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Genome-Wide Association for Major Depression Through Age at Onset Stratification Major Depressive Disorder Working Group Of King’s Research Portal DOI: 10.1016/j.biopsych.2016.05.010 Document Version Publisher's PDF, also known as Version of record Link to publication record in King's Research Portal Citation for published version (APA): Power, R., Tansey, K., Buttenschøn, H. N., Cohen-Woods, S., Bigdeli, T., Psychiatric Genomics Consortium MDD Working Group, Hall, L. S., Kutalik, Z., Hong Lee, S., Ripke, S., Steinberg, S., Teumer, A., Viktorin, A., Wray, N. R., Baune, B. T., Boomsma, D. I., Børglum, A. D., Byrne, E. M., Castelao, E., ... GERAD1 Consortium: (2017). Genome-wide Association for Major Depression Through Age at Onset Stratification. Biological psychiatry , 81(4), 325-335. https://doi.org/10.1016/j.biopsych.2016.05.010 Citing this paper Please note that where the full-text provided on King's Research Portal is the Author Accepted Manuscript or Post-Print version this may differ from the final Published version. If citing, it is advised that you check and use the publisher's definitive version for pagination, volume/issue, and date of publication details. And where the final published version is provided on the Research Portal, if citing you are again advised to check the publisher's website for any subsequent corrections. 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Sep. 2021 Biological Archival Report Psychiatry Genome-wide Association for Major Depression Through Age at Onset Stratification: Major Depressive Disorder Working Group of the Psychiatric Genomics Consortium Robert A. Power, Katherine E. Tansey, Henriette Nørmølle Buttenschøn, Sarah Cohen-Woods, Tim Bigdeli, Lynsey S. Hall, Zoltán Kutalik, S. Hong Lee, Stephan Ripke, Stacy Steinberg, Alexander Teumer, Alexander Viktorin, Naomi R. Wray, Volker Arolt, Bernard T. Baune, Dorret I. Boomsma, Anders D. Børglum, Enda M. Byrne, Enrique Castelao, Nick Craddock, Ian W. Craig, Udo Dannlowski, Ian J. Deary, Franziska Degenhardt, Andreas J. Forstner, Scott D. Gordon, Hans J. Grabe, Jakob Grove, Steven P. Hamilton, Caroline Hayward, Andrew C. Heath, Lynne J. Hocking, Georg Homuth, Jouke J. Hottenga, Stefan Kloiber, Jesper Krogh, Mikael Landén, Maren Lang, Douglas F. Levinson, Paul Lichtenstein, Susanne Lucae, Donald J. MacIntyre, Pamela Madden, Patrik K.E. Magnusson, Nicholas G. Martin, Andrew M. McIntosh, Christel M. Middeldorp, Yuri Milaneschi, Grant W. Montgomery, Ole Mors, Bertram Müller-Myhsok, Dale R. Nyholt, Hogni Oskarsson, Michael J. Owen, Sandosh Padmanabhan, Brenda W.J.H. Penninx, Michele L. Pergadia, David J. Porteous, James B. Potash, Martin Preisig, Margarita Rivera, Jianxin Shi, Stanley I. Shyn, Engilbert Sigurdsson, Johannes H. Smit, Blair H. Smith, Hreinn Stefansson, Kari Stefansson, Jana Strohmaier, Patrick F. Sullivan, Pippa Thomson, Thorgeir E. Thorgeirsson, Sandra Van der Auwera, Myrna M. Weissman, CONVERGE Consortium, CARDIoGRAM Consortium, GERAD1 Consortium, Gerome Breen, and Cathryn M. Lewis ABSTRACT BACKGROUND: Major depressive disorder (MDD) is a disabling mood disorder, and despite a known heritable component, a large meta-analysis of genome-wide association studies revealed no replicable genetic risk variants. Given prior evidence of heterogeneity by age at onset in MDD, we tested whether genome-wide significant risk variants for MDD could be identified in cases subdivided by age at onset. METHODS: Discovery case-control genome-wide association studies were performed where cases were stratified using increasing/decreasing age-at-onset cutoffs; significant single nucleotide polymorphisms were tested in nine independent replication samples, giving a total sample of 22,158 cases and 133,749 control subjects for subsetting. Polygenic score analysis was used to examine whether differences in shared genetic risk exists between earlier and adult-onset MDD with commonly comorbid disorders of schizophrenia, bipolar disorder, Alzheimer’s disease, and coronary artery disease. RESULTS: We identified one replicated genome-wide significant locus associated with adult-onset (.27 years) MDD (rs7647854, odds ratio: 1.16, 95% confidence interval: 1.11–1.21, p 5 5.2 3 10-11). Using polygenic score analyses, we show that earlier-onset MDD is genetically more similar to schizophrenia and bipolar disorder than adult-onset MDD. CONCLUSIONS: We demonstrate that using additional phenotype data previously collected by genetic studies to tackle phenotypic heterogeneity in MDD can successfully lead to the discovery of genetic risk factor despite reduced sample size. Furthermore, our results suggest that the genetic susceptibility to MDD differs between adult- and earlier-onset MDD, with earlier-onset cases having a greater genetic overlap with schizophrenia and bipolar disorder. Keywords: Age at onset, GWAS, Heterogeneity, Major depressive disorder, Polygenic scoring, Stratification http://dx.doi.org/10.1016/j.biopsych.2016.05.010 SEE COMMENTARY ON PAGE 280 & 2016 Society of Biological Psychiatry. This is an open access article under the 325 CC BY license (http://creativecommons.org/licenses/by/4.0/). ISSN: 0006-3223 Biological Psychiatry February 15, 2017; 81:325–335 www.sobp.org/journal Biological Psychiatry Genomic Analysis of Age at Onset in Depression Major depressive disorder (MDD) is a highly prevalent and METHODS AND MATERIALS heterogeneous disorder (1). With most individuals experi- encing recurrent episodes throughout life (2), MDD is now Description of Samples the second leading cause of disability worldwide (3). MDD is Full details of the studies that form the PGC-MDD are given in defined by low mood and energy, inability to experience the supplementary materials of the original data analysis (9). enjoyment, changes to eating and sleep patterns, feelings Briefly, these nine MDD studies (23–30) conducted genome- of guilt or worthlessness, and suicidal thoughts (4). Along wide genotyping on individual subjects of European ancestry. with excess mortality and increased risk of suicide (5), MDD Subjects were required to have diagnoses of DSM-IV lifetime is associated with worse clinical outcomes when comorbid MDD established using structured diagnostic instruments with health problems such as cardiovascular disease and from direct interviews by trained interviewers or clinician- cancer (6,7). Although the heritability is estimated at 31% to administered DSM-IV checklists. Two studies required recur- 42% (8), the causal variants remain elusive: a recent large rent MDD and one study required recurrent, early-onset MDD. mega-analysis with over 9000 MDD cases failed to identify Studies ascertained cases mostly from clinical sources, and any replicable associations (9), despite successes in sim- control subjects were largely randomly selected from the ilarly sized studies of schizophrenia (SCZ) and bipolar population and screened for lifetime history of MDD. This led disorder (BPD) (10,11). This lack of biological markers may to a total of 9238 cases and 9521 control subjects with be among the causes for the well-established underfund- genotype information. ingofresearchintoMDDrelativetoitseconomicand health burden (12) and the reported stigmatization of suffer- AAO Phenotype ers (13). AAO was defined as the age at which individuals first had However, several differences exist between MDD and other symptoms that met the criteria of MDD and was self-reported in psychiatric disorders in which replicable genetic associations all studies. Of the original 9238 cases included in the sample, have been identified, including higher prevalence, greater 8920 (95.6%) had a reported AAO. Cases reporting an AAO diagnostic uncertainty, lower heritability, and, crucially, older than the recorded age at interview were removed from the increased heterogeneity. One known source of heterogeneity analysis (n = 17). Within each study, cases were ordered by that may contribute substantially is age at onset (AAO). Onset AAO and then divided into octiles, giving approximately 1000 can occur at any stage of life, yet many factors associated with cases per octile. Octiles were defined within each study to MDD are either age specific or age restricted. These include account for differences in case ascertainment. We noted a wide biological events such as puberty, menopause, and dementia, range in AAO between studies ascertaining recurrent depres- and environmental risk factors including childhood maltreat- sion using the same instrument, indicating that the precise ment, childbirth, and divorce. Earlier onset is associated with setting (study, clinic, country) was important; we therefore increased risk in first-degree relatives and with higher heritability chose to order cases by AAO within each study, rather than (14–18). Considerable differences in the transmission of early- across studies, or by absolute AAO cutoffs. This strategy will versus
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