 5 and Ligand 5 with Recovery from Major Depressive Disorder and Related Neurocognitive Impairment.

INTRODUCTION: Inflammatory processes play an important role in the pathophysiology of major depressive disorder (MDD), but their relevance for specific symptoms such as neurocognitive impairment is rarely investigated. METHODS: In this observational study, we investigated the changes of leukocyte chemokine (C-C motif) receptor 5 (CCR5) and ligand 5 (CCL5) mRNA levels and inflammatory cytokines in 60 MDD patients before (PRE) and after 5 weeks (W5) of antidepressive treatment in relation to therapy response and alterations in cognitive functions by means of the Cambridge Neuropsychological Test Automated Battery (CANTAB). We hypothesized that elevated CCR5 and CCL5 levels in depressed patients would decrease upon treatment and could differ with regard to cognitive impairment associated with MDD. RESULTS: Both CCR5 and CCL5 levels were significantly decreased in the responder group compared to nonresponders even before treatment. The cytokine IL-6 as a marker of inflammation in depression did not show a difference before treatment in future responders versus nonresponders, but decreased significantly upon antidepressive therapy. Regarding neurocognitive impairment in MDD patients, an increased misperception of the emotion "anger" after 5 weeks of treatment proved to be associated with a more pronounced change in CCR5, and the perception of the emotion "disgust" became faster along with a stronger decrease in CCL5 over the same time. Executive functions typically impaired in MDD patients were not markedly associated with alterations in CCR5/CCL5. DISCUSSION: CCR5 and CCL5 are important in the targeting of immune cells by HIV. This is the first study providing valuable hints that both CCR5 and CCL5 might also serve as markers of therapy response prediction in MDD. Regarding neurocognitive impairment in depression, CCR5 and CCL5 did not reveal characteristic changes upon MDD treatment such as executive functions, which are probably delayed. However, changes of emotional perception appear to be an earlier responding feature.

Self-esteem fully mediates positive life events and depressive symptoms in a sample of 173 patients with affective disorders.

OBJECTIVES: Previous research showed that positive and negative life events influence the development of depression. However, it is less clear how life events interact with depressive symptoms and self-esteem. DESIGN AND METHODS: The present study aimed to investigate the mediating effects of self-esteem on the relationship between life events and depressive symptoms in adulthood. The Traumatic Antecedent Questionnaire, Multidimensional Self-esteem Scale (MSWS), and Becks Depression Inventory were administered in 173 psychiatric inpatients (mean age 39.69 ± 14.56 years, ranging from 18 to 76 years). At the time of assessment, all patients suffered from depressive symptoms caused by an affective disorder (major depression, bipolar I, dysthymia). RESULTS: Path analyses showed that the individual level of self-esteem (measured by MSWS) fully mediated the association between positive life events and depressive symptoms. CONCLUSIONS: The current study indicates that future therapy programmes for patients with depressive symptoms could include interventions focusing on the improvement of self-esteem, as increasing self-esteem may be beneficial for recovery. PRACTITIONER POINTS: To date, this is the first study exploring the pathways from positive/negative life events to depressive symptoms. The relationship between positive life experiences and depressive symptoms was fully mediated by self-esteem. Strengthening self-esteem in therapy might lower the vulnerability for depression.

Predicting instructed simulation and dissimulation when screening for depressive symptoms.

The intentional distortion of test results presents a fundamental problem to self-report-based psychiatric assessment, such as screening for depressive symptoms. The first objective of the study was to clarify whether depressed patients like healthy controls possess both the cognitive ability and motivation to deliberately influence results of commonly used screening measures. The second objective was the construction of a method derived directly from within the test takers' responses to systematically detect faking behavior. Supervised machine learning algorithms posit the potential to empirically learn the implicit interconnections between responses, which shape detectable faking patterns. In a standardized design, faking bad and faking good were experimentally induced in a matched sample of 150 depressed and 150 healthy subjects. Participants completed commonly used questionnaires to detect depressive and associated symptoms. Group differences throughout experimental conditions were evaluated using linear mixed-models. Machine learning algorithms were trained on the test results and compared regarding their capacity to systematically predict distortions in response behavior in two scenarios: (1) differentiation of authentic patient responses from simulated responses of healthy participants; (2) differentiation of authentic patient responses from dissimulated patient responses. Statistically significant convergence of the test scores in both faking conditions suggests that both depressive patients and healthy controls have the cognitive ability as well as the motivational compliance to alter their test results. Evaluation of the algorithmic capability to detect faking behavior yielded ideal predictive accuracies of up to 89%. Implications of the findings, as well as future research objectives are discussed. Trial Registration The study was pre-registered at the German registry for clinical trials (Deutsches Register klinischer Studien, DRKS; DRKS00007708).

Multitasking behavior and its related constructs: Executive functions, working memory capacity, relational integration, and divided attention.

Although prior investigations have revealed cognitive abilities to be important predictors of multitasking behavior, few investigations have been conducted on the relation between executive functions (EFs) and multitasking behavior. The current study examines the underlying cognitive constructs associated with the concept of multitasking behavior. A sample of 202 young adults completed a battery of EFs (shifting, updating, and inhibition), three working memory capacity (WMC) tests, three relational integration tests, two divided attention tests, and a multitasking scenario (Simultaneous Capacity). First, in direct replication attempts, the results replicated the multitasking behavior model (Bühner, König, Pick, & Krumm, 2006) and partially replicated the three-factor and nested factors EFs models (Friedman et al., 2016). Second, hierarchical multiple regression analyses and relative weight analyses revealed that updating, inhibition, relational integration, and divided attention had strong contributions in explaining multitasking behavior variance, whereas shifting and WMC did not show any explanatory power beyond these constructs. Finally, using structural equation modeling, we found that the general EF ability (common EF) representing variance common to shifting, updating, and inhibition highly overlapped with multitasking behavior. Our results are of value not only to shed light on the relevant cognitive correlates of multitasking behavior but also to position multitasking behavior in an established framework of cognitive abilities.

Right hemisphere occipital rTMS impairs working memory in visualizers but not in verbalizers.

Distinguishing between verbal and visual working memory processes is complicated by the fact that the strategy used is hard to control or even assess. Many stimuli used in working memory tasks can be processed via verbal or visual coding, such as the digits in the digit span backwards task (DSB). The present study used repetitive transcranial magnetic stimulation (rTMS) to examine the use of visual processing strategies in the DSB. A total of 47 German university students took part in the study, 23 spontaneously using a verbal processing strategy and 24 using a visual strategy. After rTMS to the right occipital cortex, visualizers showed a significantly stronger mean performance decrease compared to verbalizers. The results indicate that the visual cortex is more critical for visualizers compared to verbalizers in the DSB task. Furthermore, the favored processing modality seems to be determined by the preference for a cognitive strategy rather than the presentation modality, and people are aware of the applied strategy. These findings provide insight into inter-individual differences in working memory processing and yield important implications for laboratory studies as well as clinical practice: the stimulus does not necessarily determine the processing and the participant can be aware of that.

Time passes too fast? Then recall the past! - Evidence for a reminiscence heuristic in passage of time judgments.

Memory-based approaches suggest that retrospective judgments concerning the passage of lifetime are based on available meaningful experiences. However, an open question is whether passage of time judgments reflect the objective amount of important experiences or rather the amount of memories that are currently activated in the moment of judging. To examine this issue, we asked 473 participants to judge the passage of the last five years either before or after recalling as many important autobiographical events as possible from the last five years. Activating memories before the judgment slowed the experienced passage of time, but only if participants recalled at least four memories. For participants recalling less than four memories, the opposite effect was found: few activated memories had even an accelerating effect. Interestingly, the experienced speed of time did not continuously decrease with a rising number of memories activated: Below and above the threshold of four memories, passage of time judgments were unrelated to the number of activated memories. These results indicate that passage of time judgments are based on currently activated memories, suggesting that the common phenomenon of time flying reflects the effect of a reminiscence heuristic.

The Role of Self-Esteem in Depression: A Longitudinal Study.

BACKGROUND: Based on the vulnerability model, several studies indicate that low self-esteem seems to contribute to depressive symptoms. AIMS: The aim of this study was to treat depressive symptoms in a cognitive behavioural group therapy, focusing on the enhancement of self-esteem, and to explore co-variation in depressive symptoms and the level of self-esteem. METHOD: The Multidimensional Self-esteem Scale (MSWS) and the Beck Depression Inventory (BDI) were administered to 147 psychiatric in-patients with current depressive symptoms due to an affective disorder (major depression, bipolar I, dysthymia). Self-esteem was measured pre-treatment (t0) and post-treatment (t4, after 5 weeks of eight group sessions); the BDI was applied weekly. A linear mixed growth analysis was conducted to estimate the change in depressive symptoms including interactions with self-esteem. RESULTS: Within the 5 weeks of group therapy, depressive symptoms showed a linear decline, which was stronger for patients with higher gains in self-esteem between t0 and t4. Self-esteem at t0 was unrelated to the change in depression but predicted self-esteem at t4. CONCLUSIONS: Treating depressive symptoms in a cognitive behavioural group therapy in a naturalistic setting might have a positive effect on the process of recovery. Moreover, depressive symptoms and level of self-esteem seemed to co-vary.

Common change factors and mediation of the alliance-outcome link during treatment of depression.

OBJECTIVE: Alliance, Mastery/Self-Efficacy, Problem Actualization, and Problem Clarification exemplify common or nonspecific factors of change in psychotherapy (Grawe, 1997). In this study, we tested the hypothesis that other change factors mediate the alliance-outcome link on a within-person level over the treatment course. METHOD: Our sample consisted of 193 patients with major depression undergoing intensive inpatient cognitive-behavioral-based therapy. Each week, we assessed depressive symptoms (using the Beck Depression Inventory-II) and change factors during individual therapy. Multilevel mediation models were used to test our hypothesis. RESULTS: As expected, within-person change in Alliance (differentiated into Emotional Bond and Contentment with the Therapist) as well as Mastery/Self-Efficacy and Problem Clarification predicted symptom change over the course of therapy. Moreover, the relation between Contentment with the Therapist and subsequent change in depression was mediated by increased Mastery/Self-Efficacy on a within-person level. CONCLUSIONS: Our data suggest that within-person change of alliance and other general change factors precede symptom change in depressive patients, and that the link between alliance and outcome may be partially mediated by enhanced Mastery/Self-Efficacy. Future studies should further elucidate the mechanisms responsible for the alliance-outcome link. (PsycINFO Database Record

Macrophage-Derived Chemokine: A Putative Marker of Pharmacological Therapy Response in Major Depression?

INTRODUCTION: Inflammatory processes play an important and complex role in the pathophysiology of major depressive disorder (MDD), but, so far, no specific investigation of chemokines exists. METHODS: In this study, we investigated the changes of plasma chemokine levels (eotaxin-1, eotaxin-3, IP-10, MCP-1, MCP-4, MDC, MIP-1α, MIP-1ß, and TARC) in 47 MDD patients before (PRE) and after 1 and 6 weeks of pharmacological treatment (POST1 and POST6) in relation to the response to antidepressive therapy. We hypothesized that the direction of alterations in levels of chemokines would significantly differ between the 2 groups, responders and nonresponders. RESULTS: Among the investigated chemokines, only the level of macrophage-derived chemokine (MDC) changed significantly in relation to therapy response. MDC levels were significantly elevated in the responder group at POST6. DISCUSSION: MDC is a constitutively expressed chemokine involved in the pathophysiology of infectious and neoplastic diseases. This is the first study providing valuable hints that MDC might serve as a marker of pharmacological therapy response in MDD.