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Cho CH, Lee HJ, Kim YK. Telepsychiatry in the Treatment of Major Depressive Disorders. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2024; 1456:333-356. [PMID: 39261437 DOI: 10.1007/978-981-97-4402-2_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/13/2024]
Abstract
This chapter explores the transformative role of telepsychiatry in managing major depressive disorders (MDD). Traversing geographical barriers and reducing stigma, this innovative branch of telemedicine leverages digital platforms to deliver effective psychiatric care. We investigate the evolution of telepsychiatry, examining its diverse interventions such as videoconferencing-based psychotherapy, medication management, and mobile applications. While offering significant advantages like increased accessibility, cost-effectiveness, and improved patient engagement, challenges in telepsychiatry include technological barriers, privacy concerns, ethical and legal considerations, and digital literacy gaps. Looking forward, emerging technologies like virtual reality, artificial intelligence, and precision medicine hold immense potential to personalize and enhance treatment effectiveness. Recognizing its limitations and advocating for equitable access, this chapter underscores telepsychiatry's power to revolutionize MDD treatment, making quality mental healthcare a reality for all.
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Affiliation(s)
- Chul-Hyun Cho
- Department of Psychiatry, Korea University College of Medicine, Seoul, Republic of Korea
| | - Heon-Jeong Lee
- Department of Psychiatry, Korea University College of Medicine, Seoul, Republic of Korea
| | - Yong-Ku Kim
- Department of Psychiatry, Korea University College of Medicine, Seoul, Republic of Korea.
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102
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Medvedev VE, Kardashian RA, Frolova VI. [Fluvoxamine in the treatment of anxiety-depressive spectrum disorders]. Zh Nevrol Psikhiatr Im S S Korsakova 2024; 124:101-109. [PMID: 39072574 DOI: 10.17116/jnevro2024124061101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/30/2024]
Abstract
The RSCI and PubMed search databases have requested publications over the past 40 years on the search queries «fluvoxamine», «anxiety-depressive disorders», «anxiety», «depression», «comorbidity», devoted to the effectiveness of fluvoxamine in various variants of disorders of the anxiety-depressive spectrum, anxiety depressions. The data of the above studies indicate that fluvoxamine (Zovart San) in doses of 50-300 mg / day is a highly effective remedy for the treatment of not only anxiety depressions and genesis (psychogenic, organic, mixed, autochthonous-endogenous) and severity (up to psychotic), but also a wider range of anxiety-depressive disorders, including adaptation disorders, obsessive-compulsive disorder, somatized, dysmorphic, insomniac symptom complexes and eating disorders. A wide range of clinical effects of fluvoxamine is due to its main and additional mechanisms of action: blockade of serotonin reuptake, σ1-agonist activity and the effect on the metabolism of melatonin and neurosteroids catabolism.
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Affiliation(s)
- V E Medvedev
- Peoples' Friendship University of Russia, Moscow, Russia
| | - R A Kardashian
- Peoples' Friendship University of Russia, Moscow, Russia
| | - V I Frolova
- Peoples' Friendship University of Russia, Moscow, Russia
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103
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Kalayjian A, Laszlo K, Fassler M, Schonrock Z, Delarose KE, Ly AM, English CD, Cirrincione LR. Patterns of psychotropic medication prescribing and potential drug-hormone interactions among transgender and gender-diverse adults within 2 years of hormone therapy. J Am Pharm Assoc (2003) 2024; 64:283-289.e2. [PMID: 37839699 PMCID: PMC10873097 DOI: 10.1016/j.japh.2023.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 10/07/2023] [Accepted: 10/09/2023] [Indexed: 10/17/2023]
Abstract
BACKGROUND Transgender and gender-diverse (TGD) people have a high prevalence of psychotropic medication use, yet knowledge about the patient-level psychotropic medication burden is limited. TGD patients may take hormone therapy to meet their gender expression goals. Potential drug-hormone interactions exist between psychotropic medications and hormone therapy, requiring increased knowledge about psychotropic medication use for TGD adults undergoing hormone therapy. OBJECTIVES The objective of this study was to examine the extent of psychotropic medication polypharmacy in a cohort of TGD adults within 2 years of starting hormone therapy. We also characterized potential drug-hormone interactions and the association with psychotropic polypharmacy. METHODS Retrospective cross-sectional analysis of patients with ≥1 transgender health-related visit (2007-2017) in the University of Washington Medical System (Seattle, WA). Eligible patients had ≥1 psychotropic medication including antidepressants, antipsychotics, mood stabilizers, and sedative-hypnotics ordered within 2 years of starting hormone therapy (testosterone or estradiol with or without spironolactone, progesterone, finasteride, or dutasteride). We defined psychotropic polypharmacy as ≥2 psychotropic medication orders with overlapping treatment durations for at least 90 days and characterized potential drug-hormone interactions (Lexicomp, Hudson, OH). We descriptively summarized patients with and without polypharmacy (frequencies and percentages) and compared drug-hormone interactions using chi-square or Fishers exact tests (P < 0.05 considered significant). RESULTS A total of 184 patients had ≥1 psychotropic medication order within 2 years of hormone therapy; 68 patients (37.0%) had psychotropic polypharmacy. The most frequent type of psychotropic polypharmacy was antidepressant+sedative-hypnotic (18 of 68, 26.5%). More patients had a potential drug-hormone interaction among those with psychotropic polypharmacy (23 of 68, 33.8%) versus those without (8 of 116, 6.9%, P < 0.001). CONCLUSION Among TGD patients on psychotropic medications within 2 years of hormone therapy, one-third had psychotropic polypharmacy. Most polypharmacy types appeared to align with mental health treatment guidelines. The number of patients with a potential drug-hormone interaction was significantly higher among those with polypharmacy. Prospective studies are needed to characterize drug-hormone interactions.
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Affiliation(s)
- Alin Kalayjian
- School of Pharmacy, University of Washington, Seattle, WA, USA
| | - Kaeleb Laszlo
- Department of Pharmacy, University of Washington, Seattle, WA, USA
| | - Molly Fassler
- Department of Pharmacy, University of Washington, Seattle, WA, USA
| | | | | | - Andrew M. Ly
- School of Pharmacy, University of Washington, Seattle, WA, USA
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104
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Raspopova NI. [Pathogenetic basis of modern approaches to the therapy of sleep disorders in the clinic of depression]. Zh Nevrol Psikhiatr Im S S Korsakova 2024; 124:69-74. [PMID: 38676680 DOI: 10.17116/jnevro202412404169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2024]
Abstract
Epidemiological studies indicate that about 35% of the world's population periodically suffer from insomnia. Many authors in their studies note sleep disturbances in the clinic of both somatic and mental disorders, often considering sleep disturbances as one of the predictors of these diseases. In psychiatric practice, sleep disorders are most often described in the clinic of depression, which is determined by the general pathophysiological mechanisms of their development due to disruption of the activity of the main neurotransmitter systems of the brain. The results of clinical studies show that the drug of choice in the treatment of sleep disorders in the depression clinic is the antidepressant Mirtazapine, which has a unique profile of pharmacological activity. According to international recommendations, Mirtazapine is a first-line drug in the treatment of anxiety and depressive disorders with sleep disorders and sexual dysfunction caused by taking other antidepressants.
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Affiliation(s)
- N I Raspopova
- Kazakhstan-Russian Medical University, Almaty, Republic of Kazakhstan
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105
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Yoon S, Kim YK. Endocrinological Treatment Targets for Depressive Disorder. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2024; 1456:3-25. [PMID: 39261421 DOI: 10.1007/978-981-97-4402-2_1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/13/2024]
Abstract
Depressive disorder exhibits heterogeneity in clinical presentation, progression, and treatment outcomes. While conventional antidepressants based on the monoamine hypothesis benefit many patients, a significant proportion remains unresponsive or fails to fully recover. An individualized integrative treatment approach, considering diverse pathophysiologies, holds promise for these individuals. The endocrine system, governing physiological regulation and organ homeostasis, plays a pivotal role in central nervous system functions. Dysregulations in endocrine system are major cause of depressive disorder due to other medical conditions. Subtle endocrine abnormalities, such as subclinical hypothyroidism, are associated with depression. Conversely, depressive disorder correlates with endocrine-related biomarkers. Fluctuations in sex hormone levels related to female reproduction, elevate depression risk in susceptible subjects. Consequently, extensive research has explored treatment strategies involving the endocrine system. Treatment guidelines recommend tri-iodothyronine augmentation for resistant depression, while allopregnanolone analogs have gained approval for postpartum depression, with ongoing investigations for broader depressive disorders. This book chapter will introduce the relationship between the endocrine system and depressive disorders, presenting clinical findings on neuroendocrinological treatments for depression.
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Affiliation(s)
- Seoyoung Yoon
- Department of Psychiatry, Daegu Catholic University School of Medicine, Daegu, Republic of Korea
| | - Yong-Ku Kim
- Department of Psychiatry, Korea University College of Medicine, Seoul, Republic of Korea.
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106
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Tang N, Shu W, Wang HN. Accelerated transcranial magnetic stimulation for major depressive disorder: A quick path to relief? WILEY INTERDISCIPLINARY REVIEWS. COGNITIVE SCIENCE 2024; 15:e1666. [PMID: 37779251 DOI: 10.1002/wcs.1666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 08/21/2023] [Accepted: 08/22/2023] [Indexed: 10/03/2023]
Abstract
Transcranial magnetic stimulation (TMS) is a safe, tolerable, and evidence-based intervention for major depressive disorder (MDD). However, even after decades of research, nearly half of the patients with MDD fail to respond to conventional TMS, with responding slowly and requiring daily attendance at the treatment site for 4-6 weeks. To intensify antidepressant efficacy and shorten treatment duration, accelerated TMS protocols, which involve multiple sessions per day over a few days, have been proposed and evaluated for safety and viability. We reviewed and summarized the current knowledge in accelerated TMS, including stimulation parameters, antidepressant efficacy, anti-suicidal efficacy, safety, and adverse effects. Limitations and suggestions for future directions are also addressed, along with a brief discussion on the application of accelerated TMS during the COVID-19 pandemic. This article is categorized under: Neuroscience > Clinical Neuroscience.
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Affiliation(s)
- Nailong Tang
- Department of Psychiatry, First Affiliated Hospital of Air Force Medical University, Xi'an, Shaanxi, China
- Department of Psychiatry, the 907th Hospital of the PLA Joint Logistics Support Force, Nanping, Fujian, China
| | - Wanqing Shu
- Department of Psychiatry, First Affiliated Hospital of Air Force Medical University, Xi'an, Shaanxi, China
| | - Hua-Ning Wang
- Department of Psychiatry, First Affiliated Hospital of Air Force Medical University, Xi'an, Shaanxi, China
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107
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Cressman S, Ghanbarian S, Edwards L, Peterson S, Bunka M, Hoens AM, Riches L, Austin J, Vijh R, McGrail K, Bryan S. Costs of major depression covered / not covered in British Columbia, Canada. BMC Health Serv Res 2023; 23:1446. [PMID: 38124043 PMCID: PMC10734183 DOI: 10.1186/s12913-023-10474-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 12/12/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Major depressive disorder (MDD) is one of the world's leading causes of disability. Our purpose was to characterize the total costs of MDD and evaluate the degree to which the British Columbia provincial health system meets its objective to protect people from the financial impact of illness. METHODS We performed a population-based cohort study of adults newly diagnosed with MDD between 2015 and 2020 and followed their health system costs over two years. The expenditure proportion of MDD-related, patient paid costs relative to non-subsistence income was estimated, incidences of financial hardship were identified and the slope index of inequality (SII) between the highest and lowest income groups compared across regions. RESULTS There were 250,855 individuals diagnosed with MDD in British Columbia over the observation period. Costs to the health system totalled >$1.5 billion (2020 CDN), averaging $138/week for the first 12 weeks following a new diagnosis and $65/week to week 52 and $55/week for weeks 53-104 unless MDD was refractory to treatment ($125/week between week 12-52 and $101/week over weeks 53-104). The proportion of MDD-attributable costs not covered by the health system was 2-15x greater than costs covered by the health system, exceeding $700/week for patients with severe MDD or MDD that was refractory to treatment. Population members in lower-income groups and urban homeowners had disadvantages in the distribution of financial protection received by the health system (SII reached - 8.47 and 15.25, respectively); however, financial hardship and inequities were mitigated province-wide if MDD went into remission (SII - 0.07 to 0.6). CONCLUSIONS MDD-attributable costs to health systems and patients are highest in the first 12 weeks after a new diagnosis. During this time, lower income groups and homeowners in urban areas run the risk of financial hardship.
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Affiliation(s)
- Sonya Cressman
- The Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, BC, Canada.
- The School of Public and Population Health, University of British Columbia, Vancouver, BC, Canada.
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada.
| | - Shahzad Ghanbarian
- The Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, BC, Canada
- The School of Public and Population Health, University of British Columbia, Vancouver, BC, Canada
| | - Louisa Edwards
- The Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, BC, Canada
- The School of Public and Population Health, University of British Columbia, Vancouver, BC, Canada
| | - Sandra Peterson
- Centre for Health Services and Policy Research, University of British Columbia, Vancouver, BC, Canada
| | - Mary Bunka
- The Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, BC, Canada
- The School of Public and Population Health, University of British Columbia, Vancouver, BC, Canada
| | - Alison M Hoens
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Linda Riches
- The School of Public and Population Health, University of British Columbia, Vancouver, BC, Canada
- Patient Partner, University of British Columbia, Vancouver, BC, Canada
| | - Jehannine Austin
- Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Rohit Vijh
- The School of Public and Population Health, University of British Columbia, Vancouver, BC, Canada
- Department of Family Practice, University of British Columbia, Vancouver, BC, Canada
| | - Kimberlyn McGrail
- Centre for Health Services and Policy Research, University of British Columbia, Vancouver, BC, Canada
| | - Stirling Bryan
- The Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, BC, Canada
- The School of Public and Population Health, University of British Columbia, Vancouver, BC, Canada
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108
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Rosenblat JD, McIntyre RS. Augmentation in depression: Esketamine, a new standard? MED 2023; 4:852-854. [PMID: 38070477 DOI: 10.1016/j.medj.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 11/08/2023] [Accepted: 11/08/2023] [Indexed: 12/18/2023]
Abstract
While new add-on treatments have been developed for augmentation in depression with benefits demonstrated compared to placebo, none have demonstrated superiority compared to previously available interventions until now. In a phase IIIb, randomized, active-controlled trial (ESCAPE-TRD), Reif et al.1 demonstrate the superiority of esketamine compared to quetiapine augmentation (the current standard-of-care).
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Ataka K, Asakawa A, Iwai H, Kato I. Musclin prevents depression-like behavior in male mice by activating urocortin 2 signaling in the hypothalamus. Front Endocrinol (Lausanne) 2023; 14:1288282. [PMID: 38116320 PMCID: PMC10728487 DOI: 10.3389/fendo.2023.1288282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 11/09/2023] [Indexed: 12/21/2023] Open
Abstract
Introduction Physical activity is recommended as an alternative treatment for depression. Myokines, which are secreted from skeletal muscles during physical activity, play an important role in the skeletal muscle-brain axis. Musclin, a newly discovered myokine, exerts physical endurance, however, the effects of musclin on emotional behaviors, such as depression, have not been evaluated. This study aimed to access the anti-depressive effect of musclin and clarify the connection between depression-like behavior and hypothalamic neuropeptides in mice. Methods We measured the immobility time in the forced swim (FS) test, the time spent in open arm in the elevated-plus maze (EPM) test, the mRNA levels of hypothalamic neuropeptides, and enumerated the c-Fos-positive cells in the paraventricular nucleus (PVN), arcuate nucleus (ARC), and nucleus tractus solitarii (NTS) in mice with the intraperitoneal (i.p.) administration of musclin. Next, we evaluated the effects of a selective corticotropin-releasing factor (CRF) type 1 receptor antagonist, selective CRF type 2 receptor antagonist, melanocortin receptor (MCR) agonist, and selective melanocortin 4 receptor (MC4R) agonist on changes in behaviors induced by musclin. Finally we evaluated the antidepressant effect of musclin using mice exposed to repeated water immersion (WI) stress. Results We found that the i.p. and i.c.v. administration of musclin decreased the immobility time and relative time in the open arms (open %) in mice and increased urocortin 2 (Ucn 2) levels but decreased proopiomelanocortin levels in the hypothalamus. The numbers of c-Fos-positive cells were increased in the PVN and NTS but decreased in the ARC of mice with i.p. administration of musclin. The c-Fos-positive cells in the PVN were also found to be Ucn 2-positive. The antidepressant and anxiogenic effects of musclin were blocked by central administration of a CRF type 2 receptor antagonist and a melanocortin 4 receptor agonist, respectively. Peripheral administration of musclin also prevented depression-like behavior and the decrease in levels of hypothalamic Ucn 2 induced by repeated WI stress. Discussion These data identify the antidepressant effects of musclin through the activation of central Ucn 2 signaling and suggest that musclin and Ucn 2 can be new therapeutic targets and endogenous peptides mediating the muscle-brain axis.
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Affiliation(s)
- Koji Ataka
- Laboratory of Medical Biochemistry, Kobe Pharmaceutical University, Kobe, Japan
- Department of Psychosomatic Internal Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Akihiro Asakawa
- Department of Psychosomatic Internal Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Haruki Iwai
- Department of Oral Anatomy and Cell Biology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Ikuo Kato
- Laboratory of Medical Biochemistry, Kobe Pharmaceutical University, Kobe, Japan
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Bommena S, Goldberg A, Amini M, Alishahi Y. Depression in Women With Inflammatory Bowel Disease: A Multifaceted Approach for a Multidimensional Problem. Inflamm Bowel Dis 2023; 29:1957-1970. [PMID: 36472240 DOI: 10.1093/ibd/izac245] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Indexed: 06/17/2023]
Abstract
The prevalence of depression is higher in patients with inflammatory bowel disease (IBD) than in the general population. Women are more significantly affected by depression among those with IBD and in the general population. This review presents evidence on sex-based differences in depression pathogenesis and the effect of depression on various factors associated with IBD that affect women's lives, including sexual dysfunction, body image dissatisfaction, fertility, and overall quality of life. We also discuss sex-specific effects on IBD treatment, disease activity, and health care costs. Interestingly, women with IBD tend to seek and are more receptive to depression-related information. Given the underdiagnosis and undertreated nature of depression in individuals with IBD, effective screening and an optimal integrative treatment approach with relevant sex-specific needs are discussed. Evidence regarding the efficacy of psychotherapy, antidepressant pharmacotherapy, and IBD-specific therapy for depression is discussed. This review summarizes evidence of the effect of depression on both personal and professional aspects of the daily lives of women with IBD, which extends beyond negative moods. It applies this information to screening and integrative treatment, resulting in a holistic approach to this multidimensional problem. We also discuss how depression affects males with IBD differently from females. Finally, we discuss the need for gender-based studies on depression in individuals with IBD.
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Affiliation(s)
- Shoma Bommena
- Department of Internal Medicine, University of Arizona College of Medicine-Phoenix, Banner University Medical Center-Phoenix, AZ, USA
| | - Aaron Goldberg
- Division of Gastroenterology, University of Arizona College of Medicine-Phoenix, Phoenix VA Health Care System, AZ, USA
| | - Mona Amini
- Psychiatry and Mental Health, Phoenix VA Health Care System, Phoenix, AZ, USA
| | - Yasmin Alishahi
- Division of Gastroenterology, University of Arizona College of Medicine-Phoenix, Phoenix VA Health Care System, AZ, USA
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Christensen MC, McIntyre RS, Adair M, Florea I, Loft H, Fagiolini A. Clinical benefits of vortioxetine 20 mg/day in patients with major depressive disorder. CNS Spectr 2023; 28:693-701. [PMID: 37070529 DOI: 10.1017/s1092852923002249] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Abstract
BACKGROUND Vortioxetine has demonstrated dose-dependent efficacy in patients with major depressive disorder (MDD), with the greatest effect observed with vortioxetine 20 mg/day. This analysis further explored the clinical relevance of the more rapid and greater improvement in depressive symptoms observed with vortioxetine 20 mg/day vs 10 mg/day. METHODS Analysis of pooled data from six short-term (8-week), randomized, placebo-controlled, fixed-dose studies of vortioxetine 20 mg/day in patients with MDD (N = 2620). Symptomatic response (≥50% decrease in Montgomery-Åsberg Depression Rating Scale [MADRS] total score), sustained symptomatic response, and remission (MADRS total score ≤10) were assessed by vortioxetine dosage (20 or 10 mg/day). RESULTS After 8 weeks, 51.4% of patients receiving vortioxetine 20 mg/day had achieved symptomatic response vs 46.0% of those receiving vortioxetine 10 mg/day (P < .05). Significantly more patients achieved symptomatic response vs placebo from week 2 onwards for vortioxetine 20 mg/day and from week 6 onwards for vortioxetine 10 mg/day (both P ≤ .05). Sustained response was achieved from week 4 for 26.0% of patients receiving vortioxetine 20 mg/day vs 19.1% of those receiving vortioxetine 10 mg/day (P < .01), increasing to 36.0% and 29.8%, respectively, over the 8-week treatment period (P < .05). At week 8, 32.0% of patients receiving vortioxetine 20 mg/day were in remission vs 28.2% of those receiving vortioxetine 10 mg/day (P = .09). Rates of adverse events and treatment withdrawal were not increased during the week following vortioxetine dose up-titration to 20 mg/day. CONCLUSION Vortioxetine 20 mg/day provides more rapid and more sustained symptomatic response than vortioxetine 10 mg/day in patients with MDD, without compromising tolerability.
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Affiliation(s)
| | - Roger S McIntyre
- Mood Disorders Psychopharmacology Unit, University Health Network, University of Toronto, Toronto, ON, Canada
| | | | | | | | - Andrea Fagiolini
- Division of Psychiatry, Department of Molecular and Developmental Medicine, University of Siena School of Medicine, Siena, Italy
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Husain MI, Foster JA, Mason BL, Chen S, Zhao H, Wang W, Rotzinger S, Rizvi S, Ho K, Lam R, MacQueen G, Milev R, Frey BN, Müller D, Turecki G, Jha M, Trivedi M, Kennedy SH. Pro-inflammatory markers are associated with response to sequential pharmacotherapy in major depressive disorder: a CAN-BIND-1 report. CNS Spectr 2023; 28:739-746. [PMID: 37218291 DOI: 10.1017/s109285292300233x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVE There is limited literature on associations between inflammatory tone and response to sequential pharmacotherapies in major depressive disorder (MDD). METHODS In a 16-week open-label clinical trial, 211 participants with MDD were treated with escitalopram 10-20 mg daily for 8 weeks. Responders continued escitalopram while non-responders received adjunctive aripiprazole 2-10 mg daily for 8 weeks. Plasma levels of pro-inflammatory markers-C-reactive protein, interleukin (IL)-1β, IL-6, IL-17, interferon-gamma (IFN)-Γ, tumor necrosis factor (TNF)-α, and Chemokine C-C motif ligand-2 (CCL-2)-measured at baseline, and after 2, 8 and 16 weeks were included in logistic regression analyzes to assess associations between inflammatory markers and treatment response. RESULTS Pre-treatment IFN-Γ and CCL-2 levels were significantly associated with a lower of odds of response to escitalopram at 8 weeks. Increases in CCL-2 levels from weeks 8 to 16 in escitalopram non-responders were significantly associated with higher odds of non-response to adjunctive aripiprazole at week 16. CONCLUSION Higher pre-treatment levels of IFN-Γ and CCL-2 were associated with non-response to escitalopram. Increasing levels of these pro-inflammatory markers may be associated with non-response to adjunctive aripiprazole. These findings require validation in independent clinical populations.
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Affiliation(s)
- M Ishrat Husain
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Jane A Foster
- Centre for Depression and Suicide Studies, Unity Health, Toronto, ON, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
- Mood Disorders Program, St. Joseph's Healthcare Hamilton, ON, Canada
| | - Brittany L Mason
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, United States
| | - Sheng Chen
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Haoyu Zhao
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Wei Wang
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Susan Rotzinger
- Centre for Depression and Suicide Studies, Unity Health, Toronto, ON, Canada
| | - Sakina Rizvi
- Centre for Depression and Suicide Studies, Unity Health, Toronto, ON, Canada
| | - Keith Ho
- Centre for Depression and Suicide Studies, Unity Health, Toronto, ON, Canada
| | - Raymond Lam
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Glenda MacQueen
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Roumen Milev
- Department of Psychiatry, Queen's University, Kingston, ON, Canada
| | - Benicio N Frey
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
- Mood Disorders Program, St. Joseph's Healthcare Hamilton, ON, Canada
| | - Daniel Müller
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Gustavo Turecki
- The Douglas Hospital, Montreal, QC, Canada
- Department of Psychiatry. McGill University, Toronto, ON, Canada
| | - Manish Jha
- Icahn School of Medicine, Mount Sinai Hospital, New York, NY, United States
| | - Madhukar Trivedi
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, United States
| | - Sidney H Kennedy
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Centre for Depression and Suicide Studies, Unity Health, Toronto, ON, Canada
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Leung JG. Ethnopsychopharmacology: Clinical and scientific writing pearls. Ment Health Clin 2023; 13:276-288. [PMID: 38058595 PMCID: PMC10696167 DOI: 10.9740/mhc.2023.12.276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 09/26/2023] [Indexed: 12/08/2023] Open
Abstract
The concept of ethnopsychopharmacology aims to predict or explain the pharmacologic response to psychiatric medications based on the influence of biologic and nonbiologic factors. Interactions involving these factors are complex and influence patient outcomes in health care. Pharmacists and other clinicians working in patient care environments, research, or medical education should engage in lifelong learning to enhance ethnopsychopharmacologic knowledge gaps, which ultimately may improve and individualize care across diverse populations. Through two cases, this paper provides pearls on how biogeographical ancestry and cytochrome P450 status may influence pharmacotherapy selection, dosing, or response. A third scenario highlights a publication, like many other published works, with deficiencies in how data on ancestry, race, and ethnicity are collected or reported. Current recommendations on the use of inclusive language in scientific writing are reviewed, with attention to specific examples.
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114
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Kolasa M, Faron-Górecka A. Preclinical models of treatment-resistant depression: challenges and perspectives. Pharmacol Rep 2023; 75:1326-1340. [PMID: 37882914 PMCID: PMC10661811 DOI: 10.1007/s43440-023-00542-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/06/2023] [Accepted: 10/06/2023] [Indexed: 10/27/2023]
Abstract
Treatment-resistant depression (TRD) is a subgroup of major depressive disorder in which the use of classical antidepressant treatments fails to achieve satisfactory treatment results. Although there are various definitions and grading models for TRD, common criteria for assessing TRD have still not been established. However, a common feature of any TRD model is the lack of response to at least two attempts at antidepressant pharmacotherapy. The causes of TRD are not known; nevertheless, it is estimated that even 60% of TRD patients are so-called pseudo-TRD patients, in which multiple biological factors, e.g., gender, age, and hormonal disturbances are concomitant with depression and involved in antidepressant drug resistance. Whereas the phenomenon of TRD is a complex disorder difficult to diagnose and successfully treat, the search for new treatment strategies is a significant challenge of modern pharmacology. It seems that despite the complexity of the TRD phenomenon, some useful animal models of TRD meet the construct, the face, and the predictive validity criteria. Based on the literature and our own experiences, we will discuss the utility of animals exposed to the stress paradigm (chronic mild stress, CMS), and the Wistar Kyoto rat strain representing an endogenous model of TRD. In this review, we will focus on reviewing research on existing and novel therapies for TRD, including ketamine, deep brain stimulation (DBS), and psychedelic drugs in the context of preclinical studies in representative animal models of TRD.
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Affiliation(s)
- Magdalena Kolasa
- Department of Pharmacology, Maj Institute of Pharmacology, Polish Academy of Sciences, Smętna 12, 31-343, Kraków, Poland
| | - Agata Faron-Górecka
- Department of Pharmacology, Maj Institute of Pharmacology, Polish Academy of Sciences, Smętna 12, 31-343, Kraków, Poland.
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115
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Wang X, Ma X, Long Y, Wu G. Vortioxetine usage in an elderly patient with major depressive disorder and accompanied by multiple physical conditions: A case report. Aging Med (Milton) 2023; 6:446-449. [PMID: 38239711 PMCID: PMC10792323 DOI: 10.1002/agm2.12268] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 08/23/2023] [Accepted: 08/28/2023] [Indexed: 01/22/2024] Open
Abstract
Elderly patients with depressive disorder always have complex and diverse symptoms, and are mostly combined with chronic physical conditions. This case report presents a case of vortioxetine usage in a 67-year-old male patient with major depressive disorder and accompanied by multiple physical conditions.
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Affiliation(s)
- Xiaoman Wang
- XiangYa School of MedicineCentral South UniversityChangshaChina
| | - Xiaoqian Ma
- Department of Psychiatry, The Second Xiangya Hospital, National Clinical Research Center for Mental DisordersCentral South UniversityChangshaChina
| | - Yicheng Long
- Department of Psychiatry, The Second Xiangya Hospital, National Clinical Research Center for Mental DisordersCentral South UniversityChangshaChina
| | - Guowei Wu
- Department of Psychiatry, The Second Xiangya Hospital, National Clinical Research Center for Mental DisordersCentral South UniversityChangshaChina
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von Knorring J, Baryshnikov I, Jylhä P, Talaslahti T, Heikkinen M, Isometsä E. Prospective study of antidepressant treatment of psychiatric patients with depressive disorders: treatment adequacy and outcomes. BMC Psychiatry 2023; 23:888. [PMID: 38017416 PMCID: PMC10683284 DOI: 10.1186/s12888-023-05390-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 11/21/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND Despite numerous national depression care guidelines (DCGs), suboptimal antidepressant treatment may occur. We examined DCG concordance and depression treatment outcomes in psychiatric settings. METHODS We evaluated treatment received and outcomes of 128 psychiatric out- and inpatients participating in the PEGAD (Pharmacoepidemiology and Pharmacogenetics of Antidepressant Treatment for Depressive Disorders) study at baseline, two weeks, and eight weeks using interviews and questionnaires. Inclusion criteria were ICD-10 diagnosis of a depressive disorder, a Patient Health Questionnaire-9 symptom (PHQ-9) score ≥ 10, and a new antidepressant prescribed. The primary outcome of the study was within-individual change in PHQ-9 scores. RESULTS At baseline, patients had predominately recurrent (83%) and in 19% treatment-resistant depression (TRD). The median preceding duration of the current episode was 6.5 months. At eight weeks, 85% of the patients (n = 107) used a DCG-concordant antidepressant dose. However, due to the scarcity of antidepressant combinations and augmentations, fewer TRD than non-TRD patients (25% vs. 84%, p < 0.005) received adequate antidepressant treatment. Additionally, one-third of the patients received inadequate follow-up. Overall, only 53% received treatment compatible with DCG recommendations for adequate pharmacotherapy and follow-up. The mean decline in PHQ-9 scores (-3.8 ± SD 5.7) was significant (p < 0.0005). Nearly 40% of the patients reached a subthreshold level of depression (PHQ-9 < 10), predicted by a lower baseline PHQ-9 score, recurrent depression, and female sex. However, 45% experienced no significant clinical improvement (PHQ-9 score reduction < 20%). CONCLUSIONS Our findings suggest that inadequate treatment continues to occur in psychiatric care settings, particularly for TRD patients.
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Affiliation(s)
- Johanna von Knorring
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, P.O. Box 22, Helsinki, FI-00014, Finland
| | - Ilya Baryshnikov
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, P.O. Box 22, Helsinki, FI-00014, Finland
| | - Pekka Jylhä
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, P.O. Box 22, Helsinki, FI-00014, Finland
| | - Tiina Talaslahti
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, P.O. Box 22, Helsinki, FI-00014, Finland
| | - Martti Heikkinen
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, P.O. Box 22, Helsinki, FI-00014, Finland
| | - Erkki Isometsä
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, P.O. Box 22, Helsinki, FI-00014, Finland.
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Bahji A, Lunsky I, Gutierrez G, Vazquez G. Efficacy and Safety of Four Psychedelic-Assisted Therapies for Adults with Symptoms of Depression, Anxiety, and Posttraumatic Stress Disorder: A Systematic Review and Meta-Analysis. J Psychoactive Drugs 2023:1-16. [PMID: 37968944 DOI: 10.1080/02791072.2023.2278586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 09/29/2023] [Indexed: 11/17/2023]
Abstract
There has been a resurgence in psychedelic research for managing psychiatric conditions in recent years. This study aimed to present a comprehensive review of the current state of the field by applying a systematic search strategy for articles on the effectiveness and tolerability of four psychedelic-assisted therapies (psilocybin, lysergic acid diethylamide [LSD], 3,4-Methylenedioxymethamphetamine [MDMA], and ayahuasca) for adults with symptoms of depression, anxiety, and posttraumatic stress disorder (PTSD). Psychometric scores and adverse events were pooled using random-effects meta-analysis models with Hedges' g bias-corrected standardized mean differences (g) and rate ratios (RR) with 95% confidence intervals (CI). Bias evaluation followed PRISMA and Cochrane guidelines. Eighteen studies were identified, which suggested that psychedelic therapies were well tolerated and presented a large effect size for the management of depression symptoms in a transdiagnostic population with psilocybin (g = -1.92, 95% CI, -2.73 to -1.11) and MDMA (g = -0.71; 95% CI, -1.39 to -0.03). These are promising results that complement the current literature. However, evidence certainty was low to very low due to methodological limitations, small sample size, blinding, study heterogeneity, and publication bias. These results also highlight the need for more adequately powered studies exploring these novel therapies.
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Affiliation(s)
- Anees Bahji
- Department of Psychiatry, University of Calgary, Calgary, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
| | - Isis Lunsky
- School of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Gilmar Gutierrez
- Department of Psychiatry, Queen's University, Kingston, Ontario, Canada
| | - Gustavo Vazquez
- School of Medicine, Queen's University, Kingston, Ontario, Canada
- Department of Psychiatry, Queen's University, Kingston, Ontario, Canada
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118
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Ghanbarian S, Wong GWK, Bunka M, Edwards L, Cressman S, Conte T, Price M, Schuetz C, Riches L, Landry G, Erickson D, McGrail K, Peterson S, Vijh R, Hoens AM, Austin J, Bryan S. Cost-effectiveness of pharmacogenomic-guided treatment for major depression. CMAJ 2023; 195:E1499-E1508. [PMID: 37963621 DOI: 10.1503/cmaj.221785] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND Pharmacogenomic testing to identify variations in genes that influence metabolism of antidepressant medications can enhance efficacy and reduce adverse effects of pharmacotherapy for major depressive disorder. We sought to establish the cost-effectiveness of implementing pharmacogenomic testing to guide prescription of antidepressants. METHODS We developed a discrete-time microsimulation model of care pathways for major depressive disorder in British Columbia, Canada, to evaluate the effectiveness and cost-effectiveness of pharmacogenomic testing from the public payer's perspective over 20 years. The model included unique patient characteristics (e.g., metabolizer phenotypes) and used estimates derived from systematic reviews, analyses of administrative data (2015-2020) and expert judgment. We estimated incremental costs, life-years and quality-adjusted life-years (QALYs) for a representative cohort of patients with major depressive disorder in BC. RESULTS Pharmacogenomic testing, if implemented in BC for adult patients with moderate-severe major depressive disorder, was predicted to save the health system $956 million ($4926 per patient) and bring health gains of 0.064 life-years and 0.381 QALYs per patient (12 436 life-years and 74 023 QALYs overall over 20 yr). These savings were mainly driven by slowing or avoiding the transition to refractory (treatment-resistant) depression. Pharmacogenomic-guided care was associated with 37% fewer patients with refractory depression over 20 years. Sensitivity analyses estimated that costs of pharmacogenomic testing would be offset within about 2 years of implementation. INTERPRETATION Pharmacogenomic testing to guide antidepressant use was estimated to yield population health gains while substantially reducing health system costs. These findings suggest that pharmacogenomic testing offers health systems an opportunity for a major value-promoting investment.
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Affiliation(s)
- Shahzad Ghanbarian
- The Centre for Clinical Epidemiology and Evaluation (Ghanbarian, Wong, Bunka, Edwards, Cressman, Conte, Bryan), Vancouver Coastal Health Research Institute, and The School of Public and Population Health (Ghanbarian, Wong, Bunka, Edwards, Conte, Vijh, Bryan), University of British Columbia, Vancouver, BC; Faculty of Health Sciences (Cressman), Simon Fraser University, Burnaby, BC; Department of Family Practice (Price, Vijh), and Department of Physiatry (Schuetz), Faculty of Medicine, University of British Columbia, Vancouver, BC; Patient partner (Riches), Prince George, BC; Patient partner (Landry), New Westminster, BC; Psychology Department (Erickson), Fraser Health, New Westminster, BC; Centre for Health Services and Policy Research (McGrail, Peterson), and Departments of Physical Therapy (Hoens) and Medical Genetics (Austin), University of British Columbia, Vancouver, BC
| | - Gavin W K Wong
- The Centre for Clinical Epidemiology and Evaluation (Ghanbarian, Wong, Bunka, Edwards, Cressman, Conte, Bryan), Vancouver Coastal Health Research Institute, and The School of Public and Population Health (Ghanbarian, Wong, Bunka, Edwards, Conte, Vijh, Bryan), University of British Columbia, Vancouver, BC; Faculty of Health Sciences (Cressman), Simon Fraser University, Burnaby, BC; Department of Family Practice (Price, Vijh), and Department of Physiatry (Schuetz), Faculty of Medicine, University of British Columbia, Vancouver, BC; Patient partner (Riches), Prince George, BC; Patient partner (Landry), New Westminster, BC; Psychology Department (Erickson), Fraser Health, New Westminster, BC; Centre for Health Services and Policy Research (McGrail, Peterson), and Departments of Physical Therapy (Hoens) and Medical Genetics (Austin), University of British Columbia, Vancouver, BC
| | - Mary Bunka
- The Centre for Clinical Epidemiology and Evaluation (Ghanbarian, Wong, Bunka, Edwards, Cressman, Conte, Bryan), Vancouver Coastal Health Research Institute, and The School of Public and Population Health (Ghanbarian, Wong, Bunka, Edwards, Conte, Vijh, Bryan), University of British Columbia, Vancouver, BC; Faculty of Health Sciences (Cressman), Simon Fraser University, Burnaby, BC; Department of Family Practice (Price, Vijh), and Department of Physiatry (Schuetz), Faculty of Medicine, University of British Columbia, Vancouver, BC; Patient partner (Riches), Prince George, BC; Patient partner (Landry), New Westminster, BC; Psychology Department (Erickson), Fraser Health, New Westminster, BC; Centre for Health Services and Policy Research (McGrail, Peterson), and Departments of Physical Therapy (Hoens) and Medical Genetics (Austin), University of British Columbia, Vancouver, BC
| | - Louisa Edwards
- The Centre for Clinical Epidemiology and Evaluation (Ghanbarian, Wong, Bunka, Edwards, Cressman, Conte, Bryan), Vancouver Coastal Health Research Institute, and The School of Public and Population Health (Ghanbarian, Wong, Bunka, Edwards, Conte, Vijh, Bryan), University of British Columbia, Vancouver, BC; Faculty of Health Sciences (Cressman), Simon Fraser University, Burnaby, BC; Department of Family Practice (Price, Vijh), and Department of Physiatry (Schuetz), Faculty of Medicine, University of British Columbia, Vancouver, BC; Patient partner (Riches), Prince George, BC; Patient partner (Landry), New Westminster, BC; Psychology Department (Erickson), Fraser Health, New Westminster, BC; Centre for Health Services and Policy Research (McGrail, Peterson), and Departments of Physical Therapy (Hoens) and Medical Genetics (Austin), University of British Columbia, Vancouver, BC
| | - Sonya Cressman
- The Centre for Clinical Epidemiology and Evaluation (Ghanbarian, Wong, Bunka, Edwards, Cressman, Conte, Bryan), Vancouver Coastal Health Research Institute, and The School of Public and Population Health (Ghanbarian, Wong, Bunka, Edwards, Conte, Vijh, Bryan), University of British Columbia, Vancouver, BC; Faculty of Health Sciences (Cressman), Simon Fraser University, Burnaby, BC; Department of Family Practice (Price, Vijh), and Department of Physiatry (Schuetz), Faculty of Medicine, University of British Columbia, Vancouver, BC; Patient partner (Riches), Prince George, BC; Patient partner (Landry), New Westminster, BC; Psychology Department (Erickson), Fraser Health, New Westminster, BC; Centre for Health Services and Policy Research (McGrail, Peterson), and Departments of Physical Therapy (Hoens) and Medical Genetics (Austin), University of British Columbia, Vancouver, BC
| | - Tania Conte
- The Centre for Clinical Epidemiology and Evaluation (Ghanbarian, Wong, Bunka, Edwards, Cressman, Conte, Bryan), Vancouver Coastal Health Research Institute, and The School of Public and Population Health (Ghanbarian, Wong, Bunka, Edwards, Conte, Vijh, Bryan), University of British Columbia, Vancouver, BC; Faculty of Health Sciences (Cressman), Simon Fraser University, Burnaby, BC; Department of Family Practice (Price, Vijh), and Department of Physiatry (Schuetz), Faculty of Medicine, University of British Columbia, Vancouver, BC; Patient partner (Riches), Prince George, BC; Patient partner (Landry), New Westminster, BC; Psychology Department (Erickson), Fraser Health, New Westminster, BC; Centre for Health Services and Policy Research (McGrail, Peterson), and Departments of Physical Therapy (Hoens) and Medical Genetics (Austin), University of British Columbia, Vancouver, BC
| | - Morgan Price
- The Centre for Clinical Epidemiology and Evaluation (Ghanbarian, Wong, Bunka, Edwards, Cressman, Conte, Bryan), Vancouver Coastal Health Research Institute, and The School of Public and Population Health (Ghanbarian, Wong, Bunka, Edwards, Conte, Vijh, Bryan), University of British Columbia, Vancouver, BC; Faculty of Health Sciences (Cressman), Simon Fraser University, Burnaby, BC; Department of Family Practice (Price, Vijh), and Department of Physiatry (Schuetz), Faculty of Medicine, University of British Columbia, Vancouver, BC; Patient partner (Riches), Prince George, BC; Patient partner (Landry), New Westminster, BC; Psychology Department (Erickson), Fraser Health, New Westminster, BC; Centre for Health Services and Policy Research (McGrail, Peterson), and Departments of Physical Therapy (Hoens) and Medical Genetics (Austin), University of British Columbia, Vancouver, BC
| | - Christian Schuetz
- The Centre for Clinical Epidemiology and Evaluation (Ghanbarian, Wong, Bunka, Edwards, Cressman, Conte, Bryan), Vancouver Coastal Health Research Institute, and The School of Public and Population Health (Ghanbarian, Wong, Bunka, Edwards, Conte, Vijh, Bryan), University of British Columbia, Vancouver, BC; Faculty of Health Sciences (Cressman), Simon Fraser University, Burnaby, BC; Department of Family Practice (Price, Vijh), and Department of Physiatry (Schuetz), Faculty of Medicine, University of British Columbia, Vancouver, BC; Patient partner (Riches), Prince George, BC; Patient partner (Landry), New Westminster, BC; Psychology Department (Erickson), Fraser Health, New Westminster, BC; Centre for Health Services and Policy Research (McGrail, Peterson), and Departments of Physical Therapy (Hoens) and Medical Genetics (Austin), University of British Columbia, Vancouver, BC
| | - Linda Riches
- The Centre for Clinical Epidemiology and Evaluation (Ghanbarian, Wong, Bunka, Edwards, Cressman, Conte, Bryan), Vancouver Coastal Health Research Institute, and The School of Public and Population Health (Ghanbarian, Wong, Bunka, Edwards, Conte, Vijh, Bryan), University of British Columbia, Vancouver, BC; Faculty of Health Sciences (Cressman), Simon Fraser University, Burnaby, BC; Department of Family Practice (Price, Vijh), and Department of Physiatry (Schuetz), Faculty of Medicine, University of British Columbia, Vancouver, BC; Patient partner (Riches), Prince George, BC; Patient partner (Landry), New Westminster, BC; Psychology Department (Erickson), Fraser Health, New Westminster, BC; Centre for Health Services and Policy Research (McGrail, Peterson), and Departments of Physical Therapy (Hoens) and Medical Genetics (Austin), University of British Columbia, Vancouver, BC
| | - Ginny Landry
- The Centre for Clinical Epidemiology and Evaluation (Ghanbarian, Wong, Bunka, Edwards, Cressman, Conte, Bryan), Vancouver Coastal Health Research Institute, and The School of Public and Population Health (Ghanbarian, Wong, Bunka, Edwards, Conte, Vijh, Bryan), University of British Columbia, Vancouver, BC; Faculty of Health Sciences (Cressman), Simon Fraser University, Burnaby, BC; Department of Family Practice (Price, Vijh), and Department of Physiatry (Schuetz), Faculty of Medicine, University of British Columbia, Vancouver, BC; Patient partner (Riches), Prince George, BC; Patient partner (Landry), New Westminster, BC; Psychology Department (Erickson), Fraser Health, New Westminster, BC; Centre for Health Services and Policy Research (McGrail, Peterson), and Departments of Physical Therapy (Hoens) and Medical Genetics (Austin), University of British Columbia, Vancouver, BC
| | - David Erickson
- The Centre for Clinical Epidemiology and Evaluation (Ghanbarian, Wong, Bunka, Edwards, Cressman, Conte, Bryan), Vancouver Coastal Health Research Institute, and The School of Public and Population Health (Ghanbarian, Wong, Bunka, Edwards, Conte, Vijh, Bryan), University of British Columbia, Vancouver, BC; Faculty of Health Sciences (Cressman), Simon Fraser University, Burnaby, BC; Department of Family Practice (Price, Vijh), and Department of Physiatry (Schuetz), Faculty of Medicine, University of British Columbia, Vancouver, BC; Patient partner (Riches), Prince George, BC; Patient partner (Landry), New Westminster, BC; Psychology Department (Erickson), Fraser Health, New Westminster, BC; Centre for Health Services and Policy Research (McGrail, Peterson), and Departments of Physical Therapy (Hoens) and Medical Genetics (Austin), University of British Columbia, Vancouver, BC
| | - Kim McGrail
- The Centre for Clinical Epidemiology and Evaluation (Ghanbarian, Wong, Bunka, Edwards, Cressman, Conte, Bryan), Vancouver Coastal Health Research Institute, and The School of Public and Population Health (Ghanbarian, Wong, Bunka, Edwards, Conte, Vijh, Bryan), University of British Columbia, Vancouver, BC; Faculty of Health Sciences (Cressman), Simon Fraser University, Burnaby, BC; Department of Family Practice (Price, Vijh), and Department of Physiatry (Schuetz), Faculty of Medicine, University of British Columbia, Vancouver, BC; Patient partner (Riches), Prince George, BC; Patient partner (Landry), New Westminster, BC; Psychology Department (Erickson), Fraser Health, New Westminster, BC; Centre for Health Services and Policy Research (McGrail, Peterson), and Departments of Physical Therapy (Hoens) and Medical Genetics (Austin), University of British Columbia, Vancouver, BC
| | - Sandra Peterson
- The Centre for Clinical Epidemiology and Evaluation (Ghanbarian, Wong, Bunka, Edwards, Cressman, Conte, Bryan), Vancouver Coastal Health Research Institute, and The School of Public and Population Health (Ghanbarian, Wong, Bunka, Edwards, Conte, Vijh, Bryan), University of British Columbia, Vancouver, BC; Faculty of Health Sciences (Cressman), Simon Fraser University, Burnaby, BC; Department of Family Practice (Price, Vijh), and Department of Physiatry (Schuetz), Faculty of Medicine, University of British Columbia, Vancouver, BC; Patient partner (Riches), Prince George, BC; Patient partner (Landry), New Westminster, BC; Psychology Department (Erickson), Fraser Health, New Westminster, BC; Centre for Health Services and Policy Research (McGrail, Peterson), and Departments of Physical Therapy (Hoens) and Medical Genetics (Austin), University of British Columbia, Vancouver, BC
| | - Rohit Vijh
- The Centre for Clinical Epidemiology and Evaluation (Ghanbarian, Wong, Bunka, Edwards, Cressman, Conte, Bryan), Vancouver Coastal Health Research Institute, and The School of Public and Population Health (Ghanbarian, Wong, Bunka, Edwards, Conte, Vijh, Bryan), University of British Columbia, Vancouver, BC; Faculty of Health Sciences (Cressman), Simon Fraser University, Burnaby, BC; Department of Family Practice (Price, Vijh), and Department of Physiatry (Schuetz), Faculty of Medicine, University of British Columbia, Vancouver, BC; Patient partner (Riches), Prince George, BC; Patient partner (Landry), New Westminster, BC; Psychology Department (Erickson), Fraser Health, New Westminster, BC; Centre for Health Services and Policy Research (McGrail, Peterson), and Departments of Physical Therapy (Hoens) and Medical Genetics (Austin), University of British Columbia, Vancouver, BC
| | - Alison M Hoens
- The Centre for Clinical Epidemiology and Evaluation (Ghanbarian, Wong, Bunka, Edwards, Cressman, Conte, Bryan), Vancouver Coastal Health Research Institute, and The School of Public and Population Health (Ghanbarian, Wong, Bunka, Edwards, Conte, Vijh, Bryan), University of British Columbia, Vancouver, BC; Faculty of Health Sciences (Cressman), Simon Fraser University, Burnaby, BC; Department of Family Practice (Price, Vijh), and Department of Physiatry (Schuetz), Faculty of Medicine, University of British Columbia, Vancouver, BC; Patient partner (Riches), Prince George, BC; Patient partner (Landry), New Westminster, BC; Psychology Department (Erickson), Fraser Health, New Westminster, BC; Centre for Health Services and Policy Research (McGrail, Peterson), and Departments of Physical Therapy (Hoens) and Medical Genetics (Austin), University of British Columbia, Vancouver, BC
| | - Jehannine Austin
- The Centre for Clinical Epidemiology and Evaluation (Ghanbarian, Wong, Bunka, Edwards, Cressman, Conte, Bryan), Vancouver Coastal Health Research Institute, and The School of Public and Population Health (Ghanbarian, Wong, Bunka, Edwards, Conte, Vijh, Bryan), University of British Columbia, Vancouver, BC; Faculty of Health Sciences (Cressman), Simon Fraser University, Burnaby, BC; Department of Family Practice (Price, Vijh), and Department of Physiatry (Schuetz), Faculty of Medicine, University of British Columbia, Vancouver, BC; Patient partner (Riches), Prince George, BC; Patient partner (Landry), New Westminster, BC; Psychology Department (Erickson), Fraser Health, New Westminster, BC; Centre for Health Services and Policy Research (McGrail, Peterson), and Departments of Physical Therapy (Hoens) and Medical Genetics (Austin), University of British Columbia, Vancouver, BC
| | - Stirling Bryan
- The Centre for Clinical Epidemiology and Evaluation (Ghanbarian, Wong, Bunka, Edwards, Cressman, Conte, Bryan), Vancouver Coastal Health Research Institute, and The School of Public and Population Health (Ghanbarian, Wong, Bunka, Edwards, Conte, Vijh, Bryan), University of British Columbia, Vancouver, BC; Faculty of Health Sciences (Cressman), Simon Fraser University, Burnaby, BC; Department of Family Practice (Price, Vijh), and Department of Physiatry (Schuetz), Faculty of Medicine, University of British Columbia, Vancouver, BC; Patient partner (Riches), Prince George, BC; Patient partner (Landry), New Westminster, BC; Psychology Department (Erickson), Fraser Health, New Westminster, BC; Centre for Health Services and Policy Research (McGrail, Peterson), and Departments of Physical Therapy (Hoens) and Medical Genetics (Austin), University of British Columbia, Vancouver, BC
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119
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Clement F, Kirkham J. The value of a model to consider the cost-effectiveness of interventions for the treatment of major depressive disorder in Canada. CMAJ 2023; 195:E1518-E1519. [PMID: 37963615 DOI: 10.1503/cmaj.231441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023] Open
Affiliation(s)
- Fiona Clement
- Department of Community Health Sciences and the O'Brien Institute for Public Health (Clement) and of Psychiatry, Hotchkiss Brain Institute and the Mathison Centre for Mental Health Research and Education (Kirkham), Cumming School of Medicine, University of Calgary, Calgary, Alta.
| | - Julia Kirkham
- Department of Community Health Sciences and the O'Brien Institute for Public Health (Clement) and of Psychiatry, Hotchkiss Brain Institute and the Mathison Centre for Mental Health Research and Education (Kirkham), Cumming School of Medicine, University of Calgary, Calgary, Alta
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120
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Soubolsky A. Thoughtful prescribing for patients with difficult-to-treat depression. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2023; 69:777-783. [PMID: 37963783 PMCID: PMC10645447 DOI: 10.46747/cfp.6911777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Affiliation(s)
- Amy Soubolsky
- Pharmacist with the RxFiles Academic Detailing Program and the Saskatchewan Health Authority in Saskatoon
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121
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Moderie C, King JD, Nuñez N, Comai S, Gobbi G. Sleep Quality After Quetiapine Augmentation in Patients With Treatment-Resistant Depression and Personality Disorders. J Clin Psychopharmacol 2023; 43:498-506. [PMID: 37930201 DOI: 10.1097/jcp.0000000000001768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
PURPOSE/BACKGROUND Quetiapine is a first-line augmenting agent for treatment-resistant depression (TRD) and is used off-label in insomnia. Quetiapine and its active metabolite norquetiapine act mostly on 5-HT2A, 5-HT2C, H1, and D2 as antagonists and on 5-HT1A as partial agonists. Patients with TRD often have comorbid personality disorder (PD), and evidence suggests an association between sleep disturbance and recovery among patients with PD. Here, we aimed to evaluate the effects of quetiapine on sleep in TRD patients with and without PD (PD+/PD-). METHODS/PROCEDURES We reviewed health records of 38 patients with TRD (20 TRD/PD+) who had been treated with a pharmacotherapy regimen including quetiapine. Clinical outcomes were determined by comparing changes in sleep items of the Hamilton Depression Rating Scale at the beginning (T0) and after 3 months of an unchanged treatment (T3). FINDINGS/RESULTS Patients with TRD/PD+ and TRD/PD- taking quetiapine showed significant improvement in sleep items from T0 to T3 (P < 0.001, ηp2 ≥ 0.19). There was a significant personality × time interaction for sleep-maintenance insomnia (P = 0.006, ηp2 = 0.23), with TRD/PD+ showing a greater improvement at T3 compared with TRD/PD- (P = 0.01). While exploring other sleep items, no personality × time interaction was found. In the TRD/PD- group, improvement in sleep items was associated with an overall improvement in depressive symptoms (r = 0.55, P = 0.02). IMPLICATIONS/CONCLUSIONS Quetiapine induced greater improvements in sleep-maintenance insomnia among TRD/PD+ patients than TRD/PD-. These findings suggest quetiapine could have a therapeutic role for insomnia in PD underscoring a distinct underlying neurobiological mechanism of sleep disturbance in people living with PD.
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Affiliation(s)
- Christophe Moderie
- From the Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Jacob D King
- Division of Psychiatry, Imperial College, London, United Kingdom
| | - Nicolas Nuñez
- From the Department of Psychiatry, McGill University, Montreal, Quebec, Canada
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Wen KS, Zheng W. Optimization Strategies of Transcranial Magnetic Stimulation in Major Depressive Disorder. ALPHA PSYCHIATRY 2023; 24:270-272. [PMID: 38313448 PMCID: PMC10837582 DOI: 10.5152/alphapsychiatry.2023.231401] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 11/13/2023] [Indexed: 02/06/2024]
Affiliation(s)
- Kai-Si Wen
- Guangxi University of Traditional Chinese Medicine, Nanning, China
| | - Wei Zheng
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
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Kato M, Baba H, Takekita Y, Naito M, Koshikawa Y, Bandou H, Kinoshita T. Usefulness of mirtazapine and SSRIs in late-life depression: post hoc analysis of the GUNDAM study. Eur J Clin Pharmacol 2023; 79:1515-1524. [PMID: 37700038 DOI: 10.1007/s00228-023-03563-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 09/07/2023] [Indexed: 09/14/2023]
Abstract
OBJECTIVE Mirtazapine and SSRIs are widely prescribed as first-line agents for late-life depression. However, evidence for these drugs is mostly based on non-elderly patients. Therefore, we reanalyzed a randomized controlled trial of mirtazapine versus SSRIs for depression in a sub-population of late-life patients. METHODS A randomized controlled trial was conducted with 141 patients, of whom 41 were elderly, and 100 were non-elderly. This study compared SSRIs and mirtazapine in late-life depression, examined late-onset and early adult-onset separately and compared elderly and non-elderly patients for each drug. Treatment effects and adverse events were assessed using the Hamilton Depression Rating Scale and the Udvalg for Kliniske Undersøgelser Side Effect Rating Scale, respectively. RESULTS In late-life depression, mirtazapine showed faster HAM-D total score improvement (3.3 points difference, p = 0.021) and higher improvement in insomnia (1.7 points difference, p = 0.001) and appetite (1.2 points difference, p = 0.020). Similar findings were observed for late-onset depression with the HAM-D total score (4.3 points difference, p = 0.007) and appetite (0.9 points difference, p = 0.004), favoring mirtazapine. Depressive symptoms were generally less improved in late-life depression than in non-late-life depression. Regarding the effect of mirtazapine on appetite, late-life depression showed greater improvement (0.7 points difference, p = 0.008). Nausea and micturition disturbances were more common with SSRIs in late-life depression than in non-late-life depression. In contrast, somnolence was less common in late-life depression with mirtazapine. CONCLUSION The potential usefulness of mirtazapine in elderly patients was demonstrated. The results also showed differences in the treatment response to SSRIs and mirtazapine between elderly and non-elderly patients.
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Affiliation(s)
- Masaki Kato
- Department of Neuropsychiatry, Kansai Medical University, 2-3-1 Shin-Machi Hirakata-City, Osaka, 573-1191, Japan.
| | - Hajime Baba
- Department of Psychiatry, Faculty of Medicine, Juntendo Koshigaya Hospital, Juntendo University, Saitama, Japan
| | - Yoshiteru Takekita
- Department of Neuropsychiatry, Kansai Medical University, 2-3-1 Shin-Machi Hirakata-City, Osaka, 573-1191, Japan
| | - Minami Naito
- Department of Neuropsychiatry, Kansai Medical University, 2-3-1 Shin-Machi Hirakata-City, Osaka, 573-1191, Japan
| | - Yosuke Koshikawa
- Department of Neuropsychiatry, Kansai Medical University, 2-3-1 Shin-Machi Hirakata-City, Osaka, 573-1191, Japan
| | - Hiroki Bandou
- Seishokai Sephiroth Hospital, Nagahama, Shiga, Japan
| | - Toshihiko Kinoshita
- Department of Neuropsychiatry, Kansai Medical University, 2-3-1 Shin-Machi Hirakata-City, Osaka, 573-1191, Japan
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Razza LB, Wischnewski M, Suen P, De Smet S, da Silva PHR, Catoira B, Brunoni AR, Vanderhasselt MA. An electric field modeling study with meta-analysis to understand the antidepressant effects of transcranial direct current stimulation (tDCS). REVISTA BRASILEIRA DE PSIQUIATRIA (SAO PAULO, BRAZIL : 1999) 2023; 45:518-529. [PMID: 37400373 PMCID: PMC10897770 DOI: 10.47626/1516-4446-2023-3116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 06/08/2023] [Indexed: 07/05/2023]
Abstract
OBJECTIVE Transcranial direct current stimulation (tDCS) has mixed effects for major depressive disorder (MDD) symptoms, partially owing to large inter-experimental variability in tDCS protocols and their correlated induced electric fields (E-fields). We investigated whether the E-field strength of distinct tDCS parameters was associated with antidepressant effect. METHODS A meta-analysis was performed with placebo-controlled clinical trials of tDCS enrolling MDD patients. PubMed, EMBASE, and Web of Science were searched from inception to March 10, 2023. Effect sizes of tDCS protocols were correlated with E-field simulations (SimNIBS) of brain regions of interest (bilateral dorsolateral prefrontal cortex [DLPFC] and bilateral subgenual anterior cingulate cortex [sgACC]). Moderators of tDCS responses were also investigated. RESULTS A total of 20 studies were included (21 datasets, 1,008 patients), using 11 distinct tDCS protocols. Results revealed a moderate effect for MDD (g = 0.41, 95%CI 0.18-0.64), while cathode position and treatment strategy were found to be moderators of response. A negative association between effect size and tDCS-induced E-field magnitude was seen, with stronger E-fields in the right frontal and medial parts of the DLPFC (targeted by the cathode) leading to smaller effects. No association was found for the left DLPFC and the bilateral sgACC. An optimized tDCS protocol is proposed. CONCLUSION Our results highlight the need for a standardized tDCS protocol in MDD clinical trials.
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Affiliation(s)
- Lais B Razza
- Department of Head and Skin, Psychiatry and Medical Psychology, Ghent University Hospital, Ghent University, Ghent, Belgium. Ghent Experimental Psychiatry Lab, Ghent, Belgium
| | - Miles Wischnewski
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN, USA
| | - Paulo Suen
- Serviço Interdisciplinar de Neuromodulação, Laboratório de Neurociências, Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Stefanie De Smet
- Department of Head and Skin, Psychiatry and Medical Psychology, Ghent University Hospital, Ghent University, Ghent, Belgium. Ghent Experimental Psychiatry Lab, Ghent, Belgium
| | - Pedro Henrique Rodrigues da Silva
- Serviço Interdisciplinar de Neuromodulação, Laboratório de Neurociências, Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Beatriz Catoira
- Department of Head and Skin, Psychiatry and Medical Psychology, Ghent University Hospital, Ghent University, Ghent, Belgium. Ghent Experimental Psychiatry Lab, Ghent, Belgium. Department of Psychiatry, Free University Brussels, Ixelles, Belgium
| | - André R Brunoni
- Serviço Interdisciplinar de Neuromodulação, Laboratório de Neurociências, Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil. Departamento de Clínica Médica, Hospital das Clínicas, Faculdade de Medicina, USP, São Paulo, SP, Brazil. Hospital das Clínicas, USP, São Paulo, SP, Brazil
| | - Marie-Anne Vanderhasselt
- Department of Head and Skin, Psychiatry and Medical Psychology, Ghent University Hospital, Ghent University, Ghent, Belgium. Ghent Experimental Psychiatry Lab, Ghent, Belgium
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Soubolsky A. Prescription réfléchie pour les patients souffrant d’une dépression difficile à traiter. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2023; 69:e221-e228. [PMID: 37963790 PMCID: PMC10645449 DOI: 10.46747/cfp.6911e221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Affiliation(s)
- Amy Soubolsky
- Pharmacienne au RxFiles Academic Detailing Program et dans l’Autorité sanitaire de la Saskatchewan à Saskatoon
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126
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Zhu Y, Wang F, Wang F, Liu H, Guo X, Wang Z, He R, Wu X, Cao L, Wu Z, Peng D, Fang Y. Program of algorithm for pharmacological treatment of major depressive disorder in China: Benefits or not? Heliyon 2023; 9:e20951. [PMID: 37920522 PMCID: PMC10618797 DOI: 10.1016/j.heliyon.2023.e20951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 10/11/2023] [Accepted: 10/11/2023] [Indexed: 11/04/2023] Open
Abstract
Background This research was designed to investigate Algorithm Guided Treatment (AGT) and clinical traits for the prediction of antidepressant treatment outcomes in Chinese patients with major depressive disorder (MDD). Methods This study included 581 patients who had reached treatment response and 406 patients remained non-responded observed after three months of treatment. Sociodemographic factors, clinical traits, and psychiatric rating scales for evaluating therapeutic responses between the two groups were compared. Logistic regression analysis was adopted to determine the risk factors of unresponsive to antidepressant (URA) in MDD. Kaplan-Meier survival analysis was utilized to compare the therapeutic response between AGT and treatment as usual (TAU). Results Compared to the MDD responsive to antidepressant (RA) group, the URA group had significantly lower rates of the following clinical traits: married status, anxious distress, moderate to severe depressive symptoms, and higher rates of comorbidity (p-value < 0.05). Logistic Regression Analysis showed that eight clinical traits from psychiatric rating scales, such as anxious characteristics, were correlated positively with URA, while the other eight symptoms, such as autonomic symptoms, were negatively correlated. Time to symptomatic remission was longer in TAU without statistically significant (p-value = 0.11) by log-rank testing. Conclusions The factors may affect the therapeutic responses and compliance of patients, increasing the non-response risk for antidepressants. Therapeutic responses might be improved by increasing the clarification and elucidation of different symptom clusters of patients. Benefits on treatment response to AGT were not found in our study, indicating a one-size-fits-all approach may not work.Trial Registration: We registered as a clinical trial at the International Clinical Trials Registry Platform (No. NCT01764867) and obtained ethical approval 2012-42 from SMHC.
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Affiliation(s)
- Yuncheng Zhu
- Division of Mood Disorders, Shanghai Hongkou Mental Health Center, Shanghai, 200083, China
- Clinical Research Center, Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
- Clinical Research Center for Mental Health, School of Medicine, Shanghai University, Shanghai, 200083, China
| | - Fang Wang
- Shanghai Yangpu Mental Health Center, Shanghai, 200093, China
| | - Fan Wang
- Clinical Research Center, Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
| | - Hongmei Liu
- Clinical Research Center, Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
| | - Xiaoyun Guo
- Clinical Research Center, Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
| | - Zuowei Wang
- Division of Mood Disorders, Shanghai Hongkou Mental Health Center, Shanghai, 200083, China
- Clinical Research Center for Mental Health, School of Medicine, Shanghai University, Shanghai, 200083, China
| | - Ruoqiao He
- School of Social Work, New York University, New York, 10003, USA
| | - Xiaohui Wu
- Clinical Research Center, Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
| | - Lan Cao
- Clinical Research Center, Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
| | - Zhiguo Wu
- Shanghai Yangpu Mental Health Center, Shanghai, 200093, China
| | - Daihui Peng
- Clinical Research Center, Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
| | - Yiru Fang
- Clinical Research Center, Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
- Clinical Research Center for Mental Health, School of Medicine, Shanghai University, Shanghai, 200083, China
- Department of Psychiatry & Affective Disorders Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
- CAS Center for Excellence in Brain Science and Intelligence Technology, Shanghai, 200030, China
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai, 201108, China
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Saxby K, Dickinson H, Petrie D, Kavanagh A, Aitken Z. The impact of employment on mental healthcare use among people with disability: distinguishing between part- and full-time employment. Scand J Work Environ Health 2023; 49:598-609. [PMID: 37815158 PMCID: PMC11402066 DOI: 10.5271/sjweh.4123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/11/2023] Open
Abstract
OBJECTIVE Employment can improve mental health among people with disability (PWD), however, little is known about how different levels of workforce participation influence mental healthcare use. The aim of this study was to estimate the extent to which different levels of working hours are associated with changes in mental healthcare use among PWD. METHODS Data on working hours and healthcare use among working age PWD who were receiving government benefits (N=260 825) was obtained from Australian Census-linked administrative records between 2011 and 2019. Individual fixed effects panel models were used to estimate the impact of increased working hours on mental healthcare (services and prescriptions). Heterogeneity analyses by job security and key sociodemographic characteristics were conducted. RESULTS Compared to not working, we found that working 1-14, 15-29, and ≥30 hours per week was respectively associated with a 3.3%, 18.0%, and 9.9% reduction in the use of mental healthcare prescriptions as well as a 6.8%, 18.4%, and 22.3% reduction in the use of mental healthcare services by PWD. The effects were larger for PWD in more secure work and those living in rural and disadvantaged areas. CONCLUSIONS Working more hours was associated with reduced mental healthcare use among PWD. Policy interventions should consider the broader benefits of enabling part-time and secure work placements for PWD, particularly for those living in rural and disadvantaged regions.
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Affiliation(s)
- Karinna Saxby
- The Melbourne Institute of Applied Economic and Social Research, University of Melbourne, 111 Barry Street, Carlton, Victoria, Australia.
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128
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Baldacci A, Saguin E, Balcerac A, Mouchabac S, Ferreri F, Gaillard R, Colas MD, Delacour H, Bourla A. Pharmacogenetic Guidelines for Psychotropic Drugs: Optimizing Prescriptions in Clinical Practice. Pharmaceutics 2023; 15:2540. [PMID: 38004520 PMCID: PMC10674305 DOI: 10.3390/pharmaceutics15112540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 10/15/2023] [Accepted: 10/20/2023] [Indexed: 11/26/2023] Open
Abstract
The modalities for prescribing a psychotropic (dose and choice of molecule) are currently unsatisfactory, which can lead to a lack of efficacy of the treatment associated with prolonged exposure of the patient to the symptoms of his or her illness and the side effects of the molecule. In order to improve the quality of treatment prescription, a part of the current biomedical research is dedicated to the development of pharmacogenetic tools for individualized prescription. In this guideline, we will present the genes of interest with level 1 clinical recommendations according to PharmGKB for the two major families of psychotropics: antipsychotics and antidepressants. For antipsychotics, there are CYP2D6 and CYP3A4, and for antidepressants, CYP2B6, CYP2D6, and CYP2C19. The study will focus on describing the role of each gene, presenting the variants that cause functional changes, and discussing the implications for prescriptions in clinical practice.
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Affiliation(s)
- Antoine Baldacci
- Department of Psychiatry, Bégin Army Instruction Hospital, 94160 Saint-Mandé, France; (A.B.)
| | - Emeric Saguin
- Department of Psychiatry, Bégin Army Instruction Hospital, 94160 Saint-Mandé, France; (A.B.)
| | | | - Stéphane Mouchabac
- Department of Psychiatry, Saint-Antoine Hospital, Sorbonne University, 75012 Paris, France; (S.M.); (F.F.)
- ICRIN—Psychiatry (Infrastructure of Clinical Research in Neurosciences—Psychiatry), Brain Institute (ICM), Sorbonne Université, INSERM, CNRS, 75013 Paris, France
| | - Florian Ferreri
- Department of Psychiatry, Saint-Antoine Hospital, Sorbonne University, 75012 Paris, France; (S.M.); (F.F.)
- ICRIN—Psychiatry (Infrastructure of Clinical Research in Neurosciences—Psychiatry), Brain Institute (ICM), Sorbonne Université, INSERM, CNRS, 75013 Paris, France
| | - Raphael Gaillard
- Department of Psychiatry, Pôle Hospitalo-Universitaire, GHU Paris Psychiatrie & Neurosciences, 75014 Paris, France;
| | | | - Hervé Delacour
- Ecole du Val-de-Grâce, Army Health Service, 75005 Paris, France; (M.-D.C.); (H.D.)
- Biological Unit, Bégin Army Instruction Hospital, 94160 Saint-Mandé, France
| | - Alexis Bourla
- Department of Psychiatry, Saint-Antoine Hospital, Sorbonne University, 75012 Paris, France; (S.M.); (F.F.)
- ICRIN—Psychiatry (Infrastructure of Clinical Research in Neurosciences—Psychiatry), Brain Institute (ICM), Sorbonne Université, INSERM, CNRS, 75013 Paris, France
- Clariane, Medical Strategy and Innovation Department, 75008 Paris, France
- NeuroStim Psychiatry Practice, 75005 Paris, France
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He Y, Gan X, Li X, Wang T, Li J, Lei T, Huang Y, Liu R, Chen F, Teng T, Xie Y, Ouyang X, Zhou X. Sequenced treatment alternatives to relieve adolescent depression (STAR-AD): a multicentre open-label randomized controlled trial protocol. BMC Psychiatry 2023; 23:789. [PMID: 37891522 PMCID: PMC10612344 DOI: 10.1186/s12888-023-05221-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 09/26/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Adolescent major depressive disorder (MDD) is a prevalent mental health problem with low treatment success rates. Whether fluoxetine or fluoxetine combined with cognitive-behavioural therapy (CBT) is the more effective initial treatment for adolescent MDD remains controversial, and few studies have investigated whether treatment switching or augmentation is preferred when the initial treatment is not working well. METHODS We developed a multicentre open-label Sequential Multiple Assignment Randomized Trial (SMART) design, consisting of two phases lasting 8 weeks each. In phase 1 (at baseline), patients will be recruited and grouped in fluoxetine group or fluoxetine combined with CBT group by patient self-selection. In phase 2 (after 8 weeks of treatment), the nonresponders will be randomly assigned to six groups, in which participants will switch to sertraline, vortioxetine, or duloxetine or added aripiprazole, olanzapine, or lithium carbonate to fluoxetine. After the full 16 weeks of treatment, we will assess the long-term sustainability of the treatment effects by evaluating participants during their subsequent naturalistic treatment. The primary outcome will be the response rate, determined by the Children's Depression Rating Scale-Revised (CDRS-R). Secondary outcomes include the change in scores on the Beck Depression Inventory (BDI), the Screen for Child Anxiety-Related Emotional Disorders (SCARED) and the Safe Assessment. DISCUSSION The results from this study will aid clinicians in making informed treatment selection decisions for adolescents with MDD. TRIAL REGISTRATION This protocol was registered at ClinicalTrials.gov with Identifier: NCT05814640.
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Affiliation(s)
- Yuqian He
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Road, Yuzhong District, Chongqing, China
| | - Xieyu Gan
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xuemei Li
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Road, Yuzhong District, Chongqing, China
| | - Ting Wang
- Department of Psychology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jie Li
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Road, Yuzhong District, Chongqing, China
| | - Tingting Lei
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Road, Yuzhong District, Chongqing, China
| | - Yajie Huang
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Road, Yuzhong District, Chongqing, China
| | - Ruibing Liu
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Road, Yuzhong District, Chongqing, China
| | - Fei Chen
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Road, Yuzhong District, Chongqing, China
| | - Teng Teng
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Road, Yuzhong District, Chongqing, China
| | - Yuxin Xie
- Department of Psychiatry, The Second Xiangya Hospital, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, Central South University, Changsha, China
| | - Xuan Ouyang
- Department of Psychiatry, The Second Xiangya Hospital, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, Central South University, Changsha, China.
| | - Xinyu Zhou
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Road, Yuzhong District, Chongqing, China.
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Ogata H, Higasa K, Kageyama Y, Tahara H, Shimamoto A, Takekita Y, Koshikawa Y, Nonen S, Kato T, Kinoshita T, Kato M. Relationship between circulating mitochondrial DNA and microRNA in patients with major depression. J Affect Disord 2023; 339:538-546. [PMID: 37467797 DOI: 10.1016/j.jad.2023.07.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 06/22/2023] [Accepted: 07/14/2023] [Indexed: 07/21/2023]
Abstract
BACKGROUND MicroRNAs (miRNAs) and circulating cell-free mitochondrial DNA (ccf-mtDNA) have attracted interest as biological markers of affective disorders. In response to stress, it is known that miRNAs in mitochondria diffuse out of the cytoplasm alongside mtDNA; however, this process has not yet been identified. We hypothesized that miRNAs derived from specific cell nuclei cause mitochondrial damage and mtDNA fragmentation under MDD-associated stress conditions. METHODS A comprehensive analysis of the plasma miRNA levels and quantification of the plasma ccf-mtDNA copy number were performed in 69 patients with depression to determine correlations and identify genes and pathways interacting with miRNAs. The patients were randomly assigned to receive either selective serotonin reuptake inhibitors (SSRI) or mirtazapine. Their therapeutic efficacy over four weeks was evaluated in relation to miRNAs correlated with ccf-mtDNA copy number. RESULTS The expression levels of the five miRNAs showed a significant positive correlation with the ccf-mtDNA copy number after correcting for multiple testing. These miRNAs are involved in gene expression related to thyroid hormone synthesis, the Hippo signaling pathway, vasopressin-regulated water reabsorption, and lysine degradation. Of these five miRNAs, miR-6068 and miR-4708-3p were significantly associated with the SSRI and mirtazapine treatment outcomes, respectively. LIMITATIONS This study did not show comparison with a healthy group. CONCLUSIONS The expression levels of specific miRNAs were associated with ccf-mtDNA copy number in untreated depressed patients; moreover, these miRNAs were linked to antidepressant treatment outcomes. These findings are expected to lead to the elucidation of new pathological mechanism of depression.
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Affiliation(s)
- Haruhiko Ogata
- Department of Neuropsychiatry, Kansai Medical University, Osaka, Japan
| | - Koichiro Higasa
- Institute of Biomedical Science, Department of Genome Analysis, Kansai Medical University, Osaka, Japan
| | - Yuki Kageyama
- Department of Neuropsychiatry, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Hidetoshi Tahara
- Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Akira Shimamoto
- Faculty of Pharmaceutical Sciences, Sanyo-Onoda City University, Sanyo Onoda, Yamaguchi, Japan
| | | | - Yosuke Koshikawa
- Department of Neuropsychiatry, Kansai Medical University, Osaka, Japan
| | - Shinpei Nonen
- Department of Pharmacy, Hyogo University of Health Sciences, Hyogo, Japan
| | - Tadafumi Kato
- Department of Psychiatry & Behavioral Science, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | | | - Masaki Kato
- Department of Neuropsychiatry, Kansai Medical University, Osaka, Japan.
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Blampied M, Tylianakis JM, Bell C, Gilbert C, Rucklidge JJ. Efficacy and safety of a vitamin-mineral intervention for symptoms of anxiety and depression in adults: A randomised placebo-controlled trial "NoMAD". J Affect Disord 2023; 339:954-964. [PMID: 37268087 DOI: 10.1016/j.jad.2023.05.077] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 05/18/2023] [Accepted: 05/21/2023] [Indexed: 06/04/2023]
Abstract
BACKGROUND Anxiety and depression are increasingly burdening society. We investigated whether micronutrients (vitamins and minerals), improve anxiety and depression symptoms in an adult community setting. METHODS Participants (n = 150) describing functionally-impairing symptoms of anxiety/depression randomly received micronutrients or placebo for 10 weeks. Primary outcome measures were Patient Health Questionnaire-9 (PHQ-9), Generalised Anxiety Disorder Scale-7 (GAD-7), and Clinical Global Impression-Improvement scale (CGII). They were monitored online with regular phone contact with a clinical psychologist. RESULTS Linear mixed-effects modelling showed significant improvements in both groups, with the micronutrient group improving significantly more quickly on both the PHQ-9 (t = -2.17, p = 0.03) and the GAD-7 (t = -2.23, p = 0.03). Subsequent models with covariates showed that participant characteristics moderated time-by-group interactions; micronutrients provided fastest improvement relative to placebo for younger participants, those from lower socioeconomic groups and those who had previously tried psychiatric medication. On the CGII, there were no group differences at end-point ((F1,148) = 1.36, p = 0.25, d = 0.19, 95 % CI [-0.13 to 0.51]), with 49 % of the micronutrient and 44 % of the placebo groups being identified responders. Participants on micronutrients had significantly increased bowel motions compared with placebo. There was no increased suicidal ideation, no serious adverse events and the blind was adequately maintained. Drop out was low at 8.7 %. LIMITATIONS The improvement under placebo and lack of formal diagnoses limit generalizability. CONCLUSIONS Despite limited clinician contact, all participants improved significantly, though improvements were faster with micronutrients. Participants in some subgroups demonstrated a lower response to placebo, identifying where micronutrients may offer greatest potential as an intervention.
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Nöhles VB, Bermpohl F, Falkai P, Reif-Leonhard C, Jessen F, Adli M, Otte C, Meyer-Lindenberg A, Bauer M, Rubarth K, Anghelescu IG, Rujescu D, Correll CU. Patient characteristics, validity of clinical diagnoses and Outcomes Associated with Suicidality in Inpatients with Symptoms of Depression (OASIS-D): design, procedures and outcomes. BMC Psychiatry 2023; 23:744. [PMID: 37828493 PMCID: PMC10571442 DOI: 10.1186/s12888-023-05230-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 09/28/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND Suicidality, ranging from passive suicidal thoughts to suicide attempt, is common in major depressive disorder (MDD). However, relatively little is known about patient, illness and treatment characteristics in those with co-occurring MDD and suicidality, including the timing of and factors associated with the offset, continuation or reemergence of suicidality. Here, we present the background, rationale, design and hypotheses of the Patient Characteristics, Validity of Clinical Diagnoses and Outcomes Associated with Suicidality in Inpatients with Symptoms of Depression (OASIS-D) study, an investigator-initiated, observational study, funded by Janssen-Cilag GmbH. METHODS/RESULTS OASIS-D is an eight-site, six-month, cohort study of patients aged 18-75 hospitalized with MDD. Divided into three sub-studies and patient populations (PPs), OASIS-D will (i) systematically characterize approximately 4500 consecutively hospitalized patients with any form of unipolar depressive episode (PP1), (ii) evaluate the validity of the clinical diagnosis of moderate or severe unipolar depressive episode with the Mini-International Neuropsychiatric Interview (M.I.N.I.) and present suicidality (at least passive suicidal thoughts) present ≥ 48 h after admission with the Sheehan-Suicide Tracking Scale (S-STS), assessing also predictors of the diagnostic concordance/discordance of MDD in around 500 inpatients (PP2), and (iii) characterize and prospectively follow for 6 months 315 inpatients with a research-verified moderate or severe unipolar depressive episode and at least passive suicidal thoughts ≥ 48 h after admission, evaluating treatment and illness/response patterns at baseline, hospital discharge, 3 and 6 months. Exploratory objectives will describe the association between the number of days with suicidality and utilization of outpatient and inpatient care services, and structured assessments of factors influencing the risk of self-injurious behavior without suicidal intent, and of continuous, intermittent or remitted suicidality during the 6-month observation period. CONCLUSION Despite their frequency and clinical relevance, relatively little is known about patient and treatment characteristics of individuals with MDD and suicidality, including factors moderating and mediating the outcome of both MDD and suicidality. Results of the OASIS-D study are hoped to improve the understanding of the frequency, correlates and 6-month naturalistic treatment and outcome trajectories of different levels of suicidality in hospitalized adults with MDD and suicidality. TRIAL REGISTRATION NCT04404309 [ClinicalTrials.gov].
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Affiliation(s)
- Viktor B Nöhles
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin - Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Felix Bermpohl
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin - Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Campus St. Hedwig Hospital, Berlin, Germany
| | - Peter Falkai
- Clinic for Psychiatry and Psychotherapy, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Christine Reif-Leonhard
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Frank Jessen
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
| | - Mazda Adli
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin - Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Campus Mitte, Berlin, Germany
- Center for Psychiatry, Psychotherapy and Psychosomatic Medicine, Fliedner Klinik Berlin, Berlin, Germany
| | - Christian Otte
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin - Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Andreas Meyer-Lindenberg
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Mannheim, Germany
| | - Michael Bauer
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Kerstin Rubarth
- Institute of Medical Informatics, Charité Universitätsmedizin - Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Institute of Biometry and Clinical Epidemiology, Charité Universitätsmedizin - Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Ion-George Anghelescu
- Clinic for Psychiatry, Psychosomatics and Psychotherapy, Mental Health Institute Berlin, Berlin, Germany
| | - Dan Rujescu
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Christoph U Correll
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin - Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
- Psychiatry Research, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA.
- Department of Psychiatry and Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.
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Zhou S, Li P, Lv X, Lai X, Liu Z, Zhou J, Liu F, Tao Y, Zhang M, Yu X, Tian J, Sun F. Adverse effects of 21 antidepressants on sleep during acute-phase treatment in major depressive disorder: a systemic review and dose-effect network meta-analysis. Sleep 2023; 46:zsad177. [PMID: 37422714 PMCID: PMC10566234 DOI: 10.1093/sleep/zsad177] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 06/01/2023] [Indexed: 07/10/2023] Open
Abstract
STUDY OBJECTIVES Sleep-related adverse effects during acute treatment with antidepressants undermine adherence and impede remission. We aimed to address subtypes of sleep-related adverse effects and depict the relationship between dose and sleep-related adverse events. METHODS We searched PubMed, Embase, Cochrane Central Register of Controlled Trials, and Web of Science for double-blind randomized controlled trials of depression published before April 30th, 2023. Eligible studies reporting sleep-related adverse effects during short-term monotherapy were included. The odds ratios (ORs) for sleep-related adverse effects were addressed with network meta-analysis. A Bayesian approach was used to depict the dose-effect relationship. Heterogeneity among studies was assessed using the τ2 and I2 statistics. Sensitivity analyses were performed without studies featuring high risk of bias. RESULTS Studies with 64 696 patients were examined from 216 trials. Compared to placebo, 13 antidepressants showed higher ORs for somnolence, of which fluvoxamine (OR = 6.32; 95% CI: 3.56 to 11.21) ranked the top. Eleven had higher risks for insomnia, reboxetine ranked the top (OR = 3.47; 95% CI: 2.77 to 4.36). The dose-effect relationships curves between somnolence or insomnia and dose included linear shape, inverted U-shape, and other shapes. There was no significant heterogeneity among individual studies. The quality of evidence for results in network meta-analyses was rated as very low to moderate by Grading of Recommendations Assessment, Development, and Evaluation. CONCLUSIONS Most antidepressants had higher risks for insomnia or somnolence than placebo. The diverse relationship curves between somnolence or insomnia and dose of antidepressants can guide clinicians to adjust the doses. These findings suggest clinicians pay more attention to sleep-related adverse effects during acute treatment with antidepressants.
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Affiliation(s)
- Shuzhe Zhou
- Peking University Sixth Hospital, Peking University Institute of Mental Health, Beijing, China
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Pei Li
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Xiaozhen Lv
- Peking University Sixth Hospital, Peking University Institute of Mental Health, Beijing, China
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Xuefeng Lai
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Zuoxiang Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Junwen Zhou
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Fengqi Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Yiming Tao
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Meng Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Xin Yu
- Peking University Sixth Hospital, Peking University Institute of Mental Health, Beijing, China
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Jingwei Tian
- School of Pharmacy, Key Laboratory of Molecular Pharmacology and Drug Evaluation (Yantai University), Ministry of Education, Collaborative Innovation Center of Advanced Drug Delivery System and Biotech Drugs in Universities of Shandong, Yantai University, Yantai, China
| | - Feng Sun
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
- Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing, China
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Lee EK, Spitale N, Robillard R. Aripiprazole, a Novel Option in the Management of Restless Legs Syndrome (RLS) Patients with Augmentation and/or Severe RLS Symptoms: A Report of 4 Cases. Nat Sci Sleep 2023; 15:779-784. [PMID: 37818170 PMCID: PMC10561607 DOI: 10.2147/nss.s421189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 09/20/2023] [Indexed: 10/12/2023] Open
Abstract
Purpose Restless Legs Syndrome (RLS) is a sensorimotor disorder associated with an unpleasant urge to move the limbs, relieved with movement, occurring in the evenings and with prolonged rest/inactivity. Treatment with dopamine agonists is effective for up to 60-90% of affected individuals. However, augmentation, ie, the paradoxical worsening of RLS symptoms after prolonged RLS treatment, is frequently reported, typically after 3-10 years of treatment. Here, we present 4 patients with RLS who were successfully treated with dopamine agonists but later developed augmentation. A trial of aripiprazole, a dopamine receptor partial agonist (DRPA), was initiated for treatment of augmentation symptoms. Patients and Methods Four patients treated for RLS with dopamine agonists developed augmentation. In each instance, augmentation symptoms did not respond adequately to a variety of medications including α2δ drugs, opioids or other agents. A trial of aripiprazole was initiated for each patient, and effects were evaluated. Results All four patients with severe RLS and augmentation with dopamine agonists achieved symptom control with aripiprazole. Patients endorsed 90-100% efficacy with aripiprazole by subjective self-report after failures with other agents. Further evaluation with the International Restless Legs Syndrome Study Group RLS Rating Scale (IRLS-SGRS) showed that benefits (from moderate to very severe, to mild to moderate severity) were largely maintained for 1-2 years. Aripiprazole doses to control augmentation symptoms were low (1-4 mg). No significant side effects were reported. Conclusion Aripiprazole may have utility for augmentation in RLS. We speculate that the partial agonist and antagonist properties of aripiprazole may limit potential for dopamine hyposensitization to progress to cause augmentation. Further research is needed to see if aripiprazole and/or other DRPAs are a viable long-term treatment option for patients experiencing augmentation and/or severe RLS with dopamine agonist therapy.
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Affiliation(s)
- Elliott Kyung Lee
- Department of Psychiatry, University of Ottawa, Ottawa, Ontario, Canada
- Sleep Research Unit, Institute for Mental Health Research (IMHR), Ottawa, Ontario, Canada
| | - Naomi Spitale
- Sleep Research Unit, Institute for Mental Health Research (IMHR), Ottawa, Ontario, Canada
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Rebecca Robillard
- Sleep Research Unit, Institute for Mental Health Research (IMHR), Ottawa, Ontario, Canada
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Hasegawa N, Yasuda Y, Yasui-Furukori N, Yamada H, Hori H, Ichihashi K, Takaesu Y, Iida H, Muraoka H, Kodaka F, Iga JI, Hashimoto N, Ogasawara K, Ohi K, Fukumoto K, Numata S, Tsuboi T, Usami M, Hishimoto A, Furihata R, Kishimoto T, Nakamura T, Katsumoto E, Ochi S, Nagasawa T, Atake K, Kubota C, Komatsu H, Yamagata H, Ide K, Takeshima M, Kido M, Kikuchi S, Okada T, Matsumoto J, Miura K, Shimazu T, Inada K, Watanabe K, Hashimoto R. Effect of education regarding treatment guidelines for schizophrenia and depression on the treatment behavior of psychiatrists: A multicenter study. Psychiatry Clin Neurosci 2023; 77:559-568. [PMID: 37684711 DOI: 10.1111/pcn.13578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 07/06/2023] [Accepted: 07/10/2023] [Indexed: 09/10/2023]
Abstract
AIM This study aims to examine the real-world effectiveness of education regarding clinical guidelines for psychiatric disorders using 'the Effectiveness of guidelines for dissemination and education in psychiatric treatment (EGUIDE)' project. METHODS The EGUIDE project is a nationwide prospective implementation study of two clinical practice guidelines, i.e., the Guideline for Pharmacological Therapy of Schizophrenia and the Treatment Guidelines for Major Depressive Disorders, in Japan. Between 2016 and 2019, 782 psychiatrists belonging to 176 hospitals with psychiatric wards participated in the project and attended lectures on clinical practice guidelines. The proportions of guideline-recommended treatments in 7405 patients with schizophrenia and 3794 patients with major depressive disorder at participating hospitals were compared between patients under the care of psychiatrists participating in the project and those not participating in the project. Clinical and prescribing data on the patients discharged from April to September each year from participating hospitals of the project were also analyzed. RESULTS The proportions of three quality indicators (antipsychotic monotherapy regardless of whether other psychotropics medication, antipsychotic monotherapy without other psychotropics and no prescription of anxiolytics or hypnotics) for schizophrenia were higher among participating psychiatrists than among nonparticipating psychiatrists. As similar results were obtained in major depressive disorder, the effectiveness of the project for the dissemination of guideline-recommended treatment has been replicated. CONCLUSION This strategy of providing education regarding the clinical guidelines for psychiatric disorders was effective in improving the treatment-related behavior of psychiatrists. The use of this education-based strategy might contribute to resolving the mental health treatment gap.
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Affiliation(s)
- Naomi Hasegawa
- Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Yuka Yasuda
- Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
- Life Grow Brilliant Mental Clinic, Medical Corporation Foster, Osaka, Japan
| | - Norio Yasui-Furukori
- Department of Psychiatry, Dokkyo Medical University School of Medicine, Tochigi, Japan
| | - Hisashi Yamada
- Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
- Department of Neuropsychiatry, Hyogo Medical University, Hyogo, Japan
| | - Hikaru Hori
- Department of Psychiatry, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Kayo Ichihashi
- Department of Neuropsychiatry, University of Tokyo Hospital, Tokyo, Japan
| | - Yoshikazu Takaesu
- Department of Neuropsychiatry, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Hitoshi Iida
- Department of Psychiatry, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Hiroyuki Muraoka
- Department of Psychiatry, School of Medicine, Tokyo Women's Medical University, Tokyo, Japan
- Department of Psychiatry, Kitasato University, School of Medicine, Kanagawa, Japan
| | - Fumitoshi Kodaka
- Department of Psychiatry, The Jikei University School of Medicine, Tokyo, Japan
| | - Jun-Ichi Iga
- Department of Neuropsychiatry, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Naoki Hashimoto
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, Hokkaido, Japan
| | - Kazuyoshi Ogasawara
- Center for Postgraduate Clinical Training and Career Development, Nagoya University Hospital, Aichi, Japan
| | - Kazutaka Ohi
- Department of Psychiatry, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Kentaro Fukumoto
- Department of Neuropsychiatry, Iwate Medical University School of Medicine, Iwate, Japan
| | - Shusuke Numata
- Department of Psychiatry, Graduate School of Biomedical Science, Tokushima University, Tokushima, Japan
| | - Takashi Tsuboi
- Department of Neuropsychiatry, Kyorin University School of Medicine, Tokyo, Japan
| | - Masahide Usami
- Department of Child and Adolescent Psychiatry, Kohnodai Hospital, National Center for Global Health and Medicine, Chiba, Japan
| | - Akitoyo Hishimoto
- Department of Psychiatry, Yokohama City University Graduate School of Medicine, Kanagawa, Japan
| | - Ryuji Furihata
- Agency for Student Support and Disability Resources, Kyoto University, Kyoto, Japan
| | - Taishiro Kishimoto
- Hills Joint Research Laboratory for Future Preventive Medicine and Wellness, Keio University School of Medicine, Tokyo, Japan
| | - Toshinori Nakamura
- Department of Psychiatry, Shinshu University School of Medicine, Nagano, Japan
| | | | - Shinichiro Ochi
- Department of Neuropsychiatry, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Tatsuya Nagasawa
- Department of Neuropsychiatry, Kanazawa Medical University, Ishikawa, Japan
| | - Kiyokazu Atake
- Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
- Nippon Telegraph and Telephone West Corporation Kyushu Health Administration Center, Fukuoka, Japan
| | - Chika Kubota
- Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Hiroshi Komatsu
- Department of Psychiatry, Tohoku University Hospital, Miyagi, Japan
| | - Hirotaka Yamagata
- Division of Neuropsychiatry, Department of Neuroscience Yamaguchi University School of Medicine, Yamaguchi, Japan
| | - Kenta Ide
- Department of Hospital Pharmacy, Hospital of University of Occupational and Environmental Health, Fukuoka, Japan
| | - Masahiro Takeshima
- Department of Neuropsychiatry, Akita University Graduate School of Medicine, Akita, Japan
| | - Mikio Kido
- Department of Neuropsychiatry, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan
- Kido Clinic, Toyama, Japan
| | - Saya Kikuchi
- Department of Psychiatry, Tohoku University Hospital, Miyagi, Japan
| | - Tsuyoshi Okada
- Department of Psychiatry, Jichi Medical University, Tochigi, Japan
| | - Junya Matsumoto
- Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Kenichiro Miura
- Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Taichi Shimazu
- Division of Behavioral Sciences, Institute for Cancer Control, National Cancer Center, Tokyo, Japan
| | - Ken Inada
- Department of Psychiatry, School of Medicine, Tokyo Women's Medical University, Tokyo, Japan
- Department of Psychiatry, Kitasato University, School of Medicine, Kanagawa, Japan
| | - Koichiro Watanabe
- Department of Neuropsychiatry, Kyorin University School of Medicine, Tokyo, Japan
| | - Ryota Hashimoto
- Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
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Fancy F, Rodrigues NB, Di Vincenzo JD, Chau EH, Sethi R, Husain MI, Gill H, Tabassum A, Mckenzie A, Phan L, McIntyre RS, Rosenblat JD. Real-World Effectiveness of Repeated Ketamine Infusions for Treatment-Resistant Bipolar Depression. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2023; 21:420-429. [PMID: 38694999 PMCID: PMC11058957 DOI: 10.1176/appi.focus.23021022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/04/2024]
Abstract
Background Clinical trials have demonstrated rapid antidepressant effects with intravenous (IV) ketamine for major depressive disorder, with relatively less research specifically for bipolar depression. Herein, we describe the real-world effectiveness of repeated ketamine infusions for treatment-resistant bipolar depression. Methods This study was conducted in a community clinic in Mississauga, Ontario (Canadian Rapid Treatment Centre of Excellence; Braxia Health). In this observational study (NCT04209296), patients with treatment-resistant bipolar I/II depression (n = 66) received four sub-anesthetic doses of IV ketamine (0.5-0.75 mg/kg) over a two-week period. Symptoms of depression, suicidality, anxiety, and functioning were assessed with validated self-report measures. Results Statistically and clinically significant antidepressant effects were observed in the overall sample, as measured by the Quick Inventory for Depression Symptomatology-Self Report-16 (QIDS-SR16) with further reductions in depressive symptoms observed after each subsequent infusion (n = 66; mean QIDS-SR16 reduction of 6.08+/-1.39; p < 0.0001). Significant reductions of suicidal thoughts (QIDS-SR16-Suicide Item) and anxiety (Generalized Anxiety Disorder-7) were also observed with functional improvements on the Sheehan Disability Scale (p < 0.0001 on all measures). Moreover, the response rate (QIDS-SR16 total score decrease ≥50% from baseline) was 35% and remission rate (QIDS-SR16 total score ≤5) was 20% after four infusions. Infusions were generally well tolerated with treatment-emergent hypomania observed in only three patients (4.5%) with zero cases of mania or psychosis. Conclusions Real-world effectiveness of IV ketamine for bipolar depression was observed. Repeated doses were associated with greater symptom reduction and adequate tolerability.Reprinted from Bipolar Disord 2023; 25:99-109, with permission from John Wiley and Sons. Copyright © 2023.
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Affiliation(s)
- Farhan Fancy
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Ontario, Canada (Fancy, Rodrigues, Di Vicenzo, Sethi, Gill, Tabassum, Mckenzie, Phan, McIntyre, Rosenblat); Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada (Fancy, Gill, McIntyre, Rosenblat); Braxia Scientific, Braxia Health, Canadian Rapid Treatment Centre of Excellence, Mississauga, Ontario, Canada (Chau, McIntyre, Rosenblat); Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada (Sethi, Husain, McIntyre, Rosenblat); Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada (Husain); Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada (McIntyre, Rosenblat); Brain and Cognition Discovery Foundation, Toronto, Ontario, Canada (McIntyre)
| | - Nelson B Rodrigues
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Ontario, Canada (Fancy, Rodrigues, Di Vicenzo, Sethi, Gill, Tabassum, Mckenzie, Phan, McIntyre, Rosenblat); Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada (Fancy, Gill, McIntyre, Rosenblat); Braxia Scientific, Braxia Health, Canadian Rapid Treatment Centre of Excellence, Mississauga, Ontario, Canada (Chau, McIntyre, Rosenblat); Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada (Sethi, Husain, McIntyre, Rosenblat); Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada (Husain); Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada (McIntyre, Rosenblat); Brain and Cognition Discovery Foundation, Toronto, Ontario, Canada (McIntyre)
| | - Joshua D Di Vincenzo
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Ontario, Canada (Fancy, Rodrigues, Di Vicenzo, Sethi, Gill, Tabassum, Mckenzie, Phan, McIntyre, Rosenblat); Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada (Fancy, Gill, McIntyre, Rosenblat); Braxia Scientific, Braxia Health, Canadian Rapid Treatment Centre of Excellence, Mississauga, Ontario, Canada (Chau, McIntyre, Rosenblat); Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada (Sethi, Husain, McIntyre, Rosenblat); Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada (Husain); Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada (McIntyre, Rosenblat); Brain and Cognition Discovery Foundation, Toronto, Ontario, Canada (McIntyre)
| | - Edmond H Chau
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Ontario, Canada (Fancy, Rodrigues, Di Vicenzo, Sethi, Gill, Tabassum, Mckenzie, Phan, McIntyre, Rosenblat); Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada (Fancy, Gill, McIntyre, Rosenblat); Braxia Scientific, Braxia Health, Canadian Rapid Treatment Centre of Excellence, Mississauga, Ontario, Canada (Chau, McIntyre, Rosenblat); Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada (Sethi, Husain, McIntyre, Rosenblat); Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada (Husain); Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada (McIntyre, Rosenblat); Brain and Cognition Discovery Foundation, Toronto, Ontario, Canada (McIntyre)
| | - Rickinder Sethi
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Ontario, Canada (Fancy, Rodrigues, Di Vicenzo, Sethi, Gill, Tabassum, Mckenzie, Phan, McIntyre, Rosenblat); Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada (Fancy, Gill, McIntyre, Rosenblat); Braxia Scientific, Braxia Health, Canadian Rapid Treatment Centre of Excellence, Mississauga, Ontario, Canada (Chau, McIntyre, Rosenblat); Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada (Sethi, Husain, McIntyre, Rosenblat); Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada (Husain); Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada (McIntyre, Rosenblat); Brain and Cognition Discovery Foundation, Toronto, Ontario, Canada (McIntyre)
| | - Muhammad I Husain
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Ontario, Canada (Fancy, Rodrigues, Di Vicenzo, Sethi, Gill, Tabassum, Mckenzie, Phan, McIntyre, Rosenblat); Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada (Fancy, Gill, McIntyre, Rosenblat); Braxia Scientific, Braxia Health, Canadian Rapid Treatment Centre of Excellence, Mississauga, Ontario, Canada (Chau, McIntyre, Rosenblat); Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada (Sethi, Husain, McIntyre, Rosenblat); Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada (Husain); Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada (McIntyre, Rosenblat); Brain and Cognition Discovery Foundation, Toronto, Ontario, Canada (McIntyre)
| | - Hartej Gill
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Ontario, Canada (Fancy, Rodrigues, Di Vicenzo, Sethi, Gill, Tabassum, Mckenzie, Phan, McIntyre, Rosenblat); Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada (Fancy, Gill, McIntyre, Rosenblat); Braxia Scientific, Braxia Health, Canadian Rapid Treatment Centre of Excellence, Mississauga, Ontario, Canada (Chau, McIntyre, Rosenblat); Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada (Sethi, Husain, McIntyre, Rosenblat); Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada (Husain); Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada (McIntyre, Rosenblat); Brain and Cognition Discovery Foundation, Toronto, Ontario, Canada (McIntyre)
| | - Aniqa Tabassum
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Ontario, Canada (Fancy, Rodrigues, Di Vicenzo, Sethi, Gill, Tabassum, Mckenzie, Phan, McIntyre, Rosenblat); Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada (Fancy, Gill, McIntyre, Rosenblat); Braxia Scientific, Braxia Health, Canadian Rapid Treatment Centre of Excellence, Mississauga, Ontario, Canada (Chau, McIntyre, Rosenblat); Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada (Sethi, Husain, McIntyre, Rosenblat); Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada (Husain); Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada (McIntyre, Rosenblat); Brain and Cognition Discovery Foundation, Toronto, Ontario, Canada (McIntyre)
| | - Andrea Mckenzie
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Ontario, Canada (Fancy, Rodrigues, Di Vicenzo, Sethi, Gill, Tabassum, Mckenzie, Phan, McIntyre, Rosenblat); Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada (Fancy, Gill, McIntyre, Rosenblat); Braxia Scientific, Braxia Health, Canadian Rapid Treatment Centre of Excellence, Mississauga, Ontario, Canada (Chau, McIntyre, Rosenblat); Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada (Sethi, Husain, McIntyre, Rosenblat); Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada (Husain); Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada (McIntyre, Rosenblat); Brain and Cognition Discovery Foundation, Toronto, Ontario, Canada (McIntyre)
| | - Lee Phan
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Ontario, Canada (Fancy, Rodrigues, Di Vicenzo, Sethi, Gill, Tabassum, Mckenzie, Phan, McIntyre, Rosenblat); Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada (Fancy, Gill, McIntyre, Rosenblat); Braxia Scientific, Braxia Health, Canadian Rapid Treatment Centre of Excellence, Mississauga, Ontario, Canada (Chau, McIntyre, Rosenblat); Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada (Sethi, Husain, McIntyre, Rosenblat); Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada (Husain); Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada (McIntyre, Rosenblat); Brain and Cognition Discovery Foundation, Toronto, Ontario, Canada (McIntyre)
| | - Roger S McIntyre
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Ontario, Canada (Fancy, Rodrigues, Di Vicenzo, Sethi, Gill, Tabassum, Mckenzie, Phan, McIntyre, Rosenblat); Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada (Fancy, Gill, McIntyre, Rosenblat); Braxia Scientific, Braxia Health, Canadian Rapid Treatment Centre of Excellence, Mississauga, Ontario, Canada (Chau, McIntyre, Rosenblat); Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada (Sethi, Husain, McIntyre, Rosenblat); Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada (Husain); Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada (McIntyre, Rosenblat); Brain and Cognition Discovery Foundation, Toronto, Ontario, Canada (McIntyre)
| | - Joshua D Rosenblat
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Ontario, Canada (Fancy, Rodrigues, Di Vicenzo, Sethi, Gill, Tabassum, Mckenzie, Phan, McIntyre, Rosenblat); Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada (Fancy, Gill, McIntyre, Rosenblat); Braxia Scientific, Braxia Health, Canadian Rapid Treatment Centre of Excellence, Mississauga, Ontario, Canada (Chau, McIntyre, Rosenblat); Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada (Sethi, Husain, McIntyre, Rosenblat); Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada (Husain); Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada (McIntyre, Rosenblat); Brain and Cognition Discovery Foundation, Toronto, Ontario, Canada (McIntyre)
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McIntyre RS, Alsuwaidan M, Baune BT, Berk M, Demyttenaere K, Goldberg JF, Gorwood P, Ho R, Kasper S, Kennedy SH, Ly-Uson J, Mansur RB, McAllister-Williams RH, Murrough JW, Nemeroff CB, Nierenberg AA, Rosenblat JD, Sanacora G, Schatzberg AF, Shelton R, Stahl SM, Trivedi MH, Vieta E, Vinberg M, Williams N, Young AH, Maj M. Treatment-resistant depression: definition, prevalence, detection, management, and investigational interventions. World Psychiatry 2023; 22:394-412. [PMID: 37713549 PMCID: PMC10503923 DOI: 10.1002/wps.21120] [Citation(s) in RCA: 86] [Impact Index Per Article: 86.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/17/2023] Open
Abstract
Treatment-resistant depression (TRD) is common and associated with multiple serious public health implications. A consensus definition of TRD with demonstrated predictive utility in terms of clinical decision-making and health outcomes does not currently exist. Instead, a plethora of definitions have been proposed, which vary significantly in their conceptual framework. The absence of a consensus definition hampers precise estimates of the prevalence of TRD, and also belies efforts to identify risk factors, prevention opportunities, and effective interventions. In addition, it results in heterogeneity in clinical practice decision-making, adversely affecting quality of care. The US Food and Drug Administration (FDA) and the European Medicines Agency (EMA) have adopted the most used definition of TRD (i.e., inadequate response to a minimum of two antidepressants despite adequacy of the treatment trial and adherence to treatment). It is currently estimated that at least 30% of persons with depression meet this definition. A significant percentage of persons with TRD are actually pseudo-resistant (e.g., due to inadequacy of treatment trials or non-adherence to treatment). Although multiple sociodemographic, clinical, treatment and contextual factors are known to negatively moderate response in persons with depression, very few factors are regarded as predictive of non-response across multiple modalities of treatment. Intravenous ketamine and intranasal esketamine (co-administered with an antidepressant) are established as efficacious in the management of TRD. Some second-generation antipsychotics (e.g., aripiprazole, brexpiprazole, cariprazine, quetiapine XR) are proven effective as adjunctive treatments to antidepressants in partial responders, but only the olanzapine-fluoxetine combination has been studied in FDA-defined TRD. Repetitive transcranial magnetic stimulation (TMS) is established as effective and FDA-approved for individuals with TRD, with accelerated theta-burst TMS also recently showing efficacy. Electroconvulsive therapy is regarded as an effective acute and maintenance intervention in TRD, with preliminary evidence suggesting non-inferiority to acute intravenous ketamine. Evidence for extending antidepressant trial, medication switching and combining antidepressants is mixed. Manual-based psychotherapies are not established as efficacious on their own in TRD, but offer significant symptomatic relief when added to conventional antidepressants. Digital therapeutics are under study and represent a potential future clinical vista in this population.
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Affiliation(s)
- Roger S McIntyre
- Brain and Cognition Discovery Foundation, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
| | - Mohammad Alsuwaidan
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
| | - Bernhard T Baune
- Department of Psychiatry, University of Münster, Münster, Germany
- Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia
| | - Michael Berk
- Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia
- Deakin University IMPACT Institute, Geelong, VIC, Australia
| | - Koen Demyttenaere
- Department of Psychiatry, Faculty of Medicine, KU Leuven, Leuven, Belgium
| | - Joseph F Goldberg
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Philip Gorwood
- Department of Psychiatry, Sainte-Anne Hospital, Paris, France
| | - Roger Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Institute for Health Innovation and Technology, National University of Singapore, Singapore
| | - Siegfried Kasper
- Department of Psychiatry and Psychotherapy and Center of Brain Research, Molecular Neuroscience Branch, Medical University of Vienna, Vienna, Austria
| | - Sidney H Kennedy
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
| | - Josefina Ly-Uson
- Department of Psychiatry and Behavioral Medicine, University of The Philippines College of Medicine, Manila, The Philippines
| | - Rodrigo B Mansur
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
| | - R Hamish McAllister-Williams
- Northern Center for Mood Disorders, Translational and Clinical Research Institute, Newcastle University, and Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - James W Murrough
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Andrew A Nierenberg
- Dauten Family Center for Bipolar Treatment Innovation, Massachusetts General Hospital, Boston, MA, USA
| | - Joshua D Rosenblat
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
| | - Gerard Sanacora
- Department of Psychiatry, Yale University, New Haven, CT, USA
| | - Alan F Schatzberg
- Department of Psychiatry, Stanford University School of Medicine, Stanford, CA, USA
| | - Richard Shelton
- Department of Psychiatry, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Stephen M Stahl
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - Madhukar H Trivedi
- Department of Psychiatry, University of Illinois Chicago, Chicago, IL, USA
| | - Eduard Vieta
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
| | - Maj Vinberg
- Mental Health Centre, Northern Zealand, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
| | - Nolan Williams
- Department of Psychiatry, Stanford University School of Medicine, Stanford, CA, USA
| | - Allan H Young
- Department of Psychological Medicine, King's College London, London, UK
| | - Mario Maj
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
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138
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Dormegny-Jeanjean LC, de Billy C, Mainberger O, Weibel S, Schorr B, Obrecht A, Landré L, Berna F, Causin JB, Blanc F, Danila V, Tomsa M, Pfleger G, Meyer C, Humbert I, Javelot H, Meyer G, Bertschy G, Foucher JR. Potential efficacy of dopaminergic antidepressants in treatment resistant anergic-anhedonic depression results of the chronic anergic-anhedonic depression open trial - CADOT. Front Psychiatry 2023; 14:1194090. [PMID: 37829759 PMCID: PMC10565009 DOI: 10.3389/fpsyt.2023.1194090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 08/02/2023] [Indexed: 10/14/2023] Open
Abstract
Introduction Among treatment-resistant depression (TRD), we identified anergic-anhedonic clinical presentations (TRAD) as putatively responsive to pro-dopaminergic strategies. Based on the literature, non-selective monoamine oxidase inhibitors (MAOI) and dopamine D2 receptor agonists (D2RAG) were sequentially introduced, frequently under the coverage of a mood stabilizer. This two-step therapeutic strategy will be referred to as the Dopaminergic Antidepressant Therapy Algorithm (DATA). We describe the short and long-term outcomes of TRAD managed according to DATA guidelines. Method Out of 52 outpatients with TRAD treated with DATA in a single expert center, 48 were included in the analysis [severity - QIDS (Quick Inventory of Depressive Symptomatology) = 16 ± 3; episode duration = 4.1 ± 2.7 years; Thase and Rush resistance stage = 2.9 ± 0.6; functioning - GAF (Global Assessment of Functioning) = 41 ± 8]. These were followed-up for a median (1st - 3rd quartile) of 4 (1-9) months before being prescribed the first dopaminergic treatment and remitters were followed up 21 (11-33) months after remission. Results At the end of DATA step 1, 25 patients were in remission (QIDS <6; 52% [38-66%]). After DATA step 2, 37 patients were in remission (77% [65-89%]) to whom 5 patients with a QIDS score = 6 could be added (88% [78-97%]). Many of these patients felt subjectively remitted (GAF = 74 ± 10). There was a significant benefit to combining MAOI with D2RAG which was maintained for at least 18 months in 30 patients (79% [62-95%]). Conclusion These results support TRAD sensitivity to pro-dopaminergic interventions. However, some clinical heterogeneities remain in our sample and suggest some improvement in the description of dopamine-sensitive form(s).
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Affiliation(s)
- Ludovic Christophe Dormegny-Jeanjean
- Treatment resistant depression expert center of Alsace (CEDRA), Strasbourg-Rouffach-Erstein-Brumath, Rouffach, France
- Non-Invasive neuroModulation Center of Strasbourg (CEMNIS), University Hospital of Strasbourg, Strasbourg, France
- CNRS UMR 7357 iCube, neurophysiology, FMTS, University of Strasbourg, Strasbourg, France
| | - Clément de Billy
- Treatment resistant depression expert center of Alsace (CEDRA), Strasbourg-Rouffach-Erstein-Brumath, Rouffach, France
- Non-Invasive neuroModulation Center of Strasbourg (CEMNIS), University Hospital of Strasbourg, Strasbourg, France
- CNRS UMR 7357 iCube, neurophysiology, FMTS, University of Strasbourg, Strasbourg, France
| | - Olivier Mainberger
- Treatment resistant depression expert center of Alsace (CEDRA), Strasbourg-Rouffach-Erstein-Brumath, Rouffach, France
- Non-Invasive neuroModulation Center of Strasbourg (CEMNIS), University Hospital of Strasbourg, Strasbourg, France
- CNRS UMR 7357 iCube, neurophysiology, FMTS, University of Strasbourg, Strasbourg, France
| | - Sébastien Weibel
- Treatment resistant depression expert center of Alsace (CEDRA), Strasbourg-Rouffach-Erstein-Brumath, Rouffach, France
- Department of Psychiatry and Mental Health – University Hospital of Strasbourg, University of Strasbourg, Strasbourg, France
- INSERM UMR 1114, Physiopathology and Cognitive Psychopathology of Schizophrenia, University of Strasbourg, Strasbourg, France
| | - Benoit Schorr
- Department of Psychiatry and Mental Health – University Hospital of Strasbourg, University of Strasbourg, Strasbourg, France
- INSERM UMR 1114, Physiopathology and Cognitive Psychopathology of Schizophrenia, University of Strasbourg, Strasbourg, France
- Geriatrics Department and Expert Center for Neurocognitive Disorders, University Hospital of Strasbourg, Strasbourg, France
| | - Alexandre Obrecht
- Treatment resistant depression expert center of Alsace (CEDRA), Strasbourg-Rouffach-Erstein-Brumath, Rouffach, France
- Non-Invasive neuroModulation Center of Strasbourg (CEMNIS), University Hospital of Strasbourg, Strasbourg, France
| | - Lionel Landré
- CNRS UMR 7357 iCube, neurophysiology, FMTS, University of Strasbourg, Strasbourg, France
| | - Fabrice Berna
- Department of Psychiatry and Mental Health – University Hospital of Strasbourg, University of Strasbourg, Strasbourg, France
- INSERM UMR 1114, Physiopathology and Cognitive Psychopathology of Schizophrenia, University of Strasbourg, Strasbourg, France
| | - Jean-Baptiste Causin
- Treatment resistant depression expert center of Alsace (CEDRA), Strasbourg-Rouffach-Erstein-Brumath, Rouffach, France
- Department of Psychiatry and Mental Health – University Hospital of Strasbourg, University of Strasbourg, Strasbourg, France
- INSERM UMR 1114, Physiopathology and Cognitive Psychopathology of Schizophrenia, University of Strasbourg, Strasbourg, France
| | - Frederic Blanc
- CNRS UMR 7357 iCube, neurophysiology, FMTS, University of Strasbourg, Strasbourg, France
- Geriatrics Department and Expert Center for Neurocognitive Disorders, University Hospital of Strasbourg, Strasbourg, France
| | - Vlad Danila
- Treatment resistant depression expert center of Alsace (CEDRA), Strasbourg-Rouffach-Erstein-Brumath, Rouffach, France
- Department of Psychiatry “Pole 8/9”, Rouffach Psychiatric Hospital, Rouffach, France
| | - Mihaela Tomsa
- Treatment resistant depression expert center of Alsace (CEDRA), Strasbourg-Rouffach-Erstein-Brumath, Rouffach, France
- Department of Psychiatry “Pole 8/9”, Rouffach Psychiatric Hospital, Rouffach, France
| | - Geraldine Pfleger
- Treatment resistant depression expert center of Alsace (CEDRA), Strasbourg-Rouffach-Erstein-Brumath, Rouffach, France
- Department of Integrated Psychiatric Care, Centre Hospitalier d’Erstein, Erstein, France
| | - Camille Meyer
- Treatment resistant depression expert center of Alsace (CEDRA), Strasbourg-Rouffach-Erstein-Brumath, Rouffach, France
- Non-Invasive neuroModulation Center of Strasbourg (CEMNIS), University Hospital of Strasbourg, Strasbourg, France
- Department of Psychiatry and Mental Health – University Hospital of Strasbourg, University of Strasbourg, Strasbourg, France
| | - Ilia Humbert
- Treatment resistant depression expert center of Alsace (CEDRA), Strasbourg-Rouffach-Erstein-Brumath, Rouffach, France
- Non-Invasive neuroModulation Center of Strasbourg (CEMNIS), University Hospital of Strasbourg, Strasbourg, France
- Department of Psychiatry and Mental Health – University Hospital of Strasbourg, University of Strasbourg, Strasbourg, France
| | - Hervé Javelot
- Treatment resistant depression expert center of Alsace (CEDRA), Strasbourg-Rouffach-Erstein-Brumath, Rouffach, France
- Expert center in Psychopharmacology, Etablissement public de santé Alsace nord (EPSAN), Bischwiller, France
| | - Guillaume Meyer
- Treatment resistant depression expert center of Alsace (CEDRA), Strasbourg-Rouffach-Erstein-Brumath, Rouffach, France
- Department of Psychopharmacology, Centre Hospitalier d’Erstein, Lingolsheim, France
| | - Gilles Bertschy
- Treatment resistant depression expert center of Alsace (CEDRA), Strasbourg-Rouffach-Erstein-Brumath, Rouffach, France
- Department of Psychiatry and Mental Health – University Hospital of Strasbourg, University of Strasbourg, Strasbourg, France
- INSERM UMR 1114, Physiopathology and Cognitive Psychopathology of Schizophrenia, University of Strasbourg, Strasbourg, France
| | - Jack Rene Foucher
- Treatment resistant depression expert center of Alsace (CEDRA), Strasbourg-Rouffach-Erstein-Brumath, Rouffach, France
- Non-Invasive neuroModulation Center of Strasbourg (CEMNIS), University Hospital of Strasbourg, Strasbourg, France
- CNRS UMR 7357 iCube, neurophysiology, FMTS, University of Strasbourg, Strasbourg, France
- Department of Psychiatry and Mental Health – University Hospital of Strasbourg, University of Strasbourg, Strasbourg, France
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Wang J, Li W, Li M, Wu H, Qiu Z. Comparative efficacy and safety of 4 atypical antipsychotics augmentation treatment for major depressive disorder in adults: A systematic review and network meta-analysis. Medicine (Baltimore) 2023; 102:e34670. [PMID: 37746943 PMCID: PMC10519518 DOI: 10.1097/md.0000000000034670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 07/18/2023] [Accepted: 07/19/2023] [Indexed: 09/26/2023] Open
Abstract
BACKGROUND Atypical antipsychotic (AAP) augmentation is an alternative strategy for patients with major depressive disorder (MDD) who had an inadequate response to antidepressant therapy (ADT). We aimed to compare and rank the efficacy and safety of 4 AAPs in the adjuvant treatment of MDD. METHODS We searched randomized controlled trials (RCTs) published and unpublished from the date of databases and clinical trial websites inception to April 30, 2023. The evidence risk of bias (RoB) and certainty are assessed using the Cochrane bias risk tool and grading of recommendations assessment, development, and evaluation (GRADE) framework, respectively. Using network meta-analysis, we estimated summary risk ratios (RRs) or standardized mean difference (SMD) based on the random effects model. RESULTS 56 eligible studies comprising 11448 participants were included. In terms of primary efficacy outcome, compared with placebo (PBO), all AAPs had significant efficacy (SMD = -0.40; 95% CI, -0.68 to -0.12 for quetiapine (QTP); -0.35, -0.59 to -0.11 for olanzapine (OLA); -0.28, -0.47 to -0.09 for aripiprazole (ARI) and -0.25, -0.42 to -0.07 for brexpiprazole (BRE), respectively). In terms of acceptability, no significant difference was found, either agents versus agents or agents versus PBO. In terms of tolerability, compared with the PBO, QTP (RR = 0.24; 95% CI,0.11-0.53), OLA (0.30,0.10-0.55), ARI (0.39,0.22-0.69), and BRE (0.37,0.18-0.75) were significantly less well tolerated. 8 (14.2%) of 56 trials were assessed as low RoB, 38 (67.9%) trials had moderate RoB, and 10 (17.9%) had high RoB; By the GRADE, the certainty of most evidence was low or very low. CONCLUSION Adjuvant AAPs had significant efficacy compared with PBO, but treatment decisions must be made to balance the risks and benefits.
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Affiliation(s)
- Jia Wang
- Guangdong Pharmaceutical University, Guangzhou, Guangdong province, China
| | - Wenwei Li
- Guangdong Pharmaceutical University, Guangzhou, Guangdong province, China
| | - Mengting Li
- Guangdong Pharmaceutical University, Guangzhou, Guangdong province, China
| | - Hanbiao Wu
- Guangdong Pharmaceutical University, Guangzhou, Guangdong province, China
| | - Zhikun Qiu
- Key Department of Clinical Pharmacy, the First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, Guangdong province, China
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Corral R, Bojórquez E, Cetkovich-Bakmas M, Córdoba R, Chestaro J, Gama C, Bonetto GG, Jaramillo CL, Moreno RA, Ng B, de Leon EP, Risco L, Silva H, Vazquez G. Latin American consensus recommendations for the management and treatment of patients with treatment-resistant depression (TRD). SPANISH JOURNAL OF PSYCHIATRY AND MENTAL HEALTH 2023:S2950-2853(23)00013-3. [PMID: 38592432 DOI: 10.1016/j.sjpmh.2023.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 06/08/2023] [Accepted: 06/14/2023] [Indexed: 04/10/2024]
Abstract
Despite the abundance of literature on treatment-resistant depression (TRD), there is no universally accepted definition of TRD, and available treatment pathways for the management of TRD vary across the Latin American region, highlighting the need for a uniform definition and treatment principles to optimize the management of TRD in Latin America. METHODS Following a thematic literature review and pre-meeting survey, a Latin America expert panel comprising 14 psychiatrists with clinical experience in managing patients with TRD convened and utilized the RAND/UCLA appropriateness method to develop consensus-based recommendations on the appropriate definition of TRD and principles for its management. RESULTS The expert panel agreed that 'treatment-resistant depression' (TRD) is defined as 'failure of two drug treatments of adequate doses, for 4-8 weeks duration with adequate adherence, during a major depressive episode'. A stepwise treatment approach should be employed for the management of TRD - treatment strategies can include maximizing dose, switching to a different class, and augmenting or combining treatments. Nonpharmacological treatments, such as electroconvulsive therapy, are also appropriate options for patients with TRD. CONCLUSION These consensus recommendations on the operational definition of TRD and approved treatments for its management can be adapted to local contexts in the Latin American countries but should not replace clinical judgement. Individual circumstances and benefit-risk balance should be carefully considered while determining the most appropriate treatment option for patients with TRD.
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Affiliation(s)
- Ricardo Corral
- Department of Psychiatry, Jose T. Borda Hospital, University of Buenos Aires, Buenos Aires, Argentina
| | | | - Marcelo Cetkovich-Bakmas
- Institute of Cognitive and Translational Neurosciences (INCyT), INECO Foundation, Favaloro University, Buenos Aires, Argentina
| | - Rodrigo Córdoba
- UR Center for Mental Health - CeRSaME, School of Medicine and Health Sciences - EMCS, University of Rosario, Bogotá, Colombia
| | - Julio Chestaro
- Catholic University of Cibao, La Vega, Dominican Republic; Traumatological Hospital Juan Bosch, La Vega, Dominican Republic
| | - Clarissa Gama
- Department of Psychiatry and Legal Medicine, UFRGS, Research Unit, HCPA, Porto Alegre, Brazil
| | | | - Carlos López Jaramillo
- Department of Psychiatry, School of Medicine, University of Antioquia, Medellin, Colombia
| | | | - Bernardo Ng
- Geriatric Center Nuevo Atardecer and Department of Psychiatry, University of California San Diego, Sun Valley Behavioral and Research Centers, California, USA
| | | | - Luis Risco
- Department of Psychiatry, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Hernán Silva
- Department of Psychiatry, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Gustavo Vazquez
- Research Center on Neurosciences, University of Palermo, Buenos Aires, Argentina; Department of Psychiatry, Queen's University, Kingston, Ontario, Canada.
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Garel N, Drury J, Thibault Lévesque J, Goyette N, Lehmann A, Looper K, Erritzoe D, Dames S, Turecki G, Rej S, Richard-Devantoy S, Greenway KT. The Montreal model: an integrative biomedical-psychedelic approach to ketamine for severe treatment-resistant depression. Front Psychiatry 2023; 14:1268832. [PMID: 37795512 PMCID: PMC10546328 DOI: 10.3389/fpsyt.2023.1268832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 08/30/2023] [Indexed: 10/06/2023] Open
Abstract
Background Subanesthetic ketamine has accumulated meta-analytic evidence for rapid antidepressant effects in treatment-resistant depression (TRD), resulting in both excitement and debate. Many unanswered questions surround ketamine's mechanisms of action and its integration into real-world psychiatric care, resulting in diverse utilizations that variously resemble electroconvulsive therapy, conventional antidepressants, or serotonergic psychedelics. There is thus an unmet need for clinical approaches to ketamine that are tailored to its unique therapeutic properties. Methods This article presents the Montreal model, a comprehensive biopsychosocial approach to ketamine for severe TRD refined over 6 years in public healthcare settings. To contextualize its development, we review the evidence for ketamine as a biomedical and as a psychedelic treatment of depression, emphasizing each perspectives' strengths, weaknesses, and distinct methods of utilization. We then describe the key clinical experiences and research findings that shaped the model's various components, which are presented in detail. Results The Montreal model, as implemented in a recent randomized clinical trial, aims to synergistically pair ketamine infusions with conventional and psychedelic biopsychosocial care. Ketamine is broadly conceptualized as a brief intervention that can produce windows of opportunity for enhanced psychiatric care, as well as powerful occasions for psychological growth. The model combines structured psychiatric care and concomitant psychotherapy with six ketamine infusions, administered with psychedelic-inspired nonpharmacological adjuncts including rolling preparative and integrative psychological support. Discussion Our integrative model aims to bridge the biomedical-psychedelic divide to offer a feasible, flexible, and standardized approach to ketamine for TRD. Our learnings from developing and implementing this psychedelic-inspired model for severe, real-world patients in two academic hospitals may offer valuable insights for the ongoing roll-out of a range of psychedelic therapies. Further research is needed to assess the Montreal model's effectiveness and hypothesized psychological mechanisms.
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Affiliation(s)
- Nicolas Garel
- Department of Psychiatry, Faculty of Medicine, McGill University, Montréal, QC, Canada
| | - Jessica Drury
- Department of Psychiatry, Faculty of Medicine, McGill University, Montréal, QC, Canada
| | | | - Nathalie Goyette
- McGill Group for Suicide Studies, Douglas Mental Health Research Institute, Montreal, QC, Canada
| | - Alexandre Lehmann
- International Laboratory for Brain, Music and Sound Research, Montreal, QC, Canada
- Department of Otolaryngology, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Karl Looper
- Department of Psychiatry, Faculty of Medicine, McGill University, Montréal, QC, Canada
- Jewish General Hospital, Lady Davis Institute for Medical Research, Montreal, QC, Canada
| | - David Erritzoe
- Division of Psychiatry, Department of Brain Sciences, Centres for Neuropsychopharmacology and Psychedelic Research, Imperial College London, London, United Kingdom
| | - Shannon Dames
- Health Sciences and Human Services, Vancouver Island University, Nanaimo, BC, Canada
| | - Gustavo Turecki
- Department of Psychiatry, Faculty of Medicine, McGill University, Montréal, QC, Canada
- McGill Group for Suicide Studies, Douglas Mental Health Research Institute, Montreal, QC, Canada
| | - Soham Rej
- Department of Psychiatry, Faculty of Medicine, McGill University, Montréal, QC, Canada
- Jewish General Hospital, Lady Davis Institute for Medical Research, Montreal, QC, Canada
- Geri-PARTy Research Group, Jewish General Hospital, Montreal, QC, Canada
| | - Stephane Richard-Devantoy
- Department of Psychiatry, Faculty of Medicine, McGill University, Montréal, QC, Canada
- McGill Group for Suicide Studies, Douglas Mental Health Research Institute, Montreal, QC, Canada
| | - Kyle T. Greenway
- Department of Psychiatry, Faculty of Medicine, McGill University, Montréal, QC, Canada
- Jewish General Hospital, Lady Davis Institute for Medical Research, Montreal, QC, Canada
- Division of Psychiatry, Department of Brain Sciences, Centres for Neuropsychopharmacology and Psychedelic Research, Imperial College London, London, United Kingdom
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Chokka P, Bender A, Brennan S, Ahmed G, Corbière M, Dozois DJA, Habert J, Harrison J, Katzman MA, McIntyre RS, Liu YS, Nieuwenhuijsen K, Dewa CS. Practical pathway for the management of depression in the workplace: a Canadian perspective. Front Psychiatry 2023; 14:1207653. [PMID: 37732077 PMCID: PMC10508062 DOI: 10.3389/fpsyt.2023.1207653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 08/09/2023] [Indexed: 09/22/2023] Open
Abstract
Major depressive disorder (MDD) and other mental health issues pose a substantial burden on the workforce. Approximately half a million Canadians will not be at work in any week because of a mental health disorder, and more than twice that number will work at a reduced level of productivity (presenteeism). Although it is important to determine whether work plays a role in a mental health condition, at initial presentation, patients should be diagnosed and treated per appropriate clinical guidelines. However, it is also important for patient care to determine the various causes or triggers including work-related factors. Clearly identifying the stressors associated with the mental health disorder can help clinicians to assess functional limitations, develop an appropriate care plan, and interact more effectively with worker's compensation and disability programs, as well as employers. There is currently no widely accepted tool to definitively identify MDD as work-related, but the presence of certain patient and work characteristics may help. This paper seeks to review the evidence specific to depression in the workplace, and provide practical tips to help clinicians to identify and treat work-related MDD, as well as navigate disability issues.
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Affiliation(s)
- Pratap Chokka
- Department of Psychiatry, University of Alberta, Grey Nuns Hospital, Edmonton, AB, Canada
| | - Ash Bender
- Work, Stress and Health Program, The Centre for Addiction and Mental Health, Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Stefan Brennan
- Department of Psychiatry, University of Saskatchewan, Royal University Hospital, Saskatoon, SK, Canada
| | - Ghalib Ahmed
- Department of Family Medicine and Psychiatry, University of Alberta, Edmonton, AB, Canada
| | - Marc Corbière
- Department of Education, Career Counselling, Université du Québec à Montréal, Centre de Recherche de l’Institut Universitaire en Santé Mentale de Montréal, Montréal, QC, Canada
| | - David J. A. Dozois
- Department of Psychology, University of Western Ontario, London, ON, Canada
| | - Jeff Habert
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - John Harrison
- Metis Cognition Ltd., Kilmington, United Kingdom; Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King’s College, London, United Kingdom; Alzheimercentrum, AUmc, Amsterdam, Netherlands
| | - Martin A. Katzman
- START Clinic for the Mood and Anxiety Disorders, Toronto, ON, Canada; Department of Psychiatry, Northern Ontario School of Medicine, and Department of Psychology, Lakehead University, Thunder Bay, ON, Canada
| | - Roger S. McIntyre
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Yang S. Liu
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
| | - Karen Nieuwenhuijsen
- Department of Public and Occupational Health, Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Carolyn S. Dewa
- Department of Psychiatry and Behavioural Sciences, University of California, Davis, Davis, CA, United States
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Subhas N, Ang JK, Tan KA, Ahmad SNA. Relations between clinical characteristics and cognitive deficits among adult patients diagnosed with major depressive disorder. Int J Psychiatry Clin Pract 2023; 27:219-231. [PMID: 36448673 DOI: 10.1080/13651501.2022.2149415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 10/20/2022] [Accepted: 11/08/2022] [Indexed: 12/05/2022]
Abstract
OBJECTIVE The present study examined the relations between clinical characteristics and cognitive deficits in adult patients with major depressive disorder (MDD) from a local outpatient psychiatric clinic in Malaysia. METHODS The present sample included 110 participants aged 20-60 years old. Participants were invited to provide their information on sociodemographic variables (age, gender, and educational level) and clinical characteristics (age at onset of depression and duration of illness) and to complete a series of cognitive performance measures including the Trail Making Tests A (psychomotor speed) and B (executive function), the Digit Symbol Substitution Test (attention), and the Auditory Verbal Learning Test (immediate free recall, acquisition phase, and delayed recall). The Mini International Neuropsychiatric Interview Version 6.0 was used to confirm the diagnosis of MDD and the Montgomery-Åsberg Depression Rating Scale was used to assess illness severity. RESULTS At the bivariate level, relations of age and educational level to all cognitive deficit domains were significant. At the multivariate level, only educational level and illness severity consistently and significantly predicted all cognitive deficits domains. CONCLUSIONS Therapeutic modalities should be individualised whilst considering the impacts of cognitive deficits in an attempt to prevent further deterioration in psychosocial functioning of MDD patients.KEY POINTSCognitive deficits are an elemental component of Major Depressive Disorder (MDD) persisting during a current major depressive episode or during remission, altering individuals' ability to process information and changes the way they perceive and interact with the environment.Cognitive deficits in MDD are evident among the upper-middle income groups in South-Eastern Asian countries warranting more local research as such deficits could lead to functional decline and work performance such as absenteeism and presenteeism.Therapeutic modalities should be individualised by taking the impacts of cognitive deficits into consideration to promote psychosocial functioning of MDD patients.
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Affiliation(s)
- Natasha Subhas
- Department of Psychiatry and Mental Health, Hospital Kuala Lumpur, Ministry of Health, Kuala Lumpur, Malaysia
| | - Jin Kiat Ang
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Kit-Aun Tan
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Siti Nor Aizah Ahmad
- Department of Psychiatry and Mental Health, Hospital Umum Sarawak, Ministry of Health, Kuching, Malaysia
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Cho Y, Tural U, Iosifescu DV. Efficacy of Transcranial Photobiomodulation on Depressive Symptoms: A Meta-Analysis. Photobiomodul Photomed Laser Surg 2023; 41:460-466. [PMID: 37651208 PMCID: PMC10518694 DOI: 10.1089/photob.2023.0041] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 06/28/2023] [Indexed: 09/02/2023] Open
Abstract
Background: Transcranial photobiomodulation (tPBM) is a novel, noninvasive, device-based intervention, which has been tested as a possible treatment for various neurological and psychiatric conditions. Recently, it has been investigated as an innovative treatment for major depressive disorder (MDD). There have been several animal and clinical studies that evaluated the underlying mechanism and the efficacy of its antidepressant effects, but results have been conflicting. Objective: Thus, we conducted the first meta-analysis on effects of tPBM on depressive symptoms. Materials and methods: Thirty original articles on tPBM were retrieved, eight of them met criteria for inclusion to a random effects meta-analysis. Results: tPBM appeared effective in decreasing depressive symptom severity regardless of diagnosis (Hedges' g = 1.415, p < 0.001, k = 8), but a significant heterogeneity has been found. The meta-analysis of single-arm studies (baseline to endpoint changes) limited to participants with MDD has supported the significant effect of tPBM in reducing the depression severity, without a significant heterogeneity (Hedges' g = 1.142, 95% confidence interval = 0.780-1.504, z = 6.19, p < 0.001, k = 5). However, the meta-analysis of the few double-blind, sham-controlled studies in MDD has not supported the statistically significant superiority of tPBM over sham (Hedges' g = 0.499, p = 0.211, k = 3), although a sample size bias is likely present. Conclusions: Overall, this meta-analysis provides weak support for the promising role of tPBM in the treatment of depressive symptoms. Dose finding studies to determine optimal tPBM parameters followed by larger, randomized, sham-controlled studies will be needed to fully demonstrate the antidepressant efficacy of tPBM.
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Affiliation(s)
- Yoonju Cho
- Division of Neuropsychiatry and Neuromodulation, Department of Psychiatry, Massachusetts General Hospital, Charlestown, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Umit Tural
- Nathan Kline Institute for Psychiatric Research, Orangeburg, New York, USA
| | - Dan V. Iosifescu
- Nathan Kline Institute for Psychiatric Research, Orangeburg, New York, USA
- Department of Psychiatry, New York University School of Medicine, New York, New York, USA
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Fagiolini A, Cardoner N, Pirildar S, Ittsakul P, Ng B, Duailibi K, El Hindy N. Moving from serotonin to serotonin-norepinephrine enhancement with increasing venlafaxine dose: clinical implications and strategies for a successful outcome in major depressive disorder. Expert Opin Pharmacother 2023; 24:1715-1723. [PMID: 37501324 DOI: 10.1080/14656566.2023.2242264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 07/25/2023] [Indexed: 07/29/2023]
Abstract
INTRODUCTION Mental health disorders, especially depressive and anxiety disorders, are associated with substantial health-related burden. While the second-generation antidepressants are widely accepted as first-line pharmacological treatment for major depressive disorder (MDD), patient response to such treatment is variable, with more than half failing to achieve complete remission, and residual symptoms are frequently present. AREAS COVERED Here, the pharmacodynamics of venlafaxine XR are reviewed in relation to its role as both a selective serotonin reuptake inhibitor (SSRI) and a serotonin-norepinephrine-reuptake inhibitor (SNRI), and we look at how these pharmacodynamic properties can be harnessed to guide clinical practice, asking the question 'is it possible to develop a symptom-cluster-based approach to the treatment of MDD with comorbid anxiety utilizing venlafaxine XR?.' Additionally, three illustrative clinical cases provide practical examples of the utility of venlafaxine-XR in real-world clinical practice. The place of venlafaxine XR in managing fatigue/low energy, a frequent residual symptom in MDD, is explored using pooled data from clinical trials of venlafaxine XR. EXPERT OPINION Venlafaxine XR should be considered as a first-line treatment for MDD with or without comorbid anxiety, and there are clear pharmacodynamic signals supporting a symptom cluster-based treatment paradigm for venlafaxine XR.
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Affiliation(s)
- Andrea Fagiolini
- Department of Molecular Medicine, University of Siena School of Medicine, Siena, Italy
| | - Narcis Cardoner
- Department of Psychiatry and Legal Medicine, Hospital de la Santa Creu I Sant Pau, Biomedical Research Institute Sant Pau (IIB-Sant Pau), Universitat Autònoma de Barcelona (UAB), CIBERSAM, Carlos III Health Institute, Madrid, Spain
| | - Sebnem Pirildar
- Department of Mental Health and Diseases, Ege University Medical School, Izmir, Turkey
| | - Pichai Ittsakul
- Department of Psychiatry, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Bernardo Ng
- Mexican Consortium of Neuropsychopharmacology, Mexico, Sun Valley Research Center, Imperial, California, USA
| | - Kalil Duailibi
- Department of Psychiatry, Santo Amaro University, São Paulo, Brazil
| | - Nasser El Hindy
- American Center Neurology and Psychiatry, Dubai, United Arab Emirates
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Inserra A, Piot A, De Gregorio D, Gobbi G. Lysergic Acid Diethylamide (LSD) for the Treatment of Anxiety Disorders: Preclinical and Clinical Evidence. CNS Drugs 2023; 37:733-754. [PMID: 37603260 DOI: 10.1007/s40263-023-01008-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/19/2023] [Indexed: 08/22/2023]
Abstract
Anxiety disorders (ADs) represent the sixth leading cause of disability worldwide, resulting in a significant global economic burden. Over 50% of individuals with ADs do not respond to standard therapies, making the identification of more effective anxiolytic drugs an ongoing research priority. In this work, we review the preclinical literature concerning the effects of lysergic acid diethylamide (LSD) on anxiety-like behaviors in preclinical models, and the clinical literature on anxiolytic effects of LSD in healthy volunteers and patients with ADs. Preclinical and clinical findings show that even if LSD may exacerbate anxiety acutely (both in "microdoses" and "full doses"), it induces long-lasting anxiolytic effects. Only two randomized controlled trials combining LSD and psychotherapy have been performed in patients with ADs with and without life-threatening conditions, showing a good safety profile and persisting decreases in anxiety outcomes. The effect of LSD on anxiety may be mediated by serotonin receptors (5-HT1A/1B, 5-HT2A/2C, and 5-HT7) and/or transporter in brain networks and circuits (default mode network, cortico-striato-thalamo-cortical circuit, and prefrontal cortex-amygdala circuit), involved in the modulation of anxiety. It remains unclear whether LSD can be an efficacious treatment alone or only when combined with psychotherapy, and if "microdosing" may elicit the same sustained anxiolytic effects as the "full doses". Further randomized controlled trials with larger sample size cohorts of patients with ADs are required to clearly define the effective regimens, safety profile, efficacy, and feasibility of LSD for the treatment of ADs.
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Affiliation(s)
- Antonio Inserra
- Neurobiological Psychiatry Unit, Department of Psychiatry, McGill University, Avenue des Pins Ouest, Montreal, QC, H3A 1A1, Canada
| | - Alexandre Piot
- UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Danilo De Gregorio
- Division of Neuroscience, Vita-Salute San Raffaele University, Milan, Italy
| | - Gabriella Gobbi
- Neurobiological Psychiatry Unit, Department of Psychiatry, McGill University, Avenue des Pins Ouest, Montreal, QC, H3A 1A1, Canada.
- McGill University Health Center, Montreal, QC, Canada.
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147
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Shi W, Sun H, Peng W, Chen Z, Wang Q, Lin W, Ding M, Sun H, Wang X, Wang T, Wang X, Liu Y, Chen Y, Zhu G, Zhou D, Li J. Prevalence and risk factors of anxiety and depression in adult patients with epilepsy: a multicenter survey-based study. Ther Adv Neurol Disord 2023; 16:17562864231187194. [PMID: 37663409 PMCID: PMC10469248 DOI: 10.1177/17562864231187194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 06/22/2023] [Indexed: 09/05/2023] Open
Abstract
Background Depression and anxiety are the most common psychiatric comorbidities in patients with epilepsy (PWE). However, they are often unrecognized and consequently untreated. Objective The study was conducted to evaluate the prevalence and risk factors of anxiety and depression among Chinese adult PWE. Design Cross-sectional study. Methods Adult PWE were recruited from 13 tertiary epilepsy centers from February to September 2022. Generalized Anxiety Disorder-7 and Neurological Disorders Depression Inventory for Epilepsy were applied to evaluate anxiety and depression, respectively. Both univariate and multivariate logistic regression analyses models were performed to explore the risk factors of anxiety and depression. Results A total of 1326 PWE were enrolled in this study. The prevalence of anxiety and depression was 31.45% and 27.30%, respectively. Being female [odds ratio (OR) = 1.467, 95% CI: 1.134-1.899; p = 0.004], focal and focal to bilateral tonic-clonic seizures (TCSZ) (OR = 1.409, 95% CI: 1.021-1.939; p = 0.036), and seizure occurrence in the last 3 months (OR = 1.445, 95% CI: 1.026-2.044; p = 0.036) were the risk factors for anxiety. Focal and focal to bilateral TCSZ (OR = 1.531, 95% CI: 1.094-2.138; p = 0.013) and seizure occurrence in the last 3 months (OR = 1.644, 95% CI: 1.130-2.411; p = 0.010) were the risk factors for depression. In addition, for every 1-year increment of age, the odds of developing depression were decreased by 3.8% (p = 4.12e-5). Nevertheless, up to 70% of PWE did not receive any treatment for comorbidity. Conclusion There were approximately 30% of PWE screened positive for anxiety or depression. Both focal and focal to bilateral TCSZ and seizure occurrence in the last 3 months were estimated as risk factors for anxiety and depression. However, the current status of treatment was not optimal.
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Affiliation(s)
- Wenyan Shi
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Hanlin Sun
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Wei Peng
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Ziyi Chen
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Qun Wang
- Department of Neurology, Beijing Tiantan Hospital Affiliated to Capital Medical University, Beijing, China
| | - Weihong Lin
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Meiping Ding
- Department of Neurology, The Second Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Hongbin Sun
- Department of Neurology, Sichuan Provincial People’s Hospital, Chengdu, China
| | - Xiangqing Wang
- Department of Neurology, Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Tiancheng Wang
- Department of Neurology, Lanzhou University Second Hospital, Lanzhou, China
| | - Xuefeng Wang
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yonghong Liu
- Department of Neurology, Air Force Medical University Xijing Hospital, Xi’an, China
| | - Yangmei Chen
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Guoxing Zhu
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Dong Zhou
- Department of Neurology, West China Hospital, Sichuan University, No. 37 Guoxue Lane, Wuhou District, Chengdu, Sichuan, 610041, China
| | - Jinmei Li
- Department of Neurology, West China Hospital, Sichuan University, No. 37 Guoxue Lane, Wuhou District, Chengdu, Sichuan, 610041, China
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Mechlińska A, Wiglusz MS, Słupski J, Włodarczyk A, Cubała WJ. Exploring the Relationship between Mood Disorders and Coexisting Health Conditions: The Focus on Nutraceuticals. Brain Sci 2023; 13:1262. [PMID: 37759862 PMCID: PMC10526332 DOI: 10.3390/brainsci13091262] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 08/26/2023] [Accepted: 08/27/2023] [Indexed: 09/29/2023] Open
Abstract
Major depressive disorder and bipolar disorder are the leading causes of global disability. Approximately 50% of patients fail to attain remission, prompting a pronounced focus on the significance of dietary patterns and specific nutrients within the pathophysiology of mood disorders. The connection between chronic diseases and mood disorders follows a bidirectional pattern: physical ailments are interrelated with affective disorders, and, concurrently, mood symptoms often precede chronic diseases and have the potential to worsen their prognosis. Nutraceuticals affect factors that could potentially impact the onset of mood disorders: monoamines and brain-derived neurotrophic factor (BDNF) concentrations, neuroinflammation, oxidative stress, and sleep quality. Furthermore, mood disorders rarely manifest in isolation. Typically, such patients concurrently experience other mental disorders or somatic comorbidities: obesity, hypertension, diabetes, polycystic ovary syndrome (PCOS), etc., where providing nutritional support is also pertinent. To optimize the therapeutic approach for individuals with mood disorders, incorporating nutritional support may not solely ameliorate symptoms stemming directly from the mental condition, but also indirectly through interventions targeting comorbidities.
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Affiliation(s)
- Agnieszka Mechlińska
- Department of Psychiatry, Faculty of Medicine, Medical University of Gdańsk, Smoluchowskiego 17, 80-214 Gdańsk, Poland; (M.S.W.); (J.S.); (A.W.)
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Wang Y, Zhou J, Ye J, Sun Z, He Y, Zhao Y, Ren S, Zhang G, Liu M, Zheng P, Wang G, Yang J. Multi-omics reveal microbial determinants impacting the treatment outcome of antidepressants in major depressive disorder. MICROBIOME 2023; 11:195. [PMID: 37641148 PMCID: PMC10464022 DOI: 10.1186/s40168-023-01635-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 07/30/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND There is a growing body of evidence suggesting that disturbance of the gut-brain axis may be one of the potential causes of major depressive disorder (MDD). However, the effects of antidepressants on the gut microbiota, and the role of gut microbiota in influencing antidepressant efficacy are still not fully understood. RESULTS To address this knowledge gap, a multi-omics study was undertaken involving 110 MDD patients treated with escitalopram (ESC) for a period of 12 weeks. This study was conducted within a cohort and compared to a reference group of 166 healthy individuals. It was found that ESC ameliorated abnormal blood metabolism by upregulating MDD-depleted amino acids and downregulating MDD-enriched fatty acids. On the other hand, the use of ESC showed a relatively weak inhibitory effect on the gut microbiota, leading to a reduction in microbial richness and functions. Machine learning-based multi-omics integrative analysis revealed that gut microbiota contributed to the changes in plasma metabolites and was associated with several amino acids such as tryptophan and its gut microbiota-derived metabolite, indole-3-propionic acid (I3PA). Notably, a significant correlation was observed between the baseline microbial richness and clinical remission at week 12. Compared to non-remitters, individuals who achieved remission had a higher baseline microbial richness, a lower dysbiosis score, and a more complex and well-organized community structure and bacterial networks within their microbiota. These findings indicate a more resilient microbiota community in remitters. Furthermore, we also demonstrated that it was not the composition of the gut microbiota itself, but rather the presence of sporulation genes at baseline that could predict the likelihood of clinical remission following ESC treatment. The predictive model based on these genes revealed an area under the curve (AUC) performance metric of 0.71. CONCLUSION This study provides valuable insights into the role of the gut microbiota in the mechanism of ESC treatment efficacy for patients with MDD. The findings represent a significant advancement in understanding the intricate relationship among antidepressants, gut microbiota, and the blood metabolome. Additionally, this study offers a microbiota-centered perspective that can potentially improve antidepressant efficacy in clinical practice. By shedding light on the interplay between these factors, this research contributes to our broader understanding of the complex mechanisms underlying the treatment of MDD and opens new avenues for optimizing therapeutic approaches. Video Abstract.
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Affiliation(s)
- Yaping Wang
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, 100088, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, 100069, China
| | - Jingjing Zhou
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, 100088, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, 100069, China
| | - Junbin Ye
- Beijing WeGenome Paradigm Co., Ltd, Beijing, China
| | - Zuoli Sun
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, 100088, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, 100069, China
| | - Yi He
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, 100088, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, 100069, China
| | - Yingxin Zhao
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, 100088, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, 100069, China
| | - Siyu Ren
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, 100088, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, 100069, China
| | - Guofu Zhang
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, 100088, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, 100069, China
| | - Min Liu
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, 100088, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, 100069, China
| | - Peng Zheng
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
- NHC Key Laboratory of Diagnosis and Treatment On Brain Functional Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Gang Wang
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, 100088, China.
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, 100069, China.
| | - Jian Yang
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, 100088, China.
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, 100069, China.
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Marx W, Penninx BWJH, Solmi M, Furukawa TA, Firth J, Carvalho AF, Berk M. Major depressive disorder. Nat Rev Dis Primers 2023; 9:44. [PMID: 37620370 DOI: 10.1038/s41572-023-00454-1] [Citation(s) in RCA: 52] [Impact Index Per Article: 52.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/11/2023] [Indexed: 08/26/2023]
Abstract
Major depressive disorder (MDD) is characterized by persistent depressed mood, loss of interest or pleasure in previously enjoyable activities, recurrent thoughts of death, and physical and cognitive symptoms. People with MDD can have reduced quality of life owing to the disorder itself as well as related medical comorbidities, social factors, and impaired functional outcomes. MDD is a complex disorder that cannot be fully explained by any one single established biological or environmental pathway. Instead, MDD seems to be caused by a combination of genetic, environmental, psychological and biological factors. Treatment for MDD commonly involves pharmacological therapy with antidepressant medications, psychotherapy or a combination of both. In people with severe and/or treatment-resistant MDD, other biological therapies, such as electroconvulsive therapy, may also be offered.
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Affiliation(s)
- Wolfgang Marx
- Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Victoria, Australia.
| | - Brenda W J H Penninx
- Department of Psychiatry, Amsterdam Public Health and Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands
| | - Marco Solmi
- Department of Psychiatry, University of Ottawa, Ottawa, Ontario, Canada
- On Track: The Champlain First Episode Psychosis Program, Department of Mental Health, The Ottawa Hospital, Ottawa, Ontario, Canada
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
| | - Toshi A Furukawa
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - Joseph Firth
- Division of Psychology and Mental Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Andre F Carvalho
- Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Victoria, Australia
| | - Michael Berk
- Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Victoria, Australia
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