Mind

Psychiatry's True Blood? Pt 1.

Neuroskeptic iconNeuroskepticBy NeuroskepticFeb 5, 2012 2:32 PM

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Imagine that there was a blood test that could detect depression. Wouldn't that be useful?

It depends.

Ridge Diagnostics are a US company who offer such a test. They've just published some results of the technology in Molecular Psychiatry. In two samples of patients with major depressive disorder (MDD), they report differences in the "MDDScore", between the patients and healthy controls.

The MDDScore is an aggregate value, calculated from the levels of 9 metabolites in blood serum. They're all well-known molecules, including hormones, such as cortisol and prolactin. The novelty is in how they're put together to make the MDDScore. We're given equations - but the key variables are not provided, because they're proprietary:

Long-term Neuroskeptic readers will recall that this "secret ingredients" approach to publishing science was also adopted by another company offering a different depression test.

Anyway, the performance of the test was impressive. In both the pilot and the replication samples, the MDDScore was significantly higher in the depressed people than in the controls. In both cases, the test had a sensitivity of over 91% and a specificity of over 81%, which is pretty good. Ridge Diagnostics are already offering the MDDScore clinically. For $745 a pop.However...

Although there were two depressed patient groups (n=36 and 34), there was only one set of controls (n=43); both patient samples were compared to it. This means the second, "replication", test was not fully independent of the first one. If the first finding was a fluke caused by the control group having weird results by chance, for instance, then the second study would just repeat the fluke.

The patients were significantly older, and with a higher BMI, than the controls. They did control for these variables, which is good, but this raises the question of whether these folks differed in other ways, that they didn't measure, and hence couldn't control for.

In both samples, the patients had a very significantly higher MDDScore than the controls (p less than 0.0001, both times). But in both cases, the difference in levels of EGF (epidermal growth factor) was almost as strong: p=0.0003 and p less than 0.0001, respectively. Other metabolites weren't far behind. Testing for EGF would almost certainly be cheaper than getting an MDDScore.

Finally, all these data demonstrate is that the test can distinguish between people with MDD and entirely healthy people. But how often are doctors going to need to do that? More likely, they'll want to distinguish depression from other things that are often confused with it, such as: bipolar disorder, anxiety disorders, chronic fatigue syndrome, bereavement, "stress", and all manner of physical illnesses e.g. thyroid problems. Daniel Carlat said last year that

If the test cannot distinguish different psychiatric problems, then the MDDScore is simply a non-specific "biomarker" for emotional difficulties of all stripes, and would be essentially useless.

How disorder-specific is the MDDScore? This paper doesn't tell us. And to date, this is the only published paper mentioning the MDDScore. The website mentions some conference presentations, but none have yet appeared in a peer reviewed journal.

Ridge Diagnostics have an interesting history. But that's another story - stay tuned for Part 2.

Papakostas, G., Shelton, R., Kinrys, G., Henry, M., Bakow, B., Lipkin, S., Pi, B., Thurmond, L., and Bilello, J. (2011). Assessment of a multi-assay, serum-based biological diagnostic test for major depressive disorder: a Pilot and Replication Study Molecular Psychiatry DOI: 10.1038/mp.2011.166

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