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However, MDD is clinically heterogeneous, with symptoms varying between participants or within a participant over time, possibly due to differences in stress reactivity [4] or inflammation [5]

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Indeed, the clinical literature exhibits heterogeneity in design, dosing, duration, and outcome measures, frequent reliance on parent reported scales without uniform blinding, and underpowered samples that hinder strong inference and guideline development (Doherty et al., 2022